Introducing FORCE-TJR – New National Database

Meet the database with a name. Funded by the Agency for Healthcare Research and Quality and called FORCE-TJR, this is the first comprehensive U.S. database on total hip and knee joint replacement patients and their surgical outcomes.

Total hip and knee joint replacements (THR/TKR/TJR) are the most common inpatient surgical procedures performed in the United States and the greatest expense in the Medicare budget, according to FORCE-TJR steering committee member Joan A. McGowan, Ph.D. “The FORCE-TJR database is the first to allow independent assessment of total joint replacement effectiveness in terms of both implant performance and improvement in patient pain and physical function, ” she said.

The database will be the first to identify risk-adjusted national benchmarks, including patient risk factors that can guide surgeon and patient decision making regarding the timing of surgery and optimal patient selection.

Among the proposed benefits is the ability to more effectively time surgery. The release notes that TJR patients who wait too long to have surgery or have it too early, may not gain the highest level of improvement possible after a TJR. The database will allow for comparisons of patient risk factors and outcomes. Surgeons will be able to compare their own patients’ risk factors against national data and make adjustments if necessary.

There will be outcome data on the surgeries of individuals under the age of 65 who make up more than 40% of all TJR patients. This age group forms the fastest growing TJR population. For the first time, patients younger than 65 have more musculoskeletal risk factors, such as multiple painful joints or low back pain, than does the older population.

The database proponents note that FORCE-TJR goes beyond the traditional collection of information on only implant device failures or repeat surgeries. FORCE-TJR includes patient-reported measures of pain and function, pre- and post- surgery, as well as clinical measures such as readmission and infection rates, adverse events and co morbidities.

“With this data, for the first time, we can compare patients’ physical outcomes with varied implants, surgical approaches and follow-up programs. We have benchmarks to use to see where our patients fail on a national spectrum both pre and post-surgery, ” said David Ayers, M.D., co-lead of FORCE-TJR and chair of the Department of Orthopaedics and Physical Rehabilitation at the University of Massachusetts Medical School. “The data s invaluable for developing best practices, ” he added.