MediPoint: Total Shoulder Replacement - US 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.

This report focuses on TSR market in the US. 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. With manufacturers’ continuous innovation in implant development and fueling interest in reverse shoulder in the orthopedic community, the market revenue of total shoulder replacement is expected to experience further increase across the globe.

Scope

- An overview of arthritis, which includes epidemiology, etiology, symptoms, diagnosis, pathology and treatment guidelines.
- Annualized US 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 US TSR Market.
- Realize device preferences of physicians who have performed the tests already.
- Access market sizing, forecasts and quantified growth opportunities in the US 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 US TSR market landscape? Identify, understand and capitalize.

Table Of Contents

1 Table of Contents
1 Table of Contents 7


2 Introduction 24
2.1 Catalyst 25
3 Disease Overview 26
3.1 Anatomy and Physiology 26
3.2 Pathophysiology 28
3.2.1 Overview 28
3.2.2 Primary Osteoarthritis 28
3.2.3 Rotator Cuff Tear Arthropathy 29
3.2.4 Post-Traumatic Arthritis 31
3.2.5 Proximal Humerus Fracture 31
3.2.6 Avascular Necrosis 33
3.2.7 Rheumatoid Arthritis 34
3.3 Clinical Presentation 35
3.3.1 Diagnosis 35
3.4 Clinical Outcomes 36
3.4.1 Overview 36
3.4.2 Conservative Treatments 36
3.4.3 Joint-Preserving Treatments 37
3.4.4 Joint Replacement 39
3.5 Epidemiology 50
3.5.1 Shoulder Arthritis 50
3.5.2 Proximal Humerus Fractures 52
3.6 Economic Impact 53
3.6.1 Shoulder Arthritis 53
3.6.2 Rotator Cuff Diseases 55
3.6.3 Proximal Humerus Fractures 55
3.6.4 Cost-Effectiveness of Total Shoulder Replacement 56
3.6.5 Cost-Effectiveness of Reverse Total Shoulder Replacement 56
4 Competitive Assessment 57
4.1 Overview 57
4.2 Anatomic Total Shoulder Replacement 61
4.2.1 Univers II (Arthrex) 61
4.2.2 Comprehensive (Biomet) 63
4.2.3 Comprehensive Fracture (Biomet) 65
4.2.4 Global Advantage (DePuy Synthes) 68
4.2.5 Global Fx (DePuy Synthes) 72
4.2.6 Global AP (DePuy Synthes) 74
4.2.7 Global Unite (DePuy Synthes) 77
4.2.8 Turon (DJO Surgical) 79
4.2.9 Equinoxe (Exactech) 82
4.2.10 TITAN (Integra LifeSciences) 84
4.2.11 SMR (Lima Corporate) 86
4.2.12 Cofield 2 (Smith and Nephew) 89
4.2.13 Neer 3 (Smith and Nephew) 92
4.2.14 Promos Standard (Smith and Nephew) 95
4.2.15 Solar (Stryker) 97
4.2.16 ReUnion (Stryker) 99
4.2.17 Aequalis Primary (Tornier) 101
4.2.18 Aequalis Fracture (Tornier) 104
4.2.19 Affiniti (Tornier) 106
4.2.20 Aequalis Ascend (Tornier) 109
4.2.21 Bigliani/Flatow (Zimmer) 111
4.2.22 Anatomical (Zimmer) 114
4.2.23 Trabecular Metal (Zimmer) 116
4.3 Anatomic Stemless Total Shoulder Replacement 120
4.3.1 Eclipse (Arthrex) 120
4.3.2 T.E.S.S. (Total Evolutive Shoulder System) Anatomic (Biomet) 122
4.3.3 Comprehensive Nano (Biomet) 125
4.3.4 Simpliciti (Tornier) 127
4.3.5 InSpyre (Tornier) 130
4.3.6 Sidus (Zimmer) 132
4.4 Reverse Total Shoulder Replacement 135
4.4.1 Univers Revers (Arthrex) 135
4.4.2 T.E.S.S. (Total Evolutive Shoulder System) Reverse (Biomet) 137
