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.
November 2023
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®. The market is on track for a furious finish to 2023, so I’ll be back in late November with important segment updates and our year-end projections. See you soon!
The Market at a Glance
Joint replacement accelerated post-pandemic to reach $20 billion in sales in 2022, and accounts for 36% of the $55 billion global orthopedic market. Elective surgery demand has recovered, and overall case volumes have benefitted from a tailwind of deferred procedures. That tailwind could persist into 2024.
Exhibit 1: Worldwide Joint Replacement Sales by Type ($millions)
Market Forecast
The market’s recovery finally got on track during 2022. Procedure volumes stabilized, and backlogged procedures provided a tailwind in the second half of the year. We expect a slight increase in joint replacement procedures through 2023, after which the segment’s growth will normalize at historical levels.
We estimate that the joint replacement market will grow in the 3% range and reach $20.7 billion in 2023 and nearly $23 billion in 2026.
Exhibit 2: Worldwide Joint Replacement Sales Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 67 public and private companies by segment from 2016 through 2022.
Volume-based procurement (VBP) in China, the rate of innovation and elevated surgical volumes are some of the factors we considered in our forecast.
VBP in China
The national VBP tender in China for knee and hip implants caused a significant shakeup for some of the largest orthopedic players. The average retail price for companies participating in the tender fell by more than 80%. Companies like DePuy Synthes and Smith+Nephew still feel the sting of the price drops, but remain bullish on China.
Domestic Chinese players like AK Medical and MicroPort Orthopedics significantly increased market penetration with the implementation of VBP. AK Medical ranked first among all participating players, winning more than 15% of the tender’s total first-year volume.
Innovation Entering Joint Replacement
Technologies that span the entire patient journey are becoming more common. Companies are leaning on robotics, augmented reality navigation, connected implants and artificial intelligence to improve outcomes and drive efficiency. Stryker and Zimmer Biomet are likely to extend their robotic capabilities to shoulder replacement surgery in 2024, while Globus Medical will soon enter joint replacement with a robotic system.
Former Zimmer Biomet CEO Bryan Hanson said that technology can stabilize pricing dynamics, drive premium cementless sales and buoy the overall orthopedic market growth rate.
One of the things that we look to that can sustainably buoy the market growth is innovation, and innovation adoption right now in orthopedics is really promising. Not just the typical innovation, but technology can drive the share of wallet or mix benefit you get with that innovation.
Bryan Hanson, former Zimmer Biomet CEO
How Long Will Elevated Surgical Volumes Persist?
Knee and hip replacement surgical volumes in 2022 and 2023 clearly outperformed historical averages. The source of that tailwind, and its sustainability, are difficult to determine. Executives from Stryker and Zimmer Biomet believe there is a meaningful number of backlogged procedures that have yet to enter the sales funnel due to hospital staffing pressures.
Both companies expect the backlog to boost 2023 sales. Enovis, on the other hand, is expecting normal market volumes throughout the year. We anticipate a modest tailwind in 2023, with growth rates regressing to their averages sometime in 2024.
Other Segment Reports
Orthopedic Market Overview
October 26, 2023
Spine Implant Market
October 26, 2023
Trauma Implant Market
October 26, 2023
Sports Medicine Market
October 26, 2023
Orthobiologics Market
October 26, 2023
Enabling Technology Market
October 26, 2023
Sales by Region
COVID outbreaks in key international markets like China and Brazil impacted 2022 sales, as did VBP of knee and hip implants in China. While VBP price cuts were a significant headwind for companies competing in China, players like DePuy Synthes and Zimmer Biomet still view the market as highly attractive. A strengthening U.S. dollar also created meaningful currency headwinds for globalized companies during 2022.
U.S. joint replacement sales reached $12.7 billion and accounted for 63% of the market in 2022, while OUS sales reached $7.3 billion.
Exhibit 3: Joint Replacement Sales by Region ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg> |
|---|---|---|---|---|
| US | $12,708.5 | $11,979.6 | $728.9 | 6.1% |
| OUS | $7,299.3 | $7,122.3 | $177.0 | 2.5% |
| EMEA | $3,939.9 | $3,749.9 | $190.0 | 5.1% |
| APAC | $2,742.1 | $2,771.3 | ($29.2) | (1.1%) |
| ROW | $617.3 | $601.2 | $16.1 | 2.7% |
| Total | $20,007.8 | $19,101.8 | $905.9 | 4.7% |
Exhibit 4: Joint Replacement Market Share by Region ($millions)
Top Companies
Zimmer Biomet, Stryker, DePuy Synthes and Smith+Nephew are the incumbent top tier players in joint replacement. They each generate more than $1.5 billion in annual joint replacement sales, and together control 71% of the market.
