Implants and instruments to replace or revise failed joints in the knee, hip, shoulder, elbow, wrist, ankle and digits.
October 2024 (update coming January 2025)
Mike Evers, Senior Market Analyst
Welcome to our overview of the joint replacement market. This page builds upon and updates our joint replacement chapter in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. Joint replacement sales grew well above historical averages in 2023 and should benefit from a tailwind in 2024.
Joint replacement accelerated well beyond historical norms, as it grew 7.3% and reached $21.4 billion in sales in 2023. The segment is the largest in orthopedics, accounting for 36% of the $59 billion global market. Backlogged procedures drove overperformance in the segment, which started in late 2022 and could persist through at least the first half of 2024.
Exhibit 1: Worldwide Joint Replacement Sales by Type ($millions)
The segment’s slow recovery in the pandemic’s aftermath turned into a significant bolus of backlogged procedures. That additional volume drove elevated market growth, especially in early 2023.
However, the consensus among orthopedic executives is that the rise in cases will persist for a significant portion of 2024. Beyond that, demographic factors could lead to persistent growth acceleration for joint replacement.
Exhibit 2: Worldwide Joint Replacement Sales Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Companies Sales Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 75 public and private companies by segment from 2016 through 2024.
Volume tailwinds, the shift of procedures to the ASC setting and the impact of GLP-1 weightloss drugs are among the factors we considered in our joint replacement forecast.
The more elective nature of joint replacement surgery cost the segment three years of growth in the wake of the pandemic. It took the top four joint replacement players until 2023 to surpass 2019 sales totals for knees and hips. Postponed and canceled surgeries will steadily re-enter the funnel and drive elevated procedure volumes through 2025. The tailwind could serve as a bridge to future growth drivers like ASCs and technology.
The shift of joint replacement surgeries to the ASC accelerated during the pandemic. On average, major recon companies get about 15% of their knee sales from the ASC with double-digit growth. Zimmer Biomet said between 40% and 60% of joint replacement cases will occur in ASCs in the next five years. Despite cost and space constraints, ASCs have proven relatively welcoming to joint replacement robots. About a third of system places go to ASCs.
GLP-1 weight loss drugs represent a neutral or small upside scenario for joint replacement procedures. Obesity is an obstacle to eligibility for joint surgery. If these drugs can lower a patient’s BMI to a certain threshold, they become eligible for surgery. Additionally, healthy patients could be more active and live longer, thus extending the runway for orthopedic procedures.
Japan is the second largest market in the world for osteoarthritis with minimal obesity rates but very long life expectancy dynamics. We’ve not seen any near-term impact from GLP-1s, and the long-term impact would be a positive one for orthopedics.
The U.S. market benefitted most from volume tailwinds due to backlogged procedures, but joint replacement companies experienced strength in sales across geographic regions.
The increasing traction of robotics in international markets could cause implant share shifts in those markets over the next few years. Knee and hip sales lapped the impact of volume-based procurement (VBP) in China, but sanctions in Russia created modest headwinds for some globalized players.
Exhibit 3: Joint Replacement Sales by Region ($millions)
Region | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
US | $13,806.2 | $12,708.5 | $1,097.8 | 8.6% |
OUS | $7,667.8 | $7,299.3 | $368.5 | 5% |
EMEA | $4,197.6 | $3,939.9 | $257.7 | 6.5% |
APAC | $2,825.4 | $2,742.1 | $83.3 | 3% |
ROW | $644.8 | $617.3 | $27.5 | 4.5% |
Total | $21,474.0 | $20,007.8 | $1,466.3 | 7.3% |
Exhibit 4: Joint Replacement Market Share by Region ($millions)
Zimmer Biomet, Stryker, DePuy Synthes and Smith+Nephew are the four largest joint replacement players, accounting for more than 69% of global sales in the segment. For brevity, let’s call them the Big Four throughout the chapter.
Each has annual joint replacement revenues above $1.6 billion. These companies all field robotic systems surrounded by robust digital ecosystems that help defend lucrative implant share. As a reminder, we moved data and analysis of orthopedic enabling technology to a separate chapter in this report.