4.4.3 Comprehensive Reverse (Biomet) 140
4.4.4 Delta Xtend (DePuy Synthes) 142
4.4.5 Reverse Shoulder Prosthesis (RSP) (DJO Surgical) 145
4.4.6 Equinoxe Reverse (Exactech) 148
4.4.7 SMR Reverse (Lima Corporate) 151
4.4.8 Promos Reverse (Smith and Nephew) 154
4.4.9 Aequalis Reversed II (Tornier) 156
4.4.10 Aequalis Reversed Fracture (Tornier) 159
4.4.11 Ascend Flex (Tornier) 161
4.4.12 Anatomical Reverse (Zimmer) 163
4.4.13 Trabecular Metal Reverse (Zimmer) 165
5 Unmet Needs 168
5.1 Durable Glenoid Components 168
5.2 Augmented Glenoid Components 171
5.3 Grammont-Style versus Frankle-Style 172
5.4 Addressing Complications of Reverse Shoulder Replacement 174
5.5 Bone-Sparing Stemless Designs: Pros and Cons 176
5.6 Revision Systems 179
5.7 Long-Term Follow-Up 180
5.8 Patient Awareness in Emerging Markets 181
6 Pipeline Products 182
6.1 Overview 182
6.2 aSpire Total Shoulder Replacement System (Shoulder Options) 183
6.2.1 Overview 183
6.2.2 SWOT Analysis 184
6.3 Luna Stemless Humeral Prosthesis (Shoulder Options) 185
6.3.1 Overview 185
6.3.2 SWOT Analysis 187
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 195
7.2.1 Regulation 195
7.2.2 Adoption 196
7.2.3 Procurement 197
7.3 Reimbursement Trends 199
7.4 Regulatory Issues/Recalls 203
7.4.1 Lima Corporate’s SMR Anatomic Polyethylene Liner 203
7.5 Mergers and Acquisitions/Key Partnerships 204
7.5.1 Integra LifeSciences Acquires Ascension Orthopedics 204
8 Current and Future Players 205
8.1 Trends in Corporate Strategy 205
8.2 Company Profiles 206
8.2.1 DePuy Synthes 206
8.2.2 Tornier N.V. 210
8.2.3 Biomet 214
8.2.4 Zimmer Holdings 218
8.2.5 Exactech 222
8.2.6 Smith and Nephew 225
8.2.7 Stryker 228
8.2.8 DJO Global 231
8.2.9 Arthrex 234
8.2.10 Integra LifeSciences 236
8.2.11 Wright Medical Group 239
8.2.12 Lima Corporate S.p.a. 242
8.2.13 Other Companies 244
9 Market Drivers and Opportunities 245
9.1 Market Drivers 245
9.1.1 Rising Prevalence of Shoulder Diseases 245
9.1.2 Expanded Indications of Reverse Shoulder Replacement 246
9.1.3 Increased Patient Awareness 247
9.1.4 Availability of Long-Term Clinical Data 248
9.1.5 Corporate Promotions and Medical Education 249
9.1.6 Expected Launch of New Devices in the US 249
9.2 Opportunities 250
9.2.1 Pyrocarbon 250
9.2.2 Revision Instrumentation 251
9.2.3 Demand for a Comprehensive Shoulder Reconstruction Portfolio 251
9.2.4 Computer-Assisted Navigation 252
9.2.5 Procedure-Specific Patient Education Platform 253
9.2.6 Emerging Markets 253
9.3 Market Barriers 254
9.3.1 Postoperative Complications 254
9.3.2 Steep Learning Curve 255
9.3.3 Cost 256
9.3.4 Reimbursement 257
9.3.5 Medical Device Excise Tax 258
9.3.6 Substitutes 258
10 Country Outlooks and Forecasts 260
11 Appendix 263
11.1 Abbreviations 263
11.2 Bibliography 264
11.3 Report Methodology 281
11.3.1 Overview 281
11.3.2 Coverage 281
11.3.3 Secondary Research 282
11.3.4 Forecasting Methodology 282
11.3.5 Primary Research - Key Opinion Leader Interviews 284
11.3.6 Expert Panel Validation 284
11.4 Physicians and Specialists Included in this Study 285
11.5 About the Authors 287
11.5.1 Analysts 287
11.5.2 Bonnie Bain, Ph.D., Global Head of Healthcare 288
