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10Th Annual Report 2013 National Joint Registry for England, Wales and Northern Ireland

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10Th Annual Report 2013 National Joint Registry for England, Wales and Northern Ireland HIPS KNEES ANKLES ELBOWS SHOULDERS PROMs 10th Annual Report 2013 National Joint Registry for England, Wales and Northern Ireland ISSN 1745-1450 (Online) Surgical data to 31 December 2012 Prepared by The NJR Editorial Board NJRSC Members Mr Martyn Porter (Chairman) Mick Borroff Professor Paul Gregg Professor Alex MacGregor Mr Keith Tucker NJR RCC Network Representatives Mr Peter Howard (Chairman) Mr Colin Esler Mr Alun John Mr Matthew Porteous Orthopaedic Specialists Professor Andy Carr Mr Andy Goldberg NJR Research Fellows Mr Jeya Palan Healthcare Quality Improvement Partnership NJR Management Team and NJR Communications Rebecca Beaumont James Thornton Melissa Wright Elaine Young Northgate Information Solutions (UK) Ltd NJR Centre, IT and data management Olivia Forsyth Anita Mistry Dr Claire Newell Dr Martin Pickford Martin Royall Mike Swanson University of Bristol NJR Statistical support, analysis and research team Professor Yoav Ben Shlomo Professor Ashley Blom Dr Emma Clark Professor Paul Dieppe Dr Linda Hunt Dr Michèle Smith Professor Jonathan Tobias Kelly Vernon Pad Creative Ltd (design and production) This document is available in PDF format for download from the NJR website at www.njrcentre.org.uk This document is available in PDF format for download from the NJR website at www.njrcentre.org.uk National Joint Registry for England, Wales and Northern Ireland | 10th Annual Report Contents Chairman’s introduction 10 Foreword from the Chairman of the Editorial Board 12 Executive summary 13 Part 1: Annual progress ..............................................................................14 Part 2: Clinical activity 2012 ...........................................................................15 Part 3: Outcomes after joint replacement 2003 to 2012 ......................................................19 Part 1 Annual progress 23 1.1 Introduction 23 1.1.1 The National Joint Registry ..............................................................24 1.1.2 Management and funding ...............................................................24 1.1.3 Content of the 10th Annual Report ........................................................25 1.2 Data completeness and quality 26 1.2.1 Key indicators ........................................................................27 1.2.2 Operation totals ......................................................................29 1.3 Work of the NJR Steering Committee and its Sub-committees 33 1.3.1 Introduction ..........................................................................34 1.3.2 NJR Steering Committee ................................................................34 1.3.3 NJR Editorial Board - Mr Martyn Porter, Chairman .............................................35 1.3.4 Implant Performance Sub-committee - Mr Keith Tucker, Chairman ................................36 1.3.5 Surgeon Outliers Sub-committee - Professor Paul Gregg, Chairman ...............................36 1.3.6 NJR Research Sub-committee - Professor Alex MacGregor, Chairman .............................38 1.3.7 NJR Data Quality Group - Professor Paul Gregg, Chairman ......................................39 1.3.8 NJR Regional Clinical Coordinators’ (RCC) Network - Mr Peter Howard, Chairman ....................40 1.4 Highlights 41 1.4.1 Geographic extension of the NJR .........................................................42 1.4.2 Extension of the NJR: Elbows and shoulders .................................................42 1.4.3 Beyond Compliance: ‘Protecting Patients, Supporting Innovation’ .................................42 1.4.4 Publication of consultant-level data ........................................................44 1.4.5 Patient-focused initiatives ...............................................................44 1.4.6 NJR Feedback Services: Updates .........................................................44 1.4.7 Proposed changes to the Minimum Dataset .................................................45 1.4.8 Price Benchmarking ....................................................................45 1.4.9 International developments ..............................................................46 1.4.10 Patient Reported Outcomes Measures (PROMs) ..............................................46 1.4.11 NJR Fellowships ......................................................................47 1.4.12 Orthopaedic Data Evaluation Panel (ODEP) overview ...........................................47 1.5 Finance 48 1.5.1 Income and expenditure 2012/13 .........................................................49 Appendix 1 NJR Steering Committee 2012/13 .........................................................50 www.njrcentre.org.uk 3 Appendix 2 List of papers, publications and research requests using NJR data ................................52 Appendix 3 Additional information on the NJR website ...................................................55 Part 2 Clinical activity 2012 56 2.1 Introduction 56 2.1.1 Hospitals and treatment centres participating in the NJR ........................................57 2.2 Hip replacement procedures 2012 60 2.2.1 Primary total hip replacement procedures (THR) 2012 ..........................................62 2.2.2 Hip revision procedures 2012 ............................................................80 2.3 Knee replacement procedures 2012 84 2.3.1 Primary knee replacement procedures 2012 .................................................86 2.3.2 Knee revision procedures 2012 ..........................................................101 2.4 Ankle replacement procedures 2012 103 2.4.1 Primary ankle replacement procedures 2012 ................................................104 2.4.2 Ankle revision procedures 2012 ..........................................................109 2.5 Elbow replacement procedures 2012 111 2.5.1 Primary elbow replacement procedures 2012 (nine months) ....................................112 2.5.2 Elbow revision procedures 2012 .........................................................115 2.5.3 Elbow components used in primary and revision procedures ....................................116 2.6 Shoulder replacement procedures 2012 117 2.6.1 Primary shoulder replacement procedures 2012 (nine months) ..................................118 2.6.2 Shoulder components used in primary procedures ...........................................121 2.6.3 Shoulder revision procedures 2012 (nine months) ............................................121 Part 3 Outcomes after joint replacement 2003 to 2012 123 3.1 Summary of data sources and linkage 123 3.2 Outcomes after primary hip replacement 126 3.2.1 Overview of primary hip surgery ..........................................................128 3.2.2 Revisions after primary hip surgery ........................................................131 3.2.3 Revisions for different causes after primary hip surgery ........................................136 3.2.4 Revisions after primary hip surgery for the main stem-cup brand combinations ......................140 3.2.5 Revisions after primary hip surgery: Effect of head sizes for polyethylene liners ......................144 3.2.6 Mortality after primary hip surgery ........................................................148 3.2.7 In-depth study: Metal-on-metal hip resurfacing ..............................................150 3.2.8 Conclusions .........................................................................158 3.3 Outcomes after primary knee replacement 159 3.3.1 Overview of primary knee surgery ........................................................160 3.3.2 Revisions after primary knee surgery ......................................................165 3.3.3 Revisions for different causes after primary knee surgery .......................................169 4 www.njrcentre.org.uk National Joint Registry for England, Wales and Northern Ireland | 10th Annual Report 3.3.4 Revisions after primary knee surgery by main brands for TKR and UKR ............................173 3.3.5 Mortality after primary knee surgery .......................................................179 3.3.6 Conclusions .........................................................................181 3.4 Outcomes after primary ankle replacement 182 3.4.1 Overview of primary ankle surgery ........................................................183 3.4.2 Revisions after primary ankle surgery ......................................................184 3.4.3 Mortality after primary ankle surgery .......................................................184 3.5 PROMs outcomes 186 3.5.1 Background to Patient Reported Outcome Measures (PROMs) ..................................187 3.5.2 Data linkage from PROMs to HES to NJR ..................................................187 3.5.3 PROMs outcomes for primary hip replacements .............................................188 3.5.4 PROMs outcomes for primary knee replacements ............................................196 3.5.5 Conclusions .........................................................................201 Part 4 Trust-, Local Health Board- and unit-level activity and outcomes 2012 202 4.1 Introduction 202 4.2 Unit outlier analysis methodology 204 Trust-, Local Health Board- and unit-level data ..............................................206 Part 1 tables Table 1.1 Total joint replacement procedures entered into the NJR, 2008/09 to 2012/13, recorded by country in which the procedure took place. ..................................................29 Table
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