Orthopedic Enabling Technology Market Size and Share
Market Definition
Surgical planning, navigation technologies, robotics, patient monitoring and other digital tools used in orthopedics. Excludes sports medicine capital equipment.
November 2023
Mike Evers, Senior Market Analyst
Welcome to our overview of the orthopedic enabling technology market. This page builds upon the inaugural chapter covering enabling technology in our latest edition of THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. It is a dynamic and rapidly changing segment as the industry learns how to best leverage technology. Check back here later this month for updates and our year-end projections.
The Market at a Glance
Enabling technology sales neared $1.2 billion in 2022, accounting for 2.1% of the $55 billion global orthopedic market. The segment enjoyed relatively buoyant sales throughout the pandemic period. However, sustained market pressures shifted capital equipment acquisitions away from outright sales toward rentals and volume-based deals.
Market Forecast
We expect enabling technology sales to exceed $1.3 billion in 2023, growing just under 10%. Sustained economic pressure and looming recession fears will continue driving down technology acquisition costs, with companies instead benefiting from implant volume commitments and improved product mix. Still, we estimate that the market will continue to experience double-digit growth and reach nearly $2 billion in 2026.
Exhibit 1: Worldwide Enabling Technology Sales by Year ($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.
Changing dynamics for capital equipment, slow adoption rates and rapidly developing markets are some of the factors we considered in our forecast.
The Rise of Rentals
Zimmer Biomet launched its ROSA platform while Stryker had a massive head start in the robotics market. Remaining highly flexible to financing arrangements allowed Zimmer Biomet to quickly build up a meaningful install base, which in turn accelerated annuities like implant pull through, service fees and disposables.
Sustained economic pressure further accelerated the shift away from outright sales. The days of million-dollar robotic sales are mostly behind us. However, robotics has a proven ability to drive implant pull through, positively shift product mix to premium offerings like cementless knees and exert a stabilizing effect on pricing.
Crossing the Chasm
Enabling technologies get a lot of attention because of their potential to improve outcomes while accelerating market growth. But utilization remains low. About 20% of joint replacement cases use navigation and only 11% use robotics. Those numbers are even lower for spine surgery, at 18% and 3%, respectively.
What’s more, technology utilization in orthopedics has stalled in recent years. We remain confident that enabling technology will eventually cross the chasm into mainstream use, but that timeline could extend more than five years.
Most surgeries will eventually use software-based planning, patient-specific instruments where appropriate, and some technology-enabled guidance through the surgical process. What happens with robotics is less clear.
Matt Trerotola, Enovis CEO
Rapidly Evolving Market
We estimate that there could be approximately 6,500 joint replacement robots in the U.S. by 2026. A more competitive robotic market in spine and an emerging one in shoulder surgery will further spur growth in the coming years.
Smaller navigation-focused companies like OrthAlign target the technology needs of the ASC, while others like OrthoGrid focus on software-based solutions. Patient monitoring and engagement tools are likely to gain rapid adoption as more care moves out of the hospital setting.
Other Segment Reports
Orthopedic Market Overview
October 26, 2023
Joint Replacement Implant Market
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
Sales by Region
Companies in the enabling technology segment are focused on expanding sales outside of the U.S. Stryker reported record-breaking international robotic placements in the fourth quarter of 2022. Zimmer Biomet’s robotic placements are evenly split between the U.S and OUS markets, with ROSA robots in more than 40 countries.
Mid-sized and smaller companies like MicroPort, Naviswiss, Tinavi and Point Robotics are also making international robotics and navigation markets more competitive.
The U.S. accounted for 77% of enabling technology market sales and surpassed $900 million in 2022, while OUS markets reached nearly $270 million in enabling technology sales.
Exhibit 2: Enabling Technology Sales by Region ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $924.0 | $860.7 | $63.3 | 7.4% |
| OUS | $268.3 | $242.8 | $25.5 | 10.5% |
| EMEA | $175.9 | $160.0 | $15.9 | 9.9% |
| APAC | $81.0 | $71.7 | $9.2 | 12.9% |
| ROW | $11.4 | $11.0 | $0.4 | 3.7% |
| Total | $1,192.3 | $1,103.5 | $88.9 | 8.1% |
Exhibit 3: Enabling Technology Market Share by Region ($millions)
Top Companies
Orthopedic enabling technologies are primarily focused on joint replacement and spine surgeries. The segment is, therefore, dominated by the largest players in those markets.
