Implants and instruments to replace or revise failed joints in the knee, hip, shoulder, elbow, wrist, ankle and digits.
January 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 into 2025.
Joint replacement accelerated post-pandemic to reach $21 billion in sales in 2023, and accounts for 36% of the $59 billion global orthopedic market. Elective surgery demand has recovered, and overall case volumes have benefitted from a tailwind of deferred procedures. That tailwind could persist into 2025.
Exhibit 1: Worldwide Joint Replacement Sales by Type ($millions)
The market’s recovery finally got on track in late 2022 and remained strong throughout 2023. We expect a modest upside over historical averages for joint replacement through early 2025, after which procedure volumes will normalize..
We estimate that the joint replacement market grew 7%Â and reached $21.4 billion in 2023 and will suprass $25.6 billion in 2027.
Exhibit 2: Worldwide Joint Replacement Sales Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 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.
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.
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. U.S. joint replacement sales reached $13.7 billion and accounted for 63.5% of the market in 2023, while OUS sales reached $7.8 billion.
Exhibit 3: Joint Replacement Sales by Region ($millions)
Region | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
US | $13,608.2 | $12,708.5 | $899.7 | 7.1% |
OUS | $7,805.5 | $7,299.3 | $506.3 | 6.9% |
EMEA | $4,234.8 | $3,939.9 | $294.9 | 7.5% |
APAC | $2,902.6 | $2,742.1 | $160.5 | 5.9% |
ROW | $668.1 | $617.3 | $50.8 | 8.2% |
Total | $21,413.7 | $20,007.8 | $1,406.0 | 7% |
Exhibit 4: Joint Replacement Market Share by Region ($millions)
Zimmer Biomet, Stryker, DePuy Synthes and Smith+Nephew are the four largest joint replacement players, accounting for more than 71% of global sales in the segment. Each has annual joint replacement revenues above $1.6 billion and grew faster than the market average in 2023.
Please note that enabling technology is not included in our joint replacement sales figures and can be found in a separate market overview.
Exhibit 5: Top 10 Joint Replacement Companies and All Others ($millions)
Company | FY23E | FY22A | $ 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 | $3,593.7 | $3,384.7 | $209.0 | 6.2% |
Smith+Nephew | $1,624.8 | $1,560.2 | $64.5 | 4.1% |
Enovis | $556.7 | $472.9 | $83.8 | 17.7% |
Medacta | $497.8 | $424.6 | $73.3 | 17.3% |
Aesculap | $417.0 | $387.5 | $29.4 | 7.6% |
Exactech | $374.0 | $349.7 | $24.3 | 6.9% |
LimaCorporate | $286.2 | $256.4 | $29.8 | 11.6% |
MicroPort Orthopedics | $233.0 | $216.6 | $16.3 | 7.5% |
All Others | $3,808.5 | $3,768.9 | $39.6 | 1.1% |
Segment Total | $21,413.7 | $20,007.8 | $1,406.0 | 7% |
Exhibit 6: Joint Replacement Market Share by Company ($millions)
Joint replacement created most of the volume tailwinds that drove 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.
There’s nothing new about Stryker’s formula for success in joint replacement. Its leadership in robotics and cementless knees creates synergy that competitors have been trying to match for years. Zimmer Biomet made strides in that regard during 2023 and saw a price bump up to 15% in the ASC setting for its cementless offerings while pairing cementless and ROSA there about half the time.
Both 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 some more time to resolve in its orthopedic franchises.
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.
Enovis and Medacta anchor a strong group of mid-tier companies in joint replacement. Enovis accelerated its path to $1 billion in orthopedic revenue with the acquisition of LimaCorporate, joint replacement’s ninth largest player, that closed in January 2024. Medacta has quietly put itself on the cusp of a top five position with high-teen growth in 2023.
Among the smaller joint replacement players, we’re watching Anika closely in 2024 as it focuses on its best growth opportunities like its RevoMotion shoulder system. The company explored being sold in mid-2023 and could make a compelling target for a player looking to bolster its earlier intervention portfolio.
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 regenerative. Paragon 28 said a slowing backlog bolus in 2024 could create additional operating room capacity for procedures served by its portfolio.
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 like THINK Surgical aim to disrupt the prevailing razor-and-blade to preserve implant choice but have a long road ahead to win adoption.
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.
