About the NJR
Described as a global exemplar of an implantable medical device registry, the National Joint Registry (NJR), which is operational in England, Wales, Northern Ireland, the Isle of Man, and the Channel Islands, continues to be the largest orthopaedic registry in the world.
With an international reputation and now with around 4.5 million procedure records submitted, we collect information on hip, knee, ankle, elbow and shoulder joint replacement surgery and monitor, analyse and report on the performance of these joint replacement surgery procedures, the hospitals where these are performed; and the surgeons who perform the surgery.
Joint replacements have become more common and are generally highly successful operations that bring most patients improved mobility and a relief from pain. Many thousands of such operations take place in the UK each year and we have been collecting data since April 2003, although data submission for NHS organisations has only been mandatory since April 2011.
A wide range of implants can be used in joint replacement operations and by collecting data on outcomes, the registry can monitor the performance of these and the effectiveness of their use in different types of joint replacement, with a key focus on patient safety and improving clinical standards. This understanding benefits patients, clinicians and the orthopaedic sector as a whole.
The NJR brings many benefits to the hospitals in which data is collected, by providing an annual clinical report on their performance outcomes alongside a regional support network. An overview of these and other NJR benefits can be found in this summary here.
We are hosted by the Healthcare Quality Improvement Partnership (HQIP), an independent organisation led by the Academy of Medical Royal Colleges, The Royal College of Nursing and National Voices. As our host, HQIP is responsible for the NJR’s compliance with the necessary legal and statutory frameworks.
Our strategic direction, budget and operational activity is overseen by the NJR Board (NJRB), which is designated as an NHS England (NHSE) ‘Expert Committee’. Our Chair reports directly to the NHSE Medical Director. Our eight NJR Committees sit under the NJRB, with responsibility for monitoring many key NJR work areas.
Our core services are delivered under two separate contracts. NEC Software Solutions: for the collection and management of data; and the University of Bristol: for the provision of statistical support and analysis of data; as well as work enabling outcome monitoring; some NJR research activity; and analysis for the different joints within our Annual Report.
The NJR Management Team is responsible for the overall operational and contract management of the registry and for supporting the work of the NJRB and all of our NJR Committees; as well as for communicating regularly with our stakeholders about the work of the registry.
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Timeline of registry data collection
- The National Joint Registry was established by the Department of Health and Welsh Government in 2002 to capture data about procedures for hip and knee, following the 3M Capital Hip Implant Failure Report, 2001.
- Data collection commenced in April 2003.
- Submission of data to the registry has been mandatory for the independent sector since 2003 and for NHS trusts since April 2010 – the current compliance rate is around 95%.
- Data collection was extended to include ankles in 2010, then both elbows and shoulders in 2012.
- Northern Ireland joined the registry in 2013, the Isle of Man in 2015, Guernsey in 2019, and Jersey in 2025.
- Now the largest orthopaedic registry in the world – with currently over 4.5 million records and cited as a ‘global exemplar’ internationally.
- Around 250k procedure records are usually submitted annually, with year-on-year growth.
Our vision
We will advance joint replacement surgery by harnessing cutting-edge analytics to generate trusted evidence for patient benefit.
Our mission
We record, monitor, analyse and report on outcomes of joint replacement surgery to continuously enhance patient safety, support surgeons, and assure value and improved patient outcomes.
Our values
We are committed to excellence in all our activities and services to enable positive results for patients.
We engage in our work with passion, driving opportunities to provide the best solutions, to ultimately enable improved patient outcomes.
We are an innovative, global exemplar of an implantable medical device registry and always aspire to deliver at the cutting edge.
We demonstrate integrity and inspire trust, adhering to strong ethical standards across all our data collection, management, analysis and reporting processes.
We practice collaborative and inclusive ways of working, with broad representation from our stakeholders across our wide range of activities.
Our purpose
Our purpose is to:
- Monitor in real time the outcomes achieved by brands of implants, hospitals and surgeons level, and highlight where these fall below an expected performance level to enable early investigation and immediate follow-up action.
- Inform patients, clinicians, providers and commissioners of healthcare, regulators and implant suppliers of the outcomes achieved in joint replacement surgery.
- Evidence variations in outcome achieved across surgical practice, in order to inform best practice.
- Enhance patient awareness of joint replacement outcomes to better inform patient choice and patients’ quality of experience through engagement.
- Support evidence-based purchasing of joint replacement implants for healthcare providers to enable quality and value for money.
- Support suppliers in the routine post-market surveillance of implants and provide information to clinicians, patients, hospital management and the regulatory authorities.
Our Strategic Plan
The National Joint Registry has grown considerably since its inception in 2002 and recognising the increased role and ability to support improvements in patient safety and clinical outcomes, we regularly re-assess our strategic goals as part of the development of the registry’s three-year strategic planning work.
You can read about our current Strategic Plan here.
Data security and confidentiality
Staff use a secure electronic data entry system in hospitals to input information into the registry for each of their department’s joint replacement procedures.
This information is held securely within the registry and included with all the information about the implant used and the type of surgery. The patient’s personal information is also collected (subject to patients providing their consent). This means that if there are ever any problems with any implant, the NJR can advise a patient’s hospital that they should contact them to follow up and check that everything is okay.
All the data held on the registry is encrypted to provide secure protection. NJR data collection and processing activities are fully compliant with GDPR and Common Law duty of confidentiality. Our data processing locations are ISO027001 certified – so patient data is in safe hands.
Who can make use of the NJR data?
Patients’ personal data is treated as confidential at all times and cannot be used outside of the registry. This personal data is only available to the patient that it relates to and their surgeon.
Procedures are in place to protect the information and to keep it confidential. Data collected in the registry may be used for research but only if the application to do so has been reviewed and approved by the NJR Research Committee and also only if the outcomes that are expected will provide significant benefit to the future healthcare of patients. However, any data provided for research work will be de-identified so that it is not likely to identify any individual.
In accordance with the Data Protection Act (2018), patients can request a copy of their personal information that is held in the registry at any time.
Please see our Patient Section or contact the NJR Service Desk for further information.
Governance
The NJR Board (NJRB), which meets four times per year, is responsible for the strategic direction and operational oversight of the registry and is an NHS England ‘Committee of Experts’.
The NJR Board is supported by the NJR Management Team, who are hosted by HQIP. The team is responsible for the overall operational and contract management of the registry and for supporting the work of the NJR Board and the eight NJR Committees.
Funding
Delivery of the NJR’s strategic work programme is funded through a mandated annual hospital subscription charge which is calculated based on the contractual costs of running the registry and delivering the work programme agreed. The NJR’s income and expenditure is overseen by the NJR Board and is a restricted fund, spent in accordance with the agreed strategic plan.
Our Executive Committee undertakes an annual review of the pricing and resources required for the delivery of our strategic work programme to ensure continued value for money in the delivery of our range of products and services. This exercise is underwritten and agreed upon by the NJR Board and validated by NHS England.
The NJR is funded through a subscription service whereby payments from NHS trusts and independent providers of joint replacement surgery are based on their surgical volumes for the previous year.
Now in the year 2025, the NJR subscription cost to hospitals has been held at a constant rate that was fixed in 2019, of £16.54 [gross], £13.79 [net] per surgical procedure [England, Wales and Guernsey]; and at a rate of £17.63 [gross], £14.69 [net] per surgical procedure [Northern Ireland].
NJR income streams also include industry subscription to our data and reporting services, cost recovery charges from data sharing requests and other ad hoc income.
HQIP manages the invoice subscription payment collection processes and holds the NJR budget on behalf of the NJR Board.