World Orthopedic Instrumentation Market

World Orthopedic Instrumentation Market

This report analyzes the worldwide markets for Orthopedic Instrumentation in Millions of US$. The major product segments analyzed are Reconstructive Sector (Hip Implants, Knee Implants, & Extremities), Fracture Fixation, Arthroscopy, Spinal Implants, and Other Products. The report provides separate comprehensive analytics for the US, Canada, Japan, Europe, Asia-Pacific, Latin America and Rest of World. Annual forecasts are provided for each region for the period of 2001 through 2015. A ten-year historic analysis is also provided for these markets with annual market analytics.The report profiles 200 companies including many key and niche players worldwide such as Acumed LLC, Arthrex, Inc., Biomet, Inc., Conmed Corp., DJO Surgical, Exactech, Inc., Innomed, Inc., Johnson & Johnson, DePuy, Inc., Medtronic Sofamor Danek, Inc., Orthofix International N.V., Smith and Nephew Plc, Stryker Corp., Synthes, Inc., Wright Medical Technology, Inc., and Zimmer Holdings, Inc. Market data and analytics are derived from primary and secondary research. Company profiles are mostly extracted from URL research and reported select online sources.

ORTHOPEDIC INSTRUMENTATION MCP-3223
A GLOBAL STRATEGIC BUSINESS REPORT


CONTENTS


I. INTRODUCTION, METHODOLOGY & PRODUCT DEFINITIONS

Study Reliability and Reporting Limitations I-1
Disclaimers I-2
Data Interpretation & Reporting Level I-2
CAGR Disparities Between Historic & Current Data I-2
Quantitative Techniques & Analytics I-3
Product Definitions and Scope of Study I-3
Reconstructive Sector I-4
Hip Implants I-4
Knee Implants I-4
Extremities I-4
Fracture Fixation I-4
Arthroscopy I-4
Spinal Products I-5
Other Products I-5


II. EXECUTIVE SUMMARY

1. Industry Overview II-1
Emerging Technologies- Redefining the Future II-1
Industry Dynamics and Changing Scenario II-1
Current & Future Analysis II-2
Growth Drivers, Trends & Issues II-2
Aging Population Drives Demand II-2
Prevalence of Osteoporosis, Arthritis and other Joint
Diseases Fuel Market Growth II-3
Table 1: Select Musculoskeletal Conditions - Percentage
Breakdown by Age Group (includes corresponding Graph/Chart) II-3
Obesity - Another Catalyst to Growth II-3
Increasing Life Expectancy Rates II-4
Cost Containment Issues II-4
Developing Markets- High Potential II-4
Revision Procedures Buoy Growth II-5
Minimally Invasive Surgery – Attracts Attention II-5
Advanced Materials & Technologies Foster Growth II-5
Advanced Coatings – Enhancing Lifespan of Implants II-6
Demand for Premium Implants Continues II-6
Growing Demand for Total Hip Replacement in Young People II-6
Hip Resurfacing Replacement – for Younger Generation II-7
Gender-Specific Orthopedic Devices Gain Momentum II-8
Spinal and Orthobiologics Products Spearhead Growth II-8
Synthetic Substitutes, Growth Factors and Composites II-8
Stem Cell and Gene Therapy II-9
Growing Presence of Mid-Tier Firms & Start-Ups in Spinal Segment II-9
Focus Shifts to External R&D Operations II-9
Rising Production Costs & Complexities in Documentation –
Major Challenges II-9

2. Product Segmentation II-11
A. Reconstructive Sector II-11
Procedure of Joint Replacement: Past and Present II-11
Insertion of implants II-12
Revision Surgery: A Painful Procedure II-12
Cost of Implants - Determining Factors II-12
Hip Prosthesis II-13
Total Hip Replacement II-13
Conditions Requiring Total Hip Replacement II-13
Materials Used II-13
Cemented Hip Implants II-13
Cementless Hip Implants II-13
Complications Following THR II-14
Partial Hip Replacement II-14
Revision Hip Procedures II-14
Types of Hip Implants II-14
Ceramic-on-Ceramic II-14
Metal-on-Metal II-15
Highly Cross-Linked Polyethylene II-15
Ceramic-on-polyethylene II-15
Metal-on-polyethylene II-15
Knee Prosthesis II-15
Functional Aspects of the Knee II-16
Implant Design II-16
Unicondylar Knee Replacements II-17
Fixed and Mobile Bearing Knees II-17
Mobile Bearing Total Knee Replacement Prosthesis II-17
Secondary Joint Prosthesis/Extremeties II-17
Shoulder Prosthesis II-17
Ankle Prosthesis II-18
Elbow Prosthesis II-18
Finger Prosthesis II-18
Reconstructive Market Analysis II-18
Highlights II-19
Table 2: Hip Implant Procedures in US and Europe (2006):
Percentage Breakdown By Number of Procedures for Primary
Hip, Revision Hip and Endoprosthesis (includes
corresponding Graph/Chart) II-19
Countering Rising Hip Implant Prices II-20
Tooth ‘N Trouble II-20
Future of Reconstructive Sector II-20
B. Fracture Fixation II-21
Osteoporosis - A Bone Breaking Factor II-21
Fracture Fixation Procedures II-21
Product Overview II-21
Internal Fixation II-21
External Fixation II-22
Intramedulary Fixation II-22
Maxillofacial Fixation Products II-22
Bone Growth Stimulators II-23
Select Techniques Used in Fracture Fixation II-23
Bone Graft System II-23
Osteo-Clage Cerclage Cable System II-23
Polarus Humeral Fixation System II-23
Stableloc External Fixator II-23
Nature of a Fracture II-23
Trends and Developments in the Fracture Fixation Market II-24
Novel Technologies Boost External Fixation Device Market II-24
Increase in Less Invasive Fracture Repair Procedures II-24
New Technologies Rekindle Market for Trauma Products II-24
Intramedullary Nails Threatened by LCP Systems II-25
Locking Compression Plates Might Lose its Superfluous Growth II-25
Market Analysis II-26
Aging Population and Active Life Styles Offer Steady Growth II-26
C. Arthroscopy II-26
Arthroscopy: A Keyhole Surgery II-26
Arthroscopy - A Broad Perspective II-26
Arthroscopic Procedure II-27
Arthroscopy and its Complications: II-27
Knee Arthroscopy II-28
Hip Arthroscopy II-28
Shoulder Arthroscopy II-28
Arthroscopically Assisted Anterior Approach II-29
Arthroscopy of the Elbow II-29
Ankle Arthroscopy II-29
Developments Likely to Foster Future Growth II-29
Multi-Electrode Procedure II-29
Electrothermal Arthroscopy by Oratec II-29
Market Analysis II-30
D. Spinal Implants and Instrumentation II-30
Spinal Fusion - Lending Support to the Troubled Backs II-30
Table 3: Spinal Implant Market Worldwide (2004) - Percentage
Breakdown by Number of Surgeries for Degenerative Lumbar,
Cervical, Deformities, Thoraco-Lumbar Traumas and
Thoraco-Lumbar Tumors (includes corresponding Graph/Chart) II-32

