Hip and Knee Orthopedic Surgical Implants Market Shares, Strategies, and Forecasts, Worldwide, 2016 to 2022

Transcription

1 3 Hip and Knee Orthopedic Surgical Implants Market Shares, Strategies, and Forecasts, Worldwide, 2016 to 2022 Mountains of Opportunity Picture by Susan Eustis WinterGreen Research, Inc. Lexington, Massachusetts

2 CHECK OUT THESE KEY TOPICS Hip and Knee Orthopedic Surgical Implants Support Joint Repairs and Pain Relief Joint Surgical Implant Knee Surgical Implant Hip Surgical Implant Orthopedic Surgical Implant Implantic surgery Smart Instruments Medical Devices Healthcare Implant Enabling Technology Implantic-Assisted Minimally Invasive Surgery Implant Surgical System Minimally-Invasive Surgery, Implant Surgery Equipment Surgical Implant Applications Next Generation Implant Surgery Flexible Implant Platform Minimally Invasive Surgery MIS Hip and Knee Orthopedic Surgical Implant Growth Strategy: Hip and Knee Orthopedic Surgical Implants: Market Shares, Strategies, and Forecasts, Worldwide, LEXINGTON, Massachusetts (January 20, 2016) WinterGreen Research announces that it has published a new study Hip and Knee Orthopedic Surgical Implants: Market Shares, Strategy, and Forecasts, Worldwide, 2016 to The 2016 study has 360 pages, 188 tables and figures. Worldwide hip and knee orthopedic surgical Implant markets are poised to achieve significant growth with the aging of the population. Old people have trouble making their joints last as long as they do. The patient stability and the relief from pain provided by the implant is compelling. The major suppliers are providing implants that are state of the art. Orthopedic reconstructive implants are used to replace joints that have deteriorated. Deterioration may come as a result of aging, disease, osteoarthritis, or injury. Total hip replacement surgery has evolved dramatically over the years as advances in technology have made it possible to improve surgical techniques. 325,000 people had total hip replacement surgery in 2015 in the United States. Computer-assisted total hip replacement surgery is one of the latest revolutions in total hip replacement.

3 Zimmer is the market leader by far in the hip and knee orthopedic implant market. Zimmer M/L taper hip prosthesis has Kinectiv modular neck technology. This is better than traditional hip replacements that have had limited size and shape choices. Doctors typically adjusted the hip bone to fit the implant. Hip replacements with Zimmer Kinectiv Technology give surgeons a wide range of options to achieve a more accurate fit of the joint replacement to the hip. Reconstructive joint surgery involves the modification of the affected area of the joint and the implantation of one or more manufactured components. It may involve the use of bone cement. The primary orthopedic reconstructive targets are joints. Hips and knees are the joints most commonly repaired with orthopedic implants. Orthopedic implant vendors produce associated instruments. Instruments are required by orthopedic surgeons to implant reconstructive products. Interdisciplinary dialog in medicine through its extensive continuing education offerings is a vital part of the hip and knee implant joint replacement market. System partnership means even more intensive exchange to continuously improve patient care. The company seeks to actively contribute extensive knowledge of procurement, logistics and application processes to the medical community. The aim is to increase efficiency of joint implant surgery in hospitals. Depending on the type of disorder, the activity level of the patient and the bone quality, the most suitable implant model is selected and fixated in the bone. A great number of implants for artificial hip replacement are available. The difference between individual models and manufacturers is small, all products are technologically sophisticated and good. Surgeon adoption of an implant product line provides competitive advantage. The surgeon selects an implant based on the devices for which he or she is trained. Surgeons tend to be proficient in a particular device and have the most success implanting that one. The surgeon decision for choice of implant depends on the diagnosis, his or her own experience with the implant products, and the suitability of the selected implant for the patient. Implant assisted medial knee arthroplasty: orthopedic surgical implants are poised to take knee and hip surgery quality far beyond what has previously been available. The quality of knee arthroplasty is improved with implant capability. All the advantages of surgical implants carry into the orthopedic reconstruction surgical products.. When the knee and hip surgical implants are used, patients have reduction of post-operative pain, fewer re-admissions to hospital and faster recovery. Implants support high-precision surgery. Knee and hip surgical implants need robots to provide consistent reproducible precision. Knee or hip replacement will demand attention to quality of life. Maintenance of lifestyle provided by an implant as a joint replacement is compelling. As next generation systems, hip and knee implants provide a way to improve traditional orthopedic hip and knee replacement surgery. Total hip replacement surgery has evolved dramatically as advances in technology have brought improved surgical techniques. Surgical implants are a significant part of that advance.

