Total Joint Replacement Registry

Background
xrayKaiser Permanente is the nation's largest provider of total hip and knee replacements. First established in 2001, The KP National Total Joint Replacement Registry (TJRR) is a national level database designed as a postmarket surveillance system for elective total hip and knee replacement.

The key objectives of the registry are to:

  • Monitor revision, failure, and rates of key complications: infection, venous thromboembolic events, mortality
  • Identify patients at risk for poor clinical outcome
  • Identify the most effective techniques and implant devices (best practices and implant constructs)
  • Track implant usage and costs
  • Monitor and support implant recalls and/or advisories

The TJRR has provided a mechanism for recalls, identified patients at risk for early revisions and changed practice by providing feedback to physicians.

Data Collection and Sources

The TJRR uses an innovative observational method that collects uniform data at the point of care (collected by surgeons, medical assistants, and circulating registered nurses). The core of the TJRR is standardized preoperative, operative, and postoperative documentation forms that contain a small number of key data elements identified by consensus among all surgeons. The standardized forms replace traditional, non-uniform clinic and operative notes and provide information on patient demographics, implant characteristics, surgical techniques, and clinical outcomes.

Data from the standardized TJRR forms are supplemented with data from independent KP administrative data sources to provide a comprehensive database for TJR surveillance and monitoring. KP administrative databases such the Health Information Management System (HIMS), Kaiser Anesthesia and Surgery Information System (KASIS), Management and Information Analysis (MIA) Mortality and Membership datasets, and KP HealthConnect's (electronic medical health record) inpatient, ambulatory, operating room management, and emergency department system modules provide additional data on hospital readmissions, patient comorbidities, complications, hospital length of stay, health plan membership, and mortality.

Volume and Participating Regions

The TJRR is implemented in KPs eight regions (Southern California, Northern California, Hawaii, Northwest, Colorado, Ohio, Georgia, and Mid-Atlantic). More than 350 surgeons and 50 hospitals contribute to the database. Between April 2001 and July 2012, the registry recorded more than 148,000 joint replacement procedures and adds about 6,000 hip and 12,000 knee cases annually. Participation reports are made available to sites quarterly, at least 90 days after the closing of the current reporting quarter. Clinical support, site education, and mechanisms to enhance participation are also offered by the Registry staff. Voluntary participation in the TJRR has consistently been over 95% since its inception. Participation in the registry is validated using independent operative administrative databases (KASIS and KP HealthConnect operating room management systems).

Quality Control

Complications and revisions are identified by TJRR operative and postoperative forms and KP administrative data sources using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD 9-CM) codes as a screening mechanism. Registry clinical staff validates identified complications and revisions through chart review to ensure Centers for Disease Control and Prevention (CDC) guidelines and Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSIs) criteria are met.