CClinicalTrials.gg
Active, not recruitingNCT02566473FORCE-TJRUpdated Dec 19, 2025

FORCE-TJR: Improving Orthopedic Outcomes Through a National TJR Registry

An observational study in Osteoarthritis, sponsored by University of Massachusetts, Worcester. Active, not recruiting at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2025-12-19.

Sponsored by University of Massachusetts, Worcester · Observational

Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
30,000
Ages
18 Years and older
Sex
All
01

Study summary

Aim 1. Establish a national registry of diverse patients of orthopedic surgeons representing all regions of the country and varied hospital and surgeon practice settings (e.g., urban/rural, low and high volume) to ensure that registry analyses and research reflect typical clinical practice thereby providing optimal guidance for patients, clinicians, and national healthcare policymakers. Collect pre-operative and post-operative patient reported outcomes (PROs) for pain and function.

Aim 2: Develop new and transformative comparative effectiveness tools useful to both clinical practice and healthcare policy.

Aim 3. Broadly disseminate surveillance reports for adverse events, such as implant revision, hip dislocation, knee manipulation, and identify important variation to inform quality improvement priorities.

Read the detailed description

Patients scheduling elective total joint replacement surgery are eligible to participate.

The Aims of the registry are as follows:

Aim 1. Establish a national registry of diverse patients of orthopedic surgeons representing all regions of the country and varied hospital and surgeon practice settings (e.g., urban/rural, low and high volume) to ensure that registry analyses and research reflect typical clinical practice thereby providing optimal guidance for patients, clinicians, and national healthcare policymakers. Collect pre-operative and post-operative patient reported outcomes (PROs) for pain and function.

Pre-surgery data. Patients will complete a set of computer-based clinical and behavioral health questions prior to surgery. A paper option is available as well. Data collected include demographics, medical and musculoskeletal comorbidities, pain and function measures.

6 month survey. Patients will receive an invitation to complete the 6 month survey either on the computer at home or on paper. This survey includes the symptom assessment and a screening survey for complications.

12 month and subsequent annual surveys. The 6 month survey will be repeated at 12 months and annually thereafter. In addition, the patient's contact information will be updated.

Oxford Knee Scale, EQ-5D Survey and Satisfaction Questions may be added to a subset of questionnaires.

Using the data collected to date from more than 25,000 patients, the investigators have identified national norms for pre-op and post-op pain and function as well as a Risk-adjustment model for outcomes.

Aim 2: Develop new and transformative comparative effectiveness tools useful to both clinical practice and healthcare policy.

Aim 3. Broadly disseminate surveillance reports for adverse events, such as implant revision, hip dislocation, knee manipulation, and identify important variation to inform quality improvement priorities.

02

Conditions studied

  • Osteoarthritis

Browse trials for

Keywords

  • Patient reported outcomes
  • Osteoarthritis
  • Total joint replacement
03

In context

Osteoarthritis

4,398 studies on the registry are indexed under Osteoarthritis; 582 are open to participants now.

This study's planned enrollment of 30,000 is above the median of 100 across 791 observational studies indexed under Osteoarthritis.

Browse Osteoarthritis studies →

Lead sponsor

University of Massachusetts, Worcester is the lead sponsor of 288 studies on the registry; 54 are open to participants now.

Of its 25 completed or terminated interventional studies of FDA-regulated products, 18 (72%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes
Sampling method
Non-probability sample

Study population

Men and women older than age 18, who schedule elective primary or revision arthroplasty (total joint replacement; hip resurfacing; uni-compartmental knee procedures

Inclusion criteria

  • Must be scheduled elective primary or revision arthroplasty
  • Must speak/read English or Spanish

Exclusion criteria

Exclusion Criteria:

  • Arthroplasty is scheduled due to fracture or malignancy
  • Inability to provide informed consent due to dementia or cognitive impairment
  • Terminal illness with life expectancy of less than 1 year
  • Emergently scheduled surgery.
  • Individuals who are under 18 years of age
  • Pregnant women
  • Prisoners
05

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
30,000 participants (estimated)
Target follow-up
20 Years
Patient registry
Yes
06

What researchers measure

Primary outcomes

  1. Unadjusted and risk-adjusted patient reported pain composite score, measured by the Hip disability and Osteoarthritis Outcome Score/Knee disability and Osteoarthritis Outcome Score (HOOS/KOOS) pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: Up to 3 months prior to elective TJR surgery

  2. Unadjusted and risk-adjusted patient reported physical function composite score, measured by the Short Form 36 (SF 36) Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: Up to 3 months prior to elective TJR surgery

  3. Change in unadjusted and risk-adjusted patient reported pain composite score, measured by the HOOS/KOOS pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: 6 months post elective TJR

  4. Change in unadjusted and risk-adjusted patient reported physical function composite score, measured by the SF 36 Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: 6 months post elective TJR

  5. Change in unadjusted and risk-adjusted patient reported pain composite score, measured by the HOOS/KOOS pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: 12 months post elective TJR

  6. Change in unadjusted and risk-adjusted patient reported physical function composite score, measured by the SF 36 Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: 12 months post elective TJR

  7. Change in unadjusted and risk-adjusted patient reported pain composite score, measured by the HOOS/KOOS pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: 24 months post elective TJR

  8. Change in unadjusted and risk-adjusted patient reported physical function composite score, measured by the SF 36 Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: 24 months post elective TJR

  9. Change in unadjusted and risk-adjusted patient reported pain composite score, measured by the HOOS/KOOS pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: 36 months post elective TJR

  10. Change in unadjusted and risk-adjusted patient reported physical function composite score, measured by the SF 36 Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: 36 months post elective TJR

