indian national joint registry

ISHKS REGISTRY: ROAD TRAVELLED &

JOURNEY AHEAD

Dr Vaibhav BagariaMBBS MS FCPS DIP SICOT

CARE HOSPITAL & ORIGYN CLINICNAGPUR, INDIA

www.drbagaria.com

1Monday, 14 April 14

http://www.drbagaria.com

http://www.drbagaria.com

The Road Travelled...


ISHKS REGISTRY

CONCEIVED: 2006

CONTRIBUTORS: 72

TOTAL NO OF TKR: 66352

TOTAL NO OF THR: 5784

REVISION KNEE: 544

REVISION HIP: 584


EXPANDING FOOT PRINT

ISHKS%2006%


CONTRIBUTION TREND

0

20

40

60

80

SURGEONS

52

25

72

2006 2012 2013


RECORDED CASES

0

17500

35000

52500

70000

HIPS KNEES

2012 2013

66352

5784

51232

4958


Year on Year Knees

0

17500

35000

52500

70000

2006 2007 2008 2009 2010 2011 2012 2013

66352

51232

34478

23886

154719951

58111899

Cases


MANUFACTURERS

J& J 42.20% Zimmer 34.03%S & N 8.48%Max 5.40%Stryker 4.88%Exatac 1.60%Biomet 1.05%B Braun 0.77%Indus 0.70%B P 0.68%Wright Medical 0.06%Endo plus 0.05%

Others 0.09%

42.2

34.0

8.5

5.44.95.0

J & J ZIMMER S&N MAX STRYKER REST


TKR TREND

73.5

26.5

MALESFEMALES

3.42.1

94.5

OA RA OTHERS


TKRSCOUNTRY

INDIA SWEDISH AUSTRALIAPARA

INDIA SWEDISH AUSTRALIA

AGE 64.369(D)/70(N)/

71(S) 68.2

BMI 29.15 28.4 29.6

BILATERAL 16.48% 20% 13.3%


Bilateral Simultaneous

0

17500

35000

52500

70000

Prior 2011 2012 2013

66532

51232

23886

102915219

2147

Bilateral Total No


Surgeon Preference

3.7%21.3%

7.3%67.7%

PSCRAll Poly PSAll Poly CR

4.4%26.1%

69.4%

PSCRAll Poly PS

J & J Zimmer


Patella -J & J

19%

81%

Resurfacing Not Resurfacing

44%56%

2012 2013


Patella - Zimmer

81%

19%

81%

19%

Resurfacing Not Resurfacing

2012 2013Aus registry


Cement Used

0.4%

3%15%

19%

27%

36%

Palacos Smart Set CMW Simplex antibiotic Others


KNEE REVISIONS

0

37.5

75

112.5

150

2006 2007 2008 2009 2010 2011 2012 2013 2014*11

11310911298

4436

20

1


Reason for Knee Revision

8%4%

29%59%

Aseptic loosening Septic Loosening Fractures Others


THR

0

375

750

1125

1500

2006 2007 2008 2009 2010 2011 2012 2013

826

13541260

1036

611

175348

174

No of Cases Total So far: 5784


Reason For THR

50.3

7.16.9

1.33.43.51.96.6

9.98.7

AVN ANK SPOND RA FAILED HEMI # DISLOCATIONFAILED #FIX DYSPLASIA # NF PRIMARY OA OTHERS

AVN 50.36%Ankylosing spondyliOs 7.11%RA 6.94%Failed Hemi 1.38%Fracture dislocaOon 3.43%Failed fractures 3.50%Dysplasia 1.97%Fresh fracture neck 6.60%Primary OA 9.98%Others 8.76%


THR DEMOGRAPHICS

Male 61.20%Female 38.80%BMI 25.82

38.8%

61.2%

Male Female


THR TECHNIQUE

Uncemented 70.35%Cemeneted 19%Hybrid 6.79%Resurfacing 3.66% (this year only 10 has been added)Others 0.18%

18.0

0.13.66.7

19.070.3

Uncemented Cemented Hybrid Resurfacing Others 2012


THR TECHNIQUE

Uncemented 70.35%Cemeneted 19%Hybrid 6.79%Resurfacing 3.66% (this year only 10 has been added)Others 0.18%

18.0

0.13.66.7

19.070.3

Uncemented Cemented Hybrid Resurfacing Others 2012

Aus registry


THR - IMPLANTS

34

28

12

124 211

J & J ZIMMER B BRAUN STRYKER S& N BIOMETEXATAC EVOLOUTIS OTHERS

J & J 34.45%Zimmer 28.05%B Braun 12.26%Stryker 12.16%Smith & Nephew 4.37%Biomet 3.97%Exatac 2.48%Evolutus 1.46%Others 0.8%


THR Revisions

AsepOc loosening 70.80%DislocaOon 10.21%InfecOon 12.89%Others 6.10%

6%13%

10%

71%

Aseptic Loosening Dislocation Infection Others


The Road Ahead

Realise the potential

Increased Participation.

Detailed Analysis.

Better Use of technology: Mobile, Softwares.

Industry Participation & Legislations

One world One Registry


Realise the potential

US reports 620000 knees implanted in 2009

Indian equivalent would be: 4940000 knees /year.

Australian and Swedish registry record less than 100000/combined hip and knee procedures/yr

Revision pool after 5 years likely to be equiv to primary of some famous registry.


Increased Participation

Pull all stops to increase member participation.

Aggressive marketing

Colour coded forms

Involve Youngsters

Display the coverage data


Detailed Analysis

In depth analysis is needed.

Devil lies in details

Different publication levels: Surgeons, Industry, Public, Govt.

Statistical analysis


Better Use of technology

Keep It Simple attitude

User friendly.

Accessible

Cost effective

Attitude: We are the “pioneers”


Industry Participation

Voluntary

? Mandatory

Enlist benefits, come out with white papers.

Close cooperation, Advisory Role.

Financial Support


Legislations

Can Adverse event reporting be made compulsory

Can recommendations be made?

India specific comments on prosthesis?

Dealing with Indian Bureaucracy :-(


One world One Registry

Taking it too far?

Global registry is the way forward..

Collaboration,innovation and quest for excellence is the way forward...


It started with conviction

The team certainly deserve an Applause !


Thank You!


indian national joint registry

Health & Medicine

patella j j

poly ps j j zimmer

hybrid resurfacing

ishks registry

thr technique uncemented70

thr implants

aus registry

detailed analysis