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• The National Joint Registry (NJR) was established in 2002 as the result of an unexpectedly high failure rate of a cemented total hip replacement.

• Initial compliance with the Registry was low until data entry was mandated. Current case ascertainment is approximately 95% for primary procedures and 90% for revision procedures.

• The NJR links to other data sources to enrich the reporting processes. The NJR provides several web-based and open-access reports to the public and detailed confidential performance reports to individual surgeons, hospitals and industry bodies.

• A transparency and accountability process ensures that device and surgical performance are actively monitored on a six-monthly basis, and adverse variation is dealt with in an appropriate way that underpins patient safety.

• The NJR also manages a comprehensive research-ready database and data protection compliant access system that enables external researchers to use the dataset and perform independent analyses for patient benefit.

• Moving forwards, the NJR intends to look at factors that lead to better outcomes so that good practice can be embedded into routine care.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180084

• Total joint arthroplasty is performed to decreased pain, restore function and productivity and improve quality of life.

• One-year implant survivorship following surgery is nearly 100%; however, self-reported satisfaction is 80% after total knee arthroplasty and 90% after total hip arthroplasty.

• Patient-reported outcomes (PROs) are produced by patients reporting on their own health status directly without interpretation from a surgeon or other medical professional; a PRO measure (PROM) is a tool, often a questionnaire, that measures different aspects of patient-related outcomes.

• Generic PROs are related to a patient’s general health and quality of life, whereas a specific PRO is focused on a particular disease, symptom or anatomical region.

• While revision surgery is the traditional endpoint of registries, it is blunt and likely insufficient as a measure of success; PROMs address this shortcoming by expanding beyond survival and measuring outcomes that are relevant to patients – relief of pain, restoration of function and improvement in quality of life.

• PROMs are increasing in use in many national and regional orthopaedic arthroplasty registries.

• PROMs data can provide important information on value-based care, support quality assurance and improvement initiatives, help refine surgical indications and may improve shared decision-making and surgical timing.

• There are several practical considerations that need to be considered when implementing PROMs collection, as the undertaking itself may be expensive, a burden to the patient, as well as being time and labour intensive.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180080

• Recent concerns surrounding joint replacements that have a higher than expected rate of revision have led to stricter controls by regulatory authorities with regards to the introduction of new devices into the marketplace.

• Implant post-market surveillance remains important, and joint replacement registries are ideally placed to perform this role. This review examined if and how joint replacement registries identified outlier prostheses, outlined problems and suggested solutions to improve post-market surveillance.

• A search was performed of all joint replacement registries that had electronic or published reports detailing the outcomes of joint replacement. These reports were examined for registry identification of outlier prostheses. Five registries publicly identified outlier prostheses in their reports and the methods by which this was performed, and three others had internal reports.

• Identification of outlier prostheses is one area that may improve overall joint replacement outcomes; however, further research is needed to determine the optimum methods for identification, including the threshold, the comparator and the numbers required for notification of devices.

• Co-operation of registries at a global level may lead to earlier identification of devices and thereby further improve the results of joint replacement.