4 Once, the penetration achieves this 35% level, all orthopedic surgeons will demand that hospitals offer implant orthopedic surgical capability because the outcomes are more predictable and better. Knee and hip surgical implant markets have been impacted by the reduction in insurance payments. Payment reductions have forced hospitals to act as businesses. The cost of delivering care has become as much a factor as providing quality care when making decisions about patient improvement in condition. Cost-cutting has been made in the supply chain. Suppliers were examined closely for quality and cost. The number of suppliers is reduced to put pressure on the ones that remain. Those remaining are pressured to improve prices and efficiencies. Hospitals, physicians, and care providers have been financially incentivized to create accountable care organizations (ACOs). Coordinated patient care plans and value-based purchasing were rewarded. The med device buyer shifted from physicians to the ACOs and smart buying groups. According to Susan Eustis, lead author of the study, Use of the orthopedic implant represents a key milestone in reconstructive surgery. Implants have provided an opportunity to transform orthopedics. New materials and new designs are bringing that transformation forward. By furthering the growth of implant innovation, patients can get better treatment. By enhancing the surgeon and patient experience is is likely that the entire orthopedics implant market will grow more rapidly than it would otherwise. The aging US population has supported demand, since the occurrence of health issues that require medical devices is higher in the elderly population. Buoyed by strong demand and sales, industry profit margins have increased considerably during the past five years. The worldwide market for Hip and knee orthopedic surgical joint replacement products is $16.7 billion anticipated to reach $33 billon by The complete report provides a comprehensive analysis including procedure numbers, units sold, market value, forecasts, as well as a detailed competitive market shares and analysis of major players success, challenges, and strategies in each segment and subsegment. The reports cover markets for knee and hip Implant orthopedic surgery medical specialties and sub-specialties. WinterGreen Research is an independent research organization funded by the sale of market research studies all over the world and by the implementation of ROI models that are used to calculate the total cost of ownership of equipment, services, and software. The company has 35 distributors worldwide, including Global Information Info Shop, Market Research.com, Research and Markets, Bloomberg, and Thompson Financial. It conducts its business with integrity. WinterGreen Research is an independent research organization funded by the sale of market research studies all over the world and by the implementation of ROI models that are used to calculate the total cost of ownership of equipment, services, and software. The company has 35 distributors worldwide, including Global Information Info Shop, Market Research.com, Research and Markets, and Thompson Financial. WinterGreen Research is positioned to help customers facing challenges that define the modern enterprises.

5 The increasingly global nature of science, technology and engineering is a reflection of the implementation of the globally integrated enterprise. Customers trust wintergreen research to work alongside them to ensure the success of the participation in a particular market segment. 9 WinterGreen Research supports various market segment programs; provides trusted technical services to the marketing departments. It carries out accurate market share and forecast analysis services for a range of commercial and government customers globally. These are all vital market research support solutions requiring trust and integrity. Key Words: Hip and Knee Orthopedic Surgical Implant, Medical Devices, Healthcare Implant, Enabling Technology, Implant-Assisted Minimally Invasive Surgery, Implant Surgical System, Medical / Surgical Delivery Implants, Surgical Assistive Technology, Hospital Implants, Implant Surgery Equipment, Surgical Implant Applications, Next Generation Implants Surgery, Flexible Implant Platform, Minimally Invasive Surgery, MIS. Companies Profiled Market Leaders Johnson & Johnson / DePuy Synthes Stryker Smith & Nephew Zimmer Biomet Market Participants B Braun / Aesculap ConforMIS DJO Exactech Corin Mathys Medacta MicroPort Scientific Shenzhen Advanced Institute Spinal Surgical Robot THINK Surgical Waldemar LINK GmbH & Co. Wright Medical Technology

6 Hip and Knee Orthopedic Surgical Implants: Market Shares, Strategies, and Forecasts, Worldwide, 2016 to 2022 Report Methodology This is the 658th report in a series of primary market research reports that provide forecasts in communications, telecommunications, the Internet, computer, software, telephone equipment, health equipment, and energy. Automated process and significant growth potential are a priority in topic selection. The project leaders take direct responsibility for writing and preparing each report. They have significant experience preparing industry studies. They are supported by a team, each person with specific research tasks and proprietary automated process database analytics. Forecasts are based on primary research and proprietary data bases. The primary research is conducted by talking to customers, distributors and companies. The survey data is not enough to make accurate assessment of market size, so WinterGreen Research looks at the value of shipments and the average price to achieve market assessments. Our track record in achieving accuracy is unsurpassed in the industry. We are known for being able to develop accurate market shares and projections. This is our specialty. The analyst process is concentrated on getting good market numbers. This process involves looking at the markets from several different perspectives, including vendor shipments. The interview process is an essential aspect as well. We do have a lot of granular analysis of the different shipments by vendor in the study and addenda prepared after the study was published if that is appropriate. Forecasts reflect analysis of the market trends in the segment and related segments. Unit and dollar shipments are analyzed through consideration of dollar volume of each market participant in the segment. Installed base analysis and unit analysis is based on interviews and an information search. Market share analysis includes conversations with key customers of products, industry segment leaders, marketing directors, distributors, leading market participants, opinion leaders, and companies seeking to develop measurable market share.

