MediPoint: Total Shoulder Replacement - EU Analysis and Market Forecasts



Summary



Compared with the more mature reconstruction markets, such as hip and knee replacements, shoulder reconstruction is developing as a specialty. Current market growth in shoulder reconstruction is mainly driven by total shoulder replacement (TSR), which comprises anatomic total and reverse total shoulder replacements. Although sluggish economic growth has hindered the large-joint replacement market in the United States and Europe, the global TSR market has seen a promising growth rate in the past few years. This healthy growth can be attributed to an increasing patient population, an improved surgeon adoption of reverse shoulder implants, as well as evolving insurance and reimbursement landscape.

GlobalData evaluated currently marketed TSR prostheses, identified the unmet needs in the market, and provided an understanding of surgeon perception of the latest advances within the shoulder community. Over the forecast period, despite the dampening effect of downward pricing pressure, the TSR market is expected to enjoy healthy growth, primarily driven by the trend of active aging, continuous medical education efforts from the supply side, the introduction of additional reverse shoulder implants and the FDA’s approval of modern stemless designs. In particular, the market size of reverse TSR is expected to grow at a much faster pace compared with anatomic TSR.

Although sluggish economic growth has hindered the large-joint replacement market in Europe, the global total shoulder replacement market has seen a promising growth rate in the past few years. This healthy growth can be attributed to an increasing patient population, an improved surgeon adoption of reverse shoulder implants, as well as well-established insurance and reimbursement landscape. This report focuses on TSR market in 5 countries: France, Germany, Italy, Spain, and the UK.



Scope


- An overview of arthritis, which includes epidemiology, etiology, symptoms, diagnosis, pathology and treatment guidelines.
- Annualized EU TSR market revenue and future forecasts from 2009 to 2011, forecast for 7 years to 2018.
- Investigation of current and future market competition for TSR
- Insightful review of the key industry drivers, restraints and challenges as well as predicted impact of key events.
- Competitor assessment including device approval analysis and device sales forecasts.
- Marketed and pipeline product profiles covering efficiency, safety, clinical study details, device approvals, product positioning and device sales forecast.
- Analysis of unmet needs within the market and opportunities for future players.
- Technology trends evaluation to assess strength of pipeline.
- An overview of all devices in development including clinical study details, design and material selection considerations, efficacy reports, and device approval timelines.
- Company profiles including business description, financial overview and SWOT analysis.
- Coverage of key market players.
- Strategic assessment of the TSR sector through market impact analysis, future market scenario and company analysis.
- Direct quotes from Key Opinion Leaders (KOL) as well as Orthopedic Surgeon



Reasons to buy


- Understand the trends shaping and driving the EU TSR Market.
- Realize device preferences of physicians who have performed the tests already.
- Access market sizing, forecasts and quantified growth opportunities in the EU TSR market through 2018.
- Quantify candidate patient populations to better design product pricing & launch plans.
- Drive revenues, formulate effective sales and marketing strategies and gain in-depth understanding of the competitive landscape.
- Perform benchmarking analysis of growth opportunities against currently marketed products.
- Assess competitiveness of products in market by understanding the strengths and weaknesses of current competition.
- Take a comprehensive look at the market’s device pipeline and identify promising, paradigm-shifting products.
- Create an effective counter-strategy to gain a competitive advantage against those currently in the market.
- Organize your sales and marketing efforts by identifying the market categories and segments that present the best opportunities for growth.
- What’s the next big thing in EU TSR market landscape? Identify, understand and capitalize.

