Rapid Decline in Online Search Queries for Hip and Knee Replacements Concurrent with the COVID-19 Pandemic

Jella, Tarun K.; Samuel, Linsen T.; Acuña, Alexander J.; Emara, Ahmed K.; Kamath, Atul F.

INTRODUCTION: In response to the coronavirus disease 2019 (COVID-19) pandemic, United States (US) hospitals have cancelled elective surgeries. This decline in total joint arthroplasty (TJA) revenue may place financial strain on hospitals. Our goal was to quantify the impact of COVID-19 on the public interest in elective TJA. METHODS: The Google Search Volume Index (GSVI) identified the terms “knee replacement,” “hip replacement,” and “orthopedic surgeon” as the most common to describe TJA. The term “elective surgery cancellation” was also analyzed. Weekly GSVI data was extracted between 04-01-2015 and 04-04-2020. Time-series analysis was conducted and state GSVI values were compared to COVID-19 prevalence and unemployment claims. RESULTS: The relative public interest in elective TJA has sharply declined since the WHO declaration of COVID-19 as a global pandemic. Between 03-01-2020 and 03-29-2020, the popularity of searches for “knee replacement”, “hip replacement” and “orthopedic surgeon” dropped by 62.1%, 52.1% and 44.3% respectively. A concurrent spike was observed for the term “elective surgery cancellation.” California, New Hampshire, Maine, and Nevada showed a low relative rate for TJA searches, and the highest increase in unemployment claims. DISCUSSION: The onset of COVID-19 correlates with declining relative popularity of searches related to elective TJA. Higher volume of COVID-19 cases in certain states may correspond with lower relative search popularity, although this correlation remains unclear. These results portend the possibility of a decline in elective TJA case volume, further straining hospitals. Further research is required to inform stakeholders how best to proceed and determine any sustained effects from the current diminished relative interest in TJA. LEVEL OF EVIDENCE: Level III.