Supporting orthopaedic surgeons to avoid or reverse negative outlier status

Hip and knee replacements are common and usually successful operations. However, around 2-5% of patients need further surgery within 5-10 years. Revision surgery is more complex, carries greater risks, and has a significant impact on both patients and the NHS.

In the UK, all joint replacements are recorded in the National Joint Registry, which monitors outcomes to help maintain high standards of patient care. If a surgeon has more patients needing revision operations than expected, they may be identified as a ‘performance outlier’.

This system is designed to protect patients and improve safety. However, the reasons why surgeons become outliers are not fully understood. Factors may include the types of problems a surgeon’s patients have, their surgical techniques, or their use of new or innovative implants.

Importantly, no research has yet explored how being labelled an outlier affects surgeons’ professional practice, confidence, or personal wellbeing, nor how they respond to this situation. There is also little evidence about what support might help surgeons improve their outcomes and reverse outlier status.

Project aims

This project aims to understand why some orthopaedic surgeons become negative outliers in hip and knee replacement surgery and, importantly, how they can improve. We will explore surgeons’ views of the National Joint Registry monitoring process through a national survey and in-depth interviews. We will also analyse national data to identify patterns linked to outlier status.

Using this evidence, we will design a new support programme. This programme will aim to help surgeons reflect on their practice, make effective changes, and improve patient outcomes.

What we hope to achieve

We aim to develop a well-designed, evidence-based support programme that helps surgeons avoid or reverse outlier status. This will lead to better-supported surgeons, improved patient safety, and higher-quality care.

The final output will be a ready-to-test programme, prepared for future national evaluation and wider implementation.