Table Of Contents

1 Table of Contents
1 Table of Contents 7
1.1 List of Tables 14
1.2 List of Figures 21
2 Introduction 25
2.1 Catalyst 26
3 Disease Overview 27
3.1 Anatomy and Physiology 27
3.2 Pathophysiology 29
3.2.1 Overview 29
3.2.2 Primary Osteoarthritis 29
3.2.3 Rotator Cuff Tear Arthropathy 30
3.2.4 Post-Traumatic Arthritis 32
3.2.5 Proximal Humerus Fracture 32
3.2.6 Avascular Necrosis 34
3.2.7 Rheumatoid Arthritis 35
3.3 Clinical Presentation 36
3.3.1 Diagnosis 36
3.4 Clinical Outcomes 37
3.4.1 Overview 37
3.4.2 Conservative Treatments 37
3.4.3 Joint-Preserving Treatments 38
3.4.4 Joint Replacement 40
3.5 Epidemiology 51
3.5.1 Shoulder Arthritis 51
3.5.2 Proximal Humerus Fractures 52
3.6 Economic Impact 54
3.6.1 Shoulder Arthritis 54
3.6.2 Rotator Cuff Diseases 56
3.6.3 Proximal Humerus Fractures 56
3.6.4 Cost-Effectiveness of Total Shoulder Replacement 57
3.6.5 Cost-Effectiveness of Reverse Total Shoulder Replacement 57
4 Competitive Assessment 58
4.1 Overview 58
4.2 European Market Share 62
4.3 Anatomic Total Shoulder Replacement 63
4.3.1 Univers II (Arthrex) 63
4.3.2 Comprehensive (Biomet) 65
4.3.3 Comprehensive Fracture (Biomet) 67
4.3.4 Global Advantage (DePuy Synthes) 70
4.3.5 Global Fx (DePuy Synthes) 74
4.3.6 Global AP (DePuy Synthes) 76
4.3.7 Global Unite (DePuy Synthes) 79
4.3.8 Turon (DJO Surgical) 81
4.3.9 Equinoxe (Exactech) 84
4.3.10 TITAN (Integra LifeSciences) 86
4.3.11 SMR (Lima Corporate) 88
4.3.12 Cofield 2 (Smith and Nephew) 91
4.3.13 Neer 3 (Smith and Nephew) 94
4.3.14 Promos Standard (Smith and Nephew) 97
4.3.15 Solar (Stryker) 99
4.3.16 ReUnion (Stryker) 101
4.3.17 Aequalis Primary (Tornier) 103
4.3.18 Aequalis Fracture (Tornier) 106
4.3.19 Affiniti (Tornier) 108
4.3.20 Aequalis Ascend (Tornier) 111
4.3.21 Bigliani/Flatow (Zimmer) 113
4.3.22 Anatomical (Zimmer) 116
4.3.23 Trabecular Metal (Zimmer) 118
4.4 Anatomic Stemless Total Shoulder Replacement 122
4.4.1 Eclipse (Arthrex) 122
4.4.2 T.E.S.S. (Total Evolutive Shoulder System) Anatomic (Biomet) 124
4.4.3 Comprehensive Nano (Biomet) 127
4.4.4 Simpliciti (Tornier) 129
4.4.5 InSpyre (Tornier) 132
4.4.6 Sidus (Zimmer) 134
4.5 Reverse Total Shoulder Replacement 137
4.5.1 Univers Revers (Arthrex) 137
4.5.2 T.E.S.S. (Total Evolutive Shoulder System) Reverse (Biomet) 139
4.5.3 Comprehensive Reverse (Biomet) 142
4.5.4 Delta Xtend (DePuy Synthes) 144
4.5.5 Reverse Shoulder Prosthesis (RSP) (DJO Surgical) 147
4.5.6 Equinoxe Reverse (Exactech) 150
4.5.7 SMR Reverse (Lima Corporate) 153
4.5.8 Promos Reverse (Smith and Nephew) 156
4.5.9 Aequalis Reversed II (Tornier) 158
4.5.10 Aequalis Reversed Fracture (Tornier) 161
4.5.11 Ascend Flex (Tornier) 163
4.5.12 Anatomical Reverse (Zimmer) 165
4.5.13 Trabecular Metal Reverse (Zimmer) 167
5 Unmet Needs 170
5.1 Durable Glenoid Components 170
5.2 Augmented Glenoid Components 173
5.3 Grammont-Style versus Frankle-Style 174
5.4 Addressing Complications of Reverse Shoulder Replacement 176
