Implants and instruments such as plates, screws, intramedullary nails, pins, wires, staples and external fixators.
January 2024
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 2023 after softer procedure volumes during the prior year.
Trauma market sales surpassed $8.6 billion in 2023 and account for 14.5% of the $59 billion global orthopedic market. The trauma market remained resilient through the pandemic and follow-on disruption, driven by higher growth subsegments like foot and ankle.
Trauma procedure volumes normalized throughout 2023, offset by price declines in China due to VBP. We project the segment will reach $8.6 billion in sales in 2023 and return to and maintain its historical growth rate of just over 4% by 2025.
Exhibit 1: Worldwide Trauma Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 68 public and private companies by segment from 2016 through 2023.
Patient demographics, virtually untapped opportunities within foot and ankle as well as renewed focus on core trauma informed our forecast.
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 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.
Treace Medical said its disruptive Lapiplasty procedure targets an estimated $5 billion opportunity in the U.S. The company identified 1.1 million surgical candidates, of which only 450,000 undergo bunion surgery yearly due to the liminitations of the current standards of care. While the overall foot and ankle market has evened out after a period of consolidation, segments like bunion surgery illustrate the significant and sustained growth potential of the market.
The trauma segment endured market softness and price cuts due to volume-based procurement in China over the last few years. Those factors mitigating in 2024 will reinforce trauma’s steady growth rate. At the same time, companies are refocusing on core trauma after aligning their foot and ankle offerings. Stryker’s Pangea plating system will be its largest ever in trauma, a business the company expects to yield big results over the long term.
Our core trauma business was really diluted in its focus, and we were not paying as much attention to it. We have a great leadership team on core trauma with now dedicated R&D resources. The Wright Medical deal, it’s not just benefiting our extremities business, it’s providing more focus to core trauma, which is fueling terrific growth. We expect trauma to continue to be a very high-growth business for a long time to come.
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. Other large players like DePuy Synthes reiterated their commitment to the Chinese market, however.
The U.S. accounted for 66% of trauma market sales and surpassed $5.6 billion in 2023, while OUS markets amassed $2.9 billion in trauma sales.
Exhibit 2: Trauma Sales by Region ($millions)
Region | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
US | $5,650.7 | $5,280.7 | $370.1 | 7% |
OUS | $2,924.0 | $2,720.3 | $203.6 | 7.5% |
EMEA | $1,560.6 | $1,440.2 | $120.4 | 8.4% |
APAC | $973.2 | $920.1 | $53.1 | 5.8% |
ROW | $390.2 | $360.0 | $30.1 | 8.4% |
Total | $8,574.7 | $8,001.0 | $573.7 | 7.2% |
Exhibit 3: Trauma Market Share by Region ($millions)
The four largest trauma players — DePuy Synthes, Stryker, Zimmer Biomet and Smith+Nephew — control 71% of the market. DePuy Synthes and Stryker alone account for 58% of global trauma sales. Much of the segment’s growth and activity in 2023 focused on the foot and ankle segment.
Exhibit 4: Top 10 Trauma Players and All Others ($millions)
Company | FY23E | FY22A | $ Chg | % Chg |
---|---|---|---|---|
DePuy Synthes | $2,636.5 | $2,551.0 | $85.6 | 3.4% |
Stryker | $2,326.3 | $2,050.0 | $276.3 | 13.5% |
Zimmer Biomet | $647.6 | $639.5 | $8.1 | 1.3% |
Smith+Nephew | $486.2 | $474.4 | $11.8 | 2.5% |
Acumed | $404.3 | $381.4 | $22.9 | 6% |
Arthrex | $204.3 | $193.7 | $10.7 | 5.5% |
Medartis | $185.8 | $167.9 | $18.0 | 10.7% |
Paragon 28 | $185.4 | $158.9 | $26.5 | 16.7% |
Treace Medical Concepts | $184.0 | $141.8 | $42.2 | 29.7% |
Aesculap | $128.0 | $120.2 | $7.8 | 6.5% |
All Others | $1,186.2 | $1,122.3 | $64.0 | 5.7% |
Segment Total | $8,574.7 | $8,001.0 | $573.7 | 7.2% |
Exhibit 5: Trauma Market Share by Company ($millions)
Trauma market growth was 7.2% in 2023 because of procedure recovery and a weaker 2022 comparison. 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. The company is preparing for the 2024 launch of its Pangea plating system, the largest trauma launch in Stryker’s history.
The next tier features Paragon 28 and Treace Medical Concepts, two growth companies that went public in recent years. Many companies are also using M&A to enter the space. Enovis remained active in 2023 with two foot and ankle purchases.
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.
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 late 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.
While procedures in some areas of trauma were slower to return to normal volumes in late 2022, 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.
Trauma is the second most active segment for orthopedic M&A activity between 2016 and 2023, figuring in 16% 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.
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.
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.
Thanks for visiting! Need more insight on the trauma 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 trauma market.
