INDIAN NATIONAL JOINT REGISTRY
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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
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The Road Travelled...
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The Road Travelled...
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ISHKS REGISTRY
CONCEIVED: 2006
CONTRIBUTORS: 72
TOTAL NO OF TKR: 66352
TOTAL NO OF THR: 5784
REVISION KNEE: 544
REVISION HIP: 584
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EXPANDING FOOT PRINT
ISHKS%2006%
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CONTRIBUTION TREND
0
20
40
60
80
SURGEONS
52
25
72
2006 2012 2013
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RECORDED CASES
0
17500
35000
52500
70000
HIPS KNEES
2012 2013
66352
5784
51232
4958
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Year on Year Knees
0
17500
35000
52500
70000
2006 2007 2008 2009 2010 2011 2012 2013
66352
51232
34478
23886
154719951
58111899
Cases
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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
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TKR TREND
73.5
26.5
MALESFEMALES
3.42.1
94.5
OA RA OTHERS
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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%
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Bilateral Simultaneous
0
17500
35000
52500
70000
Prior 2011 2012 2013
66532
51232
23886
102915219
2147
Bilateral Total No
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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
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Patella -J & J
19%
81%
Resurfacing Not Resurfacing
44%56%
2012 2013
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Patella -J & J
19%
81%
Resurfacing Not Resurfacing
44%56%
2012 2013
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Patella - Zimmer
81%
19%
81%
19%
Resurfacing Not Resurfacing
2012 2013Aus registry
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Cement Used
0.4%
3%15%
19%
27%
36%
Palacos Smart Set CMW Simplex antibiotic Others
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KNEE REVISIONS
0
37.5
75
112.5
150
2006 2007 2008 2009 2010 2011 2012 2013 2014*11
11310911298
4436
20
1
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Reason for Knee Revision
8%4%
29%59%
Aseptic loosening Septic Loosening Fractures Others
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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
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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%
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THR DEMOGRAPHICS
Male 61.20%Female 38.80%BMI 25.82
38.8%
61.2%
Male Female
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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
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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
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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
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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%
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THR Revisions
AsepOc loosening 70.80%DislocaOon 10.21%InfecOon 12.89%Others 6.10%
6%13%
10%
71%
Aseptic Loosening Dislocation Infection Others
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The Road Ahead
Realise the potential
Increased Participation.
Detailed Analysis.
Better Use of technology: Mobile, Softwares.
Industry Participation & Legislations
One world One Registry
24Monday, 14 April 14
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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.
25Monday, 14 April 14
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Increased Participation
Pull all stops to increase member participation.
Aggressive marketing
Colour coded forms
Involve Youngsters
Display the coverage data
26Monday, 14 April 14
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Increased Participation
Pull all stops to increase member participation.
Aggressive marketing
Colour coded forms
Involve Youngsters
Display the coverage data
26Monday, 14 April 14
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Detailed Analysis
In depth analysis is needed.
Devil lies in details
Different publication levels: Surgeons, Industry, Public, Govt.
Statistical analysis
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Detailed Analysis
In depth analysis is needed.
Devil lies in details
Different publication levels: Surgeons, Industry, Public, Govt.
Statistical analysis
27Monday, 14 April 14
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Detailed Analysis
In depth analysis is needed.
Devil lies in details
Different publication levels: Surgeons, Industry, Public, Govt.
Statistical analysis
27Monday, 14 April 14
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Detailed Analysis
In depth analysis is needed.
Devil lies in details
Different publication levels: Surgeons, Industry, Public, Govt.
Statistical analysis
27Monday, 14 April 14
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Detailed Analysis
In depth analysis is needed.
Devil lies in details
Different publication levels: Surgeons, Industry, Public, Govt.
Statistical analysis
27Monday, 14 April 14
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Detailed Analysis
In depth analysis is needed.
Devil lies in details
Different publication levels: Surgeons, Industry, Public, Govt.
Statistical analysis
27Monday, 14 April 14
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Better Use of technology
Keep It Simple attitude
User friendly.
Accessible
Cost effective
Attitude: We are the “pioneers”
28Monday, 14 April 14
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Better Use of technology
Keep It Simple attitude
User friendly.
Accessible
Cost effective
Attitude: We are the “pioneers”
28Monday, 14 April 14
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Industry Participation
Voluntary
? Mandatory
Enlist benefits, come out with white papers.
Close cooperation, Advisory Role.
Financial Support
29Monday, 14 April 14
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Legislations
Can Adverse event reporting be made compulsory
Can recommendations be made?
India specific comments on prosthesis?
Dealing with Indian Bureaucracy :-(
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One world One Registry
Taking it too far?
Global registry is the way forward..
Collaboration,innovation and quest for excellence is the way forward...
31Monday, 14 April 14
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It started with conviction
The team certainly deserve an Applause !
32Monday, 14 April 14
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Thank You!
33Monday, 14 April 14