title: [Current status of total hip and knee replacements in Germany - results of a nation-wide survey].
abstract: BACKGROUND
  Total hip and knee replacements are very frequently performed operative procedures in German hospitals. Despite the high number of cases, only few data on treatment procedures of the clinical routine and their impact on postoperative length of stay and clinical outcome are available. The aim of our survey was to gain detailed insights of the treatment procedures in patients scheduled for elective hip or knee replacement in order to extract recommendations for improving patient care.
  
  
  METHODS
  In a nation-wide survey, we asked leading physicians of 694 trauma surgery and orthopaedic surgery departments and their corresponding colleagues in the departments of anaesthesia for treatment procedures including the process of patient admission, surgical techniques, postoperative analgesia, discharge management and follow-up. We used a multiple linear regression for analysing variables impacting on the postoperative length of stay.
  
  
  RESULTS
  Altogether, 303 replies representing 31.8 % of the contacted hospitals could be evaluated. For hip arthroplasty, the anterolateral approach was most commonly chosen. For knee arthroplasty, the parapatellar approach was most frequently used. Tourniquet and wound drainage (mostly removed on the second postoperative day) were widely used with more than 90 %. The avoidance of wound drainage was associated with a lower postoperative length of stay for patients following total hip or knee replacement. Only 70 % of the German departments followed up their patients after discharge checking especially the range of motion of the artificial joint replacement.
  
  
  CONCLUSIONS
  The treatment procedures for elective hip and knee replacement are very heterogeneous in German hospitals. The quality of the clinical outcome cannot be related to a single procedure; in fact the choice and complementary interaction of interventions are essential for improving patient care. These results provide first important evidence to which extent organisational structures and treatment procedures affect patient care and length of stay. Therefore, the analyses show relevant indications for an optimised standard in patient care.
authors.affiliation: Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln.
authors.forename: T
authors.initials: T
authors.lastname: Jaschinski
authors.affiliation: Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln.
authors.forename: D
authors.initials: D
authors.lastname: Pieper
authors.affiliation: Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln.
authors.forename: M
authors.initials: M
authors.lastname: Eikermann
authors.affiliation: Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln.
authors.forename: S
authors.initials: S
authors.lastname: Steinhausen
authors.affiliation: Biomet Deutschland GmbH, Berlin.
authors.forename: C
authors.initials: C
authors.lastname: Linke
authors.affiliation: Biomet Deutschland GmbH, Berlin.
authors.forename: T
authors.initials: T
authors.lastname: Heitmann
authors.affiliation: Biomet Deutschland GmbH, Berlin.
authors.forename: M
authors.initials: M
authors.lastname: Pani
authors.affiliation: Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln.
authors.forename: E
authors.initials: E
authors.lastname: Neugebauer
mesh_terms: D017677:Age Distribution; D019644:Arthroplasty, Replacement, Hip / Q000592:standards / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000592:standards / Q000706:statistics & numerical data*; D019090:Case Management / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000592:standards / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D017678:Sex Distribution