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The orthopedic market has largely normalized in 2025, but there are still plenty of interesting storylines to monitor as we head into the home stretch of the year.
Here are five things we’re watching in the second half: the changing competitive dynamics of spine, enabling technology’s impact on the market, the downturn of foot and ankle volumes, the progress of companies mid-turnaround and, finally, the performance of a group of fast-growing mid-tier companies.
The Spine Market’s Rapidly Changing Dynamics
The spine segment drives the most M&A activity in orthopedics, accounting for 28% of all transactions over the last 10 years. Deals for digital assets are tied for second-most (16%) during that time span, with many of those transactions having carryover to spine.
Acquisitions in spine over the last few years have completely reshaped the market. Globus merged with NuVasive, Orthofix did the same with SeaSpine, while both Zimmer Biomet and Stryker exited spine through divestitures. All the while, J&J MedTech’s spine business has floundered, and it’s not unthinkable that it may be a candidate for “portfolio management.”
As a result, spine is left with two contenders at the top of the market in Medtronic and Globus Medical that account for a combined 42% of global spinal implant market share. No other company currently has the scale and enabling technology portfolio to compete with them.
Top 3 Spine Players
So far in 2025, Medtronic has dealt with some investor drama, though it likely won’t impact its spine business, which has evolved into a steady performer on the back of the AiBLE ecosystem. Globus Medical, coming out of its integration period with NuVasive, has been up and down. Its enabling technology portfolio has faced drawn-out selling cycles, leading to a 17% decline in sales through the first half of the year.
As the two giants vie for supremacy at the top, we’re watching to see which next-tier player will emerge from the fray. ATEC is a share-taking machine. VB Spine is large enough to make some noise as well. Can J&J MedTech get its spine business back on track after years of losses?
The Evolving Enabling Technology Landscape
While enabling technology has been around orthopedics for a long time, only recently has it been such a significant competitive factor. It is now a prerequisite for leadership atop the joint replacement and spine segments.
Technology in orthopedics is entering a new phase as robotics becomes more common across segments, and more companies are entering the arena.
“With respect to enabling tech and robotics, look, we’ve clearly heard the message that enabling tech is a key part of having a complete global portfolio,” said new Enovis CEO Damien McDonald. “We’re examining whether large-format robots are cost-effective solutions and improve patient outcomes, and whether entry into the market at this point is valid. We’ve got resources dedicated to exploring all the viable pathways.”
The next battleground for competitors could be about unlocking the large segment of surgeons who are not currently using robotics. According to Zimmer Biomet, 80% of U.S. surgeons don’t use robotics. Internationally, the number is closer to 90%. The company is building a diverse technology ecosystem to draw in holdout surgeons.
Large format robotics remain an effective market share moat, but it is beginning to feel like companies will have to be more nuanced with their technology offerings to maintain that competitive edge.
Foot and Ankle Volumes Remain Slow
The foot and ankle segment has been a growth engine for orthopedic companies in recent years. It is a $5 billion market when accounting for all its various subsegments and, until recently, boasted a very consistent high-single-digit growth rate.
Starting in 2024, however, foot and ankle volumes slowed and have remained choppy ever since. The segment does have a history of transient slowdowns. Players in the space are confident that the procedures will return.
“What we’ve been seeing is some elective foot and ankle procedures, including bunions being pushed out a little bit,” said Treace Medical CEO John Treace. “We’ve seen variability in timing and scheduling of procedures in prior years. And from our experience and consistent with others in the industry, when patients defer elective procedures, those aren’t lost cases.”
Despite the temporary volume dip, Zimmer Biomet doubled-down on foot and ankle in 2025 with its $1.2 billion acquisition of Paragon 28. The acquisition moves Zimmer Biomet closer to its goals of mid-single-digit growth and category leadership in foot and ankle.
The deal supercharged Zimmer Biomet’s S.E.T. segment (sports medicine, extremities and trauma), which is now larger than its hip franchise and growing faster than both its knee and hip franchises. At the end of 2023, the company said foot and ankle sales made up just 4% of its S.E.T. category, or around $70 million. The acquisition boosted Zimmer Biomet’s foot and ankle revenue to more than $320 million.
We’ll be watching to see if foot and ankle volumes rebound in the second half of 2025. How will Zimmer Biomet’s acquisition of Paragon 28 impact the competitive dynamics of the segment?
Companies Striving to Turn Things Around
J&J MedTech, Smith+Nephew, and CONMED are among the largest companies in orthopedics, but all three have struggled to keep pace with their respective markets over the last decade. We’re waiting to see whether these companies can finish strong in 2025.
