Orthopedic Market Size and Share
December 2023
Mike Evers, Senior Market Analyst
Welcome to our overview of the orthopedic market. This page and the Segment Reports build upon our work in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. The orthopedic market ran hot in 2023, growing several percentage points above its historical average. The tailwind, especially in joint replacement, could last through early 2025.
The Market at a Glance
The orthopedic market grew 6.5% in 2023 to $59 billion worldwide. Procedures lost or deferred during the pandemic have reentered the funnel. We expect the tailwind will last throughout 2024 and into the early portion of 2025.
Orthopedic Sales by Product Segment
Joint replacement volumes rebounded sharply in 2023 after almost three years of lagging recovery compared to other orthopedic segments. The knee and hip replacement categories finished well above their historical averages, growing 8.1% and 5.6%, respectively. Trauma also bounced back after a softer 2022.
Exhibit 1: Worldwide Orthopedic Sales by Product Segment ($millions)
| Segment | FY23P | FY22A | $ Chg | % Chg |
|---|---|---|---|---|
| Joint Replacement | $21,490.5 | $20,007.8 | $1,482.8 | 7.4% |
| Spine | $10,404.1 | $9,868.2 | $535.9 | 5.4% |
| Trauma | $8,574.7 | $8,001.0 | $573.7 | 7.2% |
| Sports Medicine | $6,734.0 | $6,301.1 | $433.0 | 6.9% |
| Orthobiologics | $5,528.8 | $5,317.9 | $210.8 | 4% |
| Enabling Technology | $1,309.5 | $1,192.3 | $117.2 | 9.8% |
| Other | $5,040.6 | $4,803.5 | $237.1 | 4.9% |
| Total | $59,082.3 | $55,491.7 | $3,590.5 | 6.5% |
Segment Reports
Joint Replacement Implant Market
December 4, 2023
Spine Implant Market
December 4, 2023
Trauma Implant Market
December 4, 2023
Sports Medicine Market
December 4, 2023
Orthobiologics Market
December 4, 2023
Enabling Technology Market
December 4, 2023
Market Forecast
The orthopedic market’s post-pandemic recovery gathered momentum in the second half of 2022. Orthopedic surgery volumes improved further in 2023, with a catch-up on joint replacement procedures providing the biggest tailwind. However, there’s some “noise” in medtech that could create disruption and slow growth
We project orthopedic market sales to surpass $59 billion in 2023 and eclipse the $70 billion mark by 2027.
Exhibit 2: Worldwide Orthopedic Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 68 public and private companies by segment from 2016 through 2023.
Lingering disruption, rebounding orthopedic procedure volumes and changes to the Chinese market were among the many factors informing our forecast.
Lingering Disruptions in Supply and Staffing
Supply chain disruptions are having wide-ranging impacts on most companies. Zimmer Biomet’s former CEO Bryan Hanson said supply challenges weren’t merely on resins and packaging, but on “almost everything we deal with.” Meanwhile, CONMED CEO Curt Hartman offered a blunt assessment of the staffing situation when he predicted that it wouldn’t be resolved until 2024.
Procedure Volumes Healthy and Stable
Procedure volumes in most product segments and geographic regions normalized in 2022 despite COVID-19 surges and high incidences of respiratory illness and flu during the year. Volume trends maintained healthy levels through 2023, with joint replacement overperforming after several years of disruption.
Volume-based Procurement (VBP) in China
Companies are re-evaluating their strategies as joint replacement, trauma and spinal implants come under national VBP tenders in China. Players like ZimVie and Medartis left China, while Smith+Nephew pulled its trauma products from the market. Joint replacement implant prices declined more than 80% due to the national tender.
Domestic Chinese players like MicroPort and AK Medical saw their market access increase significantly due to VBP. Global players like DePuy Synthes and Zimmer Biomet won’t have the same upside but remain committed to the Chinese market.
Sales by Region
International orthopedic sales were strong in 2023. Despite the impact of VBP, China returned to growth for many of the players there. Several companies called out strong performances in Europe, Australia and Japan.
VBP in China changed how global companies approach that market for joint replacement, spine, trauma and sports medicine. ZimVie opted to leave the Chinese spine market, and Smith+Nephew did the same in trauma.
