As you’ve probably heard, the American Academy of Orthopaedic Surgeons (AAOS) and the North American Spine Society (NASS) have both embarked on ambitious projects to create massive registries of diagnoses, treatments, and patient outcomes.
Also, the American Orthopedic Association (AOA) has a relatively small registry called Own the Bone, founded in 2009, which tracks fracture data in patients aged 50+.
Registries like these have been around a long time in Europe. Sweden, the leader, set up a The Swedish Knee Arthroplasty Registry in 1975 and the Swedish Hip Arthroplasty Registry in 1979 for joint replacement diagnoses, procedures and outcomes, and says the registry and its use have made it the world leader in successful hip arthroplasties with the world’s lowest levels of deaths and complications.(1) (2).
Sweden’s joint registry has been so successful that the country has created 95+ other registries for various diagnoses (one paper said the number was more than 100). Other countries followed. Australia has a hip, knee, and shoulder replacement registry, too, but it was the Australian Orthopaedic Association, not the government, which established it in 1999.
So why has it taken so long here in the U.S.? Why, even now, aren’t insurers, Medicare Medicaid, and/or malpractice insurers (who stand the most to gain financially) stepping up to build registries here?
And why is the burden falling to physicians’ professional organizations to do the building, and hospitals, surgery centers, and group practices to pay for them?
The answer to that last question seems to be simply that no one else with skin in the game ever stepped up here, with an exception or two, such as Michigan Blue Cross-Blue Shield. So, professional academies and associations are taking on the hefty job of building national registries—and the next step: making them work.
Here’s an example of the raw data one can extract from a registry and analyze.
In Michigan, one stem/cup combination for hip arthroplasty was statistically 7.5 times as likely to require revision surgery within three years as another device.
However, a report on these Michigan results cautions, you cannot compare one device to another without looking at all other factors. Also, the higher risk was only 4.29%. (See: “Michigan Arthroplasty Collaborative Quality Initiative Report: 2012 – 2016,” page 27)
AAOS is modeling its array of registries on the American Joint Replacement Registry, which was first conceived under AAOS, then organized as a separate entity in 2009, and is now back under the AAOS umbrella.
AAOS is also borrowing ideas from the Michigan Blues’ registry. While the AJRR has the most records of any of these registries (1.3 million+ procedures), the Michigan registry seems to be farthest along of any U.S. orthopedic registry in using the data.
The goal of these registries is to provide verifiable, clear bodies of data on which interventions and devices have the best and worst outcomes, allowing physicians to compare their results to their colleague’s averages, and because of that feedback, make better care decisions.
Indeed, according to AJRR, the use of “Joint registries demonstrate up to a 50% reduction in revision rates after registry initiation and identification of best practices.” Furthermore, “If U.S. revision rates were cut by just 2%, Medicare could save more than $65 million.”
