Work of the NJR Committees

Data Quality Committee (DQC) 

Chair’s report 2021/22 - Mr Derek Pegg 

Having taken up post in April 2021 as the Chair of the NJR Data Quality Committee, this is my first report. It has been another challenging year in terms of monitoring and improving data quality with the ongoing COVID pandemic and we have yet to see surgical volumes return to pre-pandemic levels. 

During 2021/22, we have focused on completing the audits for the outstanding audit years, 2018/19 and 2019/20, completion of which, for many units, were directly impacted as a result of the initial COVID wave. The 2018/19 audit is now complete and work is ongoing to finalise the 2019/20 audit. The 2020/21 audit is ongoing using data quality automation, extending the audit to elbows, shoulders and ankles. As a result of automation, we are hopeful that units will be able to review their data more regularly and thus achieve conclusion of these essential audits in a more timely manner.

A total of 349 hospitals completed the 2019/20 audit by the target deadline and were eligible to receive their Data Quality Provider Awards. Particular historical issues with data quality have been identified with certain segments of the registry data for elbows, and dual-mobility hips. During the year, two additional audits have been undertaken in these areas to address these concerns. 

The elbow audit started in October 2021 and to date, nearly 3,000 elbow records have been audited across England. This has resulted in an additional 2,000 elbow procedures being added to the registry. These additional procedures will form part of the analysis in the NJR Annual Report and greatly enhance the elbow dataset. The audit has been supported by British Orthopaedic Trainee Association (BOTA), the British Orthopaedic Association (BOA), the Royal College of Surgeons of England and British Elbow & Shoulder Society (BESS) and we have benefited from the engagement of orthopaedic trainees at a local level in assisting with the audit. I would like to extend my thanks to Prof. Adam Watts for leading on this work and to all the hospitals who have completed the audit.

An additional audit of dual-mobility hips has also been undertaken with the support of NEC to resolve data issues within the registry for these procedures. Now 124 hospitals have completed the audit and it is still in progress at a further 31 hospitals. Again, thank you to all the staff in the hospitals who have been involved in this work. 

Future plans

During the coming year, the NJR will be working to improve compliance further through the introduction of the new Data Quality Award Scheme. We are looking forward to introducing this new framework to keep improving the quality of data within the NJR across all joints. 

In addition, we are hoping to build on the work of the additional audits undertaken in elbows and dual mobility hips to further enhance the dataset available for other joints. 

Regional Clinical Coordinators Committee (RCC)

Chair’s report 2021/22 – Mr Derek Pegg

Over the last twelve months the RCC committee has seen eight members complete their terms of appointment; many of whom had kindly extended their commitment to the RCC committee as COVID caused global chaos. I am extremely grateful for their valuable input in these very challenging times.

With the reorganisation of the regional structure of the NHS in England and the desire to have some degree of proportional representation across the regions, the RCC regions have been updated to reflect the new geographical regions. To reflect these changes, combined with naturally occurring vacancies, there has been a recent recruitment process. This has seen ten new consultant orthopaedic surgeons being appointed to the committee. I am also pleased to welcome Jon Mutimer to his appointment as the new Vice-Chair.

While there is now a representative in each region, there remain vacancies in London, the North East and Yorkshire and the East of England regions. The next year will therefore see further recruitment to the committee.

The RCC Committee acts as a collaborative interface between the NJR and the orthopaedic community. Members provide useful observations and suggestions from the community and act as a ‘sounding board’ for new ideas and NJR policy direction. The new Minimum Data Set (MDS) v8 will be a particular development where RCC input will be invaluable. 

The RCC members provide excellent advice on communication with hospitals, both for feedback to units and where practice and performance has been of concern. They have also raised several topics that we have then been able to clarify and address; as well as assisting individual surgeons and units in their regions who have faced challenges.

It is always extremely helpful to have a degree of local knowledge and networks where issues may arise. For example, helping ‘nudge’ units to engage with the ongoing automated data quality audits in collaboration with our Compliance Officers.

