1	The Norwegian Arthroplasty Register AAOS Chicago, March 2006 Leif Ivar Havelin, MD Geir Hallan, MD
2	"Main object" Main object Validation of data Publications Results Compliance Reporting procedures Economy
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4	Object Identification of inferior implants must be clearly inferior Examples Boneloc¹ Tropic / Atoll² Biofit / Femora³
5	Validation Compared registry data with data from Norwegian Patient Register 98-99% data completeness (2006) National Institute for Hospital Research 95-97% data completeness (1999) local hospitals^2,3 93% data completeness (small hospital,1998) 99.6% data completeness (large hospital, 2005) questionnaires to patient cohorts (1999)
6	"Completeness lower for smaller joints" Completeness lower for smaller joints Completeness lower for removal revisions Girdlestone 80% Knee 62% Ankle 10% Hand 9%
7	Publications Implant and cement; Survival Epidemiology Revision Mortality Effect of antibiotics Patient satisfaction and function Economy Effect of hospital type, op. volume and -time Disease-specific outcome, surgical approach Validation of data
8	Epidemiology Incidence 2005 TKA 67 / 100.000 / y THA 162 / 100.000 / y
9	Epidemiology, cont.
10	THA; Results
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12	Results; TKA Reported 98%¹ Primary TKA Revision TKA
13	Summary Excellent compliance Good quality data Thank you…
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15	The hip registry data collection paper forms versus electronic data entry a high level of compliance, why ? staff costs finances
16	Hip registry: Methods All hospitals and all orthopaedic surgeons all primary prostheses all revisions By use of the national ID numbers: revisions are linked to their primary operations dates of deaths from the Population Registry Survival analyses are performed
17	Data collection Paper form 1 page filled in by the surgeon immediately after each operation 1-2 minutes Stickers with implants’ catalogue numbers are delivered with the implants data entry by the secretaries located in the registry Access Oracle
18	Databases Operations: Patients’ I.D. numbers Prosthetic components: by brand code and catalogue numbers cup liner head stem
19	Paper form vs electronic data entry paper forms are available in the OR, fast and easy for the surgeons bar codes for implants electronic data entry in hospitals hospitals have different PAS and OR databases difficult to make a program compatible with these difficulties with maintenance of implant databases locally data quality ? correct registration of implants might be difficult web based reporting -- present situation: log on with a password needed systems are not compatible: double registration of patients’ ID and data from operations
20	Paper form vs electronic data entry electronic data entry: Sweden: web based: reduced set of data data entry by secretaries locally at the hospitals information also sent on paper (patients’ journals) Awaiting a new “Network for the health care system” better data security Awaiting the solutions of the mandatory registries Birth registry Cancer registry Why change of a well functioning old system ?
21	Compliance Norway: 4.5 million inhabitants and about 300 orthopaedic surgeons Reporting: Easy and fast on paper forms Surgeons’ names are not registered: a condition for participation by some some surgeons operate on high-risk patients Hospitals’ names are registered Hospitals get their own results back: Compare results with other hospitals Compare results with the national average results Hospital-results are only delivered to our contact surgeon at each hospital never published and not delivered to health authorities
22	Compliance Feedback to surgeons All surgeons get our annual report Descriptive statistics and summary of findings Surgeons get results on different implant brands Presented at orthopaedic meetings Scientific publications articles in journals book chapters papers, posters at national and international conferences
23	Compliance Cooperation and support in studies that are performed at the hospitals data delivery support statistics writing
24	Staff Joint replacement registry 1,6 secretary for data entry 1 statistician (cooperation with 2 others) 1 IT expert 1 orthopaedic surgeon split by Engesæter Furnes Hallan Havelin
25	Costs Running of the arthroplasty registry Cost per registered implant 27 USD
26	Finances All registries (joint replacement, hip fracture, ACL) about 700.000 USD annually Financed by the health authorities Regional health authorities 50% Haukeland University Hospital 50% No financial support from the industry
27	Thank you !