American Joint Replacement Registry Releases 10th Annual Report

The American Joint Replacement Registry (AJRR), the cornerstone of the American Academy of Orthopaedic Surgeons (AAOS) Registry Program, has published its 2023 Annual Report on current hip and knee arthroplasty procedural trends and patient outcomes. Marking the report’s 10th anniversary, the data represents more than 3.1 million primary and revision hip and knee arthroplasty procedures performed between 2012 and 2022. This is a 23% growth in procedural cases from the prior report.
 
“This year’s AJRR Annual Report presents a glimpse into the data over the last decade through 2022 and provides clinical insights, national trends and risk-stratified outcome analyses related to Medicare patients who undergo hip and knee arthroplasty procedures,” said James I. Huddleston III, M.D., chair of the AJRR Steering Committee. “This linkage provides a more complete picture of our patient population and their associated comorbidities and outcomes, including longitudinal outcomes of patients who receive care at non-AJRR participating sites. The information in this year’s Annual Report gives the most comprehensive picture to date of patterns of hip and knee arthroplasty practice and outcomes in the U.S.”
 
Leveraging the Power of Registry Data to Improve Patient Care
With the collection and reporting of U.S. hip and knee arthroplasty data, the report aims to provide valuable information to orthopedic surgeons, hospitals, ambulatory surgery centers (ASCs), private practices, device manufacturers, payers and most importantly, patients. Its analyses can help clinicians change practice and improve patient outcomes.
 
The AJRR is the largest orthopaedic Registry by annual procedure count. Some notable findings in the 2023 Annual Report include:

• Patient-Reported Outcome Measures (PROMs) are increasingly being utilized to evaluate the success of a hip or knee arthroplasty procedure. Through continued support of the RegistryInsights PROM platform and partnerships with third-party vendors, AJRR has experienced substantial growth in PROMs capture. By the end of last year, 496 participating sites submitted PROMs, a 24% increase compared to the previous year. Collection of PROMs data through the KOOS, JR. score revealed that 86% of patients achieved a meaningful improvement after total knee arthroplasty (TKA).
• Ambulatory surgery centers (ASCs) continue to play an increasingly important role in the delivery of total joint arthroplasty care in the United States. There are now 42,228 procedural cases reported by ASCs, an 84% increase since 2022.
• Hospital discharges to home versus a skilled nursing facility trend upward: Approximately 93% of patients are now being discharged to home following elective primary total hip arthroplasty (THA) with far fewer patients (8%) being discharged to skilled nursing facilities compared to just a few years ago. The percentage of patients being discharged to skilled nursing following primary TKA also continues to decrease and now represents less than 6% of all discharges. This data demonstrates surgeons’ ongoing commitment to transitioning patients safely back to their home environment as well as their interest in patient preoperative optimization and care coordination.
• The rate of technology use for assistance in elective primary total hip arthroplasty has increased substantially. Over the past six years, the utilization of robotics in TKA has increased over six-fold and is now reported in more than 13% of procedures, whereas computer navigation use has remained relatively stable. According to Huddleston, the continued collection and analysis of robotic data will eventually allow surgeons to assess the value proposition of these technologies.
• New analyses offer new perspectives on patient outcomes. Additional analyses provided for the first time in the 2023 AJRR Annual Report including hip and knee survivorship comparisons between pre- and post-COVID-19 emergency declaration, revision outcome following revision THA between dual mobility and standard designs, and survivorship among fracture patients treated with THA vs. hemiarthroplasty. These new analyses offer critical insights into the impact of COVID-19 on patients and shed light on the performance of new technologies and treatment paradigms.
• Peer-reviewed publications and presentations based on registry data continue to be an important focus of AJRR. 

“The publication of the 10th edition of the AJRR Annual Report further validates the commitment of healthcare institutions, clinicians and patients to improving the quality of musculoskeletal care,” said James A. Browne, M.D., chair of the AJRR Publications Subcommittee and editor of the AJRR Annual Report. “The ever-growing submission and compilation of data is driving new insights and fueling our desire to improve the value of care for our patients.”
 
The AAOS Registry Program aims to improve orthopedic care through the collection, analysis, and reporting of actionable data. The AJRR, the Academy’s hip and knee replacement registry, is the cornerstone of the AAOS’s Registry Program, and the world’s largest national registry of hip and knee joint replacement data by annual procedural count, with more than 3 million procedures contained within its database. Additional registries include the Fracture & Trauma Registry (FTR), the Musculoskeletal Tumor Registry (MsTR), the Shoulder & Elbow Registry (SER), and the American Spine Registry (ASR), a collaborative effort between the American Association of Neurological Surgeons (AANS) and the AAOS. 
 
With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world’s largest medical association of musculoskeletal specialists. The AAOS provides education to help orthopedic surgeons and allied health professionals best treat patients. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues.