India Joining the World of Hip and Knee Registries: Present Status-A Leap Forward

Abstract

Background: The number of joint replacements in India is set to grow at the highest rate in the world from 2020 to 2026. It is high time for India to have an efficient and credible registry to help curtail the clinical impact of implant failure at a very early stage by prompt reporting.

Methods: Indian Joint Registry has been established by ISHKS with new data forms for reporting. These new detailed forms record, in addition to previous form, component-wise details of implants. Additional useful features include Linking with unique ID like PAN or Aadhaar, thromboprophylaxis, untoward intra-operative event, IJR consent and type of anaesthesia.

Results: There were 712 registered surgeons in IJR database till June 2020. Total TKRs being reported to registry increased from 1019 in 2006 to 27,000 in 2019. Majority of the patients (98.5%) were diagnosed with osteoarthritis knee. Company-wise distribution unveils that Johnson & Johnson DePuy represents the highest implant usage at over 37%. There has been increased utilisation of uncemented THR over cemented THR from 2006 to 2019. Dual-mobility THRs have gained ground as surgeon preference for the choice of implant.

Conclusion: Effective use of quality registries can lead to better health outcomes at a lower cost for the society. An effective, responsive and sustainable registry in India offers many benefits and should be considered as a key objective. Making the registry function in India successfully will undoubtedly require multi-pronged efforts, but can deliver many benefits both to the patient and to the nation as a whole.

Keywords: Indian Joint Registry; Indian Society of Hip and Knee Surgeons; Revision; Total hip arthroplasty; Total knee replacement.

Fig. 1

Region-wise distribution of contributing surgeons. Surgeons from Gujarat have contributed the highest number of TKRs (21,283) and THRs (653) to the registry in the period from April 2016 to August 2017 and April 2019 till date whereas surgeons from Kerala have reported the least number of surgeries (6 TKRs and 1 THRs)

Fig. 2

Operation funding of joint replacement surgeries reported to the IJR

Fig. 3

Total number of TKRs recorded on the registry in India year-wise

Fig. 4

Type of implant utilised for TKR in the year 2019

Fig. 5

Percentage of patella being resurfaced while doing TKRs

Fig. 6

Company-wise distribution of implants being utilised for TKR

Fig. 7

Total no. of revision TKRs being reported to the registry year-wise

Fig. 8

Reasons for revision TKR

Fig. 9

Total number of THRs being reported year-wise

Fig.10

Uncemented (red bars) vs cemented THRs (blue bars) being reported year-wise

Fig. 11

Total number of dual-mobility THRs being reported year-wise