Knee replacement calendars fill up at the end of the year, and the usual reason is the insurance deductible: a patient who has already paid it down wants the surgery done before it resets in January.
The research confirms the pattern and adds the part that matters for advertising: the patient who has surgery in November was already looking at surgeons in August. By the time the operating room is booked solid, the choice of surgeon was made months earlier.
That gap is the job for Demand Gen, the campaign that puts a practice's video in front of people on YouTube before they ever type a search. An orthopedic practice that wants to be the surgeon a knee patient picks in the fall has to be in front of that patient in the summer.
Knee Searches Peak in Late Summer. The Surgeries Pile Up at Year's End.
Start with the surgeries. A 2026 study in the Journal of Arthroplasty followed 450,125 patients with knee arthritis from 2018 to 2023. For patients with average cost sharing, 30.8% of knee replacements landed in the fourth quarter. For patients with high cost sharing, it was 35.7%. If surgeries were spread evenly, each quarter would get 25%. The first quarter, right after deductibles reset, was the low point.
Now the searches. In Google's US monthly data for the last 12 months, searches for "knee replacement" peaked in August, with 28% of the year's volume in July through September. "Total knee replacement" peaked in October. "Hip replacement" followed the same pattern as "knee replacement," peaking in August. "Knee replacement surgery" was the flattest of the group, but it too peaked in October.
Put the two together and the order is clear, and it's the order an orthopedic calendar would predict. Research peaks in late summer. Surgery peaks at year's end. In between sit the consult, the imaging, the insurance approval and the surgery date, and any one of those steps can take weeks. One caution on the search side: Google returned 12 months of monthly data for these searches, so treat it as one year's pattern, not a long trend. The surgery studies cover several years.
Hips deserve a note of their own. Hip replacement searches peaked in August, just like knee searches, but the surgery studies here looked at knees only. If your practice does a lot of hips, your own surgery calendar is the evidence to trust, and the billing check in the next section will show it.
The Deductible Clock Moves Commercial Plans, Not Medicare
The year-end rush isn't about the weather or the holidays. It's about money. In the same 2026 study, the high-cost-sharing patients paid an average of $1,761.50 out of pocket for a first-quarter surgery, against $886.70 for average cost sharing and $356.50 for low. A patient who has already met this year's deductible has a strong reason to schedule before January.
That also tells you who isn't in the rush. A 2023 study at two institutions found fourth-quarter case counts rose for privately insured patients and didn't rise for publicly insured patients. In that study, the patients on public insurance simply didn't show the year-end rise.
Before planning around any of this, check it against your own practice. Ask billing for last year's joint replacements by month and by payer. If your fourth quarter is heavier than the others, and the extra surgeries are mostly commercial plans, the pattern in these studies is your pattern too. If your calendar is flat, spread the video budget evenly and skip the summer push.
The seasonal push matters most to a practice with a large share of commercially insured joint patients, the working-age knee and hip patients with high-deductible plans. A practice whose joint patients are mostly on Medicare will see a steadier year and can spread its video budget more evenly. Chapter 3 showed commercial plans also pay surgeons more than Medicare for the same knee, which is one more reason the commercially insured fall patient is worth planning for.
In August, the Knee Patient Is Still Choosing a Surgeon, and YouTube Is Where They Look
Chapter 2 split orthopedic patients by how close they are to booking, from the knee that just aches to the patient typing one surgeon's name. Search ads work at the bottom, when someone types "knee replacement surgeon." In August, a lot of fall knee patients aren't there yet. They know the knee needs fixing. They're reading, watching and comparing.
That's the stage Demand Gen is built for. In general, Demand Gen can show video and image ads across YouTube, Shorts and several other Google surfaces. An orthopedic practice gets a smaller slice of that. Health care counts as a sensitive category, and Google's overview of the campaign type keeps those ads mostly on YouTube, off Gmail and off the Display Network, and limits their targeting to audiences Google builds itself, such as its in-market and affinity segments. A separate Google help page says sensitive-category ads can also run on the Discover feed with those predefined audiences. Plan on YouTube. Treat Discover as a possible bonus. In practice, that means you choose from the categories Google has already built, and Google decides who falls inside them.
