Arthroplasty Registries, Patient Safety and Outlier Surgeons: the case for change

Joint registries were created to follow-up on the failure rate of different types of joint replacements. Since the only end-point is revision to another implant the registries are missing out today on essential data informing us about patients' outcome. Ideally, a modern and complete registry should capture 3 strata of data: 1) patient reported outcomes including both function and activity levels from before and after surgery, 2) morbidity including infection rates and mortality related to surgery, and 3) the cost of consecutive revision surgery. A modern knee specialist offering conservative solutions for defined problems enabling return to higher level activities may be reported as an outlier surgeon by registries today.