ArticleArchives of orthopaedic and trauma surgery2026
Impact of EndoCert certification on hip and knee arthroplasty outcomes in a rural hospital: a retrospective cohort study.
Article in Archives of orthopaedic and trauma surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionQuality assurance in arthroplasty has become increasingly important in light of rising procedure volumes and patient expectations. In 2012, the EndoCert system was introduced in Germany as a standardized certification program addressing structural, process, and outcome quality.
methodsThis retrospective cohort study evaluated the impact of EndoCert certification on hip and knee arthroplasty outcomes in a rural hospital. A total of 847 patients undergoing 1,011 primary or revision procedures were included, covering a pre-certification period (2014/2015) and post-certification years (2016, 2018, 2020). Process indicators (preoperative planning, imaging, operative time) and outcome indicators (infections, dislocations, thromboembolic events, revisions) were analysed.
resultsProcess quality improved markedly following certification. Preoperative planning compliance increased from 63% pre-certification to 96% post-certification, and standardized radiographic assessment improved from 71% to 98%. Operative times increased (from 82 min to 94 min) due to a higher proportion of complex revision procedures (rising from 6 revisions pre-certification to 19 revisions in 2020). Despite increased surgical complexity, overall complication rates remained low. Prosthetic joint infection (PJI) rates rose proportionally with revision volume (from 0/6 cases in 2014-2015 to 2/22 in 2018 and 3/19 in 2020), reflecting small absolute numbers rather than a true increase in infection risk.
conclusionEndoCert certification contributed to the standardization and optimization of care processes without compromising clinical outcomes. Certification programs such as EndoCert strengthen structural and process quality and serve as tools for continuous quality improvement. Future multicentre studies incorporating patient-reported outcomes are needed to comprehensively assess the long-term benefits of certification.
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