Table 4: Spinal Products Market Worldwide (2004) -
Percentage Breakdown by Implant Type for Pedicel Screws,
Plates, Rods; Fusion Cages, and Others (includes
corresponding Graph/Chart) II-32
Spinal Implants Market: Primary Growth Drivers II-32
State of Spinal Fusion Cages II-32
Emerging Technologies and Techniques II-33
Non- Invasive Surgeries II-33
Universal Multilevel Fusions II-33
Motion-Sparing Technology- Leap Forward in Spinal Fusions II-33
Artificial Nuclei II-34
Lumbar Artificial Discs Launch TimeLine II-34
Cervical Artificial Disc Launch Timeline II-34
Artificial Disc Competitive Landscape II-34
Recent Acquisitions and Mergers in Artificial Disc Sector:
2002-2004 II-35
Market Analysis II-35
E. Other Products II-35
Bone Cement II-36
Mechanical Properties of Bone Cements II-36
Soft Goods Sector II-36

3. Associated and Emerging Technologies in Orthopedics II-37

Resorbables II-37
Bone Substitutes II-37
Osteoinductive Agents/Bone Graft Factors: II-38
Viscoelastics II-39
Soft Tissue Repair and Replacement II-40
Tissue Engineering II-40

4. Orthopedics Market Structure II-42
Anatomy of the Industry II-42
Table 5: Orthopedic Instrumentation Market Worldwide by
Segment (2001, 2008 & 2012): Percentage Breakdown by Dollar
Sales for Reconstructive Sector, Fracture Fixation,
Arthroscopy, Spinal Products, and Other Products (includes
corresponding Graph/Chart) II-43
Increase in Age Spurs Demand II-43
Technology-Driven Market II-43
Designing of Device: Complex Requirements II-44
Futuristic View of Designs II-44
Consolidation - Resets Competition II-45
Mergers and Acquisitions in the Worldwide Orthopedics
Industry: 1997-2008 II-45
M & A Activity: 1993 –2008 in Orthopedic Instrumentation Segment II-46
Skull and Bones - Regional Overview II-48
The United States: Leading Orthopedics Market II-48
Japan: Growing At A Steady Pace II-48
Europe II-48
Table 6: Orthopedic Instruments Market in Europe by Region:
2008 (includes corresponding Graph/Chart) II-49
Asia-Pacific: Providing Glut of Opportunities II-49
Entry Barriers in the Asian Markets II-49

5. Competitive Focus II-50
Advancement in Power Surgical Products II-50
Competitive Factors Influencing Orthopedics Market II-50
Positive Factors II-50
Pricing and Cost Effectiveness of Products II-50
Consumer Relationships II-51
Safety and Competency of Products II-51
Technological Advancements II-51
Product Innovation II-51
Risk Factors II-52
Delays in Product Development II-52
Time Taken for Regulatory Approvals II-52
Competitive Analysis II-52
Table 7: Leading Players in the Global Orthopedic Market
(2007): Percentage Breakdown of Value Sales for Stryker, J&J,
Zimmer, Medtronic, Synthes, Smith & Nephew, Biomet, and
Others (includes corresponding Graph/Chart) II-53
Reconstructive Sector II-53
Table 8: Leading Players in the Global Reconstructive
Implants Market (2007): Percentage Share Breakdown of Value
Sales for Zimmer Holdings, DePuy Orthopedics, Stryker Corp,
Biomet, Wright Medical Group, Exactech and Others (includes
corresponding Graph/Chart) II-54

