Connect and learn more at www.aaos.org/ajrr 12/3/2018 American Joint Replacement Registry 2018 - California State Registry Supplement Connect and learn more at www.aaos.org/ajrr These slides are put together with the intent to be used in presentations and for discussions around the AJRR 2018 Annual Report – California State Registry Supplement. For more information, please contact the AJRR Marketing and Communications department at RegistryInfo@aaos.org. Established in 2009- CJRR collected and analyzed data from hip and knee replacement surgeries performed in California. CJRR became part of AJRR on 2015.

12/3/2018 Figure 1 shows an increase in the quantity/ volume of the data submitted regarding the Hip and Knee Replacement surgeries, to CJR. The time line presented in figure 1 is between 2011 and 2017. More data submitted for the Knee Replacement Surgeries. N= 596 (KRS) in 2011 went up to N=29451 (KRS) in 2017. N=483 (HRS) in 2011 went up to N =19815.

12/3/2018 Figure 2 shows the CSR participants by size. Source: American Hospital Association (AHA) Annual Survey Database Fiscal Year 2015 Small = 1-99 beds; Medium = 100-399 beds; Large = 400+ beds

12/3/2018 Table 1 shows CSR participants and cases reported through December 31, 2017. *With the integration of CJRR data into the AJRR database, a migration and validation process was implemented. As such, CJRR data that did not pass AJRR validation standards was excluded from import and analysis.

12/3/2018 Figure 3 shows the mean score distribution. The Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), which assess a patient’s hip and knee pain and function. On a 0-100 scale, higher score indicates better health.

12/3/2018 Figure 4 shows the mean score distribution. The Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), which assess a patient’s hip and knee pain and function On a 0-100 scale, higher score indicates better health.

12/3/2018 Table 2 shows the change in WOMAC Hip Function Scores Pre-Surgery and One Year Post-Surgery by Hospital. Upon comparison to the previous year’s report, most institutions had no to small changes in the number of completed pre- and 1-year post-surgery WOMAC- survey. *For hospitals with > 30 eligible patients who completed both pre-surgical and 1-year post-surgical PROMs. ¥Meaningful improvement was calculated by minimal clinically-important difference (MCID) and adjusted for age, gender and race. MCID was determined to be a positive change score of half the posted standard deviation.

12/3/2018 Table 3 shows the change in WOMAC hip pain scores re-surgery and one year post-surgery, by hospital. Upon comparison to the previous year’s report, most institutions had no to small changes in the number of completed pre- and 1-year post-surgery WOMAC- survey. *For hospitals with > 30 eligible patients who completed both pre-surgical and 1-year post-surgical PROMs. ¥Meaningful improvement was calculated by minimal clinically-important difference (MCID) and adjusted for age, gender and race. MCID was determined to be a positive change score of half the posted standard deviation.

12/3/2018 Table 4 shows the change in WOMAC hip stiffness scores pre-surgery and one year post-surgery, by hospital. Upon comparison to the previous year’s report, most institutions had no to small changes in the number of completed pre- and 1-year post-surgery WOMAC- survey. *For hospitals with > 30 eligible patients who completed both pre-surgical and 1-year post-surgical PROMs. ¥Meaningful improvement was calculated by minimal clinically-important difference (MCID) and adjusted for age, gender and race. MCID was determined to be a positive change score of half the posted standard deviation.

12/3/2018 Table 5 shows the change in WOMAC knee function scores pre-surgery and one year post-surgery, by hospital. Upon comparison to the previous year’s report, most institutions had no to small changes in the number of completed pre- and 1-year post-surgery WOMAC- survey. *For hospitals with > 30 eligible patients who completed both pre-surgical and 1-year post-surgical PROMs. ¥Meaningful improvement was calculated by minimal clinically-important difference (MCID) and adjusted for age, gender and race. MCID was determined to be a positive change score of half the posted standard deviation.

12/3/2018 Table 6 shows the change in WOMAC knee pain scores pre-surgery and one year post surgery, by hospital. Upon comparison to the previous year’s report, most institutions had no to small changes in the number of completed pre- and 1-year post-surgery WOMAC- survey. *For hospitals with > 30 eligible patients who completed both pre-surgical and 1-year post-surgical PROMs. ¥Meaningful improvement was calculated by minimal clinically-important difference (MCID) and adjusted for age, gender and race. MCID was determined to be a positive change score of half the posted standard deviation.

12/3/2018 . Table7 shows the change in WOMAC knee stiffness scores pre-surgery and one year post surgery, by hospital. Upon comparison to the previous year’s report, most institutions had no to small changes in the number of completed pre- and 1-year post-surgery WOMAC- survey. *For hospitals with > 30 eligible patients who completed both pre-surgical and 1-year post-surgical PROMs. ¥Meaningful improvement was calculated by minimal clinically-important difference (MCID) and adjusted for age, gender and race. MCID was determined to be a positive change score of half the posted standard deviation.

12/3/2018 Figure 5 shows the VR-12 hip and knee scores for physical component, pre-surgery and one year post surgery. The Veterans’ Rand 12-Item Health Survey (VR-12) to assess a patient’s overall perspective of their health- physical health. On a 0-100 scale, higher score indicates better health.

12/3/2018 Figure 6 shows the VR-12 hip and knee scores for mental component, pre-surgery and one year post surgery. The Veterans’ Rand 12-Item Health Survey (VR-12) to assess a patient’s overall perspective of their health- mental health. On a 0-100 scale, higher score indicates better health.

12/3/2018 Table 8 shows the change in VR-12 Physical Score. *For hospitals with > 30 eligible patients who completed both pre-surgical and 1-year post-surgical PROMs. ¥Meaningful improvement was calculated by minimal clinically-important difference (MCID) and adjusted for age, gender and race. MCID was determined to be a positive change score of half the posted standard deviation.

12/3/2018 Table 9 shows the change in VR-12 mental component score. *For hospitals with > 30 eligible patients who completed both pre-surgical and 1-year post-surgical PROMs. ¥Meaningful improvement was calculated by minimal clinically-important difference (MCID) and adjusted for age, gender and race. MCID was determined to be a positive change score of half the posted standard deviation.

12/3/2018 Figure 7 shows the age distribution of primary and revision hip procedures in US and California. *Source: Healthcare Cost and Utilization Project [HCUP], 2014 (US). California State Registry data January 2011 to June 15, 2017.

12/3/2018 Figure 8 shows the age distribution of primary and revision knee procedures in US and California. *Source: Healthcare Cost and Utilization Project [HCUP], 2014 (US). California State Registry data January 2011 to June 15, 2017.

12/3/2018 Figure 9 shows the Mean Body Mass Index (BMI) by procedure and sex.

12/3/2018 Figure 10 shows the principal diagnosis based on Revision Procedure. Osteoarthritis was the diagnosis at the time of surgery for approximately 90.7% of patients undergoing a primary hip arthroplasty and 97.1% for primary knee arthroplasty.

12/3/2018 Figure 11 shows the mean length of stay.

12/3/2018 Figure 12 shows observed comorbidities by percentage.