COVID-19 And Orthopedics

The April 2020 issue of Orthopedic Network News (ONN) newsletter is concentrated on trends in Trauma. It also includes this editorial from Stan Mendenhall on COVID-19 and orthopedics.

Ever since the COVID virus appeared on the world scene sometime in February, there has been a monumental shift in the priorities of both general citizens as well as the healthcare providers who are our normal customers. Many providers, physicians, nurses, and other professionals involved in direct patient care have had to deal with the life-and-death situations for themselves and their patients. In the backdrop of this unprecedented crisis is the second guessing of things that, a few months ago, would have seemed monumental—the outcome of the US presidential elections, the impact on the economy, the unemployment rate, food insecurity, among other issues.

In truth, the importance of orthopedics as a specialty or industry has been put into perspective by this crisis—the major companies have deemed most of orthopedics as “elective,” that is, not a high priority in these times. Companies from Johnson & Johnson, Stryker, and NuVasive, among others, are issuing guidance on how the shifting priorities will affect their financial results in the current quarter and going forward.

Having said that, I took some time this month to look at orthopedics and how much it has shrunk between last year and this, based on the purchasing data that we receive. We are using critical parts as proxies for procedures. For example, the number of hip stems sold is a good indicator of the number of hip procedures, the number of knee femurs sold is a good indication of the number of knee procedures, etc.

The common wisdom is that elective procedures have basically been on hold, which means most of orthopedics. There is less trauma because of fewer motor vehicle accidents and sports injuries, but possibly more broken bones because of domestic violence.

I put together the data from hospitals that purchased orthopedic devices in both March 2019 and 2020 to develop some estimates. In summary, elective joint procedures, such as hips, knees, and shoulders have declined between 19% and 27% based on the purchases of critical components. Cervical fusions increased 2% and lumbar fusions declined 24% based on purchases of spinal plates or lumbar pedicle screws. Trauma purchases showed increases with trochanteric nails up 8%, wrist fracture fixation up 2%, but general fixation plates down 5%, and fixation screws up 5%, and soft tissue attachments down 12%.

Although these represent rough estimates, it will be possible to provide updates in future months. It is already apparent that April will have greater decreases than March, since the shut-down of elective procedures in most states didn’t take place until mid-March. However we should be able to quantify how things are changing as we work through this crisis.

For detailed reports on the 2020 market trends in trauma, sign up for the ONN Newsletter.