Nicolas S. Piuzzi Presented with Kappa Delta Young Investigator Award

Nicolas S. Piuzzi, MD, was recognized as the 2025 Kappa Delta Young Investigator Award winner for research showing how leveraging advanced analytics with personalized outcome prediction tools can optimize the outcomes and satisfaction of total hip and knee arthroplasty (THA, TKA) for patients. Utilizing patient-reported outcome measures (PROMs) can help clinicians identify risk factors and predict outcomes more accurately, allowing for tailored interventions at the patient level. 

The award recognizes outstanding clinical research related to musculoskeletal disease or injury by investigators under 40 years old or no more than seven years beyond training.

Dr. Piuzzi and his colleagues from Cleveland Clinic Adult Reconstruction Research (CCARR) from the Department of Orthopaedic Surgery, Cleveland Clinic, theorized that incorporating data analytics and PROMs could help practitioners identify patients who may be at a higher risk for poor outcomes, potentially closing the gap between surgical outcomes and patient satisfaction.

In 2015, the Cleveland Clinic developed the Orthopaedic Minimal Data Set Episode of Care database as a comprehensive PROMs data collection platform specifically for TJA.[iv] Patient demographics, general health PROMs, joint-specific PROMs, and disease severity and treatment details are captured from patients and surgeons at specific points in time following surgery. Integrating PROMs collection into the routine clinical workflow achieved a high baseline completion rate (>97%) for TJA procedures.

A study published by the research team shows passive measures captured one-year PROMs for 38% of the THA cohort and 40% of the TKA cohort.[v] A significant portion of patients, 40% for THA and 41% for TKA, required more active follow-up to complete their postoperative PROMs. 

In a study of 4,034 primary THA patients, Dr. Piuzzi and the research team defined eight distinct phenotypes based on combinations of above or below median scores for Hip Disability and Osteoarthritis Outcome Score (HOOS) pain, HOOS-Physical Function Shortform (HOOS-PS), and Veterans RAND 12 Item Health Survey-Mental Health Summary Measure (VR-12 MCS), which is a self-administered health survey that captures physical and mental health aspects.[vi] 

The study found that phenotypes characterized by lower-than-median VR-12 MCS scores were significantly associated with increased dissatisfaction at one year, regardless of pain or function scores. Patients with the phenotype representing below-median scores across all three PROMs had the highest odds of dissatisfaction compared to the reference phenotype.

“The variation between the different phenotypes is a 9 to 10% risk of failure to a 25% risk of failure related to patient satisfaction and perception of improvement,” said Dr. Piuzzi. “This gives practitioners a very powerful tool to counsel patients and address some of the risk factors for each patient. If you have a patient in the high-risk group who is having mental health issues or poor function, clinicians need to set expectations and address some of the issues to mitigate risk factors. It is very applicable as it is readily available to everyone, but we need to ensure the data is collected, analyzed, and implemented.”

The Cleveland Clinic research team built a tool for TKA that incorporated separate models for predicting length of stay, 90-day readmission, and one-year improvements in Knee Injury and Osteoarthritis Outcome Score (function and quality of life sub-scores). 

These models include a range of patient factors ― demographics, comorbidities, baseline PROMs, and laboratory values ― and allow the predictive tool to consider modifiable risk factors. The personalized outcome prediction tool demonstrated high accuracy in predicting outcomes for new patients.