2016/17 Research Chairman’s report - Professor J Mark Wilkinson
The Research Sub-committee (RSC) is responsible for delivering the research agenda of the National Joint Registry. The NJR is a uniquely powerful resource that provides a foundation for definitive research into the full range of clinical, mechanical, economic, social and biological factors influencing the outcome of joint replacement. The data can also help establish the impact of joint replacement surgery on the well-being of patients and the general population. The RSC works to facilitate an effective two-way flow of ideas between the research environment and the wider healthcare economy. The aim is to enhance the understanding of the science of arthroplasty, improve and enhance clinical practice and benefit public health.
Research application submission process
The committee takes formal responsibility for the release of data for research through an impartial and objective mechanism and has oversight of the use and reporting of NJR data by research groups. We have a commitment to uphold the standard and consistency of work that is carried out on NJR data in line with UK legislation. Our priority is to ensure that any research question justifies access to the data and offers potential benefit to patients. Research should align to the NJR’s priority framework and be feasible, ethical, relevant and methodologically sound.
If you would like to submit a research application, the first step in this process is to complete an expression of interest. This form and further guidance information can be accessed on the research pages of the NJR website [link].
Research ready dataset and Data Access Portal
Work is progressing well in delivery of our “research-ready” dataset and online Data Portal, with both outputs due to launch in 2017. These resources will enable researchers to utilise the NJR Annual Report dataset more effectively as a research source, reducing the burden on researchers by providing a single, “clean” source of data that is updated each year with a new cumulative dataset. Supporting the goal of reproducible research, data analyses can be published with their data and software code so that others may verify findings and build upon them. We will provide educational resources to aid researchers using NJR data for the first time, including an introductory guide and open-access educational ’test’ dataset. This will be supplemented with a list of suitable reading materials and practical guides for more complex issues.
Research Fellowship Scheme
The RSC continues to foster its Joint Clinical Research Fellowship scheme in partnership with the Royal College of Surgeons of England. We are pleased to confirm the appointment of a seventh Research Fellow, Jonathan T Evans, and look forward to welcoming new applicants who can help us to maximise the value of NJR data to the community and find new ways to drive improvement and quality in orthopaedics. Prospective future fellows are encouraged to apply to our annual rolling programme.
Use of NJR data this year
The RSC champion external use of the NJR dataset to answer questions of clinical relevance. The NJR dataset has provided opportunities for a number of external researchers this year. During the period 2016/17, the committee sanctioned the release of data to ten research projects, six of which are externally-led projects. The NJR dataset has been used as the key resource in thirteen research papers published during this same time period, of which nine were conducted or led by external, independent researchers. We will be showcasing a number of these research studies at the British Orthopaedic Association Conference 2017.
We are currently addressing in depth several topics that relate to our identified priority areas. Topics of focus have included infection demographics, predictors and outcomes; surgeon education, training and volumes; mixing of components from different manufacturers in total hip arthroplasty, and outcomes of joint replacement in minority patient groups. One study examined provision of arthroplasty according to ethnicity. Over 640,000 patient records were studied in the first large-scale study of ethnicity and joint replacement in the UK. We found that the rates of joint replacement vary substantially with ethnic background. Another study looked at nearly 720,000 joint replacement patients demonstrating that clinicians should be aware of a patient’s potential for post-operative complications relating to the digestive system as well as cardiovascular risks. We have also examined the ‘weekend effect’ for elective joint replacement and find a lower mortality risk in patients undergoing elective surgery at the weekend versus those operated between Monday and Friday. We are also carrying out work addressing data quality and the completeness of the NJR dataset, accuracy, and systematic bias and recommendation on approaches to minimise their impact.
Working with patients
Keeping patients at the centre of what we do is a guiding principle of all NJR research activity to better inform decision-making at the individual patient and surgeon level. In development is a personalised decision aid for patients considering hip or knee replacement. This simple tool, supported by Arthritis Research UK, will help patients considering joint replacement make evidence-based choices about their treatment and share decision-making with their clinicians when considering the benefits and risks of undergoing joint replacement. We are working in collaboration with the NJR Patient Network to contribute to the development and validation of this decision aid.
Please see the NJR Research Project Portfolio, which catalogues all sanctioned research projects, progress reports and NJR updates in relation to research using the NJR dataset together with links to all publications related to NJR data.
A full list of publications related to NJR data is included in Appendix 4.
Full details of the NJR’s research application pathway, together with detailed guidance notes for applicants, can be found at www.njrcentre.org.uk.