Knee registries

摘要

The first ever national patient registry was established in Norway in 1856 for the disease leprosy [[1]Irgens L.M. Bjerkendal T. Epidemiology of leprosy in Norway: the history of The National Leprosy Registry of Norway from 1856 until today.Int J Epidemiol. 1973; 2: 81-89https://doi.org/10.1093/ije/2.1.81Crossref PubMed Scopus (31) Google Scholar]. This formed part of a programme to control a disease which at that time was a major health problem not just in Norway but throughout the world. Whilst other disease specific registries followed, it was over a century before we saw a registry for a specific medical device-knee joint replacement. The well-known business aphorism “if you can't measure it, you can't manage it” is generally credited to the Austrian–American management consultant Peter Drucker. Perhaps with this in mind, the Swedish Orthopaedic Society in 1975 commenced the Swedish Knee Arthroplasty Register with a small group of approximately 20 surgeons led by Prof Göran Bauer who regarded knee arthroplasty as a large scaled human experiment that should be monitored with respect to safety, outcomes and failure rates. Financing was initially with the Swedish Medical Research Council and with grants. Data was stored in a mainframe computer and included assessment of the Ahlbäck classification and follow up was at 1, 3, 6, and 10 years. Incomplete data collection altered the registry's mindset believing complete information on a few variables was superior to incomplete information on many [[2]Knutson K Robertsson O The Swedish Knee Arthroplasty Register (www.knee.se).Acta Orthop. 2010; 81: 5-7https://doi.org/10.3109/17453671003667267Crossref PubMed Scopus (50) Google Scholar]. Subsequently many nations have followed suit with a state-of-the-art review in this issue describing 23 arthroplasty registries along with eight for ligament, four for osteotomy and three for articular cartilage surgery [[3]Eran Beit Ner , Norimasa Nakamura, Christian Lattermann,Michael James McNicholas. Knee Registries: state of the art. JISAKOS https://doi.org/10.1136/jisakos-2021-000625.Google Scholar]. The Australian Orthopaedic Association commenced their National Joint Replacement Registry (AOANJRR) with an application to the National Government in March 1998. The specific aims were:Determine the demographic and diagnostic characteristics of patients undergoing joint replacement surgery.Provide accurate information on the types of prostheses for primary and revision replacement.Evaluate the effectiveness of different implants and techniques.Compare the results in the Australian Registry to other nations.Provide confidential outcome data to individual surgeons and hospitals.Educate Australian orthopaedic surgeons in the most effective prostheses and surgical techniques [[4]Australian orthopaedic association national joint replacement registry 1st annual report 2000. https://aoanjrr.sahmri.com/documents/10180/75186/Annual+Report+2000Google Scholar]. These lofty goals are consistent with just about every knee registry irrespective of the type of knee surgery being measured. We should ask if they have been reached. Should we continue with registries or are there better, more relevant and accurate methods to assess and ultimately improve our surgery. A management consultant whose interests lay in better outcomes following knee surgery would ask these questions of registries. Which parameters are to be measured, how is the data to be stored and analysed and how will it be promulgated so that the expense and effort resulted in improvements? And finally-have registries made a difference? A cost benefit analysis should at the very least demonstrate that knee registries produce better outcomes for both patients and health systems whilst reducing costs. Measuring the correct parameters is important. To the sceptics who see few benefits in registries, the words of James Willbanks, a former USA soldier in his collection of essays on the Vietnam War ring tru