Introduction to NJR Reports

The NJR Annual Report comprises four parts 

Parts One (annual progress), Two (clinical activity data) and the enhanced Part Four (Implant and Trust-, Local Health Board- and unit-level outcomes) are published online here at the registry’s dedicated Annual Report website. The NJR’s Annual Report website is part of a long-term strategy to share our annual dataset in a more accessible, responsive and timely manner. Part Three (the analyses of outcomes after surgery) continues to be published as a printed report.

Part One: executive summaries, annual progress and highlights 2018-2019

These sections provide a general outline of the work of the NJR undertaken in the financial year from 1 April 2018 to 31 March 2019.  As well as providing summary information about the NJR’s key data quality indicators of compliance, consent, and linkability, this section includes brief summaries of the work undertaken by the NJR throughout the year and the individual NJR sub-committee reports.

Part Two: clinical activity 2018

This section provides reports about clinical activity as reported to the NJR as at 28 February 2019.  All reports are based on the calendar year 1 January to 31 December 2018.  Clinical activity reports under Part Two are interactive, enabling users to view the data in a number of different ways through the use of built-in filters.  The reports and accompanying text can also be downloaded as pdf files.

Part Three: outcomes after joint replacement 2003 to 2018

These sections provide an analysis of survivorship for hip, knee, ankle, and shoulder replacements undertaken between 1 April 2003 and 31 December 2018.  Part Three is provided both as a printed and an online, electronic PDF document.

Part Four: implant and unit-level activity and outcomes 2018

This section provides a series of indicators about clinical level activity and the outcomes of surgery at both a Trust/Local Health Board and hospital level.  These include indicators of potential outlier performance for both mortality and revision rates in both hip and knee.

This information is also published online as part of the hospital dashboards at surgeonprofile.njrcentre.org.uk.

We continue to include data on implant performance, contrasting between the better performing implants and those that have higher than expected rates of revision and were reported to the MHRA. 

Chairman’s foreword 

Laurel Powers-Freeling, National Joint Registry Chairman

The National Joint Registry Steering Committee (NJRSC) oversees the strategic and operational work programme of the registry and I am delighted to have performed the role of Chairman of the Committee over the past seven years. It’s always a pleasure at this time of year to take a step back to look back on our work over the last year and compose this foreword for our annual report, which is now showing the output of NJR’s work in our 16th edition.

Key work and development

National Musculoskeletal Registry (NMR): This year a major work stream for the NJR has been leading a study to consider the feasibility of developing an operating model that would facilitate a closer working relationship between the NJR and the seven orthopaedic registries forming the BOA Trauma and Orthopaedic Registries Unifying Structure (TORUS). The ambitious vision that has emerged is to develop a NMR that collects and analyses high quality data for the benefit of patients, surgeons and society. This has the support of the NJR, TORUS registries and the BOA, and we are working with NHS leadership to secure their support as well.

The NMR will initially bring the seven registries together with the NJR, under a single governance body, sharing practical aspects and also be capable of aligning with NHS key strategic objectives, such as supporting the delivery of national programmes including Getting it Right First Time (GIRFT) and the National Clinical Improvement Programme (NCIP), aligning to national data strategy around single integrated datasets, encouraging a focus on economies of scale and supporting clinicians with self-appraisal and driving best practice. We will continue the development of this exciting proposal in the coming year to consider in more detail associated implementation, operational and resource arrangements.

Minimum Data Set (MDS) Version 7: The implementation of MDSv7 this year has enabled a refinement of the data that is now being collected for all joint replacement. The improvements enhance the ability of the NJR to analyse and report on the data and enable us to more appropriately reflect clinical practice and enhance reporting for clinician level feedback.

Data Quality Audit: Activity has continued to remain high on the NJR agenda, with an increased number of units that are now more experienced with the audit process, achieving high levels of compliance. We are also delighted to currently be piloting an automated data quality system for hips and knees with very positive feedback so far. Automation expands the validation work timeline, enabling units to submit and check data at any time and therefore maintain a high quality compliance figure throughout the year. As a patient safety benefit, there is an early alarm for low/non-compliance, enabling timely action to address this. The advancement of the pilot is being further developed to include shoulders with a roll-out of the full NJR automated data quality system early next year.

