Market Reviews

The second quarter of 2019 brought incremental improvement over the first. Stryker and Medtronic saw revenue growth in the mid-single digits, Smith Nephew performed at 1.6% and DePuy Synthes and Zimmer Biomet experienced a year-over-year loss. Price pressure was a common theme in the quarter for many companies, as it offset some gains made from increased surgical volumes for the reporting period.

The first quarter of 2019 brought modest growth to the orthopedic market, as expected seasonal softness and more competition in digital surgery platforms slowed sales for some of the largest players. The 25 companies covered in this article had combined total orthopedic sales of $8.7 billion, growing just 1.1% versus the prior year. While the top two players, DePuy Synthes and Zimmer Biomet, both saw -2% growth, the quarter did feature strong performances by Medtronic (+5%) and Wright Medical (+16%) among the larger players.

The first quarter of 2019 was an active one for robotic and digital surgery developments. As adoption of digital surgery tools increases, leadership from joint replacement and spine companies indicate they have seen a direct sales benefit from upselling and product pull through.

According to our estimates published in THE ORTHOPAEDIC INUSTRY ANNUAL REPORT, orthopedic industry revenue reached $51 billion worldwide in 2018 and grew 3.5% over 2017. Results were mixed among the largest companies as some stumbled operationally while others overperformed, due in part to early adoption of technology and entry into high-growth segments. Common strategic themes present in 2018 that will continue as part of the industry's narrative in 2019 and beyond include connected ecosystems of products, flagship technology (e.g. robotics), portfolio-wide pull through and a growing shift to outpatient procedures.

A summary of the major 4Q18 and full year 2018 developments for publicly-traded orthopedic companies, including key strategies and guidance for 2019.

In November, we published our downloadable report, 2018 Revenue Projections: Companies Over $200 Million, for the 25 largest orthopaedic companies. Sales for these 25 companies account for ~80% of the worldwide orthopaedic market. We project that these companies will combine for $41 billion in 2018 revenue, +3% vs. 2017.

As noted in Part I of our quarterly revenue coverage, robotics and enabling technology in general continued to be a major theme supporting growth for publicly-traded companies.

Several companies noted increased case volume in the third quarter, likely driven by a strong U.S. economy leading to more widespread insurance coverage and patients able to pay for elective procedures. Sales results were mixed outside of the U.S., particularly in the EMEA region where reimbursement issues continue to be a challenge in the U.K. and Germany. Companies generally performed well, however, in emerging markets.

The 1H18 performance of companies that make up ~80% of the joint reconstruction market achieved 4.1% growth vs. 1H17. These companies posted 2.4% growth in 1H17 vs. 1H16. Here is a look at past activity and future predictions for hip, knee and extremities.