The European Union’s Medical Device Regulation (MDR) has forced companies to reconsider their strategy in the region. MDR is a stricter regulation than the Medical Device Directive, and orthopedic companies are choosing to pull products from the market to ease the regulatory burden.
MDR’s transition deadline has been postponed from 2024 to 2027 or 2028, depending on the type of device. Startups to large players are expected to de-emphasize European Union countries moving forward.
U.S. sales make up 68.8% of the orthopedic market. U.S. orthopedic sales reached $39.4 billion in 2023, while OUS sales surpassed $19.6 billion.
Exhibit 3: Orthopedic Sales by Region ($millions)
| Total | FY23 | FY22 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $39,473.0 | $37,059.8 | $2,413.2 | 6.5% |
| OUS | $19,609.3 | $18,431.9 | $1,177.3 | 6.4% |
| EMEA | $10,807.8 | $10,100.9 | $706.9 | 7% |
| APAC | $6,793.8 | $6,460.8 | $333.1 | 5.2% |
| ROW | $2,007.6 | $1,870.2 | $137.4 | 7.3% |
| Total | $59,082.3 | $55,491.7 | $3,590.5 | 6.5% |
Exhibit 4: Orthopedic Market Share by Region ($millions)
Top Companies
The orthopedic market has more than 1,000 active companies, which we categorize into five tiers based on global annual revenue:
- Over $1 billion
- Between $400 million and $999 million
- Between $200 million and $399 million
- Between $100 million and $199 million
- All other companies below $100 million
Only 45 of the 1,000+ companies generated more than $100 million in orthopedic revenue in 2023, according to our estimates. Those companies account for 84% of all orthopedic sales. We expect the largest companies to consolidate more market share and increasingly seek to acquire enabling technologies.
Exhibit 5: Orthopedic Market Share by Company Tier ($millions)
Companies Over $1 Billion
The companies in this tier grew an average of 2% in 2022 vs. 2021. Highly globalized companies like DePuy Synthes, Zimmer Biomet and Smith+Nephew saw currency headwinds in the mid-single digits, which impacted their growth.
Globus Medical had an eventful 2022 and 1Q23 in which it entered the top tier of orthopedic players and announced its intention to acquire NuVasive, its closest competitor. Despite a chilly reaction from Wall Street and some regulatory questions, Globus closed the acquisition on time in the third quarter of 2023.
Exhibit 6: Orthopedic Sales for Top-Tier Players ($millions)
| Company | FY23P | FY22A | $ Chg | % Chg |
|---|---|---|---|---|
| Stryker | $10,293.6 | $9,425.5 | $868.1 | 9.2% |
| DePuy Synthes | $8,891.7 | $8,586.2 | $305.5 | 3.6% |
| Zimmer Biomet | $7,371.2 | $6,939.9 | $431.3 | 6.2% |
| Smith+Nephew | $3,736.3 | $3,549.5 | $186.8 | 5.3% |
| Medtronic | $3,238.0 | $3,146.4 | $91.6 | 2.9% |
| Arthrex | $2,992.0 | $2,828.6 | $163.4 | 5.8% |
| Globus Medical | $2,363.7 | $2,224.8 | $138.9 | 6.2% |
| Subtotal | $38,886.5 | $36,700.8 | $2,185.7 | 6% |
| Market Total | $59,082.3 | $55,491.7 | $3,590.5 | 6.5% |
Here are a few of the developments that we’re watching among the top-tier players.
Doubling Down on Spine
Globus Medical seemed poised for a big acquisition over the last few years, and finally made its move in 2023. The decision to acquire NuVasive and double down on spine surprised many in the industry. Spine company integrations historically lead to significant dissynergies. The culture gap between the companies is noteworthy. Still, if Globus Medical can manage through the integration with minimal disruption, it could quickly become a credible threat to market-leading Medtronic.
Smith+Nephew’s 12-Point Plan
The pandemic revealed some vulnerabilities at Smith+Nephew, resulting in a reorganization and leadership change. The company seems to be through the worst of its challenges and is now implementing CEO Deepak Nath’s 12-point plan. Five of those points aim to revitalize its orthopedic business, but company leadership admitted that it faces a long road to regaining momentum.
