Welcome to the National Joint Registry (NJR)
Hip, knee, ankle, elbow and shoulder joint replacements are common and highly successful operations that bring many patients relief from pain and improved mobility. Thousands of these joint replacement operations take place in the UK every year and the NJR collects and monitors information on these joint replacement operations to improve clinical standards and benefit patients, clinicians and the orthopaedic sector as a whole.
The NJR was set up by the Department of Health and Welsh Government in 2002 to Northern Ireland joined in 2013, the Isle of Man in 2015 and the States of Guernsey in 2019.
National Joint Registry - 2020 procedure details
The National Joint Registry advises data entry staff in all NHS and independent hospitals where joint surgery has taken place that where possible in the current climate, data entry capture should also be actioned, in accordance with the volumes of procedures performed. We request that the details of any procedure performed during the year 2020 up to 31st December should be uploaded into the registry data entry system by 28th February 2021.
It is important that the reduced volumes of arthroplasty procedures that have taken place over the past nine months since the start of Covid-19 are correctly recorded on the NJR. These are likely to be mostly small numbers of urgent and emergency procedures, but it is essential that we are able to monitor the outcomes of these patients through the NJR’s usual monitoring procedures.
There is a real danger that if these cases are not entered onto the registry that 1) the cases entered may not be representative of the hospitals' actual activity and the hospitals' relative results might be misrepresented and 2) the impact of the COVID pandemic on the delivery of proper arthroplasty services throughout the NHS may be inappropriately diminished and misrepresented.
We therefore ask that hospitals review their surgical caseload over this period to ensure that any missed cases have been entered retrospectively onto the NJR by the same date. It is important that this should be done as soon as possible.
Your co-operation in ensuring the quality of NJR’s data is very much appreciated.
Please also share this communication with any colleagues who are involved with NJR’s work.
NJR Surgeon and Hospital Outcomes Publication - 2020
The clinician preview period for the National Joint Registry (NJR) Surgeon and Hospital Outcomes Publication was open from 1-31st December 2020. Surgeons were invited to review their clinical outcomes on NJR Clinician Feedback during this time-period.
The review period has now concluded and all consultant surgeons who have carried out a hip/knee/ankle/elbow/shoulder joint replacement procedure in any hospital during the three most recent financial years - 1st April 2017 to 31st March 2020 - will be included for publication at NJR’s unit and surgeon data outcomes website: https://surgeonprofile.njrcentre.org.uk on 14th January 2021.
New NJR mail address
Please be aware that Northgate Public Services (NPS), the NJR’s contractor for the collection and management of data and reporting technology
and the provider of the NJR’s services including the NJR enquiries desk for queries and data requests, will move to new offices on the 11th of January. Thereafter all mail communication on these matters should be directed to their new address:
The NJR Service Centre
c/o Northgate Public Services
1st Floor iMex Centre
575-599 Maxted Road
Herts HP2 7DX
The phone number 0845 345 9991 and email email@example.com will remain the same.
NJR's BOA session 'Working together across the sector'
The NJR’s 17th Annual Report was launched at the British Orthopaedic Association’s Annual Congress in September 2020.
The BOA Congress was a virtual online event this year, due to the constraints of the impact of Covid-19.
All the presentations of the NJR’s session entitled: “Working together across the sector” are now available on our website and can be seen by clicking on this link
NJR launches 17th Annual Report during NJR Session at the Virtual BOA Congress 2020
(See link to Congress and Report to review)
We are delighted to announce the publication of the NJR’s 17th Annual Report. This is the formal public report of the registry and you can find it at the NJR’s dedicated Annual Report website: reports.njrcentre.org.uk. The analyses of patients’ outcomes after surgery, along with executive summaries of all NJR working committees are presented, as well as Implant and Trust, Local Health Board and unit-level outcomes, which can also be found on the website menu listing.
Having collected data since April 2003 with the aim of monitoring devices and improving patient outcomes following hip, knee, ankle, elbow, and shoulder replacement, the NJR now has over three million procedures recorded, making it the largest and most comprehensive registry of its kind in the world.
The report was launched at the British Orthopaedic Association’s Annual Congress, which due to the impact of Covid-19, was organised as a virtual online event this year. The NJR’s session is entitled: “Working together across the sector” and is available for the duration of Congress (15 to 25 September 2020) by clicking on this link: https://www.boa.ac.uk/pre-recorded-webinars/njr-open-access.html
There has been considerable work for the report this year to develop new classifications and to drill down into the analysis of the performance of implants in all joints, enabling a continued thorough and safety-conscious approach to implant outcome monitoring which will be useful to surgeons and patients alike in choosing the best performing implants. We do hope you will visit the NJR’s Annual Report website for further details of this valuable information as well as insight into the registry’s progress during 2019.
NHS trusts and independent sector hospitals have also recently received their own individual NJR Annual Clinical Report. The report includes key performance data in relation to units and surgeons, including the ability for all units to review themselves against local performance and national targets.