Most future meetings are likely to continue to be conducted online. However, it is agreed it is highly desirable to have at least one face-to-face meeting a year, to enable an opportunity to meet for extended usefully engaging interaction. At present, I am confident this will take place for our committee in the next twelve months.

Editorial Committee

Chair’s report 2021/22 – Professor Mike Reed 

The NJR Editorial Committee (previously the Editorial Board) brings together expert clinicians from the orthopaedic specialist societies for each joint; representatives from our experienced data collection and statistical analysis reporting teams, as well as valued input from our patient and industry representatives, and senior members of the NJR Management Team; to enable a collaborative focus to the content development of the NJR Annual Report and its subsequent launch in the autumn of each year at the British Orthopaedic Association (BOA) Congress event. 

The Committee develops the report content development strategy and style with all members taking responsibility for producing a report that is rigorously edited and reviewed, taking almost a full year to consider and prepare the content, design the layout, write all the numerous report sections and review all final content across the team. Each year we aim to make new progress in reporting, using our rich data resource, making data easily accessible in our aim to help to improve patient outcomes. This year we have a new report on Patient Reported Outcome Measures and an updated report on the impact of COVID.

This year, analysis by the talented and committed team at the University of Bristol on each joint can be found in the full report in the Downloads area. This contains detailed information on implant performance and survivorship up to a maximum of 18.75 years.

The Editorial Committee has always supported an in-depth research study programme and is delighted to see the developments in the NJR’s approach to research with the strategic direction being shaped by NJR Research Committee Chairman, Professor Mark Wilkinson. Precis of just some of the most recent external research papers that use NJR data are published in section 3.7 of the full report. In addition, we would particularly encourage you to explore research using NJR data that has been published since the last annual report which you can find here.

Details of implant and unit-level activity and performance can be found both in the full report and in more detail in the specific document in the Downloads area. We no longer publish the document reporting usage of prostheses in the most recent full calendar year as all this information is now available for suppliers on our reporting portal, NJR Connect - Data Services.

Enhancing the online digital format

With the continued progress of development of the NJR Reports website, alongside the demise of printed publications more generally, the NJR Executive and Editorial committees have made the ecological, cost-saving decision to only publish the Annual Report on our online website this year, so we will not have any print copies available. Sharing the report online makes all sections of the report more accessible as navigable pages on the report website or as downloadable files, which can all be found here.

Descriptive analysis of the NJR’s demographic data and activity trends can also be found by using the above link to the site. The data is filterable to enable user-driven enquiries and members of the Editorial Committee provided invaluable contributions towards the interactive filter options offered in the presentation of clinical activity data for all joint types. The intuitive, flexible options help readers to engage with the data and have been well received by visitors to the NJR Reports website and we continually review and strengthen this report website further each year.

The 19th NJR Annual Report will be formally launched at the BOA Annual Congress in Birmingham in September 2022, during the NJR Session.

Research Committee (RC)

Chair’s report 2021/22 - Professor J Mark Wilkinson

The Research Committee is responsible for delivering the research agenda of the NJR. The committee’s aim is to enhance the understanding of the science of arthroplasty, improve clinical practice and benefit public health.

Research provides the route to improved treatments and keeping patients at the centre of what we do is a guiding principle for all of our research activity. During 2021/22 the committee has had oversight of several major projects. Below are details of a small selection of these projects amongst a varied programme of work currently underway. These projects represent key achievements for the NJR in meeting our aim to maximise the value of the registry dataset to patients and the wider healthcare community. My thanks go to all members of the committee for their efforts in the past year and for their hard work which makes it possible to facilitate data access and to support these high quality research outputs.

We are pleased to welcome Tom Joyce to the committee as a co-opted member with specialism in orthopaedic engineering. I’d also like to express my thanks to Jonathan Jeffers for all his contributions to the committee over recent years. 