5.5 Bone-Sparing Stemless Designs: Pros and Cons 178
5.6 Revision Systems 181
5.7 Long-Term Follow-Up 182
6 Pipeline Products 184
6.1 Overview 184
6.2 aSpire Total Shoulder Replacement System (Shoulder Options) 185
6.2.1 Overview 185
6.2.2 SWOT Analysis 186
6.3 Luna Stemless Humeral Prosthesis (Shoulder Options) 186
6.3.1 Overview 186
6.3.2 SWOT Analysis 188
6.4 AFT Proximal Humerus Fracture Prosthesis (Shoulder Options) 188
6.4.1 Overview 188
6.4.2 SWOT Analysis 189
6.5 Others 190
6.5.1 Stryker’s Reverse Shoulder Implant 190
6.5.2 Tornier’s Patient-Specific Image-Driven Glenoid Replacement Device 190
6.5.3 Integra’s Reverse Shoulder Implant 190
6.5.4 Integra’s PYROHEMI 190
7 Industry Overview 191
7.1 Procedure Trends 191
7.2 Market Access 194
7.2.1 Regulation 194
7.2.2 Adoption 195
7.3 Reimbursement Trends 197
7.3.1 France 198
7.3.2 Germany 199
7.3.3 Italy 200
7.3.4 Spain 200
7.3.5 UK 201
7.4 Regulatory Issues/Recalls 201
7.4.1 Lima Corporate’s SMR Anatomic Polyethylene Liner 201
7.5 Mergers and Acquisitions/Key Partnerships 202
7.5.1 Integra LifeSciences Acquires Ascension Orthopedics 202
8 Current and Future Players 203
8.1 Trends in Corporate Strategy 203
8.2 Company Profiles 203
8.2.1 DePuy Synthes 203
8.2.2 Tornier N.V. 206
8.2.3 Zimmer Holdings 209
8.2.4 Biomet 213
8.2.5 Lima Corporate S.p.a. 217
8.2.6 Arthrex 219
8.2.7 Stryker 221
8.2.8 Smith and Nephew 224
8.2.9 Integra LifeSciences 227
8.2.10 Exactech 230
8.2.11 DJO Global 233
8.2.12 Mathys Ltd Bettlach 236
8.2.13 Wright Medical Group 238
8.2.14 Other Companies 241
9 Market Drivers and Opportunities 242
9.1 Market Drivers 242
9.1.1 Rising Prevalence of Shoulder Diseases 242
9.1.2 Expanded Indications of Reverse Shoulder Replacement 243
9.1.3 Increased Patient Awareness 244
9.1.4 Availability of Long-Term Clinical Data 245
9.1.5 Corporate Promotions and Medical Education 246
9.1.6 Expected Launch of New Devices 246
9.2 Opportunities 247
9.2.1 Pyrocarbon 247
9.2.2 Revision Instrumentation 248
9.2.3 Demand for a Comprehensive Shoulder Reconstruction Portfolio 248
9.2.4 Computer-Assisted Navigation 249
9.2.5 Procedure-Specific Patient Education Platform 250
9.2.6 Emerging Markets 250
9.3 Market Barriers 251
9.3.1 Postoperative Complications 251
9.3.2 Steep Learning Curve 252
9.3.3 Reimbursement 253
9.3.4 Substitutes 253
10 Country Outlooks and Forecasts 255
10.1 Major Markets Overview 255
10.2 France 257
10.3 Germany 259
10.4 Italy 261
10.5 Spain 263
10.6 UK 265
11 Appendix 267
11.1 Abbreviations 267
11.2 Bibliography 268
11.3 Report Methodology 286
11.3.1 Overview 286
11.3.2 Coverage 286
11.3.3 Secondary Research 287
11.3.4 Forecasting Methodology 287
11.3.5 Primary Research - Key Opinion Leader Interviews 289
11.3.6 Expert Panel Validation 289
11.4 Physicians and Specialists Included in this Study 290
11.5 About the Authors 292
11.5.1 Analysts 292
11.5.2 Bonnie Bain, Ph.D., Global Head of Healthcare 293
11.6 About MediPoint 294
11.7 About GlobalData 294
11.8 Disclaimer 294

