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Our early year-end estimates have orthopedic sales growing 5% in 2024, a significant increase from its historical average of around 3.5%. As the market continues to settle, many orthopedic leaders predict its growth rate will stay elevated beyond its pre-COVID average.
While many factors drove accelerated growth, innovative companies in newer segments are providing an important growth engine for the industry.
The foot and ankle market, for instance, is still relatively fragmented and features many unsolved or partially-solved problems. Paragon 28 CEO Albert DaCosta called it the “last gem” remaining in orthopedics. While not a product segment, per se, pediatric orthopedics has a similarly attractive profile.
So it’s no surprise that Treace Medical, Paragon 28 and OrthoPediatrics are among the fastest-growing companies in orthopedics, as we showed in our most recent Chart of the Month.
Below we dive a little deeper into the 2024 performance of these mid-tier growth companies, as well as the challenges and opportunities ahead of them.
Treace Medical Expands Footprint in Bunion Market
Treace Medical’s incredible growth came from its ability to simplify a very complex procedure. By making freehand 3D Lapidus procedures more accessible with reproducible results, the company enjoyed a 33.6% CAGR from 2018 through 2024.
The company’s growth slowed in 2024 as it faced a rapidly evolving landscape and increased competitive pressure from giants like Stryker, against which Treace recently launched a patent infringement suit. We estimate that Treace Medical will generate $205.6 million in 2024, up 9.9% compared to 2023.
“The market environment and competitive landscape are quickly evolving,” said Treace Medical Founder and CEO John Treace. “We’re seeing increased use and surgeon adoption of MIS osteotomy solutions. At the same time, we’re facing even more competition from knockoffs of our Lapiplasty products. Both of these dynamics are creating incremental headwinds to our Lapiplasty growth.”
According to Treace Medical, the overall procedure volume in the U.S. bunion market is approximately 70% osteotomies. Of those osteotomies, 10% to 15% are performed using MIS techniques.
Despite the high interest of surgeons and patients, these MIS procedures are technically challenging and are predominantly performed freehand. A learning curve as high as 40 cases has limited the procedure’s adoption among foot and ankle surgeons.
By applying its proven playbook to MIS osteotomies, the company launched its Nanoplasty 3D MIS system in a limited market release. It is Treace’s first foray into the large metatarsal osteotomy market and could significantly expand the company’s surgeon base and overall penetration of the bunion market.
Paragon 28 Innovating Across Product Segments
Paragon 28 also faced increasing competition and a choppy foot and ankle market during portions of 2023 and 2024. However, its broader reach across the market’s sub-segments insulated the company from the worst impacts of any one headwind.
The company further expanded its presence with 13 new product launches during the year, including its first enabling technology launch. The SMART 28 case management portal hosts 3D pre-operative planning modules and patient-specific implants, as well as case coordination and image submission features.
The system’s first module, SMART Bun-Yo-Matic for bunion correction, can leverage both CT scans and x-ray imaging to make 3D planning widely available to all surgeons. Paragon 28 said that using AI-enabled algorithms and statistical models will allow surgeons to export a surgical plan in about 10 minutes.
“The SMART 28 ecosystem is a massive advancement in helping surgeons understand highly complex deformities and optimize multiplanar correction, which we believe will ultimately result in improved precision and reproducible outcomes,” said Paragon 28 CEO Albert DaCosta.
The company launched a restructure in the second quarter of 2024 to lay the foundations for long term, sustainable growth. The cuts included reductions to current and planned workforce size, changes to executive compensation and cost containment measures for areas like travel, professional services and freight.
We estimate that Paragon 28 will finish 2024 with $253.4 million in sales, representing a CAGR of 17.8% since 2018.
OrthoPediatrics Racing Toward Market Dominance
OrthoPediatrics still flies under the radar in terms of competition from the largest orthopedic players. We estimate the company will generate $175.2 million in orthopedic sales for 2024, a CAGR of 17.2% since 2018.
“The Trauma and Deformity business is well positioned to continue to deliver sustainable growth,” said OrthoPediatrics CEO David Bailey. “Further, we believe certain players are placing even less focus on pediatric trauma and limb deformity, if not entirely exiting the space in the coming years. This places us in the driver’s seat to claim the dominant share position across the next five years.”
While the company may have faced easier competition compared to Treace and Paragon 28, it has remained aggressive.
OrthoPediatrics established itself as one of the more acquisitive companies, with five orthopedic deals since 2019. The 2022 purchase of Pega Medical drove significant growth in 2023. Sales of Pega products have been better than ever expected, according ot the company.
With pediatric orthopedic volumes now largely stabilized after up-and-down bouts with RSV and specialized pediatric staff shortages, the company has a clear line of sight on 50% market share within the childrens’ trauma and deformity market over the next few years.
To further differentiate its core business, OrthoPediatrics launched its Enabling Technologies division in late 2024.
Treace Medical, Paragon 28 and OrthoPediatrics remain among the fast-growing orthopedic companies in 2024. All three faced and met a variety of challenges in recent years and appear to be well-positioned for sustained above-market growth in the years ahead.
Our early year-end estimates have orthopedic sales growing 5% in 2024, a significant increase from its historical average of around 3.5%. As the market continues to settle, many orthopedic leaders predict its growth rate will stay elevated beyond its pre-COVID average.
While many factors drove accelerated growth, innovative companies...