NJR Research Webinar

In January 2022 we held the first NJR Research Webinar titled, ‘Accessing and Utilising National Joint Registry Data for Research’. The event provided a rich programme of presentations and discussion from members of the research committee, NJR research fellows and the NJR Management Team, with opportunities for attendees to submit questions throughout. The webinar was developed with the aim to motivate and support ideas for the development of future projects, to engage with external researchers and to provide valuable guidance through all the processes involved. The event ran successfully with an international attendance and the committee look forward to future collaborations as a result. The recording of the event is available as a highly useful resource and can be found here or via the NJR website. 

NJR ePREMs pilot

Collection of patient-reported metrics remains a major strategic priority for us and the NJR PROMs Working Group was established to collaboratively draft an operational plan for how the NJR develops its patient reported outcome measures (PROMs).

This multidisciplinary group – consisting of clinicians, academics, information management and communication specialists as well as patient representatives – has undertaken a review of ongoing PROMs activity in the area of arthroplasty surgery across the UK, engaging with multiple key stakeholders who are involved with orthopaedic PROMs – including NHS Digital, NHS England/Improvement, the Care Quality Commission (CQC) and the Medicines and Healthcare products Regulatory Agency (MHRA).

Having developed and agreed tools for the pilot collection of electronic Patient Reported Experience Measures (ePREMs) from all patients at six weeks following their surgery, we had delayed starting this pilot due to reduced surgical volumes as a result of COVID. As surgical volumes are being monitored in the recovery period, the pilot remains paused. Once feasible again, patients that have provided their contact details (email address and mobile number) or have consented for these to be pulled from patient data already held by hospitals will be contacted to complete ePREMs. At the end of the pilot, data will be analysed to determine if patient reported metrics are likely to be feasible at scale. Aggregate PREMs results will also be shared with hospitals to enable these to usefully feed into any relevant local improvement discussions.

Patient Decision Support Tool

In 2019 we launched the NJR Patient Decision Support Tool. This is a web-enabled personalised patient decision-making tool for those considering hip or knee replacement. This simple tool, the development of which was supported by the charity Versus Arthritis, will help patients who are considering having a joint replacement to make evidence-based choices about their treatment and share decision-making with their clinicians, when considering the benefits and risks of their undergoing joint replacement. To date, there have been over 35,000 visits to the website from over 100 countries, with very positive feedback received.

Having launched this tool (available at https://www.njrcentre.org.uk/patients/patient-decision-support-tool/), we are continuing to collaborate with academic partners to further develop the underpinning prediction algorithm methodology. This will result in more agile algorithms that will allow the most up-to-date registry data to be used to calculate the projected risks and benefits of joint replacement surgery, thus increasing the versatility of the prediction tool.

NJR Health Economics

We continue to fund health economics work conducted at the University of Bristol and this year this programme has focused on developing economic models for implants for total knee replacement. Bristol has developed a Markov model classifying implants by constraint, mobility, fixation technique, and bearing surface materials. The model includes tunnel states to pick up the different risks of revision over time. Results are being finalised with a view to presentation and publication over the next 12 months. 

In a second piece of research, Bristol is using linked NJR, Hospital Episode Statistics (HES), and PROMS databases to estimate costs and quality adjusted life-years in the year before and after primary and revision hip replacement. Differences in costs and outcomes are being investigated by implant type, characterised by bearing surface combination and fixation techniques. These estimates will inform an economic model to be developed to look at the long-term cost-effectiveness according to the choice of bearing.

NJR Data Access Portal

The NJR Data Access Portal represents a secure data access platform that houses registry data in a secure environment that researchers can access under strict data protection protocol, reducing the administrative burden of legal permissions that would be required if data were to be released to them directly. This portal has been used by many groups to access registry data and the portal is now the standard mechanism by which data is made available to researchers. We have entered into a sub-licensing agreement with NHS Digital that allows applications for linked NJR, HES, PROMs and mortality data to be managed under a single application. Details of how to apply for secure access to NJR data for research purposes can be found here.

