A national early warning system that aims to detect failures in hip and other joint replacements may not include all private hospitals, it has emerged.
The new Irish National Orthopaedic Register (INOR), due to be fully rolled out in public hospitals next year, comes in the wake of the DePuy scandal, which saw the company withdraw its metal-on-metal (MoM) hip replacements from the market after issues with their safety.
About 10,000 hip and knee replacements are undertaken in Ireland annually. The register will record all hip and knee replacements nationally in the first instance and, once operative, other joint replacements will be added.
The electronic, bespoke register will help identify poor outcomes among joint-surgery patients and in doing so, assist in preventing another major patient incident, such as the DePuy hip scandal, from recurring.
Register
Almost half of all joint surgeries are performed in private hospitals, but despite this, they are not currently included in the register, which is the only full electronic system of its kind in the world.
To date the register has been rolled out in four hospitals: South Infirmary Victoria University Hospital, Cork; Croom Orthopaedic Hospital, Limerick; Kilcreene Orthopaedic Hospital, Kilkenny; and Midland Regional Hospital, Tullamore.
The national joint registry is being rolled out in Ireland and is a significant advance with respect to monitoring implants
It will be introduced in a further three hospitals in Navan, Finglas and Galway by the end of the year.
The president of the Irish Institute of Trauma and Orthopaedic Surgery, consultant orthopaedic surgeon Prof John O'Byrne, welcomed the development but criticised private hospitals for their lack of involvement.
“The national joint registry is being rolled out in Ireland and is a significant advance with respect to monitoring implants,” he said.
“The provision of a joint register to monitor implant survivorship, which was requested long before the ASR recall [DePuy], will only include the public hospitals for the foreseeable future. To date, the private hospitals, where almost half the arthroplasties [joint surgeries] are performed, have taken no steps to participate in Irish National Orthopaedic Register despite our engagement with the PHA [Private Hospitals Association] from day one.”
Discussions have taken place with the Private Hospitals Association (PHA) but it is understood discussions are at an early stage.
A spokesman for the PHA said it supports all initiatives that improve the quality of care and patient outcomes.
“The Private Hospitals Association supports all initiatives that can help improve the quality of care and improve patient outcomes and is fully supportive of the Irish National Orthopaedic Register (INOR) and its implementation in both public and private hospitals across Ireland. The National Office of Clinical Audit (NOCA) has clearly indicated that private hospitals are part of the Phase 2 implementation plan for INOR,” he said.
“The association’s role is to act as a forum for information exchange, and thus we have informed our members of the register and they have discretion as to whether they participate.”
Mr Paddy Kenny, orthopaedic surgeon and Chairman of INOR, said that private hospitals have recently enquired about how to get involved in the project.
“They are talking about it and they know about it and they want to be involved. But there are costs involved for them … for the private hospitals it will cost them to get our software into their systems,” Mr Kenny said.
“Because of our limited resources and limited staff I felt it was important to get all the public hospitals online first and then once we have our systems established we should approach the private hospitals. But the private hospitals have approached us in the last few months and they want to be involved.”
In August 2010, hip manufacturer DePuy announced a recall of MoM hip devices the DePuy ASR (articular surface replacement) XL Acetabular System and DePuy ASR hip resurfacing system.
In Ireland, 3,311 patients in public and private hospitals were registered as part of the DePuy recall process.
At the time, no patient register existed to help determine how many patients were affected. This meant the HSE was forced to contact each hospital for details of potentially-affected patients.
The national joint register, when fully rolled out, will enable instant tracking of affected patients in the event of any future device recalls.
Staff in each hospital manually tracked all orthopaedic paper records to identify the recalled devices and recorded contact details for affected patients.
Following the recall, patient safety concerns regarding other MoM hip devices intensified.
MoM hip implants are now no longer used in Ireland, the HSE has confirmed, following a huge decline in their manufacture globally amid ongoing concern surrounding their safety and efficacy.
Tracking
The national joint register, when fully rolled out, will enable instant tracking of affected patients in the event of any future device recalls.
The system enables the electronic capture of components live in theatre via scanning and aims to reduce surgical revision rates and improve patient outcomes. Work on the register commenced in 2013. The fully electronic system took one year to build and went live in 2016.
The project is funded and managed by the HSE and the National Office of Clinical Audit.
This article was updated on July 9th, 2018.