Joint arthroplasty is the main treatment for end-stage joint disease. China’s population is aging and osteoarthritis is becoming more common. As a result, the number of arthroplasty procedures continues to grow. National volume-based procurement has substantially increased the use of domestic implants. China, however, has not yet conducted a unified nationwide arthroplasty cohort study. It therefore lacks the real-world data needed to assess implant quality and to detect revision risk early. This shortfall makes it harder to improve care, strengthen insurance oversight, and advance the domestic device industry. Experience from cohort studies in other countries shows that a unified national arthroplasty registry can identify revision risk early, lower medical costs, and improve quality of care. China has now completed a unified national medical insurance platform. Its data cover nearly the entire population, span long periods, reach a large scale, and link directly to payment policy. Together these features provide a strong basis for arthroplasty cohort research. This article reviewed the current state of arthroplasty cohort studies in China and abroad. It analyzed the feasibility, value, and limitations of building a Chinese arthroplasty cohort from full-process medical insurance data. It then offered recommendations for standardizing data, refining outcome measures, and improving follow-up. The aim is to inform better clinical care, stronger regulation of high-value implants, and the growth of China’s domestic medical device industry.