 Joint replacement is a commonly performed major procedure that has considerable success in alleviating pain and disability. The rate of joint replacement surgery is increasing rapidly and will continue to do so. For the last ten years there has been an average annual increase of just over 7% each year. Figures show that almost 60,000 hip and knee replacements were performed during the financial year 2003-2004. This compares to 32,000 procedures in 1993-1994. Knee replacement procedures have increased at over twice the rate of hip replacements during this period. The Registry has estimated that expenditure for acute care alone is now approaching AUS$1 billion per annum.
The outcomes of joint replacement are variable. There are many factors known to influence this. Age, gender and diagnosis of patients, the type prosthesis and the surgical techniques used are just some of these. Superimposed on this, is the rapid rate of change in medical technology. There is continual development and use of new types of prostheses and surgical techniques, the results for many of which remain uncertain.
 The Australian Orthopaedic Association recognised the need to establish a National Joint Replacement Registry in 1993. At that time, the outcomes of this surgery in Australia were unknown. It was not even clear who was receiving joint replacement or the types of prostheses and techniques being used to implant them. The need to establish a Registry was in part based on the documented success of a number of arthroplasty registries in other countries in particular the Swedish Arthroplasty Registries. The ability to identify factors important in achieving successful outcomes had resulted in both improved standards and significant cost savings.
In 1998 the Commonwealth Department of Health and Aging agreed to fund the Australian Orthopaedic Association to establish the Registry. The Registry began data collection on 1st September 1999. Its continued implementation was then undertaken in a staged manner in each of the Australian states and territories becoming fully national during 2002 (Table NJRR1). The Department of Health and Aging continues to provide the entire funding to maintain the Registry.
 The purpose of the Registry is to define, improve and maintain the quality of care of individuals receiving joint replacement surgery. It achieves this by collecting a defined minimum data set that enables outcomes to be determined on the basis of patient characteristics, prosthesis type and features, method of prosthesis fixation and surgical technique used. The principal measure of outcome is revision surgery. It is an unambiguous measure of the need for further intervention. Combined with a careful analysis of the timing and reasons for revision this can be used as an accurate measure of the success or otherwise of a procedure. The Registry also monitors mortality rates. This information is then used to inform surgeons, other health care professionals, governments, orthopaedic companies and the community.
Although the Registry has only been in existence and fully operational for a short time the continual monitoring process inherent in the Registry's function has established that information provided by the Registry is already influencing joint replacement in a beneficial manner. The major benefit from the Registry however will not be achieved until longer-term outcomes can be established.
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