Exhibit 5: Top 10 Joint Replacement Companies and All Others ($millions)
Company | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
Zimmer Biomet | $5,410.6 | $5,053.9 | $356.6 | 7.1% |
Stryker | $4,611.6 | $4,132.2 | $479.4 | 11.6% |
DePuy Synthes | $3,487.6 | $3,306.9 | $180.7 | 5.5% |
Smith+Nephew | $1,624.8 | $1,560.2 | $64.5 | 4.1% |
Enovis | $542.2 | $471.2 | $70.9 | 15.1% |
Medacta | $497.8 | $424.6 | $73.3 | 17.3% |
Aesculap | $409.6 | $387.5 | $22.1 | 5.7% |
Exactech | $358.4 | $349.7 | $8.7 | 2.5% |
LimaCorporate | $286.2 | $256.4 | $29.8 | 11.6% |
MicroPort Orthopedics | $229.9 | $216.6 | $13.2 | 6.1% |
Waldemar Link | $168.7 | $158.7 | $10.0 | 6.3% |
Corin | $164.2 | $154.0 | $10.2 | 6.6% |
Beijing Chunlizhengda | $145.4 | $146.5 | ($1.1) | (0.7%) |
AK Medical | $143.5 | $134.1 | $9.4 | 7% |
KYOCERA | $123.2 | $117.8 | $5.3 | 4.5% |
Amplitude Surgical | $113.4 | $100.9 | $12.5 | 12.4% |
All Others | $3,157.0 | $3,036.4 | $120.6 | 4% |
Segment Total | $21,474.0 | $20,007.8 | $1,466.3 | 7.3% |
Exhibit 6: Joint Replacement Market Share by Company ($millions)
Joint replacement experienced the most procedure volume tailwinds from the pandemic, driving the orthopedic market’s overperformance in 2023. While Stryker is the number two player by revenue, it consistently grows faster than its peer group and the overall market.
Our hip replacement growth is based on the Insignia stem and Mako. We launched the Mako Total Hip 4.0 software in the last two years and that, combined with Insignia, positions us beautifully for the direct anterior approach. We really like the momentum that we’re seeing in hip replacement, and we expect it to continue.
There’s nothing new about Stryker’s formula for success in joint replacement. Its leadership in robotics and cementless knees creates a synergy that competitors have tried to match for years. Zimmer Biomet made strides in that regard during 2023, but DePuy Synthes and Smith+Nephew have grown more slowly.
DePuy Synthes has performed better since the pandemic as it reclaimed some lost ground on the strength of VELYS traction and new products. However, Smith+Nephew’s operational and commercial issues will take longer to resolve in its orthopedic franchises.
When we spoke to THINK Surgical CEO Stuart Simpson in late 2023, he said he wanted the large device companies to see THINK as a partner rather than competition. The top players are starting to get on board, judging from Zimmer Biomet’s recent distribution agreement with THINK Surgical. It is part of a larger strategy shift at Zimmer Biomet aimed at adding breadth to its enabling tech portfolio, as it plans to launch multiple new ROSA applications and recently acquired OrthoGrid for its navigation technology.
The word is optionality. Zimmer Biomet is the only company in the world with three different forms of navigation with ROSA Hip, OrthoGrid and HipInsight. We have three different ways to do navigation that appeals to pretty much every customer.
Increasing adoption of enabling technology outside the United States is driving significant joint replacement growth for global players. Stryker called Mako the tip of the spear for its international sales while DePuy Synthes’ VELYS system is in 20 markets. The system’s international success helped DePuy Synthes turn around its knee franchise, which lagged behind its peers in growth. Since the start of 2023. DePuy Synthes’ international knee sales have averaged double-digit growth.
Overall medtech volumes normalized in 2024 but the knee and hip markets remain robust. Stryker said it sees the large joint market as a mid-single-digit grower with volumes elevated compared to the pre-pandemic period, based on the schedules of its surgeons. The company expects the tailwind to last through 2024 and potentially into 2025.
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.