Data Access Portal: Another significant NJR development is our Data Access Portal which has been completed to streamline the process of researchers accessing NJR data once applications have been approved by the NJR Research Committee. Research is very important to the NJR and with over 2.8 million records on our database, we remain the largest arthroplasty register in the world and are able to support research across the range of orthopaedic practice to provide greater understanding and outcomes to benefit and inform patients. The new data access portal will facilitate streamlining and simplifying our associated processes and governance arrangements for this purpose and is scheduled to go live this autumn. Further detail of research projects that have used NJR data appear in our In-depth studies within this year’s report.

Patient Decision Support Tool: NJR data has also been used by the Universities of Sheffield and Bristol to develop the patient decision support tool. This will be of significant benefit to patients considering or due to undergo joint replacement surgery, as the tool will be able to produce calculations based on real patient outcome data that will enable shared decision-making between health professionals, patients and their families. The tool is now available on the NJR website, but will be formally launched on the refreshed NJR website patient area later in the year.

Future plans for the coming year 2019/20

As always, the NJR has ambitious plans for continued development which enable us to maintain our reputation as a world class, innovative registry. These plans are reflected in both our Strategic Plan 2018-21 and Annual Plan 2019/20. However, two major areas of focus and resource I would like to mention will be continuing with the Phase 2 development of the proposed implementation of a National Musculoskeletal Registry and development of the new NJR Cloud-based IT Platform. This is an exciting project to amalgamate our currently separate reporting portals to a single NJR securely encrypted cloud-based platform, which would provide the NJR with increased flexibility for all future change, enhance user and public interrogation of the data including PROMs, and have the capacity to extend to any additional TORUS registry alignment.

Acknowledgments

This year there have been further changes to the membership of the NJRSC. I would like to give a special mention to Martyn Porter, NJR Medical Director and Vice Chairman, who at the end of 12 years of dedicated service to the NJR, came to the end of his final term in December 2018. I would like to offer my sincere thanks and appreciation to Martyn for the significant role he has played in the overall development of the NJR and specifically for his valuable advice, expertise and clinical leadership of the NJR Medical Advisory Committee, which has been instrumental in forging the strong working relationships between the NJR and the BOA and professional orthopaedic societies, that we benefit from today. At a personal level, I have learned a great deal from Martyn and valued his wise counsel and creative thinking; he will be missed.

New member appointments have included Mr Tim Wilton who succeeded Martyn as NJR Medical Director and Vice Chairman from 1 January 2019. Tim was previously a co-opted member of the NJRSC in his role as BOA President and brings considerable clinical and leadership expertise to the NJR. Robin Brittain also commenced on 1 January 2019 as the second patient representative, joining Gillian Coward who has provided excellent service and advice pending Robin’s appointment. Patient involvement is of considerable importance to the NJR and I greatly value this second patient member appointment to the NJRSC. I would like to take the opportunity to welcome both new members to the Committee and I look forward to working with them in the future.

I would also like to thank Professor Philip Turner for his considerable contribution this year as a co-opted member of the NJRSC in his capacity as BOA President, which has been of significant value 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.

I would like to end by thanking all members of the NJR Steering Committee and sub-committees, for their continued enthusiastic and valuable contribution to our work and specifically to the Chairs of each of the NJR sub-committees: Tim Wilton, Peter Howard, Mark Wilkinson, Mike Reed and Matthew Porteous, for their hard work and extraordinary effort which maintains the NJR’s international reputation and influence as a leading arthroplasty register. I would encourage you to read and review the reports from each committee chairman at reports.njrcentre.org.uk where they provide an insightful overview in our key work areas.

I would also like to extend my grateful thanks to our contract partners Northgate Public Services (UK) Ltd, University of Bristol and University of Oxford, for their excellent work throughout the year in supporting the NJR to deliver its work agenda and objectives.

Finally, the NJR Management team has this year once again brought all this work together to deliver a genuinely world-class registry under the leadership of Elaine Young, Director of Operations. We ask more from them each year, and each year they delight us with their energy and enthusiasm for the tasks at hand; thank you.