The discipline of orthopedics and trauma surgery strives for constant improvement of the quality of results in arthroplasty; however, in order to enable targeted alterations to the establish standard operating procedures, dedicated documentation of the current quality of results is necessary. This can be achieved by so-called external quality assurance, evaluation of routine data of healthcare providers, analysis of clinical studies and the consultation of registry data. To achieve further improvement of the quality of results, legislature has been passed setting requirements for minimum quantities and by the specialist society (German Society for Orthopedics and Orthopedic Surgery, DGOOC) the adherence to certain process and structural guidelines within the framework of the certification system EndoCert®. A valid score for risk adjustment for assessment of the level of difficulty of orthopedic surgical interventions is so far lacking. As a future direction, the application of risk stratification concerning patient-specific anatomy should be developed. Through the combination of dedicated certification systems, the recording and evaluation of external inpatient quality assurance data, further quality assurance through routinely collected data and the development of adequate minimum quantity regulations, sustainable improvement of the quality of results can be achieved.
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