Professor Sir Paul Curran, Chair of the National Joint Registry
It is a great pleasure to write the foreword to the National Joint Registry’s Annual Report and reflect on another twelve months of progress. Every year I am reminded that the NJR's success depends on the commitment of hundreds of clinicians, hospital staff, academics, regulators, industry partners and our own dedicated staff team, alongside the generosity of many thousands of patients who trust us with their data. Together, we have built a registry that is recognised internationally for the quality of its data and the positive effect it has on patient care. I would like to thank everyone who has contributed to our success during the financial year 2025-2026.
This has been a particularly important year for the NJR as we have looked ahead to the next stage of our development. The publication of the NJR Strategic Plan 2026-2030 sets out a clear ambition for the future, building on more than two decades of achievement whilst ensuring that the NJR continues to meet the changing needs of patients, clinicians and the wider healthcare system.
The opportunities ahead of us are considerable. Advances in data science and artificial intelligence, the adoption of new surgical technologies and significant changes across the NHS; all have the potential to reshape how registries support clinical practice and improve patient outcomes. The NJR is well placed to play a leading role in that future by providing trusted evidence that informs clinical decision-making, supports research and helps increase the quality of care.
One of the first priorities arising from the new strategy has been a review of the NJR's governance structure. As the registry grows, it is right that our governance evolves with it, thus ensuring that decision-making remains clear, efficient and responsive, whilst preserving the strong clinical leadership and stakeholder engagement that have always been central to the NJR's success. We have also begun work on the registry's first ‘Artificial Intelligence and Data Analytics Strategy’, which offers exciting opportunities to enhance the value of registry data. Our approach will be measured, responsible and transparent, always with the aim of strengthening the evidence we provide.
The collection and effective use of Patient Reported Outcome Measures (PROMs) remains one of the NJR's highest priorities. Surgical revision rates provide an essential measure of implant performance, but they do not capture the full benefit of joint replacement surgery from the patient's perspective. During the year we submitted a proposal to NHS England outlining our ambition for the NJR to lead the national hip and knee PROMs programme. We were delighted by the positive response we received to that proposal and look forward to working with NHS England to further develop this initiative. It was equally encouraging to see the renewed emphasis placed on PROMs within the NHS Quality Strategy, reflecting the increasing importance of these data in understanding the quality and effectiveness of care.
Robotic-assisted surgery is another area where the NJR’s evidence base will become increasingly important over the coming years. As new technologies become more widely adopted, patients and surgeons alike will need independent, high-quality evidence on their performance. We look forward to working with the new National Registry of Robotically Assisted Surgery to ensure that robust joint replacement data contributes to this important national initiative.
Patients continue to play a central role in shaping the work of the registry. Our Patient Network has grown to around ninety members whose insight has informed reviews of the NJR consent model, patient information materials and the Surgeon and Hospital Profile website. Their contribution ensures that the patient voice remains embedded throughout the registry's work and helps us focus on issues that matter to those undergoing joint replacement surgery.
The NJR has also made significant progress in strengthening the way implant survivorship is reported. Reliable long-term outcome data remains one of the registry's defining strengths. During the year we have advanced plans to adopt Kaplan-Meier survivorship methods in place of the aggregated Prosthesis Time Incidence Rate approach used in our implant scrutiny programme. This development will provide a clearer picture of implant performance over time and strengthen our ability to identify emerging signals at an earlier stage.
Our healthcare system continues to change, with developments in both NHS England and the Department of Health and Social Care creating both opportunities and challenges for national clinical registries. Throughout this period the NJR has maintained our close working relationships with national partners, whilst also retaining the independence that underpins confidence in our analyses and recommendations for improvement. I would like to welcome Professor Frankie Swords as National Medical Director and Professor Ramani Moonesinghe as Deputy National Medical Director, and I look forward to working with them in the future.
There have also been several changes within the NJR team. After nineteen years of dedicated service, Elaine Young, our Director of Operations, retired from the registry. Elaine made an enormous contribution to the NJR during its development, and on behalf of the Board I would like to thank her sincerely and wish her a long and happy retirement. Following a wide-ranging recruitment process, Chris Boulton was appointed as her successor. Chris has already made significant contributions to the registry over many years, and I look forward to working with him as we deliver the ambitions set out in our new strategy.
The NJR Board has also welcomed several new members during the past financial year, including Rebecca Beesley, who is already making a valuable contribution as Patient Representative whilst also taking on the position of co-Chair of the Patient Network. I am also pleased to welcome Konstanze Hüeller as industry representative and Mr Colin Esler as new Chair of the Implant Scrutiny Committee. Finally, I would like to recognise the longstanding contributions of Andrew Smallwood and Mr Peter Howard, both of whom have supported the NJR since its earliest days.
This report highlights the breadth of work delivered by the registry during the past year. It demonstrates the continuing value of high-quality registry data in improving patient care, and in advancing research and supporting improved decision making across our public and independent health services. I remain enormously proud of what the NJR has achieved, and optimistic about what we can accomplish in the future. With a clear sense of purpose, strong partnerships and an unwavering commitment to patients, I am confident that the NJR will continue to make an important contribution to joint replacement care, both here and internationally.