1.1 List of Tables

Table 1: Walch Classification of Glenoid Wear Associated with Primary Osteoarthritis 30
Table 2: Clinical Symptoms and Descriptions 36
Table 3: Major Indications and Contraindications for Humeral Head Resurfacing 41
Table 4: Major Indications and Contraindications for Stemmed Partial Shoulder Replacement 44
Table 5: Major Indications and Contraindications for Anatomic Total Shoulder Replacement 47
Table 6: Major Indications and Contraindications for Anatomic Total Shoulder Replacement 50
Table 7: Shoulder Arthritis Prevalence in 5EU Countries (2013-2019) 51
Table 8: Proximal Humerus Fracture Prevalence in 5EU Countries (2013-2019) 53
Table 9: Direct and Indirect Costs of Arthritis 55
Table 10: Currently Marketed Anatomic Total Shoulder Replacement Implants 60
Table 11: Currently Marketed Anatomic Stemless Shoulder Replacement Implants 61
Table 12: Currently Marketed Reverse Total Shoulder Replacement Implants 61
Table 13: Product Profile - Univers II 64
Table 14: SWOT Analysis - Univers II 65
Table 15: Product Profile - Comprehensive 66
Table 16: SWOT Analysis - Comprehensive 67
Table 17: Product Profile - Comprehensive Fracture 68
Table 18: List of Clinical Studies - Comprehensive Fracture 69
Table 19: SWOT Analysis - Comprehensive Fracture 69
Table 20: Product Profile - Global Advantage 72
Table 21: List of Clinical Studies - Global Anchor Peg Glenoid 73
Table 22: SWOT Analysis - Global Advantage 73
Table 23: Product Profile - Global Fx 75
Table 24: SWOT Analysis - Global Fx 76
Table 25: Product Profile - Global AP 77
Table 26: List of Clinical Studies - Global AP 78
Table 27: SWOT Analysis - Global AP 78
Table 28: Product Profile - Global Unite 80
Table 29: SWOT Analysis - Global Unite 81
Table 30: Product Profile - Turon 83
Table 31: SWOT Analysis - Turon 83
Table 32: Product Profile - Equinoxe 85
Table 33: SWOT Analysis - Equinoxe 86
Table 34: Product Profile - TITAN 87
Table 35: SWOT Analysis - TITAN 88
Table 36: Product Profile - SMR 89
Table 37: List of Clinical Studies - SMR 90
Table 38: SWOT Analysis - SMR 90
Table 39: Product Profile - Cofield 2 92
Table 40: List of Clinical Studies - Cofield 2 92
Table 41: SWOT Analysis - Cofield 2 93
Table 42: Product Profile - Neer 3 95
Table 43: SWOT Analysis - Neer 3 96
Table 44: Product Profile - Promos Standard 98
Table 45: List of Clinical Studies - Promos Standard 98
Table 46: SWOT Analysis - Promos Standard 99
Table 47: Product Profile - Solar 100
Table 48: SWOT Analysis - Solar 101
Table 49: Product Profile - ReUnion 102
Table 50: SWOT Analysis - ReUnion 102
Table 51: Product Profile - Aequalis Primary 104
Table 52: List of Clinical Studies - Aequalis Primary 105
Table 53: SWOT Analysis - Aequalis Primary 105
Table 54: Product Profile - Aequalis Fracture 107
Table 55: List of Clinical Studies - Aequalis Fracture 107
Table 56: SWOT Analysis - Aequalis Fracture 108
Table 57: Product Profile - Affiniti 110
Table 58: List of Clinical Studies - Affiniti 110
Table 59: SWOT Analysis - Affiniti 111
Table 60: Product Profile - Aequalis Ascend 112