7 Over 200 in depth interviews are conducted for each report with a broad range of key participants and industry leaders in the market segment. We establish accurate market forecasts based on economic and market conditions as a base. Use input/output ratios, flow charts, and other economic methods to quantify data. Use in-house analysts who meet stringent quality standards. Interviewing key industry participants, experts and end-users is a central part of the study. Our research includes access to large proprietary databases. Literature search includes analysis of trade publications, government reports, and corporate literature. Findings and conclusions of this report are based on information gathered from industry sources, including manufacturers, distributors, partners, opinion leaders, and users. Interview data was combined with information gathered through an extensive review of internet and printed sources such as trade publications, trade associations, company literature, and online databases. The projections contained in this report are checked from top down and bottom up analysis to be sure there is congruence from that perspective. The base year for analysis and projection is With 2011 and several years prior to that as a baseline, market projections were developed for 2012 through These projections are based on a combination of a consensus among the opinion leader contacts interviewed combined with understanding of the key market drivers and their impact from a historical and analytical perspective. The analytical methodologies used to generate the market estimates are based on penetration analyses, similar market analyses, and delta calculations to supplement independent and dependent variable analysis. All analyses are displaying selected descriptions of products and services. This research includes referencde to an ROI model that is part of a series that provides IT systems financial planners access to information that supports analysis of all the numbers that impact management of a product launch or large and complex data center. The methodology used in the models relates to having a sophisticated analytical technique for understanding the impact of workload on processor consumption and cost. WinterGreen Research has looked at the metrics and independent research to develop assumptions that reflect the actual anticipated usage and cost of systems. Comparative analyses reflect the input of these values into models. The variables and assumptions provided in the market research study and the ROI models are based on extensive experience in providing research to large enterprise organizations and data centers. The ROI models have lists of servers from different manufacturers, Systems z models from IBM, and labor costs by category around the world.

8 This information has been developed from WinterGreen research proprietary data bases constructed as a result of preparing market research studies that address the software, energy, healthcare, telecommunicatons, and hardware businesses. YOU MUST HAVE THIS STUDY Knee and Hip Orthopedic Surgical Implant Market Shares, Strategy, and Forecasts, 2016 to 2022 Table of Contents Knee and Hip Orthopedic Surgical Implants: Executive Summary The study is designed to give a comprehensive overview of the knee and hip orthopedic surgical implants equipment market segment. Research represents a selection from the mountains of data available of the most relevant and cogent market materials, with selections made by the most senior analysts. Commentary on every aspect of the market from independent analysts creates an independent perspective in the evaluation of the market. In this manner the study presents a comprehensive overview of what is going on in this market, assisting managers with designing market strategies likely to succeed. KNEE AND HIP ORTHOPEDIC IMPLANT MARKET EXECUTIVE SUMMARY 27 Knee and Hip Orthopedic Implant Market Driving Forces 27 Knee and Hip Surgical Robot Market Shares 31 Knee and Hip Surgical Implant Forecasts KNEE AND HIP ORTHOPEDIC IMPLANTS MARKET DESCRIPTION AND MARKET DYNAMICS Challenges In The Field Of Healthcare Clinical Limited Financial Resources Clinical Economic Efficiency Reducing Fixed Costs Homogeneous Supplier Structure Optimizing Processes Orthopedic Reconstructive Implants Continuing Education Implant Industry Characterized by Frequent Patent Litigation Primary Customers Knee Orthopaedic Reconstructive Implants Knee Replacement Hip Implants Hip Replacement KNEE AND HIP ORTHOPEDIC IMPLANT MARKET SHARES AND MARKET FORECASTS Knee and Hip Orthopedic Implant Market Driving Forces Knee and Hip Surgical Robot Market Shares Products Orthopedic Implant Surgical Companies Zimmer Persona Knee: The Personalized Knee System Zimmer Persona Knee - The Personalized Knee System 59

