Will registries slow down or accelerate innovation?

Figures

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  Fig. 1a. Showing performance trajectories over time of established and sustaining innovations. The area between the dashed lines represents the gap between the least and most demanding patients. The pace of change of established innovation is nearly always greater than the capacity of patients to take it on board. This allows the potential for new disruptive technologies to find a place in the market. Currently, in joint replacement surgery, the industry and professional focus is predominantly centred on sustaining innovations due to financial, organizational and professional incentives.

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  Fig. 1b. Showing performance trajectories over time of established and sustaining innovations where a deleterious modification has been (a) identified early and stopped by an effective surveillance programme and registry, or (b) left unchecked in the absence of clinical evidence.

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  Fig. 1c. Showing performance trajectories over time of a new and disruptive technology. Including examples of innovations that have either been (a) stopped, or (b) slowed down by the costs and difficulties of increased regulation and evaluation. Adapted from Christensen CM, Bohmer RMJ, Kenagy J. Will disruptive innovations cure health care? Harvard Business Review 2000;September–October:102–117.

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  Fig. 2. The European Commission Regional Innovation Scoreboard which classifies regions of Europe into four groups: Innovation Leaders, Strong Innovators, Moderate Innovators and Modest Innovators. The most innovative regions are in Sweden, Denmark, Finland, Germany and the UK, all of which have established Joint Replacement Registries. https://ec.europa.eu/growth/industry/innovation/facts-figures/regional_en (last accessed 30 September 2018).

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  Fig. 3. Showing countries in Europe which have active hip and knee replacement registries. The registries are sub-divided into those with more than and less than 75% national coverage.