Bone Fracture Clinical Trial
Official title:
HealthEast Community Hip and Knee Replacement Registry
HealthEast Care System began the first community-based joint replacement registry (HJRR) in
the U.S. in 1991, and now has more than 30,000 total joints registered. The purpose of the
HJRR is to maintain and improve the care of individuals undergoing joint replacement surgery
by providing timely information to their surgeons and the broader orthopaedic community.
As it moves into the third decade, the HJRR is proud of its role in the development of the
national American Joint Replacement Registry (AJRR) and will remain an important contributor
to the larger national effort in the advancement of orthopaedic science.
HealthEast Care System began the first community-based joint replacement registry (HJRR) in
the U.S. in 1991, with a database that allowed tracking of implant use and failure rates
among the 90 orthopaedic surgeons performing arthroplasty surgery in the greater metropolitan
area of St. Paul, MN. Initially conceived as part of a process to better manage costs and
determine which implants were most cost-efficient, it became apparent that the registry would
allow insight into the same process that had proven its value in the Scandinavian joint
registries. With the knowledge that a majority of total joint arthroplasties in the U.S. are
performed by relatively low-volume community surgeons, the HJRR remains uniquely positioned
to reflect contemporary U.S. surgical practices.
The purpose of the HJRR is to maintain and improve the care of individuals undergoing joint
replacement surgery by providing timely information to their surgeons and the broader
orthopaedic community. With the primary outcome measure of time to revision surgery, combined
with analysis of confounding factors and mortality monitoring, the HJRR can provide some
realistic measure of the success of a given arthroplasty procedure in our community. In
addition, the registry can evaluate the relative effectiveness of different prosthetic
designs, identify patient variables that may impact implant survival, and provide the
tracking mechanism necessary in the event of implant recalls.
Over the 20 years of its existence, the HJRR has refined its data-gathering, data
verification, and data analysis and utilizes a process design that requires no direct surgeon
involvement with data input. Volunteer surgeons review each revision chart and operative note
to carefully delineate the reason for revision. The HJRR capture process has been validated
and more than 94% of the revision surgery is performed within the HJRR. The database is used
to generate information of practical use to the surgeon, and has been demonstrated to
influence surgeon behavior. Among other examples, HJRR reports on the failure rates
associated with unicompartmental knee arthroplasty, hybrid and cementless total knee
arthroplasty, and metal-on-metal total hip designs have led to significant declines in their
respective use over the periods documented. Similarly, the HJRR allowed for rapid
notification of surgeons and expedited patient care during the three significant hip implant
recalls of the last decade.
As it moves into the third decade, the HJRR is proud of its influential role in the
development of the national American Joint Replacement Registry (AJRR) as one of the earliest
participants and pilot hospitals. It will remain an important contributor to the larger
national effort, particularly for certain data subsets that may be outside of the scope of
the much larger AJRR. The HJRR core workgroup has published widely on its findings in the
last two decades, and looks forward to the future as a compelling example of how worthwhile
information and advancements in orthopaedic science can be made in the community setting.
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