9 2.2.5 Biomet Vanguard SSK 360 Revision System is the best-selling Biomet knee revision implant Zimmer Biomet Oxford Partial Knee Stryker Accolade II Johnson and Johnson / DePuy Surgical Orthopedic Implants Segments Johnson and Johnson / DePuy Hip Smith & Nephew Surgical Orthopedic Implants Segments Exactech Surgical Orthopedic Implants Segments Exactech Mathys Surgical Orthopedic Implants Segments, DJO ConforMIS Aesculap Bicontact Universal Hip System Wright Medical Technology Wright Medical Technology Total Hip Replacement Total Hip Replacement Leaching Metal Debris Causes A Condition Called Metallosis Total Knee Replacement Other Surgical Orthopedic Implant Segments Knee and Hip Surgical Implant Forecasts Knee Implants Market Forecasts Hip Implant Market Forecasts Knee and Hip Surgical Implant Unit Analysis Knee and Hip Orthopedic Surgical Procedure Analysis Knee and Hip Surgical Robot Regional Analysis Orthopedic Implant Regional Positioning Zimmer Americas Zimmer Europe Charité Europe European Reconstructive Implant And Trauma Product Markets Asia Pacific Market For Reconstructive Implant And Trauma Products Asia Pacific Zimmer Local Distribution Facilities KNEE AND HIP SURGICAL ROBOT PRODUCTS Zimmer Holdings / Biomet Hip Zimmer Fitmore Hip Stem Zimmer Continuum Acetabular system Zimmer Facing Lawsuits over Durom Acetabular Component Zimmer Holdings / Biomet Knee Zimmer / Biomet Knee and Hip Biomet Knee reconstructive products Biomet Oxford Partial Knee Smith & Nephew Smith & Nephew Orthopaedic Product Line Smith & Nephew Hip Smith & Nephew Recall of Metal Liner Component Of Its Modular R Smith & Nephew Redapt Hip Implant Smith & Nephew Knee Smith & Nephew Knee Implant Systems Smith & Nephew LEGION HK Hinge Knee Replacement Johnson and Johnson / DePuy Hip DePuy s ASR XL Acetabular Total Hip Replacement System Recalled DePuy ATTUNE Knee System DePuy GLIDERIGHT Articulation Knee Implant DePuy AOX Polyethylene DePuy ORTHOVISC Knee Injections Stryker Stryker Triathlon Total Knee Implants Stryker MAKOplasty Robotic Arm Hip Replacement Solution 148

10 3.4.3 Stryker MAKOplasty Surgical Robotic Total Hip Arthroplasty Stryker MAKO Surgical Knee Replacements Stryker s Mako Total Knee Application Receives FDA Clearance Stryker Knee and Hip Surgical Robot Products Benefits Stryker / Mako Stryker Knee Replacement System Microport Profemur Z Hip Stem System MicroPort Evolution Knee MicroPort Orthopedics Knee Replacement MicroPort Orthopedic Devices Corin DJO Hip DJO Revelation Hip System DJO Revelation micromax Hip DJO Linear Hip System DOJ LMR Hip DJO 3DKnee System DJO 3DKnee System DJO FMP Acetabular System DJO RSP Monoblock DJO Reverse Shoulder Prosthesis (RSP) DJO Turon Modular Shoulder System DJO e-plus Exactech Exactech Knee ConforMIS ConforMIS itotal CR Mimics Natural Shape Of The Knee ConforMIS in Development of the itotal Hip Medacta B. Braun / Aesculap AG Aesculap Hip Arthroplasty Low Abrasion Ceramic Articulation And Bioactive Surface Coatings Aesculap Bicontact Universal Hip System Aesculap Knee Arthroplasty Waldemar LINK GmbH & Co LINK Hip Prostheses Mathys AG Mathys Stem Mathys Cup Mathys Hip Head Mathys Knee Portfolio Mathys Shoulder Portfolio Wright Medical Technology KNEE AND HIP SURGICAL RESEARCH, TECHNOLOGY, AND REGULATION Cemented / Cement-Free Implants Cement-Free Anchorage Cemented Anchorage Well Described Problem For Hip Replacements Allergy Considerations Smith-Nephew VERILAST Technology for Knees Smith & Nephew VERILAST Technology May Last Up To 30 Years Of Wear Hip Implant Failure Epidemic Of Failures Of Hip Implant Devices Implants Involved In These Lawsuits Regulation U.S. Food and Drug Administration 237 U.S. Food and Drug Administration Regulatory FDA s Premarket Clearance and Approval Requirements 238

