Trauma Implant Market Size and Share
Market Definition
Implants and instruments such as plates, screws, intramedullary nails, pins, wires, staples and external fixators.
November 2023
Mike Evers, Senior Market Analyst
Welcome to our overview of the trauma market. This page builds upon and updates our trauma chapter in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. The segment overperformed through the first half of 2023 after softer procedure volumes during the prior year. I’ll be back in late November with important segment updates and our year-end projections. See you soon!
The Market at a Glance
Trauma market sales surpassed $8 billion in 2022 and account for 14.4% of the $55 billion global orthopedic market. The trauma market remained resilient through the pandemic and subsequent recovery but slowed in 2022 due to transitory market softness, currency headwinds and a national volume-based procurement (VBP) tender in China.
While the overall trauma market saw slower procedure recovery and pressure for highly globalized companies, the foot and ankle portion of trauma has significant room for growth and innovation.
Market Forecast
Trauma procedure volumes normalized throughout 2023, offset somewhat by price declines in China due to VBP. We project the segment will reach $8.2 billion in sales in 2023 and return to and maintain its historical growth rate of around 4% by 2024.
Exhibit 1: Worldwide Trauma Sales by Year ($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.
Patient demographics, VBP in the Chinese trauma market and opportunities to advance the foot and ankle market are some of the dynamics that contributed to our forecast.
Demographic Tailwinds
Foot and ankle, as well as the trauma segment in general, benefit from patient demographic trends toward longer life but increased incidence of diabetes and obesity. According to 2019 data from the U.S. Department of Health and Human Services, about 16% of the U.S. population is aged 65 or older. By 2040, that percentage will increase to 22%.
According to the Centers for Disease Control and Prevention (CDC), the prevalence of diagnosed diabetes in the U.S. population increased from 0.9% in 1958 to 10.5% in 2018. Likewise, a staggering 74% of the U.S. adult population had an overweight or obese body mass index per 2018 data published by the CDC.
VBP in China
Prices for trauma fixation implants in China decreased drastically as a third national VBP tender went into effect. The change forces the top-tier global companies to be far more cost-efficient in the Chinese market. While Smith+Nephew pulled its trauma devices from China, DePuy Synthes and Zimmer Biomet still see China as an attractive market. Demand for domestic trauma devices dwarfs the demand for imported devices and shifted significant market share to Chinese companies.
The Last Gem in Orthopedics
Paragon 28 estimates that the entire foot and ankle segment, which reaches into joint replacement, sports medicine and orthobiologics, is worth $4.6 billion and growing in the high single digits. Company CEO Albert DaCosta said it is the “last gem” in orthopedics. Mr. DaCosta pointed to soft tissue, external fixation and enabling technology as areas for additional innovation.
The segment is full of subspecialties that are rapidly developing, leading to ample innovation opportunities. Paragon 28 launched 10 new products in 2022 and more than 90 new products since 2020. Treace Medical says it has penetrated less than 2% of U.S. bunion surgery candidates, representing a badly underserved $5 billion market opportunity.
We’re excited about being a part of this space in a meaningful way. Foot and ankle is still a young and emerging segment of orthopedics. We need meaningful research. We need a better understanding of the limitations of the procedures we’re doing and maybe even considerations we haven’t yet generated.
Albert DaCosta, Paragon 28 CEO
Other Segment Reports
Orthopedic Market Overview
October 26, 2023
Joint Replacement Implant Market
October 26, 2023
Spine 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 and lockdowns in important international markets like Australia, China and Brazil impacted growth in those countries. Likewise, a strengthening U.S. dollar became a significant currency headwind for large, globalized players in 2022.
A national VBP tender in China for trauma products drastically reduced implant pricing. The changing economics of the Chinese market caused Smith+Nephew to pull its trauma offerings in China.
The U.S. accounted for 66% of trauma market sales and surpassed $5.2 billion in 2022, while OUS markets amassed $2.7 billion in trauma sales.
Exhibit 2: Trauma Sales by Region ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $5,280.7 | $5,048.4 | $232.2 | 4.6% |
| OUS | $2,720.3 | $2,730.3 | ($10.0) | (0.4%) |
| EMEA | $1,440.2 | $1,353.5 | $86.7 | 6.4% |
| APAC | $920.1 | $1,019.0 | ($98.9) | (9.7%) |
| ROW | $360.0 | $357.8 | $2.2 | 0.6% |
| Total | $8,001.0 | $7,778.8 | $222.2 | 2.9% |
Exhibit 3: Trauma Market Share by Region ($millions)
Top Companies
The four largest trauma players — DePuy Synthes, Stryker, Zimmer Biomet and Smith+Nephew — control 72% of the market. DePuy Synthes and Stryker alone account for 58% of global trauma sales. Much of the segment’s growth and activity in 2022 focused on the foot and ankle segment.
