The American Joint Replacement Registry's The Register
Letter from the Executive Director
AJRR Executive Director
Jeffrey P. Knezovich, CAE

At the center of all of our efforts lies our participant experience. The Registry is able to continue because of the hard work that our participating hospitals, surgery centers, and private practice groups put into submitting their data to us on a regular basis. That's why we want to be the best organization we can be, and we continue to learn and enhance our capabilities to better serve our stakeholders.

This month, AJRR representatives will be attending the 6th International Congress of Arthoplasty Registries, the annual meeting of the International Society of Arthroplasty Registries (ISAR). By meeting with leaders and listening to the presentations of these foreign registries, we'll be able to take away important lessons from their past experiences and challenges. After all, AJRR is relatively new compared to the Swedish Knee Arthoplasty Register that will be going on 42 this year.

If AJRR isn't attending a particular meeting, look for our Authorized Vendors. Pictured  above is AJRR Authorized Vendor  AmkaiSolutions
at ASCA 2017.
In addition to engaging with our registry contemporaries from around the globe, we have appearances scheduled at several national annual meetings this year. To make our data more comprehensive and valuable for our users, we would like to meet as many potential participants as possible. Earlier in May we had a booth at the Ambulatory Surgery Center Association (ASCA) Annual Meeting in Washington D.C., and were exposed to a large number of interested ASCs. 

We have a couple of meetings of our own that we are hosting in the coming months. The AJRR California State Registry Committee Annual Meeting will be held in May in San Francisco. We are looking to expand our services to state registries throughout the country to fill gaps in data and provide a more enhanced platform and benefits.  Our next User Group Network (Unet) conference call will be held on June 15. Finalized agendas for both of these events will be released soon.

Detailed information on these meetings is included in the Additional Upcoming Events section in this newsletter and on our website. If you will be in attendance at any of these conferences, stop by our booths to say hello. We'll be happy to engage with you about the Registry and answer any questions that you may have. 

Best regards,

From Data to Innovative Models: Reducing Risk & Improving Joint Replacement Outcomes

Join us for a joint webinar with our Authorized Vendor OM1 addressing emerging initiatives, technologies, and best practices for managing and improving joint replacement outcomes and  succeeding under new payment models. During the session, AJRR Director of Analytics Dr. Caryn Etkin and OM1 CEO Dr. Richard Gliklich will explore:
  • Best practices for managing and improving joint replacement and orthopaedic surgery outcomes
  • Understanding quality improvement initiatives and metrics, including benefits of participating in the AJRR
  • Maximizing performance in value-based care programs, including the Centers for Medicare & Medicaid Services' (CMS') Comprehensive Care for Joint Replacement (CJR) program
  • Integrating patient-reported and clinical outcomes management into clinical practice
  • Leveraging predictive analytics to reduce complications and avoid high cost events.
The webinar will be held on Tuesday, May 16, 2017 from 11:00 a.m. - 12:00 p.m. Eastern Time.

Register here.
IRBs and the AJRR

There has been some recent confusion surrounding our participants about whether a local Institutional Review Board (IRB) review is necessary in order to participate in the AJRR. We would like to clear that up. 

The Registry operates within the context of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Common Rule. Our data use agreement allows us to not be considered research. We've also received a determination letter from the Western Institution Review Board (WIRB), an IRB certified by the Association for the Accreditation of Human Research Protection Programs (AAHRPP). This letter confirms that patient authorization is not required under HIPAA and informed consent is not required under the Common Rule in relation to AJRR participation. The HIPAA Privacy Rule permits one IRB or Privacy Board's documentation of waiver of Authorization to suffice for any institution, meaning that our participants don't need to seek local IRB approval unless their policies or federalwide assurances require it.

If you would like a copy of the WIRB determination letter or would like additional details on this topic, please contact us at We would be happy to send a memorandum outlining this in greater depth.
Champion of the Quarter

Each quarter, we highlight individuals from participating institutions who have championed AJRR enrollment and have demonstrated outstanding cooperation and professionalism while helping to implement the Registry into their institutions. Selections for Champions of the Quarter are made based on nominations and are voted on by our staff. To view our past Champions, visit our Champions of the Quarter section of our website. To nominate someone from your institution, please contact AJRR Marketing and Communications Specialist Erik Michalesko at

This quarter, we would like to recognize Ms. Cindi Hoffner from Mercy Medical Center - Cedar Rapids in Cedar Rapids, IA.