NJR Annual Research Programme

Building on many high quality publications over the years, we continue to develop our annual research programme. Current projects include: inequalities in provision and outcomes; development of an arthroplasty morbidity index; examining factors associated with revision and its outcomes and an examination of the data quality of the national PROMs programme. As projects complete, new topics are brought on-stream. All projects are delivered in a collaboration between the NJR Research Committee and the University of Bristol.

Use of NJR data this year

The Research Committee encourages external use of the registry dataset to address questions of clinical relevance and this year the dataset has provided opportunities for several external researchers to develop innovative projects.

Our dataset has been used as the key resource in 22 research papers published during this same time-period, of which five were conducted or led by external, independent researchers.

Please see the NJR Research Project Portfolio here which catalogues all sanctioned research projects, progress reports and NJR updates in relation to research, using the NJR dataset, together with links to all publications related to NJR data. 

Research Fellowship Scheme

We are pleased to welcome Andrew Davies in his appointment as the tenth Research Fellow to the joint NJR – Royal College of Surgeons of England research fellowship programme. Andrew is investigating patient reported outcomes and adverse events following elective total shoulder arthroplasty and hemiarthroplasty.

Prospective Fellows are encouraged to apply to the rolling programme and can look out for current opportunities on the NJR website.  The NJR welcomes applications from a diverse pool of applicants, including those from the allied health professions and non-clinical backgrounds. 

Submitting a research application

The Research Committee takes formal responsibility for the approval for the release of NJR data for research through an impartial and objective process and has oversight of the use and reporting of this data by research groups. Its priority is to ensure that any research question justifies access to the data and offers potential benefits to patients. Research proposals should align to our priority framework and be feasible, ethical, relevant, and methodologically-sound.

We have a commitment to uphold the standard and consistency of work that is carried out using registry data, in line with both national and international legislation. Therefore, all requests must also be approved by the Healthcare Quality Improvement Partnership (HQIP) Data Access Request Group for final authorisation of data release.

Further information

If you would like to submit a research application, the first step in this process is to check whether the same topic is currently being examined by another research team by visiting the NJR Research Project Portfolio, then submit an expression of interest for consideration via the data access portal website. Invited full applications are reviewed by the committee quarterly. Full details of the NJR’s research application pathway can be found here and please refer to the recording of our research webinar for full guidance 

A full list of publications related to NJR data is included in Appendix 4.

Surgical Performance Committee (SPC) 

Chair’s report 2021/22 - Mr Peter Howard

The SPC comprises its Chair, and also the NJR Medical Director, RCC Chairman, surgeon representatives from the RCC committee, Care Quality Commission (CQC) representatives, a patient representative, representation from the NJR Management Team and representatives of both Lot 1 and Lot 2 NJR contractors. 

We have continued with the schedule of two data reviews each year, assessing performance over the previous five and ten years for both units and surgeons performing hip and knee joint replacement. The Accountability and Transparency Model, that we first introduced in 2017 is now well embedded and we work closely with the CQC and NHS Improvement to escalate issues where necessary. 

This year, for the first time, surgeons who are at alert level over five years of data were notified that they may wish to review their outcome data to address any potential issues as early as possible. 

Annual Clinical Report and Consultant Level Report

Further changes and updates have been made this year to the Annual Clinical Report (ACR) provided for all trusts, health boards and independent hospitals and also to the Consultant Level Report (CLR) provided for consultant surgeons. These reports are accessible through the NJR Connect - Data Services portal. In addition, as part of NJR Connect – Data Services, hospitals are now able to access a wider range of information around hospital performance via management feedback. 

Implant mismatch

We are continuing to alert surgeons and units to the very rarely occurring mismatches in size, side and manufacturer. This alert process is well embedded and is monitored regularly by both the SPC and NJR Data Quality Committee. The implant scanning tool is now available for hospitals to check implant compatibility in real time in theatre and it is hoped that this will further reduce the numbers of “never events”. 