Table 61: SWOT Analysis - Aequalis Ascend 113
Table 62: Product Profile - Bigliani/Flatow 114
Table 63: List of Clinical Studies - Bigliani/Flatow 115
Table 64: SWOT Analysis - Bigliani/Flatow 115
Table 65: Product Profile - Anatomical 117
Table 66: SWOT Analysis - Anatomical 118
Table 67: Product Profile - Trabecular Metal 120
Table 68: List of Clinical Studies - Trabecular Metal 120
Table 69: SWOT Analysis - Trabecular Metal 121
Table 70: Product Profile - Eclipse 123
Table 71: List of Clinical Studies - Eclipse 123
Table 72: SWOT Analysis - Eclipse 124
Table 73: Product Profile - T.E.S.S. Anatomic 125
Table 74: List of Clinical Studies - T.E.S.S. Anatomic 126
Table 75: SWOT Analysis - T.E.S.S. Anatomic 127
Table 76: Product Profile - Comprehensive Nano 128
Table 77: SWOT Analysis - Compressive Nano 129
Table 78: Product Profile - Simpliciti 130
Table 79: List of Clinical Studies - Simpliciti 131
Table 80: SWOT Analysis - Simpliciti 131
Table 81: Product Profile - InSpyre 133
Table 82: SWOT Analysis - InSpyre 133
Table 83: Product Profile - Sidus 135
Table 84: List of Clinical Studies - Sidus 135
Table 85: SWOT Analysis - Sidus 136
Table 86: Product Profile - Univers Revers 138
Table 87: List of Clinical Studies - Univers Revers 138
Table 88: SWOT Analysis - Univers Reverse 139
Table 89: Product Profile - T.E.S.S. Reverse 140
Table 90: List of Clinical Studies - T.E.S.S. Reverse 141
Table 91: SWOT Analysis - T.E.S.S. Reverse 141
Table 92: Product Profile - Comprehensive Reverse 143
Table 93: SWOT Analysis - Comprehensive Reverse 144
Table 94: Product Profile - Delta Xtend 145
Table 95: List of Clinical Studies - Delta Xtend 146
Table 96: SWOT Analysis - Delta Xtend 146
Table 97: Product Profile - Reverse Shoulder Prosthesis (RSP) 148
Table 98: List of Clinical Studies - Reverse Shoulder Prosthesis (RSP) 149
Table 99: SWOT Analysis - Reverse Shoulder Prosthesis (RSP) 150
Table 100: Product Profile - Equinoxe Reverse 151
Table 101: List of Clinical Studies - Equinoxe Reverse 152
Table 102: SWOT Analysis - Equinoxe Reverse 152
Table 103: Product Profile - SMR Reverse 154
Table 104: List of Clinical Studies - SMR Reverse 155
Table 105: SWOT Analysis - SMR Reverse 155
Table 106: Product Profile - Promos Reverse 157
Table 107: List of Clinical Studies - Promos Reverse 157
Table 108: SWOT Analysis - Promos Reverse 158
Table 109: Product Profile - Aequalis Reversed II 159
Table 110: List of Clinical Studies - Aequalis Reversed II 160
Table 111: SWOT Analysis - Aequalis Reversed II 160
Table 112: Product Profile - Aequalis Reversed Fracture 162
Table 113: List of Clinical Studies - Aequalis Reversed Fracture 162
Table 114: SWOT Analysis - Aequalis Reversed Fracture 163
Table 115: Product Profile - Ascend Flex 164
Table 116: SWOT Analysis - Ascend Flex 165
Table 117: Product Profile - Anatomical Reverse 166
Table 118: SWOT Analysis - Anatomical Reverse 167
Table 119: Product Profile - Trabecular Metal Reverse 168
Table 120: List of Clinical Studies - Trabecular Metal Reverse 169
