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Background/Objectives: According to the guidelines of the EndoCert initiative, certified maximum-care arthroplasty centers (ACmax) are obliged to admit patients from certified arthroplasty centers (AC) if these patients need to be transferred to the more specialized ACmax due to difficult replacement and revision procedures as well as after complications in primary care that are beyond the expertise of the smaller centers. This study investigated whether the cohort of transferred patients differed from the patients directly recruited at the ACmax for factors such as severity of diagnosis, comorbidities or outcome. The aim was to determine whether transferred patients increased the resource requirements for the ACmax. Methods: A total of 136 patients were included in the retrospective study and analyzed in terms of case severity, length of hospital stays (LOS), Diagnosis-Related Group charges, readmission rate and concomitant diseases. All patients were followed for up to 12 months after the initial hospital stay. Results: There were significant differences between the groups of transferred and self-recruited patients. For example, transferred patients had a higher Patient Clinical Complexity Level (PCCL). Similarly, the increased Case Mix Index (CMI) of transferred patients indicated more intensive care during the inpatient stay. The higher values for the comorbidity indices also supported these results. This had an impact on the LOS and overall costs, too. The differences between the groups were also reflected by adverse events during the one-year follow-up. The higher percentage of patients with septic revisions, whose treatment is especially demanding, among transferred patients aggravated the differences even further. Thus, transferred patients were associated with increased resource requirements for the ACmax. Conclusions: While it serves patients' safety to transfer them to an ACmax with specialized expertise and greater structural quality, the care of transferred patients ties up considerable resources at the ACmax that might only be insufficiently reimbursed by the generalized tariffs. [ABSTRACT FROM AUTHOR]

To improve arthroplasty care quality, the EndoCert initiative focuses on structural, processual, and surgeon-related quality assurance. The aim of this study was to assess the impact of a surgeon's case load in certified centers on quality of care, distinguished by different types of surgeons. Data from the annual reports of EndoCert certified centers for the years 2017 to 2021 were analyzed. The study revealed reduced numbers of cases, while the number of surgeons remained constant. Since 2020, the decrease in the average case load per surgeons has become more pronounced. There were also differences between senior (sECrs) and EndoCert-registered surgeons (ECrs). Before the 2020 pandemic, over half of surgeons exceeded minimum annual case requirements, while, afterwards, this number declined, especially for the ECrs. Affiliated surgeons, who are also sECrs or ECrs, performed predominantly lower numbers of arthroplasties. However, a higher percentage of affiliated surgeons in a center correlated with faster surgeries and lower mortality rates. High numbers of arthroplasties per center or surgeon were not necessarily associated with better quality indicators, especially in the knee. While the comprehensive quality standards may offset volume effects, EndoCert should reconsider minimum volume regulations based on surgeon, but also on each joint. [ABSTRACT FROM AUTHOR]

Competing Interests: K. Osmanski-Zenk wird über ein Drittmittelprojekt der EndoCert GmbH finanziert, die hundertprozentige Tochter der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie ist. O. Melsheimer ist Mitarbeiter beim Endoprothesenregister Deutschland. W. Mittelmeier ist ehrenamtliches Mitglieder der Zertifizierungskommission der EndoCert GmbH. Bei M. Ellenrieder besteht kein Interessenkonflikt.

Background: The subjective evaluation of the patient's state of health with the help of Patient-reported Outcome Measurements (PROMs) provides valuable information for assessing the treatment outcome and for treatment planning. However, the use of PROMs in the field of arthroplasty is not mandatory, so that there is a lack of standardised recording and interpretation. The present study aims to identify patients, who have not achieved the intended treatment goals with regard to pain, function and quality of life after total knee arthroplasty, more easily in the future on the basis of postoperative PROMs., Material and Methods: Data collection (for 3-month postoperative follow-up) included a standardised clinical follow-up (NU) and a questionnaire of different PROMs (Oxford Knee Score [OKS], OKS Pain Score [OKSS] and EndoCert Risk Score [ERS]). During the specialist follow-up examination, it was decided whether further medical therapy had to be initiated. Accordingly, patients were grouped into four post-treatment categories (NU not required/further diagnostics/new prescription/revision required)., Results: For individual scores and questions, there were significant differences between the respective groups of consequences resulting from the follow-up examination. The OKS, OKS Pain Score and the ERS are suitable for detecting thresholds to determine the need for a follow-up examination. The postoperative thresholds of the scores are 24 for the OKS total score, 52 for the OKS pain score and 4 for the ERS pain intensity score., Conclusion: In the initial three months after knee arthroplasty, certain PROMs are suitable for identifying patients for whom further diagnostics and therapy are indicated. In particular, the OKS and the pain intensity score of the ERS are suitable for detecting a potentially unfavourable development in rehabilitation after total knee arthroplasty., Competing Interests: K. Osmanski-Zenk wird über ein Drittmittelprojekt der EndoCert GmbH finanziert, die hundertprozentige Tochter der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie ist. W. Mittelmeier ist ehrenamtliches Mitglied der Zertifizierungskommission der EndoCert GmbH., (Thieme. All rights reserved.)