Our overview of the $21 billion joint replacement market includes up-to-date information on forecasted growth, the top companies and industry-driving trends.
Implants and instruments to replace or revise failed joints in the knee, hip, shoulder, elbow, wrist, ankle and digits.
October 2024 (update coming January 2025)
Mike Evers, Senior Market Analyst
Welcome to our overview of the joint replacement market. This page builds upon and updates our joint replacement chapter in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. Joint replacement sales grew well above historical averages in 2023 and should benefit from a tailwind in 2024.
Joint replacement accelerated well beyond historical norms, as it grew 7.3% and reached $21.4 billion in sales in 2023. The segment is the largest in orthopedics, accounting for 36% of the $59 billion global market. Backlogged procedures drove overperformance in the segment, which started in late 2022 and could persist through at least the first half of 2024.
Exhibit 1: Worldwide Joint Replacement Sales by Type ($millions)
The segment’s slow recovery in the pandemic’s aftermath turned into a significant bolus of backlogged procedures. That additional volume drove elevated market growth, especially in early 2023.
However, the consensus among orthopedic executives is that the rise in cases will persist for a significant portion of 2024. Beyond that, demographic factors could lead to persistent growth acceleration for joint replacement.
Exhibit 2: Worldwide Joint Replacement Sales Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Companies Sales Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 75 public and private companies by segment from 2016 through 2024.
Volume tailwinds, the shift of procedures to the ASC setting and the impact of GLP-1 weightloss drugs are among the factors we considered in our joint replacement forecast.
The more elective nature of joint replacement surgery cost the segment three years of growth in the wake of the pandemic. It took the top four joint replacement players until 2023 to surpass 2019 sales totals for knees and hips. Postponed and canceled surgeries will steadily re-enter the funnel and drive elevated procedure volumes through 2025. The tailwind could serve as a bridge to future growth drivers like ASCs and technology.
The shift of joint replacement surgeries to the ASC accelerated during the pandemic. On average, major recon companies get about 15% of their knee sales from the ASC with double-digit growth. Zimmer Biomet said between 40% and 60% of joint replacement cases will occur in ASCs in the next five years. Despite cost and space constraints, ASCs have proven relatively welcoming to joint replacement robots. About a third of system places go to ASCs.
GLP-1 weight loss drugs represent a neutral or small upside scenario for joint replacement procedures. Obesity is an obstacle to eligibility for joint surgery. If these drugs can lower a patient’s BMI to a certain threshold, they become eligible for surgery. Additionally, healthy patients could be more active and live longer, thus extending the runway for orthopedic procedures.
Japan is the second largest market in the world for osteoarthritis with minimal obesity rates but very long life expectancy dynamics. We’ve not seen any near-term impact from GLP-1s, and the long-term impact would be a positive one for orthopedics.
The U.S. market benefitted most from volume tailwinds due to backlogged procedures, but joint replacement companies experienced strength in sales across geographic regions.
The increasing traction of robotics in international markets could cause implant share shifts in those markets over the next few years. Knee and hip sales lapped the impact of volume-based procurement (VBP) in China, but sanctions in Russia created modest headwinds for some globalized players.
Exhibit 3: Joint Replacement Sales by Region ($millions)
Region | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
US | $13,806.2 | $12,708.5 | $1,097.8 | 8.6% |
OUS | $7,667.8 | $7,299.3 | $368.5 | 5% |
EMEA | $4,197.6 | $3,939.9 | $257.7 | 6.5% |
APAC | $2,825.4 | $2,742.1 | $83.3 | 3% |
ROW | $644.8 | $617.3 | $27.5 | 4.5% |
Total | $21,474.0 | $20,007.8 | $1,466.3 | 7.3% |
Exhibit 4: Joint Replacement Market Share by Region ($millions)
Zimmer Biomet, Stryker, DePuy Synthes and Smith+Nephew are the four largest joint replacement players, accounting for more than 69% of global sales in the segment. For brevity, let’s call them the Big Four throughout the chapter.
Each has annual joint replacement revenues above $1.6 billion. These companies all field robotic systems surrounded by robust digital ecosystems that help defend lucrative implant share. As a reminder, we moved data and analysis of orthopedic enabling technology to a separate chapter in this report.
