Published 1/1/2014

AJRR Surpasses Enrollment Goal

Growing registry receives data on approximately 2,000 procedures each week

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

Since it officially began operations in August 2011, the American Joint Replacement Registry (AJRR) has made significant strides toward building the first comprehensive national hip and knee orthopaedic implant registry in the United States. As this issue went to print, the AJRR had enrolled 224 hospitals—far surpassing its goal of enrolling 180 hospitals by the end of 2013—and had accepted data on more than 65,000 hip and knee procedures.

Currently, the registry receives data on approximately 2,000 procedures each week, putting the AJRR on track to receive data on more than 100,000 procedures per year. That number will grow as more hospitals participate. By 2018, the AJRR aims to enroll 90 percent of all U.S. hospitals that provide hip and knee total joint arthroplasty (TJA) procedures.

Hospitals participating in the registry vary greatly in terms of size, ranging from small hospitals (1 bed to 99 beds) to much larger institutions (400 or more beds). Participating institutions span 47 states, with only Alabama, Oklahoma, and Rhode Island yet to contribute data.

Reviewing the data
Data collected through 2012 correspond to factors such as patient age, diagnoses linked to hip and knee TJA, and types of implant fixation used. TJA patients had a mean age of 66 years at time of surgery, and osteoarthritis was the predominant diagnosis leading to TJA.

Among total hip arthroplasty (THA) procedures, the predominant method of fixation was uncemented (88 percent), and the most commonly used femoral head sizes were 36 mm or larger. Among total knee arthroplasty (TKA) procedures, the predominant method of fixation was cemented (73 percent). In addition, posterior-stabilized implants predominated in TKA, and approximately two thirds of all TKAs performed used highly cross-linked polyethylene.

As data continue to come in, AJRR staff members are collaborating with industry and other registries to develop a more comprehensive device database. Thus far, data on more than 35,000 components have been received. The registry intends to expand data reporting to include more details on component types, accessories, and materials.

This information will facilitate data queries and device system performance assessments. It will also help ensure that component data remain consistent with requirements imposed by the U.S. Food and Drug Administration’s Unique Device Identification (UDI) Final Rule.

Collecting Level II, III data
To expand its reach, the AJRR recently launched a pilot program to begin collecting Level 2 and Level 3 data from 15 hospitals already participating in the registry. With the additional data, the AJRR will be able to provide enhanced reports and dashboards, risk-adjusted data, and Patient Reported Outcome Measures (PROMs) for hospitals that use the AJRR web-based platform.

The pilot study will enable the AJRR to assess the availability of Level 2 elements via local electronic health record systems and test Level 3 workflow models for completing PROMs with patients. When the program is complete, the AJRR will begin full-scale collection of Level 2 and Level 3 data elements.

The AJRR Demand Reporting and Electronic Dashboard Service will soon be available for participating hospitals. (See “AJRR Reporting Dashboards.”) The subscription service will allow hospitals to access Level 1 data reports and national benchmarks on-demand (Fig. 1). Sites will also be able to compare their outcomes to those of other hospitals of similar size and other characteristics of interest.

Regulatory, legislative issues
On Nov. 27, 2013, the Centers for Medicare & Medicaid Services (CMS) released the final rule pertaining to the definition of a Qualified Clinical Data Registry (QCDR), as mandated under the “fiscal cliff” legislation passed in 2012.

For purposes of the Physician Quality Reporting System (PQRS), a QCDR is defined as a CMS-approved entity (such as a registry, certification board, or collaborative) that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care furnished to patients. Provider participation in the PQRS using a QCDR is voluntary, and the QCDR is one of several mechanisms that can be used to report quality measures. The AJRR provided comments on the draft versions of the rule and is reviewing the final rule as it pertains to the registry’s operations.

In addition, the AJRR has been working with supporting industry partners to implement the final UDI ruling, which was released in September 2013. The AJRR is including UDI data elements in the new device database. Finally, the AJRR has enlisted the services of an advisory services company based in Washington, D.C.; the company is working with the AJRR to assess the registry’s current business plan and identify an attainable growth rate for hospital participation and data collection.

Learn more at Annual Meeting
The AJRR will host an educational session on “Worldwide Orthopaedic Arthroplasty Registries” during the AAOS 2014 Annual Meeting in New Orleans, at 9 a.m. on Wednesday, March 12, in room 260 of the Morial Convention Center. Moderated by William J. Maloney, MD, chair of the AJRR board of directors, and David G. Lewallen, MD, AJRR medical director, the session will be an opportunity for orthopaedic surgeons, hospital executives, nurses, and others to learn how orthopaedic registries collaborate and what benefits they can provide.

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

More about AJRR
The AJRR is a non-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, the Hip Society, the Knee Society, hospitals, health insurers, and medical device manufacturers. For more information—including the AJRR Fall 2013 Update—visit

AJRR Reporting Dashboards
A video that demonstrates the AJRR reporting dashboards is available online. The reports and dashboards shown will be continuously improved over time with input from stakeholders.

To access the video, visit www.youtube.com and search for “AJRR reporting dashboards.”