As joint replacement procedures increasingly shift out of the hospital, companies are tailoring implant and technology designs to 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.
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.
January 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 into 2025.
Joint replacement accelerated post-pandemic to reach $21 billion in sales in 2023, and accounts for 36% of the $59 billion global orthopedic market. Elective surgery demand has recovered, and overall case volumes have benefitted from a tailwind of deferred procedures. That tailwind could persist into 2025.
Exhibit 1: Worldwide Joint Replacement Sales by Type ($millions)
The market’s recovery finally got on track in late 2022 and remained strong throughout 2023. We expect a modest upside over historical averages for joint replacement through early 2025, after which procedure volumes will normalize..
We estimate that the joint replacement market grew 7%Â and reached $21.4 billion in 2023 and will suprass $25.6 billion in 2027.
Exhibit 2: Worldwide Joint Replacement Sales Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 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.
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.
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. U.S. joint replacement sales reached $13.7 billion and accounted for 63.5% of the market in 2023, while OUS sales reached $7.8 billion.
Exhibit 3: Joint Replacement Sales by Region ($millions)
Region | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
US | $13,608.2 | $12,708.5 | $899.7 | 7.1% |
OUS | $7,805.5 | $7,299.3 | $506.3 | 6.9% |
EMEA | $4,234.8 | $3,939.9 | $294.9 | 7.5% |
APAC | $2,902.6 | $2,742.1 | $160.5 | 5.9% |
ROW | $668.1 | $617.3 | $50.8 | 8.2% |
Total | $21,413.7 | $20,007.8 | $1,406.0 | 7% |
Exhibit 4: Joint Replacement Market Share by Region ($millions)
Zimmer Biomet, Stryker, DePuy Synthes and Smith+Nephew are the four largest joint replacement players, accounting for more than 71% of global sales in the segment. Each has annual joint replacement revenues above $1.6 billion and grew faster than the market average in 2023.
Please note that enabling technology is not included in our joint replacement sales figures and can be found in a separate market overview.
Exhibit 5: Top 10 Joint Replacement Companies and All Others ($millions)
Company | FY23E | FY22A | $ 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 | $3,593.7 | $3,384.7 | $209.0 | 6.2% |
Smith+Nephew | $1,624.8 | $1,560.2 | $64.5 | 4.1% |
Enovis | $556.7 | $472.9 | $83.8 | 17.7% |
Medacta | $497.8 | $424.6 | $73.3 | 17.3% |
Aesculap | $417.0 | $387.5 | $29.4 | 7.6% |
Exactech | $374.0 | $349.7 | $24.3 | 6.9% |
LimaCorporate | $286.2 | $256.4 | $29.8 | 11.6% |
MicroPort Orthopedics | $233.0 | $216.6 | $16.3 | 7.5% |
All Others | $3,808.5 | $3,768.9 | $39.6 | 1.1% |
Segment Total | $21,413.7 | $20,007.8 | $1,406.0 | 7% |
Exhibit 6: Joint Replacement Market Share by Company ($millions)
Joint replacement created most of the volume tailwinds that drove 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.
There’s nothing new about Stryker’s formula for success in joint replacement. Its leadership in robotics and cementless knees creates synergy that competitors have been trying to match for years. Zimmer Biomet made strides in that regard during 2023 and saw a price bump up to 15% in the ASC setting for its cementless offerings while pairing cementless and ROSA there about half the time.
Both 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 some more time to resolve in its orthopedic franchises.
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.
Enovis and Medacta anchor a strong group of mid-tier companies in joint replacement. Enovis accelerated its path to $1 billion in orthopedic revenue with the acquisition of LimaCorporate, joint replacement’s ninth largest player, that closed in January 2024. Medacta has quietly put itself on the cusp of a top five position with high-teen growth in 2023.
Among the smaller joint replacement players, we’re watching Anika closely in 2024 as it focuses on its best growth opportunities like its RevoMotion shoulder system. The company explored being sold in mid-2023 and could make a compelling target for a player looking to bolster its earlier intervention portfolio.
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 regenerative. Paragon 28 said a slowing backlog bolus in 2024 could create additional operating room capacity for procedures served by its portfolio.
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 like THINK Surgical aim to disrupt the prevailing razor-and-blade to preserve implant choice but have a long road ahead to win adoption.
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.
As joint replacement procedures increasingly shift out of the hospital, companies are tailoring implant and technology designs to 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.
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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