New Zealand Joint Registry data underestimates the rate of prosthetic joint infection

Abstract

Background and purposeRecent studies have revealed deficiencies in the accuracy of data from joint registries when reoperations for prosthetic joint infections (PJIs) are reported, particularly when no components are changed. We compared the accuracy of data from the New Zealand Joint Registry (NZJR) to a multicenter audit of hospital records to establish the rate of capture for PJI reoperations.Methods4,009 cases undergoing total knee or hip arthroplasty performed at 3 tertiary referral hospitals over a 3-year period were audited using multiple hospital datasets and the NZJR. The number of reoperations for PJI that were performed within 2 years of the primary arthroplasty was obtained using both methods and the data were compared.ResultsThe NZJR reported a 2-year reoperation rate for PJI of 0.67%, as compared to 1.1% from the audit of hospital records, giving the NZJR a sensitivity of 63%. Only 4 of 11 debridement-in-situ-only procedures and 7 of 12 modular exchange procedures were captured in the NZJR.InterpretationThe national joint registry underestimated the rate of reoperation for PJI by one third. Strategies for improving the accuracy of data might include revising and clarifying the registry forms to include all reoperations for PJI and frequent validation of the registry data against other databases.

Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees

“…However, such registries lack clinical and radiologic data, making accurate analysis of revision indications difficult. Additionally, some studies show registry capture of certain revision indications is poor [12,28]. In the current study, we combined local hospital data with national joint registry data to provide more-complete followup of patients who have undergone TKA during a long period and to allow accurate clinical and radiographic analyses of these indications.…”

“…Although registry data often have the indication for revision TKA, interpretation is limited by the lack of standardized definitions of revision reasons and objective assessment of radiologic and laboratory parameters [22]. In addition, one study suggested that registry-recorded indications for revision TKA are often inaccurate, particularly regarding periprosthetic joint infections (PJI) [28]. By contrast, large series of revision TKAs from tertiary referral centers are able to provide a more-accurate assessment of revision reasons because standardized definitions can be used.…”

One-year incidence of prosthetic joint infection in total hip arthroplasty: a cohort study with linkage of the Danish Hip Arthroplasty Register and Danish Microbiology Databases

“…This was instrumental for achieving valid estimates of PJI trend, the microbiological spectrum of PJI, and the antimicrobial resistance pattern. However, validated data on PJI can be obtained in different ways, e.g., by combination of other registers, such as prescription registers 9 or medical records review 45 .…”

Operation rate is more than double the revision rate for periprosthetic femur fractures

“…In these circumstances, where the prostheses are retained (not revised), cases of PFF would not necessarily be recorded by a registry. A similar situation occurs for infection after primary THA, where registries may under report prosthetic joint infection between 33% and 40% by only including those treated with implant revision …”

“…A similar situation occurs for infection after primary THA, 10 where registries may under report prosthetic joint infection between 33% and 40% by only including those treated with implant revision. 11,12 The Australian Orthopaedic Association National Joint Replacement Registry has reported that revision for fracture is the third most common reason for revision (20.3%) in THA performed for osteoarthritis, after loosening (25.0%) and dislocation (21.1%). 5 For a primary diagnosis of fractured neck of femur, fracture is the second most common reason for revision (27.4%), after dislocation (32.5%).…”