Table 121: SWOT Analysis - Trabecular Metal Reverse 169
Table 122: Currently Marketed Grammont-Style and Frankle-Style Reverse Shoulder Implants 175
Table 123: Major Pipeline Products in Total Shoulder Replacement Market, 2013 184
Table 124: Product Profile - aSpire 185
Table 125: SWOT Analysis - aSpire 186
Table 126: Product Profile - Luna 187
Table 127: SWOT Analysis - Luna 188
Table 128: Product Profile - AFT 189
Table 129: SWOT Analysis - AFT 189
Table 130: Company Profile - DePuy Synthes 204
Table 131: DePuy Synthes’ Shoulder Portfolio Assessment, 2013 205
Table 132: DePuy Synthes’ SWOT Analysis, 2013 206
Table 133: Company Profile - Tornier N.V. 207
Table 134: Tornier’s Shoulder Portfolio Assessment, 2013 208
Table 135: Tornier's SWOT Analysis, 2013 209
Table 136: Company Profile - Zimmer Holdings 210
Table 137: Zimmer Holdings’ Shoulder Portfolio Assessment, 2013 211
Table 138: Zimmer Holdings’ SWOT Analysis, 2013 212
Table 139: Company Profile - Biomet 213
Table 140: Biomet’s Shoulder Portfolio Assessment, 2013 215
Table 141: Biomet’s SWOT Analysis, 2013 216
Table 142: Company Profile - Lima Corporate S.p.a. 217
Table 143: Lima Corporate S.p.a.’s Shoulder Portfolio Assessment, 2013 218
Table 144: Lima Corporate S.p.a.'s SWOT Analysis, 2013 218
Table 145: Company Profile - Arthrex 219
Table 146: Arthrex’s Shoulder Portfolio Assessment, 2013 220
Table 147: Arthrex's SWOT Analysis, 2013 220
Table 148: Company Profile - Stryker 221
Table 149: Stryker’s Shoulder Portfolio Assessment, 2013 222
Table 150: Stryker's SWOT Analysis, 2013 223
Table 151: Company Profile - Smith and Nephew 225
Table 152: Smith and Nephew’s Shoulder Portfolio Assessment, 2013 226
Table 153: Smith and Nephew’s SWOT Analysis, 2013 226
Table 154: Company Profile - Integra LifeSciences 227
Table 155: Integra LifeSciences’ Shoulder Portfolio Assessment, 2013 228
Table 156: Integra LifeSciences' SWOT Analysis, 2013 229
Table 157: Company Profile - Exactech 230
Table 158: Exactech’s Shoulder Portfolio Assessment, 2013 231
Table 159: Exactech's SWOT Analysis, 2013 232
Table 160: Company Profile - DJO Global 233
Table 161: DJO Global’s Shoulder Portfolio Assessment, 2013 234
Table 162: DJO Global's SWOT Analysis, 2013 235
Table 163: Company Profile - Mathys Ltd Bettlach 236
Table 164: Mathys Ltd Bettlach’s Shoulder Portfolio Assessment, 2013 236
Table 165: Mathys Ltd Bettlach’s SWOT Analysis, 2013 237
Table 166: Company Profile - Wright Medical Group 239
Table 167: Wright Medical Group’s Shoulder Portfolio Assessment, 2013 239
Table 168: Wright Medical Group's SWOT Analysis, 2013 240
Table 169: Other Companies in the Global Shoulder Replacement Market, 2013 241
Table 170: Global Sales Forecasts for TSR in 5EU Countries (2012-2019) 255
Table 171: Sales Forecasts for TSR in France (2012-2019) 257
Table 172: Sales Forecasts for TSR in Germany (2012-2019) 259
Table 173: Sales Forecasts for TSR in Italy (2012-2019) 261
Table 174: Sales Forecasts for TSR in Spain (2012-2019) 263
Table 175: Sales Forecasts for TSR in the UK (2012-2019) 265

