Greater Consistency in Data Collection Would Increase Value of Joint Replacement Registries

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Joint replacement registries around the world, which collect important data used to monitor patient outcomes from surgery, would increase their value even more by improving the consistency in how they collect and analyze information and report results, Canadian researchers have found.

The researchers, led by Dr. Deborah Marshall, ABJHI’s Director of Health Technology Assessment and Research, examined the data collection and reporting practices of six high-quality national registries for total hip replacement and hip resurfacing surgeries. They found consistency lacking in how data are collected, how procedures are defined, the analysis methods used and the outcomes reported.

These inconsistencies make it more difficult to interpret and compare the data reducing their value in improving the quality of care and implants. The findings are described in an article in the April issue of The Bone & Joint Journal.

Lead author Sarah Lacny said demand for total hip arthroplasty (THA) and hip replacement arthroplasty (HRA) is growing worldwide. “The rising volume of joint replacements is making better monitoring of the outcomes of these surgeries more important,” Ms. Lacny said. “But the ability to compare results broadly and monitor for trends is compromised when registries use different terminology to describe procedure types, do not differentiate between procedure types, or employ different methods of collecting and analyzing data.”

The study compared six national registries. The six, located in Australia, New Zealand, the U.K., Norway, Sweden and Slovakia, were chosen on the basis of full membership in the International Society of Arthroplasty Registries (ISAR) and the availability of their annual reports in English.

Among the problems discovered were instances in which registries did not differentiate between THA and HRA when reporting patient outcomes even though outcomes have been shown to vary between the two procedure types. Revision and reoperation were treated as the same type of surgery by some registries while others categorized them as discrete surgery types.

Dr. Marshall said the degree of inconsistency may be even higher in registries that, unlike the six included in the study, do not meet the higher standard of quality required for full membership in ISAR.

“Given the projected rise in demand worldwide for hip replacement, consensus is needed among registries to further improve the standardization of data collection, definitions, methods of analysis, and the reporting of outcomes by implant, procedural design, and patient characteristics to ensure that their data are comparable,” Dr. Marshall said.

Dr. Eric Bohm, co-chair of the Canadian Joint Replacement Registry, said, “Collectively comparing data across registries can help to identify strengths and weaknesses within individual registries and thus improve their value.”

The findings are thought to be applicable to registries of other joint replacements. In addition to her position as ABJHI’s Director of Health Technology Assessment and Research, Dr. Marshall is a Professor in the Departments of Medicine and Community Health Sciences, University of Calgary. Ms. Lacny is a trainee of Dr. Marshall. Other coauthors are Dr. Gillian Hawker and Dr. James Powell.