Frequently Asked Questions

The website displays orthopaedic data, which is published on an annual basis, listing hospitals where any joint replacement operations are carried out, in the geographical areas where the NJR is operational.

There has been an ongoing drive for greater transparency across the NHS to improve standards and patient safety. As part of this, under the 'Everyone Counts' initiative, in 2012 NHS England asked thirteen surgical and medical specialties, including orthopaedics, to prepare their data to share publicly the following year.

This is the eleventh time that the orthopaedic sector has published this information on the Surgeon and Hospital Profile website. It is intended to empower patients to contribute input to their own decision-making about their surgery by giving them accurate data about orthopaedic surgery that is provided in England, Wales, Northern Ireland, the Isle of Man and Guernsey.

NJR's Surgeon and Hospital Profile enables patients and their family and carers to view surgeon specific data and to make comparisons between hospitals in their local regions.

Patients are thus more informed and able to discuss the website information with their surgeon and get a full picture of their practice in the context of the care delivered by the whole healthcare team at the hospital.

Hip, knee, ankle, elbow and shoulder joint replacements are common and highly successful operations that bring many patients improved mobility and relief from pain. Usually more than 200,000 of these operations take place at NHS and independent sector hospitals in England, Wales, Northern Ireland, the Isle of Man and Guernsey every year. It is a procedure with very low mortality.

The fact that England, Wales, Northern Ireland, the Isle of Man and Guernsey have an established registry to monitor the quality of joint replacement implants, hospitals and surgeons, is a mark of safety and quality and demonstrates a commitment to improving patient outcomes.

A wide range of implants can be used in the joint replacement operations that are carried out. We monitor the performance of these implants as well as the effectiveness of different types of surgery. The overall aim is to improve clinical standards and outcomes for the benefit of patients, surgeons, healthcare professionals and the wider orthopaedic community.

The National Joint Registry (NJR) collects information on hip, knee, ankle, elbow and shoulder joint replacement surgery and monitors the performance of joint replacement implants, hospitals and surgeons. We were set up in 2002 by the Department of Health and Welsh Government. Northern Ireland joined in 2013, the Isle of Man in 2015 and Guernsey in 2019.

NJR mission statement:

'The mission of the National Joint Registry is to collect and analyse high quality and relevant data about joint replacement surgery in order to provide timely warnings of issues relating to patient safety. In a continuous drive to improve patient outcomes and to ensure the quality and value of joint replacement surgery, we will monitor and report on outcomes, and enable and support related orthopaedic research.'

More information on the registry can be found at www.njrcentre.org.uk/

Patients receiving joint replacement surgery are invited by their hospital to consent for their personal details to be recorded in the registry (name, address, NHS number/national patient ID, contact details). The hospital will then upload the details of patients receiving joint replacement surgery through an electronic data capture system, which includes details of the patient, the operation and date, the consultant surgeon and the joint replacement implants used.

If the patient on the registry receives any future revision surgery (for example, where the implanted joint is replaced due to loss of function), these records can be linked in order to measure the time between the first-time or primary surgery and the revision operation.

Patients should always be given additional information before they consent via the NJR Patient Consent Form. Please click here to read the NJR's Patient Information Leaflet.

The accuracy and completeness of the data relies heavily on the commitment of the hospital teams and surgeons in correctly entering the exact details of all primary and revision operations. It is mandatory for cases to be registered; without patient identification of personal details if no consent has been given by the patient. This is termed as ‘compliance’ with the NJR. We measure and monitor the proportion of cases recorded and we compare this to the expected number of cases (i.e. those ascertained from other hospital data sources).

We encourage and support all hospitals in achieving full compliance through the work of our NJR Compliance Officers. Compliance with the NJR is measured at a national level and trust-/local health board-level.

The NJR does not currently have a way of cross-checking hospitals in Northern Ireland, the Isle of Man, Guernsey or the independent sector to ensure all of the relevant procedures are submitted. This is why there are no compliance figures on the website relating to these hospitals.

The compliance rate is presented for each hospital in England and Wales (at trust-/local health board-level) as part of the information found in Surgeon and Hospital Profile. We define the best practice currently for hospitals as being 95% data submission and above.

Surgeons are advised to regularly check to ensure data held by the registry are accurate. Surgeons who do not already have a username and password can find out how to register for the service on NJR Connect - Data Services. Surgeons have been invited to review and check their individual data prior to this publication.

Consultant surgeons in England, Wales, Northern Ireland, the Isle of Man and Guernsey, who have undertaken one or more hip, knee, ankle, elbow or shoulder procedures between 1 April 2022 and 31 March 2023 are listed on the website, under the hospitals in which they are reported as working. If there is no profile for an individual surgeon, or an area of their joint replacement practice (e.g. knee) does not appear, it is likely to be because of considerations about the accuracy of the data originally submitted onto the registry, which will be going through a process of checking and, therefore, be withheld from publication.

It is important that the NJR presents a full and accurate picture of outcomes in the hospital at any given time. The data represents procedure details entered by each hospital into the registry. Whilst the NJR has a strong focus on data quality, it is possible for data entry errors to occur.

Yes, only ‘Consultants in Charge’ are included for publication on the website. All joint replacement procedures are overseen by a Consultant in Charge and they have responsibility for the care the patient receives. However, the Consultant in Charge of the operation is not necessarily always the operating surgeon.

Yes. All surgeons who have undertaken a hip, knee, ankle elbow or shoulder joint replacement procedure between 1 April 2022 and 31 March 2023 are included on the website. All the hospitals in which they have worked during this period will be listed. The volumes of procedures performed at NHS and independent practice is not disclosed; only the total volume is published.