Table 9: Leading Players in the Worldwide Hip & Knee
Replacement Market (2008E): Percentage Share Breakdown of
Revenues for Zimmer, J&J DePuy, Stryker, Smith & Nephew,
Biomet, Wright Medical and Others (includes corresponding
Graph/Chart) II-54
Hip Implants II-54
Table 10: Leading Players in the Global Hip Implants Market
(2007 & 2008E): Percentage Share Breakdown of Revenues for
Zimmer, DePuy, Stryker, Smith & Nephew, Biomet, Wright
Medical, and Others (includes corresponding Graph/Chart) II-55
Knee Implants II-55
Table 11: Leading Players in the Global Knee Reconstruction
Market (2007): Percentage Share Breakdown of Value Sales for
Zimmer, Stryker, DePuy, Smith & Nephew, Biomet, Wright
Medical and Others (includes corresponding Graph/Chart) II-56
Extremities II-56
Table 12: Leading Players in World Market for Extremities
(2005) – Percentage Share Breakdown of Dollar Sales by
Company for DePuy, Zimmer, Stryker, Biomet, Smith & Nephew
Orthopedics, and Others (includes corresponding Graph/Chart) II-56
Fracture Fixation II-56
Table 13: Leading Players in the Global Trauma &
Craniomaxillofacial Market (2007): Percentage Breakdown of
Value Sales for Synthes, Stryker, Smith & Nephew, J&J,
Zimmer, Biomet, and Others (includes corresponding
Graph/Chart) II-57
Arthroscopy II-57
Table 14: Leading Players in the Worldwide Arthroscopy Market
(2007): Percentage Share Breakdown of Value Sales for Smith &
Nephew, Arthrex, Mitek (J&J), Stryker, Linvatec, Arthrocare
and Others (includes corresponding Graph/Chart) II-58
Spinal Implants II-58
Table 15: Leading Players in the Worldwide Spinal Implants
Market (2008E): Percentage Share Breakdown of Revenues for
Medtronic/Kyphon, DePuy (J&J), Synthes, Stryker, Biomet,
Zimmer and Others (includes corresponding Graph/Chart) II-58

Table 16: Leading Players in the Global Orthobiologics Market
(2006): Percentage Breakdown of Value Sales for Medtronic,
Synthes, J&J, Stryker, Osteotech, and Others (includes
corresponding Graph/Chart) II-58

6. End Users of Orthopedic Instruments II-59
Competitive Factors from End-Use Perspective II-59
Demographics Crucial Factor Driving Demand II-59
Hospitals: The Largest End-Use Industry II-59
Physicians’ Offices/Clinics II-60
New Technology Adds to the Growth II-60
Home Health Care Market: A Fast Growing Segment II-60

7. Distribution Structure-A Skeletal View II-61
An Insight into the Distribution Network of Select Players II-61
BioMet, Inc. II-61
Medtronic Sofamor Danek II-61
Synthes II-62
Zimmer Holdings, Inc., II-62

8. Product Launches & Developments II-63
Wright Medical Introduces Titanium Knee Implant II-63
Medtronic Introduces NANOSTIM® Synthetic Bone Paste II-63
CONMED Unveils Medical Devices II-63
DePuy Unveils Pinnacle Hip Solutions II-64
Smith & Nephew Introduces VERILAST™ Technology II-64
DePuy Expands Sigma® Knee Product Portfolio II-64
Smith & Nephew Introduces R3™ Acetabular Cup System for Hip
Replacement II-65
Smith & Nephew Launches Bioraptor 2.3 PK Suture Anchor II-65
RTI Introduces of Fresh-Stored OC Allografts II-65
Wright Medical Group Launches Profemur Xm Hip Stem II-65
ConforMIS Launches Patient-Specific Implant II-65
Stryker Introduces Triathlon PKR System in the US II-65
Orthovita Launches New Bone Graft Substitute II-66
DePuy Launches ALPS for Orthopaedic Trauma II-66
DJO Surgical Gains FDA Approval to Market New X-alt II-66
Osteotech Obtains FDA Clearance for Plexur M Biocomposite II-66
ConforMIS Wins CE Mark Approvals for Two Arthritis Products II-67
Smith & Nephew Unveils New High Definition Surgical Camera System II-67
Modern Plastics Announces New Medical Grade PMMA II-67
Wright Medical Introduces a New Biologic Grafting System II-67
Wright Medical Unveils Hip Solutions Products II-68
Smith & Nephew Introduces Bi-Compartmental Knee System II-68
DePuy Introduces Computer Software for Assisting Surgery II-68
Medtronic Launches CD Horizon® Legacy™ Anterior Spinal System II-68
Depuy Orthopaedics Unveils New Coating for Biological Fixation II-68