Seven of the top 10 enabling technology companies are players with more than $1 billion in total annual sales — together, these companies command 74% of the segment. However, the space also hosts many small, innovative companies seeking to address gaps in orthopedic care through preoperative planning software and navigation.
There are two questions that we try to solve with payors and providers every day: Can we shorten the length of a stay post-surgery? Can we lower readmission rates? If you can do that with data and technology, the market will pay for it.
Ivan Tornos, Zimmer Biomet CEO
Exhibit 4: Top 10 Enabling Technology Players and All Others ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| Stryker | $280.8 | $315.3 | ($34.5) | (10.9%) |
| Medtronic | $151.7 | $139.3 | $12.4 | 8.9% |
| NuVasive | $129.5 | $109.8 | $19.7 | 17.9% |
| Globus Medical | $96.1 | $81.3 | $14.8 | 18.2% |
| Zimmer Biomet | $94.1 | $86.5 | $7.7 | 8.8% |
| Smith+Nephew | $77.9 | $82.1 | ($4.2) | (5.1%) |
| DePuy Synthes | $55.0 | $34.6 | $20.4 | 59% |
| ATEC | $48.0 | $30.0 | $18.0 | 60% |
| OrthAlign | $41.5 | $32.0 | $9.5 | 29.7% |
| Corin | $33.1 | $28.6 | $4.4 | 15.5% |
| All Others | $184.6 | $163.9 | $20.7 | 12.6% |
| Total | $1,192.3 | $1,103.5 | $88.9 | 8.1% |
Exhibit 5: Enabling Technology Market Share by Company ($millions)
Enabling technology sales started slowly in 2022 as COVID overhang stagnated the progression of deals. Additionally, supply chain disruption made critical components like circuit boards difficult to source.
Despite those challenges, most companies finished 2022 with substantial momentum in the segment. Companies set new records in the fourth quarter, a trend highlighted by Stryker’s highest-ever placement of Mako robots and Globus topping its previous mark in sales of enabling technology.
In Stryker’s case, changing purchasing models made the revenue comparison from 2021 impossible to achieve. ATEC’s EOS platform is driving a predictable, incremental revenue stream that will likely accelerate as the company shifts its placement focus to the U.S. market.
Important Developments in the Enabling Technology Market
Data is Currency
Orthopedic enabling technologies generate troves of data that companies are using to create predictive analytics through artificial intelligence. Companies with broad ecosystems of technologies are excited about the possibilities of collecting and integrating data throughout the patient experience. Zimmer Biomet, for example, can collect data through ROSA robotic procedures, use of the mymobility platform and the Persona IQ smart knee implant.
We’ve relied on other static modalities for decades. We should be looking to develop intelligent, intuitive imaging technologies that collect clean, informative datasets that we can utilize to fuel truly effective AI.
Samuel Browd, M.D., Ph.D., Proprio CMO
Globus Medical’s Acquisition of NuVasive
This market-altering deal could greatly enhance the penetration of Globus’ flagship enabling technologies across robotics and imaging. The synergy would give Globus added punching power in its head-to-head competition with Medtronic. Less clear is what happens to NuVasive’s Pulse platform. Given the importance of efficient and user-friendly integration among components of an ecosystem, it could be some time before Pulse is fully folded in.
Make or Break in Spine?
Stryker’s struggles in the spine segment highlight the importance of enabling technology. The company said that its spine business will remain in a “dogfight” into 2024 because it lacks a robotic solution in that segment. Stryker reprioritized its robotic development roadmap to focus on its spine application over its shoulder surgery application. Still, the company remains conservative on its timelines. “Robotics is hard,” said Stryker CEO Kevin Lobo. “Ask any of the companies that are trying to launch platforms.”
Nimbleness of Navigation
The number of companies with navigation systems is more than double those with surgical robots. Further, we expect smaller companies to continue developing navigated instruments that integrate with systems on the market. Navigation will remain an essential and accessible technology due to its cost, size and speed. Integrating augmented reality and artificial intelligence could be game changers in its adoption.
Further Reading
Thanks for visiting! Need more insight on the enabling technology 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 gathered a few posts about enabling technology from recent months. Enjoy!
September 7, 2023
,
Mike Evers
September 5, 2023
,
Julie A. Vetalice
May 30, 2023
,
Julie A. Vetalice
Welcome to our overview of the $1.2 billion orthopedic enabling technology market. This page builds upon the inaugural chapter covering enabling technology in our latest edition of THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. It is a dynamic and rapidly changing segment as the industry learns how to best leverage technology. The segment enjoyed relatively buoyant sales throughout the pandemic period. However, sustained market pressures shifted capital equipment acquisitions away from outright sales toward rentals and volume-based deals.
