Each year, more than 700,000 US adults elect total joint replacement (TJR) surgery to restore physical function and eliminate the pain of advanced knee or hip arthritis that persists despite comprehensive medical treatment. Despite broad use, wide variation persists in surgical practice and outcomes. Furthermore, there is a lack of comparative effectiveness data to guide surgeon and patient decisions on optimal implant timing, surgical approach, implant selection, and peri-operative management to prevent adverse sequelae and revision. Therefore, the National Orthopedic Outcome Registry (NOOR) and Cohort Study will establish a national registry of over 33,000 diverse patients of 130 orthopedic surgeons representing all regions of the country and varied hospital and surgeon practice settings. As such, the registry is designed to reflect typical US clinical practice, rather than focusing exclusively on high-volume academic centers. Data will include baseline patient attributes;procedure approach and technology;hospital course;surgeon and institutional characteristics;longitudinal patient function, post-procedure complications and revisions, and serum/DNA samples. Web-based data collection will enhance efficient data gathering. The research team will develop new outcome measures and will determine the relative contributions of patient factors, technology use, and delivery factors to (1) early functional failure and (2) adverse post-arthroplasty events;(3) examine disparities in TJR use and outcome, seeking to elucidate root causes;and (4) conduct economic analyses to determine the personal and societal value of TJR in working aged adults. A national network of orthopedists will partner with innovative scientists with expertise in large-scale registry development and implementation, web-based technology, outcome measurement, and statistical techniques to assure success. Sound governance principles will ensure efficient implementation. The registry will actively encourage ancillary research to assure optimal use of all data and biomaterials. We propose to transform the network of clinical centers and orthopedic offices into a research laboratory that will serve as a national model for comparative effectiveness research.

Public Health Relevance

The proposed national orthopedic outcome registry will collect important patient, surgical, and delivery setting data to answer critical patient and surgeon questions about optimal implant selection, surgical timing and approach, and peri-operative care for the large number of patients who undergo total joint replacement and other procedures each year. Research will also address TJR value in young patients and use disparities,

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Specialized Center (P50)
Project #
5P50HS018910-03
Application #
8331860
Study Section
Special Emphasis Panel (ZHS1-HSR-O (01))
Program Officer
Berliner, Elise
Project Start
2010-09-30
Project End
2014-09-29
Budget Start
2012-09-30
Budget End
2013-09-29
Support Year
3
Fiscal Year
2012
Total Cost
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Orthopedics
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
01655
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Rolfson, Ola; Wissig, Stephanie; van Maasakkers, Lisa et al. (2016) Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group. Arthritis Care Res (Hoboken) 68:1631-1639
Chimenti, Peter C; Drinkwater, Christopher J; Li, Wenjun et al. (2016) Factors Associated With Early Improvement in Low Back Pain After Total Hip Arthroplasty: A Multi-Center Prospective Cohort Analyses. J Arthroplasty 31:176-9
Ayers, David C; Fehring, Thomas K; Odum, Susan M et al. (2015) Using joint registry data from FORCE-TJR to improve the accuracy of risk-adjustment prediction models for thirty-day readmission after total hip replacement and total knee replacement. J Bone Joint Surg Am 97:668-71
Franklin, Patricia; Nguyen, Uyensa; Ayers, David et al. (2015) Improving the criteria for appropriateness of total joint replacement surgery: comment on the article by Riddle et Al. Arthritis Rheumatol 67:585
Ayers, David C; Li, Wenjun; Harrold, Leslie et al. (2015) Preoperative pain and function profiles reflect consistent TKA patient selection among US surgeons. Clin Orthop Relat Res 473:76-81
Ayers, David C; Li, Wenjun; Harrold, Leslie et al. (2015) Reply to the letter to the editor: preoperative pain and function profiles reflect consistent TKA patient selection among US surgeons. Clin Orthop Relat Res 473:395-6
Franklin, Patricia D; Lewallen, David; Bozic, Kevin et al. (2014) Implementation of patient-reported outcome measures in U.S. Total joint replacement registries: rationale, status, and plans. J Bone Joint Surg Am 96 Suppl 1:104-9
Ayers, David C; Franklin, Patricia D (2014) Joint replacement registries in the United States: a new paradigm. J Bone Joint Surg Am 96:1567-9
Zheng, Hua; Li, Wenjun; Harrold, Leslie et al. (2014) Web-based Comparative Patient-reported Outcome Feedback to Support Quality Improvement and Comparative Effectiveness Research in Total Joint Replacement. EGEMS (Wash DC) 2:1130

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