DePuy Introduces Delta Xtend™ Reverse Shoulder System II-69
DePuy Launches New System for Hip Fractures II-69
DePuy Introduces New Hip-Bearing System II-69
DePuy Introduces Pinnacle® Acetabular Cup System AltrX™ II-69
Biomet Introduces Two New Hip Stem Products II-69
ArthroCare Introduces Opus® TwinLock™ Knotless Fixation System II-70
SBI Introduces Advanced RingFIX™ System and Forefoot Repair Set II-70
SBI Launches New Distal Radius Plating System II-70
Smith & Nephew Endoscopy Introduces New Lateral Hip Distractor II-70
HydroCision Launches SpineJet® EndoResector II-71
Wright Medical Launches Latest Stature-Specific Knee Replacement II-71
Integra LifeSciences Introduces Uni-CP Compression Plate II-71
Wright Medical Introduces the CAROLINA™ Jones Fracture II-71
Wright Medical Launches EVOLVE® PROLINE System II-72
SBi Launches Artelon® STT Spacer II-72
Amedica Gains FDA Approval for Valeo VBR Spinal Implant II-72
Amedica Obtains FDA Marketing Approval for Valeo Pedicle Screw
System II-72
Corin Group Obtains FDA for Cormet Resurfacing Hip Device II-73
Altiva Obtains FDA Approval for Altiva® Classic ACP II-73
SBI Obtains FDA Approval for Artelon CMC Spacer Arthro II-73
Smith & Nephew’s Knee Systems Receive FDA Approval II-73
Amedica Gains FDA Clearance for Valeo™ Cervical Plate System II-73
Zimmer Obtains FDA Approval for Zimmer® NexGen® Knee II-74
Invibio Receives Approval to Market Implantable Spinal Implant
in Japan II-74
BioMedical Obtains FDA Clearance for OSSpine Spinal Product II-74
Blackstone Medical Introduces New Spinal Fusion Product line II-74
CONMED Linvatec Launches New Powered Surgical Instruments &
Arthroscopy Products II-75
Smith & Nephew Introduces New JOURNEY BI-Cruciate Stabilized
Knee System II-75
Stryker Launches Triathlon Knee System for Women II-76
Wright Medical Unveils ODYSSEY™ Distal Cut First Instruments
for MIS Procedures II-76
FDA Grants Approval for Marketing Smith & Nephew’s BHR System II-76
Smith & Nephew Unveils LEGION Revision Knee System with
OXINIUM Material II-76
Smith & Nephew Rolls Out TRIGEN* HFN II-77
Wright Medical Introduces New SUPER-FIX Acetabular System II-77
Cedara Introduces OrthoWorks Spine Analyzer II-77
Arthrex Launches the Small Joint OATS Set II-78
OSH Launches Navitrack Navigation System II-78
Biomet Obtains FDA Clearance for ArComXL™ II-78
Bonutti Receives FDA Approval II-78
Smith & Nephew Unleashes PERI-LOC System II-79
Biomet’s C2a-Taper™ Acetabular System Approved by FDA II-79
Depuy Mitek Inc Launches Soft Tissue Tibial Fixation System II-79
Arthrex’s V-Tak for Bone Reconstruction II-79
Low Profile Plate and Screw Sets for Osteotomy II-79
Arthrex Introduces Conical and Reverse Cutting Needles for
Soft Tissue Repairs II-79
DePuy Orthopedics Introduces New Biologic Shoulder Implant II-80
DePuy Orthopaedics Introduces UnI-Compartmental Knee Implant II-80
DePuy Orthopaedics Introduces Agility™ Total Ankle System II-80
Biomet Develops First Spring-Enhanced, Stress- Sharing
Orthopedic Implant II-80
Eurosurgical Unveils Improved Versions of Zenith, Claris and SCS II-81
Biomet’s Meniscal Unicompartmental System in the US II-81
Biomet Develops First Spring-Enhanced, Stress-Sharing
Orthopedic Implant II-81
Synthes Receives FDA mark of Vertical Expandable Prosthetic
Titanium Rib II-82
MBI Receives CE Approval II-82
Smith & Nephew’s Uncemented Porous Coated Knees II-82
Smith & Nephew’s Bone Graft Substitute II-83
Stryker’s Revolutionary Ceramic-on-ceramic Hip Replacement in
the US II-83
Wright Medical Receives FDA Clearance for LINEAGE II-83
Exactech Unveils Two New Products II-83
Sulzer Orthopedics Launches Anatomical Shoulder II-83
Sulzer Medica Launch the Knee Prosthesis Innex II-84
MedNet Locator Launches New Prosthesis System II-84
SaluMedica Develops Knee Cartilage Prosthesis from Hydrogel
Biomaterial II-84
Linvatec Launches New Products II-84
Biomet to Unveil a Group of Reconstructive Products II-84
Corin Medical- 2000 Launches Rotaglide 2000 II-85