Market Definition
Surgical planning, navigation technologies, robotics, patient monitoring and other digital tools used in orthopedics. Excludes sports medicine capital equipment.
November 2023
Mike Evers, Senior Market Analyst
Welcome to our overview of the orthopedic enabling technology market. This page builds upon the inaugural chapter covering enabling technology in our latest edition of THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. It is a dynamic and rapidly changing segment as the industry learns how to best leverage technology. Check back here later this month for updates and our year-end projections.
The Market at a Glance
Enabling technology sales neared $1.2 billion in 2022, accounting for 2.1% of the $55 billion global orthopedic market. The segment enjoyed relatively buoyant sales throughout the pandemic period. However, sustained market pressures shifted capital equipment acquisitions away from outright sales toward rentals and volume-based deals.
Market Forecast
We expect enabling technology sales to exceed $1.3 billion in 2023, growing just under 10%. Sustained economic pressure and looming recession fears will continue driving down technology acquisition costs, with companies instead benefiting from implant volume commitments and improved product mix. Still, we estimate that the market will continue to experience double-digit growth and reach nearly $2 billion in 2026.
Exhibit 1: Worldwide Enabling Technology Sales by Year ($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.
Changing dynamics for capital equipment, slow adoption rates and rapidly developing markets are some of the factors we considered in our forecast.
The Rise of Rentals
Zimmer Biomet launched its ROSA platform while Stryker had a massive head start in the robotics market. Remaining highly flexible to financing arrangements allowed Zimmer Biomet to quickly build up a meaningful install base, which in turn accelerated annuities like implant pull through, service fees and disposables.
Sustained economic pressure further accelerated the shift away from outright sales. The days of million-dollar robotic sales are mostly behind us. However, robotics has a proven ability to drive implant pull through, positively shift product mix to premium offerings like cementless knees and exert a stabilizing effect on pricing.
Crossing the Chasm
Enabling technologies get a lot of attention because of their potential to improve outcomes while accelerating market growth. But utilization remains low. About 20% of joint replacement cases use navigation and only 11% use robotics. Those numbers are even lower for spine surgery, at 18% and 3%, respectively.
What’s more, technology utilization in orthopedics has stalled in recent years. We remain confident that enabling technology will eventually cross the chasm into mainstream use, but that timeline could extend more than five years.
Most surgeries will eventually use software-based planning, patient-specific instruments where appropriate, and some technology-enabled guidance through the surgical process. What happens with robotics is less clear.
Matt Trerotola, Enovis CEO
Rapidly Evolving Market
We estimate that there could be approximately 6,500 joint replacement robots in the U.S. by 2026. A more competitive robotic market in spine and an emerging one in shoulder surgery will further spur growth in the coming years.
Smaller navigation-focused companies like OrthAlign target the technology needs of the ASC, while others like OrthoGrid focus on software-based solutions. Patient monitoring and engagement tools are likely to gain rapid adoption as more care moves out of the hospital setting.
Other Segment Reports
Orthopedic Market Overview
October 26, 2023
Joint Replacement Implant Market
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
Sales by Region
Companies in the enabling technology segment are focused on expanding sales outside of the U.S. Stryker reported record-breaking international robotic placements in the fourth quarter of 2022. Zimmer Biomet’s robotic placements are evenly split between the U.S and OUS markets, with ROSA robots in more than 40 countries.
Mid-sized and smaller companies like MicroPort, Naviswiss, Tinavi and Point Robotics are also making international robotics and navigation markets more competitive.
The U.S. accounted for 77% of enabling technology market sales and surpassed $900 million in 2022, while OUS markets reached nearly $270 million in enabling technology sales.
Exhibit 2: Enabling Technology Sales by Region ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $924.0 | $860.7 | $63.3 | 7.4% |
| OUS | $268.3 | $242.8 | $25.5 | 10.5% |
| EMEA | $175.9 | $160.0 | $15.9 | 9.9% |
| APAC | $81.0 | $71.7 | $9.2 | 12.9% |
| ROW | $11.4 | $11.0 | $0.4 | 3.7% |
| Total | $1,192.3 | $1,103.5 | $88.9 | 8.1% |
Exhibit 3: Enabling Technology Market Share by Region ($millions)
Top Companies
Orthopedic enabling technologies are primarily focused on joint replacement and spine surgeries. The segment is, therefore, dominated by the largest players in those markets.