J&J MedTech has a 10-year CAGR of 0.3% due to its late entry into robotics, middling trauma growth and a spine business that is under constant competitive pressure. The company has taken steps in recent years to restructure and refocus its orthopedics operations, but those changes have yet to demonstrate improved sales growth.
Volume-based procurement in China has been a multi-year headwind for Smith+Nephew. The company’s joint replacement and trauma performance hasn’t been up to the standard of its peers, leading to a 10-year CAGR of 2.6%. Smith+Nephew, however, has shown legitimate improvement in orthopedics due to its 12-Point plan. The company finished with mid-single-digit growth in both 2023 and 2024, and we expect the company to achieve that threshold again this year.
CONMED’s 10-year CAGR of 3.1% is for a sports medicine player. Supply chain disruptions and other operational challenges have caused the company to lose share over the last several quarters. While CONMED gets its operations in order, it can rely on the success of BioBrace and its fledgling foot and ankle business to keep some positive momentum.
Mid-Tier Companies Leveling Up
M&A activity continues to diminish the number of companies in orthopedics’ mid-tier. Three public companies currently at the upper reaches of the mid-tier, Orthofix, Medacta and ATEC, will likely become $1 billion annual revenue players relatively soon.
According to our estimates, all three companies will generate over $700 million in orthopedic sales for 2025. Orthofix will finish just north of $800 million. Over the last ten years, Orthofix has a CAGR of 8% while Medacta and ATEC have CAGRs of 11% and 22% respectively.
Fast-Growing Mid-Tier Players
More immediately, Orthofix needs to get on the other side of the distributor transition that has slowed its growth. Medacta continues to produce steady, double-digit growth and could find additional opportunities in the sports medicine segment and the U.S. market. Finally, ATEC is likely to be the first of these companies to hit the $1 billion milestone and is focused on becoming profitable in the interim.
In general, we think the orthopedic market is healthy and on track for growth at or slightly above its historical average. Public companies will start reporting third quarter results soon, and we’ll start to get a sense of how the second half will play out.
The orthopedic market has largely normalized in 2025, but there are still plenty of interesting storylines to monitor as we head into the home stretch of the year.
Here are five things we’re watching in the second half: the changing competitive dynamics of spine, enabling technology’s impact on the market, the downturn of foot and ankle...
The orthopedic market has largely normalized in 2025, but there are still plenty of interesting storylines to monitor as we head into the home stretch of the year.
Here are five things we’re watching in the second half: the changing competitive dynamics of spine, enabling technology’s impact on the market, the downturn of foot and ankle volumes, the progress of companies mid-turnaround and, finally, the performance of a group of fast-growing mid-tier companies.
The Spine Market’s Rapidly Changing Dynamics
The spine segment drives the most M&A activity in orthopedics, accounting for 28% of all transactions over the last 10 years. Deals for digital assets are tied for second-most (16%) during that time span, with many of those transactions having carryover to spine.
Acquisitions in spine over the last few years have completely reshaped the market. Globus merged with NuVasive, Orthofix did the same with SeaSpine, while both Zimmer Biomet and Stryker exited spine through divestitures. All the while, J&J MedTech’s spine business has floundered, and it’s not unthinkable that it may be a candidate for “portfolio management.”
As a result, spine is left with two contenders at the top of the market in Medtronic and Globus Medical that account for a combined 42% of global spinal implant market share. No other company currently has the scale and enabling technology portfolio to compete with them.
Top 3 Spine Players
So far in 2025, Medtronic has dealt with some investor drama, though it likely won’t impact its spine business, which has evolved into a steady performer on the back of the AiBLE ecosystem. Globus Medical, coming out of its integration period with NuVasive, has been up and down. Its enabling technology portfolio has faced drawn-out selling cycles, leading to a 17% decline in sales through the first half of the year.
As the two giants vie for supremacy at the top, we’re watching to see which next-tier player will emerge from the fray. ATEC is a share-taking machine. VB Spine is large enough to make some noise as well. Can J&J MedTech get its spine business back on track after years of losses?
The Evolving Enabling Technology Landscape
While enabling technology has been around orthopedics for a long time, only recently has it been such a significant competitive factor. It is now a prerequisite for leadership atop the joint replacement and spine segments.
Technology in orthopedics is entering a new phase as robotics becomes more common across segments, and more companies are entering the arena.