11 (k) Clearance Pathway Premarket Approval Pathway Clinical Trials Pervasive and Continuing FDA Regulation KNEE AND HIP SURGICAL COMPANY DESCRIPTIONS B Braun / Aesculap B. Braun Products B.Braun Braun / Aesculap Revenue Aesculap Hip Arthroplasty Aesculap Knee Arthroplasty ConforMIS ConforMIS Fully Paid Up, Worldwide License Agreement with Wright Medical Group, ConforMIS itotal PS Knee Replacement Product Systems Voluntary Recall ConforMIS Makes The Implant Fit The Patient ConforMIS Revenue Third Quarter ConforMIS Third Quarter 2015 Financial Results DJO DJO Trademarks, Service Marks And Brand Names DJO Linear Hip System DJO TaperFill Hip System DJO Revelation micromax Hip DJO Knee DJO e DJO Movation and S.U.R.E. System DJO Surgical DJO purchases the Biomet Cobalt HV Bone Cement and Optivac Cement Mixing from Zimmer Biomet DJO Advanced Technologies DJO Revenue DJO Sales by Business Segment Exactech Johnson and Johnson / Depuy Depuy Synthes Trauma Launches New Biologic Implant DePuy Synthes Companies of Johnson & Johnson J&J DePuy Synthes DePuy Synthes ASR Hips Failed Solutions In The Specialties Of Joint Reconstruction, Trauma Johnson and Johnson / DePuy Synthes Google Collaborating With Johnson & Johnson To Develop Surgical Robots DePuy Johnson & Johnson Johnson & Johnson / Ethicon Johnson & Johnson Business Johnson & Johnson Geographic Areas Corin Corin Hip Components Corin Knee Components Mathys Medacta Medacta Business MicroPort Scientific Corporation MicroPort Orthopedic Devices MicroPort acquires OrthoRecon Business from Wright Medical Technologies Microport Hip Systems Shenzhen Advanced Institute Spinal Surgical Robot Smith & Nephew Smith & Nephew Revenue Smith & Nephew 2015 Q3 Highlights 295

12 5.12 Stryker Corporation Stryker Revenue Stryker Results Of Operations Stryker Segment Orthopaedics Stryker Business Segment Operations Stryker Revenue Stryker Hip Recall: $1.4 Billion Settlement Stryker Regional Revenue Segment Stryker Robots Stryker / MAKO Surgical Stryker / Mako MAKO Surgical RIO Robotic Arm Stryker Endoscopy Mako Surgical Business Mako Products Mako Surgical Strategy Mako Surgical Revenue THINK Surgical THINK Surgical TPLAN 3D Planning Workstation THINK Surgical TCAT Computer Assisted Tool Think Surgical Think Surgical Robodoc Waldemar LINK GmbH & Co Waldemar Link GmbH und Co. KG Wright Medical Technology Wright Revenue Wright Medical Group NV Revenue Wright Medical Group N.V. Revenue for 2015 Third Quarter Wright / Tornier Zimmer Biomet Zimmer Biomet Sales by Product Category Zimmer Biomet Zimmer Metal-on-Metal Hip Recall 355 List of Tables and Figures Figure ES-1 27 Knee and Hip Orthopedic Implant Market Driving Forces 27 Figure ES-2 28 Knee and Hip Orthopedic Implant Market Aspects 28 Table ES-3 29 Knee and Hip Orthopedic Implant Market Challenges 29 Table ES-4 30 Innovative Knee and Hip Orthopedic Implant Features 30 Figure ES-5 32 Hip and Knee Surgical Orthopedic Implants Market Shares, Shipments, Dollars, Worldwide

13 Figure ES-6 33 Orthopedic Implants Market Forecasts, Dollars, Worldwide, Table Clinical Economic Efficiency 36 Figure Knee Replacement Operation Resurfaces The Damaged Knee Joint With Metal And Plastic Implants To Restore Movement 42 Table Hip Implant Surgeon Implant Decision Process Metrics 45 Table Hip Implant Surgery Challenges 46 Table Hip Implant Surgery Difficulties 46 Figure Orthopedic Hip Implant Instrumentation 47 Figure Knee and Hip Orthopedic Implant Market Driving Forces 49 Figure Knee and Hip Orthopedic Implant Market Aspects 50 Table Knee and Hip Orthopedic Implant Market Challenges 51 Table Innovative Knee and Hip Orthopedic Implant Features 52 Figure Hip and Knee Surgical Orthopedic Implants Market Shares, Shipments, Dollars, Worldwide Table Hip and Knee Surgical Orthopedic Implants Markets and Systems Shares, Dollars, Worldwide, Figure Zimmer Biomet Knee 58 Figure Zimmer Persona Knee 59 Table Zimmer Surgical Orthopedic Implants Segments, Dollars, Worldwide, Table

