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2 TABLE OF CONTENTS 1. The US Orthopedic Implants and Devices Market Introduction 2. The US Orthopedic Implants and Devices Market Value Chain 3. The US Orthopedic Implants and Devices Market Size, The US Orthopedic Implants and Devices Market Segmentation, The US Reconstructive Joint Replacement Implants Market Introduction and Market Size, The US Reconstructive Joint Replacement Implants Market Segmentation by Hips, Knee, Shoulders and Others, The US Hip Implants Market Introduction 7.1. The US Hip Implants Market Size by Value, The US Hip Implants Market Segmentation, By Type of Hip Replacement Procedure, 2011 and By Type of Components, 2010 and Market Shares of the Major Players in the US Hip Implant Market, 2009, 2010 and Future Outlook and Projections of the US Hip Implants Market, The US Knee Implants Market Introduction The US Knee Implants Market Size by Value, The US Knee Implants Market Segmentation, By Type of Knee Replacement Procedure, 2008 and By Type of Components, 2010 and Market Shares of the Major Players in the US Knee Implant Market, 2009, 2010 and Future Outlook and Projections of the US Knee Implants Market, Trends and Developments in the US Hip and Knee Implants Market Minimally Invasive Hip and Knee Replacement Surgeries Gaining Traction Consolidation of the Orthopedic Devices Market Specialized and Custom Fitted Hip Implants

3 Rise in the Readmissions of the Hip Replacement Patients with Shorter Stays in Hospitals Post-surgery Manufacturers Focusing on Customized and Personalized Knee Implants Growing Demnad for Gender-specific Knee Implants Increasing Adoption of Computer Assisted Surgery Recall of Metal-on-Metal Hip Replacement Implants Growing Knee Replacement Lawsuits and Recall of Knee Implants Other Emerging Trends in the US Orthopedic Implants Market 16. Government Regulations in the US Orthopedic Implants and Devices Market 17. Company Profiles of the Major Players 18. SWOT Analysis of the US Orthopedic Implants Industry Strengths Weaknesses Opportunities Threats 19. Porter s Five Forces Analysis of the US Orthopedic Implants and Devices Market Bargaining Power of Buyers Bargaining Power of Suppliers Threat of New Entrants Threat of New Substitute Products Rivalry between Competitors 20. Future Outlook and Projections of the US Orthopedic Implants and Devices Market, Macro-economic and Industry Factors Historical and Projections Total and Old Population in the US, Obese and Overweight Population in the US, Personal Disposable Income of the Population in the US,

4 21.4. Total Healthcare Expenditure in the US, Total Health Insurance Premiums Underwritten, Total Diagnosed Diabetic Population in the US, Appendix Market Definitions Abbreviations Research Methodology Data Collection Methods Approach Variables (Dependent and Independent) Multi Factor Based Sensitivity Model Final Conclusion Disclaimer

5 LIST OF FIGURES Figure 1: The Orthopedic Implants and Devices Value Chain Figure 2: The US Orthopedic Implants and Devices Market Size by Value on the Basis of Revenues in USD Million, Figure 3: The US Reconstructive Joint Replacement Implants Market Size by Value on the Basis of Revenues in USD Million, Figure 4: The US Reconstructive Joint Replacement Implants Market Segmentation by Knee, Hip, Shoulder and Other Implants on the Basis of Revenue in Percentage, Figure 5: Hip Implant Components Figure 6: The US Hip Implants Market Size by Value on the Basis of Revenues in USD Million, Figure 7: The US Hip Implant Market Segmentation by Type of Hip Replacement Procedure on the Basis of Revenue in Percentage, 2011 and 2013 Figure 8: The US Hip Implant Market Segmentation by Type of Components on the Basis of Revenue in Percentage, 2010 and 2013P Figure 9: The US Hip Stem Market Segmentation by Coated, Uncoated, Long and Resurfacing on the Basis of Revenue in Percentage, 2010 and 2013P Figure 10: The US Hip Implants Market Future Projections by Value on the Basis of Revenues in USD Million, Figure 11: Knee Implant Components Figure 12: The US Knee Implants Market Size by Value on the Basis of Revenues in USD Million, Figure 13: The US Knee Implant Market Segmentation by Type of Knee Replacement Procedure on the Basis of Revenue in Percentage, 2008 and 2013 Figure 14: The US Knee Implant Market Segmentation by Type of Components on the Basis of Revenue in Percentage, 2010 and 2013P Figure 15: The US Knee Implants Market Future Projections by Value on the Basis of Revenues in USD Million, Figure 16: The US Orthopedic Implants and Devices Market Future Projections by Value on the Basis of Revenues in USD Million, Figure 17: Total and Old Population in the US in Million,