Future plans

During 2022/23, the NJR is looking to provide procedure outcomes at both trust and geographical level to help improve hospital performance. A full review of the NJR Accountability and Transparency model will be undertaken to ensure that it provides a robust framework to manage performance at surgeon and hospital level.

After extensive discussions it has been decided that in the future, the reporting of alarm (potential outlier) status for knee replacements to surgeons and trusts, will be based on the performance in the knee sub-types, rather than only on all knees analysed together. The performance in “all knees” will continue to be monitored and will appear in surgeons’ Annual Clinical Reports, but reaching alarm level will not automatically trigger a notification involving the Medical Director.

Implant Scrutiny Committee (ISC) 

Chair’s report 2021/22 - Mr Peter Howard

The ISC meets formally four times a year. The committee comprises surgeons, the NJR Medical Director (Deputy Chair), and representatives from the NJR’s core contractors: University of Bristol (our Lot 2 providers), NEC Software Solutions (our Lot 1 providers), Medicines and Healthcare products Regulatory Agency (MHRA), representatives from the NJR Management Team and Orthopaedic Data Evaluation Panel (ODEP)/Beyond Compliance. 

Examining the data

The registry data is refreshed and analysed every six months. The committee assesses potential outlier implant performance and notifies the MHRA when there are concerns. In addition, the committee also responds to any queries and concerns raised by surgeons and regulators, undertaking additional analysis to investigate these where necessary.

We currently use a Patient Time Incidence Rate (PTIR) method to identify poor performance, in line with other registries. It has become apparent that this method alone is not sensitive enough to identify failure in sub-groups or in the longer-term. A working group is currently developing a methodology to use Kaplan-Meier estimates which we aim to start using during 2022/23. 

Further stratification has been introduced into the current analysis to separate out different sub-groups. Primary knee replacements are now analysed by posterior stabilizing and cruciate retaining types, as it becomes clear that this could make a difference to implant performance.

Future developments

A working group is currently developing the processes and methodology to enable us to monitor the performance of shoulder implants more closely, in line with the current processes for hip and knee implants. This key development will ensure that the NJR is committed to even greater levels of scrutiny of implant performance. 

The ISC are investigating additional ways to publicise data on implant performance. 

Implants and combinations identified as outliers

Details of implants and combinations identified as outliers are again included in this year’s report. We encourage all surgeons to review this carefully to help inform their clinical decisions. Since the 2021 report, there have been several new notifications to the MHRA in hip and knee replacement. During the coming year, surgeons will be able to access a greater level of information on implant performance via our new implant library which will be part of NJR Connect - Data Services portal. Surgeons will have access to supplier feedback information for all implants, regardless of their outlier status as part of the new implant library.

Medical Advisory Committee (MAC) 

Chair’s report 2021/22 – Mr Tim Wilton 

The MAC has met three times during the year in ‘virtual’ meetings, as we also did last year.  The nature of these virtual meetings has undoubtedly diminished some of the interaction that used to occur at the committee meetings, in particular the informal discussions between members outside of the formal meeting.  With this in mind, we anticipate that we will return to having some of the meetings face-to-face during 2022 and 2023.

Some of the considerations previously addressed have continued to be important topics for discussion amongst members and these include patellar resurfacing and the question of how to record and analyse DAIR procedures (Debridement, Antibiotics and Implant Retention).

A formal position statement and document have been agreed with the British Association for Surgery of the Knee (BASK) about how the operation for secondary resurfacing of the patella should be recorded and analysed, which hopefully will significantly diminish any misunderstandings in that area. The NICE guidance suggesting that all patients should be offered patellar resurfacing at the primary procedure is still not welcomed by a very significant proportion of joint replacement surgeons in the UK and the data from recent and future years will be important in determining whether that advice should be modified in the future.  We believe that the stratification of results now published in the Annual Report will help significantly in this regard.

