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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 provide an early warning of issues relating to patient safety, improve the quality of outcomes and ensure the quality and cost-effectiveness of joint replacement surgery. Northern Ireland joined in 2013, the Isle of Man in 2015 and the States of Guernsey in 2019.


 

NJR News:

 

BOA Annual Congress:

The BOA Annual Congress will take place on the 21st-24th September 2021. 
This year the programme is being created around the theme of ‘Tackling Infection’ with four days of lectures alongside three days of orthopaedic exhibition, which will be held for the first time at The Event Complex Aberdeen (TECA). 

We will be holding our NJR session in the afternoon of Tuesday 21st September with a focus on what is new in the NJR, during which we will launch our 18th Annual Report, you can find the session agenda here. We will also have an NJR exhibition stand at the event which delegates are invited to visit to pick up a copy the annual report, see our featured research topic information and find out more about the developments to upgrade the NJR’s clinical reporting services.

Click the link below for the BOA website for further information about the event:

https://www.boa.ac.uk/events/boa-annual-congress-2021.html

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Tender bids are currently open for the following contract opportunities:

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New NJR Implant Scanning Interface

The NJR has recently developed a mobile / tablet friendly responsive website interface which provides an ‘front end’ that enables details of component lists to be scanned with a bar code scanner, mobile phone or tablet, and the results or flag concerning the combination are returned directly to the user.

The advantage of this interface is that users are able to access the implant validation function without the need for development of other third-party IT systems. This independence from third-party systems is beneficial when a hospital does not have the Scan4Safety system, or access to IT system development resources. You can find further details here https://www.njrcentre.org.uk/njrcentre/Healthcare-providers/NJR-Implant-Scanning-Tool

This option is offered free of charge to all hospitals that undertake orthopaedic joint replacements in England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey.

Please contact us at: njr@njr.org.uk should you wish to make an enquiry regarding either interface.

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Consultant Level Report (CLR) and Surgeon Level Report (SLR)

This year's CLRs and SLRs have been available to download at NJR Connect - Data Services platform since 20th July. There are many changes to the reports this year click here for more information on this. You can find information on how to access your reports here.

Understanding ODEP / NJR data in your report

ODEP and the NJR work closely together in order to collect and monitor joint replacement data in the UK and the data in the NJR Consultant Level Reports (CLRs) are courtesy of both organisations. There are some important points that you shouldn’t overlook, particularly as this year the data you are receiving are more comprehensive.

Please see this explanatory document which will make the data easier to understand.

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Statement regarding recent media coverage about orthopaedic surgery -  9th July 2021

The NJR and BOA have drafted a joint statement in response to recent media coverage of joint replacement surgery.
 

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BOA Annual Congress

The BOA Annual Congress will take place on the 21st-24th September 2021. 

This year the programme is being created around the theme of ‘Tackling Infection’ with four days of lectures alongside three days of orthopaedic exhibition, which will be held for the first time at The Event Complex Aberdeen (TECA). 

We will be holding our NJR session in the afternoon of Tuesday 21st September with a focus on what is new in the NJR, during which we will launch our 18th Annual Report. We will also have an NJR exhibition stand at the event which delegates are invited to visit to pick up a copy the annual report, see our featured research topic information and find out more about the developments to upgrade the NJR’s clinical reporting services.

Click the link below for the BOA website for further information about the event:
https://www.boa.ac.uk/events/boa-annual-congress-2021.html
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Northgate Public Services (NPS) becomes NEC Software Solutions UK (NEC)

Please note that NEC Software Solutions UK (NEC), who were formerly called NPS, are the NJR’s contractor for the collection and management of data and reporting technology and the service provider for the NJR's Service Desk.

