2013/14 Implant Performance Chairman’s report ~ Mr Keith Tucker
As outlined in previous reports, the Implant Performance Committee comprises members of the Scrutiny Group together with representatives from industry. The Scrutiny Group includes surgeons, representatives from the MHRA, Northgate and the University of Bristol. The NJRSC Chairman is also a member of both groups and both groups are supported by HQIP.
Examining the data
There are two main committee examinations of the NJR data to assess implant performance and identify potential outlier performance, one in Spring and one in Autumn. The Scrutiny Group meet more regularly however and they will consider any concerns about specific implants which are raised to them directly, outside of the formal data assessment process.
The Scrutiny Group continues to assess potential outlier implant performance and notifies the MHRA when there are concerns. This process is reviewed constantly and, as a result of recent reviews it is likely that more comprehensive reports will be developed for the future. It is also planned that future reports will contain details of surgical performance, including case mix.
Notification from surgeons of poor performance
We are greatly indebted to members of the orthopaedic profession who notify us when they have concerns with the performance of specific implants. We know that the NJR database does not always pick up on devices which are ‘variations’ on a very well used device range which, overall, has excellent results. That is to say, a relatively minor modification to a well known hip or knee implant range, with the same name and manufacturer, might not be performing as well as would be wished. If there were, for example 20,000 implantations which were excellent and 500 of a variant which were not so good, we would rely heavily on surgeons notifying us of their concerns. The NJR describes this anomaly in data analysis as ‘camouflaging’. We continue to encourage surgeons who have noticed worrying performance to contact us directly.
As always, we are looking to improve our skills at identifying poor performance, whilst at the same time recognising good performance. We see the introduction of Unique Device Identifiers (UDI) as an opportunity for the NJR’s component database to be improved along with our capability to detect poor performance.
The NJR Implant Performance Committee also works closely with the other, international registries through the International Society of Arthroplasty Registers (ISAR) and the International Consortium of Arthroplasty Registers (ICOR). We will review our processes in the 2014/15 year.
Outgoing NJR Steering Committee member Mick Borroff attended his last meeting of the Implant Performance Committee. Mick has been closely associated with the NJR since its inception and I would like to record our indebtedness to his enormous effort in helping shape the committees and for providing a link between the NJR and the manufacturers. We welcome the newly appointed industry members, Nick Wishart and Michael Green, to the main committee. I would also like to thank Crina Cacou, MHRA representative, for all her help and cooperation as a member of our group until 2014.
With the increasing maturity of the NJR shoulder, elbow and ankle data we are looking forward to representation from the appropriate professional societies on our committee.