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The worldwide orthopedic market should eclipse $57 billion this year, according to ORTHOWORLD estimates. Several segments are primed for companies to increase market share and tap into new revenue streams with innovative solutions that attract the attention of surgeons and improve patient care. Here are a few that provide plenty of opportunity and upside.
Joint Replacement Surgery
The joint replacement market picked up momentum in 2023 and accounted for ~36% of all orthopedic sales, according to ORTHOWORLD, which noted that revenues in the market are expected to approach $23 billion by 2026.
Sg2, a healthcare market intelligence firm, expects elective hip and knee replacements to increase by 27% between 2023 and 2028, with 91% of cases performed on an outpatient basis. Shoulder replacement procedural volume should increase by 53% over the same period with 90% of the cases performed in outpatient settings, according to Sg2.
“Our forecasts indicate significant growth in elective primary hip, knee and shoulder replacements,” said Donnelle Jageman, who is part of Sg2’s Intelligence Team. “We project primary shoulder replacements to grow by 91% over the next decade.”
New and developing robotic platforms will increasingly assist surgeons who operate on small joints, such as wrists and ankles, according to orthopedic surgeon Douglas Unis, M.D., Founder and Chief Medical Officer of Monogram Orthopaedics. He called shoulder arthroplasty “the next big thing” in joint replacement surgery and described the space as being ripe for innovation.
Jageman explained that a projected increase in the use of enabling technology will allow surgeons to treat more complex shoulder replacements in same-day surgery settings than they previously could with traditional implants and surgical tools.
“New computer-assisted planning systems and the personalization of shoulder replacement surgery have allowed surgeons to take on procedures that they previously wouldn’t attempt,” Jageman said. “Patients are experiencing better outcomes, so patient eligibility has expanded due to technology advances that lead to improved patient care.”
Janet Tamborini, part of Sg2’s Spend Management Team, noted that about half of ankle replacements are projected to be performed on an outpatient basis as early as 2026. According to Tamborini, the data is intriguing because the three-year procedural growth is expected to be 60% for outpatient primary ankle replacements.
This is a significantly higher rate compared to other higher volume outpatient procedures such as primary shoulder and hip arthroplasty and total and partial knee replacements. The steadily increasing performance of ankle implants is behind the rapid growth that Sg2 predicts for the ankle space within two to three years.
Jageman added that motion-preservation ankle implant technology is likely to improve outcomes and increase demand. “Motion preservation is a growing trend,” she said. “It’s driving innovation and changing care pathways for patients, even though it’s in the early phases of innovation and adoption.”
The continued evolution of personalized joint replacement implants is another area that is poised for growth, according to Tamborini. She explained that personalized implant designs are increasingly being used in complex cases in which they leverage the unique anatomical attributes of patients and spare bone mass as a result.
Monogram, a Texas-based medical device company that’s developing a robotic surgical platform to install 3D-printed joint replacement implants, expects robotic assistance to be used for half of knee replacements by 2027, up from just 12% today. The company projects a 21.6% compound annual growth rate for knee replacements by 2027 and expects surgical robots to help drive the market’s growth.
“We’re at a tipping point,” Dr. Unis said. “Ten years from now, it won’t be acceptable to perform knee replacements without robotic assistance.”
Dr. Unis said about 85% of knee replacements are currently performed with conventional manual techniques. He believes that percentage will gradually shrink as surgical robots continue to evolve and surgeon adoption increases in the coming years.
In May 2023, THINK Surgical received FDA 510(k) clearance for its TMINI Miniature Robotic System, which features wireless handpieces designed to help surgeons locate bone pins and make precise cuts during knee replacement surgery. The platform combines with THINK Surgical’s commitment to an open implant library concept that could attract a broad customer base and increase the adoption of enabling technology among previously hesitant surgeons.
“We are excited to expand the number of implant modules supported by the TMINI system, allowing more patients access to robotic-assisted technology for knee replacement,” said Stuart Simpson, President and CEO of THINK Surgical.
Foot and Ankle
Paragon 28 estimates that the foot and ankle market is worth over $4 billion annually across the joint replacement, trauma, sports medicine and orthobiologic segments. The company enjoyed record-setting revenues in the first quarter of 2023, fueled by U.S. growth of 20% or better in subsegments within foot and ankle. It reported $103 million in sales across the first half of 2023, a nearly 23% increase from the previous year.
Paragon 28 will soon launch its Smart 28 platform, an ecosystem of enabling technologies for preoperative planning, intraoperative support and postoperative evaluation in foot and ankle surgery.
“We have made no secret that we think enabling technology is giving us better visibility in the planning, diagnosing and predicting outcomes phases of surgery that we expect to contribute in a meaningful way to improved patient outcomes,” said Paragon 28 CEO Albert DaCosta. “The foot and ankle market desperately needs that.”
Treace Medical’s new Hammertoe PEEK Fixation System is designed to address hammertoe, claw toe and mallet toe deformities. The company estimates that it has penetrated just 6.3% of its targeted bunion surgery market, a largely untapped segment that holds plenty of growth potential for specialized companies.
“Foot and ankle gets a fractional portion of a sales team’s time and attention in most highly diversified companies with large bags of products,” said Treace Founder and CEO John Treace. “I can’t say that there’s any one of these multiline, distracted companies that’s slowing our business momentum.”
Advanced Manufacturing
Jeff McCaulley, CEO of Avalign Technologies, sees steady growth in all orthopedic segments, fueled by numerous long-term patient demographics, with extremities continuing to grow slightly faster than large joints. “We also see a lot of new product development activity that should continue to fuel growth and improve patient care and outcomes,” he said.
According to McCaulley, Avalign is capitalizing on the projected opportunities for growth with its broad scope of specialties and services. “We’re experiencing a significant increase in co-development and manufacturer of record projects as OEMs look to accelerate time to market,” he said.
McCaulley believes automation and additive manufacturing will continue to improve and help orthopedic companies grow.
Dr. Unis also identified additive manufacturing as a space that’s poised for significant growth. “The 3D printing of personalized implants is going to become economically viable, and robotic systems like ours will allow surgeons to place them more precisely based on the anatomy of individual patients,” he said. “These factors will lead to personalized joint replacement surgery for which individual patients receive implants made specifically for them.”
Transitioning to additively manufactured personalized implants will also make sense from a financial standpoint, according to Dr. Unis, who said the largest expense for many medical device companies is maintaining massive inventories of implants. “It’s one reason that the orthopedic implant market is controlled by four major players,” he explained. “The need for massive inventories of off-the-shelf options makes the barrier to entry so high.”
