This year 2023-24, the NJR celebrates its 20th anniversary. It began capturing hip and knee data in 2003 across England and Wales, but has since expanded to incorporate ankle, elbow and shoulder joints and cover Northern Ireland, the Isle of Man and Guernsey. Representing a greater number of patients, the NJR now has around 3.7 million records and is the largest orthopaedic registry in the world.
The registry is always striving for the best in patient outcomes and safety. Through monitoring the performance of surgeons, hospitals and implants, it is able to identify issues of safety and poor performance, a previous example being the use of metal-on-metal hip implants.
The NJR research programme includes supporting fellowships and application requests to use NJR data. NJR data have been used for a wide range of research studies, which have highlighted and informed best practice in joint replacement surgery, for the benefit of patients.
NJR data was also used in the development of the NJR Patient Decision Support Tool. This can be used by patients considering joint replacement surgery to help them understand the potential benefits and risks and to make informed choices about their treatment in shared decision-making discussions with their clinicians. The NJR has identified, and continues to identify, the effects of the COVID pandemic on the number of joint replacement procedures being undertaken, and the detrimental effect on patient waiting times.
The NJR was recognised by the Independent Medicines & Medical Devices Safety Review, chaired by Baroness Julia Cumberlege, which published its report and findings in 2020, as a 'leader in its field' and 'being an exemplar registry with world-leading expertise'. The NJR was thereafter identified in the government response and implementation reports as being ‘widely regarded as setting international best practice in analysing outcomes for device procedures.'
So, what’s next?
Patient Reported Outcome Measures (PROMs) The NJR would like to manage the collection of PROMs across all joints recorded in the registry, (at present it only manages those for shoulders). The NJR records repeat operations (revisions) as a quality measure of outcome, but PROMs is a missing link enabling an understanding of pain and function outcomes, that are also important to patients. Currently PROMs are collected and managed by NHS Digital (who merged with NHSE on 1 February 2023), but the NJR has faced challenges in accessing the resource. In recent years the NJR has proposed to the NHS how it could effectively enhance the collection and administration of PROMs as it continues to work tirelessly to build a fuller understanding of the success of joint replacement surgery.
Patient involvement The NJR recognises the value of patients and is keen to involve them across its work programme. Membership of the NJR Steering Committee includes two patient members and this year an NJR patient network is being developed, to strengthen patient support and ensure greater input across the NJR’s work and activities.
As a patient with musculoskeletal joint issues, on behalf of my patient and public peers, I would like to thank the NJR for the work it does, and the progress and achievements it has made over the last 20 years. We look forward to the future and the continued development of the NJR and what will be accomplished. We thank patients undergoing joint replacement surgery for consenting to provide their data for use by the NJR and the data entry staff in all participating hospitals and units, who ensure that data collected are of high quality, accurate and complete, to meet the stringent requirements for use of data by the NJR.
Robin Brittain,
with support from Gillian Coward
NJR Patient Representatives
Our annual report
The registry’s purpose is to record patient information and provide data on the performance and longevity of replacement joint implants, the surgical outcomes for the hospitals where these operations are carried out, and on the performance outcomes of the surgeons who conduct the procedures. We produce this Annual Report, summarising our work and sharing the analysis of data, visually in tables and graphs, for procedures across each of the joints, as well as implant and hospital outcomes.
The report also includes some short excerpts which showcase the NJR’s contribution to orthopaedic research activity, demonstrating the value of the use of these collected data. Registry data are made available under strict security conditions to medical and academic researchers, to further progress the pool of work in measuring and understanding which practices provide better outcomes.
The NJR has shown that orthopaedic surgery, as one of the main users of implant devices in the UK, is demonstrating the highest standards of patient safety with regard to their use. A key message from the report is that safety and clinical outcomes continue to improve, as identified through the reduction of revision surgery.
The NJR’s data collection and analysis of around 3.7 million records provide the evidence to drive the continuous development and implementation of measures, to ensure implant safety and the enhancement of patient outcomes is always top of the agenda, alongside a focus on reduced revision rates year-on-year, as well as improvements in standards in the quality of care whilst also addressing overall value for money in joint replacement surgery.