Cindi Hoffner
Mercy Medical Center - Cedar Rapids
Ms. Cindi Hoffner is the Total Joint Registry Registrar at Mercy Medical Center - Cedar Rapids. She ensures complete and accurate data abstraction, collection, entry, and reporting for the total joint replacement patient population, and contributes to organizational performance improvement, medical staff performance improvement, patient safety, and risk management. Ms. Hoffner began working at Mercy 13 years ago as a Data Entry Specialist for their existing total joint registry program. Because of that experience, she was able to learn from the ground up how to build the workings of a strong base for her institution's system, and therefore apply it to her work with AJRR. Ms. Hoffner has participated in numerous clinical research studies and papers with Mercy's orthopaedic surgeons.

Q: What is your favorite thing about your job?

A: Currently, I love the challenges of getting our own personalized version of the AJRR built at Mercy. We have our dedicated internal AJRR team to work on the logistics related to interfacing with our EPIC documentation system and with the Operating Room staff's documentation of critical data such as the surgical approaches and manufacturer specifications. Implementing AJRR data submission is not a one-person job. I couldn't have done this without the help of my Quality Analyst, Theresa Mahoney and my Program Coordinator, Linda Weiler. We have also had great assistance from the Clinic Manager to train all the staff and providers about the Level III patient-reported outcome measures (PROMs) data collection process within the clinic. We are all anticipating our next step of development as we move on to Level II patient risk factors, comorbidities, and complications data.

Q: Do you enjoy working with AJRR staff? If yes, why?

A: Yes, I do enjoy working with the staff at AJRR, especially Steve Hamada. He has been a great addition to the team and has helped solve several of our problems. I have a lot of respect for the whole AJRR staff! They were very helpful in our early stages of implementing the AJRR.

I am a pretty intense person and I have extreme attention to detail. I am so passionate about making sure that we have good clean data in the AJRR. We do not want to create a "garbage in and garbage out" type of system. My goal is to work with the AJRR staff, on both the large and small details to ensure our data is very valuable.

Q: How long have you been working with AJRR, and what is your role in the data submission process?

A: We started working with the AJRR in April 2016, and signed our initial contract on August 8, 2016. We began the process of submitting Level I data in November 2016. My role in the data submission process is to basically evaluate so that we "dot all of the i's and cross all of the t's." Whether that means working with our internal hospital team, or with the AJRR staff, it's imperative that we have impeccable data submitted to this national Registry. I figure if everyone around the country does this, the AJRR will grow to be the best of the best over time.

Beyond that, I have taken on the responsibility of working with our providers and staff in the hospital and clinic to get the AJRR program implemented. Our surgeons do over 1,000 total joint replacements annually. We have collected Registry data for this population for over 20 years now and I am proud to be a part of our continued commitment to tracking total joint replacement outcomes.

Q: What do you think is the most valuable aspect of Registry participation?

A: Being part of a national database is a very appealing aspect of the AJRR. I think it is great that the system has been built into the unique levels of data collection of I through III. It has been easy to articulate the various aspects of the Registry to our key stakeholders as we have rolled it out. Ultimately, it is our hope that the reported data will become valuable to all the participants as the database grows over time.

Q: What do you like to do in your free time? Do you have any hobbies or is there something about yourself that might surprise us?

A: I love volunteering. For example, I created about 72 hand-tied blankets for the kids participating in the Tanager Place program that serves kids of various ages needing assistance. It ended up being about double what I had anticipated, but it was such a rewarding experience. I am also an avid scrapbooker. I have scrapbooks dating back over the events of the past 25 years from births to graduations and many special activities in between. It's a great way to showcase the great times in our lives.

Q: If you could pass on one piece of information to a new AJRR participant, what would it be?

A: It takes a few months to get up and running with the Registry. Due diligence, and having a strong team working together are critical pieces of the AJRR puzzle.
Additional Upcoming Events
We will be attending many more events in 2017 than in past years. The "Additional Upcoming Events" section is an on-going list of annual meetings and trade shows that AJRR will participate in. If you have any questions about a particular event, contact us at or visit the Events & Webinars section of our website.

California Orthopaedic Association (COA) Annual Meeting

The  California Orthopaedic Association (COA)  will hold its 2017 Annual Meeting/QMECourse from May 18-21, 2017 at the Omni La Costa Resort in Carlsbad, CA. Hundreds of orthopaedic surgeons, residents, and practice managers are expected to attend. The California Bones Society (C-Bones) Annual Meeting will be taking place at the resort at the same time too.

