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The orthopedic market started strong in 2026, but some of the top players are facing challenges. Below, we take a look at some of the issues facing orthopedic players as we move into the second half and beyond.
We’ll discuss the slower growth of U.S. knee replacement, the move to smaller form factor technologies and outlook for the trauma segment.
US Knee Replacement Rebound
Knee replacement sales in the U.S. were notably lower than expected in the first quarter. However, there wasn’t anything structural limiting growth across the segment.
Stryker, of course, saw deferred cases and delayed revenue recognition in the first quarter due to the enterprise-wide hack it suffered. The company expects to recoup those deferred cases over the balance of 2026.
Smith+Nephew has been frank about the need to modernize its U.S. knee product portfolio to meet the market’s demand for cementless. The company has engaged in a balancing act between legacy system sales and the rollout of its LANDMARK kinematic knee system, slated for launch in Q3.
Zimmer Biomet’s U.S. knee troubles are varied. The company is in the midst of overhauling its U.S. commercial organization while also contending with disruptions in some of its largest accounts.
“The single largest reason why the U.S. knee number was not higher is some of the changes that we made in the U.S. organization,” said Zimmer Biomet CEO Ivan Tornos. “We lost two accounts in the quarter, fairly large. We believe we’re going to be able to recoup some of that business. There was a Kaiser strike in the West Coast, where we have the highest share in knees. While that was disruptive for everybody, it was more disruptive for us.”
As we said, we’re bullish on the overall U.S. knee market and expect these company-specific issues to resolve over the coming quarters.
Trends in Enabling Technology
Large-format robotics and navigation systems are firmly entrenched in orthopedics, but a wide swath of the surgeon population has yet to fully adopt technology. According to estimates from Zimmer Biomet, 80% of U.S. orthopedic surgeons do not use robotics. Internationally, the number is closer to 90%.
Increasingly, it seems like the surgeon masses prioritize speed, ease of use and efficiency when it comes to adopting technology. Device companies are starting to recognize the leap from manual instruments to a full-scale system may be too great.
Stryker’s handheld Mako RPS system is a recent entry into the market designed to entice late adopters.
“We’re getting tremendous feedback from customers who felt that the move all the way to Mako was too big a leap,” said Stryke CEO Kevin Lobo. “The actual transition to RPS is much easier for a surgeon than going all the way to Mako. In terms of how you do the procedure, it’s just very easy to adopt. There were some competitive surgeons that felt that they really like the idea of going to a robotic solution, obviously, with haptic boundaries. But just the move all the way to Mako was just a little bit too intimidating.”
Companies like OrthAlign already have an established presence in the small form factor technology space and continue to make inroads into the manual instrument surgeon population. The company’s newly-approved Lantern ASC system feels like the right technology at the right place and time.
While technology trends take years to develop in orthopedics, we expect accelerating adoption of small form factor technologies through this year and into the future.
Trauma Outlook Remains Mixed
The overall trauma segment performed well in the first quarter of 2026, but there’s still some choppiness. Stryker and DePuy Synthes both drove high single-digit growth in the first quarter, mainly on the strength of core trauma. Smith+Nephew had respectable growth around the market average.
Globus continued making inroads into trauma with greater than 30% growth in the first quarter, driven by its core trauma offerings and the Precice Limb Lengthening portfolio. The company said its ANTHEM elbow plating system is a standout among surgeons.
However, Zimmer Biomet’s legacy trauma business remains challenged. We estimate the company’s organic trauma sales declined almost 5% in the first quarter. Likewise, Orthofix’s trauma sales were slowed down by the sunsetting of about 30 products and the timing on some capital sales.
Any improvements in the foot and ankle environment during the first quarter were likely isolated. Overall, the segment remains down versus historical volumes. Enovis cited a “slight improvement,” while Stryker’s view of the space was obscured by the hack it suffered in the first quarter.
Treace Medical’s first-quarter sales declined more than 10% due to volume softness and shifting product mix.
“I do want to note the dynamics that impacted 2025, including macro pressures on procedure demand and portfolio mix shifts, remain present,” said company CEO John Treace.
While the foot and ankle market can be a little volatile from quarter to quarter, we don’t see much evidence that volumes will suddenly stabilize in the second half.
The orthopedic market started strong in 2026, but some of the top players are facing challenges. Below, we take a look at some of the issues facing orthopedic players as we move into the second half and beyond.
We’ll discuss the slower growth of U.S. knee replacement, the move to smaller form factor technologies and outlook for the...
