Joint Replacement Market Size and Share

There are four companies with more than $1 billion in annual joint replacement sales: Zimmer Biomet, Stryker, DePuy Synthes and Smith+Nephew. Together, the Big Four  account for 71% of global joint replacement sales, but have seen their combined market share erode slightly over the last decade.

By our estimation, they controlled 75.5% of the large joint replacement market in 2016. That share fell to 73.1% in 2025, a decline of -2.5%. It doesn’t sound like much, but one point of large joint share in 2025 is worth over $200 million.

Of these four companies, only Stryker gained share during the last decade, adding 4.5% share mostly weighted toward knees. Companies like Enovis and Medacta have become far larger and more competitive over that period.

The top tier players all improved upon their 2024 performances. Zimmer Biomet’s growth was just short of 5%, but the company expects some disruption in 2026 as it overhauls its U.S. commercial channel. Stryker once again led the way with high-single digit growth. DePuy Synthes’ growth was better than 2024 but still well below its peers at 2.6%. Finally, Smith+Nephew more than doubled its growth rate from 2024 as its orthopedic operations become an area of strength.

In the mid-tier, Enovis and Medacta are closing in on $1 billion in joint replacement sales due to their differentiated offerings and strength in Europe. Exactech’s restructuring deal saw it sell its operations and assets to a group of investors who ultimately launched Advita Ortho in late 2025. Beijing Chunlizhengda had a big rebound in 2025, but its gains weren’t enough to offset the impact of China’s VBP price cuts, and the company’s joint replacement revenue remains below its 2023 totals.

Important Developments in the Joint Replacement Market

The Battle for Technology Leadership. There’s no question that enabling technology has impacted the competitive balance of orthopedics. Even companies like Enovis that have long taken the wait-and-see approach are redoubling efforts to build out their technology portfolios.

While enabling technology in general is a no-brainer, robotics is still a bit of an open question in terms of format and functionality. Robotics penetration remains relatively low, at around 20% in the U.S. and 10% globally. In response, orthopedic companies are focused on meeting surgeons where they are on the adoption curve. For example, Zimmer Biomet is pioneering the push for “optionality” across technology portfolios, offering surgeons an array of choices to compel adoption and utilization.

Shifting Competitive Balance. Johnson & Johnson’s announcement that it plans to spin off its orthopedics business within the next two years was one of the biggest developments of 2025. And while not solely related to joint replacement, the move promises to create significant disruption in the market. DePuy Synthes will likely emerge from this move as a  focused company with a chance to eventually be more competitive. But we expect a few hard years ahead, and possible contraction of its share positions in the U.S. and international markets.

A Steady March Toward the ASC. Joint replacement procedures continue to shift to the ASC setting due to payor pressure, employer cost-containment strategies and policy initiatives to move procedures from higher cost inpatient hospital settings. The removal of total knee replacement from the CMS inpatient-only list in 2018 was a major catalyst in the procedure shift, which was further accelerated by COVID and its immediate aftermath. We expect the shift to continue as device companies refine implants and inventory, streamline enabling technology platforms and develop solutions that promote efficient surgical procedures to address the unique requirements of the ASC.

Further Reading

Thanks for visiting! Need more insight into the joint replacement market? Questions and comments are always welcome. You can reach me by email. Until then, I’ve selected a few posts that give insight into our thinking on the joint replacement market.