“With respect to enabling tech and robotics, look, we’ve clearly heard the message that enabling tech is a key part of having a complete global portfolio,” said new Enovis CEO Damien McDonald. “We’re examining whether large-format robots are cost-effective solutions and improve patient outcomes, and whether entry into the market at this point is valid. We’ve got resources dedicated to exploring all the viable pathways.”
The next battleground for competitors could be about unlocking the large segment of surgeons who are not currently using robotics. According to Zimmer Biomet, 80% of U.S. surgeons don’t use robotics. Internationally, the number is closer to 90%. The company is building a diverse technology ecosystem to draw in holdout surgeons.
Large format robotics remain an effective market share moat, but it is beginning to feel like companies will have to be more nuanced with their technology offerings to maintain that competitive edge.
Foot and Ankle Volumes Remain Slow
The foot and ankle segment has been a growth engine for orthopedic companies in recent years. It is a $5 billion market when accounting for all its various subsegments and, until recently, boasted a very consistent high-single-digit growth rate.
Starting in 2024, however, foot and ankle volumes slowed and have remained choppy ever since. The segment does have a history of transient slowdowns. Players in the space are confident that the procedures will return.
“What we’ve been seeing is some elective foot and ankle procedures, including bunions being pushed out a little bit,” said Treace Medical CEO John Treace. “We’ve seen variability in timing and scheduling of procedures in prior years. And from our experience and consistent with others in the industry, when patients defer elective procedures, those aren’t lost cases.”
Despite the temporary volume dip, Zimmer Biomet doubled-down on foot and ankle in 2025 with its $1.2 billion acquisition of Paragon 28. The acquisition moves Zimmer Biomet closer to its goals of mid-single-digit growth and category leadership in foot and ankle.
The deal supercharged Zimmer Biomet’s S.E.T. segment (sports medicine, extremities and trauma), which is now larger than its hip franchise and growing faster than both its knee and hip franchises. At the end of 2023, the company said foot and ankle sales made up just 4% of its S.E.T. category, or around $70 million. The acquisition boosted Zimmer Biomet’s foot and ankle revenue to more than $320 million.
We’ll be watching to see if foot and ankle volumes rebound in the second half of 2025. How will Zimmer Biomet’s acquisition of Paragon 28 impact the competitive dynamics of the segment?
Companies Striving to Turn Things Around
J&J MedTech, Smith+Nephew, and CONMED are among the largest companies in orthopedics, but all three have struggled to keep pace with their respective markets over the last decade. We’re waiting to see whether these companies can finish strong in 2025.
J&J MedTech has a 10-year CAGR of 0.3% due to its late entry into robotics, middling trauma growth and a spine business that is under constant competitive pressure. The company has taken steps in recent years to restructure and refocus its orthopedics operations, but those changes have yet to demonstrate improved sales growth.
Volume-based procurement in China has been a multi-year headwind for Smith+Nephew. The company’s joint replacement and trauma performance hasn’t been up to the standard of its peers, leading to a 10-year CAGR of 2.6%. Smith+Nephew, however, has shown legitimate improvement in orthopedics due to its 12-Point plan. The company finished with mid-single-digit growth in both 2023 and 2024, and we expect the company to achieve that threshold again this year.
CONMED’s 10-year CAGR of 3.1% is for a sports medicine player. Supply chain disruptions and other operational challenges have caused the company to lose share over the last several quarters. While CONMED gets its operations in order, it can rely on the success of BioBrace and its fledgling foot and ankle business to keep some positive momentum.
Mid-Tier Companies Leveling Up
M&A activity continues to diminish the number of companies in orthopedics’ mid-tier. Three public companies currently at the upper reaches of the mid-tier, Orthofix, Medacta and ATEC, will likely become $1 billion annual revenue players relatively soon.
According to our estimates, all three companies will generate over $700 million in orthopedic sales for 2025. Orthofix will finish just north of $800 million. Over the last ten years, Orthofix has a CAGR of 8% while Medacta and ATEC have CAGRs of 11% and 22% respectively.
Fast-Growing Mid-Tier Players
More immediately, Orthofix needs to get on the other side of the distributor transition that has slowed its growth. Medacta continues to produce steady, double-digit growth and could find additional opportunities in the sports medicine segment and the U.S. market. Finally, ATEC is likely to be the first of these companies to hit the $1 billion milestone and is focused on becoming profitable in the interim.
In general, we think the orthopedic market is healthy and on track for growth at or slightly above its historical average. Public companies will start reporting third quarter results soon, and we’ll start to get a sense of how the second half will play out.
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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.
