(iii) What we can learn from the registries

The National Joint Registry (NJR) in England and Wales is currently the largest database of its kind in the world, with over one million records. Data entry has become compulsory, but even prior to this the registry has been 85% complete since inception. It offers web-based feedback to surgeons, hospitals and implant manufacturers, in addition to cooperating with other regulatory and professional bodies, and recently encouraging greater patient engagement. It produces annual reports covering what is occurring at a national level, with detailed analysis of patient demographics and large numbers of hip and knee arthroplasties, and more recently ankle replacements. It has been involved in the withdrawal of implants and assisting in the management of medical device alerts. It has many potential roles in improving patient outcomes, encouraging evidence-based practice and optimizing resource utilization.