Joint Replacement Registries Significantly Reduce Revision Rates

Abstract BackgroundDespite the rapid establishment of joint replacement registries (JRR), its effect on key outcomes such as revision rates is uncertain. While some countries with JRR have recorded reductions in revision rates, other countries without JRR also have reported similar reductions. This study evaluated the impact of JRR on revision rates across countries while controlling for non-JRR related factors and JRR outcomes transfer (to non-registry countries) that could contribute to reduction in revision rates. MethodsThis assessment was performed by a difference-in-differences statistical approach using a panel regression model. We compared revision rates of non-registry countries to registry countries, and further compared non-registry period revision rates to registry period (of registry countries) revision rates. We controlled for non-JRR related factors and JRR outcomes transfer by the inclusion of a linear trend in the model. Data were collected from 1980 – 2018. Registry data were obtained from JRR databases while non-registry data were obtained from literature search in Medline and Google Scholar. ResultsThe average difference in revision rates between registry countries compared to non-registry countries was not statistically significant for hip (p-value = 0.056) and knee (p-value = 0.501) respectively. The average difference in revision rate in the registry period of registry countries relative to the non-registry periods was statistically significant for hip (p-value < 0.0001) and knee (p-value = 0.004) respectively. The impact of JRR on revision rate reduction as a percentage was 19.23% (95% CI: 10.86 – 31.55%) and 13.07% (95% CI: 3.28 – 31.18%) for hip and knee respectively. ConclusionsJoint replacement registries cause significant reduction in revision rates and its effect on this outcome may be further improved by increasing surgeons’ participation. Establishment of JRR in countries or regions yet to would be a worthwhile decision.