Several organizations including the AJRR will be exhibiting with booths during the meeting. Be sure to stop by the symposium "Data Collection and Reporting: How to Earn 70 QPP Points or More and be Rewarded" on Friday, May 19. AJRR Executive Director Jeffrey P. Knezovich will be speaking at 11:20 a.m. about qualified clinical data registries (QCDRs) and the additional benefits of registry reporting. You'll also receive CME hours in the double digits by attending the meeting.

Register for the COA Annual Meeting 
here .
International Society of Arthroplasty Registries (ISAR) Annual Meeting

The 6th Annual International Society of Arthroplasty Registers Congress, the Annual Meeting of the
International Society of Arthroplasty Registries (ISAR) , will be held from May 20-22, 2017, in San Francisco, CA. The conference will be held at the Parc 55 San Francisco, a Hilton Hotel.  Each year, the AJRR and the California State Registry Committee send representatives to present research and display posters. 

Visit the ISAR website for more information. You can register for the ISAR Annual Meeting here. Visit the AJRR website for links to posters from past ISAR meetings.
The 2017 California State Registry Committee Annual Meeting will be held in San Francisco during this time as well, on May 20 from 12:00 p.m. to 2:00 p.m. at the Parc 55 San Francisco. The meeting will be a complimentary luncheon that gives California hospitals the opportunity to discuss current issues affecting the collection of data, the expansion of data collection, and reporting methods. California State Registry Committee Chair James I. Huddleston, III, MD, will be leading the meeting. The finalized agenda will be released soon.
Register for the California State Registry Committee Annual Meeting here.
Authorized Vendor Profile
Company Name:  VitalHealth Software

Company Website:

AJRR Vendor Since: February 2017

General Description: VitalHealth Software is a fast-growing healthcare software company founded in 2006. They provide cloud-based Health IT solutions for collaborative health management with the mission of "Improving the health of millions of people through eHealth solutions." VitalHealth is a leader in markets such as care coordination, Patient-Reported Outcomes Measurement (PROs), Routine Outcome Monitoring (ROM), patient engagement, and eMentalHealth. In addition, they provide their core platform to their partners to develop innovative new products.

Features Offered: VitalHealth offers an integrated outcome measurement solution that enables caregivers to automate the complete process of measuring outcomes, either patient-reported outcomes (Level III data) or clinical data (Level II data). Their outcome measurement solution can be integrated with any electronic medical record (EMR) so that EMR data can be used to automatically assign surveys, e.g. based on an appointment, and patient demographic data is also used to streamline the entire intake process. VitalHealth helps by automating the process of assigning, completing, processing, and reporting on intake questionnaires, which saves a lot of work and optimizes the information flow for physicians. In addition, VitalHealth offers a complete solution to support bundled payments for Comprehensive Care for Joint Replacement (CJR) model hospitals.

Integration with AJRR: The VitalHealth solution automatically creates the files that are necessary to submit data to the AJRR. They are looking forward to working with the AJRR in delivering data one step further by automatically sending the data to the AJRR from their solution, making the whole data submission process even more efficient for their clients.

Fun Fact: VitalHealth Software was founded by Mayo Clinic in the U.S. and the Noaber Foundation in the Netherlands. One of the benefits of their Dutch heritage is that they enjoy eating stroopwafels in the office all the time!
A full list of AJRR's technology partners can be found here.
Data Corner

Our  2016 Annual Report   contains a wealth of information on procedural and component data. According to the report, posterior stabilized type implants continue to be the most common design used in primary knee arthroplasty procedures in our sample, accounting for approximately 50% over the three-year span. Cruciate retaining designs were the next most common and made up nearly 42% of the total over the same time frame. Ultracongruent designs, varus/valgus constrained designs, and rotating hinge designs account for the remainder. The figure above provides a visual representation of this data.

Slides with all the tables and figures from the AJRR 2016 Annual Report can be found on our website. Feel free to use them in any talks, presentations, or lectures that you may have.
Upcoming Webinars and Calls
Introductory Webinars
AJRR staff hosts monthly introductory webinars for those who are interested in joining the Registry and would like a basic overview of what we offer. If your institution resides in one of the CJR metropolitan statistical areas, this webinar should be of special interest to you! A demonstration of the new dashboards will be provided. Introductory webinars will be held at the following times this year:
To register for a session, click here.

