Patricia D. Franklin

Each year, more than 700,000 adults in the Unites States have knee or hip replacement surgery to eliminate what can often be debilitating pain, and regain joint function and mobility lost to advanced arthritis. With that number expected to grow significantly in the next 20 years, both for older adults and patients under age 65, accurately assessing the surgery’s real, everyday quality-of-life improvements for patients becomes critically important.

The Agency for Healthcare Research and Quality (AHRQ) has awarded the University of Massachusetts Medical School a $12 million grant to begin making these important assessments. As part of an in-depth study of key factors related to total joint replacement (TJR) surgery, UMMS will establish a nationwide registry of 33,000 TJR patients, develop tools with which to assess the success and failure of the surgery, and conduct research to guide both clinical care and health care policy.

Arthritis is a significant public health issue, with 60 million U.S. adults diagnosed with osteoarthritis, a degenerative condition of joint connective tissue, making it the leading cause of disability in adults. “We expect the number of total joint replacements to increase by 600 percent in the next 20 years as the population ages and the prevalence of obesity increases,” said Patricia D. Franklin, MD, MBA, MPH, the Joy McCann Professor for Women in Medicine, professor of orthopedics & physical rehabilitation and family medicine & community health, and principal investigator of the study. “As it does, more and more people under the age of 65 are opting for total knee or total hip replacements in order to maintain their active lifestyle, their ability to work and their long-term health.”

Although TJR surgery is a relatively common procedure offering consistent pain relief, there is wide variation in function after surgery, which could be associated with such factors as the type of implant, the surgical approach, type of hospital or surgical center, recovery plan and ongoing care. Research data currently available is limited to the Medicare population—Medicare funds the surgery for patients older than 65—and focuses on joint replacement failure: whether an implant has to be removed or revised with further surgery. Franklin, whose area of expertise includes patient-centered outcomes research, said, “We consider the surgery a failure if it doesn’t provide pain relief or improved mobility or function for the patient. We want to do a better job of measuring the real human outcome of joint replacement for those patients that are active, working adults under 65, as well as older.”

The proposed national database of more than 33,000 diverse patients treated by 130 orthopedic surgeons representing all regions of the country and varied practice settings (urban and rural, low and high volume, community clinic and academic medical center) will be the basis of the study. UMMS will lead six high-volume sites across the United States and one community practice network in recruiting patients into the registry. Participating high volume centers are: 
  • UMass Memorial Medical Center, Worcester, Mass.
  • University of Rochester Medical Center, Rochester, N.Y.
  • University of Maryland Medical Center, Baltimore, Md.
  • Baylor College of Medicine, Houston, Texas
  • Connecticut Joint Replacement Institute at St. Francis, Hartford, Conn.
  • Kaiser Permanente Georgia
In addition, a community practice network of 26 orthopedic offices with more than 100 surgeons will also participate. 

The registry will provide information for key research areas such as joint replacement failure and technical or mechanical issues, as well as the impact of the replacement on the patient’s mobility, function, pain and quality of life. In addition, data will be compiled regarding disparities in TJR use among certain ethnic, socioeconomic or demographic groups, and the value of TJR in younger patients.

“UMMS is uniquely positioned to oversee this project because of our expertise not only in orthopedics but also in data analysis, outcomes research and health policy,” said David C. Ayers, MD, the Arthur M. Pappas, MD, Chair in Orthopedics and chair and professor of orthopedics & physical rehabilitation. The Department of Quantitative Health Sciences at UMMS will have a major role in the project, both in collecting patient data and in analyzing a vast array of information culled from the registry to identify areas in which TJR and patient outcomes can be improved. In addition, experts from the Center for Outcomes Research, Division of Preventive and Behavioral Medicine, and Center for Health Policy and Research will use the data collected to help guide future clinical care and health policy regarding the procedure.


About the AHRQ
The Agency for Healthcare Research and Quality (AHRQ) is the Federal agency charged with improving the quality, safety, efficiency and effectiveness of health care for all Americans. As one of 12 agencies within the Department of Health and Human Services, AHRQ supports health services research that will improve the quality of health care and promote evidence-based decision making. For more information, go to www.ahrq.gov.