Kaiser Permanente Total Joint Replacement Registry began in 2001 and has so far registered 100,000 implants. Kaiser Permanente researchers recently released a prospective study of 80,000 total joint replacements and 5,000 anterior cruciate ligament reconstruction procedures from the Anterior Cruciate Ligament Reconstruction Registry to examine the patients' demographics, implants and surgical techniques in relationship with the outcomes for the procedures. The study concluded that the TJR and ACLR was an effective tool in assessing the risk of revision, which could result in a change of procedure, according to a Kaiser Permanente report.
There currently isn't a national joint replacement registry in the United States, though the Kaiser Permanente registries have demonstrated several advantages to having a national registry available. Tad Funahashi, MD, chair of Kaiser Permanente Implant Registries, and Robert S. Namba, MD, an orthopedic surgeon at Southern California Permanente Medical Group in Orange County, were co-authors of the study. They discuss four advantages of implementing a national joint registry in the future.
1. Implant and device monitoring. The number of patients needing joint replacements in the future will increase, says Dr. Funahashi, and the current method of monitoring these replacements is at a default state. The joint registry compiles a list of patients who receive each specific implant so in the event of implant failures or recalls, physicians have a list of patients to contact concerning their implant. "The registry allows us to identify failures, contact patients and look for related implant types that might also fail and identify those patients," says Dr. Funahashi.
2. Implant and surgical technique performance monitoring. Physicians can access the data on joint replacements performed around the country to see which procedures and implants are most successful on which patients. "By comparing the differences in performance of the implant design and surgical technique, the physician can decide what might be best for their patient," says Dr. Funahashi. "We can see what kinds of procedures lead to the best outcomes."
3. Patient counseling. When physicians are counseling patients on the best treatment options, they can consult cases in the national joint registry of patients from similar demographic backgrounds. The outcomes of treatment for those patients can be helpful in predicting the outcomes of various treatment methods and procedures for the patient still deciding which direction to take their treatment, says Dr. Namba. "Physicians can identify patient risk factors, which can be helpful in counseling patients," he says. "Those who are at a high risk of reoperation for elective surgery may also be at an increased risk for medical revision." If this is the case, physicians can advise patients to take a different treatment course with potentially better outcomes.
4. Research data. Researchers can use the data from cases collected in the joint registry to identify the risk factors in patients. Physicians have used the data from the Kaiser total joint registry to identify young age as a factor in failed knee replacements. There have also been breakthroughs in identifying the reasons for increased ACL injuries in women. "We are beginning to get some insights into ACL injuries in young female patients," says Dr. Funahashi. "Researchers are trying to develop programs that can decrease the rate of ACL tears in women and learning about how the reconstruction surgery should be done to maximize recovery and minimize revisions."
Read more coverage on joint replacements:
- Study: Standardize Processes to Increase Total Joint Arthroplasty Patient Volume
- 7 Success Factors for Developing an Outstanding Joint Replacement Program
- Hospital for Special Surgery Creates Musculoskeletal Outcomes and Research Center
There currently isn't a national joint replacement registry in the United States, though the Kaiser Permanente registries have demonstrated several advantages to having a national registry available. Tad Funahashi, MD, chair of Kaiser Permanente Implant Registries, and Robert S. Namba, MD, an orthopedic surgeon at Southern California Permanente Medical Group in Orange County, were co-authors of the study. They discuss four advantages of implementing a national joint registry in the future.
1. Implant and device monitoring. The number of patients needing joint replacements in the future will increase, says Dr. Funahashi, and the current method of monitoring these replacements is at a default state. The joint registry compiles a list of patients who receive each specific implant so in the event of implant failures or recalls, physicians have a list of patients to contact concerning their implant. "The registry allows us to identify failures, contact patients and look for related implant types that might also fail and identify those patients," says Dr. Funahashi.
2. Implant and surgical technique performance monitoring. Physicians can access the data on joint replacements performed around the country to see which procedures and implants are most successful on which patients. "By comparing the differences in performance of the implant design and surgical technique, the physician can decide what might be best for their patient," says Dr. Funahashi. "We can see what kinds of procedures lead to the best outcomes."
3. Patient counseling. When physicians are counseling patients on the best treatment options, they can consult cases in the national joint registry of patients from similar demographic backgrounds. The outcomes of treatment for those patients can be helpful in predicting the outcomes of various treatment methods and procedures for the patient still deciding which direction to take their treatment, says Dr. Namba. "Physicians can identify patient risk factors, which can be helpful in counseling patients," he says. "Those who are at a high risk of reoperation for elective surgery may also be at an increased risk for medical revision." If this is the case, physicians can advise patients to take a different treatment course with potentially better outcomes.
4. Research data. Researchers can use the data from cases collected in the joint registry to identify the risk factors in patients. Physicians have used the data from the Kaiser total joint registry to identify young age as a factor in failed knee replacements. There have also been breakthroughs in identifying the reasons for increased ACL injuries in women. "We are beginning to get some insights into ACL injuries in young female patients," says Dr. Funahashi. "Researchers are trying to develop programs that can decrease the rate of ACL tears in women and learning about how the reconstruction surgery should be done to maximize recovery and minimize revisions."
Read more coverage on joint replacements:
- Study: Standardize Processes to Increase Total Joint Arthroplasty Patient Volume
- 7 Success Factors for Developing an Outstanding Joint Replacement Program
- Hospital for Special Surgery Creates Musculoskeletal Outcomes and Research Center