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A HISTORICAL LOOK AT JOINT REGISTRIES + 1969: Mayo Clinic physician Mark B. Coventry, M.D., establishes the first total joint registry. + 1975: The Swedish Knee Arthroplasty Register is established. + 1979: Research begins for the Swedish National Hip Register. + 1987: The Norwegian Arthroplasty Register begins collecting hip replacement data. + 1991: The HealthEast Joint Replacement Registry is established. + 1997: The Danish Knee Arthroplasty Registry is initiated. + 1998: The Australian National Joint Replacement Registry receives funding, and New Zealand's National Joint Registry begins a pilot study in Christchurch. + 2001: Kaiser Permanente forms the National Total Joint Replacement Registry for its member providers, and the Canadian Institute for Health Information establishes the Canadian Joint Replacement Registry. + 2002: The National Joint Registry of England and Wales is founded. + 2005: The statewide Virginia Joint Registry launches. + 2010: The American Academy of Orthopaedic Surgeons began collecting data in the American Joint Replacement Registry, with HJRR as a participant. + 2011: The Food and Drug Administration launches the International Consortium of Orthopaedic Registries, including HJRR and other registries from around the globe. surgical processes within the HealthEast system and nationwide. In one study, HJRR released results on the survivability and revision rate of all-polyethylene tibia components in total knee arthroplasty. This research demonstrated that plastic components yielded superior outcomes at lower cost compared to modular metal-backed tibia components. More recently, HJRR data showed that a specific metal-on-metal hip implant design showed a relatively high-failure rate, particularly in comparison with metal-on-polyethylene bearing surfaces. This information quickly drove a change in surgical practices, reducing usage of one particular metal-on-metal hip implant design to nearly 0% within the HealthEast system after 2009. HJRR also showed the relative sur- vival and revision rate associated with unicompartmental arthroplasty. These replacement procedures carried a higher revision rate than total knee arthroplasty. As a result of these findings, surgeons within the HealthEast system have gradu- ally diminished use of unicompartmental arthroplasty over the last decade. In some cases, this type of data has even been useful in recalls of specific implant devices. "There have been three significant recalls of hip replacement devices in the last 10 years. We were able to identify those patients within 24 hours and begin a rapid notification process," Dr. Hoeffel says. "This expedited patient care allowed surgeons to reassure patients who were concerned about the implant devices." The Future of Joint Surgery As a community resource, HJRR served as a significant influence for the development of the national American Joint Replacement Registry (AJRR), created in 2010 by the American Academy of Orthopaedic Surgeons. In fact, HealthEast was among the earliest participants. As national data is assembled and compared with registries from other countries, HJRR remains a crucial source of primary research and analysis. Current investigations include a study of the effects of larger head sizes in total hip arthroplasty, a long-term follow-up study comparing cemented Aseptic loosening (28%) and wear/osteolysis (23%) are the most common reasons for TKA revision procedures. Total Hip Arthroplasty Revision Reasons Total Knee Arthroplasty Revision Reasons Aseptic loosening (27%) and dislocation (29%) were the most common reasons for THA revision procedures. femoral stems with cementless varieties, and research concerning waste factors in total implant procedures. "Our registry is a really compelling example of how worthwhile information and advancements in orthopedic science can be made in a community setting," Dr. Gioe says. "The AJRR is a really large and important database, but smaller registries will still be required to look at certain subsets of data. Our role is chang- ing, but that won't take anything away from what we've already accomplished." For more information about orthopedic services available within the HealthEast Care System, visit www.healtheast.org/ orthopaedic-care. ■ MDNEWS.COM ■ MD NEWS Twin Cities | 13