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First-time joint replacement continues to benefits thousands of patients, but early figures confirm ‘re-do’ surgery does not offer same success

Equal focus on revision surgery required, says National Joint Registry [NJR] Annual Report 

While first-time hip and knee replacement operations continue to be hugely successful, when joint replacements require further work (revision or ‘re-do’ surgery) the outlook is not as comparable, the NJR’s 12th Annual Report finds today (Tuesday 15 September 2015).

  • Now publishing over 10 years of results, the latest report emphasises that for first-time surgery:
  • overall life of implants meet national standards, with 95%+ lasting ten or more years 
  • hip and knee brands offer comparable results and are demonstrating a low risk of revision
  • patient factors have a significant bearing on how long the implant will last, with younger patients reporting higher revision rates than their older counterparts

Launching the results at the British Orthopaedic Congress in Liverpool, NJR Medical Director Mr Martyn Porter said: “We encourage all those in orthopaedics to pay heed to the results. It is heartening and very encouraging that hip and knee implants are lasting ten years or more, with risk of revision lower than 5%. Joint replacement surgery offers significant benefits – getting patients back to their chosen lifestyle sooner, free from pain and with improved mobility.”

New for this year however, the analysis includes early results on the relative success of revision surgery. This confirms that the outcome for the patient is poorer than the first-time surgery – the risk of the implant failing within ten years is much higher than when a first-time implant is replaced. Today’s study reports that between 2003 (when the NJR was established) and 2014, overall, primary hips and primary knees have at least a 95% chance of survival in ten years after surgery. However, once revised, those figures could drop to around 85%.

Porter, a revision specialist, continued: “Patient age, advancement of joint disease and loss of bone health are part of the reality of revision surgery so we cannot expect results to be truly comparable. That said, as a practising orthopaedic surgeon, it’s important to acknowledge these early but significant variations and work to identify ways of enabling better outcomes for revision patients. As important, we must continue to work to get the first time surgery as right for the patient as possible – especially where younger patients are concerned as they are most likely to need at least one revision surgery in their lifetime.”

On the provision of this surgery type, Porter concluded: “We must also look to the sustainability of revision surgery. Revision operations represent a significantly cost to the NHS, more so than first-time surgery. There is no doubt that this surgery must be offered to patients however, we must evaluate the safest, most reliable and efficient way to do this.”

NJR Chairman and joint replacement patient Laurel Powers-Freeling added: “The work of the NJR must continue to be part of the discussions about centralisation and specialisation of services in the NHS and any future changes must be based on robust evidence. Work is already underway to try and develop a future model of care that takes into account the needs of the patient as well as need to ensure quality in outcome – as a patient yourself, would you travel further for a complex operation if it meant the results showed you likely to have a better outcome?.”

Those interested in the full report are encouraged to visit to download the outcomes analysis and view, online, the clinical activity data through new, interactive reports. 

The NJR records performance data for hip, knee, ankle, shoulder and elbow joint replacements in England, Wales, Northern Ireland and the Isle of Man and input into it is mandatory for all hospitals.

The NJR, managed at the Healthcare Quality Improvement Partnership, is part of the National Clinical Audit and Patient Outcomes Programme.

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