New NJR report highlights that patient factors can have major impact on revision of hip replacements

Younger joint replacement patients, who are likely to be more active, may put more strain on their implants and increase the risk of revision, a new report published today (Tuesday 13 September 2016) has said.

The 13^th Annual Report from the National Joint Registry (NJR) highlights that patient factors have a significant bearing on how long the implant will last, with younger patients having an increased risk of revision than their older counterparts. Moreover, the data reveal that a patient from a younger age group is more likely to be revised irrespective of gender, with the youngest group having the worst predicted outcomes in terms of the risk of subsequent revision.

Established in 2002 by the Department for Health, the NJR monitors the performance of hip, knee, ankle, elbow and shoulder joint replacements to improve clinical outcomes for the benefit of patients, clinicians and industry.

Commenting on the results of the report, NJR medical director, Mr Martyn Porter said:

Data emerging from this year’s report show that revision - or ‘re-do’ surgery - estimates following first-time joint replacement procedures remain low. These impressive results underpin the enormous success and reliability of this operation.

However, it is important to note that the patient has an important effect on how long a hip replacement will last. Revision estimates are much higher in younger patients under-55 compared to patients over-75 years of age. This presumably relates to patient activity.

Younger patients should not be denied life changing surgery but they need to be advised that revision may be two or three times more likely at ten years compared to less active patients.

The report’s analysis also includes further results on the relative success of revision surgery.  The ten year further revision risk, known as re-revision, is nearly 15 percent, which is three times greater than the risk for the primary procedure. The message is that revision risk for most patients is low at ten years but if they do fail then the risk of further revision is substantially increased.

If patients under-55 years are most likely to need at least one revision surgery in their lifetime, then we must use the maturing dataset of the NJR to analyse long-term trends and get the first time surgery as right for the patient as possible. These findings reinforce the principles of the Department of Health’s ‘Getting It Right First Time’ initiative in England.

The results of the report will be launched today at the British Orthopaedic Association’s Annual Congress in Belfast to an international audience of over 1,000 joint replacement surgeons. Due to the registry’s rich dataset, important determinants that influence the outcome and longevity of joint replacement procedures can now be studied.  Since 2003, osteoarthritis is the predominant diagnosis in 92 and 96 percent of hip and knee replacement procedures respectively.

Mr Porter, a practising orthopaedic surgeon and a revision specialist, added:

Joint replacement surgery offers significant benefits – getting patients back to their chosen lifestyle sooner, free from pain and with improved mobility. As a joint replacement patient myself, I particularly understand the importance of this.

Financial pressures on the NHS have resulted in some providers recently suggesting a temporary suspension of joint replacement procedures or excluding certain patient groups based on lifestyle factors, such as weight. The evidence from today’s report suggests that this is not rational.

Joint replacement surgery is not a lifestyle operation, it is primarily an operation to relieve pain, keep people at work and free patients from community care. The taxpayer will not save money by providers denying joint replacements to patients as these are highly effective and cost effective procedures.

For the period 1 April 2015 to 31 March 2016 there were just under 225,000 cases submitted to the NJR, bringing the total number of records in the registry to over 2.09 million since it was established in 2002.

On the collection of joint replacement data, NJR chairman, Laurel Powers-Freeling said:

The NJR has continued to maintain its position as the world’s largest joint replacement registry and is proud to continue providing critical insights to all our stakeholders. We remain 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. Everyone associated with the NJR looks forward to another year of progress and continued service to patients, clinicians and the orthopaedic sector as a whole.