Background: The EndoCert initiative does not yet allow a long-term assessment of outcome quality. The assessment cannot be achieved without cooperation with the German arthroplasty registry (EPRD) and other quality assurance infrastructure, such as the quality assurance system of the nationwide healthcare insurance data for inpatient hospital treatment (QSR) by the German local healthcare fund (AOK). Therefore, the quality of care of all certified centres for joint replacement (EPZ) after primary hip and knee arthroplasty was to be examined for the first time. These data were subsequently compared to the data of the EPRD., Materials and Methods: In EPZ that provided care to at least one AOK-insured patient in 2016, the risk-adjusted 3‑year revision rate and the SMR-value (standardised mortality or morbidity ratio), which is the quotient of the observed and expected revision rate, were analysed as markers for the quality of care. Annual hospital volume, type of centre and audit results were examined as possible influencing factors., Results: In the group comparison, significant differences (p = 0.042) for the SMR value of the 3‑year revision rate were demonstrated for hip arthroplasty with regard to the EPZ type. The annual number of primary hip arthroplasties, however, did not influence the 3‑year revision rate. For knee arthroplasties, no effect of the defined categories on the 3‑year revision rate and its SMR value was observed. The comparison of our 3‑year revision rates with those of the EPRD showed similar results for the hip but indicated significant differences for the knee., Conclusion: We did not observe a correlation between quality of care and annual hospital volume in certified EPZ. However, different quality assurance procedures can lead to different results with respect to the outcome quality. Therefore, a considerably improved interaction of the German quality systems must be achieved. Participation in the EPRD is not sufficient for this. Rather, a complete report of all arthroplasties must be required, at least with the achievement of a minimum reporting rate per participating hospital. Uniform inclusion and exclusion criteria should be defined., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Postural control helps maintain upright posture and contributes to balance regulation. Increasing neuromuscular deficits in older subjects lead to a deterioration in postural control, which can be improved through neuromuscular training. Assuming that neuromuscular deficits occur at an early age, the postural abilities of 20 to 40 year olds were investigated. In addition, the influence of competitive sports on postural control was examined by including karate squad athletes., Methods and Material: For an age comparison, 123 age-homogeneous healthy people between 20 and 40 years were examined. 24 karate squad athletes were compared with the 20 -25 year old healthy subjects. A neuromuscular training device, the Human Body Equilibrium 360, was used to collect data., Results: In the age comparison, there were no significant differences for all seven measurements. The study group was too young to detect deficits. However, some general findings could be published. In the two-legged stance, a significant increase in the fluctuations of the body centre of gravity after eye closure could be seen in all groups. The influence of footedness and handedness could be seen in the one-legged stance and the strength test. Gender-specific differences could be observed. The examination of karate squad athletes showed various training-specific adaptations. For example, karate athletes were better able to compensate for the loss of visual information. Karate athletes also showed a significantly wider gait pattern and a larger stability area. Athletes were able to shift their body centre of gravity further without getting out of balance., Conclusion: The Huber 360 is only conditionally suitable as a rehabilitation and training device, due to the low discriminatory power of the tests in its entire range of applications, as significant differences between the groups are difficult to detect. Individual training specific adaptations through performance-oriented karate training are recognisable and underline the influence of training on postural control. In summary, the use of the Huber 360 to assess postural abilities in age comparisons and to distinguish training specific adaptations requires a differentiated and more selective use of the individual tests. Further studies with older patients with different diseases are planned., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The number of patients receiving inpatient treatment for back pain is increasing, as the current structures of outpatient care cannot meet the demand adequately. Although the infrastructure of the maximum care provider ensures possible emergency care and imaging procedures on the one hand, it is not geared to providing replacement services for outpatient care on the other., Objectives: Analysis of the readmission rates of primarily conservatively treated inpatients with back pain., Materials and Methods: In this retrospective study, the recovery rate of patients with back pain who were admitted as emergency inpatients and treated primarily conservatively as inpatients was investigated within 6 months at a university orthopaedic clinic. The study period was 2 years with a follow-up of 6 months. 413 patients were evaluated., Results: After primarily conservative therapy, 17.9% of the patients were readmitted to hospital. It took 25 (±33.25) days until the first readmission and 25.9 (±31.99) days until the second readmission. Pensioners were admitted to hospital significantly more often but were treated mainly conservatively during their stays; 66.8% of the presentations were emergencies without referral., Conclusions: Readmission after primarily conservative inpatient treatment is relatively high. In most cases, the return of the patient to outpatient care can be achieved by tight management with a rapid diagnostic procedure and targeted aftercare strategies. The patient may return to outpatient care for surgical treatment or, unplanned, due to failed conservative, outpatient treatment.