Review and comparison of orthopaedic registries in the United States and Norway

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Abstract

The global rise in orthopaedic care coupled with increasing costs necessitates surgical auditing. Orthopaedic registries in the United States (US) and Norway survey data to discern practice differences and improve clinical decisions, but they have key distinctions. In this study, we elucidate the creation, growth, and clinical relevance of registries in the US and Norway, emphasizing distinguishing features and effects on orthopaedic practice. Registries were selected based on geographic representation, enrollment, and scholarly relevance. The databases surveyed were PubMed, MEDLINE, The Texas Medical Center Library, The University of Texas System Library, and Google Scholar. Registry reports, websites, and direct conversations with staff were also utilized. Twelve US and five Norwegian registries were studied. Norwegian registries began in 1987, publish more clinical practice changes than US registries, are federally mandated, and operate on the national level. US registries began in 1969, are fragmented, and not mandated. The majority of US and Norwegian registries gather level II and III data, while some report level IV data. Delayed US registry adoption is due to scale, patient identification, and a multi-payer system, impediments absent in Norway. Norwegian registries produce annual reports and publish clinical improvements in open journals. We recommend similar US registry accessibility to advance patient care. Additionally, we convey that the American Joint Replacement Registry is poised to become a prodigious national registry due to high demographic diversity, data volume, and potential to collect level IV elements. Overall, US orthopaedic practice may benefit by incorporating aspects of the Norwegian registry system.

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