scholarly journals The Uptake of New Knee Replacement Implants in the UK: Analysis of the National Joint Registry for England and Wales

2020 ◽  
Vol 35 (3) ◽  
pp. 699-705.e3 ◽  
Author(s):  
Chris M. Penfold ◽  
Ashley W. Blom ◽  
J. Mark Wilkinson ◽  
Andrew Judge ◽  
Michael R. Whitehouse
Keyword(s):  
Knee Replacement ◽  
National Joint Registry ◽  
England And Wales ◽  
Joint Registry ◽  
The Uk

scholarly journals Understanding the uptake of new hip replacement implants in the UK: a cohort study using data from the National Joint Registry for England and Wales

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029572 ◽  
Author(s):  
Chris M Penfold ◽  
Ashley W Blom ◽  
Adrian Sayers ◽  
J Mark Wilkinson ◽  
Linda Hunt ◽  
...  
Keyword(s):  
Femoral Stem ◽  
Acetabular Cup ◽  
National Joint Registry ◽  
England And Wales ◽  
Logistic Regression Models ◽  
Joint Registry ◽  
Large Numbers ◽  
Hip Replacements ◽  
Using Data ◽  
The Uk

ObjectivesPrimary: describe uptake of new implant components (femoral stem or acetabular cup/shell) for total hip replacements (THRs) in the National Joint Registry for England and Wales (NJR). Secondary: compare the characteristics of: (a) surgeons and (b) patients who used/received new rather than established components.DesignCohort of 618 393 primary THRs performed for osteoarthritis (±other indications) by 4979 surgeons between 2008 and 2017 in England and Wales from the NJR. We described the uptake of new (first recorded use >2008, used within 5 years) stems/cups, and variation in uptake by surgeons (primary objectives). We explored surgeon-level and patient-level factors associated with use/receipt of new components with logistic regression models (secondary objectives).OutcomesPrimary outcomes: total number of new cups/stems, proportion of operations using new versus established components. Secondary outcomes: odds of: (a) a surgeon using a new cup/stem in a calendar-year, (b) a patient receiving a new rather than established cup/stem.ResultsSixty-eight new cups and 72 new stems were used in 47 606 primary THRs (7.7%) by 2005 surgeons (40.3%) 2008–2017. Surgeons used a median of one new stem and cup (25%–75%=1–2 both, max=10 cups, max=8 stems). Surgeons performed a median total of 22 THRs (25%–75%=5–124, range=1–3938) in the period 2008–2017. Surgeons used new stems in a median of 5.0% (25%–75%=1.3%–16.1%) and new cups in a median of 9.4% (25%–75%=2.8%–26.7%) of their THRs. Patients aged <55 years old versus those 55–80 had higher odds of receiving a new rather than established stem (OR=1.83, 95% CI=1.73–1.93) and cup (OR=1.31, 95% CI=1.25–1.37). Women had lower odds of receiving a new stem (OR=0.87, 95% CI=0.84–0.90), higher odds of receiving a new cup (OR=1.06, 95% CI=1.03–1.09).ConclusionsLarge numbers of new THR components have been introduced in the NJR since 2008. 40% of surgeons have tried new components, with wide variation in how many types and frequency they have been used.

Trust compliance with best practice tariff criteria for total hip and knee replacement

2019 ◽  
Vol 80 (9) ◽  
pp. 537-540
Author(s):  
Ivor Vanhegan ◽  
Andrew Sankey ◽  
Warwick Radford ◽  
Simon Ball ◽  
Charles Gibbons
Keyword(s):  
Knee Replacement ◽  
Best Practice ◽  
Outcome Measure ◽  
Participation Rate ◽  
Patient Reported Outcome ◽  
Measure Data ◽  
National Joint Registry ◽  
Joint Registry ◽  
Patient Reported Outcome Measure ◽  
Patient Reported

