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Record numbers of joint replacements carried out

National report reveals ‘impressive’ outcomes

Jo Carlowe

Tuesday, 19 September 2017

A record number of joint replacement procedures have been carried out, new figures show.

In its report, published today, the orthopaedic joint replacement register for England, Wales, Northern Ireland and the Isle of Man highlights a record number of procedures were carried out in the financial year 2016/17, with just fewer than 243,000 cases submitted to the National Joint Registry (NJR). This sees a significant increase of more than 20,000 joint replacement operations recorded in the registry on the previous period.

Today's National Joint Registry 14th Annual Report presents outcome data in relation to hip, knee, shoulder, elbow and ankle replacements. The published figures bring the total number of records in the registry to approximately 2.35 million since it was established in 2002. The report highlights that for most patients across all joint replacement procedures recorded in the registry:

  • the risk of having revision surgery within 13 years was low
  • primary procedures were performed predominately for osteoarthritis or inflammatory arthritis
  • the average patient is female, with only ankle replacement procedures showing a male majority

Commenting on the outcome data and statistics presented in the report, NJR medical director, Mr Martyn Porter, said: "The consistently high number of joint replacement cases submitted per year suggests continuing high levels of patient confidence and clinical performance, in what is a remarkably successful surgical intervention.

"Specifically, in the case of hip replacement, today's report shows that in the vast majority of patients over the age of 75 at the time of their operation, their hip implant will not need to be replaced again in their remaining lifetime. Similarly, for patients over the age of 75, the data for the most common types of total knee replacement show less than a 3% chance of requiring further surgery at 13 years.

"These are very impressive results and we should not lose sight of the fact that joint replacement gets patients back to their chosen lifestyle sooner, free from pain and with improved mobility."

Elsewhere, however, analysis from this year's report continues to show the trend for increased likelihood of revision (or 're-do' surgery) associated with younger patients across all types of joint replacement procedures recorded in the registry. Younger patients may be at higher risk of revision because they are more active which may put more strain on their implants. 

Porter, a revision specialist, continued: "This trend is particularly relevant given the increase in total numbers of younger patients undergoing joint replacement. If younger patients are most likely to need at least one revision surgery in their lifetime, then we must use the maturing dataset of the NJR to get the first-time surgery as right for the patient as possible.

"Whilst standards in British orthopaedics are high, surgeons must continue to use the NJR's rich dataset to see important determinants that influence the outcome and longevity of joint replacement procedures, to evaluate where additional benefits for patients can be maximised.

"This can be achieved through evidence-based evaluation of the proposed implant, the way in which it will be fixed into place in patients of a particular, age, gender and health.”

To assist clinicians and young hip and knee replacement patients in the pre-operative decision-making process, the NJR has, for the first time, presented findings on the effect of age and gender on hip and knee revision rates across the various types of implants and fixation methods.

Commenting, NJR chairman, Laurel Powers-Freeling, said: "Today's report should drive greater confidence in the public and with commissioners of healthcare, that joint replacement is one of the most effective interventions that the NHS has to offer.

"The NJR remains committed to improving the quality of our data to ensure the most robust evidence is available to monitor the performance of implants, the effectiveness of different types of surgery and to improve clinical standards - all with a sharp focus on patient outcomes.”

The results of the report will be launched today at the British Orthopaedic Association's Annual Congress in Liverpool to an international delegation of more than 1,000 joint replacement surgeons.

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