AAOS Now

Published 12/1/2016

AJRR Expands TJA Data Collection

Annual report shows significant increase in procedure count since 2015
Each year, the American Joint Replacement Registry (AJRR) releases its Annual Report on Hip and Knee Arthroplasty Data at the American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting. The AJRR published and distributed its 2016 report on Friday, Nov. 11, at the meeting in Dallas, Tex. The AJRR has seen significant growth in the past year, leading to this year's report being the most comprehensive representation of data from an American orthopaedic registry to date. With a 102 percent increase in procedures since the last report, the AJRR is well on its way to fulfilling its mission of collecting data on 90 percent of all hip and knee arthroplasty procedures performed in the United States.

"The AJRR currently has over half a million procedures in the registry," said Daniel J. Berry, MD, chair of the AJRR Board of Directors. "[Data on] around 427,000 of those procedures, which were collected between 2012 and 2015, are included in this year's report. These additional procedures provide increasingly detailed and accurate information on primary and revision joint replacement procedures in America."

The 2016 annual report includes data from 416 hospitals and 3,710 surgeons, compared to 236 hospitals and 2,200 surgeons in last year's report. A temporary challenge that AJRR faced this year was the conversion from International Classification of Diseases, 9th Edition Clinical Modifications (ICD-9) to ICD-10. Fewer procedures were submitted in the fourth quarter of 2015 due to the change, but overall the data in this year's report is much more extensive than in previous years.

According to Dr. Berry, obtaining data from more hospitals and surgeons provides a most robust, comprehensive understanding of hip and knee arthroplasty outcomes. He noted that the surgeons who provided data included in the 2016 annual report "practice at hospitals that range anywhere from major teaching hospitals to small hospitals with less than 100 beds. These hospitals also range from urban to rural."

Analyzing the 2016 data
Some findings remain very similar to those obtained from data collected last year. The average patient age was 66.5 years, with nearly half of all procedures performed on individuals younger than 65 years. Hemiarthroplasty accounted for approximately 10 percent of all hip arthroplasties.

Other findings for 2016 diverged from earlier data. AJRR found that ceramic femoral head usage has grown significantly over the past four years. The registry's analysis also shows ceramic heads are used in a much higher percentage of younger than older patients, but that ceramic head use is also growing among older patients. Dual mobility articulations continue to become more commonly used in the United States, with dual mobility cups used in 7 percent of all primary hip arthroplasties and more than 20 percent of all revision hip arthroplasties.

As for knees, unicompartmental knee arthroplasties accounted for 5.2 percent of all primary knee arthroplasties. There has been a slight downward trend in their use in the past 4 years. However, while unicompartmental procedures were performed at the majority of hospitals who provide data to AJRR, only roughly 30 percent of surgeons reported that they performed such procedures.

Future enhancements
This year, the registry has made many improvements to the ways in which it uses technology to collect and present data. More changes are planned for early next year as well. These changes will enable the AJRR to meet the evolving needs of all of its users and stakeholders. In the beginning, the AJRR was focused on device surveillance. The increased prominence of quality reimbursement initiatives such as Comprehensive Care for Joint Replacement (CJR) and the Merit-Based Incentive Payment System (MIPS) and insurer quality distinction programs has led AJRR to embrace functionality that enables it to collect the robust information required for quality reporting.

"As the field of health care changes and expands from surveillance to surveillance and reporting quality, the national registry needs to do the same," said Dr. Berry. "Our data collection and reporting will continue to advance, offering surgeons and researchers a comprehensive means to improve orthopaedic care through data."

To access a copy of the AJRR 2016 Annual Report, visit www.ajrr.net.