Changes in Capital Purchasing Models
Upfront capital sales of enabling technologies helped top-tier players like Stryker, Medtronic and Globus Medical soften the impact of reduced implant sales during the worst of the pandemic. By mid-2021, prolonged economic uncertainty and a more crowded robotics market changed the way hospitals acquired orthopedic technology. Options like rentals and volume-based “earnout” placements now spread the incremental revenue across longer periods.
Get Market Data for More Companies. 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.
Companies Between $400 Million and $999 Million
This tier remains highly active. Globus Medical outgrew this category in 2022, and Enovis’ reconstruction business will likely do the same by the end of 2024. The combined organization of Orthofix and SeaSpine is near the top of this group in 2023, with projected orthopedic sales of almost $750 million.
Players between $400 million and $999 million made up 8.6% of the orthopedic market in 2023. Here are some of the things that we’re watching among these companies.
If You Work in Recon, You Must Grow in Double-Digits
We estimate Enovis’ recon sales at $681.1 million in 2023. The company’s reconstruction business met high expectations once again and grew at multiples of the market average thanks to its highly regarded implants, deep ASC penetration and ability to seamlessly integrate acquired companies. Recently acquired companies showed double-digit growth in 2022 and have started to scale. Enovis will likely remain active on the M&A front.
ZimVie Turnaround a Long-term Play
In its first year post-spin from Zimmer Biomet, the company took necessary steps in its years-long transformation. ZimVie prioritized making cuts to right-size its business. It exited some unprofitable geographies and began the process of optimizing its portfolio. The company will likely end the year with $407.7 million in orthopedic sales.
ZimVie also canceled time-consuming, low-return projects. The company expects to return its spine business to growth within five years by focusing on faster-growing markets like motion preservation, minimally invasive surgery and enabling technology.
Hyaluronic Acid Reimbursement Changes Hurt Bioventus
In mid-2022, the company reported that changes to hyaluronic acid reimbursement from wholesale acquisition cost to average selling price could hinder sales growth. That impact was worse than expected, but Bioventus saw signs of improvement by the third quarter of 2023.
Bioventus is projected to generate 2023 orthopedic sales of $437.4 million.
Companies Between $200 Million and $399 Million
The 10 players in this tier generated 4.6% of all orthopedic sales in 2023. Below are a few of the storylines that we’re following for companies in the $200 million to $399 million revenue tier.
LimaCorporate Acquired by Enovis
We project Lima will finish 2023 with $294.8 million in orthopedic sales. Enovis will complete its acquisition of the company in early 2024, further expanding its global footprint and cross-selling opportunities.
MicroPort Expands Access Through VBP
The company generated orthopedic sales over $240 million in 2023. Revenues in China declined sharply due to VBP reductions and the COVID pandemic. However, MicroPort’s market access increased dramatically under the national tender.
Its joint replacement products entered 140 new hospitals, a 10% increase in its national coverage. VBP also brought a major breakthrough for the company’s spine and trauma products, adding access to 200 more hospitals and doubling its previous total.
Companies Between $100 Million and $199 Million
The $100 million to $199 million tier accounted for 5% of worldwide orthopedic sales in 2023. As a group these 19 companies grew in the double digits, paced by strong performances from pure-play foot and ankle companies.
Below are a few of the trends that we’re watching for this diverse group of companies.
Low Volume-Based Procurement Tender Pays Off for AK Medical
The Chinese company ranked first among all participating players in the VBP joint replacement rollout with an allotment of 81,000 pieces, more than 15% of the tender’s total first-year volume. AK Medical’s hospital access grew to nearly 3,500, of which 953 are newly-covered hospitals. The newfound access should allow the company to build upon the $181.8 million in orthopedic sales it generated in 2023.
Anika’s Regenerative Products Makes Strides
Anika Therapeutics amassed $156.2 million in orthopedic sales for 2023 while it progressed market expansion opportunities for its regenerative products. The company plans to grow Tactoset’s market to more than $100 million by gaining 510(k) clearances for additional hardware augmentation indications. A new rotator cuff patch system in 2024 and a longer-term opportunity with Hyalofast could expand Anika’s target addressable market by an additional $500 million.
OrthoPediatrics Overcomes Record RSV Cases
The company’s strong 2023 performance ended with $150.5 million in sales, continuing a trend of annual growth in excess of 20% since its inception in 2006, with the exception of pandemic-ridden 2020. Deeper account penetration and synergies from recent acquisitions drive the company’s growth.
