David C. Ayers,Patricia D. Franklin

This commentary serves as an introduction to an upcoming series of articles about orthopaedic registries, in general, with an emphasis on lessons learned from the evolving U.S. and international total joint replacement registries. This paper provides an overview of total joint replacement registries and the current expansion of data collection beyond implant attributes and survival to include postoperative complications and patient-reported outcomes.

Osteoarthritis is the most common cause of physical disability in the U.S. The combination of osteoarthritis prevalence and the success of total joint replacement in relieving pain and improving function in patients with advanced osteoarthritis has resulted in total joint replacement becoming the most common and costly inpatient procedure among Medicare beneficiaries. Moreover, the fastest growing subgroup of patients undergoing total joint replacement consists of those less than sixty-five years of age. More than one million total joint replacements are performed annually in the U.S., making measurement of total joint replacement outcomes a public health priority. To measure and monitor the outcomes of total joint replacement, state and national total joint replacement registries are emerging that incorporate lessons learned from long-standing international implant registries as well as integrate new methods to quantify perioperative quality and patient-reported outcomes.

International total joint replacement registries have traditionally focused on implant revision rates and tracked the length of time between the initial total joint replacement and implant removal. In this model, national registries incorporate large numbers of arthroplasties to identify relatively low annual failure rates and the focus is on device longevity. However, today’s total joint replacement registries are broadening their focus to include perioperative complications and patient-reported outcomes following surgery. While the implant revision rate remains an important outcome, implant materials and technology have matured and patients and insurers want to understand the quality of care of …