Data entry capture resumed for the National Joint Registry
Following recent NHSE wider notification to hospitals of the gradual resumption of elective surgery and associated audit activity, in order to support NHS recovery as the Covid-19 pandemic lessens, the National Joint Registry advises data entry staff in all NHS and independent hospitals where joint surgery has resumed, that data entry capture should also resume as normal, in accordance with the volumes of procedures performed.
It is also important that the reduced volumes of arthroplasty procedures that have taken place over the past four months are correctly recorded on the NJR. These are likely to be small numbers of urgent and emergency procedures, but it is essential that we are able to monitor the outcomes of these patients through the NJR’s usual monitoring procedures. We therefore ask that hospitals review their surgical caseload over this period to ensure that any missed cases are entered retrospectively onto the NJR.
For any advice and support on NJR data entry or training: please contact our Helpdesk on 0845 345 9991 or by email firstname.lastname@example.org
NJR Regional Events
The National Joint Registry is always pleased to invite all staff in both the NHS and independent sector to attend the NJR annual programme of free-to-attend regional events and our last event took place on 30th October. Due to the uncertainty of COVID-19 we have postponed the planning for any NJR events this year until we know more about the possibility of public gatherings. By attending an NJR event, delegates will take away skills to demonstrate the highest possible standards of clinical governance that all hospitals strive to achieve. All staff involved with the NJR process in your hospitals are welcome including: data entry, pre-assessment, theatre, clinical governance staff, surgeons, managers and nurses.
The NJR is a national mandatory audit and so once the new programme dates have been released, time can be requested from your line-manager to support your attendance. This is part of ongoing continuing professional development training and we will be providing certificates for all delegates. The programme presents a unique networking opportunity for all those engaged with the NJR and those involved in assuring data quality and patient safety.
NJR data is behind the Patient Decision Support Tool, the first comprehensive web-based patient tool for supporting consideration of joint replacement, representing a practical example of an effective software implementation of a health information system for the orthopaedic sector.
Read the newly published paper written by the scientists who developed the tool, showing how user-centred design can be practically applied to produce an effective health information system, while also improving its development efficiency - https://www.sciencedirect.com/science/article/pii/S1386505620301568
NJR Statement on the publication of The Cumberlege Report
The National Joint Registry (NJR) welcomes the report recommendations from the Independent Medicines and Medical Devices Safety Review, chaired by Baroness Julia Cumberlege. The NJR also fully supports the development of a wider implant medical devices registry to ensure greater patient safety.
(Read the full statement here)
Effect on bearing survival of Cementless and Hybrid Total Hip Arthoplasty
We’re very pleased to congratulate Professor Edward Davis and his team on their recently published study on the effects of bearing surface on survival of cementless and hybrid THA.
You can read more about it here:
Covid-19 and the associated impact on Elective Surgery - March 2020
Whilst the National Joint Registry is in alignment with the absolute necessity of surgery postponement in freeing up essential services for those who are in need of these due the spread and impact of Covid-19, we would like to express our empathy with those patients whom the delay will impact and to advise that the British Orthopaedic Association has helpfully published some ‘Frequently Asked Questions’ for patients, which they will keep updated as the coronavirus situation unfolds.
You can view these FAQs here: https://www.boa.ac.uk/resources/coronavirus-boa-faqs-for-patients.html
Restructure of NJR regional support service
Since inception, the NJR Regional Coordinator function has provided a key link to all of our participating hospitals and surgeons. This link remains as important to our successful operations as it did then. However, much has changed in terms of how the NJR service is delivered today, compared to when it was first established over 17 years ago. In line with our intentions when services were first contracted, we are currently reviewing our regional service delivery model to reflect the current and anticipated future demands of all of our service users. Our restructure will ensure we remain efficient and effective in our delivery to meet those needs.
The service will be supported with increased coordination of the workload by the central NJR Service Centre team via the NJR Helpdesk, to ensure that a continued consistent service is delivered across all regions, both in the interim whilst recruitment to the new structure is finalised, and longer term. The NJR Regional Coordinator role, originally made up of a team of six, has been replaced by a new role, the NJR Compliance Officer. The Compliance Officer team is now made up of four officers, each with a geographical region of NHS trusts and a group of independent hospitals within their specific remit. The Compliance Officer team will be primarily focussed on providing support to hospital units to achieve compliance with NJR's Key Performance Indicators. This is will be realised through liaison with hospitals, documenting any local challenges they are experiencing and recommending best practice solutions in order to counteract these.
If necessary the NJR Compliance Officers will also escalate any problems encountered through hospital management teams and the NJR's Regional Clinical Coordinators, to attain greater resolution. The NJR's Compliance Officer team also provides training, advice and guidance to all hospital-based NJR stakeholders wherever required. Hospitals can continue to receive NJR support and request any training that they require by emailing the Helpdesk at: email@example.com or by calling 0845 345 9991
The National Joint Registry welcomes the States of Guernsey on Board
The National Joint Registry (NJR) is delighted to welcome the States of Guernsey onto the registry having extended its data collection, reporting and information services to Guernsey's Princess Elizabeth Hospital (PEH) from the beginning of November 2019.