Important Trends in Orthopedics
Companies Pivoting R&D Dollars to Digital
Skip Kiil, President of Medtronic’s Cranial and Spinal Technologies Division, said that the company’s R&D efforts are disproportionately slanted toward technology. Bryan Hanson, former President and CEO of Zimmer Biomet, previously said that more than 70% of the company’s development dollars are spent on the ZBEdge ecosystem of digital technologies.
Companies of all sizes are investing in new technologies, with an increasing focus on integrated monitoring through more of the patient journey to enable predictive analytics.
Orthopedic M&A Returning, IPOs Still Frozen
Orthopedic M&A activity accelerated between 2017 and 2020. The pandemic brought unprecedented orthopedic funding and M&A markets, culminating in 42 transactions in 2020. Since then, deal volume declined more than 40% in 2021 and dropped another 12% in 2022. However, the market is on pace for slightly more M&A activity in 2023.
On the IPO front, the door effectively slammed shut just after Treace Medical Concepts, Bioventus and Paragon 28 went public in 2021 amid a highly favorable landscape. Sustained economic pressure is likely to limit orthopedic IPOs in 2024.
Acceleration of Procedures in ASCs Driving Design Considerations
Both implants and enabling technologies are being designed specifically for the ASC setting. Anika Therapeutics’ RevoMotion shoulder implant features a streamlined two tray design.
Enovis’ EMPOWR 3D knee is a proven winner in the ASC market. The company recently added the ARVIS navigation system to its portfolio, prioritizing improved accuracy and efficiency at a lower cost and smaller footprint than traditional navigation systems. Midsized and smaller companies have targeted the ASC market for years and will face mounting pressures from large players with new aggressive strategies.
Further Reading
Thanks for visiting! Need more insight into the orthopedic 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.
The posts below feature some of the biggest developments and trends in orthopedics that we’re watching for 2024.
August 18, 2023
,
Dan Cook
July 21, 2023
,
Mike Evers
Welcome to our overview of the $59 billion orthopedic market. This page and the Segment Reports build upon our work in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. The market ran hot through 2023, with growth rates a few percentage points above historical averages. The tailwind is expected to last into early 2025.
December 2023
Mike Evers, Senior Market Analyst
Welcome to our overview of the orthopedic market. This page and the Segment Reports build upon our work in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. The orthopedic market ran hot in 2023, growing several percentage points above its historical average. The tailwind, especially in joint replacement, could last through early 2025.
The Market at a Glance
The orthopedic market grew 6.5% in 2023 to $59 billion worldwide. Procedures lost or deferred during the pandemic have reentered the funnel. We expect the tailwind will last throughout 2024 and into the early portion of 2025.
Orthopedic Sales by Product Segment
Joint replacement volumes rebounded sharply in 2023 after almost three years of lagging recovery compared to other orthopedic segments. The knee and hip replacement categories finished well above their historical averages, growing 8.1% and 5.6%, respectively. Trauma also bounced back after a softer 2022.
Exhibit 1: Worldwide Orthopedic Sales by Product Segment ($millions)
| Segment | FY23P | FY22A | $ Chg | % Chg |
|---|---|---|---|---|
| Joint Replacement | $21,490.5 | $20,007.8 | $1,482.8 | 7.4% |
| Spine | $10,404.1 | $9,868.2 | $535.9 | 5.4% |
| Trauma | $8,574.7 | $8,001.0 | $573.7 | 7.2% |
| Sports Medicine | $6,734.0 | $6,301.1 | $433.0 | 6.9% |
| Orthobiologics | $5,528.8 | $5,317.9 | $210.8 | 4% |
| Enabling Technology | $1,309.5 | $1,192.3 | $117.2 | 9.8% |
| Other | $5,040.6 | $4,803.5 | $237.1 | 4.9% |
| Total | $59,082.3 | $55,491.7 | $3,590.5 | 6.5% |
Segment Reports
Joint Replacement Implant Market
December 4, 2023
Spine Implant Market
December 4, 2023
Trauma Implant Market
December 4, 2023
Sports Medicine Market
December 4, 2023
Orthobiologics Market
December 4, 2023
Enabling Technology Market
December 4, 2023
Market Forecast
The orthopedic market’s post-pandemic recovery gathered momentum in the second half of 2022. Orthopedic surgery volumes improved further in 2023, with a catch-up on joint replacement procedures providing the biggest tailwind. However, there’s some “noise” in medtech that could create disruption and slow growth
We project orthopedic market sales to surpass $59 billion in 2023 and eclipse the $70 billion mark by 2027.
