Joint Replacement Implant Market Size and Share
Market Definition
Implants and instruments to replace or revise failed joints in the knee, hip, shoulder, elbow, wrist, ankle and digits.
April 2024
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.
The Market at a Glance
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)
Market Forecast
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 68 public and private companies by segment from 2016 through 2023.
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.
Primary Contributor to Surgical Backlog
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.
ASC Volume Could Explode in the Next 5 Years
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-1s Likely Much Ado About Nothing
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.
Ivan Tornos, Zimmer Biomet CEO
Sales by Region
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)
Top Companies
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.
Kevin Lobo, Stryker CEO
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.
Important Developments in the Joint Replacement Market
Does More Tech Mean Fewer Choices?
Four massive companies dominate joint replacement. Each one has built a digital ecosystem with robotics at its center. The proliferation of joint replacement robots locks hospitals and surgeons into implants from the same company. Early movers on robotics like Stryker are defending their hard-won market share. As more robots enter the market across orthopedic segments, the closed model creates a Gordian Knot for hospitals and could stifle innovation. Companies with open platform robotic systems aim to disrupt the prevailing razor-and-blade to preserve implant choice but have a long road ahead to win adoption.
LimaCorporate Acquisition Kickstarts Enovis’ Revision Hips
Enovis completed its $744 million acquisition of LimaCorporate in early 2024, setting the company firmly on the path to $1 billion in annual joint replacement sales. The deal also advances Enovis’ revision hip offering, which was in the early innings of gaining traction before the acquisition.
Lima had a very strong revision position. Revisions are a very attractive part of the market. We've been earlier days in terms of our revision position in hip and knee, so that's attractive and complementary.
Matt Trerotola, Enovis CEO
Large Joint Catch-Up Squeezes Smaller Players
The knee and hip markets ran very hot in 2023 and generated significant growth for the largest companies in orthopedics. However, it also caused headaches for smaller players focused on smaller joints. Some of Anika Therapeutics’ distributors focused on the large joint catch-up to the detriment of the company’s newly launched shoulder system. Paragon 28 said a return to normal procedure volumes in 2024 could create additional operating room capacity for procedures served by its portfolio.
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.
December 18, 2023
,
Julie A. Vetalice
Our overview of the $21 billion joint replacement market includes up-to-date information on forecasted growth, the top companies and industry-driving trends.
Market Definition
Implants and instruments to replace or revise failed joints in the knee, hip, shoulder, elbow, wrist, ankle and digits.
April 2024
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.
The Market at a Glance
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)
Market Forecast
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 68 public and private companies by segment from 2016 through 2023.
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.
Primary Contributor to Surgical Backlog
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.
ASC Volume Could Explode in the Next 5 Years
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-1s Likely Much Ado About Nothing
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.
Ivan Tornos, Zimmer Biomet CEO
Sales by Region
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)
Top Companies
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.
Kevin Lobo, Stryker CEO
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.
Important Developments in the Joint Replacement Market
Does More Tech Mean Fewer Choices?
Four massive companies dominate joint replacement. Each one has built a digital ecosystem with robotics at its center. The proliferation of joint replacement robots locks hospitals and surgeons into implants from the same company. Early movers on robotics like Stryker are defending their hard-won market share. As more robots enter the market across orthopedic segments, the closed model creates a Gordian Knot for hospitals and could stifle innovation. Companies with open platform robotic systems aim to disrupt the prevailing razor-and-blade to preserve implant choice but have a long road ahead to win adoption.
LimaCorporate Acquisition Kickstarts Enovis’ Revision Hips
Enovis completed its $744 million acquisition of LimaCorporate in early 2024, setting the company firmly on the path to $1 billion in annual joint replacement sales. The deal also advances Enovis’ revision hip offering, which was in the early innings of gaining traction before the acquisition.
Lima had a very strong revision position. Revisions are a very attractive part of the market. We've been earlier days in terms of our revision position in hip and knee, so that's attractive and complementary.
Matt Trerotola, Enovis CEO
Large Joint Catch-Up Squeezes Smaller Players
The knee and hip markets ran very hot in 2023 and generated significant growth for the largest companies in orthopedics. However, it also caused headaches for smaller players focused on smaller joints. Some of Anika Therapeutics’ distributors focused on the large joint catch-up to the detriment of the company’s newly launched shoulder system. Paragon 28 said a return to normal procedure volumes in 2024 could create additional operating room capacity for procedures served by its portfolio.
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.
December 18, 2023
,
Julie A. Vetalice
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