Knowledge and Safety Can Be Gained for Canadians Through A Comprehensive Orthopaedic Registry

June 15, 2012 - PRLog -- Orthopaedic procedures to repair or replace knees or hips are among the most commonly performed surgeries in Canada with over 80,000 surgeries performed on a yearly basis. It seems extraordinary then that such a large aspect of the healthcare system does not have attached to it an adequate system to monitor patient outcomes and implant performance.  Only one province currently requires that hospitals enter data into a registry to support their procedural reimbursements. The data collected monitors the short and long-term performance and survivorship of all hip and knee implants as they enter the market.  Without a comprehensive registry it is hard to identify what new technologies are performing well and under what circumstances or how certain technologies and procedures pair with given patient demographics.

Right now the rate of revision surgery needed over a fifteen-year period is around 15 per cent. Though this number is relatively low, it could be improved if there was a way to more accurately track patient outcomes and make appropriate changes to procedures or technologies to further improve overall patient value.
Currently the majority of testing and data on new implant technologies comes from the manufacturer, leaving many companies to create products similar to previous design in order to gain approval, which tends to stifle rather than promote innovation.  Another issue with the current system is that when a recall or implant issue is discovered, the lack of a centralized database makes finding the effected patients both laborious and susceptible to error as the process has to be conducted manually.

The Canadian Joint Replacement Registry (CJRR) is the only body responsible for maintaining information on the performance of knee and hip implants, however the participation in this program is only mandatory in Ontario. Hospitals in other provinces use their own discretion when choosing whether or not to submit data to the CJRR.  The CJRR is currently working with hospitals to expand their database, which provides key information on patient demographics, procedures, implant performance and wait times.  However, with Ontario being the only province with a mandatory compliance policy the database is not as expansive as it could be.  The other provinces need to get on board and follow suite with Ontario in order for this database to continue to grow and reach its full potential.

But, there is broader opportunity ahead for reducing preventable complications in hip and knee surgery that will benefit patients and their families, according to the Canadian Orthopaedic Association (COA) (May 9, 2012/CNW).  The release outlines collaborative work started in 2010 to reduce preventable complications in hip and knee surgery, thanks to the COA’s National Standards Committee, Chaired by Dr. Eric Bohm, the Canadian Institute for Health Information, Accreditation Canada and the Canadian Patient Safety Institute.

“Improving Safety and Outcomes for Canadians Undergoing Hip and Knee Replacement Surgery” is the public position statement that was drafted as a result of this work.  It promotes the adoption of a surgical safety checklist prior to commencing surgery and a minimum data set to the Canadian Joint Replacement Registry after surgery.  The safety checklist requires that critical steps be completed for all surgical patients to confirm that the surgical team has taken preventive measures and is properly prepared for potential complications or emergencies. For its part, data submission to the joint replacement registry, that would occur electronically during the surgery, makes it possible to match patients with an implant, should problems surface with a particular device.
This also means that clinical researchers can develop more effective evidence-based care and track the performance of different types of hip and knee devices. However, to get the best value from the registry, the COA and its partners are urging all institutions performing arthroplasties to register their data.

“Canadians who need hip or knee replacement surgery can take comfort in knowing that these operations will become even safer than they are now,” says Dr. Ross Leighton, who practices at Halifax’s QE II Health Sciences Centre and is the immediate past-president of the Canadian Orthopaedic Association.

The technologies and procedures developed by companies in the orthopaedic industry are always striving for the best possible patient outcomes, that is less revision, decreased recovery time and overall decrease in pain and regaining of as much mobility as possible.   The deeper the wells of data are for organizations, such as the CJRR, the greater the ability of doctors and developers of technologies to create better overall value for patients.

For more information visit:

COA Safety Statement
http://www.coa-aco.org/images/stories/library/health_poli...

CIHR’s most recent Joint Replacement Registry Report
http://www.cihi.ca/CIHI-ext-portal/internet/EN/TabbedCont...