School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia.
Acta Orthop. 2013 Aug;84(4):348-52. doi: 10.3109/17453674.2013.831320.
Joint Replacement Registries play a significant role in monitoring arthroplasty outcomes by publishing data on survivorship of individual prostheses or combinations of prostheses. The difference in outcomes can be device- or non-device-related, and these factors can be analyzed separately. Although registry data indicate that most prostheses have similar outcomes, some have a higher than anticipated rate of revision when compared to all other prostheses in their class. This report outlines how the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has developed a method to report prostheses with a higher than expected rate of revision. These are referred to as "outlier" prostheses.
Since 2004, the AOANJRR has developed a standardized process for identifying outliers. This is based on a 3-stage process consisting of an automated algorithm, an extensive analysis of individual prostheses or combinations by registry staff, and finally a meeting involving a panel from the Australian Orthopaedic Association Arthroplasty Society. Outlier prostheses are listed in the Annual Report as (1) identified but no longer used in Australia, (2) those that have been re-identified and that are still used, and (3) those that are being identified for the first time.
78 prostheses or prosthesis combinations have been identified as being outliers using this approach (AOANJRR 2011 Annual Report). In addition, 5 conventional hip prostheses were initially identified, but after further analysis no longer met the defined criteria. 1 resurfacing hip prosthesis was initially identified, subsequently removed from the list, and then re-identified the following year when further data were available. All unicompartmental and primary total knee prostheses identified as having a higher than expected rate of revision have continued to be re-identified.
It is important that registries use a transparent and accountable process to identify an outlier prosthesis. This paper describes the development, implementation, assessment, and impact of the approach used by the Australian Registry.
关节置换登记处通过发布有关个体假体或假体组合的生存率数据，在监测关节置换结果方面发挥着重要作用。结果的差异可能与器械或非器械相关，并且可以分别分析这些因素。尽管登记处数据表明大多数假体的结果相似，但与同类中的其他所有假体相比，某些假体的翻修率高于预期。本报告概述了澳大利亚矫形协会国家关节置换登记处（AOANJRR）如何开发一种报告翻修率高于预期的假体的方法。这些被称为“异常”假体。
自 2004 年以来，AOANJRR 已经开发出一种识别异常的标准化流程。这是基于一个由三个阶段组成的过程，包括一个自动化算法、登记处工作人员对个别假体或假体组合的广泛分析，最后是一个涉及澳大利亚矫形协会关节置换学会小组的会议。异常假体在年度报告中列出为 (1) 已识别但不再在澳大利亚使用，(2) 已重新识别且仍在使用，和 (3) 首次识别。
使用这种方法，已经确定了 78 个假体或假体组合是异常的（AOANJRR 2011 年度报告）。此外，最初确定了 5 个常规髋关节假体，但经过进一步分析，它们不再符合定义的标准。最初确定了 1 个髋关节表面假体，随后从列表中删除，次年在有更多数据时再次被识别。所有被确定为翻修率高于预期的单髁和原发性全膝关节假体都继续被重新识别。
登记处使用透明和负责的流程来识别异常假体非常重要。本文描述了澳大利亚登记处使用的方法的开发、实施、评估和影响。
