• R. Kyle MartinEmail author
  • Andreas Persson
  • Håvard Visnes
  • Lars Engebretsen


The use of registries in orthopaedic surgery has evolved since the first one was created in the 1970s for arthroplasty surgery. Today they are used by many orthopaedic subspecialties and often include patient-reported outcome measures in addition to the traditional end point of revision surgery. The primary goals of these registries are to improve patient outcomes through detecting implants or surgical techniques with inferior results or early failures and to identify prognostic factors that may influence choice of treatment and outcome. By collecting a large amount of data and following outcomes over time, registries are an extremely valuable research tool that can lead to high-quality and potentially practice-changing studies. Annual reports provide feedback to surgeons, hospitals, government, and society as a whole and can also impart regional or surgeon-specific data. In designing an orthopaedic registry, one must be cognizant of the limitations and challenges to be overcome. Since the strength of a registry is based on the accuracy and completeness of the data, a high compliance rate is crucial and represents the greatest challenge. In the future, it is expected to see more international registry-based collaboration and the expansion of current surgical registries to include non-surgical patients.


Registry Epidemiology Revision Ligament reconstruction Arthroplasty 


  1. 1.
    Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med. 2000;342:1878–86. Scholar
  2. 2.
    Bohm ER. Personal communication with Dr. E. Bohm, Professor of Surgery, University of Manitoba; Chair, Canadian Joint Replacement Registry Advisory Committee; Chair, Manitoba Provincial Orthopaedic Standards and Quality Committee. 2017.Google Scholar
  3. 3.
    Bohm ER, Dunbar MJ, Bourne R. The Canadian Joint Replacement Registry—what have we learned? Acta Orthop. 2010;81:119–21. Scholar
  4. 4.
    Comber H, Perry IJ. Observational studies for intervention assessment. Lancet. 2001;357:2141–2. Scholar
  5. 5.
    Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342:1887–92. Scholar
  6. 6.
    Drolet BC, Johnson KB. Categorizing the world of registries. J Biomed Inform. 2008;41:1009–20. Scholar
  7. 7.
    Engebretsen L, Forssblad M, Lind M. Why registries analysing cruciate ligament surgery are important. Br J Sports Med. 2015;49:636–8. Scholar
  8. 8.
    Granan L-P, Bahr R, Steindal K, Furnes O, Engebretsen L. Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. Am J Sports Med. 2008;36:308–15. Scholar
  9. 9.
    Granan L-P, Forssblad M, Lind M, Engebretsen L. The Scandinavian ACL registries 2004-2007: baseline epidemiology. Acta Orthop. 2009;80:563–7. Scholar
  10. 10.
    Havelin LI, Engesaeter LB, Espehaug B, Furnes O, Lie SA, Vollset SE. The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties. Acta Orthop Scand. 2000;71:337–53. Scholar
  11. 11.
    Havelin LI, Espehaug B, Vollset SE, Engesaeter LB. The effect of the type of cement on early revision of Charnley total hip prostheses. A review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian Arthroplasty Register. J Bone Joint Surg Am. 1995;77:1543–50.CrossRefGoogle Scholar
  12. 12.
    Havelin LI, Espehaug B, Vollset SE, Engesaeter LB. Early aseptic loosening of uncemented femoral components in primary total hip replacement. A review based on the Norwegian Arthroplasty Register. J Bone Joint Surg Br. 1995;77:11–7.CrossRefGoogle Scholar
  13. 13.
    Horan FT. Judging the evidence. J Bone Joint Surg Br. 2005;87:1589–90. Scholar
  14. 14.
    Irgens LM. The origin of registry-based medical research and care. Acta Neurol Scand. 2012;126:4–6. Scholar
  15. 15.
    Irgens LM, Bjerkedal T. Epidemiology of leprosy in Norway: the history of The National Leprosy Registry of Norway from 1856 until today. Int J Epidemiol. 1973;2:81–9.CrossRefGoogle Scholar
  16. 16.
    Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews. Chichester: Wiley; 2012.Google Scholar