11.6 About MediPoint 289
11.7 About GlobalData 289
11.8 Disclaimer 289

1.1 List of Tables
Table 1: Walch Classification of Glenoid Wear Associated with Primary Osteoarthritis 29
Table 2: Clinical Symptoms and Descriptions 35
Table 3: Major Indications and Contraindications for Humeral Head Resurfacing 40
Table 4: Major Indications and Contraindications for Stemmed Partial Shoulder Replacement 43
Table 5: Major Indications and Contraindications for Anatomic Total Shoulder Replacement 46
Table 6: Major Indications and Contraindications for Anatomic Total Shoulder Replacement 49
Table 7: Shoulder Arthritis Prevalence in the US (2013-2019) 50
Table 8: Proximal Humerus Fracture Prevalence in the US (2013-2019) 52
Table 9: Direct and Indirect Costs of Arthritis 54
Table 10: Currently Marketed Anatomic Total Shoulder Replacement Implants 59
Table 11: Currently Marketed Anatomic Stemless Shoulder Replacement Implants 60
Table 12: Currently Marketed Reverse Total Shoulder Replacement Implants 60
Table 13: Product Profile - Univers II 62
Table 14: SWOT Analysis - Univers II 63
Table 15: Product Profile - Comprehensive 64
Table 16: SWOT Analysis - Comprehensive 65
Table 17: Product Profile - Comprehensive Fracture 66
Table 18: List of Clinical Studies - Comprehensive Fracture 67
Table 19: SWOT Analysis - Comprehensive Fracture 67
Table 20: Product Profile - Global Advantage 70
Table 21: List of Clinical Studies - Global Anchor Peg Glenoid 71
Table 22: SWOT Analysis - Global Advantage 71
Table 23: Product Profile - Global Fx 73
Table 24: SWOT Analysis - Global Fx 74
Table 25: Product Profile - Global AP 75
Table 26: List of Clinical Studies - Global AP 76
Table 27: SWOT Analysis - Global AP 76
Table 28: Product Profile - Global Unite 78
Table 29: SWOT Analysis - Global Unite 79
Table 30: Product Profile - Turon 81
Table 31: SWOT Analysis - Turon 81
Table 32: Product Profile - Equinoxe 83
Table 33: SWOT Analysis - Equinoxe 84
Table 34: Product Profile - TITAN 85
Table 35: SWOT Analysis - TITAN 86
Table 36: Product Profile - SMR 87
Table 37: List of Clinical Studies - SMR 88
Table 38: SWOT Analysis - SMR 88
Table 39: Product Profile - Cofield 2 90
Table 40: List of Clinical Studies - Cofield 2 90
Table 41: SWOT Analysis - Cofield 2 91
Table 42: Product Profile - Neer 3 93
Table 43: SWOT Analysis - Neer 3 94
Table 44: Product Profile - Promos Standard 96
Table 45: List of Clinical Studies - Promos Standard 96
Table 46: SWOT Analysis - Promos Standard 97
Table 47: Product Profile - Solar 98
Table 48: SWOT Analysis - Solar 99
Table 49: Product Profile - ReUnion 100
Table 50: SWOT Analysis - ReUnion 100
Table 51: Product Profile - Aequalis Primary 102
Table 52: List of Clinical Studies - Aequalis Primary 103
Table 53: SWOT Analysis - Aequalis Primary 103
Table 54: Product Profile - Aequalis Fracture 105
Table 55: List of Clinical Studies - Aequalis Fracture 105
Table 56: SWOT Analysis - Aequalis Fracture 106
Table 57: Product Profile - Affiniti 108
Table 58: List of Clinical Studies - Affiniti 108
Table 59: SWOT Analysis - Affiniti 109
Table 60: Product Profile - Aequalis Ascend 110
