Are joint replacement registries associated with burden of revision changes? A real-world panel data regression analysis

OBJECTIVES: The association of joint replacement registries with outcomes such as revision burden is uncertain. This study aimed to evaluate whether joint replacement registries are associated with the burden of revision changes while controlling for confounders that could affect the association. DESIGN: A longitudinal study involving a combination of cross-sectional and time series data from 1980 to 2018. The study was a panel regression analysis using the difference-in-difference method. SETTING: Data from countries with joint replacement registries and countries without joint replacement registries were used. Registry data were obtained from joint replacement registries’ annual reports, while non-registry data were obtained from each included country’s pooled hospitals’ annual revision burden reported in the literature. OUTCOME MEASURES: Changes in revision burden from 1980 to 2018 was the outcome measure. The revision burden in the registry periods of registry countries was compared with the non-registry periods of registry and non-registry countries. RESULTS: Data were obtained from 12 registry periods and 8 non-registry periods. The average difference in revision burden in the registry periods of registry countries relative to the non-registry periods of registry and non-registry countries was statistically significant for hip, −3.80 (95% CI (−2.50 to −5.10); p<0.001) percentage points and knee, −1.63 (95% CI (−1.00 to −2.30); p<0.001) percentage points. This translates to a 19.30%, and 21.85% reduction in revision burden for hip and knee registries, for the whole sampling period. CONCLUSION: Joint replacement registries are associated with a significant reduction in the burden of revision. Although revision burden reduces over time even without the registries, the establishment of joint replacement registries is associated with an increased reduction. The establishment of joint replacement registries in non-registry countries would be a worthwhile decision as it will further improve the outcomes of arthroplasty surgeries.