2025 Kappa Delta Young Investigator Award: Optimizing Hip and Knee Arthroplasty Outcomes Through a PROMs-Based Personalized Approach.

Abstract

Value-based healthcare models emphasize high-quality, patient-centered care while managing costs. Patient-reported outcome measures (PROMs) are crucial for assessing the effectiveness of total joint arthroplasty (TJA) from the patient's perspective. Recognizing the importance of PROMs, the Centers for Medicare & Medicaid Services now require PROM collection and reporting for TJA patients. However, PROM implementation and interpretation are complex, influenced by multiple patient factors beyond immediate health status. Our work aims to integrate PROMs into personalized medicine and evidence-based orthopaedics to optimize TJA outcomes. Key findings included establishing comprehensive PROMs data collection that is crucial for driving quality improvement, with multimodal follow-up, maximizing response rates across diverse patient populations. One-year PROMs provide relevant data to inform quality initiatives while reducing costs compared with long-term follow-up. Metrics like minimal clinically important difference, patient acceptable symptom state, and clinical relevance ratio provide clinically meaningful thresholds for interpreting PROMs and assessing surgical effectiveness. Preoperative PROM phenotypes based on pain, function, and mental health allow nuanced understanding of baseline status and outcome prediction, allowing for targeted preoperative interventions. Predictive tools integrating PROM phenotypes and patient factors can provide personalized outcome estimates, informing shared decision making. Ultimately, this PROMs-based personalized approach enhances continuous quality improvement, patient engagement, and delivery of high-value, patient-centered TJA care. As value-based models expand, developing and implementing such approaches will be pivotal for optimizing outcomes and patient satisfaction.