Seven of the top 10 enabling technology companies are players with more than $1 billion in total annual sales — together, these companies command 74% of the segment. However, the space also hosts many small, innovative companies seeking to address gaps in orthopedic care through preoperative planning software and navigation.
There are two questions that we try to solve with payors and providers every day: Can we shorten the length of a stay post-surgery? Can we lower readmission rates? If you can do that with data and technology, the market will pay for it.
Ivan Tornos, Zimmer Biomet CEO
Exhibit 4: Top 10 Enabling Technology Players and All Others ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| Stryker | $280.8 | $315.3 | ($34.5) | (10.9%) |
| Medtronic | $151.7 | $139.3 | $12.4 | 8.9% |
| NuVasive | $129.5 | $109.8 | $19.7 | 17.9% |
| Globus Medical | $96.1 | $81.3 | $14.8 | 18.2% |
| Zimmer Biomet | $94.1 | $86.5 | $7.7 | 8.8% |
| Smith+Nephew | $77.9 | $82.1 | ($4.2) | (5.1%) |
| DePuy Synthes | $55.0 | $34.6 | $20.4 | 59% |
| ATEC | $48.0 | $30.0 | $18.0 | 60% |
| OrthAlign | $41.5 | $32.0 | $9.5 | 29.7% |
| Corin | $33.1 | $28.6 | $4.4 | 15.5% |
| All Others | $184.6 | $163.9 | $20.7 | 12.6% |
| Total | $1,192.3 | $1,103.5 | $88.9 | 8.1% |
Exhibit 5: Enabling Technology Market Share by Company ($millions)
Enabling technology sales started slowly in 2022 as COVID overhang stagnated the progression of deals. Additionally, supply chain disruption made critical components like circuit boards difficult to source.
Despite those challenges, most companies finished 2022 with substantial momentum in the segment. Companies set new records in the fourth quarter, a trend highlighted by Stryker’s highest-ever placement of Mako robots and Globus topping its previous mark in sales of enabling technology.
In Stryker’s case, changing purchasing models made the revenue comparison from 2021 impossible to achieve. ATEC’s EOS platform is driving a predictable, incremental revenue stream that will likely accelerate as the company shifts its placement focus to the U.S. market.
Important Developments in the Enabling Technology Market
Data is Currency
Orthopedic enabling technologies generate troves of data that companies are using to create predictive analytics through artificial intelligence. Companies with broad ecosystems of technologies are excited about the possibilities of collecting and integrating data throughout the patient experience. Zimmer Biomet, for example, can collect data through ROSA robotic procedures, use of the mymobility platform and the Persona IQ smart knee implant.
We’ve relied on other static modalities for decades. We should be looking to develop intelligent, intuitive imaging technologies that collect clean, informative datasets that we can utilize to fuel truly effective AI.
Samuel Browd, M.D., Ph.D., Proprio CMO
Globus Medical’s Acquisition of NuVasive
This market-altering deal could greatly enhance the penetration of Globus’ flagship enabling technologies across robotics and imaging. The synergy would give Globus added punching power in its head-to-head competition with Medtronic. Less clear is what happens to NuVasive’s Pulse platform. Given the importance of efficient and user-friendly integration among components of an ecosystem, it could be some time before Pulse is fully folded in.
Make or Break in Spine?
Stryker’s struggles in the spine segment highlight the importance of enabling technology. The company said that its spine business will remain in a “dogfight” into 2024 because it lacks a robotic solution in that segment. Stryker reprioritized its robotic development roadmap to focus on its spine application over its shoulder surgery application. Still, the company remains conservative on its timelines. “Robotics is hard,” said Stryker CEO Kevin Lobo. “Ask any of the companies that are trying to launch platforms.”
Nimbleness of Navigation
The number of companies with navigation systems is more than double those with surgical robots. Further, we expect smaller companies to continue developing navigated instruments that integrate with systems on the market. Navigation will remain an essential and accessible technology due to its cost, size and speed. Integrating augmented reality and artificial intelligence could be game changers in its adoption.
Further Reading
Thanks for visiting! Need more insight on the enabling technology 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 gathered a few posts about enabling technology from recent months. Enjoy!
September 7, 2023
,
Mike Evers
September 5, 2023
,
Julie A. Vetalice
May 30, 2023
,
Julie A. Vetalice
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