This article originally appeared in Connections, a magazine
published for physicians and the community by UMass Memorial Medical
Last fall, the Agency for Healthcare Research and Quality (AHRQ) awarded
UMass Medical School through the Department of Orthopedics and Physical
Rehabilitation a $12 million grant to assess quality-of-life improvements among
total joint replacement (TJR) surgery patients - the largest single AHRQ grant
ever awarded to the Medical School, the academic partner of UMass Memorial
This groundbreaking project involves creating a first-of-its-kind national
registry of 30,000-plus TJR patients and assessing the success and failure of
TJR surgery relating to patient outcomes and quality of life.
This holds tremendous promise for the more than 1,200 patients who choose to
undergo TJR surgery at UMass Memorial each year. The intent of this grant is to
improve the result of joint replacement surgery throughout the United
"With 60 million US adults diagnosed with osteoarthritis, an aging population
and the growing prevalence of obesity, the number of total joint replacements is
expected to increase significantly in the next 20 years," explained Patricia
Franklin, MD, MBA, MPH,
professor of orthopedics and physical rehabilitation
and family medicine and community health at the Medical School, and principal
investigator of the study.
"Accurately assessing the surgery's real impact on quality of life is
critically important." "In the past, joint registries have focused only on
implant failures and whether the joint replacement had to be revised or
removed," added David Ayers, MD, the Arthur M. Pappas, MD, Chair of Orthopedics
and Physical Rehabilitation at UMass Memorial Medical Center and chair and
professor of orthopedics and physical rehabilitation at the Medical School.
"We are looking at how patients' lives are changed after joint replacement
surgery, to what extent pain is relieved and how they are able to return to
function in daily living, work and recreation."
While TJR surgery is a relatively common procedure (more than 700,000 US
adults undergo hip or knee replacement annually), there is wide variation in
postoperative function, which could be associated with the type of implant,
surgical approach, type of hospital or surgical center, recovery plan or ongoing
"This study will give us important information about surgical approaches, the
types of joint replacements used, rehabilitation pathways and surgical setting,"
Dr. Ayers said. The study also will analyze postop complication rates, racial
and ethnic disparities in joint replacement procedures, and variable costs for
the procedure across the nation.
"We'll also look in-depth at younger adults who undergo joint replacement
while still working," he added, noting that patients under age 65 are the
fastest-growing population segment undergoing TJR surgery.
UMass Memorial Health Care's Musculoskeletal Center of Excellence, of which
Dr. Ayers is director, is among the top 10 percent of TJR centers in the nation
in terms of volume and patient outcomes. The center is leading five other
nationally respected, high-volume orthopedic programs and a community practice
network of 26 orthopedic offices in recruiting patients and gathering data.
Altogether, data on 33,000 diverse patients treated by 130 orthopedic surgeons
from all regions of the country will be collected.
Dr. Ayers was integral in putting together this national consortium. "We were
chosen as the lead center and the site where the registry will reside because of
our longstanding recognition as a joint replacement center of excellence and the
quality clinical work we do here for patients with advanced arthritis," Dr.
Ayers said. "We've also already done cutting-edge research to improve functional
outcomes for patients with severe limitations in their daily activities.
"This study will provide a wealth of information to further advance the care
of joint replacement patients and will be especially beneficial to the patients
who choose us for their procedures," he added.
Data collection for the AHRQ project began in February 2011 and the first
round of analysis will start at the one-year point. The project is funded for a
four-year initial period.
For more information, visit www.force-tjr.org.