9. Technological Developments II-86
Alternate-Bearing Materials in the Hip Implants Market II-86
Diamond-on-Diamond Technology II-86
Cementless Procedures Gain Ground II-86
Trabecular Metal Technology II-87
Surface Modification Technology II-87
Novel Minimally Invasive Approaches II-87
Zimmer Launches Quad-Sparing Total Knee Replacement II-87
Spire’s Subsidiary Expands Ion Implantation Processing II-87
Zimmer to Launch New Minimally Invasive Hip Procedure II-88
DePuy Introduces New MinI-Incision Technique in Hip Replacement II-88

10. Recent Industry Activity II-89
Wright Medical Takes Over INBONE Technologies II-89
Riverside Acquires Summit Medical II-89
UniPhar to Acquire Forth Medical and Northstar II-89
Regeneration Technologies and Tutogen Merge to Form RTI Biologics II-89
Precimed Acquires DePuy Orthopaedics' Chaumont Plant II-90
SBI to Acquire Ankle Replacement Technology II-90
Symmetry Medical Acquires Orthopaedic Instrument Facility of
DePuy II-90
Greatbatch Completes Acquisition of Precimed II-90
Exactech Acquires Altiva II-91
Exactech to Acquire France Medica; Starts Direct Distribution
in Japan II-91
Tornier and LifeCell Sign Distribution Agreement II-91
Osteotech Enters into Distribution Agreement with Harvest
Technologies II-91
Misonix Signs Distribution Deal with Aesculap II-92
Alynx Acquires MiMedx II-92
Alphatec Acquires Rights for Interbody/Vertebral Body
Replacement Technology II-92
Exactech Inks License Deal for Cartilage Repair Technology II-92
Biomet Ties Up with Massachusetts General Hospital for
Clinical Studies II-93
Stryker Recalls Select Hip Products II-93
Biomet Merges with LVB Acquisition Merger Sub II-93
Cardinal Health Completes Acquisition of VIASYS Healthcare II-93
Biomet Sports Medicine and Marc Tec Ink Licensing Agreement II-94
Zimmer Inks a Distribution Agreement with Regeneration
Technologies II-94
Sandvik Inks Agreement with Medtronic to Acquire Medtronic’s
Plant II-95
Medtronic and Weigao to Establish Joint Venture in China II-95
HealthpointCapital Takes over Ideal Medical Products II-95
Covidien’s Subsidiary Takes Over Scandius Biomedical II-95
Integra LifeSciences Takes over IsoTis II-96
DePuy Spine Completes Acquisition of Certain Disc-O-Tech Assets II-96
Wright Medical Acquires BIO-ARCH™ Subtalar Implant II-96
UniPhar Merges Whelehan Surgical and Surgicare Divisions II-97
Orthofix International Completes Acquisition of InSWing™
Technology II-97
Sandvik Acquires Doncasters Medical Technologies II-97
Medtronic Completes Acquisition of Kyphon II-97
Tornier Takes Over DVO Extremity Solutions & Nexa Orthopedics II-98
Medtronic Takes over O-arm Imaging from Breakaway Imaging II-98
Wright Medical Takes over Assets of R&R Medical II-98
Wright Medical Acquires DARCO’s Reconstructive Foot Surgery
Business II-99
Zimmer Holdings Acquires Endius II-99
Leis Medical and MedicineLodge Merge to Form iMDs II-99
Zimmer Takes Over ORTHOsoft II-99
NuVasive Takes Over Radius Medical II-100
DJO Completes ReAble Merger II-100
Smith & Nephew Acquires Plus Orthopedics II-100
Orchid Takes Over Three Orthopedic Instrument Companies II-101
Synthes Takes Over N Spine II-101
Avalign Technologies Acquires Nemcomed II-101
Wright Medical and A.M. Surgical in Distribution and License
Agreement II-102
Symmetry Medical and MAKO Surgical Enter into an Agreement II-102
Medtronic and Axon Enter into Agreement II-102
Wright Medical Shuts Down Facility in France II-102
Portland Orthopaedics Retakes US Distribution II-103
Tornier and Bioretec in Partnership for Bioresorbable Surgical
Devices II-103
Impulse Takes Over Clinical Support Services II-103
Alphatec Holdings Gains License for Vertebroplasty Technology
System II-103
Smith & Nephew Signs Global Distribution Agreement with Teknimed II-103
Corin Enters into Marketing and Distribution Deal with Stryker II-104
Biomet and Kensey Signs Marketing and Distribution Agreement II-104
BSN Medical Acquires FLA Orthopedics II-104
SimplexityMD Takes Over OrthoAccel Technologies II-104
Hanger Orthopedic Group Acquires Paris O&P Laboratory II-104
Smith & Nephew Recalls Knee Implants II-104
Alphatec to Merge with Scient’X II-105
Endius and Quantum Form Strategic Alliance II-105
Biomet to Expand Indiana Facility II-105
DJ Orthopedics Acquires Newmed II-105
FDA Clears Zimmer’s Gender Solutions Artificial Knee for Women II-106
Zimmer Acquires Surgical Instrument Technology from MedTech S.A II-106
dj Orthopedics Acquires Aircast II-106
FDA Approves Biomet’s Regenerex™ Acetabular System II-106
DePuy Mitek Takes Over FMS Operations II-106
Medtronic Provides Research Grant to OTA II-107
Orthofix Restructures its International Business Operations II-107
Orthofix Acquires IMeS to Expand European Operations II-107
Encore Medical Enters into Multi-Year Collaboration Agreement
with UCDHSC II-107
Alphatec Spine Acquires All Assets of Cortek II-108
HealthpointCapital Takes Over Alphatec II-108
VIASYS Acquires Intermed Precision II-108
RTI Amends Distribution Contracts with Medtronic and Exactech II-109
Zimmer Holdings Enters Into Agreement with Heraeus Kulzer II-109
Genzyme Corp. Acquires Verigen II-109
Nash Corporation Enters into Agreement with Orthovita, Inc II-109
Biomet Acquires Interpore II-110
Synthes-Stratec Merger with Mathys Medizinaltechnik II-110
Tailwind Capital Acquires Aircast II-110
Conmed Forges Strategic Partnership with eTrauma II-110
DePuy Orthopaedics Launches New Trauma & Extremities Division II-110
Synthes Acquires Gelifex II-111
Angiotech Acquires Neucoll II-111
Encore Takes Over Empi II-111
Arthrocare Acquires Opus Medical II-111
Orthologic Acquires CBI II-111
Orthofix Signs Contract With Premier II-112
Angiotech Signs Sales and Distribution Agreement with Orthovita II-112
Hanger Orthopedic Acquires Advanced Bio-Mechanics andNorthern
Virginia Orthotics & Prosthetics II-113
Zimmer Completes the Acquisition of Implex II-113
Smith & Nephew Acquires MMT II-113

11. Industry Activity in the Recent Past II-114
Exactech Acquires Total Shoulder System of Teknimed II-114
Zimmer Acquires Centerpulse II-114
Virtual Scopics Collaborates with Anderson Orthopaedic
Research Institute II-114
Haemonetics Extends Agreement with Zimmer II-114
DePuy Orthopaedics Establishes New Trauma & Extremities Group II-115
Orthofix Acquires Breg II-115
Symmetry Medical Merges with Mettis Orthopedic II-115
Hanger Acquires Two US Orthopedic Firms II-116
Spire Biomedical Expands Orthopedic Surface Processing Facilities II-116
Abbott Acquires Orthopedics Market through the Acquisition of
Spinal Concepts II-116
DePuy Acquires Link Spine Group II-116
Synthes-Stratec and Spine Solutions, Inc. II-116
Conmed Acquires Bionx Implants II-116
Year 2002 in Review II-117
Major M&A and Divestments in 1999- 2001 II-119

12. Focus on Select Players II-120
Acumed LLC (US) II-120
Arthrex, Inc (US) II-120
Biomet, Inc. (US) II-120
Conmed Corp. (US) II-121
DJO Surgical (US) II-122
Exactech, Inc. (US) II-122
Innomed, Inc. (US) II-123
Johnson & Johnson (US) II-123
DePuy Inc. (US) II-123
Medtronic Sofamor Danek, Inc. (US) II-124
Orthofix International N.V. (The Netherlands) II-124
Smith and Nephew Plc (UK) II-125
Stryker Corp., (US) II-125
Synthes, Inc. (Switzerland) II-126
Wright Medical Technology, Inc. (US) II-127
Zimmer Holdings, Inc. (US) II-127