The orthopedic market started strong in 2026, but some of the top players are facing challenges. Below, we take a look at some of the issues facing orthopedic players as we move into the second half and beyond.
We’ll discuss the slower growth of U.S. knee replacement, the move to smaller form factor technologies and outlook for the trauma segment.
US Knee Replacement Rebound
Knee replacement sales in the U.S. were notably lower than expected in the first quarter. However, there wasn’t anything structural limiting growth across the segment.
Stryker, of course, saw deferred cases and delayed revenue recognition in the first quarter due to the enterprise-wide hack it suffered. The company expects to recoup those deferred cases over the balance of 2026.
Smith+Nephew has been frank about the need to modernize its U.S. knee product portfolio to meet the market’s demand for cementless. The company has engaged in a balancing act between legacy system sales and the rollout of its LANDMARK kinematic knee system, slated for launch in Q3.
Zimmer Biomet’s U.S. knee troubles are varied. The company is in the midst of overhauling its U.S. commercial organization while also contending with disruptions in some of its largest accounts.
“The single largest reason why the U.S. knee number was not higher is some of the changes that we made in the U.S. organization,” said Zimmer Biomet CEO Ivan Tornos. “We lost two accounts in the quarter, fairly large. We believe we’re going to be able to recoup some of that business. There was a Kaiser strike in the West Coast, where we have the highest share in knees. While that was disruptive for everybody, it was more disruptive for us.”
As we said, we’re bullish on the overall U.S. knee market and expect these company-specific issues to resolve over the coming quarters.
Trends in Enabling Technology
Large-format robotics and navigation systems are firmly entrenched in orthopedics, but a wide swath of the surgeon population has yet to fully adopt technology. According to estimates from Zimmer Biomet, 80% of U.S. orthopedic surgeons do not use robotics. Internationally, the number is closer to 90%.
Increasingly, it seems like the surgeon masses prioritize speed, ease of use and efficiency when it comes to adopting technology. Device companies are starting to recognize the leap from manual instruments to a full-scale system may be too great.
Stryker’s handheld Mako RPS system is a recent entry into the market designed to entice late adopters.
“We’re getting tremendous feedback from customers who felt that the move all the way to Mako was too big a leap,” said Stryke CEO Kevin Lobo. “The actual transition to RPS is much easier for a surgeon than going all the way to Mako. In terms of how you do the procedure, it’s just very easy to adopt. There were some competitive surgeons that felt that they really like the idea of going to a robotic solution, obviously, with haptic boundaries. But just the move all the way to Mako was just a little bit too intimidating.”
Companies like OrthAlign already have an established presence in the small form factor technology space and continue to make inroads into the manual instrument surgeon population. The company’s newly-approved Lantern ASC system feels like the right technology at the right place and time.
While technology trends take years to develop in orthopedics, we expect accelerating adoption of small form factor technologies through this year and into the future.
Trauma Outlook Remains Mixed
The overall trauma segment performed well in the first quarter of 2026, but there’s still some choppiness. Stryker and DePuy Synthes both drove high single-digit growth in the first quarter, mainly on the strength of core trauma. Smith+Nephew had respectable growth around the market average.
Globus continued making inroads into trauma with greater than 30% growth in the first quarter, driven by its core trauma offerings and the Precice Limb Lengthening portfolio. The company said its ANTHEM elbow plating system is a standout among surgeons.
However, Zimmer Biomet’s legacy trauma business remains challenged. We estimate the company’s organic trauma sales declined almost 5% in the first quarter. Likewise, Orthofix’s trauma sales were slowed down by the sunsetting of about 30 products and the timing on some capital sales.
Any improvements in the foot and ankle environment during the first quarter were likely isolated. Overall, the segment remains down versus historical volumes. Enovis cited a “slight improvement,” while Stryker’s view of the space was obscured by the hack it suffered in the first quarter.
Treace Medical’s first-quarter sales declined more than 10% due to volume softness and shifting product mix.
“I do want to note the dynamics that impacted 2025, including macro pressures on procedure demand and portfolio mix shifts, remain present,” said company CEO John Treace.
While the foot and ankle market can be a little volatile from quarter to quarter, we don’t see much evidence that volumes will suddenly stabilize in the second half.
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Mike Evers is a Senior Market Analyst and writer with over 15 years of experience in the medical industry, spanning cardiac rhythm management, ER coding and billing, and orthopedics. He joined ORTHOWORLD in 2018, where he provides market analysis and editorial coverage.