Exhibit 2: Worldwide Orthopedic Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 68 public and private companies by segment from 2016 through 2023.
Lingering disruption, rebounding orthopedic procedure volumes and changes to the Chinese market were among the many factors informing our forecast.
Lingering Disruptions in Supply and Staffing
Supply chain disruptions are having wide-ranging impacts on most companies. Zimmer Biomet’s former CEO Bryan Hanson said supply challenges weren’t merely on resins and packaging, but on “almost everything we deal with.” Meanwhile, CONMED CEO Curt Hartman offered a blunt assessment of the staffing situation when he predicted that it wouldn’t be resolved until 2024.
Procedure Volumes Healthy and Stable
Procedure volumes in most product segments and geographic regions normalized in 2022 despite COVID-19 surges and high incidences of respiratory illness and flu during the year. Volume trends maintained healthy levels through 2023, with joint replacement overperforming after several years of disruption.
Volume-based Procurement (VBP) in China
Companies are re-evaluating their strategies as joint replacement, trauma and spinal implants come under national VBP tenders in China. Players like ZimVie and Medartis left China, while Smith+Nephew pulled its trauma products from the market. Joint replacement implant prices declined more than 80% due to the national tender.
Domestic Chinese players like MicroPort and AK Medical saw their market access increase significantly due to VBP. Global players like DePuy Synthes and Zimmer Biomet won’t have the same upside but remain committed to the Chinese market.
Sales by Region
International orthopedic sales were strong in 2023. Despite the impact of VBP, China returned to growth for many of the players there. Several companies called out strong performances in Europe, Australia and Japan.
VBP in China changed how global companies approach that market for joint replacement, spine, trauma and sports medicine. ZimVie opted to leave the Chinese spine market, and Smith+Nephew did the same in trauma.
The European Union’s Medical Device Regulation (MDR) has forced companies to reconsider their strategy in the region. MDR is a stricter regulation than the Medical Device Directive, and orthopedic companies are choosing to pull products from the market to ease the regulatory burden.
MDR’s transition deadline has been postponed from 2024 to 2027 or 2028, depending on the type of device. Startups to large players are expected to de-emphasize European Union countries moving forward.
U.S. sales make up 68.8% of the orthopedic market. U.S. orthopedic sales reached $39.4 billion in 2023, while OUS sales surpassed $19.6 billion.
Exhibit 3: Orthopedic Sales by Region ($millions)
| Total | FY23 | FY22 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $39,473.0 | $37,059.8 | $2,413.2 | 6.5% |
| OUS | $19,609.3 | $18,431.9 | $1,177.3 | 6.4% |
| EMEA | $10,807.8 | $10,100.9 | $706.9 | 7% |
| APAC | $6,793.8 | $6,460.8 | $333.1 | 5.2% |
| ROW | $2,007.6 | $1,870.2 | $137.4 | 7.3% |
| Total | $59,082.3 | $55,491.7 | $3,590.5 | 6.5% |
Exhibit 4: Orthopedic Market Share by Region ($millions)
Top Companies
The orthopedic market has more than 1,000 active companies, which we categorize into five tiers based on global annual revenue:
- Over $1 billion
- Between $400 million and $999 million
- Between $200 million and $399 million
- Between $100 million and $199 million
- All other companies below $100 million
Only 45 of the 1,000+ companies generated more than $100 million in orthopedic revenue in 2023, according to our estimates. Those companies account for 84% of all orthopedic sales. We expect the largest companies to consolidate more market share and increasingly seek to acquire enabling technologies.
Exhibit 5: Orthopedic Market Share by Company Tier ($millions)
Companies Over $1 Billion
The companies in this tier grew an average of 2% in 2022 vs. 2021. Highly globalized companies like DePuy Synthes, Zimmer Biomet and Smith+Nephew saw currency headwinds in the mid-single digits, which impacted their growth.
