May 25, 2021
Cedars-Sinai Kerlan-Jobe Institute Studies Impact of COVID-19 on Orthopedic Surgery
The COVID-19 pandemic ushered in significant changes to just about every aspect of “normal” living for people worldwide. Be it work, school, athletics, or exercise, many things a human could engage in pre-COVID were significantly altered, or in some cases, wholly suspended during the pandemic. The Cedars-Sinai Kerlan-Jobe Institute set out to understand how these pandemic-related changes in human behavior may have changed the experience of our orthopedic surgery practice. Our research team performed a study analysis carefully comparing the proportion of patients with an orthopedic injury requiring surgery during the pre-COVID-19 timeframe to those requiring surgery during the post-COVID-19 timeframe. This analysis was recently published in the Journal of Orthopaedics and highlighted some interesting findings and patterns.
The study examined 2,848 cases operated on between September 31, 2019, and September 4, 2020. The pre-COVID-19 cohort included 1917 patients, and the post-COVID-19 cohort included 913 patients. Although our practice experienced a significant decrease in the overall number of orthopedic surgeries performed during the post-COVID-19 period, one interesting finding was that the makeup of surgical cases changed by type. For instance, we saw a significant percentage increase in surgical procedures involving the hip and a substantial decrease in the percentage of hand and wrist procedures during the post-COVID-19 period when compared with the pre-COVID-19 period.
Though it is difficult to identify a particular reason why these changes in orthopedic surgery patterns occurred, there are some plausible explanations. One potential explanation for the increase in the surgical treatment of conditions affecting the hip might be attributable to patients experiencing more time flexibility in their schedule that could be dedicated to recovery from surgery. Whether it was working from home or a pause in athletics, we hypothesize that some patients were able to undergo surgical procedures they may have put off pre-pandemic due to newfound downtime in their otherwise busy life schedules.
Another possible explanation for the increased percentage of hip procedures is that many patients, especially those in California, experienced a sudden stay-at-home order and found themselves spending more of their time in a seated position. This may have led to an increase in the frequency, and potentially, the severity of hip condition symptoms. Yet another possible explanation for the rise in surgical cases involving the hip is that some patients found new forms of exercise during the pandemic. Regions throughout the nation experienced limited public exercise options due to pandemic-related closures of gyms, fitness studios, and swimming pools. Some patients who would have otherwise chosen these options for exercise may have taken to running outside as a safer alternative to maintaining their fitness. Running can aggravate issues with the hip and may have led to increased experience of symptoms for some patients. The above-cited examples likely were some of the major themes associated with our practice’s observed increase in hip surgery procedures.
While we experienced an increase in surgical hip procedures, the inverse was true for trigger finger surgeries. Related to the decreased number of these procedure types, our study’s co-authors hypothesized two major themes. The first theme is similar to the one stated above for hip surgeries. The day-to-day practices of patients changed drastically for some people. Those changes may have led to a decrease in activities that aggravated trigger finger symptoms in some instances. Secondarily, trigger finger surgery is considered a minor procedure. Our authors speculate that people who may have opted for surgical repair pre-COVID-19 assessed their risks and may have decided to hold off surgery until the threat of COVID-19 exposure was not as high. Of course, these potential causes for the reduction we experienced in trigger finger procedures are hypotheses and certainly warrant further investigation.
In addition, we discovered that the number of surgical repairs of the distal biceps tendon in the elbow significantly increased in the post-COVID-19 timeframe. We think that because people were able to work from home, they had more time to do their own home improvement projects and a more regular weightlifting program which we speculate could be a cause for the increase in distal biceps tears.
It is important to note that, to our knowledge, a study such as this has not been conducted by another orthopedic institution to date. While we hope that will change over time, the informational findings in our study cannot necessarily yet be extrapolated to a larger orthopedic population. Additional research and further exploration should be conducted so that definitive results can emerge, which will help orthopedic practices more effectively tailor services to their patients in the future.