As with Performance Max in Chapter 10, there's no patient list, no remarketing to your site's knee page and no lookalike audience. Demand Gen reaches knee patients the way Google has grouped them, not the way your records do. Use the same Presence location and surgical counties from Chapter 9.
Demand Gen Only Belongs in an Account That Already Books Consults
Here's the catch in all this timing: Demand Gen isn't a launch campaign. In this guide's order of campaigns, video waits its turn: exact match Search first, then broad match Search, then Performance Max, and only then YouTube.
"Already there" has a number. It's the same gate as Performance Max: Isolation and Exploration together booking at least 30 quality consults a month, month after month. Around months 6 or 7 is typical; bigger practices get there sooner. Below that, Google doesn't have enough booked patients to learn what a future knee patient looks like on YouTube.
That means the fall calendar only applies to an account that's already there. A practice that launches its first Search campaign in June shouldn't rush into video to catch the fall. Search carries that fall; the summer video push starts the following year.
Budget matters more than usual here, too. Google's own advice for a Demand Gen campaign with a cost target is a budget ten times that target, at minimum. Take Chapter 3's illustration, about $33 per booked consult: that works out to roughly $330 a day for Demand Gen. Google sets the floor that high because the campaign needs room to learn which viewers go on to book, and below it there isn't much to learn from. A practice that can't fund it properly is better off putting the same money into Search in August, when knee searches are at their peak.
The Surgeon Explaining a Knee X-Ray Is the Whole Ad
Chapter 8 found that the moment patients praise most is a surgeon explaining the X-ray in plain words. That's also the best video an orthopedic practice can run. No studio, no actors, no stock footage of someone jogging on a beach.
- One surgeon, one knee, 30 to 60 seconds. The surgeon holds up or points to an X-ray and explains what arthritis looks like in the joint, what the options are and when replacement makes sense. Plain words, the way they'd say it in the room.
- Shot in your clinic, on a good phone, with decent light and a clip-on microphone. Patients recognize a real exam room.
- A vertical cut for Shorts and a horizontal version for the rest of YouTube. The video has to live on YouTube; it can be unlisted.
- Captions. Plenty of people watch on a phone with the sound off.
- Stills too. Demand Gen also runs image ads. Give it real photos of the same surgeon in three shapes Google asks for: wide (1.91:1), square (1:1) and tall (4:5).
- No outcome promises. The Chapter 8 rule holds: a result-claiming testimonial needs a visible disclaimer, and a surgeon promising a result in a video is making the same kind of claim.
Make one per surgeon and one per joint if you can. Filming goes faster than most practices expect: one afternoon per surgeon, three or four short explanations each, knee, hip, shoulder, whatever they do most. A knee patient in August is choosing a person. Let them meet one.
A Video Seen in July Books Its Knee Consult in October
Here's what the calendar looks like for one commercially insured knee patient.
In July or August, they see a surgeon from your practice explain a knee X-ray on YouTube. In September, when knee searches peak, they search, and your Search ads from Chapters 6 through 8 show up. In October, they book the consult. In November or December, they have surgery, before the deductible resets.
That's why Demand Gen should be judged on the fall, not the week it runs. Views and click-through rates tell you almost nothing about whether a knee patient booked. Three numbers tell you whether the summer video worked. Fall knee and hip consults compared with last fall. Searches for your surgeons by name, which show up in the brand campaign. And Demand Gen's own conversion count, read knowing that many of its viewers will book later through a Search ad instead.
Start the video in July, keep it running through October, and let the Search campaigns do the booking.
Then wind it down. A patient who first sees your surgeon in mid-November is unlikely to consult, clear insurance and get on the schedule before the deductible resets, so the last weeks of the year belong to Search, where the patients who already decided are typing surgeon names. Next summer, run the same videos again, with whatever you learned about which surgeon and which joint drew the most consults.
Next: Your Surgeons Already Have Their Own Map Listings
The fall patient eventually searches a surgeon's name or "orthopedic surgeon near me," and a lot of what they see is on Google Maps. Chapter 12 covers why most orthopedic Maps listings belong to individual surgeons, not practices, and how local ads work with both.
The guide home has the full sequence.
For orthopedic groups that hand us their Google Ads management, the video push is planned around the practice's own payer mix, and it starts in summer only when the account is ready for it.
