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NJR In-depth studies

As part of its annual reporting process, specialist topic areas for research are discussed. These proposals are then managed through the NJR Research Committee as internally-supported project proposals.

These studies often reflect significant areas of interest for the whole orthopaedic community and current and ongoing areas of in-depth study work include:

  • Inequalities in provision and outcomes of arthroplasty performed in England
  • Development of an Orthopaedic Arthroplasty Specific Morbidity Index
  • Factors associated with revision and its outcomes
  • Surgical approach for primary hip and knee replacements

 In-depth studies are detailed in the NJR annual report each year as well as being published in peer reviewed publications.


NJR 15th Annual Report                                                           

Heart failure after metal-on-metal hip replacement

This study found a lower incidence of heart failure and mortality in patients with metal-on-metal hip replacements, compared to other hip types in the first seven years after surgery. Whilst there may be residual confounding by indication, these results should provide reassurance to clinicians and patients alike regarding cardiac sequelae associated with these devices. We recommend epidemiological analysis at five yearly intervals to investigate for any latent effects.

Full paper details: The risk of cardiac failure following metal-on-metal hip arthroplasty;  S. A. Sabah, J. C. Moon, S. Jenkins-Jones, C. LI. Morgan, C. J. Currie, J. M. Wilkinson, M. Porter, G. Captur, J. Henckel, N. Chaturvedi, P. Kay, J. A. Skinner, A. Hart, C. Manisty;  Published in the Bone and Joint Journal, January 2018. Bone Joint J 2018;100-B:20–7

Revision for Periprosthetic Femoral Fracture in total hip arthroplasty

This study demonstrates, based on longitudinal registry data, that there is an overall higher risk of PFF revision in THA with cementless stem-fixation in the first three months following implantation. Loaded taper cemented stems showed a higher risk of PPF revision compared with other cemented and cementless stem designs. Collared cementless stems appear to offer some protection against revision for PFF. Overall, the association between implant design and risk of PFF is complex with implant-specific variation evident, based on NJR data.

Author: Tanvir Khan, NJR Research Fellow, University of Nottingham

Trabecular metal in primary and revision total hip arthroplasty

This work demonstrated that in patients undergoing primary THA, TM coated implants had a reduced risk of both aseptic and septic revision compared with non-TM implants. However these differences in revision risk between the groups were small, and may only be clinically significant if the TM designs were implanted in the most complex cases.

In patients undergoing revision THA, both TM and non-TM coated acetabular components were associated with comparable and relatively low re-revision rates. Extended follow-up of large revision THA cohorts will establish whether TM components have any clinical benefit over non-TM designs when used in patients with similar acetabular bone stock.

Full paper details: Trabecular metal acetabular components reduce the risk of revision following primary total hip arthroplasty: A propensity score matched study from the National Joint Registry for England and Wales;  Gulraj S. Matharu, BSc (Hons), MRCS, MRes, DPhil, Andrew Judge, BSc, MSc, PhD, David W. Murray, MD, FRCS (Orth) and, Hemant G. Pandit, DPhil, FRCS (Orth); The Journal of Arthroplasty 2018;33(2):447-452. DOI:

Trabecular metal versus non-trabecular metal acetabular components and the risk of re-revision following revision total hip arthroplasty. A propensity score-matched study from the National Joint Registry for England and Wales. Matharu GS, Judge A, Murray DW, Pandit HG. The Journal of Bone & Joint Surgery America 2018;100:1132-40. DOI:

Download the NJR 15th Annual Report (pdf) to find further detail and analysis from these published papers.



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