Published 6/1/2011

Two views on value of joint registries

The comments made by David G. Lewallen, MD, chair of the American Joint Replacement Registry (AJRR) board of directors, expressing enthusiasm about the “exciting year” the AJRR had (AAOS Now, March 2011), prompted me to share my reservations regarding the Registry. Despite the altruistic and sound rationale of the Registry, I believe the United States is not as yet ready for it for several reasons. We assume that the alleged success of the Scandinavian registries can be easily duplicated in this country, despite the profound differences between those countries and our own. I am also concerned about the lack of a mechanism to ensure the veracity of the data submitted by the relatively small number of participating surgeons and the role industry will play in the project.

I have tried to follow the evolution of the AJRR as carefully as possible and was pleased to read Dr. Lewallen’s optimistic analysis.My pleasure rapidly waned when he made it clear that industry has a seat on the board and would also contribute financially.

I am concerned that if industry plays a significant role in the AJRR, it might soon chart its future, much as it now controls both orthopaedic education and research. I urge reconsideration of the relationship of industry in the AJRR. Orthopaedists have long worked closely with industry and that relationship must be maintained, but the degree of cooperation must be tempered with reality. Under no circumstances should industry have the opportunity to dictate the future of our profession.

Augusto Sarmiento, MD
Miami, Fla.

I read with interest the report on the Specialty Day presentation regarding metal-on-metal (MOM) hip replacements. It left the impression that the advent of the larger head diameters seen with MOM prostheses have in fact resulted in a lower dislocation rate and lower revision rate in the Medicare population.

However, AAOS Now has also reported work by Thomas P. Vail, MD, who found no benefit in the Medicare population with large head size in terms of decreasing the revision rate (AAOS Now, January 2010).

I think the question was asked whether the increased cost of these implants (borne by the Medicare system) has had the desired effect of decreasing the overall cost for providing hip replacement surgery to this particular patient group.

The promotion of MOM articulation in the face of registry data that suggest that it carries a substantially higher revision rate than conventional bearing surfaces demonstrates the need for information that will allow practicing surgeons to make appropriate decisions on behalf of their patients, distinct from marketing pressures.

James P. Waddell, MD, FRCSC
Toronto, Ontario, Canada

Editor’s note: For more on the MOM debate, see the articles in this issue, beginning on page 6. As for the future of the AJRR, keep reading AAOS Now, and watch next month for an update from Michael P. Dohm, MD, director of the Western Slope Study Group.