Main objective of Indian Joint Registry is to help patient safety, bring stability to the market

In the wake of several patients suffering from the impact of faulty hip implants, it is vital that India has a national joint registry to track such patients and avoid future episodes. Richard Armstrong, Head, Health Registries, Northgate Public Services tells Viveka Roychowdhury about the response to the Indian Joint Registry

What has been the progress since the launch of the Indian Joint Registry (IJR) in April 2019?

We have been successful in registering doctors and hospitals on IJR who have contributed 28,364 records of which 2,274 are hip procedures and 26,090 knee procedures. With the data available and tracking of the implant performance, we will be able to identify the faulty implants and get it replaced from a better performing one, saving the patient from harm. The implant tracking will ensure that the manufacturers are more careful and conduct proper research and testing before the product launch. The main objective of IJR is to help patient safety and bring stability in the market, avoiding past issues with faulty implants as we had seen with the Johnson & Johnson episode in India .

Kindly share results of the pilot study started in April 2016, which ran for 9 months with 7 doctors participating across 4 cities in India. Did the procedure need tweaking for the India market?

The pilot has evidenced that doctors in India are willing and able to document their cases, and to track the long term outcomes of patients. Whilst this requires a small amount of time and effort on behalf of the hospital staff to ensure data is entered into the system, doctors have shown that the value delivered from the registry makes this effort worthwhile to enable long term tracking of patient outcomes. The pilot highlighted trends in clinical practice across India, detailing the types of implants in common use, and the common types of procedures undertaken. This was compared across different hospitals, and also in comparison to data from other registries from around the world. (See visuals giving details of

How many surgeons, hospitals have now signed up from India?

The IJR was officially launched in April 2019, since then we have registered 697 doctors and 713 hospitals as of January 20, 2020.

How does a national implant registry work? Which are the countries which have such registries?

A registry collects information on patients undergoing hip and knee replacement in India, to monitor the performance of implants, to assure high standards of care, and to further research into best practice. The UK has been running the Joint Registry for a decade now. Australia, US and some European nations have been successfully maintaining their joint registries for years.

What is the role of Northgate Public Services in these registries?

Northgate Public Services is the technology partner and has developed the Indian Joint Registry. NPS has been maintaining the IJR to enable hospitals across India to submit data securely and efficiently. Northgate Public Services has been the technology and implementation service provider for the NHS in the UK for the National Joint Registry (NJR) since last 16 years. NPS is also the technology partner for Eurospine, the world’s largest spine registry. We also are the partner for NHS for National Vascular Registry.

Any initial success stories of how the information gained so far in the registry has helped orthopaedic surgeons to recall implants, or better their clinical practice?

We have developed the National Joint Registry (NJR) in the UK, the world’s largest joint registry which has over three million records. Our team has been working closely with the NJR team to study and analyse the data. Through this data, NJR identified higher than expected revision rates among patients with metal-on-metal hips, which led to a global recall of a number of implants. (https://www.theguardian.com/society/2018/nov/26/firm-pays-out-nhs-defective-hip-replacements)

How can patients be assured that their data is not compromised?

The data is stored and processed securely by the technical partner, Northgate Public Services. Strict rules and secure procedures are in place to ensure that information is kept safe. Patient’s personal details are only shared with surgeons directly involved in their care. Northgate Public Services comply with Indian law, and also apply the same rules and procedures for handling data as it does for NHS data, in accordance with UK and European laws on data protection.

The patients are asked to sign the consent form, which gives permission to the IJR to use their data for the following purpose:

• For monitoring the performance of implants, ensuring patient safety, improving the outcomes of joint replacement surgery, and enabling orthopaedic research in India
• Allowing your personal details to be used for the purpose of contacting you to ask you to complete the questionnaire about how you are getting on after your surgery. We may also invite you to take part in research projects.

How do patients benefit from such an initiative?

IJR will benefit patients in a number of important ways. It will :

• Monitor the performance of implants so that potential problems can be identified early.
• In the case of failing implants being identified, assist hospitals in the recall of patients for review.
• Provide information to patients so that they can make informed decisions about the types of treatment available and where to get it.
• Provide assurance to patients about the safety and the quality of care that they receive.
• Provide information to surgeons, hospitals, and implant manufacturers to ensure that the highest standard of care is given to patients.

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