National clinical audit & registries
Quality Accounts: national clinical audits for inclusion
National Joint Registry
Clinical databases and registers
Engaging clinicians in QI via national audit
National Clinical Audit data for CQC inspections

National Joint Registry



Hip, knee, ankle, elbow and shoulder joint replacements are common and highly successful operations that bring many patients relief from pain and improved mobility. Thousands of these joint replacement operations take place in the UK every year. The National Joint Registry (NJR) was set up by the Department of Health and Welsh Government in 2002 to collect information on joint replacement operations and to monitor the performance of implants, hospitals and surgeons. Northern Ireland joined in February 2013. 

Data collection began in April 2003 and submission for NHS organisations has been mandatory since April 2011. The registry now holds over 1.85 million records, making it the largest register of its kind in the world.

Hip and knee replacements have been collected since 2003, ankle joint replacements since 2010 and elbow and shoulder joint replacements since April 2012.



NJR Annual Reports analyse the data submitted to the NJR, and highlight the aims and achievements of the National Joint Registry, its Steering Committee and its sub-committees and are released in September each year. The key analyses of the NJR's 11th, and latest, Annual Report - covering 2013/14 data - were presented at the NJR’s 11th Annual Report launch at the BOA Congress, Brighton on Friday 12 September 2014.

2014 report highlights

In addition to a wealth of new data to help clinicians improve the quality and outcomes of hip, knee, ankle, elbow and shoulder joint replacements, this year's report includes:

  • More than 10 years of follow-up for hip and knee replacement surgery
  • Three years of ankle replacement data and early outcomes analysis
  • More than 12 months of elbow replacement and shoulder replacement data
  • Analysis from more than 1.6 million procedures
  • In-depth topics looking at short-term mortality after hip and knee replacement surgery
  • Trust-, Local Health Board- and unit-level activity and outcomes data for hip and knee procedures
Later in the year, early shoulder outcomes analysis will also be published at  

Previous editions of the Annual Report can be downloaded here >>


Public and Patient Guide to the 11th Annual Report

The NJR produces a Public and Patient Guide to its Annual Report, and was amongst the first national clinical audits to publish a patient guide of this type.  The document takes hundreds of pages of surgical data and breaks it down into more accessible and relevant information for patients.

The 2014 guides are now published and can be found here:

Interactive PDFs - these open in format that allow you to read the document like a magazine on screen

Normal PDF documents - allowing you to read and scroll down through each of the pages in turn

Previous editions of the Public and Patient Guide to the NJR's Annual Report can be downloaded here >>


Aims of the NJR

As part of the development of the 2013-16 NJR strategic plan, its aims were reviewed to take into account maturity of the registry and the NJR's growing involvement, impact and engagement with its stakeholders. These aims continue to be met, either by the NJR alone or through its work with key stakeholders and partners.

The key aims of the registry are to:

  • Monitor in real time the outcomes achieved by brand of prosthesis, hospital and surgeon, and highlight where these fall below an expected performance in order to allow prompt investigation and to support 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 with patients and patient organisations
  • Support evidence-based purchasing of joint replacement implants for healthcare providers to support quality and cost-effectiveness
  • Support suppliers in the routine post-market surveillance of implants and provide information to clinicians, patients, hospital management and the regulatory authorities

Organisation of the NJR

NJR Steering Committee

The NJR Steering Committee oversee the strategic direction and work programme of the registry and is a DH Committee of Experts. Membership includes representatives of the surgical profession, patient groups, orthopaedic implant suppliers, public health/epidemiology, NHS purchasing and supply agency, Medicines and Healthcare products Regulatory Agency, NHS Trust Management, Independent Healthcare Sector, and the Welsh Government.

HQIP supports the work of the steering committee, including the implementation of its strategic plans and development work on its behalf. HQIP manages the levy payment (raised on the sale of hip, knee, ankle, elbow and shoulder replacement implants) collections and holds the budget of the steering committee. The development team in HQIP, led by Elaine Young, supports the NJR.

The NJR joins the rest of the National Clinical Audit and Patient Outcomes Programme (NCAPOP - commissioned and managed by HQIP), which has been confimed as mandatory with all other projects under the NHS Standard Contract for Acute Services as of April 2011.

Find out more about all of the following on the NJR's website at

NJR eBulletin

Keep informed of the latest news, events and work with NJR's regular eBulletin.