Globus Medical had an eventful 2022 and 1Q23 in which it entered the top tier of orthopedic players and announced its intention to acquire NuVasive, its closest competitor. Despite a chilly reaction from Wall Street and some regulatory questions, Globus closed the acquisition on time in the third quarter of 2023.
Exhibit 6: Orthopedic Sales for Top-Tier Players ($millions)
| Company | FY23P | FY22A | $ Chg | % Chg |
|---|---|---|---|---|
| Stryker | $10,293.6 | $9,425.5 | $868.1 | 9.2% |
| DePuy Synthes | $8,891.7 | $8,586.2 | $305.5 | 3.6% |
| Zimmer Biomet | $7,371.2 | $6,939.9 | $431.3 | 6.2% |
| Smith+Nephew | $3,736.3 | $3,549.5 | $186.8 | 5.3% |
| Medtronic | $3,238.0 | $3,146.4 | $91.6 | 2.9% |
| Arthrex | $2,992.0 | $2,828.6 | $163.4 | 5.8% |
| Globus Medical | $2,363.7 | $2,224.8 | $138.9 | 6.2% |
| Subtotal | $38,886.5 | $36,700.8 | $2,185.7 | 6% |
| Market Total | $59,082.3 | $55,491.7 | $3,590.5 | 6.5% |
Here are a few of the developments that we’re watching among the top-tier players.
Doubling Down on Spine
Globus Medical seemed poised for a big acquisition over the last few years, and finally made its move in 2023. The decision to acquire NuVasive and double down on spine surprised many in the industry. Spine company integrations historically lead to significant dissynergies. The culture gap between the companies is noteworthy. Still, if Globus Medical can manage through the integration with minimal disruption, it could quickly become a credible threat to market-leading Medtronic.
Smith+Nephew’s 12-Point Plan
The pandemic revealed some vulnerabilities at Smith+Nephew, resulting in a reorganization and leadership change. The company seems to be through the worst of its challenges and is now implementing CEO Deepak Nath’s 12-point plan. Five of those points aim to revitalize its orthopedic business, but company leadership admitted that it faces a long road to regaining momentum.
Changes in Capital Purchasing Models
Upfront capital sales of enabling technologies helped top-tier players like Stryker, Medtronic and Globus Medical soften the impact of reduced implant sales during the worst of the pandemic. By mid-2021, prolonged economic uncertainty and a more crowded robotics market changed the way hospitals acquired orthopedic technology. Options like rentals and volume-based “earnout” placements now spread the incremental revenue across longer periods.
Get Market Data for More Companies. 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.
Companies Between $400 Million and $999 Million
This tier remains highly active. Globus Medical outgrew this category in 2022, and Enovis’ reconstruction business will likely do the same by the end of 2024. The combined organization of Orthofix and SeaSpine is near the top of this group in 2023, with projected orthopedic sales of almost $750 million.
Players between $400 million and $999 million made up 8.6% of the orthopedic market in 2023. Here are some of the things that we’re watching among these companies.
If You Work in Recon, You Must Grow in Double-Digits
We estimate Enovis’ recon sales at $681.1 million in 2023. The company’s reconstruction business met high expectations once again and grew at multiples of the market average thanks to its highly regarded implants, deep ASC penetration and ability to seamlessly integrate acquired companies. Recently acquired companies showed double-digit growth in 2022 and have started to scale. Enovis will likely remain active on the M&A front.
ZimVie Turnaround a Long-term Play
In its first year post-spin from Zimmer Biomet, the company took necessary steps in its years-long transformation. ZimVie prioritized making cuts to right-size its business. It exited some unprofitable geographies and began the process of optimizing its portfolio. The company will likely end the year with $407.7 million in orthopedic sales.
ZimVie also canceled time-consuming, low-return projects. The company expects to return its spine business to growth within five years by focusing on faster-growing markets like motion preservation, minimally invasive surgery and enabling technology.
Hyaluronic Acid Reimbursement Changes Hurt Bioventus
In mid-2022, the company reported that changes to hyaluronic acid reimbursement from wholesale acquisition cost to average selling price could hinder sales growth. That impact was worse than expected, but Bioventus saw signs of improvement by the third quarter of 2023.
Bioventus is projected to generate 2023 orthopedic sales of $437.4 million.
