[EndoCert-Concept, development, and current challenges of a certification system in endoprosthetics]

Hip and knee arthroplasty rank among the most frequently performed elective procedures in Germany. Against a background of rising quality requirements and ongoing health policy reform, structured quality assurance in arthroplasty is gaining increasing importance.

To describe the concept, development and current challenges of the EndoCert certification system in the context of scientific and health policy developments.

Narrative review based on published peer-reviewed literature, the EndoCert system manual, annual reports, health policy documents (KHVVG, KHAG), and internal data analyses provided by EndoCert GmbH.

EndoCert is the world's first certification system for arthroplasty centers, available nationwide since October 2012. It integrates structural, process, and outcome quality within a standardized annual audit procedure and has established itself as the leading quality assurance instrument in German-speaking arthroplasty care, with more than 500 certified institutions. Over 5800 audits identifying more than 4300 deviations demonstrate the practical effectiveness of the certification process. Since 2026, joint-specific certification levels allow institutions to align their certification precisely with their respective scope of care. The current hospital reform (KHVVG/KHAG) conceptually confirms the core principles of EndoCert. Key challenges include the further development of risk adjustment models and the broader use of patient-reported outcomes.

EndoCert has established itself as an adaptive quality assurance system that integrates structural requirements, standardized processes and data-driven outcome monitoring within a single certification framework. The ongoing hospital reform offers the opportunity to establish the standards implemented by EndoCert since 2012 as mandatory nationwide requirements.