Three Million Milestone Reached
We are delighted to announce that a patient who had a procedure at The Royal Orthopaedic Hospital has been the three millionth entry in the National Joint Registry!
Frimley Health NHS Foundation Trust has been named as National Joint Registry (NJR) Quality Data Provider
We are very pleased that Frimley Health NHS Foundation Trust is just one of many hospitals to have gained the NJR award for the achievement of their high quality data in our recent data quality audit. Link
A Joint statement from the NJR Implant Scrutiny Committee and the Executive Council of the British Elbow and Shoulder Society (BESS) on the definition of revision joint replacement:
The NJR has recently updated the MDS forms for primary and revision shoulder and elbow replacements. This was after input and collaboration with BESS Council and the BESS Arthroplasty Working Groups. During that process it became clear that revision surgery means any further operation on a patients joint replacement to remove, change or reduce any of the components.
It has been suggested by some stakeholders that some shoulder arthroplasty procedures should be considered a ‘conversion’ rather than a ‘revision’. The failure of a replaced shoulder or elbow joint is usually multifactorial and can be a complex interaction of patient, implant and surgical factors. Conversion implies that the implant construct is blameless in any failure mechanism and this can be misleading. Therefore in relation to shoulder and elbow replacement surgery, BESS and the NJR Implant Scrutiny Group will continue to consider a revision as any further operation to remove, change, add or reduce any of the components, and such procedures will be recorded thus on the new MDS forms.
000___________________________________________________________________________________________________________________________ NJR Statement regarding metal-on metal implants The majority of patients with metal-on-metal hip replacements do very well but because of the negative side-effects that have been experienced by a small number of patients, careful follow-up for all has been important. In accordance with the patient-safety driven mission of the National Joint Registry (NJR), patients with any metal-on-metal implant who have consented to their data being registered, have been identified and recalled for monitoring. Without such a comprehensive registry, working in the interests of patients, hospitals would be unable to identify which patients had specific implants. The NJR enables the mandatory collection of data on hip, knee, ankle, elbow and shoulder joint replacements and its organisational structure encompasses various specialist groups, such as the implant scrutiny committee, and surgeon performance committee, which closely monitor the performance of implants, hospitals and surgeons. Where there are performance issues, these can be quickly processed and addressed in line with NJR procedures and in the case of implants, referred for consideration by the Regulator [MHRA] and expert representatives, such as those on the Orthopaedic Expert Advisory Group, who proposed the alert and recommendations made regarding metal-on-metal hip implants by the MHRA in 2010. NJR therefore advises any patients who have had metal-on-metal implants that should they be concerned about symptoms that they consider may be related to their implants, they should consult their Surgeon or GP, who can discuss these with them. The NJR have recently updated the MDS forms for primary and revision shoulder and elbow replacements. This was after input and collaboration with BESS Council and the BESS Arthroplasty Working Groups. During that process it became clear that revision surgery means any further operation on a patient's joint replacement to remove, change or reduce any of the components. It has been suggested by some stakeholders that some shoulder arthroplasty procedures should be considered a ‘conversion’ rather than a ‘revision’.
_______________________________________________________________________________________________________________________________Measuring NJR Compliance – dealing with outsourced cases_______________________________________________________________________________________________________________________________
Measuring NJR Compliance:
NJR Compliance measures the proportion of cases reported to NJR, compared to cases reported to other sources of comparative data, such as HES. This provides a basis for NJR to report on the completeness of its data. NJR Compliance is also used as part of the Best Practice Tariff calculation for hip and knee surgery.
Where cases are outsourced to another provider, but reported through HES by the originally commissioned Trust, some procedures may be reported as ‘missing’ from the NJR. This is because the corresponding NJR record will have been submitted by the outsourced provider and the HES record does not accurately record the identity of that outsourced provider. To prevent such cases being reported as ‘missing’ from the NJR, it is essential to complete the ORGANISATION SITE IDENTIFIER OF TREATMENT code field in SUS with the NACS code (formerly the ODS code) of the organisation to which the procedure has been outsourced. Completion of this field enables NJR to exclude the record from the data it expects to be recorded for the Trust, whilst also enabling NJR to ensure that the corresponding record has been submitted by the outsourced provider.
Another important reason to complete the SITETREP field in SUS with the appropriate ORGANISATION SITE IDENTIFER OF TREATMENT code whenever you sub-contract qualifying arthroplasty procedures to other hospitals, is that it ensures that any subcontracting activity is not only picked up but also that the subscription cost for this particular procedure won’t be attributed the Trust. We are unable to track any movements in activity regarding this without this field being completed. It also ensures NJR compliance information is accurate in relation to achieving Best Practice Tariff.
Any queries should be directed to the NJR Service Desk using the following contact details: Tel 0845 345 9991 or firstname.lastname@example.org