THE ROLE OF JOINT REGISTERS IN DETECTING INFERIOR IMPLANTS AND ACTING APPROPRIATELY

Abstract

The Trent Arthroplasty Audit Group has been prospectively collecting data on primary hip and knee arthroplasties since 1990. Details of 61,000 primary and 4,00 revision arthroplasties have been registered. The Royal College of Surgeons of England. Capital Hip Report (July 2001) concluded that a national joint register could have detected failures of an implant at an earlier stage. We examined data on the register to ascertain why we had been unable highlight a problem with this implant.

The Trent Arthroplasty Register was unable to detect the poor results with Capital hips at an earlier stage than surgeons. A scientific presentation had raised concern before our register could detect a problem. The hips had been listed for revision but were still on a waiting list. Additionally some of the failed hips were not revised as patients were insufficiently fit for surgery.

The stated reason for revision on revision forms was vague and not sufficient to draw conclusions as to the mechanism of failure. Radiological studies have identified a higher radiological failure rate than expected (Charnley & Elite +) but we have shown that outcome scores (Oxford Scores) were not successful at identifying these failures. Since the implementation of the Data Protection Act (1998) consent must be obtained before details are registered, which may lead to further inaccuracy in the creation of survivorship curves.

Joint registers can contain the problem once it is detected but are not a substitute for regular follow-up. Surgical vigilance and a scientific approach is required to ascertain the reason for failure. Revision should not be the only endpoint for registration. Joint registers may be part of the solution but need to be backed up with adequate resources, financial and intellectual, to analyse clinical information, if valid conclusions are to be drawn.