HISTORY SIR JOHN CHARNLEY

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HISTORY SIR JOHN CHARNLEY
Serious consideration should be given to
establishing a Central Register to keep a finger
on the pulse of total implant surgery on a
nation-wide basis. JC Internal Publication No.
39 July 1972
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HISTORY

• 1990 - Trent Region Arthroplasty Register
• 2002 decision to establish National Joint
  Registry
• following 3-M Capital Hip Problem
• April 2003 National Joint Registry (England and
  Wales) commenced data collection

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AIMS OF NJR

• Comparative audit of hospitals and prostheses
• Monitor new prostheses
• Major research database
• Identify patients with poorly performing
  prostheses

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NATIONAL JOINT REGISTRY (NJR)

• Run by private sector company
• AEA Technology 2003 2006
• Northgate Information Solution (NIS) 2006 - 2009
  
• Overseen by NJR Steering Committee
• Regional Clinical Coordinators
• Financed by levy on prostheses

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NATIONAL JOINT REGISTRY (NJR)

• Minimum Dataset collected at time of surgery
• Electronic transfer to NIS
• Organisation and analysis of data by NIS and
  Royal College of Surgeons Clinical Effectiveness
  Unit (RCS CEU)

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MINIMUM DATA-SET

• Patient demographics
• ASA grade
• Orthopaedic unit
• Date of surgery
• Consultant
• Name and grade of lead surgeon
• Surgical technique
• Prosthesis
• Thromboprophylaxis

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NATIONAL JOINT REGISTRY

• 202 NHS hospitals/TCs
• 11 ISTCs
• 159 IHs
• gt 600,000 hip and knee joint replacements
  registered

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NATIONAL JOINT REGISTRY

• 39,000 registrations per quarter
• Compliance gt 80
• Patient consent 88
• Linkability 83 (20 in 03/04)

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MEASURABLE OUTCOMES (PRESENT)

• Mortality (0.6 at 3 months)
• Revision of joint replacment

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MEASURABLE OUTCOMES (FUTURE)

• Infection
• Dislocation
• Patient Reported Outcome Measures (PROMS)

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TOTAL KNEE REPLACEMENT BRANDS

• 65 Total Condylar
• 15 Uni-condylar
• 9 Patello-Femoral
• 14 Hinged

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PRIMARY TOTAL KNEE REPLACEMENT (2007)

• Cemented 83
• Uncemented 6
• Unicondylar 8 (50 MIS)
• Patello-Femoral 1

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3 YEAR TKR REVISION RATES (95 C.I.)

• Cemented 1.2 (1.1 1.3)
• Uncemented 1.5 (1.2 1.9)
• Hybrid 1.7 (1.0 2.8)
• Unicondylar 2.0 (1.5 2.7)

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3 YEAR TKR REVISION RATES (95 C.I.)

• PFC Sigma 1.1 (1.0 1.3)
• AGC 1.1 (0.9 1.4)
• Nexgen 0.8 (0.6 1.1)
• Scorpio 1.2 (0.9 1.6)

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MULTIVARIATE ANALYSIS (HAZARD RATIO)

• Age, sex, physical status, provider type
• Risk of revision of Unicondylar x 1.4 that of
  cemented TKR at 3 years

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ANALYSIS OKS
Mean OKS 25.0 (S.D 10.1) Median OKS 22 (IQR
1731)

• Figure 1 Distribution of OKS in 7230 pts for
  whom it could be calculated

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ANALYSIS SATISFACTION

• Satisfaction questions were completed by 8095
  patients
• Overall
• - 81.8 were satisfied
• - 11.2 were unsure
• - 7.0 were not satisfied
• The OKS varied according to patient satisfaction
  (plt0.001)

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OKS AND SATISFACTION
Table 1 Breakdown of OKS by satisfaction
status Between group comparison using ANOVA,
plt0.001 between all groups (Bartletts test for
equality of variance pgt0.05)
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SUMMARY REGRESSION ANALYSIS

• Higher levels of both pain and functional
  limitaton, as measured by the OKS, were
  associated with lower levels of patient
  satisfaction (plt0.001)
• The effect of variations in pain on patient
  satisfaction is approximately twice the effect of
  variations in function

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SUMMARY REGRESSION ANALYSIS

• Men were more satisfied than women (plt0.05)
• Patients with a diagnosis other than OA were more
  often satisfied than those who had surgery for OA
  (plt0.05)
• We also found evidence that
• Patients with unicondylar replacement were less
  likely to be satisfied than patients who
  underwent cemented total knee replacement
  (p0.002)
• People aged 70-80 were more likely to be
  satisfied when compared to those aged lt65
  (plt0.05)
• Patients who were ASA grade 3 were more likely to
  be satisfied when compared to those who were ASA
  1 (p0.002)