James I. Huddleston III, MD, FAAOS, chair of the American Joint Replacement Registry Steering Committee, gives a presentation at the Engagement Theater titled “Optimizing Value in the AAOS Registry Portfolio.”
Published 7/30/2025
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Jennifer Lefkowitz
The AAOS 2025 Annual Meeting provided participants with opportunities to explore research rooted in data collected from AAOS’ family of registries and gain actionable insights to inform and elevate their clinical practice. With more than 4.5 million procedures captured across specialized registries — the American Joint Replacement Registry (AJRR); Musculoskeletal Tumor Registry (MsTR); Shoulder & Elbow Registry (SER); and American Spine Registry (ASR), a collaborative effort between the American Association of Neurological Surgeons and AAOS — researchers are using these datasets to improve musculoskeletal care.
The AAOS Registry Program’s leadership in clinical benchmarking and data-driven decision-making was highlighted throughout the Annual Meeting, where registry-based research took center stage. From scientific poster sessions and podium presentations to Engagement Theater events, these sessions highlighted real-world outcomes, surgical decision-making strategies, and methods for delivering high-quality, cost-effective care.
“It’s remarkable to witness firsthand how our registries are being utilized to challenge conventional approaches, test new treatments, advance discoveries, and streamline care,” said Vishal Hegde, MD, FAAOS, American Joint Replacement Research-Collaborative (AJRR-C) research fellow and director of clinical research for the Adult Reconstruction Division at Johns Hopkins University School of Medicine. “With over 4 million captured hip and knee arthroplasty procedures, the potential to innovate care for our patients is limitless. The Annual Meeting is a great opportunity for the orthopaedic community to discover the tangible benefits registries bring to their everyday practice.”
James I. Huddleston III, MD, FAAOS, and Traci Granston, MD, FAAOS, shared key points during OrthoLive sessions. Their presentations covered strategies for optimizing value in the AAOS Registry portfolio and how registry data can support “green lighting” decisions in surgical planning.
Also during the Annual Meeting, research teams from around the country showcased 12 posters and papers using patient outcome data from AJRR and SER. AJRR remains the largest orthopaedic registry by annual procedure count. As of 2024, SER included data from 424 surgeons across 82 facilities in 40 states, making it a powerful tool for examining real-world outcomes in shoulder arthroplasty. Read on for more highlights of the registry research presented at the Annual Meeting.
Shoulder arthroplasty research: Matched versus mismatched implants
The study “Is there a difference in revision rates for implant matched vs. mismatched components in shoulder arthroplasty?” used SER data to evaluate whether mismatched implants (glenoid and humeral components from different manufacturers) posed a higher revision risk compared with matched systems.
Among Medicare-eligible patients, researchers found no significant difference in revision rates over four years: 0 of 98 mismatched cases compared with 41 of 4,494 matched cases (0.91%; P = 0.32). These results suggest that the off-label use of mismatched components appears to be safe in selected patients. The study further encourages surgeons to exercise their clinical judgment when selecting implants, while acknowledging the need for additional research with larger sample sizes.
Comparing TKA approaches
The AJRR study “Navigated and robotic total knee arthroplasty (TKA) do not confer improved five-year survivorship compared to conventional TKA” was the first study to examine outcomes among navigation-assisted, robotic-assisted, and conventional TKA procedures to demonstrate midterm outcomes. It found no significant differences in all-cause revision or revisions due to mechanical loosening among the three groups.
Interestingly, conventional TKA had a higher rate of mechanical complications at the five-year mark, but this did not translate to an increased revision rate. Although the study was limited in assessing broader clinical outcomes, these results challenge assumptions about the superiority of navigation and robotic techniques, reinforcing the importance of evidence-based adoption of technology.
Evaluating database accuracy in tracking technology use in TKA
Another AJRR-based study, “Comparing the AJRR to the Centers for Medicare & Medicaid Services (CMS) database: how specific and sensitive is the AJRR to CMS when evaluating new technology use in total knee arthroplasty?” evaluated the accuracy of these two databases in identifying technology use in TKA. There are substantial implications for the reliability and validity of studies that use these research methods to examine new technologies.
By linking 330,270 cases of TKA among Medicare-eligible patients treated between 2017 and 2022, researchers found that AJRR reported a significantly higher rate of technology use (9.9%) compared with CMS (2.7%). Although overall agreement between the databases was high (90.7%), statistical measures showed only fair concordance (Cohen’s kappa = 0.23), suggesting discrepancies in how technology use is captured. The findings indicate that better capture of technology use in large databases needs improvement.
“There is an ever-growing need for robust, real-world data to benchmark outcomes, challenge assumptions, and advance quality improvements in orthopaedic care,” Dr. Hegde said. “AAOS registries are more than data repositories — they’re engines of insight and innovation. If your institution isn’t yet participating, now is the time.”
Jennifer Lefkowitz is a freelance writer for AAOS Now.