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Replacements are concerned. So that's the NJ R and the then President John Timper at the time in 2010, 2012, basically said that a lot of hip arthroscopies or hip preservation procedures are being done. The trajectory was quite high. We were growing at the rate of almost 700% per annum and we needed to monitor the outcomes uh of these procedures. So the philosophy was to capture the data of the non arthroplasty procedures as well, pretty much like the NJ R. So the British Hip Society established the non Arthroplasty Hip Registry in 2012. So pretty much ahead of their time in terms of measuring outcomes. Now, why would you want to do it basically because of this philosophy? Because if you can't measure it, you can't improve it. So if you want to improve something, you've actually got to start measuring it. And that's the philosophy behind it all. So the aims of the N hr when it was set up for three fold, we wanted to assess the outcomes and the efficacy of this type of surgery. That's non arthroplasty surgery. We wanted to provide feedback to the surgeons with validated outcome data. We wanted to obviously improve patient care. And then eventually we wanted to link up the N hr to the he data to see how many of these non arthroplasty procedures are actually getting converted to hip arthroplasty. And we're just coming up with some papers on that as well, so that we can actually follow up the joint throughout, right from the beginning, in terms of when there is just a label, tear and impingement through to arthroplasty. So the whole lifespan of the patient's hip. So this is the N Hr Committee uh uh that we have at the moment, it's supported by the British Ship Society, British Orthopedic Association and our data partners are Amplitude Clinical Outcomes. This is the portal that we have. So we can actually submit data via the portal, a good website, fairly easy to use. And then after you put in that data, we worked a lot on a GDPR compliant consent form. So this is the new consent form that we have now uh and a good governance process in place for this. And we use two scoring systems because we want everybody to fill it. So we've kept it fairly simple. We use the IOP 12 which is essentially 12 questions, use for young adults with HEP pathology. It's a validated outcome measuring or pro scoring system for uh young adults with he pathology. And then we use a generic one which is the EQ five D. So these two scores, the patient will fill up preoperatively at six months, at 12 months and then at two years. And this is our NH RMD S version three, which is what the surgeon would fill up. So what do you find in the central compartment of the hip? What you find in the peripheral compartment, how many anchors you're using, et cetera? So this is the operative details uh that you'll fill in. So, automatic emails are sent to the patients at six months, 12 months and 24 months. The data is owned by the BHS. Ex surgeon cannot see why surgeons data. So you've got your own data and every year you will get your own uh outcome measures in comparison to the average outcome measures of the country. It's the world's only national registry of its kind. The Danish is there. But in terms of the number numbers, uh we are pretty, pretty high. The American one has just started based on our registry. I'm sure they will, they will catch up with the numbers fairly soon just because of the numbers of hip arthroscopy being done uh there. But we're basically leading the world in the field of registry data. So this you can take for your surgeon appraisal. This is your individual data. You can compare it to the national data and see how you're doing and your diagnosis as well. And that's uh that's what it'll give you. We get the annual report out every year. And uh any hr fellows help us actually producing that. And over the years, you can see that the numbers have kept on increasing and we are almost over 25,000 hip uh hip reservation procedures uh in the registry. So that's sort of the background to the registry and where we are now, II chaired the registry for 23 years and then it was a MLB. So what are the lessons learned uh whilst actually setting up the registry? And also in terms of the papers that we published. So hip specific lessons. So over 25 actually 1000 pathways that was 2023 data, 25,000. Now we have over 100 and 10 unique surgeons contributing that data to the registry. Uh If you look at the number of surgeons who are doing more than f uh 40 more than 50 procedures, you will see that there are about 40 surgeons, more than 100 procedures, there are 27 surgeons and more than 505 in the registry. So clearly see that uh which is a, which is the right thing that you've got high volume surgeons who are actually doing a lot of these procedures, which is how uh it should be. If you look at the age distribution, it's essentially between the ages of 15 to 50. But if you again scale it down, then it uh the maximum numbers are being done between 20 to 45 which is again, right? Which is what you want rather than the few ages, in terms of acetabular procedures. Two years ago, when I gave the stock lab debridement was quite high and lab repair was done there, but labral repair now has taken over la debridement again, which is right. Uh So more lab repair is being done in the, in terms of femoral procedures, obviously, the cam uh osteochondroplasty is the largest one that is being done. Uh If you look at the outcome data, then as I said, we look at the IOP 12 and the EQ five D, uh the commonest indication is fe table impingement. So they started about 3233 points and they go up to 58 points and the MCI for I have 12 is 13 points. So you can see that uh all these patients are improving significantly. Um Actually crossing the NCI D. If you do that for cam lesion alone, you're, you're seeing the similar kind of result out there, but the spread is quite wide pilar. Again, you're getting a similar effect uh both at six months and at 12 months follow up. And if you look at Peria or osteotomies, again, you're getting a similar effect. Uh This is pre op really jumps up at six months, continues to improve up to 12 months uh in patients following pa So there's steady improvement in all the data collection both in terms of surgeons and in demographics, there's significant improvement in Crohn's at the six month level and also at the 12 month level for fa surgery for cam, for pins and for peria osteotomy. Now let's dig down a bit deeper. So we looked at about 5000 of the patients having fa surgery again, over 100 and 10 surgeons uh in this data group. And we published that and this is what we got. So this is a bit worrying because it tells you that only two thirds of the patients in these 5, uh 5000 patients are actually achieving their MC and only half are achieving substantial clinical benefit, which is over 26 points. So less about one third, some of them are actually getting worse. Those red ones that you can see and these orange ones are less than the MCD. So one third are actually not improving following hip surgery. So that clearly tells you that this procedure is not suited for all. And we need to be very careful about whom we are offering this procedure to. And we need to be looking at that very carefully. The second. So that's, that was one bit that came out. The second bit we looked at was what happens if you do a chondroplasty for these patients versus a micro fracture. So all the adult hip arthroscopies from first Jan 2012 to uh May 2020. We included a chondroplasty patients are about 1500 micro fracture, about uh 300 we identified them and then we again looked at the eye heart ve and the EQ five D. So these are the raw scores and you can clearly see the chondroplasty is the blue one and micro fracture is the orange one and the green is no cartilage procedure. So they are improving but clearly higher scores for chondroplasty at six months and at 12 months in comparison, uh to the microfracture, uh if you look at the age, so this is chondroplasty, this is micro fracture and this is the no cartilage uh in terms of age. Now, older patients, you can clearly see that they are slower to improve in the microfracture group, but significant improvement in both and we've looked at under 40 above 40. And then if you look at uh control damage or the control procedure itself, in terms of the I score, grade 1 to 4, clearly significant improvement in all groups, but grade four, obviously worse.