Exhibit 4: Top 10 Trauma Players and All Others ($millions)
| Company | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| DePuy Synthes | $2,551.3 | $2,562.2 | ($10.9) | (0.4%) |
| Stryker | $2,095.6 | $2,005.4 | $90.2 | 4.5% |
| Zimmer Biomet | $639.5 | $658.7 | ($19.3) | (2.9%) |
| Smith+Nephew | $474.4 | $508.2 | ($33.8) | (6.6%) |
| Acumed | $381.4 | $368.1 | $13.3 | 3.6% |
| Arthrex | $193.7 | $187.5 | $6.2 | 3.3% |
| Medartis | $167.9 | $149.0 | $18.9 | 12.7% |
| Paragon 28 | $158.9 | $129.2 | $29.7 | 22.9% |
| Treace Medical Concepts | $141.8 | $94.4 | $47.4 | 50.2% |
| Aesculap | $120.2 | $116.6 | $3.6 | 3.1% |
| All Others | $1,076.4 | $999.4 | $77.0 | 7.7% |
| Total | $8,001.0 | $7,778.8 | $222.2 | 2.9% |
Exhibit 5: Trauma Market Share by Company ($millions)
Trauma market growth slowed to +2.9% in 2022 due to softer procedure volumes and macro factors. Of the four largest players, Stryker suffered the least impact from VBP in China and exceeded its own expectations for the Wright Medical integration in core trauma and foot and ankle.
Smith+Nephew left the Chinese trauma market and made strides in rewiring its operations. At one point during 2022, a majority of Smith+Nephew trauma reps spent 40% of their time managing inventory and logistics. DePuy Synthes acquired CrossRoads Extremity Systems early in 2022 to build out its foot and ankle portfolio.
The next tier features Paragon 28 and Treace Medical Concepts, two growth companies that recently went public. Many companies are also using M&A to enter the space. Medartis, Enovis and CONMED recently made trauma acquisitions. Trauma was the second most active segment for orthopedic M&A in 2022, accounting for 27% of all publicly announced transactions.
You will see our entrepreneurial-minded spirit continue. Enovis allows us to do that. We get to run our business as a startup. We have that energy and excitement. It requires an investment in innovation, point blank.
Gary Justak, Enovis Foot and Ankle President
Important Developments in the Trauma Market
A Major Player Retools
Smith+Nephew’s trauma and extremities franchise has lagged behind the market growth rate for several years. The franchise’s fortunes suffered further due to Smith+Nephew’s supply issues and exit from the Chinese market. However, the company’s trauma business may have turned the corner in 2022. The launch of EVOS Large Plates has Smith+Nephew well-positioned to compete in RFPs and tenders previously out of reach. Improving supply levels and fewer inventory burdened reps will also drive growth.
The fundamental efficiency and reliability of our supply chain is not where it needs to be. The effect is not just the outright shortages that we saw last year and continuing into this year, but also that reps have spent far too much of their time managing existing customers rather than acquiring new business. These challenges weren’t always there.
Deepak Nath, Smith+Nephew CEO
Market Noise and Softness
While procedures in some areas of trauma were slower to return to normal volumes, orthopedic executives believe that the pressure is transitory. Stryker CEO Kevin Lobo said the core trauma market can soften from quarter to quarter as it responds to various external factors, but he has zero concerns about the company’s prospects in the segment.
An Attractive M&A Space
Trauma is the second most active segment for orthopedic M&A activity between 2016 and mid-2023, figuring in 17% of all transactions during that period. The fragmented nature of the foot and ankle market makes it especially compelling to acquisitive companies, such as Enovis, that are actively seeking smaller-scale tuck-in deals. Enovis most recently added Novastep, a subsidiary of Amplitude Surgical, to its stable of foot and ankle buys that include MedShape and Trilliant.
A Focus on Materials
Newer companies continue to prioritize resorbable magnesium and polymer materials that allow implants to degrade slowly as fractures heal. These technologies prevent the need for costly implant removal in the future. While companies like OSSIO and Bioretec have products that reached the market, several others have solutions in development and that received FDA Breakthrough Device Designation.
Simplifying Procedures
Companies seek to target the growing ASC market by condensing implant and instrument systems, building single-use systems and developing minimally invasive technologies. Outpatient trauma procedures shifted to ASC settings during COVID, and companies expect more surgeries to occur in this environment as technology adapts to surgeon and patient needs.
Further Reading
Thanks for visiting! Need more insight on the trauma 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 trauma market.
January 12, 2022
,
Julie A. Vetalice
Welcome to our overview of the $8 billion trauma market. This page builds upon and updates our trauma chapter in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. The segment overperformed in 2023 after softer procedure volumes during the prior year, buoyed by fast-growing subsegments like foot and ankle.
