The Canadian Joint Replacement Registry: Gaining Momentum

Robert B. Bourne, M.D., FRCSC
London, ON

The Canadian Joint Replacement Registry (CJRR), operated through the Canadian Institute for Health Information (CIHI), serves as Canada's leading source of information on hip and knee replacement surgeries. The CJRR captures national data on elective primary and revision hip and knee replacement surgeries and subsequent patient outcomes. The goal of the CJRR is to improve the quality of care in clinical outcomes of joint replacement recipients in Canada.

Canadian orthopaedic surgeons, through their voluntary participation in the CJRR and CIHI, have been collaborative partners during the implementation stages of CJRR. Orthopaedic surgeons from across Canada are represented on the CJRR Advisory Committee and the Research and Development Committee.

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Figure 1. The proportion of primary total joint replacements received within six months of decision in each of seven scenarios. The scenarios vary in the annual increase in the number of surgeries available.

The Canadian Joint Replacement Registry has had many successes in addition to the valuable annual reports which have been published since 2001. The CJRR has played a pivotal role in demonstrating the increased demand for total hip and knee replacement surgery in Canada to health care providers, resulting in total hip and knee replacement procedures being included in the priority wait time initiative. As a result, a 50% increase in THR and TKR volumes has been achieved in Canada over the past three years. CJRR data has also proven valuable in: 1) predicting the future need for joint replacement surgeries in Canada1 (Figure 1), 2) establishing the minimal clinical improvement which patients require for TKR's and THR's to be satisfied2 (Figure 2), and 3) demonstrating the effect of obesity on THR and TKR rates3 (Figure 3).

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Figure 2.Mean total WOMAC change score and 99% confidence limits (CL) by grouped transition ratings for function (-7 to -1 = degrees of dissatisfaction, 0 = uncertain, +1 to +7 = degrees of satisfaction) and patient-rated global assessment of willingness to undergo THR/TKR surgery again (n=2709).

The voluntary nature of the Canadian Joint Replacement Registry has posed a challenge. To date, only about 70% of Canadian orthopaedic surgeons participate in the CJRR and less than 50% of actual THR and TKR procedures are captured. For example, in 2005-2006, there were 68,146 elective joint replacement surgeries performed in Canada (28,045 THR's and 40,701 TKR's) according to the CIHI Discharge Abstract database. Unfortunately, only 31,124 (47%) of these procedures were captured in the CJRR. This poor data capture rate has greatly curtailed the effectiveness of the CJRR in identifying patients and implants with greater risks for revision surgery. The participation rate of Canadian surgeons in the CJRR pales considerably with those achieved in Sweden and Australia where almost 100% data collection is achieved. The challenge for the Canadian Joint Replacement Registry is obvious. Ideally, 100% THR and TKR data collection could be achieved through either voluntary mandatory participation. Since the CJRR provides valuable quality assurance data to hospitals, this data collection could be hospital rather than surgeon-based. In addition, patient follow-up for untoward events, satisfaction and health-related quality of life outcomes could be performed independently of the surgeon, provided that consent had been obtained from both surgeons and patients.

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Figure 3.Relative risk ratio was calculated for THA and TKA according to weight category.

Canadian orthopaedic surgeons have a glorious opportunity to develop a national joint replacement registry which serves the needs of their patients, their continuous improvement and health care providers. Let's make this happen and develop a Canadian Joint Replacement Registry of which we can all be proud!

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=services_cjrr_e

References

  1. Cipriano L.E., Chesworth B.M., Anderson C.K. and Zaric G.S. Predicting joint replacement waiting times. Health Care Manage Sci. 2007 Jun;10(2):195-215.
  2. Chesworth B.M., Mahomed N.M., Bourne R.B. and Davis A. Willingness to go through surgery again validated the WOMAC clinically important difference from THR/TKR surgery. J Clin Epi in press'
  3. Bourne R.B., Mukhi S., Zhu N., Keresteci M. and Marin M. Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res, 465:185- 188, 2007.

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