Abstract
Despite the well-documented benefits, some countries have yet to agree on the establishment of a national joint register. A questionnaire study was undertaken to ascertain the opinions of the consultant orthopaedic surgeons and specialist registrars, regarding establishment of an Irish National Joint Register. The aim was to find out the possible reasons why a national joint register has not been established in Ireland. A 69% first response rate was recorded. Ninety-seven percent believe it is time to set up a registry and 81% say it should be made compulsory for unwilling surgeons and hospitals to participate. Despite the overwhelming support, privacy and liability issues were major concerns. Fifty-eight percent agree that access to registry report by general public can expose surgeons and hospitals to medico-legal implications. Legislation may be required to protect the integrity of a national joint replacement registry to ensure that the data are used as intended.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Herbert P, Malchau H (2000) Long-term registration has improved the quality of hip replacement: a review of the Swedish THR Register comparing 160, 000 cases. Acta Orthop Scand 71:111–112. doi:10.1080/000164700317413067
Herbert P, Malchau H (1997) How outcome studies have changed total hip arthroplasty in Sweden. Clin Orthop Relat Res 344:44–60
Total Joint Registry workshop. The Agency for Healthcare Research and Quality/The American Academy of Orthopaedic Surgeons, Washington, DC, 10–11 December 2001 (final report)
Council directive 93/42/EEC of 14 June 1993 concerning medical devices. Official Journal of The European Communities 1993; Ll69:1–43
William J, Maloney MD (2001) National Joint Replacement Registries: has the time come? J Bone Joint Surg Am 83:1582–1585
SAS Version 9.1 for Windows. SAS Institute Inc., Cary, 2002–2003
Finnish Arthroplasty Register. http://www.nam.fi/english/medical_devices/index.html
Canadian Joint Replacement Register. http://secure.cihi.ca/
England/Wales National Joint Registry. http://www.njrcentre.org.uk. Accessed 2 Dec 2006
Kolling C, Simmen BR, Labek G, Goldhahn J (2007) Key factors for a successful National Arthroplasty Register. J Bone Joint Surg Br 89-B:1567–1573
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
Malchau H, Garellick G, Eisler T, Karrholm J, Herberts P (2005) Presidential guest address: the Swedish Hip Registry: increasing the sensitivity by patient outcome data. Clin Orthop 441:19–29
Kärrholm J, Garellick G, Lindahl H, Herberts P (2007) Improved analyses in the Swedish Hip Arthroplasty Register. Scientific exhibition presented at the annual meeting of the American Academy of Orthopaedic Surgeons, San Diego, 14–18 February 2007
Barrack RL, Sawhney J, Hsu J, Cofield RH (1999) Cost analysis of revision total hip arthroplasty. A 5-year follow-up study. Clin Orthop 369(18):175–178
Robertsson O, Lewold S, Knutsen K, Lidgren L (2000) The Swedish Knee Arthroplasty project. Acta Orthop Scand 71:7–18
Philipson MR, Westwood MJ, Geoghegan JM, Henry AP, Jefferiss CD (2005) Shortcomings of the National Joint Registry: a survey of consultants’ views. Ann R Coll Surg Engl 87:109–112
Acknowledgments
The authors wish to acknowledge the efforts of Ursula Gormally and Eilish Baile both at the Cappagh National Orthopaedic Hospital, Finglas, Dublin in making this study successful.
Author information
Authors and Affiliations
Corresponding author
Appendices
Appendix
Irish Orthopaedic Surgeons opinion on a Irish National Joint Register
Establishment of an Irish National Joint Register
1. In my opinion, it is time to set up an Irish National Joint register.
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
2. If set up, I would contribute to the register by enrolling my patients.
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
3. A national registry would be expected to have a high initial operating cost, but it is a worthwhile expenditure in the long term.
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
4. Who should be bearing the running costs?
1. | HSE (Dept of Health / Hospitals) |
2. | Implant manufacturers |
3. | Irish Orthopaedic Association |
4. | Shared by all of the above |
5. Arthroplasty Register in Canada, England/Wales, and Finland are implemented by health authorities.1,2,3
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
It should be made compulsory for all the Hospitals to participate.
6. Registers versus randomised studies
The randomised, controlled trial (RCT) provides the best evidence. However, it is a laborious and costly process and such trials are not suitable for large studies over a long period of time.
Randomised Clinical Trial cannot replace register studies when it comes to long-term evaluation of different procedures.
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
7. Outcome measure
The main outcome measure in register studies has been the need for revision as a measure of survival of the implant.1,2,3
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
8. Not only the inherent characteristics of the implant but also the surgical procedures as well as surgeons experience as a whole have an impact on the result of an Arthroplasty surgery - Swedish register 2005.
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
9. Dissemination of information
Since information is gathered in real time and can be analyzed on an ongoing basis a national registry can provide timely information for the orthopaedic community on the outcomes faster than the traditional way (publications).5
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
10. Undocumented failures
Failures, which are not revised for medical or other reasons, do not become registered and patients may be lost to follow-up
This problem will totally compromise the ideal of the register.
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
11. Surgeons may have tendency to use only implants which are well documented in the registers. Do you think this will hinder introduction of new implants?
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
12. Results of a National registry may drive patients to tertiary centres with a high turnover.
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
13. Medico-legal concern
The reports of the registry are accessible to the patients and general public as a whole.
This can expose surgeons and Hospitals to a medico-legal loophole.
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
14. With regard to question No.13, access to the registry report should be restricted.
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
15. Political issues
The administrators of health-care systems may use registers as benchmarking tools to discriminate methods, implants, surgeons or hospitals, which are found to be underperforming.4
Strongly agree | Agree | No Opinion | Disagree | Strongly Disagree |
Comment/suggestion;
|
|
|
|
References;
1. Finnish Arthroplasty Register. http://www.nam.fi/english/medical_devices/index.html
2. Canadian Joint Replacement Register. http://secure.cihi.ca/
3. England/Wales National Joint Registry. http://www.njrcentre.org.uk (date last accessed 2 December 2006
4. Knee Arthroplasty registers. O. Robertsson, MD, PhD, Orthopaedic Surgeon Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 1, 1–4
5. William J. Maloney, MD National Joint Replacement Registries: Has the Time Come? The Journal of Bone and Joint Surgery (American) 83:1582–1585 (2001)
Please return completed questionnaire to
Ursula, Professorial unit RCSI
Email:
Thank you
Rights and permissions
About this article
Cite this article
Oduwole, K.O., Codd, M.B., Byrne, F. et al. Irish National Joint Registry: a concept. Ir J Med Sci 177, 347–353 (2008). https://doi.org/10.1007/s11845-008-0222-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-008-0222-3