Australian Orthopaedic Association
National Joint Replacement Registry (NJRR)
The NJRR, hosted by the Australian Orthopaedic Association, monitors the outcomes of joint replacement and has
been effectively used to improve care quality for patients receiving total joint replacement in Australia.1 The NJRR is
one of the most established and well-known registries worldwide, and includes information on 7,000 procedures per
month from over 300 hospitals.2,3
The NJRR is used to:
Achieve cost savings by reducing costly revision surgeries that often result from failed implants or complications;
Inform medical device offerings by analyzing verified data on device performance to determine which are
offered in the Australian market; and,
Educate surgeons by providing information on the most effective medical devices and on individual provider
performance and patient outcomes.
Since full implementation, the NJRR has shown a reduction in the number of revision (or repeat) hip replacement
surgeries in Australia from 13 percent in 2003 to 11.2 percent in 2010. This equates to 630 fewer hip revisions in
2010, and 2,883 fewer since 2003.4 It is estimated that decreasing revision surgeries has reduced Australia’s health
expenditures by $16-32 million Australian dollars per year.5
Features
The NJRR collects information from hospitals and clinicians on
patient demographics (e.g., age, gender), implant models, and
health outcomes of joint replacement. The NJRR validates data
collected from individual hospitals by comparing it with data
provided by state and territory health departments. While supplying data to the Registry is voluntary, compliance from hospitals
undertaking joint replacement surgery is 100 percent, with less
than 1 percent of data lost to patient follow-up. Long-term follow
up is conducted indefinitely, and the Registry tracks revisions and
re-revisions though specific follow-up forms.6 Data is analyzed
and findings are published in annual reports.
Key Contributions
Usefulness to Broad Range of Stakeholders
The NJRR is completely integrated into the Australian health
care system and used by a broad range of stakeholders, such as
surgeons, hospitals, local and state health departments, medical
device companies, patients and consumers, and the Australian
Therapeutic Goods Administration (TGA) – the national body
tasked with regulating therapeutic goods in Australia for safety
and effectiveness.
The NJRR is praised for its ability to quickly and accurately
identify medical devices that perform better or worse than
others; in both cases, this leads to changes in surgeon
practice and quality of care improvements. Arguably, its most
well-known achievement is being the first registry to report
that the ASR Hip System (referred to as a “metal-on-metal”
implant) – a once commonly used implant – had a higher rate
of revision due to pain and disability in patients, ultimately
leading to the implant being recalled.7
Device Monitoring
Since implementation, the NJRR has identified over 100 devices
that are underperforming relative to others. Fifty of these devices
have been removed from the Australian market. The Registry
is able to identify poor performers by using advanced statistical analyses as well as expert review. For every device that the
Registry identifies as a performance outlier, the TGA performs
its own analyses using a combination of both NJRR and external
data; based on these analyses, they may allow the device to remain
on the market with an alert, or institute a device recall.8 Device
companies and other regulators outside of Australia (e.g., the U.S.
Australian Orthopaedic Association National Joint Replacement Registry (NJRR)
Food and Drug Administration) have access to the online portal
to track the performance of specific products and can also request
ad hoc reports for additional analyses.9
Quality Improvement
Hospitals and health systems can request reports that compare
their performance relative to similar providers, as well as with the
national average. This information is often used to inform quality
improvement initiatives. Surgeons also have access to a secure
online portal where they can review outcomes of the procedures
they performed.
Graves, S. and Wells, V. “A Review of Joint Replacement Surgery
and its Outcomes: Appropriateness of Prostheses and Patient Selection.” Prepared for the Australian Centre for Health Research
Ltd. October 2006. Available at: http://www.achr.com.au/pdfs/
Graves.pdf. Accessed May 29, 2014.
5
Graves, S. et al. “The Australian Orthopaedic Association
National Joint Replacement Registry,” Medical Journal of
Australia, Vol.180(5 Suppl):S31–4. March 1, 2004. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.190.7248&rep=rep1&type=pdf. Accessed May 29,
2014.
6
U.S. Food and Drug Administration, Medical Device Recalls,
available at: http://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/metalonmetalhipimplants/ucm241770.htm. Accessed May 29, 2014.
7
Expanded Research Capabilities
Due to its size and high-quality data, the NJRR is used to conduct tailored research on factors that are not otherwise easily
researched (e.g., impact of surgeon experience and regional variations).10 These findings allow surgeons to make more informed
decisions, based on detailed information that is not readily available or known.
Key informant interview, Spring 2014.
8
Key informant interview, Spring 2014.
9
News.com.au, Australian Orthopaedic Association Research Shows Best Artificial Joints, available at: http://
www.news.com.au/lifestyle/health/australian-orthopaedic-association-research-shows-best-artificial-joints/story-fneuz9ev-1226743989393. Accessed May 29, 2014.
10
For More Information
More than 85,000 hip and knee replacements are performed each
year in Australia, and this number is rapidly increasing.11 As such,
information on the safety and comparative effectiveness of the
medical devices available for total joint replacement and other opportunities for improvement is critical for surgeons and patients
to make informed decisions and improve health outcomes.
Visit https://aoanjrr.dmac.adelaide.edu.au/en/home for more information about the Australian Orthopaedic Association National
Joint Replacement Registry.
Citations
1
2
Australian Orthopaedic Association National Joint Replacement
Registry, Home, available at: https://aoanjrr.dmac.adelaide.edu.
au/en/home. Accessed May 29, 2014.
Bosch, H. et al. Report of the National Joint Replacement Registry Review Committee for the Australian Orthopaedic Association. Published October 7, 2012.
3
Australian Orthopaedic Association National Joint Replacement
Registry, Number of Hospitals Contributing Data to the AOA
NJRR, available at: https://aoanjrr.dmac.adelaide.edu.au/en/contributing-hospitals. Accessed May 29, 2014.
4
Bosch, H. et al. Report of the National Joint Replacement Registry Review Committee for the Australian Orthopaedic Association. Published October 7, 2012.
Australian Orthopaedic Association National Joint Replacement
Registry, Background, available at: https://aoanjrr.dmac.adelaide.
edu.au/en/background. Accessed May 29, 2014.
11
About the Authors
Jessica Winkler, M.P.H., is a senior associate at AcademyHealth.
She can be reached at Jessica.winkler@academyhealth.org.
Emily Moore is a research assistant at AcademyHealth.
Acknowledgements
Sponsorship for this project was provided by The Pew Charitable
Trusts. We thank our partners at Kaiser Permanente Institute for
Health Policy and all those interviewed for their contributions to
these resources. A special thank you to Stephen Graves, M.D.,
Richard de Steiger, M.D., Adrian Cosenza, Ann Tomkins, and
other registry staff for their review and assistance.
This document represents a synthesis of information generated by a series of key informant interviews. Any views expressed are those of the interviewees.