
At the heart of the National Joint Registry is an organisation that looks after the best interest of patients undergoing joint surgery. It does this by recording, monitoring, analysing, and reporting on the performance of surgeons, hospitals, and implants in terms of outcomes and safety.
The NJR processes identify surgical performance issues which can allow remedial actions such as further surgeon training and professional development, or changes in implant use, or recall. This is central to its work activities. This work has taken time to develop a registry that has reliable and useable data. As it celebrates its 20th anniversary, the NJR has recently recorded four million records, making it the largest orthopaedic registry in the world.
The purpose and work of the NJR is for clinical improvement, to improve standards for the benefit of patients, clinicians, and the orthopaedic sector.
NJR data has other uses and benefits. The NJR makes its data available for use in research studies and delivers a research fellowship programme, which leads to published research ranging from component uses to geographical variations and inequalities in the provision, access, and outcomes of joint surgery. Research highlights best practice.
NJR data was used in the development of the NJR Patient Decision Support Tool, an online tool for patients considering joint replacement surgery to make informed choices about their treatment. The scale and quality of the work of the NJR is breath-taking.
Joint surgery is a highly successful procedure and intervention. It is rewarding to know that the NJR contributes significantly to this.
The Registry was recognised by the Independent Medicines and Medical Devices Safety Review, chaired by Baroness Cumberlege, which identified it as ‘a leader in its field’, and ‘being an exemplar registry with world-leading expertise’.
One of the IMMDS review’s recommendations was to collect data more widely and routinely, with Patient Reported Outcome Measures (PROMs) forming part of the assessment of the benefits and risks of treatments.
The NJR records primary or first-time surgery and when revision or repeat operations are needed in terms of surgical performance and outcomes. PROMs are a missing link, enabling an understanding, pre- and post-surgery, of a patient’s health, from their perspective. The use of PROMs should be the norm for joint surgery.
Currently, the NJR only manages PROMs for shoulders. Hip and knee PROMs have been collected and managed by the NHS but would benefit from being taken over by the NJR. Issues with ongoing poor data quality and completeness impact their use for analysis, which lets down patients.
The future for the work of the NJR should be managing PROMs across joint surgery to enhance its work, and benefit patients. Its proven track-record in not only managing but analysing data attests to this and would make it a world leader.
I have been involved as a volunteer in the musculoskeletal community with different organisations for over 25 years. The NJR is an organisation I hold in the highest regard because of the excellence and quality in standards of its work and the dedication and hard work of everyone involved in delivering improved patient outcomes.
Robin Brittain is a volunteer with the National Joint Registry.