Expert Interviews Describe Arthroplasty Registers’ Role in Value-Based Care

An exploratory interview study of 15 arthroplasty register experts found that registry data may support value-based health care by contributing to evidence-based medicine, quality improvement and clinical decision-making. Participants described possible links between registration and improved patient outcomes, but the research did not directly measure clinical effects, quantify cost savings or establish that registration itself caused better results. The findings instead document the roles that experts attributed to local, national and international arthroplasty registers and identify areas where those roles remain uncertain.

Researchers explored the proposed “symbiosis” between high-quality register data and value-based health care, a concept that has gained traction since 2006 and places value from both a patient’s perspective and a health system’s perspective at the center of care. Arthroplasty registers, including those represented by the International Society of Arthroplasty Registries, seek to improve outcomes for people receiving joint replacements. The study examined how register data relate to evidence-based medicine, quality improvement and the development of arthroplasty pathways, as well as what participants understood these relationships to mean in practice.

The study used online, semi-structured interviews with 15 experts from regionally, nationally and internationally recognized registers. Participants received contextual questions before the interviews. Their responses were transcribed and analyzed in NVivo through qualitative coding designed to identify trends in their views, and confirmatory coding and analysis were then undertaken by a social science researcher.

As an exploratory qualitative study, the work elicited professional experiences and judgments rather than estimating the causal effect or economic benefit of registry participation. Its conclusions therefore reflect the accounts of this expert sample and cannot establish registry effectiveness across all settings. Interviewees emphasized the importance of clinician-led registers in integrating outcome measures with evidence-based practice.

In their accounts, registers can support improved patient outcomes and connect value to care by generating evidence and informing decisions. The participants identified four stakeholder groups that use register information: patients, clinical teams, health systems and society. They also described how information can support choices about effective implants and pre- and postoperative care regimes, providing a basis for clinical decisions rather than direct proof that any particular decision improves outcomes.

Overall, the study supports a relationship between the value-based health care aim of reducing unwarranted variation and the evidence-generating potential of arthroplasty registers, although the strength and direction of that relationship were not tested directly. The role of registers in developing arthroplasty pathways was less consistent. Participants regarded this contribution as ambiguous and variable across territories and among practitioners, indicating that the use of registry evidence in pathway development was not described in the same way everywhere.

The authors conclude that registers and value-based health care share a purpose in pursuing improved outcomes and value for patients, surgical teams, healthcare organizations and society. They plan further research to clarify the complete pathway and examine the potential for closer relationships between registers and value-based health care, but that work is proposed rather than reported here.

Subject of Research: Exploration of arthroplasty register data and value-based health care through expert interviews

Article Title: The “symbiosis” between high-quality register data and value-based health care and the role of local, national, and international registers in the development and promotion of value-based healthcare projects

Article References: Cnudde, P., Rolfson, O., & Huxtable-Thomas, L. (2026). The “symbiosis” between high-quality register data and value-based health care and the role of local, national, and international registers in the development and promotion of value-based healthcare projects. BMC Health Services Research, 26(1), Article 1465. https://doi.org/10.1186/s12913-026-15593-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15593-w

Keywords: arthroplasty registries, value-based health care, joint replacement, qualitative interviews, clinical outcomes, evidence-based medicine, quality improvement, care pathways, implant selection, patient value, symbiosis, between