13. Global Market Perspective II-129
Table 17: World Recent Past, Current & Future Analysis for
Orthopedic Instrumentation by Geographic Region – US, Canada,
Japan, Europe, Asia-Pacific (excluding Japan), Latin America
and Rest of World Markets Independently Analyzed with Annual
Sales Figures in US$ Million for Years 2001 through 2010
(includes corresponding Graph/Chart) II-129

Table 18: World Long-term Projections for Orthopedic
Instrumentation by Geographic Region – US, Canada, Japan,
Europe, Asia-Pacific (excluding Japan), Latin America & Rest
of World Markets Independently Analyzed with Annual Sales
Figures in US$ Million for Years 2011 through 2015 (includes
corresponding Graph/Chart) II-130

Table 19: World Historic Review for Orthopedic Instrumentation
by Geographic Region – US, Canada, Japan, Europe, Asia-Pacific
(excluding Japan), Latin America and Rest of World Markets
Independently Analyzed with Annual Sales Figures in US$
Million for Years 1991 through 2000 (includes corresponding
Graph/Chart) II-131

Table 20: World 15-Year Perspective for Orthopedic
Instrumentation by Geographic Region – Percentage Breakdown of
Dollar Sales for US, Canada, Japan, Europe, Asia-Pacific
(excluding Japan), Latin America and Rest of World Markets for
Years 1998, 2008 & 2012 (includes corresponding Graph/Chart) II-132
By Segment II-133
Table 21: World Recent Past, Current & Future Analysis for
Reconstructive Sector by Geographic Region – US, Canada,
Japan, Europe, Asia-Pacific (excluding Japan), Latin America
and Rest of World Markets Independently Analyzed with Annual
Sales Figures in US$ Million for Years 2001 through 2010
(includes corresponding Graph/Chart) II-133

Table 22: World Long-term Projections for Reconstructive
Sector by Geographic Region – US, Canada, Japan, Europe,
Asia-Pacific (excluding Japan), Latin America and Rest of
World Markets Independently Analyzed with Annual Sales Figures
in US$ Million for Years 2011 through 2015 (includes
corresponding Graph/Chart) II-134

Table 23: World Historic Review for Reconstructive Sector by
Geographic Region – US, Canada, Japan, Europe, Asia-Pacific
(excluding Japan), Latin America and Rest of World Markets
Independently Analyzed with Annual Sales Figures in US$
Million for Years 1991 through 2000 (includes corresponding
Graph/Chart) II-135

Table 24: World 15-Year Perspective for Reconstructive Sector
by Geographic Region – Percentage Breakdown of Dollar Sales
for US, Canada, Japan, Europe, Asia-Pacific (excluding Japan),
Latin America and Rest of World Markets for Years 1998, 2008 &
2012 (includes corresponding Graph/Chart) II-136

Table 25: World Recent Past, Current & Future Analysis for
Reconstructive Sector by Product Segment - Hip Implants, Knee
Implants and Extremities Markets Independently Analyzed with
Annual Sales Figures in US$ Million for Years 2001 through
2010 (includes corresponding Graph/Chart) II-137

Table 26: World Long-term Projections for Reconstructive
Sector by Product Segment - Hip Implants, Knee Implants and
Extremities Markets Independently Analyzed with Annual Sales
Figures in US$ Million for Years 2011 through 2015 (includes
corresponding Graph/Chart) II-137

Table 27: World Historic Review for Reconstructive Sector by
Product Segment - Hip Implants, Knee Implants and Extremities
Markets Independently Analyzed with Annual Sales Figures in
US$ Million for Years 1991 through 2000 (includes
corresponding Graph/Chart) II-138

Table 28: World 15-Year Perspective for Reconstructive Sector
by Product Segment – Percentage Breakdown of Dollar Sales for
Hip Implants, Knee Implants and Extremities Markets for Years
1998, 2008 & 2012 (includes corresponding Graph/Chart) II-138

Table 29: World Recent Past, Current & Future Analysis for
Fracture Fixation by Geographic Region – US, Canada, Japan,
Europe, Asia-Pacific (excluding Japan), Latin America and Rest
of World Markets Independently Analyzed with Annual Sales
Figures in US$ Million for Years 2001 through 2010 (includes
corresponding Graph/Chart) II-139

Table 30: World Long-term Projections for Fracture Fixation by
Geographic Region – US, Canada, Japan, Europe, Asia-Pacific
(excluding Japan), Latin America & Rest of World Markets
Independently Analyzed with Annual Sales Figures in US$
Million for Years 2011 through 2015 (includes corresponding
Graph/Chart) II-140

Table 31: World Historic Review for Fracture Fixation by
Geographic Region – US, Canada, Japan, Europe, Asia-Pacific
(excluding Japan), Latin America and Rest of World Markets
Independently Analyzed with Annual Sales Figures in US$
Million for Years 1991 through 2000 (includes corresponding
Graph/Chart) II-141

Table 32: World 15-Year Perspective for Fracture Fixation by
Geographic Region – Percentage Breakdown of Dollar Sales for
US, Canada, Japan, Europe, Asia-Pacific (excluding Japan),
Latin America and Rest of World Markets for Years 1998, 2008 &
2012 (includes corresponding Graph/Chart) II-142

Table 33: World Recent Past, Current & Future Analysis for
Arthroscopy/ Soft Tissue by Geographic Region – US, Canada,
Japan, Europe, Asia-Pacific (excluding Japan), Latin America
and Rest of World Markets Independently Analyzed with Annual
Sales Figures in US$ Million for Years 2001 through 2010
(includes corresponding Graph/Chart) II-143