Companies Between $200 Million and $399 Million
The 10 players in this tier generated 4.6% of all orthopedic sales in 2023. Below are a few of the storylines that we’re following for companies in the $200 million to $399 million revenue tier.
LimaCorporate Acquired by Enovis
We project Lima will finish 2023 with $294.8 million in orthopedic sales. Enovis will complete its acquisition of the company in early 2024, further expanding its global footprint and cross-selling opportunities.
MicroPort Expands Access Through VBP
The company generated orthopedic sales over $240 million in 2023. Revenues in China declined sharply due to VBP reductions and the COVID pandemic. However, MicroPort’s market access increased dramatically under the national tender.
Its joint replacement products entered 140 new hospitals, a 10% increase in its national coverage. VBP also brought a major breakthrough for the company’s spine and trauma products, adding access to 200 more hospitals and doubling its previous total.
Companies Between $100 Million and $199 Million
The $100 million to $199 million tier accounted for 5% of worldwide orthopedic sales in 2023. As a group these 19 companies grew in the double digits, paced by strong performances from pure-play foot and ankle companies.
Below are a few of the trends that we’re watching for this diverse group of companies.
Low Volume-Based Procurement Tender Pays Off for AK Medical
The Chinese company ranked first among all participating players in the VBP joint replacement rollout with an allotment of 81,000 pieces, more than 15% of the tender’s total first-year volume. AK Medical’s hospital access grew to nearly 3,500, of which 953 are newly-covered hospitals. The newfound access should allow the company to build upon the $181.8 million in orthopedic sales it generated in 2023.
Anika’s Regenerative Products Makes Strides
Anika Therapeutics amassed $156.2 million in orthopedic sales for 2023 while it progressed market expansion opportunities for its regenerative products. The company plans to grow Tactoset’s market to more than $100 million by gaining 510(k) clearances for additional hardware augmentation indications. A new rotator cuff patch system in 2024 and a longer-term opportunity with Hyalofast could expand Anika’s target addressable market by an additional $500 million.
OrthoPediatrics Overcomes Record RSV Cases
The company’s strong 2023 performance ended with $150.5 million in sales, continuing a trend of annual growth in excess of 20% since its inception in 2006, with the exception of pandemic-ridden 2020. Deeper account penetration and synergies from recent acquisitions drive the company’s growth.
Important Trends in Orthopedics
Companies Pivoting R&D Dollars to Digital
Skip Kiil, President of Medtronic’s Cranial and Spinal Technologies Division, said that the company’s R&D efforts are disproportionately slanted toward technology. Bryan Hanson, former President and CEO of Zimmer Biomet, previously said that more than 70% of the company’s development dollars are spent on the ZBEdge ecosystem of digital technologies.
Companies of all sizes are investing in new technologies, with an increasing focus on integrated monitoring through more of the patient journey to enable predictive analytics.
Orthopedic M&A Returning, IPOs Still Frozen
Orthopedic M&A activity accelerated between 2017 and 2020. The pandemic brought unprecedented orthopedic funding and M&A markets, culminating in 42 transactions in 2020. Since then, deal volume declined more than 40% in 2021 and dropped another 12% in 2022. However, the market is on pace for slightly more M&A activity in 2023.
On the IPO front, the door effectively slammed shut just after Treace Medical Concepts, Bioventus and Paragon 28 went public in 2021 amid a highly favorable landscape. Sustained economic pressure is likely to limit orthopedic IPOs in 2024.
Acceleration of Procedures in ASCs Driving Design Considerations
Both implants and enabling technologies are being designed specifically for the ASC setting. Anika Therapeutics’ RevoMotion shoulder implant features a streamlined two tray design.
Enovis’ EMPOWR 3D knee is a proven winner in the ASC market. The company recently added the ARVIS navigation system to its portfolio, prioritizing improved accuracy and efficiency at a lower cost and smaller footprint than traditional navigation systems. Midsized and smaller companies have targeted the ASC market for years and will face mounting pressures from large players with new aggressive strategies.
Further Reading
Thanks for visiting! Need more insight into the orthopedic 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.
The posts below feature some of the biggest developments and trends in orthopedics that we’re watching for 2024.
August 18, 2023
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Dan Cook
July 21, 2023
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Mike Evers
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