AAOS will move forward on joint registry

By G. Jake Jaquet
Board votes to take next step; approves position statements

At its meeting on Monday, the AAOS Board of Directors received a report from David G. Lewallen, MD, chair of the American Joint Replacement Registry (AJRR) Oversight Board, reviewed the results of a consumer and surgeon study on the image of the orthopaedic surgeon, and adopted several new position statements.

David A. Halsey, MD, chair of the Council on Advocacy, presented the position statements to the Board.

Next steps for joint registry

According to Dr. Lewallen, the joint registry is a long-term data collection and follow-up project that would gather prospective data on patients in U.S. hospitals with total joint replacements (TJRs). Initially, the registry would focus on hip and knee replacements, with the potential to expand to other anatomic areas, such as the shoulder, ankle, or spine.

The registry would collect demographic data, laterality, and device information. Data would be collected for the primary procedure, any revision, and at death, following the life-cycle of the implanted device. The registry would embody the following four national goals that speak to patient safety:

  • Establish an infrastructure and a uniform system for collecting implant device data and monitoring TJR outcomes throughout the United States
  • Identify patients who may need follow-up evaluation
  • Create real-time survivorship curves to detect poorly performing implants
  • Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research

Dr. Lewallen explained that the AJRR Oversight Board has sought proposals from organizations qualified to provide comprehensive project management assistance in response to the December 2008 Board action that a basic registry be implemented within approximately 12 months. He then requested and received Board approval for a $300,000, 12-month budget for project management assistance.

Image survey results reported

John R. Tongue, MD, provided preliminary results of the recently concluded orthopaedic surgeon image study. The study, which paralleled a similar study conducted in 1998, found that more consumers today are familiar with the profession of orthopaedics than in 1998 (57 percent v 49 percent). Consumers also rate orthopaedists higher in areas such as highly trained, caring and compassionate, spending time, successful results, and research-oriented. Overall, consumers noted significant improvement in all nine categories.

Surprisingly, orthopaedic surgeons today have a much more modest view of themselves than 10 years ago. When asked to rate themselves as they believe their patients view them, orthopaedists rated themselves lower in all categories, compared to 1998. For example, while 75 percent of consumers rate orthopaedists as highly trained, only 62 percent of orthopaedists say their patients would describe them in that way.

One interpretation of this trend, Dr. Tongue reported, is that surgeons today have a more sober appreciation of their image, as do their patients.

Three position statements approved

The Board approved new versions of two existing position statements (retiring the earlier versions)

and approved one new position statement.

As a result, the position statement on “Value Driven Use of Ortho­paedic Implants” replaces the one on “Containing the Cost of Ortho­paedic Implants.” The new statement incorporates wording that better reflects the current environment with respect to implant selection.

The position statement on “Gainsharing” is being replaced by one titled “Alignment of Physician and Facility Payment and Incentives,” which better addresses the current environment.

Recognizing the need to provide guidance to the AAOS office of government relations and to set forth some general principles, the Board approved a new statement on “Principles of Health Care Reform and Specialty Care.” The statement covers issues such as the uninsured, financing issues in health care, patient empowerment and personal responsibilities, finding alternatives to the “medical home” concept, ensuring patient access to specialty services, emergency department care, antitrust relief, medical liability reform, reducing administrative costs, health information technology, professionalism, workforce and graduate medical education, and medical care for non-citizens.

The statement concludes, “As we approach the great public debate on healthcare reform in America, the AAOS believes that preserving the autonomy of the doctor-patient relationship is of the highest priority … All Americans are or will become patients. Implementing a reformed public-private partnership healthcare system that reflects the principles addressed will serve this and future generations with meaningful universal coverage and real access for all.”