[Challenges of fast-track arthroplasty in Germany].

BACKGROUND: While fast-track arthroplasty has been already established in many European countries and the United States, Germany still struggles to introduce appropriate programs. This is due to a variety of reasons. REASONS: From an organizational and medical scope, the fear of alteration, the adherence to restrictions rooted in historical tradition, the reluctance to interdisciplinary cooperation, and the lack of a willingness to implement externally-guided process analysis tools, stand in the foreground. This is system related, and especially the DRG-system with the continuous devaluation of lump compensation rates in primary hip and knee arthroplasty, also in 2020, hinders the implementation. The resulting fears and concerns that an additional reduction of the length-of-stay by fast-track programs is leading to a consistent reduction of the DRG returns, are understandable. On the other hand, the disconnectedness of the ambulatory, inpatient and rehabilitation sector in Germany inhibits the introduction of fast-track programs. SOLUTIONS: A well-thought-out change-management is the basic requirement for the successfull establishment of a Fast-Track-Program. Perspectively, a rethinking towards sector-comprehensive care strategies for the implantation of a total hip or knee replacement, including the required rehabilitation procedures, has to be demanded.