Our early year-end estimates have orthopedic sales growing 5% in 2024, a significant increase from its historical average of around 3.5%. As the market continues to settle, many orthopedic leaders predict its growth rate will stay elevated beyond its pre-COVID average.
While many factors drove accelerated growth, innovative companies in newer segments are providing an important growth engine for the industry.
The foot and ankle market, for instance, is still relatively fragmented and features many unsolved or partially-solved problems. Paragon 28 CEO Albert DaCosta called it the “last gem” remaining in orthopedics. While not a product segment, per se, pediatric orthopedics has a similarly attractive profile.
So it’s no surprise that Treace Medical, Paragon 28 and OrthoPediatrics are among the fastest-growing companies in orthopedics, as we showed in our most recent Chart of the Month.
Below we dive a little deeper into the 2024 performance of these mid-tier growth companies, as well as the challenges and opportunities ahead of them.
Treace Medical Expands Footprint in Bunion Market
Treace Medical’s incredible growth came from its ability to simplify a very complex procedure. By making freehand 3D Lapidus procedures more accessible with reproducible results, the company enjoyed a 33.6% CAGR from 2018 through 2024.
The company’s growth slowed in 2024 as it faced a rapidly evolving landscape and increased competitive pressure from giants like Stryker, against which Treace recently launched a patent infringement suit. We estimate that Treace Medical will generate $205.6 million in 2024, up 9.9% compared to 2023.
“The market environment and competitive landscape are quickly evolving,” said Treace Medical Founder and CEO John Treace. “We’re seeing increased use and surgeon adoption of MIS osteotomy solutions. At the same time, we’re facing even more competition from knockoffs of our Lapiplasty products. Both of these dynamics are creating incremental headwinds to our Lapiplasty growth.”
According to Treace Medical, the overall procedure volume in the U.S. bunion market is approximately 70% osteotomies. Of those osteotomies, 10% to 15% are performed using MIS techniques.
Despite the high interest of surgeons and patients, these MIS procedures are technically challenging and are predominantly performed freehand. A learning curve as high as 40 cases has limited the procedure’s adoption among foot and ankle surgeons.
By applying its proven playbook to MIS osteotomies, the company launched its Nanoplasty 3D MIS system in a limited market release. It is Treace’s first foray into the large metatarsal osteotomy market and could significantly expand the company’s surgeon base and overall penetration of the bunion market.
Paragon 28 Innovating Across Product Segments
Paragon 28 also faced increasing competition and a choppy foot and ankle market during portions of 2023 and 2024. However, its broader reach across the market’s sub-segments insulated the company from the worst impacts of any one headwind.
The company further expanded its presence with 13 new product launches during the year, including its first enabling technology launch. The SMART 28 case management portal hosts 3D pre-operative planning modules and patient-specific implants, as well as case coordination and image submission features.
The system’s first module, SMART Bun-Yo-Matic for bunion correction, can leverage both CT scans and x-ray imaging to make 3D planning widely available to all surgeons. Paragon 28 said that using AI-enabled algorithms and statistical models will allow surgeons to export a surgical plan in about 10 minutes.
“The SMART 28 ecosystem is a massive advancement in helping surgeons understand highly complex deformities and optimize multiplanar correction, which we believe will ultimately result in improved precision and reproducible outcomes,” said Paragon 28 CEO Albert DaCosta.
The company launched a restructure in the second quarter of 2024 to lay the foundations for long term, sustainable growth. The cuts included reductions to current and planned workforce size, changes to executive compensation and cost containment measures for areas like travel, professional services and freight.
We estimate that Paragon 28 will finish 2024 with $253.4 million in sales, representing a CAGR of 17.8% since 2018.
OrthoPediatrics Racing Toward Market Dominance
OrthoPediatrics still flies under the radar in terms of competition from the largest orthopedic players. We estimate the company will generate $175.2 million in orthopedic sales for 2024, a CAGR of 17.2% since 2018.
“The Trauma and Deformity business is well positioned to continue to deliver sustainable growth,” said OrthoPediatrics CEO David Bailey. “Further, we believe certain players are placing even less focus on pediatric trauma and limb deformity, if not entirely exiting the space in the coming years. This places us in the driver’s seat to claim the dominant share position across the next five years.”
While the company may have faced easier competition compared to Treace and Paragon 28, it has remained aggressive.
OrthoPediatrics established itself as one of the more acquisitive companies, with five orthopedic deals since 2019. The 2022 purchase of Pega Medical drove significant growth in 2023. Sales of Pega products have been better than ever expected, according ot the company.
With pediatric orthopedic volumes now largely stabilized after up-and-down bouts with RSV and specialized pediatric staff shortages, the company has a clear line of sight on 50% market share within the childrens’ trauma and deformity market over the next few years.
To further differentiate its core business, OrthoPediatrics launched its Enabling Technologies division in late 2024.
Treace Medical, Paragon 28 and OrthoPediatrics remain among the fast-growing orthopedic companies in 2024. All three faced and met a variety of challenges in recent years and appear to be well-positioned for sustained above-market growth in the years ahead.
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Mike Evers is a Senior Market Analyst and writer with over 15 years of experience in the medical industry, spanning cardiac rhythm management, ER coding and billing, and orthopedics. He joined ORTHOWORLD in 2018, where he provides market analysis and editorial coverage.