AJRR Data FAQ Webinars
AJRR IT and Support staff will be hosting Data FAQ Webinars every Thursday in May. We will be discussing focused topics and frequently asked questions. The second half of the session will be devoted to Q & A, so be sure to bring any questions that you've been meaning to ask.

Register for one of the sessions below:
  • May 11, 2017 at 1:00 p.m. Central Time
  • May 18, 2017 at 1:00 p.m. Central Time
  • May 25, 2017 at 1:00 p.m. Central Time
Click here to sign up.

From Data to Innovative Models: Reducing Risk & Improving Joint Replacement Outcomes
Join us for a joint webinar with our Authorized Vendor OM1 addressing emerging initiatives, technologies, and best practices for managing and improving joint replacement outcomes and succeeding under new payment models. The presenters will be AJRR Director of Analytics Dr. Caryn Etkin and OM1 CEO Dr. Richard Gliklich.

The webinar will be held on Tuesday, May 16, 2017 from 11:00 a.m. - 12:00 p.m. Eastern Time. 

Register here.

AJRR User Group Network Conference Call
The AJRR User Group Network (Unet) hosts quarterly conference calls. The next call will be held on Thursday, June 15, 2017 from 12:00 p.m. - 1:00 p.m. Central Time. A finalized agenda will be released soon.

Register here.

Previous Webinars
AJRR 2017 Data Specifications Webinar
If you were unable to attend the AJRR 2017 Data Specifications Webinar, we have a recording and slides that you can view. Click here to access the Unet Forum and view the recording and slides.

AJRR Introductory Webinar for Ambulatory Surgery Centers
If you were unable to attend the AJRR Introductory Webinar for Ambulatory Surgery Centers, a webinar hosted by AJRR in partnership with the Ambulatory Surgery Center Association (ASCA), we have a recording that you can view. Click here to view the recording.

AJRR Orthopaedic Quality Resource Center: What You Need to Know  
If you were unable to attend AJRR Orthopaedic Quality Resource Center: What You Need to Know, a webinar we hosted with CECity, a Premier Inc. Company, we have a recording that you can view. Click  here to view the recording.

Registry Participation 101: A Simple Step-by-Step Guide to Understanding What You Really Need to Know from AJRR 
If you were unable to attend Registry Participation 101: A Simple Step-by-Step Guide to Understanding What You Really Need to Know from AJRR, a Wellbe, Inc. sponsored webinar, we have a recording that you can view. Click  here to view the recording.

Recordings and slides from all other previously held webinars can be found on our  website .
Volunteer for the Management of Osteoarthritis Of the Hip AUC Voting Panel

American Academy of Orthopaedic Surgeons (AAOS) fellows: the Appropriate Use Criteria (AUC) Section is looking for volunteers for their Management of Osteoarthritis of the Hip voting panel. There will be two rounds of voting that will rate how appropriate different osteoarthritis of the hip treatments are. All voting panel members will need to travel to Rosemont, IL for a one-day meeting. Voting panel nominees must complete the AAOS conflict of interest enhanced disclosure form online.

Please contact Mary DeMars at by Monday, May 22, 2017, if you are interested in participating in the voting panel.
Our Newest Hospitals

We've welcomed these participants into the Registry since the last volume of the The Register:

#908 - Creekside Surgery Center in Anchorage, AK
#909 - OrthoIllinois in Rockford, IL
#910 - Ripon Medical Center in Ripon, WI
#911 - St. Agnes Hospital in Fond du Lac, WI
#912 - Waupun Memorial Hospital in Waupun, WI
#913 - Inova Fair Oaks Hospital in Fairfax, VA
#914 - Northwest Surgical Hospital in Oklahoma City, OK
#915 - Southwest Health in Platteville, WI
#916 - Yale New Haven Hospital York Street Campus in New Haven, CT
AJRR currently has 9 16 participating hospitals in all 50 states and the District of Columbia! Click here for a full list of all participating sites.

Special Thanks to Each of Our Supporters!

The Register is the official newsletter of the American
Joint Replacement Registry serving to connect the 
orthopaedic community. For questions, comments, 
or concerns, please contact Erik Michalesko, Marketing 
and Communications Specialist at

The Register editor: Erik Michalesko
©2017. All rights reserved.