American Joint Replacement Registry (AJRR): First Annual Report and Subsequent Progress

With nearly 50% of adults at risk of developing knee osteoarthritis by age 85 and 25% of adults at risk of developing hip osteoarthritis, successful treatment options are critical.  Total joint arthroplasty (TJA) offers improvement in quality of life for individuals with severe osteoarthritis.  Maintaining quality care for TJA patients, and understanding implant performance is imperative given the recent recall of a hip implant system which affected nearly 100,000 patients globally. AJRR is the first national, multi-stakeholder clinical data registry designed to improve the quality of TJA care.  Hospitals submit data via secure electronic file transfer of procedural metrics extracted from their electronic health record.  Imported procedures are subject to additional verification and in 2013 a statistically powered sample (N=12 hospitals) was audited for accuracy (agreement rate = 92.3%).  Data on N=43,823 procedures from N=123 hospitals (n= 16,665 hips; n=27,158 knees) were collected in 2013.  Results pertaining to ICD-9 procedure and diagnosis codes were consistent with other registries’ findings as was the frequency of revision procedures (n=2,877; 6.6%).  Of the revisions with an index procedure occurring within 2 years, (n=222), n=151 (68.0%) occurred less than 3 months after the index procedure.  Revisions were primarily due to preventable issues such as complications (hip=69.6%; knee=84.8%) including infection and peri-prosthetic fracture.  Understanding reasons for earlier than expected revisions will assist with improvements in TJA.  As of today, AJRR has enrolled over 430 hospitals representing 50 states.  Acquiring more procedures will enhance our ability to generalize data and conduct longitudinal analyses including implant survivorship.