14 Stryker Surgical Orthopedic Implants Segments, Dollars, Worldwide, Table Johnson and Johnson DePuy Surgical Orthopedic Implants Segments, Dollars, Worldwide, Figure Johnson and Johnson / Depuy Hip Implants 65 Table Smith & Nephew Surgical Orthopedic Implants Segments, Dollars, Worldwide, Table Exactech Surgical Orthopedic Implants Segments, Dollars, Worldwide, Figure Exactech Knee Implant Images 69 Table Mathys Surgical Orthopedic Implants Segments, Dollars, Worldwide, Table DJO Surgical Orthopedic Implants Segments, Dollars, Worldwide, Figure DJO Hip Implant 72 Table ConforMIS Surgical Orthopedic Implants Segments, Dollars, Worldwide, Table Wright Medical Technology Persona Knee features 74 Table Total Knee Replacement Leading Causes Of Dissatisfaction 76 Table Other Surgical Orthopedic Implant Segments, Dollars, Worldwide, Figure Orthopedic Implants Market Forecasts, Dollars, Worldwide, Table Total Orthopedic Surgical Implant Market Segment Forecasts Dollars, Worldwide, Table Surgical Orthopedic Implant Market Segments, Units and Dollars, Worldwide, Table Hip, Knee and Other Orthopedic Surgical Implant Market Segment Forecasts, Dollars, Worldwide,

15 Figure Knee Implants Market Forecasts, Dollars, Worldwide, Table Knee Orthopedic Surgical Implant Market Segment Forecasts, Units, Dollars, and Dollars per Unit, United States and Worldwide, Figure Hip Implants Market Forecasts, Dollars, Worldwide, Table Hip Orthopedic Surgical Implant Market Segment Forecasts, Dollars, Units, Dollars per Unit, United States and Worldwide, Table Surgical Orthopedic Implant Knee and Hip Market Segments, Units and Dollars, Worldwide, Figure Other Implants Market Forecasts, Dollars, Worldwide, Table Surgical Orthopedic Implant Market Segments, Units and Dollars, Worldwide, Table Hip, Knee, and Other Orthopedic Surgical Implant Market Segment Forecasts, Units, United States and Worldwide, Figure Orthopedic Surgical Implant Regional Market Segments, Dollars, Worldwide, Table Orthopedic Surgical Robot Regional Market Segments, Dollars, Figure Zimmer Holdings / Biomet Hip 97 Table Zimmer Significant Hip Brands 98 Figure Zimmer Continuum Acetabular System 101 Figure Zimmer Continuum Acetabular Orthopedic Implant Hip System 102 Figure Zimmer Continuum Acetabular System Meets Individual Patient Needs 102

16 Table Zimmer Continuum Acetabular System Features 103 Table Zimmer Trabecular Metal Material Characteristics 104 Table Zimmer Significant Knee Brands: 106 Figure Zimmer Holdings / Biomet Knee 107 Table Zimmer Personalized Total Knee Arthroplasty System Functions 108 Figure Zimmer Holdings / Biomet Knee Components 110 Figure Zimmer Holdings / Biomet Implantable Knee Component Unlock and Pull 111 Table Biomet Key Products Description 112 Table Biomet Knee Reconstructive Key Products 114 Figure Smith & Nephew Product Line 116 Table Smith & Nephew REFLECTION Ceramic Acetabular Hip Features 119 Figure Smith & Nephew REFLECTION Ceramic Acetabular Hip System 120 Figure Smith-nephew Reflection Ceramic Acetabular Hip System Optimized Neck 121 Figure Smith & Nephew Hip Implant 122 Figure Smith & Nephew Hip Implant CLose-up 123 Smith & Nephew Redapt Hip Implant 124 Figure Smith & Nephew Journey BCS Knee Implant 126 Figure

17 Smith & Nephew Legion TKS Total Knee System 127 Figure Johnson and Johnson / Depuy Hip Implants 129 Table Johnson & Johnson DePuy ASR & Pinnacle Hip Replacement Orthopedics Features 130 Figure DePuy ATTUNE Knee Implant System Works With Knee Muscles And Ligaments 134 Figure DePuy ATTUNE Knee 135 Figure DePuy ATTUNE Knee Side View 136 Figure Innovative Technology of the DePuy ATTUNE Knee 138 Figure Anika Therapeutics Hyaluronic Acid Knee Injections 140 Figure Stryker Implant Products 141 Table Stryker Mobile Bearing Hip System Stability and Longevity Features 144 Table Stryker Mobile Bearing Hip System Advanced Fixation Features 145 Table Stryker ADM X3 and WDM X3 Hip System 145 Figure Stryker Triathlon Total Knee 146 Figure Stryker Mako Advanced RIO Robotic Arm 147 Figure Stryker MAKOplasty Robotic Arm Solution 148 Figure Stryker MAKOplasty Hip Arthroplasty 149 Figure Stryker MAKOplasty Hip Arthroplasty 150 Table