Market Definition
Implants and instruments such as plates, screws, intramedullary nails, pins, wires, staples and external fixators.
November 2023
Mike Evers, Senior Market Analyst
Welcome to our overview of the trauma market. This page builds upon and updates our trauma chapter in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. The segment overperformed through the first half of 2023 after softer procedure volumes during the prior year. I’ll be back in late November with important segment updates and our year-end projections. See you soon!
The Market at a Glance
Trauma market sales surpassed $8 billion in 2022 and account for 14.4% of the $55 billion global orthopedic market. The trauma market remained resilient through the pandemic and subsequent recovery but slowed in 2022 due to transitory market softness, currency headwinds and a national volume-based procurement (VBP) tender in China.
While the overall trauma market saw slower procedure recovery and pressure for highly globalized companies, the foot and ankle portion of trauma has significant room for growth and innovation.
Market Forecast
Trauma procedure volumes normalized throughout 2023, offset somewhat by price declines in China due to VBP. We project the segment will reach $8.2 billion in sales in 2023 and return to and maintain its historical growth rate of around 4% by 2024.
Exhibit 1: Worldwide Trauma Sales by Year ($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.
Patient demographics, VBP in the Chinese trauma market and opportunities to advance the foot and ankle market are some of the dynamics that contributed to our forecast.
Demographic Tailwinds
Foot and ankle, as well as the trauma segment in general, benefit from patient demographic trends toward longer life but increased incidence of diabetes and obesity. According to 2019 data from the U.S. Department of Health and Human Services, about 16% of the U.S. population is aged 65 or older. By 2040, that percentage will increase to 22%.
According to the Centers for Disease Control and Prevention (CDC), the prevalence of diagnosed diabetes in the U.S. population increased from 0.9% in 1958 to 10.5% in 2018. Likewise, a staggering 74% of the U.S. adult population had an overweight or obese body mass index per 2018 data published by the CDC.
VBP in China
Prices for trauma fixation implants in China decreased drastically as a third national VBP tender went into effect. The change forces the top-tier global companies to be far more cost-efficient in the Chinese market. While Smith+Nephew pulled its trauma devices from China, DePuy Synthes and Zimmer Biomet still see China as an attractive market. Demand for domestic trauma devices dwarfs the demand for imported devices and shifted significant market share to Chinese companies.
The Last Gem in Orthopedics
Paragon 28 estimates that the entire foot and ankle segment, which reaches into joint replacement, sports medicine and orthobiologics, is worth $4.6 billion and growing in the high single digits. Company CEO Albert DaCosta said it is the “last gem” in orthopedics. Mr. DaCosta pointed to soft tissue, external fixation and enabling technology as areas for additional innovation.
The segment is full of subspecialties that are rapidly developing, leading to ample innovation opportunities. Paragon 28 launched 10 new products in 2022 and more than 90 new products since 2020. Treace Medical says it has penetrated less than 2% of U.S. bunion surgery candidates, representing a badly underserved $5 billion market opportunity.
We’re excited about being a part of this space in a meaningful way. Foot and ankle is still a young and emerging segment of orthopedics. We need meaningful research. We need a better understanding of the limitations of the procedures we’re doing and maybe even considerations we haven’t yet generated.
Albert DaCosta, Paragon 28 CEO
Other Segment Reports
Orthopedic Market Overview
October 26, 2023
Joint Replacement Implant Market
October 26, 2023
Spine 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 and lockdowns in important international markets like Australia, China and Brazil impacted growth in those countries. Likewise, a strengthening U.S. dollar became a significant currency headwind for large, globalized players in 2022.
A national VBP tender in China for trauma products drastically reduced implant pricing. The changing economics of the Chinese market caused Smith+Nephew to pull its trauma offerings in China.
The U.S. accounted for 66% of trauma market sales and surpassed $5.2 billion in 2022, while OUS markets amassed $2.7 billion in trauma sales.
Exhibit 2: Trauma Sales by Region ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $5,280.7 | $5,048.4 | $232.2 | 4.6% |
| OUS | $2,720.3 | $2,730.3 | ($10.0) | (0.4%) |
| EMEA | $1,440.2 | $1,353.5 | $86.7 | 6.4% |
| APAC | $920.1 | $1,019.0 | ($98.9) | (9.7%) |
| ROW | $360.0 | $357.8 | $2.2 | 0.6% |
| Total | $8,001.0 | $7,778.8 | $222.2 | 2.9% |
Exhibit 3: Trauma Market Share by Region ($millions)
Top Companies
The four largest trauma players — DePuy Synthes, Stryker, Zimmer Biomet and Smith+Nephew — control 72% of the market. DePuy Synthes and Stryker alone account for 58% of global trauma sales. Much of the segment’s growth and activity in 2022 focused on the foot and ankle segment.