Our overview of the $8.6 billion trauma market includes up-to-date information on forecasted growth, the top companies and industry-driving trends.
Implants and instruments such as plates, screws, intramedullary nails, pins, wires, staples and external fixators.
January 2024
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 2023 after softer procedure volumes during the prior year.
Trauma market sales surpassed $8.6 billion in 2023 and account for 14.5% of the $59 billion global orthopedic market. The trauma market remained resilient through the pandemic and follow-on disruption, driven by higher growth subsegments like foot and ankle.
Trauma procedure volumes normalized throughout 2023, offset by price declines in China due to VBP. We project the segment will reach $8.6 billion in sales in 2023 and return to and maintain its historical growth rate of just over 4% by 2025.
Exhibit 1: Worldwide Trauma Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 68 public and private companies by segment from 2016 through 2023.
Patient demographics, virtually untapped opportunities within foot and ankle as well as renewed focus on core trauma informed our forecast.
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 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.
Treace Medical said its disruptive Lapiplasty procedure targets an estimated $5 billion opportunity in the U.S. The company identified 1.1 million surgical candidates, of which only 450,000 undergo bunion surgery yearly due to the liminitations of the current standards of care. While the overall foot and ankle market has evened out after a period of consolidation, segments like bunion surgery illustrate the significant and sustained growth potential of the market.
The trauma segment endured market softness and price cuts due to volume-based procurement in China over the last few years. Those factors mitigating in 2024 will reinforce trauma’s steady growth rate. At the same time, companies are refocusing on core trauma after aligning their foot and ankle offerings. Stryker’s Pangea plating system will be its largest ever in trauma, a business the company expects to yield big results over the long term.
Our core trauma business was really diluted in its focus, and we were not paying as much attention to it. We have a great leadership team on core trauma with now dedicated R&D resources. The Wright Medical deal, it’s not just benefiting our extremities business, it’s providing more focus to core trauma, which is fueling terrific growth. We expect trauma to continue to be a very high-growth business for a long time to come.
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. Other large players like DePuy Synthes reiterated their commitment to the Chinese market, however.
The U.S. accounted for 66% of trauma market sales and surpassed $5.6 billion in 2023, while OUS markets amassed $2.9 billion in trauma sales.
Exhibit 2: Trauma Sales by Region ($millions)
Region | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
US | $5,650.7 | $5,280.7 | $370.1 | 7% |
OUS | $2,924.0 | $2,720.3 | $203.6 | 7.5% |
EMEA | $1,560.6 | $1,440.2 | $120.4 | 8.4% |
APAC | $973.2 | $920.1 | $53.1 | 5.8% |
ROW | $390.2 | $360.0 | $30.1 | 8.4% |
Total | $8,574.7 | $8,001.0 | $573.7 | 7.2% |
Exhibit 3: Trauma Market Share by Region ($millions)
The four largest trauma players — DePuy Synthes, Stryker, Zimmer Biomet and Smith+Nephew — control 71% of the market. DePuy Synthes and Stryker alone account for 58% of global trauma sales. Much of the segment’s growth and activity in 2023 focused on the foot and ankle segment.
Exhibit 4: Top 10 Trauma Players and All Others ($millions)
Company | FY23E | FY22A | $ Chg | % Chg |
---|---|---|---|---|
DePuy Synthes | $2,636.5 | $2,551.0 | $85.6 | 3.4% |
Stryker | $2,326.3 | $2,050.0 | $276.3 | 13.5% |
Zimmer Biomet | $647.6 | $639.5 | $8.1 | 1.3% |
Smith+Nephew | $486.2 | $474.4 | $11.8 | 2.5% |
Acumed | $404.3 | $381.4 | $22.9 | 6% |
Arthrex | $204.3 | $193.7 | $10.7 | 5.5% |
Medartis | $185.8 | $167.9 | $18.0 | 10.7% |
Paragon 28 | $185.4 | $158.9 | $26.5 | 16.7% |
Treace Medical Concepts | $184.0 | $141.8 | $42.2 | 29.7% |
Aesculap | $128.0 | $120.2 | $7.8 | 6.5% |
All Others | $1,186.2 | $1,122.3 | $64.0 | 5.7% |
Segment Total | $8,574.7 | $8,001.0 | $573.7 | 7.2% |
Exhibit 5: Trauma Market Share by Company ($millions)
Trauma market growth was 7.2% in 2023 because of procedure recovery and a weaker 2022 comparison. 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. The company is preparing for the 2024 launch of its Pangea plating system, the largest trauma launch in Stryker’s history.
The next tier features Paragon 28 and Treace Medical Concepts, two growth companies that went public in recent years. Many companies are also using M&A to enter the space. Enovis remained active in 2023 with two foot and ankle purchases.
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.
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 late 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.
While procedures in some areas of trauma were slower to return to normal volumes in late 2022, 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.
Trauma is the second most active segment for orthopedic M&A activity between 2016 and 2023, figuring in 16% 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.
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.
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.
Thanks for visiting! Need more insight on the trauma 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 trauma market.
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