Background: Satisfaction of the best practice tariff criteria for primary hip and knee replacement enables on average an additional £560 of reimbursement per case. The Getting it Right First Time report highlighted poor awareness of these criteria among orthopaedic departments. Methods: The authors investigated the reasons for non-compliance with the best practice tariff criteria at their trust and implemented a quality improvement approach to ensure successful adherence to the standards (a minimum National Joint Registry compliance rate of 85%, a National Joint Registry unknown consent rate below 15%, a patient-reported outcome measure participation rate of ≥50%, and an average health gain not significantly below the national average). This was investigated using quarterly online reports from the National Joint Registry and NHS Digital. Results: Initially, the trust had a 31% patient-reported outcome measures participation rate arising from a systematic error in the submission of preoperative patient-reported outcome measure scores. Re-audit following the resubmission of patient-reported outcome measure data under the trust's correct organization data service code confirmed an improvement in patient-reported outcome measure compliance to 90% and satisfaction of all criteria resulting in over £450 000 of additional reimbursement to the trust. Conclusions: The authors would urge others to review their compliance with these four best practice tariff criteria to ensure that they too are not missing out on this significant reimbursement sum.

scholarly journals Obesity and revision surgery, mortality, and patient-reported outcomes after primary knee replacement surgery in the National Joint Registry: A UK cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (7) ◽  
pp. e1003704
Author(s):  
Jonathan Thomas Evans ◽  
Sofia Mouchti ◽  
Ashley William Blom ◽  
Jeremy Mark Wilkinson ◽  
Michael Richard Whitehouse ◽  
...  
Keyword(s):  
Knee Replacement ◽  
Revision Surgery ◽  
Early Years ◽  
Minimal Detectable Change ◽  
National Joint Registry ◽  
Joint Registry ◽  
Obese Class ◽  
Patient Reported ◽  
Surgery Mortality ◽  
High Bmi

Background One in 10 people in the United Kingdom will need a total knee replacement (TKR) during their lifetime. Access to this life-changing operation has recently been restricted based on body mass index (BMI) due to belief that high BMI may lead to poorer outcomes. We investigated the associations between BMI and revision surgery, mortality, and pain/function using what we believe to be the world’s largest joint replacement registry. Methods and findings We analysed 493,710 TKRs in the National Joint Registry (NJR) for England, Wales, Northern Ireland, and the Isle of Man from 2005 to 2016 to investigate 90-day mortality and 10-year cumulative revision. Hospital Episodes Statistics (HES) and Patient Reported Outcome Measures (PROMs) databases were linked to the NJR to investigate change in Oxford Knee Score (OKS) 6 months postoperatively. After adjustment for age, sex, American Society of Anaesthesiologists (ASA) grade, indication for operation, year of primary TKR, and fixation type, patients with high BMI were more likely to undergo revision surgery within 10 years compared to those with “normal” BMI (obese class II hazard ratio (HR) 1.21, 95% CI: 1.10, 1.32 (p < 0.001) and obese class III HR 1.13, 95% CI: 1.02, 1.26 (p = 0.026)). All BMI classes had revision estimates within the recognised 10-year benchmark of 5%. Overweight and obese class I patients had lower mortality than patients with “normal” BMI (HR 0.76, 95% CI: 0.65, 0.90 (p = 0.001) and HR 0.69, 95% CI: 0.58, 0.82 (p < 0.001)). All BMI categories saw absolute increases in OKS after 6 months (range 18–20 points). The relative improvement in OKS was lower in overweight and obese patients than those with “normal” BMI, but the difference was below the minimal detectable change (MDC; 4 points). The main limitations were missing BMI particularly in the early years of data collection and a potential selection bias effect of surgeons selecting the fitter patients with raised BMI for surgery. Conclusions Given revision estimates in all BMI groups below the recognised threshold, no evidence of increased mortality, and difference in change in OKS below the MDC, this large national registry shows no evidence of poorer outcomes in patients with high BMI. This study does not support rationing of TKR based on increased BMI.

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