The American Joint Replacement Registry (AJRR) has just released its 2017 Annual Report on hip and knee arthroplasty data at the American Association of Hip and Knee Surgeons (AAHKS) 2017 Annual Meeting.
AJRR: 2017 Annual Report on 860,000 Hip, Knee Arthroplasties

According to AJRR, “The 2017 Annual Report analyzes data on 860,080 hip and knee replacement procedures from 4,755 surgeons at 654 institutions.”
“It has a section on overall results, as well as individual sections analyzing primary and revision hip and knee procedural data. There are sections providing information on the Registry’s collaborative projects, yearly data audit, 2017 accomplishments, and future areas of interest. Data from the AJRR’s state registry, the California State Registry, is analyzed and presented too.”
“AJRR would like to thank its diverse stakeholders, because without their dedication towards improving orthopaedic care, this report would not have been made,” said Daniel J. Berry, M.D., chair of the AJRR Board of Directors.
“We consider everyone’s perspective when creating the annual report, and after receiving feedback from hospital administrators at our participating hospitals, we included new ‘Actions & Insights’ pullouts to highlight important pieces of the more clinical text. We’re also continuing to publish a Report to the Public on our data so that patients can be informed.”
“AJRR’s data appeals to a wide audience, and as the Registry expands its data collection and capabilities, its data will become more complete and continue to help advance the field of orthopaedics.”
Asked about highlights from the Actions & Insights portion, AJRR Medical Director David Lewallen, M.D. told OTW, “By the end of 2016, the AJRR had collected data on over 860,000 procedures performed by more than 4,700 surgeons operating at the more than 650 hospitals, ambulatory surgery centers, and private practice groups submitting data.”
“As such, the AJRR now reports on approximately 28% of the annual procedural volume in the U.S. and this number is growing quickly. Beyond the wealth of descriptive data on the demographics and characteristics of patients undergoing arthroplasty in the U.S., we provide important information on surgical practice patterns and implant use by surgeons.”
“As an example, we are able to document the dramatic decline in use of some recent technologies with reports of problems (double modular neck hip stems) and the rapid rise in others (dual mobility articulations, especially for revisions). We have also been able to highlight an area where U.S. practice differs from that in other countries: the use of cementless femoral stems predominates in primary procedures for osteoarthritis and fracture treatment, even for those patients over 80 years of age.”
“The AJRR has matured and is now poised to soon provide survivorship data on an even larger percentage of the national cohort, and currently allows for the collection of patient-reported outcome measures (PROMs) data by interested institutions and surgeons. With our just announced integration with the AAOS [American Academy of Orthopaedic Surgeons] and plans for development of similar registries across all subspecialties, there has never been a better and more important time to support expanded participation by those already reporting, and to actively work toward enrollment by those who are not yet on board.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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