April 6, 2019
- What does the NJR’s 15th Annual Report tell us?
Who is receiving joint replacement?
Hips
- April 6, 2019
Hips](What does the 15th annual report tell us_assets/slide-02-01.png)
Who is receiving joint replacement?
Knees
- April 6, 2019
Knees](What does the 15th annual report tell us_assets/slide-03-01.png)
Who is receiving joint replacement?
Shoulders
- April 6, 2019
Shoulders](What does the 15th annual report tell us_assets/slide-04-01.png)
Who is receiving joint replacement?
Elbows and Ankles
- April 6, 2019
Elbows and Ankles](What does the 15th annual report tell us_assets/slide-05-01.png)
Elbows and Ankles](What does the 15th annual report tell us_assets/slide-05-02.png)
Data Analysis
- April 6, 2019
Trends - Hips
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Hips – Revision rates
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- Hips – Being female and young remains higher risk, moderated by removing MoM
Hips – Watch the head size: material dependent
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Hips – Best 10 year performance by fixation
Most common constructs with >2500 implantations (>1000 for resurfacing) and >250 remaining at risk. Kaplan-Meier estimate (95% CI)
Age and gender – cemented fixation, lowest revision in all age bands and both genders
Cemented 1.55 (1.1 – 2.1)
Uncemented 2.89 (2.3 – 3.6)
Hybrid 2.28 (1.7 – 3.0)
Reverse Hybrid 3.36 (2.4 – 4.7)
Resurfacing 7.95 (7.6 - 8.4)
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Hips – Re-revision rates by time to revision
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Knees – Use of fixation
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Knees – Use of fixation and type 2017
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| Fixation | Constraint | % of primary knee procedures |
|---|---|---|
| Cemented | Unconstrained | 63.1 |
| Posterior stabilised | 20.4 | |
| Constrained condylar | 1.4 | |
| Monobloc polyethylene tibia | 1.6 | |
| Uncemented | Unconstrained | 1.8 |
| Posterior stabilised | 0.2 | |
| Unicondylar | Fixed | 4.6 |
| Mobile | 5.5 | |
| Patellofemoral | 1.0 |
Knees – Revision rates over time
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Knees – Survivorship by constraint and type for cemented TKR
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Knees – Survivorship by type for unicompartmental
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Knees – Revision risk by age and gender
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Knees – Best 10 year performance (Kaplan-Meier, 95% CI)
Cemented
- Unconstrained fixed 2.41 (2.3 – 2.5)
- Posterior stabilised fixed 3.05 (2.9 – 3.2)
- Monobloc poly tibia 2.20 (1.8 – 2.7)
Uncemented
- Unconstrained fixed 2.27 (1.6 – 3.2)
Unicondylar
- Unicondylar fixed 10.20 (9.0 – 11.6)
- Unicondylar mobile 11.44 (11.1 – 11.8)
Patellofemoral 15.21 (14.0 – 16.6)
April 6, 2019
Knees – Type
Patterns above consistent across age and gender bands
Age (and age as a surrogate for activity) on its own not the reason for increased revision rates in partial knees
April 6, 2019
Knees – Re-revision rates by time to first revision
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Ankles - Use and volume
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Ankles – Number by brand
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Ankle – revision rates (Kaplan-Meier 95% CI)
1 year 0.78 (0.6 – 1.1)
3 years 3.98 (3.4 – 4.7)
5 years 6.93 (6.0 – 8.0)
7 years 8.70 (7.4 – 12.0)
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Shoulder - Usage
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Shoulders - Volume
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Shoulders - Indication
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Shoulders – Revision by trauma/elective split
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Shoulders – Revision by type (elective only)
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Elbow - Usage
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Elbow – Trauma/elective split
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Elbow – Indication for total elbow
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Elbow – Revision rates
- April 6, 2019
Thank you to the team!
NJR Editorial Board
- NJRSC Members: Mr Martyn Porter (Chairman, Editorial Board), Mr Peter Howard, Sandra Lawrence, Professor Mike Reed, Jeffrey Stonage, Professor Mark Wilkinson
- NJR RCC Network Representatives: Mr Matthew Porteous (Chairman, RCC Sub-committee), Mr Sebastian Dawson-Bowling, Mr Adam Watts
- Orthopaedic Specialists: Mr Ricahrd Craig, Mr Colin Esler, Mr Andy Goldberg, Professor Jonathan Rees
Healthcare Quality Improvement Partnership
- NJR Management Team and NJR Communications: Deirdra Taylor, Elaine Young
Northgate Public Services
- NJR Centre, IT and data management: Victoria McCormack, Anita Mistry, Dr Claire Newell, Dr Martin Pickford, Martin Royall , Mike Swanson
University of Bristol / University of Oxford
- NJR Statistical support, analysis and research team: Professor Yoav Ben Shlomo, Professor Ashley Blom, Dr Emma Clark, Kevin Deere, Dr Celia Gregson, Dr Linda Hunt, Professor Andrew Judge, Sofia Mouchti, Professor Andrew Price, Adrian Sayers, Mr Michael Whitehouse
Pad Creative Ltd (design and production)
April 6, 2019