Introduction to NJR Reports

Chairman’s foreword 

Laurel Powers-Freeling, National Joint Registry Chairman

The National Joint Registry’s Steering Committee (NJRSC) oversees the strategic and operational work programme of the registry. As Chairman, and in the role for the past six years, it is always a pleasure to offer a foreword to our annual report, now showcasing our work in its 15th edition, and to update on significant developments during the previous year 2017/18.

Key work and developments

Improving data quality has remained a strategic priority, with continuation of our national data quality audit activity this year. The audit is designed to assess the completeness and quality of data submitted to the registry, as the collection of high quality data is vital to the work of the NJR in providing robust evidence to support decision-making in regard to patient safety, quality standards of care and cost effectiveness of joint replacement surgery. This year the NJR has invested additional resource to support a Data Quality Assurance Team to work with hospitals to ensure their NJR audit tools were completed. We have also begun to consider how we can use automation to facilitate the process and feed back results to hospitals, with encouraging early results. Continuing automation will be a key focus for next year with the aim that it becomes increasingly embedded in each hospital.

This year, Elaine Young and I facilitated a workshop with our key stakeholders, including professional societies, CQC, NHSE, NHS Improvement, manufacturers, MHRA and others, to develop the NJR Strategic Plan for the three year period 2018-2021. The plan sets out key strategic themes which inform our work programme and priorities each year. Our overarching theme - unsurprisingly - is patient safety, but this is supported by other important work areas including information availability and access to NJR data, research, data quality, international collaboration, service development, stakeholder communications and operating model. The plan can be downloaded from the NJR website.

During the year an NJR review group chaired by Matthew Porteous, an NJR Steering Committee Surgeon Representative, undertook a review of the data we collect about joint replacement procedures as part of the Minimum Data Set (MDS). MDS version 7 was completed after extensive consultation with the professional societies and the NJR Regional Clinical Coordinators and went live in June 2018. As well as changes to the data we collect to reflect evolution in clinical practice and advances in implant technology, work also included an upgrade of the user interface on the data entry application.

The collection of Patient Reported Outcome Measures (PROMs) remains a priority for the NJR. This year we commenced the regular six-month follow-up of shoulder joint replacement procedures for patients who had undergone surgery after 1 October 2016. Three- year follow-up will begin in 2019. Work is ongoing to finalise outcomes from the five-year follow-up of hip and knee PROMs and a newly convened working group will consider the future strategy for NJR PROMs.

Work on development of NJR information and feedback systems has included the reclassification and re- structuring of the NJR’s component database. The NJR has collaborated with the German registry and key stakeholders, including suppliers, on this important area of work and reclassification of hip, knee and shoulder devices will be completed in 2018/19. Also, enhancements to the NJR Clinician Feedback and Management Feedback systems and Consultant Level Reports have ensured we continue to improve the way the NJR provides information to our stakeholders.

Future plans for the coming year 2018/19

In addition to our core schedule of activities and continuing development of a number of work streams described above, the NJR will:

• Work with Northgate Public Services and the University of Sheffield in the final security testing and live implementation of the Data Access Portal as a key mechanism for data access for NJR stakeholders.

• Work with the Universities of Sheffield and Bristol to deliver the web-enabled version of a Patient Decision Aid tool to enable shared decision-making between health professionals, patients and their families in considering hip or knee replacement.

• Redevelop the NJR website to make it more engaging and easier to navigate, with a specific portal of useful information for patients and their carers.

• Implement the Healthcare Safety Investigation Branch (HSIB) report recommendations regarding the implantation of wrong prostheses during joint replacement surgery. The NJR welcomes the HSIB report and is already working to take forward the related action regarding the NJR database alert mechanism, to further enhance patient safety.


During this reporting period, there have been a number of changes to the NJRSC membership. Members leaving the NJRSC included patient representative member Sue Musson and industry representatives, Nick Wishart and Michael Green. My sincere thanks to them all - Sue for her exemplary work as a patient ‘champion’ and her support in raising awareness of the patient perspective at many of our NJR events; and Nick and Michael for their advice and input on behalf of orthopaedic implant manufacturers.

Members who were granted extensions to their membership of the NJRSC included: Mr Peter Howard and Professor Amar Rangan, surgeon members, until May 2020 and May 2021 respectively; Mr Rob Hurd, NHS Trust management representative until June 2020; Professor Mark Wilkinson, public health/epidemiology representative to January 2022 and Gillian Coward, patient representative to September 2022.

Also Mr Martyn Porter, NJR Vice Chairman and Medical Director, was granted an extension to his membership until December 2018, when his final term will come to an end. Work is now underway with the Department of Health Appointments Team to recruit Martyn’s successor, as well as a new patient member to replace Sue Musson.

New member appointments included Professor Mike Reed as a surgeon representative, Professor Karen Barker as Practitioner with Special Interest in Orthopaedics representative and Sandra Lawrence and Jeff Stonadge, as Orthopaedic Implant Manufacturer representatives. I would like to take the opportunity to welcome all these new members to the NJRSC and look forward to working with them in the future.

I would also like to thank Ananda Nanu for his considerable contribution this year as a co-opted member of the NJRSC in his capacity as BOA President, which has been significant to the NJR in continuing our valued relationship with the orthopaedic profession. I look forward to welcoming his successor who takes up post from September.

Also I would like to end by thanking all members of the NJRSC and sub-committees, for their valuable contribution, support and enthusiasm. In particular in his final term, my special thanks to Mr Martyn Porter, for his valuable contribution and unstinting dedication in undertaking the role of NJR Medical Director as the first appointee to this post. I have greatly appreciated his advice and tremendous support. Also, my thanks to the Chairs of each of the NJR sub-committees for their hard work and insight. Without their commitment and effort the NJR would not be the world leading and ground-breaking arthroplasty register that it is. I would encourage you to read and review the reports from each committee chairman at where they provide strategic oversight and professional awareness into key work areas. 

Finally, my thanks go to Elaine Young, our tireless NJR Director and her team, as well as our NJR contract partners Northgate Public Services (UK) Ltd and the University of Bristol for all their hard work and efforts throughout the year in progressing the NJR work agenda.


Laurel Powers-Freeling

Chairman, National Joint Registry Steering Committee