Please note that enabling technology is not included in our joint replacement sales figures and can be found in a separate market overview.
Exhibit 5: Top 10 Joint Replacement Companies and All Others ($millions)
| Company | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| Zimmer Biomet | $5,152.6 | $4,981.1 | $171.5 | 3.4% |
| Stryker | $4,223.1 | $3,938.8 | $284.3 | 7.2% |
| DePuy Synthes | $3,249.8 | $3,171.9 | $77.9 | 2.5% |
| Smith+Nephew | $1,561.0 | $1,566.8 | ($5.8) | (0.4%) |
| Enovis | $472.9 | $354.9 | $118.0 | 33.3% |
| Medacta | $420.7 | $350.6 | $70.1 | 20% |
| Aesculap | $384.0 | $365.6 | $18.3 | 5% |
| Exactech | $349.7 | $340.0 | $9.7 | 2.9% |
| LimaCorporate | $241.1 | $209.7 | $31.5 | 15% |
| MicroPort Orthopedics | $218.1 | $210.2 | $7.9 | 3.8% |
| All Others | $3,734.7 | $3,612.2 | $122.5 | 3.4% |
| Total | $20,007.8 | $19,101.8 | $905.9 | 4.7% |
Exhibit 6: Joint Replacement Market Share by Company ($millions)
Procedure volume recovery drove joint replacement sales growth for most players. Zimmer Biomet’s investments in technology helped accelerate its joint replacement business, while Stryker’s combination of the Mako robot and cementless knees remains unmatched. DePuy Synthes gained traction with its VELYS digital ecosystem and performed well in the ASC setting. Smith+Nephew undertook a 12-point plan to address serious commercial and operational shortcomings.
Enovis is racing up the revenue ranks among mid-tier companies as it fuels long-term double-digit growth through a string of successful acquisitions.
Between the integrated channel, great innovation and being able to lean in on STAR next year, we feel like our foot and ankle business will be on a very nice growth path. There’s also some interesting bolt-ons in that space as well.
Matt Trerotola, Enovis CEO
Medacta and LimaCorporate (being acquired by Enovis) are growing at multiples, aided by increased penetration in key markets. Players like MicroPort Orthopedics and AK Medical greatly expanded hospital access in China through the VBP process, and expect sales volumes to offset price declines.
Important Developments in the Joint Replacement Market
Supply Chain Disruptions
The pandemic broke global supply chains in 2020, and orthopedic players have been dealing with the fallout ever since. Much of the impact filtered through to the bottom line, as players ate higher spot-buy and freight fees to maintain service levels.
The disruption further weakened the already cracked foundations of Smith+Nephew’s orthopedics franchise. The company lost share in 2022 as it struggled to fulfill orders of key products like the JOURNEY II knee and POLARSTEM hip. Most players foresee supply chain issues persisting into 2024.
Accelerating Cementless Knee Adoption
The synergy between robotics and cementless knee implants keyed Stryker’s incredible success in the segment over the last several years. By the end of 2021, nearly half of Stryker’s U.S. knee replacement surgeries involved the Mako robot and a cementless implant. A year later, the company marked its one-millionth cementless knee procedure.
Stryker’s competitors have adopted the same strategy with varying degrees of success. Smith+Nephew has struggled to align its offerings in the space. Zimmer Biomet’s cementless penetration started in 2022 in the mid-teens, but should accelerate rapidly with the company’s new cementless form factor and expanding ROSA robot placements.
Knees have been an outperformer for us since we launched the Mako Total Knee application. I am not at all worried about competitive entrants on cementless. People aren’t going to move away from our cementless for a competitive product when we have a million procedures done.
Kevin Lobo, Stryker CEO
ASC-Driven Design Considerations
As joint replacement procedures increasingly shift out of the hospital, companies are tailoring implant and technology designs for the unique needs of the ASC. Enovis’ streamlined instrument sets, OaraScore patient risk assessment software and ARVIS navigation all demonstrate the company’s ASC-focused mentality. Anika Therapeutics’ RevoMotion Shoulder is another example of implants that play especially well in 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. I’ll be back soon with updates to this page as we complete our projections for the 2023 finish.
Until then, I’ve selected a few posts that give insight into our thinking on the joint replacement market.
April 14, 2023
,
Julie A. Vetalice
Welcome to our overview of the $20 billion joint replacement market. This page builds upon and updates our joint replacement chapter in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. Joint replacement accelerated post-pandemic and accounts for over a third of the global orthopedic market. Elevated procedure demand is expected to last into early 2025.
