Certification as an Endoprosthetics Center (EPZ)

Physicians who hold this seal are medical facilities that are certified by endocert as an Endoprosthetics Center (EPZ) or as a Maximum-Care Endoprosthetics Center (EPZmax) and have thus demonstrated through an audit that they meet the established requirements. Recertification is required every three years.

The criteria, requirements, and differences between EPZ and EPZmax can be found here.

Additional relevant documents regarding the certification of Endoprosthetics Centers can be found here.

What is a certified Endoprosthetics Center?

A certified endoprosthetics center is a medical facility that specializes in performing endoprosthetic procedures—that is, surgeries to implant artificial joints (endoprostheses)— and has obtained certification as an Endoprosthetics Center under the so-called EndoCert initiative. Since October 2012, specialized trauma surgery and orthopedic clinics and departments have been able to obtain certification as an Endoprosthetics Center (EPZ) or Maximum-Care Endoprosthetics Center (EPZmax) if they meet the EndoCert requirements and have successfully completed the certification process.

The “EndoCert” initiative was launched in 2009 by the German Society for Orthopedics and Orthopedic Surgery (DGOOC) in collaboration with other medical experts to ensure and improve the quality of endoprosthetic procedures. A working group consisting of representatives from the DGOOC, the Endoprosthetics Working Group (AE)—a section of the German Society for Orthopedics and Trauma Surgery (DGOU)—and the Professional Association of Specialists in Orthopedics and Trauma Surgery (BVOU) developed, as part of the EndoCert initiative, a comprehensive certification system for specialized clinics and departments focusing on endoprosthetics and defined the criteria these clinics must meet to be successfully certified as endoprosthetics centers.

Background Information on Endoprosthetics

The technical term “endoprosthetics” refers to the surgical replacement of joints that have been destroyed or damaged due to injury or wear and tear with artificial joints, also known as endoprostheses. Endoprostheses, which generally remain in the body permanently, are intended to fully or partially replace the damaged joint. This is intended to restore pain relief, mobility, and an overall improved quality of life for the affected patients.

The implantation of artificial joints as part of joint replacement surgery is now one of the most commonly performed surgical procedures in Germany. In fact, approximately 400,000 damaged joints are replaced with endoprostheses in German hospitals each year. Endoprostheses are most commonly used for the hip and knee joints—a total of approximately 210,000 hip prostheses and 165,000 knee prostheses are implanted each year.

In addition, worn-out shoulder, ankle, and elbow joints can also be replaced with endoprostheses. As a result, approximately 30,000 shoulder prostheses, 1,500 ankle prostheses, and 150 elbow prostheses are now implanted each year. Since the implantation of endoprostheses is a complex surgical procedure, it is advisable to have such an operation performed at a certified endoprosthetics center that has a proven track record of employing specialists in this field.

Objectives of the Certification of Endoprosthetics Centers

By applying a high-quality certification process for orthopedic and surgical clinics or specialty departments as “Endoprosthetics Centers,” the quality of care in endoprosthetics is to be maintained and improved, and patient safety during and after endoprosthetic surgery to implant an artificial joint is to be ensured and enhanced. For this reason, only those clinics that, as part of the certification process, have demonstrated a high level of expertise, specialization, and experience in the field of endoprosthetics as part of the certification process and subsequently undergo regular evaluations and reviews of the quality of care and treatment outcomes for endoprosthetic surgeries by external experts.

Another goal of certifying joint replacement centers is to assist patients in finding a specialized clinic for joint replacement and to give them the assurance that they will receive optimal treatment at that clinic. The certification granted to an endoprosthetics center allows patients to recognize that the medical facility meets the quality requirements for joint replacement established by experts and professional societies and is thus proven to be among the specialists in the field of endoprosthetics.

Certification of Joint Replacement Centers by EndoCert

The certification procedure for endoprosthetics centers—developed as part of the EndoCert initiative by the German Society for Orthopedics and Orthopedic Surgery (DGOOC), the Endoprosthetics Working Group (AE) as a section of the German Society for Orthopedics and Trauma Surgery (DGOU), and the Professional Association of Specialists in Orthopedics and Trauma Surgery (BVOU), was tested in two pilot phases before being rolled out nationwide in October 2012 following three years of intensive preparation.

All orthopedic or trauma surgery hospitals or hospital departments that primarily perform joint replacement surgeries and are intensively involved in endoprosthetics have since been able to obtain certification as an Endoprosthetics Center (EPZ) or Maximum-Care Endoprosthetics Center (EPZmax). To qualify for certification as an Endoprosthetics Center, a facility must meet the quality requirements defined by EndoCert and demonstrate compliance during a two-day audit.

Criteria for Certified Endoprosthetics Centers

Orthopedic, surgical, and trauma surgery clinics and specialized departments must meet uniform requirements for certification as an Endoprosthetics Center in order to standardize and ensure the quality of structures and processes in the field of endoprosthetics. These requirements cover, among other things, the following areas:

• Range of Services in Diagnostics and Therapy
• Minimum number of surgeries
• Patient care
• Participation in training, continuing education, and professional development programs
• Scientific work

These requirements give rise to various criteria and technical standards that an orthopedic or trauma surgery clinic or department must meet in order to be successfully certified as an Endoprosthetics Center (EPZ) or a Maximum-Care Endoprosthetics Center (EPZmax). These criteria are defined in a special survey form.

The criteria that a medical clinic or department specializing in endoprosthetic procedures must meet—in terms of minimum surgical volume—to be certified as an Endoprosthetics Center (EPZ) include, among others:

• The presence of at least two well-trained and experienced lead surgeons
• Each lead surgeon must perform at least 50 endoprosthetic procedures per year
• Performing at least 100 endoprosthetic procedures per year

To obtain certification as a Maximum-Care Endoprosthetics Center (EPZmax), an orthopedic or trauma surgery clinic or specialty department must meet the following certification criteria regarding minimum volumes of surgeries:

• Availability of at least two well-trained and experienced senior lead surgeons
• Each senior lead surgeon must perform at least 100 joint replacement procedures per year
• Performing at least 200 endoprosthetic procedures per year, 50 of which must be prosthesis replacement surgeries

In addition, both Endoprosthetics Centers (EPZ) and Maximum-Care Endoprosthetics Centers (EPZmax) must meet the following requirements, among others, for successful certification:

• Special qualifications for surgeons and other personnel involved in treatment
• Interdisciplinary collaboration among specialists from various disciplines before, during, and after an endoprosthetic surgery
• Implementation of standardized treatment pathways and their continuous review
• Regular participation of all involved staff in training, continuing education, and professional development in the field of endoprosthetics
• Comprehensive information, involvement, and support for patients throughout their entire treatment
• Participation in the German Endoprosthesis Registry (EPRD) with complete and traceable documentation of treatment courses and outcomes
• Availability of the necessary equipment to offer an appropriate range of diagnostic and therapeutic services
• Scientific engagement, such as through the conduct or support of research projects
• Assessment of patient satisfaction

After a hospital or hospital department has demonstrated, during a two-day review, that it meets all quality requirements, it receives certification as an Endoprosthetics Center (EPZ) or a Maximum-Care Endoprosthetics Center (EPZmax). This is followed by annual inspections and recertification as an Endoprosthetics Center every three years.