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Death rates halve as joint replacement numbers increase

12 September 2014

While more joint replacements than ever before were carried in 2013 mortality rates have halved since 2003* and for most patients, the risk of having the implant replaced within ten years was less than 5%**

Today's National Joint Registry (NJR) 11th Annual Report shows that while more joint replacements than ever are taking place (205,686***), the numbers of people dying following surgery have halved and that for most patients, the risk of having the implant replaced within ten years was less than 5%.

According to the NJR's Medical Director Mr Martyn Porter, "against a backdrop of joint replacement surgery success, surgeons must now focus on evidence-based practice more than ever in order to achieve even better results for patients."

"Electing for joint replacement is more popular than ever before. The report demonstrates this not only in terms of the number of people having joint replacement surgery year on year but that, for most patients, revisions rates of less than 5% at ten years after implantation can be achieved."

The report, launched today at the first-day of the British Orthopaedic Association (BOA) congress in Brighton, also includes analysis of more than 1.6 million joint replacement records and high-profile research demonstrating that mortality following both hip and knee replacement surgery has halved since 2003.

"Whilst standards in British orthopaedics are high, I must encourage my colleagues to scrutinise and engage with NJR data on a regular basis to evaluate where additional benefits for patients can be maximised. This can be achieved through evidence-based evaluation of the proposed implant, the way in which it will be fixed into place in patients of a particular, age, gender and health."

"This is particularly relevant to those operations where reoperation rates are known to be higher for example, partial knee replacement. In these consultations, surgeons must engage patients in the decision-making process so they are fully aware of the benefits and risks associated with each type of procedure."

NJR patient representative Mary Cowern, who has undergone three knee surgeries for arthritis since 1996 added: "From my own experience, I know how valuable an open discussion is - it can really help you to understand the risks and benefits of surgery and what role you have to play in your own recovery."

"Evidence provided by an organisation like the National Joint Registry offers surgeons and patients an opportunity to start a meaningful dialogue within a shared decision making framework - where the surgeon and the patient can work together to make a decision about treatment."

The registry, managed at the Healthcare Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcomes Programme, shares its information today at a new, dedicated website

It also provides the following headlines for hip, knee, ankle, elbow and shoulder surgery. On average, these patients were:

  • Aged between 64 and 74 years old
  • ‘Overweight' or ‘obese'
  • Women, with only ankle replacement procedures showing a male majority
  • Diagnosed with osteoarthritis or inflammatory arthritis
  • Treated in the NHS

Also published today is a report from the National Hip Fracture Database (NHFD) shows further improvement in care for orthopaedic patients. Their data shows that fewer people are dying after surgery for hip fracture, against a backdrop of an increasing number of patients. NHFD also demonstrate than an evidence-based approach leads to improvements in patient care.

NJR Chairman Laurel Powers-Freeling concluded: "We are delighted that the NJR can demonstrate, through its annual report that an evidence-based approach to medicine results in better patient safety and patient outcomes."

"The registry is committed to working with all those involved in joint replacement to provide data that can aid collaborative decision-making between surgeons and patients as well as robust decision-making in regards to evaluating implant, surgeon and hospital performance as well as service delivery."

* NJR studies show mortality rates for hip replacement have dropped from 0.56% in 2003 to 0.29% in 2011 and from 0.37% to 0.2% for knee replacement

** Based on analysis of hip and knee joint replacement. Ankle replacements outcomes data is only available up to three years
*** A total of 205,686 hip, knee, ankle, elbow and shoulder joint replacements were carried out in 2013

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