The DAIR procedure for hips and knees can be performed without exchanging the “insert”, or with the exchange of that insert.  This has caused significant concern in some quarters as the former does not meet the definition for a ‘revision’ adopted by the NJR for surgeon, unit and implant performance analysis, while the latter does.  Many surgeons may feel that exchanging the insert is the clinically appropriate thing to do, and yet some might be deterred from doing so by the fact that the revision might be counted against them.  The numbers of such cases (DAIR without exchange of insert) seem to be small, but this concern nevertheless needs to be addressed and with the new Minimum Data Set (MDSv8, due for release in 2023), this will be included as a separate choice in the ‘Re-operations other than Revision (RO)’ form which is being introduced. These “other procedures” will include a wide variety of further interventions which are important, but which do not meet the definition of ‘revision’ that is otherwise used.

After a considerable time and a great deal of discussion, it has been confirmed by NHSEI and the Department of Health, that funding will not be available to take forward the proposal to integrate the group of orthopaedic registries that form the BOA TORUS programme, under the umbrella of the NJR, to create a musculo-skeletal registry. This does not mean that those TORUS registries will not get support with finance or governance, but that this is to be done through the Getting It Right First Time (GIRFT) programme rather than by alignment with the NJR.

A significant proportion of our time this year has involved the planning and provision of data regarding the loss of throughput due to the pandemic and how that information can be best used to guide recovery of planned orthopaedic services.  In addition to the NJR supported research papers summarised in the Annual Report, weekly updates about activity levels across the country are now updated and published on our website so that everyone has access to the latest data in this regard.  We believe that this update regarding volumes of procedures is vital and serves as useful information for every orthopaedic unit and specialist society.

Useful discussions have taken place with specialist societies: British Association for Surgery of the Knee (BASK), British Hip Society (BHS), British Orthopaedic Foot & Ankle Society (BOFAS) and British Elbow & Shoulder Society (BESS) about the question of additional data collection and analysis with regard to revision networks and similar developments.  It is important that much of the additional material should be collected within the NJR where it relates specifically to operative data so that all such data can be linked easily to the primary operation using existing data-sharing arrangements. This has been agreed with BASK and BHS (and supported by Professor Tim Briggs, GIRFT Programme Chair and National Director of Clinical Improvement and NHSEI) for the networks that are already being set up in hip and knee revision.

The NJR has also been able to assist various specialist societies with special projects such as the production of geographical ‘heat maps’ to indicate where operations are being carried out, where they are being revised and how those movements relate to the populations.  We are particularly grateful to the specialist societies for the additional help that they and their British Orthopaedic Trainee Association (BOTA) trainees have given us in performing certain focussed audits of groups of joint replacements where there has historically been missing data, such as that for elbow replacements (BESS) and dual mobility hips (BHS).

NJR Executive Committee (NJREC) 

Interim Chair’s report 2021/22 – Mr Tim Wilton 

The NJR Executive Committee (NJREC) meets quarterly to provide additional operational and financial capability to the NJR Steering Committee’s broader strategic and governance roles. It plays a vital role in facilitating faster decision-making across the large and complex range of NJR business. In 2021/2022 four meetings of NJREC were held. The committee has been led by interim Chair, Mr Tim Wilton who has also been interim NJRSC Chair.

The committee membership comprises the NJR Chair, NJR Medical Director (interim Chair for 2021/22), NJR Director of Operations and additional representatives comprising the NJRSC sub-committee chairs, senior representatives of the NJR Management team as required and representatives from NJR contractors.

Importantly, the NJREC has delegated authority from the NJRSC for operational decisions that are under a financial threshold of £50,000 and for review and approval of proposed projects and developments that constitute a change in the strategic direction of individual work streams and previously agreed project plans. Please see the online appendices for a record of members.

Given the expansion of the NJR’s work in more recent years, as set out in our NJR Strategic and Annual Plans, the committee has consistently provided invaluable support to the NJRSC.

