When searching for a clinic, pay attention to the number of cases and ask about the results in the EPRD
24.08.2021 11:23
An artificial hip or knee joint should serve for as many years as possible. But how do you find a clinic with good long-term results? This is one of the most important concerns for patients who are about to have a replacement joint implanted. In fact, the evaluations of the German Endoprosthesis Register (EPRD) show that the risk of premature replacement surgery tends to be lower if the initial implantation takes place at a clinic that carries out many such procedures (1, 2). Nevertheless, not every hospital with a high number of cases automatically has a better result. Rather, there are exceptions in both directions. The AE – German Society for Endoprosthetics e. V. therefore advises that when choosing a clinic, not only ask about participation in the EPRD as a quality indicator, but also the actual results.
Further findings from the EPRD and what consequences this will have for future patient care with replacement joints will be the subject of the AE's online press conference on September 16, 2021. It will take place in the run-up to the AE annual congress (September 24 to 25, 2021, Regensburg ) to mark the 25th anniversary of the specialist society.
It can be difficult for patients to assess the quality of a clinic in advance. Recommendations from family doctors and the EndoCert certificate (3), which stands for tested quality of processes in endoprosthetic centers, help here. Another important quality feature is the clinic's voluntary participation in the EPRD: "This shows that the facility works transparently, is open to comparison with other hospitals and, above all, is interested in the best possible results," says Professor Dr. med. Carsten Perka, Secretary General of the AE and spokesman for the EPRD. Since 2012, hospitals have been able to report data on the operation, the prosthesis components used and patient data such as gender, age and previous illnesses in the EPRD. The data is continually systematically evaluated and compared. “This allows valuable conclusions to be drawn at an early stage, for example about implant failure and quality of care, and thus avoid major damage across the board,” explains Perka. There are currently data sets from around 1.8 million implantations at around 750 participating clinics. The recording rate was recently almost 70 percent of all annual endoprosthetic procedures on the hip or knee.
The report currently shows probabilities of failure up to five years after the initial implantation of a replacement joint: “The currently implanted prostheses, provided they are already recorded in the EPRD, are safe,” states Perka. “But the data also shows that choosing the right hospital is more relevant for the patient than choosing the respective implant,” said the Medical Director of the Center for Musculoskeletal Surgery, Clinic for Orthopedics and Trauma Surgery at the Charité Berlin and 1st Vice- President of the German Society for Orthopedics and Orthopedic Surgery (DGOOC). “Clinics with 700 or more initial hip or knee prosthesis implantations generally have significantly better service life (4),” says the orthopedist and trauma surgeon. Nevertheless, you should have the actual performance shown, because exceptions to this rule are possible. Patient-specific factors such as age, gender, BMI and comorbidities such as type 2 diabetes would also have a further influence on the long-term result.
The best possible patient safety when providing hip and knee replacement joints was the declared goal of the founders of the EPRD, above all the DGOOC as well as health insurance companies and industry.
According to current status, a reporting requirement to the newly created statutory implant register for endoprostheses of the hip and knee joints (IRD) is scheduled to come into force on January 1, 2024 (4).
It is planned to transfer the essential parts of the EPRD's data collected over the years to the IRD in compliance with data protection regulations. “This means we can continue to use this valuable data in the future and don’t have to start from scratch again,” summarizes Perka. “This is crucial to our pursuit of maximum patient safety and satisfaction in endoprosthetics.”
Sources:
(1) Endoprosthesis Register Germany (EPRD): www.eprd.de/de/
(2) Influence of institutional experience on the results in total hip and knee arthroplasty: An analysis from the Endoprosthesis Register Germany (EPRD): Arnd Steinbrück, Alexander Grimberg, Oliver Melsheimer, Volkmar Jansson, Orthopäde 2020 49:808–814, https:// doi.org/10.1007/s00132-020-03963-z
(3) www.endocert.de
(5) https://www.bundesgesundheitsministerium.de/implantateregister-deutschland.html