New Zealand Orthopaedic Association
National Joint Register
Background
In 1997 the New Zealand Orthopaedic Association (NZOA) agreed to establish a national Hip and Knee Register to be based at the Department of Orthopaedic Surgery at Christchurch Hospital, directed by Mr Alastair Rothwell (National Coordinator). While this initiative was intended to mark 30 years of joint arthroplasty in New Zealand it was also recognised that there was a real need to collect data on implants and outcomes. Advantages and outcomes of a Register were seen to include:
- Survivorship of different types of implants;
- Revision rates and reason for revisions;
- Patient satisfaction assessments;
- Audit for individual surgeons, hospitals and regions;
- Opportunities for in-depth studies in the area of joint replacement; and
- Provision of a database for research
The National Joint Register was set up and became fully operational on 1 April 1999 and with national coverage in October 1999. Similar Registers operate in a number of countries.
Method of Operation
National Coordination
An efficient communication network has been established between the National Coordinator, Regional Supervisors, orthopaedic surgeons, theatre nurses, hospital administration and individual patients.
Data Forms
A data form is completed before the patient leaves the operating suite. This includes clinical data and the implant suppliers' label(s).
Data entry/Database
All forms are submitted to Christchurch where the information is entered into an efficient database, which has powerful query functions.
Patient Generated Outcomes
Follow up questionnaires are/will be sent to each patient at 6 month, 2 years, 5 years and thereafter at 3 yearly intervals. Questions are asked covering dislocations, infections, and other complications. This data will also be collected via a website to be developed in the immediate future.
Ethical Approval
The necessary ethical approvals were obtained from regional Ethical Committees.
Confidentiality
Surgeon and patient confidentiality is paramount. Database access is confined to the Coordinator and Supervisor only.
General Comments
The National Coordinator reports that in general the collection and entry of data is progressing smoothly with virtually total cooperation of all orthopaedic surgeons throughout New Zealand. Some preliminary data has been extracted from the database, but meaningful analysis is 4 or more years away.
One slight problem encountered was the sheer numbers of joint replacements over the last twelve months, probably as a result of the greater funding being made available for elective surgery and the subsequent reduction of waiting lists. This is expected to stabilise over the next year, although with the general ageing of the population joint replacements will undoubtedly increase in the coming years.
One slight problem encountered was the sheer numbers of joint replacements over the last twelve months, probably as a result of the greater funding being made available for elective surgery and the subsequent reduction of waiting lists. This is expected to stabilise over the next year, although with the general ageing of the population joint replacements will undoubtedly increase in the coming years.
Outcomes
The key objective of the National Joint Register can be summarised as follows:
The development and maintenance of a database for recording information on all implant procedures resulting in the ability to:
The development and maintenance of a database for recording information on all implant procedures resulting in the ability to:
- Assess survivorship of different types of implants and techniques;
- Revision rates and reasons for revision;
- Assess patient satisfaction and quality of life outcomes;
- Audit individual surgeons and hospitals;
- Provide accurate data to enable evidence based decisions to be made;
- Assist funding agencies to make appropriate decisions on joint replacement; and
- Enable the early assessment of new technologies in implant products and procedures
Summary
The New Zealand National Joint Register is now fully established and operational. It is proving its value in providing an exceptional database of implant information and outcomes. It will form an important part of the wider medical information available for many surgeons as it is further supported now and in the future.
The NZOA are committed to its ongoing development of the Register but are not in a position to continue to provide additional financial support. The value of the Register as an information resource in the health sector is such that other organisations that may seek output data from the Register should now consider financial support to maintain this resource.
For detailed information about the New Zealand National Join Register, please visit the Canterbury District Health Board's website at www.cdhb.govt.nz/njr/
The NZOA are committed to its ongoing development of the Register but are not in a position to continue to provide additional financial support. The value of the Register as an information resource in the health sector is such that other organisations that may seek output data from the Register should now consider financial support to maintain this resource.
For detailed information about the New Zealand National Join Register, please visit the Canterbury District Health Board's website at www.cdhb.govt.nz/njr/