1.2 List of Figures

Figure 1: Schematic Diagram of Shoulder Anatomy 27
Figure 2: Schematic Diagram of Rotator Cuff 28
Figure 3: Wide Spectrum of Disease Seen in Rotator Cuff Tear Arthropathy 31
Figure 4: Neer Classification of Proximal Humerus Fractures 33
Figure 5: Four-Part and Three-Part Proximal Humerus Fractures 34
Figure 6: An Example of Humeral Head Resurfacing 41
Figure 7: An Example of Stemmed Partial Shoulder Replacement 44
Figure 8: An Example of Anatomic Total Shoulder Replacement 47
Figure 9: An Example of Reverse Total Shoulder Replacement 48
Figure 10: Shoulder Arthritis Prevalence in 5EU Countries 52
Figure 11: Proximal Humerus Fracture Prevalence in 5EU Countries 53
Figure 12: TSR Market Share in 5EU Countries (2013) 62
Figure 13: Product Image - Univers II 63
Figure 14: Product Image - Univers Glenoid Components 64
Figure 15: Product Image - Comprehensive 66
Figure 16: Product Image - Comprehensive Fracture 68
Figure 17: Product Image - Global Advantage 71
Figure 18: Product Image - Global Steptech Anchor Peg Glenoid 71
Figure 19: Product Image - Global Fx 74
Figure 20: Product Image - Global AP 77
Figure 21: Product Image - Global Unite 79
Figure 22: Product Image - Turon 82
Figure 23: Product Image - Equinoxe Primary 84
Figure 24: Product Image - Equinoxe Fracture 85
Figure 25: Product Image - TITAN 87
Figure 26: Product Image - SMR (Anatomic and Fracture) 89
Figure 27: Product Image - Cofield 2 91
Figure 28: Product Image - Neer 3 95
Figure 29: Product Image - Promos Standard 97
Figure 30: Product Image - Solar 100
Figure 31: Product Image - ReUnion 101
Figure 32: Product Image - Aequalis Primary 103
Figure 33: Product Image - Aequalis Fracture 106
Figure 34: Product Image - Affiniti 109
Figure 35: Product Image - Cortiloc Glenoid 109
Figure 36: Product Image - Aequalis Ascend 112
Figure 37: Product Image - Bigliani/Flatow 114
Figure 38: Product Image - Anatomical Primary 116
Figure 39: Product Image - Anatomical Fracture 117
Figure 40: Product Image - Trabecular Metal 119
Figure 41: Product Image - Eclipse 122
Figure 42: Product Image - T.E.S.S. Anatomic 125
Figure 43: Product Image - Comprehensive Nano 128
Figure 44: Product Image - Simpliciti 130
Figure 45: Product Image - InSpyre 132
Figure 46: Product Image - Sidus 134
Figure 47: Product Image - Univers Revers 137
Figure 48: Product Image - T.E.S.S. Reverse 139
Figure 49: Product Image - Comprehensive Reverse 143
Figure 50: Product Image - Delta Xtend 145
Figure 51: Product Image - Reverse Shoulder Prosthesis (RSP) 147
Figure 52: Product Image - RSP Monoblock 148
Figure 53: Product Image - Equinoxe Reverse 151
Figure 54: Product Image - SMR Reverse and SMR Reverse HP 153
Figure 55: Product Image - Promos Reverse 156
Figure 56: Product Image - Aequalis Reversed II 159
Figure 57: Product Image - Aequalis Reversed Fracture 161
Figure 58: Product Image - Ascend Flex 164
Figure 59: Product Image - Anatomical Reverse 166
Figure 60: Product Image - Trabecular Metal Reverse 168
Figure 61: Product Image - aSpire 185
Figure 62: Product Image - Luna 186
Figure 63: Product Image - Luna Anchored 187
Figure 64: Product Image - AFT 188
Figure 65: Shoulder Replacement Procedure Volume in 5EU (2010-2019) 192
Figure 66: Total Shoulder Replacement Procedure Volume in 5EU (2010-2019) 192
Figure 67: Anatomic and Reverse Total Shoulder Replacement Procedure Volume in 5EU (2010-2019) 194
Figure 68: Adoption Trend of Shoulder Replacement in the EU, 2013 and 2019 195
Figure 69: Global Sales Forecasts for TSR Market (2010-2019) 255
Figure 70: 5EU Market Sales for TSR by Region (2012-2019) 256
Figure 71: Sales Forecasts for TSR Market in France (2010-2019) 258
Figure 72: Sales Forecasts for TSR Market in Germany (2010-2019) 260
Figure 73: Sales Forecasts for TSR Market in Italy (2010-2019) 262
Figure 74: Sales Forecasts for TSR Market in Spain (2010-2019) 264
Figure 75: Sales Forecasts for TSR Market in the UK (2010-2019) 266

Companies Mentioned

DePuy Synthes
Tornier N.V.
Zimmer Holdings
Biomet
Lima Corporate S.p.a.
Arthrex
Stryker
Smith and Nephew
Integra LifeSciences
Exactech
DJO Global
Mathys Ltd Bettlach
Wright Medical Group

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