18 Stryker MAKOplasty Surgical Robotic Total Hip Arthroplasty Features 151 Figure Stryker Hip Joint Kinematics 152 Figure Stryker RIO Robotic Arm Interactive Orthopedic System 153 Figure Stryker MAKOplasty 154 Figure Stryker Mako RESTORIS Hip System Components 157 Table Stryker Mako Diverse Family of RESTORIS Hip Implant Systems 158 Figure MAKO Surgical Maker Of Robots To Assist In Knee Replacements 159 Figure Stryker Mako Robotic Stations for Surgery Planning and Bone Cutting 161 Figure Stryker Knee and Hip Surgical Robot For Bone Cutting 162 Figure Stryker Knee Surgical Robot Precision Cutter Decreases Need For Bone Resurfacing 163 Figure Stryker Mako Surgical Preoperative and Post Operative Knee Surgery Images 165 Table Stryker Mako Surgical Robot Knee Arthroplasty Benefits 166 Figure Microport Profemur Z Hip Stem System 169 Figure MicroPort Orthopedics Knee Replacement 170 Table MicroPort Implant Medical Conditions Treated: 171 Table MicroPort Medical Solutions: 173 Figure MicroPort Hips and Knees 174 Figure

19 MicroPort Knees 176 Figure MicroPort Evolution Medial-Pivot Knee System 178 Table MicroPort e MP Knee System Flexion Stability Features 179 Figure Corin Hip Product Line 180 Figure Corin Product Line 181 Table Early Intervention and Primary Hip Implants 182 Figure DJO Hip Implant 183 Figure DJO Revelation Lateral Flare Total Hip 184 Figure DJO Revelation micromax Hip 184 Figure DJO Linear Hip System 185 Figure DOJ LMR Hip 186 Figure DJO 3DKnee System 187 Figure DJO 3DKnee System 188 Table DJO EMPOWR 3D Knee System: Key design Features 189 Figure DJO Foundation Knee System 190 Figure Exactech Knee Implant Images 193 Figure Exactech Knee Implant 194 Figure

20 Exactech Knee System 194 Figure ConforMIS itotal Customized Knee Replacement 197 Figure ConforMIS itotal CR Mimics Natural Shape Of The Knee 199 Table ConforMIS ifit Technology Platform Key Elements 202 Source: WinterGreen Research, Inc. 202 Figure ConforMIS itotal Hip 203 Figure B. Braun / Aesculap Bicontact System Implant Components 206 Figure B. Braun / Aesculap Implant System Components 207 Figure Aesculap Knee Arthroplasty Components 210 Table Link Target Product Markets 212 Figure LINK Prosthesis Standard Stems 213 Figure Link Primary Instrumentation 215 Figure Link Cementless And Cemented Hip Stems And Hip Cups For Revision Surgery 215 Figure Link Prosthesis Heads 216 Figure Mathys AG Primary Hip Modules 217 Figure Mathys AG Primary Hip Monobloc and Bipolar / Hemi Modules 218 Figure Mathys AG Primary Cemented and Uncemented Hip Modules 219 Figure Mathys AG Primary Hip Revision Modules 220

21 Table Mathys AG Hip Implant Stems That Are Anchored Cement-Free 221 Figure Mathys AG Hip Implant Stems 222 Figure Mathys Modular Cups Can Be Implanted With Cement-Free Or Cemented Anchorage 223 Figure Mathys Ceramic Hip Heads 224 Figure Mathys Knee Portfolio 225 Figure Mathys Uni Knee and Revision Knee 226 Figure Mathys Shoulder Portfolio 227 Figure Smith & Nephew Hip Stem For Cement-Free (Left) And Cemented (Right) Anchorage 230 Figure Smith & Nephew Metal Content of Implants 232 Table U.S. Food and Drug Administration Regulatory Governance Of Activities 238 Table Continuing FDA Regulation 241 Table B. Braun Products 244 Table B. Braun Product Descriptions 245 Figure DJO Hip, Knee, Upper Extremity, and Cement Solutions 255 Figure DJO Linear Hip System 257 Figure DJO TaperFill Hip System 258 Figure DJO Empowr 3D Knee 259

22 Figure DJO e+ 260 Figure Movation and S.U.R.E. System 261 Figure DJO Provides ArmorCoat Implant Protection For Maximum Performance 262 Figure Johnson and Johnson / Depuy Hip Implants 270 Figure Depuy Synthes Biologic Implant 271 Table Johnson and Johnson Family of Companies Comprises: 275 Table Johnson & Johnson Business 279 Figure Corin Orthopaedic Hip Implant 281 Figure Corin Knee Components 282 Figure Mathys Worldwide Presence 283 Table MicroPort Advanced Technology Product Segments Addressed 286 Table Microport Hip Systems 287 Figure Smith & Nephew Laser Surgical Instrument 289 Figure Stryker Joint Implants 307 Figure Stryker Patient Specific Pre-Operative Planning 308 Figure Stryker Patient Specific Pre-Operative Planning 309 Table Stryker Better Fit Orthopedics 309

