LR7 / Improvement of Safety in Total Joint Replacement

Type of Patient Safety Practice
Clinical Practice (CP)
Related practices from PaSQ database
“Best fit” category of the reported practice


Surgical/Invasive procedure
Patient safety theme the SCP/clinical risk management practice is aimed at
Improvement of Safety in Total Joint Replacement. Arthroplasty Register based on the German Arthroplasty Register (EPRD)
Objective of the CRM practice
The German Arthorplasty Register will for the first time allow for nationwide implant surviva records and implant-specific evaluations, making it possible to identify prestheses with conspicuously short survival times at an early stage.
Short description of the CRM practice, including any references for further information
Selected routine data from hospitals and health insurance funds are linked with implant-specific data from a product database. After sophisticated analysis the results will be made available to the partners involved, the expert audience and also to the general public in due form.
Innovator of the SCP, country of origin
Germany. The German Arthroplasty Register will also form the basis of a European Joint Replacement Register, which is currently at the planning stage.
Involved health care staff
The registry is run as a co-operation of the Scientific Society, the German Association of Medical Manufacturers, and the largest German health insurance funds, which cover 70 % of the whole population. The BQS Institute [Institute for Quality and Patient Safety] is also directly involved.
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
E.g. Community hospitals / Neurology, Orthopaedics/ [1]
Tested in Germany, in 20 hospitals in a first phase – objective to cover a 1000 hospitals. Clinical Speciality: Orthopaedics
Summary of evidence for effectiveness, including references
The German Arthorplasty Register is supposed to provide a nationwide record of implant survival times and lead to an increase in patient safety. [The German Arthroplasty Register EPRD, Structure Procedures and Organisation. An Overview presented at the 2012 EFORT Congress in Berlin. Joachin Hassenpflug, EAR 2012]; [Structure and Organisation of the German Arthroplasty Registry. Presented at the 1st Cogress of Arthroplasy Registries ISAR , Bergen, 2012]. The register is in its early phasis.
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
Results not available yet. The trial-phase has just started and have included about 3000 patients whithin the last 3 months from 20 hospitals. In the end the register will include about 1000 hospitals, starting the implementation in summer 2013.
Summary of available information on feasibility, including references
What are exisiting barriers to implementation and if so, what does the literature suggest for them to be overcome? Please always add the source and where necessary the page number [p.xx, 1].

Voluntary participation of the hospitals is overcome by intensive information and PR. A critical success factor is also patients participation as it is on a voluntary basis.

Existing implementation tools, including references
E.g. guideline, checklist, material that may be compiled for distribution within healthcare settings, a starter kit, criteria, webinars, training kits

The Register is based on the use of routine accounting data for arthroplasty implantations and revisions, which are forwarded to the Register as a part of the routine accounting procedures between the hospitals and the health insurance providers. Moreover, the Register has a globally unique product database at its disposal developed by implant manufacturers in cooperation with the EPRD. The implants are registered in the hospitals by means of their barcodes and identified through automatic collation with the product database.

Potential for/description of patient involvement in the CRM practice, including references
Transparency for patients about the choice of implants
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
[The German Arthorplasty Register EPRD, Joachin Hassenpflug, European Arthroplasty Register EFORT , EAR 2012]
[German Arthroplasty Registry established. Joachim Hassenpflug, Dtsch Med Wochenschr 2011;136:1]
[Structure and Organisation of the German Arthroplasty Registry. Joachim Hassenpflug, Thoralf Liebs, 1st Congress of International Society of Arthroplasty Registries ISAR 2012]Sources available on the EPRD website at:
[Registerprotokoll des Deutschen Endoprothesenregisters, Zusammenfassung, Version 1.0; 17.12.2010]
[Das Endoprothesenregister Deutschland – Information für teilnehmende Krankenhäuser; Vorabversion · Stand 4. September 2012]
1. Joachin Hassenpflug
2. Amanda Bogg
EFORT & Health First Europe
Any additional information on the CRM (e.g. implementation barriers and drivers)