National Register of Joint Replacements in the Czech Republic

It is very important today, that the medical devices are used as effectively as possible, with the greatest possible benefit for the patient, and according to the principles of EBD (Evidence-Based Medicine). Patients with injuries and arthrosis of joints are more and more indicated for surgical management. Hip replacement surgery has been used in the Czech Republic for the treatment of degenerative, congenital, post-injury impairments of the hip joint for more than forty years.

National Register of Joint Replacements (NRKN) has been officially established in the Czech Republic on 1^st September 2002. The main aim of NRKN is to register data of patients undergoing implantation of endoprosthesis, and to collect more detailed information regarding the type of surgical procedure (type, size, specification of endoprosthesis surface, use of cement, previous surgical procedures, surgical approach). The register provides summary data for statistical overviews on the national, as well as international level for comparison, epidemiological studies and medical research. It also provides information concerning the characteristics of used implantation materials, namely from the point of view of their life span and costs associated with these materials. Institute of Health Information and Statistics of the Czech Republic (ÚZIS ČR) has been appointed the administrator of the National Health Registers. Providing data into this register is a compulsory part of the medical record in patients undergoing total hip replacement, as defined by the Journal of the Ministry of Health of the Czech Republic No. 6/2002. The data should be entered into the register within one month from the surgery. At the same time, it is necessary to remind that cervico-capital endoprostheses of the hip joint also belong among the monitored – i.e. compulsorily reported surgeries.

The idea of establishing an endoprosthesis register in the Czech Republic is associated with the name of Dr Štědrý, and later on namely Dr Vavřík and Head-Physician Dr Kubeš. Abroad, registers have been established since 1979, when the first Swedish register of alloplasties was founded, and other countries of the world gradually followed. Today, when routinely entering the data into the NRKN register, we do not even realize how difficult it was to establish this register. It was necessary to appoint a register administrator, define legal groundwork for collection and processing of data, find a suitable and safe computer programme, database of used implants, which needs to be constantly updated, and, last but not least, link the data in the register to the database of the deceased, which made addition of survival curves possible. In the first years of its operation, the NRKN register had problems with incomplete data regarding performed surgical procedures, however, the orthopaedic public later realized the importance of the register, and the fact that the further administrative work required is important especially for specialists in orthopaedics, and data entry has significantly improved. That is why high-quality and valid outcomes are available now.

It is important to realize that if we want our efforts and treatment to be in accordance with the principles of EBD – Evidence-Based Medicine, it is necessary to have valid data available.

That is why we would like to call upon not only the wide orthopaedic but also traumatology public, and remind them that entering data concerning the implanted joint replacements will enable them a correct retrospective analysis and gives them the possibility to select the most appropriate surgical procedure for their patients. What is more, it is the legislative duty of the workplace where the operation is being performed.

Jan Káňa, MD

jan.kana@nnj.agel.cz