23 Table Stryker Osteoarthritis Affects Compartments Of The Knee 310 Figure Stryker / MAKO Surgical RIO Robotic Arm Interactive System 311 Figure MAKO Surgical Restoris 318 Figure Mako Robotic Arm Technology Assists in Total Hip Replacement 320 Figure MAKO Surgical 321 Figure MAKO Surgical Implants 322 Table MAKO Robotic Surgery Benefits 327 Figure THINK Surgical TPLAN 3D Planning Workstation 331 Figure THINK Surgical TPLAN Workstation 332 Figure THINK Surgical TCAT Computer Assisted Tool 333 Figure Think Surgical Planning 335 Figure Think Surgical Robodoc 336 Figure LINK Prosthetic Stems Precision Turning 337 Figure Link Baking Ceramic Molds at VACUCAST 338 Table Zimmer Biomet Musculoskeletal Healthcare Offerings 354 Table Zimmer Metal On Metal Hip Replacement Difficulties and Side Effects. 356

24 ABOUT THE COMPANY WinterGreen Research, research strategy relates to identifying market trends through reading and interviewing opinion leaders. By using analysis of published materials, interview material, private research, detailed research, social network materials, blogs, and electronic analytics, the market size, shares, and trends are identified. Analysis of the published materials and interviews permits WinterGreen Research senior analysts to learn a lot more about markets. Discovering, tracking, and thinking about market trends is a high priority at WinterGreen Research. As with all research, the value proposition for competitive analysis comes from intellectual input. WinterGreen Research, founded in 1985, provides strategic market assessments in telecommunications, communications equipment, health care, Software, Internet, Energy Generation, Energy Storage, Renewable energy, and advanced computer technology. Industry reports focus on opportunities that expand existing markets or develop major new markets. The reports access new product and service positioning strategies, new and evolving technologies, and technological impact on products, services, and markets. Innovation that drives markets is explored. Market shares are provided. Leading market participants are profiled, and their marketing strategies, acquisitions, and strategic alliances are discussed. The principals of WinterGreen Research have been involved in analysis and forecasting of international business opportunities in telecommunications and advanced computer technology markets for over 30 years. The studies provide primary analytical insight about the market participants. By publishing material relevant to the positioning of each company, readers can look at the basis for analysis. By providing descriptions of each major participant in the market, the reader is not dependent on analyst assumptions, the information backing the assumptions is provided, permitting readers to examine the basis for the conclusions. WinterGreen Research is positioned to help customers facing challenges that define the modern enterprises. The increasingly global nature of science, technology and engineering is a reflection of the implementation of the globally integrated enterprise. Customers trust wintergreen research to work alongside them to ensure the success of the participation in a particular market segment. WinterGreen Research supports various market segment programs; provides trusted technical services to the marketing departments. It carries out accurate market share and forecast analysis services for a range of commercial and government customers globally. These are all vital market research support solutions requiring trust and integrity. ABOUT THE PRINCIPAL AUTHORS Ellen T. Curtiss, Technical Director, co-founder of WinterGreen Research, conducts strategic and market assessments in technology-based industries. Previously she was a member of the staff of Arthur D. Little, Inc., for 23 years, most recently as Vice President of Arthur D. Little Decision Resources, specializing in strategic planning and market development services. She is a graduate of Boston University and the Program for Management Development at Harvard Graduate School of Business Administration. She is the author of recent studies on worldwide telecommunications markets, the top ten internet equipment companies, the top ten contract manufacturing companies, and the Top Ten Telecommunications market analysis and forecasts.

25 Susan Eustis, President, co-founder of WinterGreen Research is a senior analyst. She has done research in communications and computer markets and applications. She holds several patents in microcomputing and parallel processing. She has the original patents in electronic voting machines. She has new patent applications in format varying, mulitprocessing, and electronic voting. She is the author of recent studies of the Solar REnewable Energy, Wind Energy, Thin Film Batteries, Business Process Management marketing strategies, Internet equipment, biometrics, a study of Internet Equipment, Worldwide Telecommunications Equipment, Top Ten Telecommunications, Digital Loop Carrier, Web Hosting, Web Services, and Application Integration markets. Ms. Eustis is a graduate of Barnard College. Worldwide Who s Who named her Top Female CEO of 2012.