Table 61: SWOT Analysis - Aequalis Ascend 111
Table 62: Product Profile - Bigliani/Flatow 112
Table 63: List of Clinical Studies - Bigliani/Flatow 113
Table 64: SWOT Analysis - Bigliani/Flatow 113
Table 65: Product Profile - Anatomical 115
Table 66: SWOT Analysis - Anatomical 116
Table 67: Product Profile - Trabecular Metal 118
Table 68: List of Clinical Studies - Trabecular Metal 118
Table 69: SWOT Analysis - Trabecular Metal 119
Table 70: Product Profile - Eclipse 121
Table 71: List of Clinical Studies - Eclipse 121
Table 72: SWOT Analysis - Eclipse 122
Table 73: Product Profile - T.E.S.S. Anatomic 123
Table 74: List of Clinical Studies - T.E.S.S. Anatomic 124
Table 75: SWOT Analysis - T.E.S.S. Anatomic 125
Table 76: Product Profile - Comprehensive Nano 126
Table 77: SWOT Analysis - Compressive Nano 127
Table 78: Product Profile - Simpliciti 128
Table 79: List of Clinical Studies - Simpliciti 129
Table 80: SWOT Analysis - Simpliciti 129
Table 81: Product Profile - InSpyre 131
Table 82: SWOT Analysis - InSpyre 131
Table 83: Product Profile - Sidus 133
Table 84: List of Clinical Studies - Sidus 133
Table 85: SWOT Analysis - Sidus 134
Table 86: Product Profile - Univers Revers 136
Table 87: List of Clinical Studies - Univers Revers 136
Table 88: SWOT Analysis - Univers Reverse 137
Table 89: Product Profile - T.E.S.S. Reverse 138
Table 90: List of Clinical Studies - T.E.S.S. Reverse 139
Table 91: SWOT Analysis - T.E.S.S. Reverse 139
Table 92: Product Profile - Comprehensive Reverse 141
Table 93: SWOT Analysis - Comprehensive Reverse 142
Table 94: Product Profile - Delta Xtend 143
Table 95: List of Clinical Studies - Delta Xtend 144
Table 96: SWOT Analysis - Delta Xtend 144
Table 97: Product Profile - Reverse Shoulder Prosthesis (RSP) 146
Table 98: List of Clinical Studies - Reverse Shoulder Prosthesis (RSP) 147
Table 99: SWOT Analysis - Reverse Shoulder Prosthesis (RSP) 148
Table 100: Product Profile - Equinoxe Reverse 149
Table 101: List of Clinical Studies - Equinoxe Reverse 150
Table 102: SWOT Analysis - Equinoxe Reverse 150
Table 103: Product Profile - SMR Reverse 152
Table 104: List of Clinical Studies - SMR Reverse 153
Table 105: SWOT Analysis - SMR Reverse 153
Table 106: Product Profile - Promos Reverse 155
Table 107: List of Clinical Studies - Promos Reverse 155
Table 108: SWOT Analysis - Promos Reverse 156
Table 109: Product Profile - Aequalis Reversed II 157
Table 110: List of Clinical Studies - Aequalis Reversed II 158
Table 111: SWOT Analysis - Aequalis Reversed II 158
Table 112: Product Profile - Aequalis Reversed Fracture 160
Table 113: List of Clinical Studies - Aequalis Reversed Fracture 160
Table 114: SWOT Analysis - Aequalis Reversed Fracture 161
Table 115: Product Profile - Ascend Flex 162
Table 116: SWOT Analysis - Ascend Flex 163
Table 117: Product Profile - Anatomical Reverse 164
Table 118: SWOT Analysis - Anatomical Reverse 165
Table 119: Product Profile - Trabecular Metal Reverse 166
Table 120: List of Clinical Studies - Trabecular Metal Reverse 167
Table 121: SWOT Analysis - Trabecular Metal Reverse 167
Table 122: Currently Marketed Grammont-Style and Frankle-Style Reverse Shoulder Implants 173
