Published 10/1/2012

American Joint Replacement Registry Continues to Grow

Initiative has collected data on more than 30,000 total joint arthroplasty procedures

Caryn D. Etkin, PhD, MPH, and Susan E. Hobson, MPH

The American Joint Replacement Registry (AJRR) has been making tremendous progress toward its goal of becoming the first comprehensive national hip and knee orthopaedic implant registry in the United States. In 2011, the registry completed a pilot program that collected data on more than 3,600 total joint arthroplasty (TJA) procedures. Today, the initiative has contracts with 51 institutions—representing 72 hospitals—and has obtained data on more than 30,000 TJA procedures. Every month, more institutions sign on to participate.

In addition, three new staff members have recently joined the AJRR, including Executive Director Jeffrey Knezovich, CAE, and Pamella Leiter, MSA, OTR/L director, policy and strategic alliances, as well as September Catrue, MPH research associate.

Power of a total joint registry
Terence J. Gioe, MD,
a member of the AJRR board of directors and a key participant in the HealthEast Joint Replacement Registry (HJRR), a community-based joint replacement registry in St. Paul, Minn., attributes the AJRR’s rapid growth to the many benefits offered by participating in total joint registries.

“I have really been impressed with the power of a total joint registry, based on what our own HJRR has been able to accomplish over the past 20 years,” said Dr. Gioe. “We have seen significant declines in the use of certain devices and techniques based on the ability to provide timely feedback to surgeons.”

As the AJRR moves toward its goal of becoming the United States’ national total joint registry, it is actively collaborating with hospitals and other initiatives that have databases of TJA procedures to help eliminate duplicative data collection efforts. Registry data can also provide a great deal of data for hospital quality teams and service line administrators.

“We have a long history of having our own database, or ‘registry,’ at Rush, so it was natural for us to want to be involved with AJRR,” said Craig Della Valle, MD, of Rush University Medical Center, one of the AJRR pilot program sites. “As we move forward and attempt to further improve what are already extremely successful medical interventions, a national registry will enable us to see how newer implants or techniques are performing compared to prior implants.”

Incentives and collaboration
The AJRR participates in numerous collaborative activities with various entities, including governmental agencies, The Joint Commission, and payers. It recently joined both the International Society of Arthroplasty Registers and the International Consortium of Orthopaedic Registries to strengthen cooperation and facilitate information sharing with other established registries.

AJRR is also laying the groundwork for future collaboration with state registries, such as the California Joint Replacement Registry and the Michigan Arthroplasty Registry Collaborative for Quality Improvement. In addition, the registry is part of a national research effort funded by the Agency on Healthcare Research and Quality and implemented by the University of Massachusetts Department of Orthopedics and Physical Rehabilitation. The Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) is collecting data on TJA patients in various hospital and practice settings across the United States.

The project aims to report longitudinal outcomes, focusing on patient-reported measures as well as clinically refined measures of postoperative events.

“FORCE-TJR members can submit implant data to the AJRR to contribute to implant revision monitoring,” said FORCE-TJR Principal Investigator Patricia Franklin, MD, MBA, MPH. “In combination, data from the AJRR and FORCE-TJR will inform surgeons and patients about key factors involved in optimizing outcomes after TJR surgery.”

AJRR’s plans for the future
The AJRR initially collected just Level 1 data (procedural and demographic information) to establish a broad base for analyzing implant survivorship. It will begin accepting Level II and Level III data in early 2013. Level II data—such as patient comorbidities, Physician Quality Reporting Initiative measures, surgical approaches, prophylaxis, and American Society of Anesthesiologists scores—will be used for risk adjustment of data. Level III data will include the results of patient-reported outcomes instruments that assess health-related quality of life and physical function.

According to Dr. Gioe, the AJRR’s progression to collecting Level II and Level III data mirrors the path followed by other registries, such as the HJRR.

“The HJRR began with a fairly simple database designed to track implant use and failure rates primarily as a way to manage implant costs, but now it enables us to do much more. For example we can evaluate relative effectiveness of different designs while accounting for confounding factors, track implants in the event of a recall, and provide information to individual surgeons about their own performance.”

Dr. Gioe is enthusiastic about the future of the AJRR.

“It’s really exciting to be part of the AJRR effort—it’s long overdue in many surgeons’ opinions,” added Dr. Gioe. “It’s staggering to think of the massive database the United States could muster in only a few years of collecting data from 80 percent to 90 percent of U.S. hospitals performing arthroplasty.”

Caryn D. Etkin, PhD, MPH, is research director and Susan E. Hobson, MPH, is research associate for the AJRR. If you are interested in learning more about the AJRR, please contact them at 847-292-0530, via email at info@ajrr.net, or online at www.ajrr.net

About the AJRR
The AJRR is a not-for-profit 501(c)(3) organization for data collection and research on total hip and knee replacement. The AJRR is a collaborative effort supported by the AAOS, the American Association of Hip and Knee Surgeons (AAHKS), the Hip Society, the Knee Society, hospitals, health insurers, and medical device manufacturers. For more information, visit