Market Definition
Implants and instruments to replace or revise failed joints in the knee, hip, shoulder, elbow, wrist, ankle and digits.
November 2023
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®. The market is on track for a furious finish to 2023, so I’ll be back in late November with important segment updates and our year-end projections. See you soon!
The Market at a Glance
Joint replacement accelerated post-pandemic to reach $20 billion in sales in 2022, and accounts for 36% of the $55 billion global orthopedic market. Elective surgery demand has recovered, and overall case volumes have benefitted from a tailwind of deferred procedures. That tailwind could persist into 2024.
Exhibit 1: Worldwide Joint Replacement Sales by Type ($millions)
Market Forecast
The market’s recovery finally got on track during 2022. Procedure volumes stabilized, and backlogged procedures provided a tailwind in the second half of the year. We expect a slight increase in joint replacement procedures through 2023, after which the segment’s growth will normalize at historical levels.
We estimate that the joint replacement market will grow in the 3% range and reach $20.7 billion in 2023 and nearly $23 billion in 2026.
Exhibit 2: Worldwide Joint Replacement Sales Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 67 public and private companies by segment from 2016 through 2022.
Volume-based procurement (VBP) in China, the rate of innovation and elevated surgical volumes are some of the factors we considered in our forecast.
VBP in China
The national VBP tender in China for knee and hip implants caused a significant shakeup for some of the largest orthopedic players. The average retail price for companies participating in the tender fell by more than 80%. Companies like DePuy Synthes and Smith+Nephew still feel the sting of the price drops, but remain bullish on China.
Domestic Chinese players like AK Medical and MicroPort Orthopedics significantly increased market penetration with the implementation of VBP. AK Medical ranked first among all participating players, winning more than 15% of the tender’s total first-year volume.
Innovation Entering Joint Replacement
Technologies that span the entire patient journey are becoming more common. Companies are leaning on robotics, augmented reality navigation, connected implants and artificial intelligence to improve outcomes and drive efficiency. Stryker and Zimmer Biomet are likely to extend their robotic capabilities to shoulder replacement surgery in 2024, while Globus Medical will soon enter joint replacement with a robotic system.
Former Zimmer Biomet CEO Bryan Hanson said that technology can stabilize pricing dynamics, drive premium cementless sales and buoy the overall orthopedic market growth rate.
One of the things that we look to that can sustainably buoy the market growth is innovation, and innovation adoption right now in orthopedics is really promising. Not just the typical innovation, but technology can drive the share of wallet or mix benefit you get with that innovation.
Bryan Hanson, former Zimmer Biomet CEO
How Long Will Elevated Surgical Volumes Persist?
Knee and hip replacement surgical volumes in 2022 and 2023 clearly outperformed historical averages. The source of that tailwind, and its sustainability, are difficult to determine. Executives from Stryker and Zimmer Biomet believe there is a meaningful number of backlogged procedures that have yet to enter the sales funnel due to hospital staffing pressures.
Both companies expect the backlog to boost 2023 sales. Enovis, on the other hand, is expecting normal market volumes throughout the year. We anticipate a modest tailwind in 2023, with growth rates regressing to their averages sometime in 2024.
Other Segment Reports
Orthopedic Market Overview
October 26, 2023
Spine Implant Market
October 26, 2023
Trauma Implant Market
October 26, 2023
Sports Medicine Market
October 26, 2023
Orthobiologics Market
October 26, 2023
Enabling Technology Market
October 26, 2023
Sales by Region
COVID outbreaks in key international markets like China and Brazil impacted 2022 sales, as did VBP of knee and hip implants in China. While VBP price cuts were a significant headwind for companies competing in China, players like DePuy Synthes and Zimmer Biomet still view the market as highly attractive. A strengthening U.S. dollar also created meaningful currency headwinds for globalized companies during 2022.
U.S. joint replacement sales reached $12.7 billion and accounted for 63% of the market in 2022, while OUS sales reached $7.3 billion.
Exhibit 3: Joint Replacement Sales by Region ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg> |
|---|---|---|---|---|
| US | $12,708.5 | $11,979.6 | $728.9 | 6.1% |
| OUS | $7,299.3 | $7,122.3 | $177.0 | 2.5% |
| EMEA | $3,939.9 | $3,749.9 | $190.0 | 5.1% |
| APAC | $2,742.1 | $2,771.3 | ($29.2) | (1.1%) |
| ROW | $617.3 | $601.2 | $16.1 | 2.7% |
| Total | $20,007.8 | $19,101.8 | $905.9 | 4.7% |
Exhibit 4: Joint Replacement Market Share by Region ($millions)
Top Companies
Zimmer Biomet, Stryker, DePuy Synthes and Smith+Nephew are the incumbent top tier players in joint replacement. They each generate more than $1.5 billion in annual joint replacement sales, and together control 71% of the market.
