a940 National Joint Registry (NJR)
National clinical audit & registries
National Clinical Audits (including the NCAPOP programme and CORP Confidential Enquiries)
Clinical databases and registers
Everyone Counts - planning for patients: more transparency
Multi-site Clinical Audit Programme
Wales: Clinical Audit and Outcome Reviews (Confidential Enquiries)

National Joint Registry

The National Joint Registry (NJR) was established in 2002 to improve patient care by finding out more about joint replacement implants and surgery, carried out in both the NHS and independent healthcare sector in England, Wales and Northern Ireland.

Data collection began in April 2003 and the registry now holds over 1.3 million records and more records about certain procedure types than any other registry in the world. As a result of the increasing volume and quality of data it is possible to make accurate analysis available to all stakeholders and contribute significantly to good practice and patient safety.

The NJR has collected data about hip and knee joint replacements since 2003, ankle joint replacements since 2010 and elbow and shoulder joint replacements since April 2012. 

ANNUAL REPORT

NJR Annual Reports analyse the data submitted to the NJR, and highlight the aims and achievements of the National Joint Registry, its Steering Committee and its sub-committees and are released in September each year. The key analyses of the NJR's 9th, and latest, Annual Report - covering 2011/12 data - were presented at the British Orthopaedic Association Annual Congress in Manchester on Thursday 13 September 2012.

Download the full NJR 9th Annual Report 2012 (pdf) >>

Download the Welsh translation of Part One - NJR 9th Annual Report (pdf) >>

As well as a wealth of new data to help clinicians improve the quality and outcomes of hip, knee and ankle joint replacements, this year's report includes Trust-, Health Board- and unit-level data for hip and knee procedures for the first time.

The structure of the NJR Annual Report is now divided into four main parts:

• Part one: an overview of activity for the financial year 1 April 2011 to 31 March 2012. This provides statistical highlights of the data provided during 2011/12, summarises major developments, and outlines proposed work for 2012/13.

• Part two: a description of hip and knee joint replacement activity as reported to the NJR in the calendar year 1 January to 31 December 2011. Also included here is reporting on ankle joint replacement surgery, which became part of the NJR as of 1 April 2010.

• Part three: this provides an analysis of survivorship of hip and knee joint replacement surgery, using data submitted to the NJR from 1 April 2003 to 31 December 2011.

• Part four: this provides a report on clinical activity and outcomes at both Trust-, Health Board- and unit-level on a range of indicators for hip and knee replacements. This is a new addition for 2012 and is being published as part of the Government's transparency agenda, the NJR intends to build in this level of reporting in the future.

2012 report highlights

  • Data from 1.2 million procedures
  • Highest-ever patient consent rates (90.4%)
  • First complete year of ankle data included
  • Extended and updated survivorship reporting made possible through a more sophisticated method of classifying implant components
  • Special topics: Papers and analysis on metal-on-metal hip replacements
  • Trust-, Health Board- and unit-level activity and outcomes data for hip and knee procedures

Previous editions of the Annual Report can be downloaded here >>

Public and Patient Guide to the 9th Annual Report (published 2012)

The NJR has produced a Public and Patient Guide to its 9th Annual Report.  A second edition in 2012, the NJR is among the first registries to publish a patient guide of this type.  The document takes over 150 pages of surgical data produced by the NJR and breaks it down into more accessible and relevant information for patients.

Download the Public and Patient Guide to the 8th Annual Report here >>

AIMS of the NJR:

As part of the development of the 2012-14 NJR strategic plan, its aims were reviewed to take into account maturity of the registry and the NJR's growing involvement, impact and engagement with its stakeholders. These aims continue to be met, either by the NJR alone or through its work with key stakeholders and partners.

The key aims of the registry are to:

  • Monitor in real time the outcomes achieved by brand of prosthesis, hospital and surgeon, and highlight where these fall below an expected performance in order to allow prompt investigation and to support follow-up action.
  • Inform patients, clinicians, providers and commissioners of healthcare, regulators and implant suppliers of the outcomes achieved in joint replacement surgery.
  • Evidence variations in outcome achieved across surgical practice in order to inform best practice.
  • Enhance patient awareness of joint replacement outcomes to better inform patient choice and patients' quality of experience through engagement with patients and patient organisations.
  • Support evidence-based purchasing of joint replacement implants for healthcare providers to support quality and cost-effectiveness.
  • Support suppliers in the routine post-market surveillance of implants and provide information to clinicians, patients, hospital management and the regulatory authorities.

ORGANISATION of the NJR:

NJR Steering Committee
The NJR Steering Committee oversee the strategic direction and work programme of the registry and is a DH Committee of Experts. Membership includes representatives of the surgical profession, patient groups, orthopaedic implant suppliers, public health/epidemiology, NHS purchasing and supply agency, Medicines and Healthcare products Regulatory Agency, NHS Trust Management, Independent Healthcare Sector, and the Welsh Government.

HQIP supports the work of the steering committee, including the implementation of its strategic plans and development work on its behalf. HQIP manages the levy payment collections and holds the budget of the steering committee. The development team in HQIP, led by Elaine Young, supports the NJR.

Regional Clinical Coordinators Network
Regional Clinical Coordinators are consultant orthopaedic surgeons who act as NJR local ‘champions' to ensure that the benefits of the NJR are understood and encourage compliance with NJR data requirements.

NJR Centre
The NJR Centre manages the development and running of the NJR database for all data collection and analysis. It is managed by Northgate Information Solutions (UK) Ltd under contract with the Healthcare Quality improvement Partnership, (and previously with the Department of Health).

Levy
The NJR is self financing and funded through a levy raised on the sale of hip, knee, ankle, elbow and shoulder replacement implants. The rate of levy is set by the NJR Steering Committee in consultation with the Department of Health.

Participation
Data submission for NHS organisations to the National Joint Registry of England and Wales (NJR) has been confirmed as mandatory by the Department of Health and Welsh Government.

The NJR joins the rest of the National Clinical Audit and Patient Outcomes Programme (NCAPOP - commissioned and managed by HQIP), which saw confirmation earlier this year of the mandatory status of all projects under the NHS Standard Contract for Acute Services as of 1 April 2011.

NJR Newsletter
The NJR newsletter (Joint Approach) is published quarterly and is full of useful information.  View the latest and previous copies here >>

NJR Website:
Further details can be found on the NJR website with regular updates published on the NJR News and Events page.

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