NJR Steering Committee (NJRSC)

Interim Chair’s report 2021/22 – Mr Tim Wilton

This section provides a brief outline of the work undertaken by the NJR Steering Committee (NJRSC) and our sub-committees during 2021/22. Although brief, these sections are written with the intent of illustrating the ever-increasing scope and complexity of our work and the valuable commitment made by all committee members to ensure the work of the NJR meets the needs of our patient, clinical, regulatory and industry stakeholders.

NJRSC Structure, Governance and Operating Model

The NJRSC is designated as an NHS England/Improvement (NHSEI) ‘Expert Committee’ and is responsible for overseeing the strategic direction and management of the NJR. Joint NHSEI/NJR/HQIP accountability meetings are held quarterly. The NJR Chair, Medical Director and Director of Operations represent the NJR. Meetings are also held between the NJR Chair and NHSEI National Medical Director as needed, to discuss areas of NJR strategy and policy.

The NJRSC is responsible for setting our strategic direction and for overseeing the successful delivery of our work and closely managing the associated budget. The committee also oversees a supporting structure of our eight sub-committees, each responsible for a dedicated area of NJR work and ensuring the delivery of work plans and development activities against agreed objectives. 

Key responsibilities of the NJRSC are to ensure that:

3.1 Appropriate advice is provided to NHSEI Medical Directorate and HQIP, on the NJR’s strategic direction, annual operational plan, work activity and financial position (including annual review of subscription charges and any proposed change); 

3.2 Appropriate advice is provided to NHSEI Medical Directorate and HQIP on any financial and/or intellectual property implications associated with licensing of the ‘NJR’ brand, particularly related to international collaboration with other national orthopaedic joint registries;

3.3 Accurate, relevant and timely data collected by the NJR, is made available to relevant stakeholders (regulators, commissioners/providers of orthopaedic healthcare) in an appropriate format, in order to support clinical governance;

3.4 Appropriate stakeholders (regulators, professional societies and implant suppliers) are involved in and consulted on the work of the NJR as appropriate and informed of outcomes in joint replacement surgery;

3.5 The NJR budget is effectively managed and monitored;

3.6 The NJRSC sub-committee structure is fit for purpose and all sub-committees have clear terms of reference, agreed composition and defined purpose and responsibilities;

3.7 Outcomes achieved by brand of prostheses, hospital and surgeon, are monitored and, where these fall below expected performance, are highlighted to enable prompt investigation and follow-up by relevant stakeholders (implant suppliers, regulators, commissioners/ providers of orthopaedic healthcare);

3.8 Patient awareness of joint replacement outcomes is enhanced, to better inform patient choice and quality of experience, through engagement with patients, patient organisations and providers of care;

3.9 Evidence-based purchasing (quality and cost-effectiveness) of joint replacement implants by healthcare providers is supported;

3.10 Post-market surveillance of implants by key stakeholders (implant suppliers, the Regulator, Beyond Compliance and ODEP) is supported; 

3.11 Delivery and quality of work by NJR Contractors and the codes of conduct applied to NJR Contractors in their relationship with key stakeholders, are effectively managed and monitored by the NJR Management Team;

3.12 An annual report on the work of the NJR is published and made available in both the English and Welsh languages (and languages appropriate to any future countries that may be incorporated into the NJR) and in patient-friendly language;

3.13 Appropriate governance and monitoring arrangements are in place to facilitate the use of NJR data to support and enable related research.

Membership 2021/22

During this reporting period, the following changes to the membership of the NJRSC can be reported:

Mr Bob Handley completed his annual co-opted membership as British Orthopaedic Association (BOA) President in September 2021 and was succeeded by incoming BOA President, Professor John Skinner.

We are thankful to all NJR committee members, past and present, for their considerable contribution to the registry. Details of the membership of the NJRSC and each sub-committee for 2021/22 can be found online in appendices. Further information on changes this year, along with the NJR Chair’s notes of thanks, can also be found within the Chair’s Foreword.