Please note that enabling technology is not included in our joint replacement sales figures and can be found in a separate market overview.
Exhibit 5: Top 10 Joint Replacement Companies and All Others ($millions)
| Company | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| Zimmer Biomet | $5,152.6 | $4,981.1 | $171.5 | 3.4% |
| Stryker | $4,223.1 | $3,938.8 | $284.3 | 7.2% |
| DePuy Synthes | $3,249.8 | $3,171.9 | $77.9 | 2.5% |
| Smith+Nephew | $1,561.0 | $1,566.8 | ($5.8) | (0.4%) |
| Enovis | $472.9 | $354.9 | $118.0 | 33.3% |
| Medacta | $420.7 | $350.6 | $70.1 | 20% |
| Aesculap | $384.0 | $365.6 | $18.3 | 5% |
| Exactech | $349.7 | $340.0 | $9.7 | 2.9% |
| LimaCorporate | $241.1 | $209.7 | $31.5 | 15% |
| MicroPort Orthopedics | $218.1 | $210.2 | $7.9 | 3.8% |
| All Others | $3,734.7 | $3,612.2 | $122.5 | 3.4% |
| Total | $20,007.8 | $19,101.8 | $905.9 | 4.7% |
Exhibit 6: Joint Replacement Market Share by Company ($millions)
Procedure volume recovery drove joint replacement sales growth for most players. Zimmer Biomet’s investments in technology helped accelerate its joint replacement business, while Stryker’s combination of the Mako robot and cementless knees remains unmatched. DePuy Synthes gained traction with its VELYS digital ecosystem and performed well in the ASC setting. Smith+Nephew undertook a 12-point plan to address serious commercial and operational shortcomings.
Enovis is racing up the revenue ranks among mid-tier companies as it fuels long-term double-digit growth through a string of successful acquisitions.
Between the integrated channel, great innovation and being able to lean in on STAR next year, we feel like our foot and ankle business will be on a very nice growth path. There’s also some interesting bolt-ons in that space as well.
Matt Trerotola, Enovis CEO
Medacta and LimaCorporate (being acquired by Enovis) are growing at multiples, aided by increased penetration in key markets. Players like MicroPort Orthopedics and AK Medical greatly expanded hospital access in China through the VBP process, and expect sales volumes to offset price declines.
Important Developments in the Joint Replacement Market
Supply Chain Disruptions
The pandemic broke global supply chains in 2020, and orthopedic players have been dealing with the fallout ever since. Much of the impact filtered through to the bottom line, as players ate higher spot-buy and freight fees to maintain service levels.
The disruption further weakened the already cracked foundations of Smith+Nephew’s orthopedics franchise. The company lost share in 2022 as it struggled to fulfill orders of key products like the JOURNEY II knee and POLARSTEM hip. Most players foresee supply chain issues persisting into 2024.
Accelerating Cementless Knee Adoption
The synergy between robotics and cementless knee implants keyed Stryker’s incredible success in the segment over the last several years. By the end of 2021, nearly half of Stryker’s U.S. knee replacement surgeries involved the Mako robot and a cementless implant. A year later, the company marked its one-millionth cementless knee procedure.
Stryker’s competitors have adopted the same strategy with varying degrees of success. Smith+Nephew has struggled to align its offerings in the space. Zimmer Biomet’s cementless penetration started in 2022 in the mid-teens, but should accelerate rapidly with the company’s new cementless form factor and expanding ROSA robot placements.
Knees have been an outperformer for us since we launched the Mako Total Knee application. I am not at all worried about competitive entrants on cementless. People aren’t going to move away from our cementless for a competitive product when we have a million procedures done.
Kevin Lobo, Stryker CEO
ASC-Driven Design Considerations
As joint replacement procedures increasingly shift out of the hospital, companies are tailoring implant and technology designs for the unique needs of the ASC. Enovis’ streamlined instrument sets, OaraScore patient risk assessment software and ARVIS navigation all demonstrate the company’s ASC-focused mentality. Anika Therapeutics’ RevoMotion Shoulder is another example of implants that play especially well in 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. I’ll be back soon with updates to this page as we complete our projections for the 2023 finish.
Until then, I’ve selected a few posts that give insight into our thinking on the joint replacement market.
April 14, 2023
,
Julie A. Vetalice
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