The American Joint Replacement Registry and Arthroplasty Today

Joint replacement registries have been in place in Europe and Australia for decades. This registry data have given researchers robust information to evaluate joint replacement volume, utilization patterns, and outcomes. In many instances, registries can also serve as a mechanism for implant surveillance and an early warning system for underperforming implants. As the US health care system evolves from a volume-based system to a value-based system, the role of registry data will become increasingly more important. The true value of a registry in this type of health care environment will allow for an evaluation of value, cost, comparative effectiveness, and patient reported outcomes.

The American Joint Replacement Registry (AJRR) is a multistakeholder, independent nonprofit organization established by the American Academy of Orthopaedic Surgeons in 2009. AJRR has experienced wide support across the orthopaedic community and as such as seen a rapid expansion in the number of participating hospitals and procedural volume reported. On concluding a pilot study in 2011, AJRR had 8 hospitals enrolled and approximately 13,000 procedures. In the latest annual report for 2014, these numbers had increased dramatically to 417 enrolled hospitals and over 225, 000 procedures in the registry. In addition, AJRR has been recognized for 2 years by the Centers for Medicare and Medicaid Services as a Qualified Clinical Data Registry that satisfies Physician Quality Reporting System requirements for eligible professionals. In addition, the American Association of Hip and Knee Surgeons recognizes AJRR as its official registry.

To date, most of the data collected and reported in AJRR have been descriptive procedural (level I) data such as surgical volume, diagnoses, component metrics, and reasons for early failure of implants. AJRR has embarked on an ambitious plan to substantially increase collection of subsequent levels of data submitted to the registry. Level II data include patient risk factors, comorbidities, and operative and postoperative complications. The collection of this data will allow for the development of a risk adjustment model to accurately and fairly evaluate hospital and surgeon level data. In addition, AJRR is currently collecting and accepting Patient Reported Outcome Measures. Disease-specific outcome measures, consistent with those recommended by Centers for Medicare and Medicaid Services for the Comprehensive Care for Joint Replacement initiative, such as the Hip disability and Osteoarthritis Outcome Score Junior and Knee disability and Osteoarthritis Outcomes Score Junior forms, and general health measures, such as Veterans RAND 12 and Patient Reported Outcome Measure Information System 10 Global, will help providers and payors better assess the value and improvements in quality of life that patients receive after joint replacement surgery.

AJRR has partnered with Arthroplasty Today to provide the readership with in-depth information regarding registry data in the United States. Given the changing health care environment, registry data provided at the national level will greatly impact health care and lead to improvements in our clinical practice. Each year Arthroplasty Today will publish the Executive Summary of the AJRR Annual Report in its December issue. Subsequently, in the June issues, Arthroplasty Today will publish important research and information from AJRR. In this issue, McGrory, Etkin, and Lewallen look at the definitions of revision and revision burden across international registries.

With the rapid expansion in the amount of quality data being reported, registry data will become the mainstay to evaluate outcomes and value. The collaborative efforts of AJRR and Arthroplasty Today will bring the most relevant information to readers and hopefully encourage all surgeons and hospitals to participate in AJRR as we work toward our goal of a truly comprehensive national total joint registry.