Practice profiles show the total number and type of procedures overseen by the Consultant in Charge for the period 1 April 2022 to 31 March 2023 (12-month profile) and 1 April 2020 to 31 March 2023 (36-month profile), as recorded in the registry. Procedures are attributed to a surgeon where the surgeon is the Consultant in Charge of the operation, but they may not necessarily be the operating surgeon.

Procedures recorded against a surgeon may have been undertaken in any of the hospitals in which the surgeon has practised and include both NHS- and privately-funded activity. This means that patients are looking at the total practice for the surgeon in the time-period presented.

Activity is also shown alongside the national average (mean) number of procedures of each type undertaken over the same time-period.

This graph shows data on the proportion of patients who die within 90 days of first-time (primary) joint replacement surgery, in the form of a Funnel Plot. A Funnel Plot analysis means that surgeons can be compared, after important risk adjustments are made for patient characteristics that affect outcomes of surgery, for example, age group and general health prior to surgery (excluding the joint problem being addressed).

Each surgeon is represented by a blue dot on the graph. On each profile, the surgeon you are reviewing will be highlighted with an orange triangle All those under the top red line have a mortality rate in line with expectation.

Progression along the horizontal (x) axis means that the surgeon has done more operations and/or operations on patients that are at a higher risk of death such as older or elderly patients. Progression along the vertical (y) axis means the surgeon has had more patient deaths. Those surgeons that appear above the top red line have a higher-than-expected patient-mortality rate. Those on the central (green) horizontal line have had exactly the expected number of patient deaths, taking into account the types of patients they operate on and number of operations. Surgeons either side of the central green line, but below the upper red line have had a level of mortality that is within the expected range.

Outcome indicators (mortality and revision) are 'risk adjusted' to take account of the fact that different surgeons may operate on higher-risk or lower-risk patients (e.g. because of the overall health condition of the patient population they work with). Risk adjustment enables surgeon and hospital data to be adjusted to show what the outcome would have been had each surgeon operated on an average patient. Case-mix adjustment is not precise and some differences in rates may be the result of random events.

The role of the NJR Surgical Performance Committee is to ensure that, at the earliest stage, any concerns about clinical performance of hospitals and surgeons are highlighted and communicated specifically to those concerned in order to initiate a local audit review and subsequent improvement plan. The NJR Surgical Performance Committee has been carrying out this role since 2008.

An ‘outlier’ surgeon or hospital is one whose performance outcomes fall outside the boundaries of national expectation. It is important to emphasise that the identification of a potential outlier surgeon/hospital does not mean that performance is poor. Many other contributing factors may have an influence on this status, for example, the type of patient operated on or the incomplete entering of data on to the registry. All, or a combination, of these factors have been seen to contribute to potential outlier status being identified in some cases.

The information on the surgeons has been presented as a 'funnel plot', which we feel is the best way to portray this information. We do not feel that it is helpful to patients to portray one surgeon as being better than another, when there are many factors that can influence their performance outcomes, particularly the health of the patient at the time of their surgery.

If you are already undergoing treatment or have surgery booked in the near future, we suggest you talk to your surgeon about this. They can talk to you about their data and explain more about their expertise and any factors that may have influenced their data.

If you still have concerns thereafter, you can talk to your GP and ask to be referred to a different surgeon.

You can ask for more information. Your GP and/or your healthcare team at the hospital should be able to provide further information as to the numbers and results of procedures carried out locally. Importantly, this might include local context for example, additional information on the specific types of procedures or the types of patients that are treated.

The hospital will be aware of the results shown through our service and will receive regular, detailed information on their data that we hold and monitor. Using these results, the hospital will normally start a period of review to identify the reasons why it may have been identified as outside the expected range of performance. Sometimes this may be a result of not providing the registry with all of the relevant procedure data for the analysis and we support them in identifying any gaps through our stringent NJR audit process.

Statistics should not, on their own, be taken as a guide to the standards of a hospital and the care you would receive. However, if you have any doubts or questions, we encourage you to speak with your GP, your surgeon and healthcare team at the hospital.

Note on hospital revision-rate information.

It is important to note that the data shown is a snapshot in time of the relative performance of this hospital. A hospital’s performance outcome results may fluctuate over time and get progressively better or worse, reflecting the types of procedures they carry out and/or the types of patients that they treat, amongst other local factors, and whether the hospital is providing a complete and accurate submission of data to the registry.

More information on the work of the NJR and the data we collect, monitor and analyse can be found at www.njrcentre.org.uk. and in the latest NJR Annual Report, available at reports.njrcentre.org.uk/.

Surgeons wishing to check their data can do so through our NJR Connect - Data Services portal. Surgeons who do not already have a username and password can find out how to register for the service on the NJR Connect - Data Services website or go to the Surgeon section of the NJR website.

More information about the publication of data for surgeons can be found on the British Orthopaedic Association's website.

The ‘NJR Quality Data Provider’ award scheme has been devised to offer hospitals public recognition for achieving excellence in supporting the promotion of patient safety standards through their compliance with our mandatory registry data submission quality audit process and by awarding certificates, the scheme rewards those hospitals who have met the stringent targets.

To gain Quality Data Provider (QDP) status hospitals are required to meet the targets for best practice, demonstrate engagement and awareness of the importance of the quality of the data collected, and embed the ethos that thorough and accurate data ultimately enables the NJR to develop improved patient outcomes. One of the targets which hospitals are required to complete is compliance with the NJR’s mandatory national audit aimed at assessing data completeness and quality within the registry. If these targets are achieved, the NJR Award emblem will be placed on the hospital’s dashboard page on the Surgeon and Hospital Profile website, so you can see those hospitals who have been awarded. Other NJR targets include having a high level of patients consenting for their details to be included in the registry.