  11. Change in unadjusted and risk-adjusted patient reported pain composite score, measured by the HOOS/KOOS pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: 48 months post elective TJR

  12. Change in unadjusted and risk-adjusted patient reported physical function composite score, measured by the SF 36 Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: 48 months post elective TJR

  13. Change in unadjusted and risk-adjusted patient reported pain composite score, measured by the HOOS/KOOS pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: 60 months post elective TJR

  14. Change in unadjusted and risk-adjusted patient reported physical function composite score, measured by the SF 36 Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: 60 months post elective TJR

  15. Change in unadjusted and risk-adjusted patient reported pain composite score, measured by the HOOS/KOOS pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: 10 years post elective TJR

  16. Change in unadjusted and risk-adjusted patient reported physical function composite score, measured by the SF 36 Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: 10 years post elective TJR

  17. Change in unadjusted and risk-adjusted patient reported pain composite score, measured by the HOOS/KOOS pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: 15 years post elective TJR

  18. Change in unadjusted and risk-adjusted patient reported physical function composite score, measured by the SF 36 Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: 15 years post elective TJR

  19. Change in unadjusted and risk-adjusted patient reported pain composite score, measured by the HOOS/KOOS pain score

    Collection of patient reported pain composite score from the HOOS/KOOS measure

    Time frame: 20 years post elective TJR

  20. Change in unadjusted and risk-adjusted patient reported physical function composite score, measured by the SF 36 Physical Component sub-score

    Collection of patient reported physical function composite score from the SF 36 Physical Component sub-score measure

    Time frame: 20 years post elective TJR

Secondary outcomes

  1. Surveillance reports for adverse events, such as implant revision, hip dislocation, knee manipulation and other adverse events.

    Patients will complete questions regarding visits to the ER, hospital, day surgery and additional surgery

    Time frame: 6 months post elective TJR

07

Study locations

1 site
  • University of Massachusetts Memorial Health Center; Arthritis and Total Joint Center
    Worcester, Massachusetts 01655, United States
08

References and documents

Publications

  • Ayers DC, Yousef M, Zheng H, Yang W, Franklin PD. The Prevalence and Predictors of Patient Dissatisfaction 5-years Following Primary Total Knee Arthroplasty. J Arthroplasty. 2022 Jun;37(6S):S121-S128. doi: 10.1016/j.arth.2022.02.077. Epub 2022 Feb 26. PubMed 35227816 ↗
  • Ayers DC, Yousef M, Zheng H, Yang W, Franklin PD. Do Patient Outcomes Vary by Patient Age Following Primary Total Hip Arthroplasty? J Arthroplasty. 2022 Jul;37(7S):S510-S516. doi: 10.1016/j.arth.2022.03.032. Epub 2022 Mar 12. PubMed 35292339 ↗
  • Ayers DC, Zheng H, Yang W, Yousef M. How Back Pain Affects Patient Satisfaction After Primary Total Knee Arthroplasty. J Arthroplasty. 2023 Jun;38(6S):S103-S108. doi: 10.1016/j.arth.2023.03.072. Epub 2023 Mar 30. PubMed 37001625 ↗
  • Ayers DC, Yousef M, Yang W, Zheng H. Age-Related Differences in Pain, Function, and Quality of Life Following Primary Total Knee Arthroplasty: Results From a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) Cohort. J Arthroplasty. 2023 Jul;38(7 Suppl 2):S169-S176. doi: 10.1016/j.arth.2023.04.005. Epub 2023 Apr 29. PubMed 37121490 ↗
  • Ayers DC, Zheng H, Yang W, Yousef M. Gender Differences in Pain, Function, and Quality of Life Five Years Following Primary Total Knee Arthroplasty. J Arthroplasty. 2024 Aug;39(8 Suppl 1):S100-S107. doi: 10.1016/j.arth.2024.04.031. Epub 2024 Apr 17. PubMed 38640963 ↗
  • Zheng H, Ash AS, Yang W, Liu SH, Allison J, Ayers DC. Strengthening Quality Measurement to Predict Success for Total Knee Arthroplasty: Results from a Nationally Representative Total Knee Arthroplasty Cohort. J Bone Joint Surg Am. 2024 Apr 17;106(8):708-715. doi: 10.2106/JBJS.23.00602. Epub 2024 Jan 25. PubMed 38271493 ↗
  • Yousef M, Zheng H, Yang W, Ayers DC. Predictive Factors of Pain and Functional Outcome 5 Years Following Total Hip Arthroplasty: A Prospective Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement Cohort Study. J Arthroplasty. 2024 Sep;39(9 Suppl 1):S105-S111. doi: 10.1016/j.arth.2024.02.050. Epub 2024 Feb 25. PubMed 38412901 ↗
  • Ayers DC, Zheng H, Yang W, Yousef M. The Chitranjan S. Ranawat Award: Factors That Predict Outcome Five Years Following Total Knee Arthroplasty. J Arthroplasty. 2025 Jul;40(S7):S12-S19. doi: 10.1016/j.arth.2025.03.006. Epub 2025 Mar 9. PubMed 40068725 ↗

Related links

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Dec 19, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT02566473
Lead sponsor
University of Massachusetts, Worcester
Collaborators
Agency for Healthcare Research and Quality (AHRQ)
Responsible party
David Ayers (Principal Investigator, University of Massachusetts, Worcester) — Principal investigator
First posted
Oct 2, 2015
Start date
Apr 2011
Primary completion
Apr 2031 (estimated)
Completion
Apr 2031 (estimated)
Last update
Dec 19, 2025

Study contacts

David Ayers, MD
principal investigator · University of Massachusetts, Worcester

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is active, not recruiting, as verified in Dec 2025. You cannot join it, but the record below documents what was studied.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Start the discussion