Table 123: Major Pipeline Products in Total Shoulder Replacement Market, 2013 182
Table 124: Product Profile - aSpire 183
Table 125: SWOT Analysis - aSpire 184
Table 126: Product Profile - Luna 186
Table 127: SWOT Analysis - Luna 187
Table 128: Product Profile - AFT 188
Table 129: SWOT Analysis - AFT 189
Table 130: Medicare Coding Guide for Shoulder Arthroplasty - 2013 199
Table 131: 2013 Medicare National Payment Average for Shoulder Arthroplasty 201
Table 132: Company Profile - DePuy Synthes 206
Table 133: DePuy Synthes’ Shoulder Portfolio Assessment, 2013 208
Table 134: DePuy Synthes’ SWOT Analysis, 2013 209
Table 135: Company Profile - Tornier N.V. 210
Table 136: Tornier’s Shoulder Portfolio Assessment, 2013 212
Table 137: Tornier's SWOT Analysis, 2013 213
Table 138: Company Profile - Biomet 214
Table 139: Biomet’s Shoulder Portfolio Assessment, 2013 216
Table 140: Biomet’s SWOT Analysis, 2013 217
Table 141: Company Profile - Zimmer Holdings 219
Table 142: Zimmer Holdings’ Shoulder Portfolio Assessment, 2013 220
Table 143: Zimmer Holdings’ SWOT Analysis, 2013 221
Table 144: Company Profile - Exactech 222
Table 145: Exactech’s Shoulder Portfolio Assessment, 2013 223
Table 146: Exactech's SWOT Analysis, 2013 224
Table 147: Company Profile - Smith and Nephew 226
Table 148: Smith and Nephew’s Shoulder Portfolio Assessment, 2013 227
Table 149: Smith and Nephew’s SWOT Analysis, 2013 227
Table 150: Company Profile - Stryker 228
Table 151: Stryker’s Shoulder Portfolio Assessment, 2013 229
Table 152: Stryker's SWOT Analysis, 2013 230
Table 153: Company Profile - DJO Global 231
Table 154: DJO Global’s Shoulder Portfolio Assessment, 2013 232
Table 155: DJO Global's SWOT Analysis, 2013 233
Table 156: Company Profile - Arthrex 234
Table 157: Arthrex’s Shoulder Portfolio Assessment, 2013 235
Table 158: Arthrex's SWOT Analysis, 2013 235
Table 159: Company Profile - Integra LifeSciences 236
Table 160: Integra LifeSciences’ Shoulder Portfolio Assessment, 2013 237
Table 161: Integra LifeSciences' SWOT Analysis, 2013 238
Table 162: Company Profile - Wright Medical Group 240
Table 163: Wright Medical Group’s Shoulder Portfolio Assessment, 2013 240
Table 164: Wright Medical Group's SWOT Analysis, 2013 241
Table 165: Company Profile - Lima Corporate S.p.a. 242
Table 166: Lima Corporate S.p.a.’s Shoulder Portfolio Assessment, 2013 243
Table 167: Lima Corporate S.p.a.'s SWOT Analysis, 2013 243
Table 168: Other Companies in the Global Shoulder Replacement Market, 2013 244
Table 169: Sales Forecasts for TSR in the US (2012-2019) 260

1.2 List of Figures
Figure 1: Schematic Diagram of Shoulder Anatomy 26
Figure 2: Schematic Diagram of Rotator Cuff 27
Figure 3: Wide Spectrum of Disease Seen in Rotator Cuff Tear Arthropathy 30
Figure 4: Neer Classification of Proximal Humerus Fractures 32
Figure 5: Four-Part and Three-Part Proximal Humerus Fractures 33
Figure 6: An Example of Humeral Head Resurfacing 40
Figure 7: An Example of Stemmed Partial Shoulder Replacement 43
Figure 8: An Example of Anatomic Total Shoulder Replacement 46
Figure 9: An Example of Reverse Total Shoulder Replacement 47
Figure 10: Shoulder Arthritis Prevalence in the US 51
Figure 11: Proximal Humerus Fracture Prevalence in the US 52
Figure 12: Product Image - Univers II 61
Figure 13: Product Image - Univers Glenoid Components 62
Figure 14: Product Image - Comprehensive 64
Figure 15: Product Image - Comprehensive Fracture 66
Figure 16: Product Image - Global Advantage 69
Figure 17: Product Image - Global Steptech Anchor Peg Glenoid 69
Figure 18: Product Image - Global Fx 72
Figure 19: Product Image - Global AP 75
Figure 20: Product Image - Global Unite 77
Figure 21: Product Image - Turon 80
Figure 22: Product Image - Equinoxe Primary 82
Figure 23: Product Image - Equinoxe Fracture 83
Figure 24: Product Image - TITAN 85
Figure 25: Product Image - SMR (Anatomic and Fracture) 87
Figure 26: Product Image - Cofield 2 89
Figure 27: Product Image - Neer 3 93
Figure 28: Product Image - Promos Standard 95
Figure 29: Product Image - Solar 98
Figure 30: Product Image - ReUnion 99
Figure 31: Product Image - Aequalis Primary 101
Figure 32: Product Image - Aequalis Fracture 104
Figure 33: Product Image - Affiniti 107
Figure 34: Product Image - Cortiloc Glenoid 107
Figure 35: Product Image - Aequalis Ascend 110
Figure 36: Product Image - Bigliani/Flatow 112
Figure 37: Product Image - Anatomical Primary 114
Figure 38: Product Image - Anatomical Fracture 115
Figure 39: Product Image - Trabecular Metal 117
Figure 40: Product Image - Eclipse 120
Figure 41: Product Image - T.E.S.S. Anatomic 123
Figure 42: Product Image - Comprehensive Nano 126
Figure 43: Product Image - Simpliciti 128
Figure 44: Product Image - InSpyre 130
Figure 45: Product Image - Sidus 132
Figure 46: Product Image - Univers Revers 135
Figure 47: Product Image - T.E.S.S. Reverse 137
Figure 48: Product Image - Comprehensive Reverse 141
Figure 49: Product Image - Delta Xtend 143
Figure 50: Product Image - Reverse Shoulder Prosthesis (RSP) 145
Figure 51: Product Image - RSP Monoblock 146
Figure 52: Product Image - Equinoxe Reverse 149
Figure 53: Product Image - SMR Reverse and SMR Reverse HP 151
Figure 54: Product Image - Promos Reverse 154
Figure 55: Product Image - Aequalis Reversed II 157
Figure 56: Product Image - Aequalis Reversed Fracture 159
Figure 57: Product Image - Ascend Flex 162
Figure 58: Product Image - Anatomical Reverse 164
Figure 59: Product Image - Trabecular Metal Reverse 166
Figure 60: Product Image - aSpire 183
Figure 61: Product Image - Luna 185
Figure 62: Product Image - Luna Anchored 186
Figure 63: Product Image - AFT 188
Figure 64: Shoulder Replacement Procedure Volume in the US (1993-2008) 191
Figure 65: Shoulder Replacement Procedure Volume in the US (2010-2019) 192
Figure 66: Anatomic and Reverse Total Shoulder Replacement Procedure Volumes in the US (2010-2019) 194
Figure 67: Adoption Trend of Shoulder Replacement in the US, 2013 and 2019 196
Figure 68: Changes in Implant Cost, Surgeon and Hospital Reimbursement for Total Shoulder Replacement (2008-2013) 200
Figure 69: Sales Forecasts for TSR Market in the US (2010-2019) 261
Figure 70: US TSR Market Competitive Landscape, 2013 262

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