6 Figure 18: Total Obese and Overweight Population in the US in Million, Figure 19: Personal Disposable Income of the Population in the US in USD Million, Figure 20: Total Healthcare Expenditure in the US in USD Million, Figure 21: Total Health Insurance Premiums Underwritten in the US in USD Million, Figure 22: Total Diagnosed Diabetic Population in the US in Million,

7 LIST OF TABLES Table 1: The US Orthopedic Implants and Devices Market Segmentation by Implants and Devices on the Basis of Revenue in Percentage, Table 2: The US Orthopedic Implants and Devices Market Segmentation by Implants and Devices on the Basis of Revenue in USD Million, Table 3: The US Orthopedic Implants Market Segmentation by Type of Implants on the Basis of Revenue in Percentage, Table 4: The US Orthopedic Implants Market Segmentation by Type of Implants on the Basis of Revenue in USD Million, Table 5: Market Share of the Major Players in the US Hip and Knee Implant Market on the Basis of Revenue in Percentage, 2009, 2010 and 2013P Table 6: Revenues of the Major Players in the US Hip and Knee Implant Market in USD Million, 2009, 2010 and 2013P Table 7: The US Reconstructive Joint Replacement Implants Market Segmentation by Knee, Hip, Shoulder and Other Implants on the Basis of Revenue in USD Million, Table 8: The US Reconstructive Joint Replacement Implants Market Segmentation and Projections by Knee, Hip, Shoulder and Other Implants on the Basis of Revenue in USD Million, Table 9: The US Hip Implant Market Segmentation by Type of Hip Replacement Procedure on the Basis of Revenue in USD Million, 2011 and 2013 Table 10: The US Hip Implant Market Segmentation by Type of Components on the Basis of Revenue in USD Million, 2010 and 2013P Table 11: The US Hip Stem Market Segmentation by Coated, Uncoated, Long and Resurfacing on the Basis of Revenue in USD Million, 2010 and 2013P Table 12: Market Share of the Major Players in the US Hip Implant Market on the Basis of Revenue in Percentage, 2009, 2010 and 2013P Table 13: Revenues of the Major Players in the US Hip Implant Market in USD Million, 2009, 2010 and 2013P Table 14: The US Knee Implant Market Segmentation by Type of Knee Replacement Procedure on the Basis of Revenue in USD Million, 2008 and 2013 Table 15: The US Knee Implant Market Segmentation by Type of Component on the Basis of Revenue in Percentage, 2010 and 2013P

8 Table 16: Market Share of the Major Players in the US Knee Implant Market on the Basis of Revenue in Percentage, 2009, 2010 and 2013P Table 17: Revenues of the Major Players in the US Knee Implant Market in USD Million, 2009, 2010 and 2013P Table 18: Company Profiles of the Major Players present in the US Hip and Knee Implant Market Table 19: Financial Performance of the Major Players present in the US Orthopedic Equipment Market in USD Million, Table 20: Financial Performance of Biomet Inc. in USD Million, Table 21: The US Orthopedic Implants and Devices Market Segmentation and Projections by Implants and Devices on the Basis of Revenue in USD Million, Table 22: The US Orthopedic Implants Market Segmentation and Projections by Type of Implants on the Basis of Revenue in Percentage, Table 23: Correlation Matrix for the US Hip Implants Market Table 24: Regression Coefficients Output