  17. 17.
    Knutson K, Lewold S, Robertsson O, Lidgren L. The Swedish knee arthroplasty register. A nation-wide study of 30,003 knees 1976-1992. Acta Orthop Scand. 1994;65:375–86.CrossRefGoogle Scholar
  18. 18.
    Lind M, Menhert F, Pedersen AB. The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc. 2009;17:117–24. Scholar
  19. 19.
    Malchau H, Herberts P, Eisler T, Garellick G, Söderman P. The Swedish total hip replacement register. J Bone Joint Surg Am. 2002;84-A(Suppl 2):2–20.CrossRefGoogle Scholar
  20. 20.
    Maloney WJ. National Joint Replacement Registries: has the time come? J Bone Joint Surg Am. 2001;83-A:1582–5.CrossRefGoogle Scholar
  21. 21.
    Mygind-Klavsen B, Grønbech Nielsen T, Maagaard N, Kraemer O, Hölmich P, Winge S, Lund B, Lind M. Danish Hip Arthroscopy Registry: an epidemiologic and perioperative description of the first 2000 procedures. J Hip Preserv Surg. 2016;3:138–45. Scholar
  22. 22.
    Naylor CD, Guyatt GH. Users’ guides to the medical literature. X. How to use an article reporting variations in the outcomes of health services. The Evidence-Based Medicine Working Group. JAMA. 1996;275:554–8.CrossRefGoogle Scholar
  23. 23.
    Persson A, Fjeldsgaard K, Gjertsen J-E, Kjellsen AB, Engebretsen L, Hole RM, Fevang JM. Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004-2012. Am J Sports Med. 2014;42:285–91. Scholar
  24. 24.
    Pocock SJ, Elbourne DR. Randomized trials or observational tribulations? N Engl J Med. 2000;342:1907–9. Scholar
  25. 25.
    Robertsson O. Knee arthroplasty registers. J Bone Joint Surg Br. 2007;89:1–4. Scholar
  26. 26.
    Rolfson O, Bohm E, Franklin P, Lyman S, Denissen G, Dawson J, Dunn J, Eresian Chenok K, Dunbar M, Overgaard S, Garellick G, Lübbeke A, Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries. Patient-reported outcome measures in arthroplasty registries: Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries Part II. Recommendations for selection, administration, and analysis. Acta Orthop. 2016;87:9–23. Scholar
  27. 27.
    Rolfson O, Eresian Chenok K, Bohm E, Lübbeke A, Denissen G, Dunn J, Lyman S, Franklin P, Dunbar M, Overgaard S, Garellick G, Dawson J, The Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries. Patient-reported outcome measures in arthroplasty registries: Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty RegistriesPart I. Overview and rationale for patient-reported outcome measures. Acta Orthop. 2016;87:3–8. Scholar
  28. 28.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88–96. Scholar
  29. 29.
    Røtterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Årøen A. Effect on patient-reported outcomes of debridement or microfracture of concomitant full-thickness cartilage lesions in anterior cruciate ligament-reconstructed knees: a nationwide cohort study from Norway and Sweden of 357 patients with 2-year follow-up. Am J Sports Med. 2016;44:337–44. Scholar
  30. 30.
    Singh J, Politis A, Loucks L, Hedden DR, Bohm ER. Trends in revision hip and knee arthroplasty observations after implementation of a regional joint replacement registry. Can J Surg. 2016;59:304–10. Scholar
  31. 31.
    de Steiger RN, Miller LN, Davidson DC, Ryan P, Graves SE. Joint registry approach for identification of outlier prostheses. Acta Orthop. 2013;84:348–52. Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  • R. Kyle Martin
    • 1
    • 2
    • 3
    Email author
  • Andreas Persson
    • 1
    • 4
  • Håvard Visnes
    • 1
    • 3
    • 4
    • 5
  • Lars Engebretsen
    • 1
    • 2
    • 3
  1. 1.Division of Orthopedics, Department of Orthopaedic SurgeryOslo University HospitalOsloNorway
  2. 2.Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Oslo Sports Trauma Research Center, The Norwegian School of Sport SciencesOsloNorway
  4. 4.The Norwegian Knee Ligament Registry, Orthopedic DepartmentHaukeland University HospitalBergenNorway
  5. 5.Department of Orthopaedic SurgeryHaukeland University HospitalBergenNorway

Personalised recommendations