Table 34: World Long-term Projections for Arthroscopy/ Soft
Tissue Products by Geographic Region – US, Canada, Japan,
Europe, Asia-Pacific (excluding Japan), Latin America & Rest
of World Markets Independently Analyzed with Annual Sales
Figures in US$ Million for Years 2011 through 2015 (includes
corresponding Graph/Chart) II-144

Table 35: World Historic Review for Arthroscopy by Geographic
Region – US, Canada, Japan, Europe, Asia-Pacific (excluding
Japan), Latin America and Rest of World Markets Independently
Analyzed with Annual Sales Figures in US$ Million for Years
1991 through 2000 (includes corresponding Graph/Chart) II-145

Table 36: World 15-Year Perspective for Arthroscopy by
Geographic Region – Percentage Breakdown of Dollar Sales for
US, Canada, Japan, Europe, Asia-Pacific (excluding Japan),
Latin America and Rest of World Markets for Years 1998, 2008 &
2012 (includes corresponding Graph/Chart) II-146

Table 37: World Recent Past, Current & Future Analysis for
Spinal Products by Geographic Region – US, Canada, Japan,
Europe, Asia-Pacific (excluding Japan), Latin America and Rest
of World Markets Independently Analyzed with Annual Sales
Figures in US$ Million for Years 2001 through 2010 (includes
corresponding Graph/Chart) II-147

Table 38: World Long-term Projections for Spinal Products by
Geographic Region – US, Canada, Japan, Europe, Asia-Pacific
(excluding Japan), Latin America and Rest of World Markets
Independently Analyzed with Annual Sales Figures in US$
Million for Years 2011 through 2015 (includes corresponding
Graph/Chart) II-148

Table 39: World Historic Review for Spinal Products by
Geographic Region – US, Canada, Japan, Europe, Asia-Pacific
(excluding Japan), Latin America and Rest of World Markets
Independently Analyzed with Annual Sales Figures in US$
Million for Years 1991 through 2000 (includes corresponding
Graph/Chart) II-149

Table 40: World 15-Year Perspective for Spinal Products by
Geographic Region – Percentage Breakdown of Dollar Sales for
US, Canada, Japan, Europe, Asia-Pacific (excluding Japan),
Latin America and Rest of World Markets for Years 1998, 2008 &
2012 (includes corresponding Graph/Chart) II-150

Table 41: World Recent Past, Current & Future Analysis for
Other Products by Geographic Region – US, Canada, Japan,
Europe, Asia-Pacific (excluding Japan), Latin America and Rest
of World Markets Independently Analyzed with Annual Sales
Figures in US$ Million for Years 2001 through 2010 (includes
corresponding Graph/Chart) II-151

Table 42: World Long-term Projections for Other Orthopedic
Instrumentation Products by Geographic Region – US, Canada,
Japan, Europe, Asia-Pacific (excluding Japan), Latin America
and Rest of World Markets Independently Analyzed with Annual
Sales Figures in US$ Million for Years 2011 through 2015
(includes corresponding Graph/Chart) II-152

Table 43: World Historic Review for Other Products by
Geographic Region – US, Canada, Japan, Europe, Asia-Pacific
(excluding Japan), Latin America and Rest of World Markets
Independently Analyzed with Annual Sales Figures in US$
Million for Years 1991 through 2000 (includes corresponding
Graph/Chart) II-153

Table 44: World 15-Year Perspective for Other Products by
Geographic Region – Percentage Breakdown of Dollar Sales for
US, Canada, Japan, Europe, Asia-Pacific (excluding Japan),
Latin America and Rest of World Markets for Years 1998, 2008 &
2012 (includes corresponding Graph/Chart) II-154


III. MARKET

1. The United States III-1
A.Market Analysis III-1
Outlook III-1
United States – The Largest Orthopedics Market III-1
An Overview of the US Orthopedic Healthcare System III-1
Table 45: US Orthopedics Market (2006): Percentage Share
Breakdown of Number of Physician Visits for Back, Knee,
Neck, Lower Back, Hip, and Small Bone and Joint (includes
corresponding Graph/Chart) III-2

Table 46: Musculoskeletal Procedures Performed in US
Hospitals (2004): Mean Duration of Hospitalization (in
Days) (includes corresponding Graph/Chart) III-2

Table 47: Rate of Procedures (Per 10,000 Individuals) for
Knee Arthroplasty, Hip Replacement, and Spinal Fusion:
Breakdown by Age Group (includes corresponding Graph/Chart) III-3
Trends & Issues III-3
Aging Population & Obesity Drive Demand for Orthopedic
Procedures III-3
Table 48: Primary Hip and Knee Replacement Procedures in
the US (2005): Percentage Breakdown by Age Group (includes
corresponding Graph/Chart) III-3
Technological Developments Promote Growth III-4
Biomaterials Market – Keeping Pace with Changing Times III-4
Orthopedic Soft Tissue Allograft Market in the US III-4
Rising Incidence of Arthritis Aids Growth in Implant
Procedures III-5
Orthopedic Implants Market in the US III-5
Wear Debris-A Major Concern III-5
Reimbursement Scenario III-6
CMS Implements MS-DRG System III-6
Reimbursement for Trauma Procedures III-9
Table 49: Medicare Reimbursement Codes for Leading Trauma
Procedures in US (includes corresponding Graph/Chart) III-9
Table 50: Percentage Change in Medicare Reimbursement
Rates (2000-2005) (includes corresponding Graph/Chart) III-10
Reconstructive Market: An Overview III-10
Large Joint Reconstructive Implants Market – An Overview III-10
Aging Population Demographics III-11
Table 51: Percentage of Population in terms of Age Groups
in the US (includes corresponding Graph/Chart) III-11
Table 52: US Population in the Over 45 Years Age Group
(2006-2008) (includes corresponding Graph/Chart) III-12
Arthritis: Stats III-12
Joint Replacement Procedures – Improving Technologies &
Materials III-12
Knee Implants Market III-12
Knee Implant Pricing Scenario III-13
Table 53: Knee Implants Market in the US (2004):
Percentage Breakdown by Dollar Sales for Implant Type -
Cemented Femoral, Cemented Tibial, Cementless Femoral,
Cementless Tibial and Polyethylene Liner (includes
corresponding Graph/Chart) III-13

