The financial impact of joint registries in identifying poorly performing implants.

We analyzed the effect of the Australian National Joint Registry on the cost of joint arthroplasty through identification of implants with higher than expected failure rates. From 2003 to 2007, 242,454 primary joint arthroplasties were performed in Australia at a total cost of $4.1 billion. Of these cases, 19,224 were performed using components identified by the Registry as poorly performing. If all of these cases were performed using average-performing designs, the number of revisions would have dropped by 28.6%. We also predicted that over a 5-year period after Registry identification, 32,807 primary procedures would be performed using poorly performing implants. If implants of average longevity were selected instead, we predict that 25.8% fewer revision procedures would be needed, ranging from 7% in unicompartmental knee replacement to 47% in total hip arthroplasty. This change in practice is expected to save 10.2% of direct costs, corresponding to $14 million over a 5-year period.