9 THE US ORTHOPEDIC IMPLANTS AND DEVICES MARKET SIZE, device manufacturers have leveraged their position in the market to steadily increase the prices while the reimbursement rates of the US government have stagnated or declined. The overall orthopedic implants and devices market in the US has expanded at a CAGR of ~% during to reach USD ~ million in 2013 from around USD ~ million in Figure: The US Orthopedic Implants and Devices Market Size by Value on the Basis of Revenues in USD Million, , ,000.0 USD Million 20, , , , THE US ORTHOPEDIC IMPLANTS AND DEVICES MARKET SEGMENTATION, the orthopedic implants market of the US can also be segmented into seven major segments which include implants used in reconstructive joint replacements, spinal implants, trauma implants, orthobiologics, bone cement and accessories, extremity implants and others. Reconstructive joint replacement implants are the largest segment and represented around ~% of

10 the revenues generated in the US orthopedic implants market in These implants largely comprise of knee, hip and shoulder implants Table: The US Orthopedic Implants Market Segmentation by Type of Implants on the Basis of Revenue in Percentage, Implant Segment Reconstructive Joint Replacements Spinal Implants Trauma Implants Orthobiologics Bone Cement and Accessories Extremities Others Table: The US Orthopedic Implants Market Segmentation by Type of Implants on the Basis of Revenue in USD Million, Implant Segment Reconstructive Joint Replacements Spinal Implants Trauma Implants Orthobiologics Bone Cement and Accessories Extremities Others Total

11 THE US RECONSTRUCTIVE JOINT REPLACEMENT IMPLANTS MARKET SEGMENTATION BY HIPS, KNEE, SHOULDERS AND OTHERS, The reconstructive joint replacement implant market in the US can be segmented into knee, hip, shoulder and others on the basis of the use of implant and the site of the repair. Knee implants was the largest segment with a share of ~% in terms of revenue in While the contribution of the segment has largely remained unchanged over the years, the revenues from the sales of knee implants have increased from around USD ~ million in 2008 to USD ~ million in 2013 Figure: The US Reconstructive Joint Replacement Implants Market Segmentation by Knee, Hip, Shoulder and Other Implants on the Basis of Revenue in Percentage, % 90.0% Percentage 80.0% 70.0% 60.0% 50.0% 40.0% Knees Hips Shoulders Others Table: The US Reconstructive Joint Replacement Implants Market Segmentation by Knee, Hip, Shoulder and Other Implants on the Basis of Revenue in USD Million, Implant Segment Knees

12 Hips Shoulders Others Total THE US HIP IMPLANTS MARKET SEGMENTATION, BY TYPE OF COMPONENTS, 2010 AND 2013 On the basis of the type of components, the hip implant market of the US can segmented into stem, shell/liner, head and others. Stem is the largest segment with a share of around ~% in the overall hip implant market of the US in The segment generated revenue of USD ~ million in 2013, inclining from USD ~ million in The high share of stem in the hip implant market of the US has majorly resulted from the large number of total hip replacement (THR) procedures performed in the country Figure: The US Hip Implant Market Segmentation by Type of Components on the Basis of Revenue in Percentage, 2010 and 2013P 100.0% 90.0% 80.0% 70.0% 60.0% Percentage 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Stem Shell/Liner Head Other

13 Table: The US Hip Implant Market Segmentation by Type of Components on the Basis of Revenue in USD Million, 2010 and 2013P Hip Implant Component P Stem Shell/Liner Head Other MARKET SHARES OF THE MAJOR PLAYERS IN THE US HIP IMPLANT MARKET, 2009, 2010 AND 2013 The hip implants market of the US is dominated by six leading players which account for over 90.0% of the market in terms of sales revenue. These companies include DePuy Synthes, Stryker, Zimmer, Biomet, Wright and Exactech. DePuy Synthes which is owned by Johnson & Johnson is the largest player with a market share of ~% in the domestic sales of hip implants by value in the US in 2013 Table: Market Shares of the Major Players in the US Hip Implant Market on the Basis of Revenue in Percentage, 2009, 2010 and 2013P Company P DePuy Stryker Zimmer Synthes Biomet Wright Exactech Others