Table 54: Knee Replacements in the US (1998-2008): Number
of Procedures (in Thousands) and Average Duration of
Hospitalization for Total, and Revision Knee Replacement
Procedures (includes corresponding Graph/Chart) III-14
Historic Note: III-14
Hip Implants Market III-14
New Materials Emerge as Polyethylene Alternatives III-15
Table 55: Hip Replacements in the US (1998-2005): Number
of Procedures (in Thousands) and Average Duration of
Hospitalization for Total, Partial and Revision Procedures
(includes corresponding Graph/Chart) III-16
Shift from Cemented to Press-Fit Procedures III-16
Cost Containment for Implants III-16
Fracture Fixation Market III-17
Table 56: Number of Inpatient Fracture Repair Procedures in
the US (2006): Percentage Breakdown by Anatomical Site for
Femur, Tibia/Fibula, Radius/Ulna, Humerus, Face,
Ankle/Foot, Others (includes corresponding Graph/Chart) III-17
Shift Towards LCPs Drive Growth III-17
Arthroscopy Market III-17
New Technologies Fuel Arthroscopy Market III-18
Spinal Implants Market III-18
Troubled Backs III-19
Spinal Procedures in US Witness Substantial Growth III-19
Table 57: Spinal Implant Procedures in the US : 2001-
2008E (includes corresponding Graph/Chart) III-20
Artificial Disc Replacement III-20
Bone Graft Market III-21
Competitive Landscape III-22
Table 58: Leading Players in the US Reconstructive Implants
Market (2007): Percentage Share Breakdown of Revenues for
Zimmer, DePuy, Stryker, Biomet, Smith & Nephew, Wright
Medical and Others (includes corresponding Graph/Chart) III-22

Table 59: Leading Players in the US Hip Implants Market
(2007): Percentage Share Breakdown of Revenues for Zimmer,
DePuy, Stryker, Smith & Nephew, Biomet, Wright Medical and
Others (includes corresponding Graph/Chart) III-22

Table 60: Leading Players in the US Knee Reconstruction
Market (2007): Percentage Share Breakdown of Revenues for
Zimmer, DePuy, Stryker, Biomet, Smith & Nephew, Wright
Medical and Others (includes corresponding Graph/Chart) III-23

Table 61: Leading Players in the US Fracture Fixation
Market (2005): Percentage Breakdown by Dollar Sales for
Synthes-Stratec Smith and Nephew, Zimmer, Biomet, Stryker,
DePuy (J&J) and Other (includes corresponding Graph/Chart) III-23

Table 62: Leading Players in the US Spinal Implants Market
(2006): Percentage Breakdown of Value Sales for Medtronic
Sofamor Danek, DePuy Spine, Zimmer Spine, Synthes, Stryker
Biomet and Others (includes corresponding Graph/Chart) III-23
Key Player Review III-24
Acumed LLC III-24
Arthrex, Inc III-24
Biomet, Inc III-24
CONMED Corp III-25
DJO Surgical III-26
Exactech, Inc. III-26
Innomed, Inc. III-27
Johnson & Johnson III-27
DePuy, Inc. III-27
Medtronic Sofamor Danek, Inc. III-28
Smith & Nephew, Inc. III-28
Stryker Corp. III-28
Stryker Orthopaedics III-29
Wright Medical Technology III-29
Zimmer Holdings, Inc. III-29
Product Launches & Developments III-30
Technological Developments III-52
Strategic Corporate Developments III-54
B.Market Analytics III-78
Table 63: US Recent Past, Current & Future Analysis for
Orthopedic Instrumentation by Product Segment
–Reconstructive Sector (Hip Implants, Knee Implants and
Extremities), Fracture Fixation, Arthroscopy, Spinal
Products and Other Orthopedic Products Markets Independently
Analyzed with Annual Sales Figures in US$ Million for Years
2001 through 2010 (includes corresponding Graph/Chart) III-78

Table 64: US Long-term Projections for Orthopedic
Instrumentation by Product Segment –Reconstructive Sector
(Hip Implants, Knee Implants and Extremities), Fracture
Fixation, Arthroscopy, Spinal Products and Other Orthopedic
Products Markets Independently Analyzed with Annual Sales
Figures in US$ Million for Years 2011 through 2015 (includes
corresponding Graph/Chart) III-79

Table 65: US Historic Review for Orthopedic Instrumentation
by Product Segment – Reconstructive Sector (Hip Implants,
Knee Implants and Extremities), Fracture Fixation,
Arthroscopy, Spinal Products and Other Orthopedic Products
Markets Independently Analyzed with Annual Sales Figures in
US$ Million for Years 1991 through 2000 (includes
corresponding Graph/Chart) III-80

Table 66: US 15-Year Perspective for Orthopedic
Instrumentation by Product Segment – Percentage Breakdown of
Dollar Sales for Reconstructive Sector (Hip Implants, Knee
Implants and Extremities), Fracture Fixation, Arthroscopy,
Spinal Products and Other Orthopedic Products Markets for
1991, 1998, 2008 & 2012 (includes corresponding Graph/Chart) III-81