All mail communication should be directed to:

The NJR Service Desk
c/o NEC Software Solutions UK
1st Floor iMex Centre
575-599 Maxted Road 
Hemel Hempstead 
Herts HP2 7DX

The NJR Service Desk telephone number remains as 0845 345 9991, email address as: enquiries@njrcentre.org.uk 

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NJR Connect - Data Services ​

Our new surgeon reports portal, NJR Connect - Data Services is now live.

All orthopaedic surgeons can now login and review their outcome data and reports. The new system includes the following functionality:

  • Dynamic reports - view and interact with their own data using predefined filters.
  • Static reports - view and download a range of pdf and excel document reports. For example: Consultant Level Reports and Annual Clinical Reports.
  • 90-day mortality / attributable revisions module - view a list of records, dating back to 1st January 2019, with the capability to drill down to further detail.
  • Resources - access a list of useful supporting documents including system user guides and user training videos, as well as a useful document detailing links to other NJR websites.
  • NJR Contacts Database - you can search for other surgeons who practice at the same hospital as your own.

The new login url is: https://platform.njrcentre.org.uk/R4NJR/R4NJR/SignIn
Surgeons will be redirected to the new system should they attempt to login to Clinician Feedback, as this new system replaces that former service portal.

Surgeons should use their Clinician Feedback user ID to log in and will then need to click on the 'Forgotten password' link on the login page, to enable a temporary password to be created and emailed to them, in order to access the system for the first time. The temporary password can be changed at any point thereafter to a password of choice.

Should surgeons encounter any problems in accessing the system they are asked to get in touch with us at:

The NJR Service Desk by email at: enquiries@njrcentre.org.uk or by phone: 0845 3459991.


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National Joint Registry - Power Point Presentations

Our most recent NJR presentations as below can be viewed here

  • Working together: Excellence through collaboration
  • A Patient’s experience of knee surgery during Covid-19
  • Infection risk factors and outcomes of treatment
  • Are we getting better at what we are doing? Revision rates dropping for all joints
  • The association between obesity, revision, mortality and PROMs in total hip replacement
  • Surgical approaches - what we know so far
  • Knee surgery - Patella resurfacing and non-resurfacing by implant / Unicompartmental knee replacement / Multicompartmental knee replacement
  • The evolving picture of shoulder and elbow arthroplasty
  • Dual mobility hip replacement; Infection


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NJR Surgeon and Hospital Outcomes Publication

All hospitals unit and surgeon data outcomes can be viewed at: https://surgeonprofile.njrcentre.org.uk 

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 are listed.

 

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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 available on our website and can be seen by clicking on this link.

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We launched our 17th NJR Annual Report

We have launched 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.

NHS trusts and independent sector hospitals also receive 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.

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Data entry capture resumed for the National Joint Registry

Following NHSE wider notification to hospitals of the 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 COVID-19 height of the pandemic period 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 enquiries@njrcentre.org.uk

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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, once these resume 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.

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The NJR Patient Decision Support Tool - JointCalc

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 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

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NJR Statement on the publication of The Cumberlege Report

The National Joint Registry (NJR) welcomed 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.

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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 published study on the effects of bearing surface on survival of cementless and hybrid THA.

You can read more about it here: 
https://journals.lww.com/jbjsoa/Fulltext/2020/06000/Effect_of_Bearing_Surface_on_Survival_of.10.aspx

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COVID-19 and the associated impact on Elective Surgery

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 also advise that the British Orthopaedic Association (BOA) has helpfully published some ‘Frequently Asked Questions’ for patients, which they will keep updated throughout the effects of the pandemic.

You can view these FAQs here:  https://www.boa.ac.uk/resources/coronavirus-boa-faqs-for-patients.html

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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: enquiries@njrcentre.org.uk or by calling 0845 345 9991.

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The National Joint Registry welcomes the States of Guernsey on Board

The National Joint Registry (NJR) was 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.

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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!

Press Release

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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 updated the MDS forms for primary and revision shoulder and elbow replacements 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 NJR MDS forms.

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’.

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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.  
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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 enquiries@njrcentre.org.uk
 

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