Exhibit 4: Top 10 Trauma Players and All Others ($millions)
| Company | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| DePuy Synthes | $2,551.3 | $2,562.2 | ($10.9) | (0.4%) |
| Stryker | $2,095.6 | $2,005.4 | $90.2 | 4.5% |
| Zimmer Biomet | $639.5 | $658.7 | ($19.3) | (2.9%) |
| Smith+Nephew | $474.4 | $508.2 | ($33.8) | (6.6%) |
| Acumed | $381.4 | $368.1 | $13.3 | 3.6% |
| Arthrex | $193.7 | $187.5 | $6.2 | 3.3% |
| Medartis | $167.9 | $149.0 | $18.9 | 12.7% |
| Paragon 28 | $158.9 | $129.2 | $29.7 | 22.9% |
| Treace Medical Concepts | $141.8 | $94.4 | $47.4 | 50.2% |
| Aesculap | $120.2 | $116.6 | $3.6 | 3.1% |
| All Others | $1,076.4 | $999.4 | $77.0 | 7.7% |
| Total | $8,001.0 | $7,778.8 | $222.2 | 2.9% |
Exhibit 5: Trauma Market Share by Company ($millions)
Trauma market growth slowed to +2.9% in 2022 due to softer procedure volumes and macro factors. Of the four largest players, Stryker suffered the least impact from VBP in China and exceeded its own expectations for the Wright Medical integration in core trauma and foot and ankle.
Smith+Nephew left the Chinese trauma market and made strides in rewiring its operations. At one point during 2022, a majority of Smith+Nephew trauma reps spent 40% of their time managing inventory and logistics. DePuy Synthes acquired CrossRoads Extremity Systems early in 2022 to build out its foot and ankle portfolio.
The next tier features Paragon 28 and Treace Medical Concepts, two growth companies that recently went public. Many companies are also using M&A to enter the space. Medartis, Enovis and CONMED recently made trauma acquisitions. Trauma was the second most active segment for orthopedic M&A in 2022, accounting for 27% of all publicly announced transactions.
You will see our entrepreneurial-minded spirit continue. Enovis allows us to do that. We get to run our business as a startup. We have that energy and excitement. It requires an investment in innovation, point blank.
Gary Justak, Enovis Foot and Ankle President
Important Developments in the Trauma Market
A Major Player Retools
Smith+Nephew’s trauma and extremities franchise has lagged behind the market growth rate for several years. The franchise’s fortunes suffered further due to Smith+Nephew’s supply issues and exit from the Chinese market. However, the company’s trauma business may have turned the corner in 2022. The launch of EVOS Large Plates has Smith+Nephew well-positioned to compete in RFPs and tenders previously out of reach. Improving supply levels and fewer inventory burdened reps will also drive growth.
The fundamental efficiency and reliability of our supply chain is not where it needs to be. The effect is not just the outright shortages that we saw last year and continuing into this year, but also that reps have spent far too much of their time managing existing customers rather than acquiring new business. These challenges weren’t always there.
Deepak Nath, Smith+Nephew CEO
Market Noise and Softness
While procedures in some areas of trauma were slower to return to normal volumes, orthopedic executives believe that the pressure is transitory. Stryker CEO Kevin Lobo said the core trauma market can soften from quarter to quarter as it responds to various external factors, but he has zero concerns about the company’s prospects in the segment.
An Attractive M&A Space
Trauma is the second most active segment for orthopedic M&A activity between 2016 and mid-2023, figuring in 17% of all transactions during that period. The fragmented nature of the foot and ankle market makes it especially compelling to acquisitive companies, such as Enovis, that are actively seeking smaller-scale tuck-in deals. Enovis most recently added Novastep, a subsidiary of Amplitude Surgical, to its stable of foot and ankle buys that include MedShape and Trilliant.
A Focus on Materials
Newer companies continue to prioritize resorbable magnesium and polymer materials that allow implants to degrade slowly as fractures heal. These technologies prevent the need for costly implant removal in the future. While companies like OSSIO and Bioretec have products that reached the market, several others have solutions in development and that received FDA Breakthrough Device Designation.
Simplifying Procedures
Companies seek to target the growing ASC market by condensing implant and instrument systems, building single-use systems and developing minimally invasive technologies. Outpatient trauma procedures shifted to ASC settings during COVID, and companies expect more surgeries to occur in this environment as technology adapts to surgeon and patient needs.
Further Reading
Thanks for visiting! Need more insight on the trauma 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 trauma market.
January 12, 2022
,
Julie A. Vetalice
You are out of free articles for this month
Subscribe as a Guest for $0 and unlock a total of 5 articles per month.
You are out of five articles for this month
Subscribe as an Executive Member for access to unlimited articles, THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT and more.