Exhibit 5: Top 10 Joint Replacement Companies and All Others ($millions)
Company | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
Zimmer Biomet | $5,410.6 | $5,053.9 | $356.6 | 7.1% |
Stryker | $4,611.6 | $4,132.2 | $479.4 | 11.6% |
DePuy Synthes | $3,487.6 | $3,306.9 | $180.7 | 5.5% |
Smith+Nephew | $1,624.8 | $1,560.2 | $64.5 | 4.1% |
Enovis | $542.2 | $471.2 | $70.9 | 15.1% |
Medacta | $497.8 | $424.6 | $73.3 | 17.3% |
Aesculap | $409.6 | $387.5 | $22.1 | 5.7% |
Exactech | $358.4 | $349.7 | $8.7 | 2.5% |
LimaCorporate | $286.2 | $256.4 | $29.8 | 11.6% |
MicroPort Orthopedics | $229.9 | $216.6 | $13.2 | 6.1% |
Waldemar Link | $168.7 | $158.7 | $10.0 | 6.3% |
Corin | $164.2 | $154.0 | $10.2 | 6.6% |
Beijing Chunlizhengda | $145.4 | $146.5 | ($1.1) | (0.7%) |
AK Medical | $143.5 | $134.1 | $9.4 | 7% |
KYOCERA | $123.2 | $117.8 | $5.3 | 4.5% |
Amplitude Surgical | $113.4 | $100.9 | $12.5 | 12.4% |
All Others | $3,157.0 | $3,036.4 | $120.6 | 4% |
Segment Total | $21,474.0 | $20,007.8 | $1,466.3 | 7.3% |
Exhibit 6: Joint Replacement Market Share by Company ($millions)
Joint replacement experienced the most procedure volume tailwinds from the pandemic, driving the orthopedic market’s overperformance in 2023. While Stryker is the number two player by revenue, it consistently grows faster than its peer group and the overall market.
Our hip replacement growth is based on the Insignia stem and Mako. We launched the Mako Total Hip 4.0 software in the last two years and that, combined with Insignia, positions us beautifully for the direct anterior approach. We really like the momentum that we’re seeing in hip replacement, and we expect it to continue.
There’s nothing new about Stryker’s formula for success in joint replacement. Its leadership in robotics and cementless knees creates a synergy that competitors have tried to match for years. Zimmer Biomet made strides in that regard during 2023, but DePuy Synthes and Smith+Nephew have grown more slowly.
DePuy Synthes has performed better since the pandemic as it reclaimed some lost ground on the strength of VELYS traction and new products. However, Smith+Nephew’s operational and commercial issues will take longer to resolve in its orthopedic franchises.
When we spoke to THINK Surgical CEO Stuart Simpson in late 2023, he said he wanted the large device companies to see THINK as a partner rather than competition. The top players are starting to get on board, judging from Zimmer Biomet’s recent distribution agreement with THINK Surgical. It is part of a larger strategy shift at Zimmer Biomet aimed at adding breadth to its enabling tech portfolio, as it plans to launch multiple new ROSA applications and recently acquired OrthoGrid for its navigation technology.
The word is optionality. Zimmer Biomet is the only company in the world with three different forms of navigation with ROSA Hip, OrthoGrid and HipInsight. We have three different ways to do navigation that appeals to pretty much every customer.
Increasing adoption of enabling technology outside the United States is driving significant joint replacement growth for global players. Stryker called Mako the tip of the spear for its international sales while DePuy Synthes’ VELYS system is in 20 markets. The system’s international success helped DePuy Synthes turn around its knee franchise, which lagged behind its peers in growth. Since the start of 2023. DePuy Synthes’ international knee sales have averaged double-digit growth.
Overall medtech volumes normalized in 2024 but the knee and hip markets remain robust. Stryker said it sees the large joint market as a mid-single-digit grower with volumes elevated compared to the pre-pandemic period, based on the schedules of its surgeons. The company expects the tailwind to last through 2024 and potentially into 2025.
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.
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