July 22, 2010
2 min read

National joint replacement registry can influence optimal techniques, evaluate revision risk

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Based on an analysis of data included in the Kaiser Permanente Total Joint Replacement Registry, researchers from the institution found that a national registry can enhance patient safety, quality of care, cost-effectiveness and research.

Their findings are available in the online and print editions of Clinical Orthopedics and Related Research.

“To be successful, a large registry must have physician involvement, integration into workflow including rigorous validation and quality control methods, and provide ongoing feedback to participating surgeons and staff,” Elizabeth Paxton, MA, lead author of the study and director of surgical outcomes and analysis at Kaiser Permanente stated in a press release. “Having used our registry to conduct research and translate these findings into actionable clinical care guidelines, our total joint replacement registry shows that a national registry has the potential to improve patient safety and quality across the industry.”

Registry capabilities

The Kaiser Permanente Total Joint Replacement Registry (TJRR) contains information on more than 100,000 joint replacement cases performed by more than 350 Kaiser Permanente surgeons nationwide. It enables health care providers to identify best practices and evaluate risk of revision and clinical effectiveness of implants. It can also be used to study patient demographics, implant characteristics and surgical techniques in relationship to postoperative complications, according to the release.

The TJRR makes it possible to immediately identify and notify patients about recalled or defective implants prior to an official recall notice. In 2009, the TJRR was used to assess more than 15 advisories and concerns with implants, the release noted.

Risk calculation

Paxton and colleagues reported that the highest risk for revision total joint surgery was among younger patients and patients with diabetes and diagnoses other than osteoarthritis, such as post-traumatic and rheumatoid arthritis. The availability of such information allows surgeons and patients to assess potential risk factors when making decisions about treatment, the release stated.

Additionally, information available in the registry on surgical techniques and implants have influenced changes in clinical practice, the researchers noted.

“Within the United States, more than 600,000 total joint replacement procedures are performed each year, and the volume and costs associated with these procedures are projected to increase dramatically over the next 20 years,” Monti Khatod, MD, co-author of the article and orthopedic surgeon at Kaiser Permanente in Baldwin Park, Calif, said. “Our registry allows health care professionals and other researchers to evaluate ways to be more efficient while enhancing quality and assessing new technology in order to determine which implants are best for our patients.”


Paxton EW, Incacio MCS, Khatod M, et al. Kaiser Permanente national total joint replacement registry: Aligning operations with information technology. Clin Orthop Relat Res. Published online ahead of print July 23, 2010.

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