14 Table: Revenues of the Major Players in the US Hip Implant Market in USD Million, 2009, 2010 and 2013P Company P DePuy Stryker Zimmer Synthes Biomet Wright Exactech Others THE US KNEE IMPLANTS MARKET SEGMENTATION, BY TYPE OF COMPONENTS, 2010 AND 2013 Knee implants can also be segmented on the basis of various components which are used as implants while performing knee replacement surgeries. On the basis of the types of components the knee implants can be categorized into Bicondylar femurs, tibia, tibial inserts, Patellas, unicondylar knees and others which include stems, wedges and hinged knees. Bicondylar femurs are the largest segment and accounted for around ~% of the knee implant market in terms of sales revenues in Around USD ~ million worth of Bicondylar femurs were sold in the US in 2013

15 Figure: The US Knee Implant Market Segmentation by Type of Components on the Basis of Revenue in Percentage, 2010 and 2013P 100.0% 90.0% 80.0% 70.0% Percentage 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% P Bicondylar Femurs Tibial Inserts Unicondylar Knees Tibia Patellas Others (stems, wedges, hinged knees) Table: The US Knee Implant Market Segmentation by Type of Component on the Basis of Revenue in Percentage, 2010 and 2013P Knee Implant Component P Bicondylar Femurs Tibia Tibial Inserts Patellas Unicondylar Knees Others (stems, wedges, hinged knees) Total

16 MARKET SHARES OF THE MAJOR PLAYERS IN THE US KNEE IMPLANT MARKET, 2009, 2010 AND 2013 The knee implant market in the US has primarily been dominated by six large implant manufacturing companies over the past few years. These companies together represent more than 90.0% of the knee implant sales in the US in terms of value. Presently DePuy Synthes is the largest player and has a market share of around ~%. DePuy acquired Synthes in 2012 and independently it had a share of around ~% and ~% in 2009 and 2010 respectively Table: Market Shares of the Major Players in the US Knee Implant Market on the Basis of Revenue in Percentage, 2009, 2010 and 2013P Company P DePuy Zimmer Stryker Biomet Synthes Wright Exactech Other Table: Revenues of the Major Players in the US Knee Implant Market in USD Million, 2009, 2010 and 2013P Company P DePuy Zimmer Stryker Biomet Synthes Wright Exactech Others

17 FUTURE OUTLOOK AND PROJECTIONS OF THE US ORTHOPEDIC IMPLANTS AND DEVICES MARKET, It was estimated that mean annual caseload per surgeon would be around 52 surgeries annually by 2010; while by 2030 the annual caseload per surgeon was anticipated would triple to 167. The overall orthopedic implants and devices market of the US is projected to surge to around USD ~ million in 2018 from USD ~ million in 2013 by expanding at a CAGR of ~% during the forecast period of In 2014 the market is estimated to reach USD ~ million by experiencing an annual growth of ~% over Figure: The US Orthopedic Implants and Devices Market Future Projections by Value on the Basis of Revenues in USD Million, USD Million 35, , , , , , , , , , Table: The US Orthopedic Implants and Devices Market Segmentation and Projections by Implants and Devices on the Basis of Revenue in USD Million, Implant Segment Implants

18 Equipments/Devices Total Table: The US Orthopedic Implants Market Segmentation and Projections by Type of Implants on the Basis of Revenue in Percentage, Implant Segment Reconstructive Joint Replacements Spinal Implants Trauma Implants Orthobiologics Bone Cement and Accessories Extremities Others Total

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