State of the Market
US Foot and Ankle Orthopedic Devices
Market Highlights
- The US foot and ankle orthopedic device market—consisting of reconstructive implants, trauma devices, and sports medicine devices—will continue to grow through 2028, supported by growth in foot and ankle orthopedic device procedure volumes, which will expand from 1.3 million procedures in 2018 to over 2 million in 2028.
- This growth will be driven by innovations, such as newer-generation total ankle implants for ankle arthritis and suture button systems for syndesmosis disruptions and Lisfranc injuries, spurred by the ongoing procedural shift toward outpatient settings and the increasing utilization of value-based care models in the US.
Foot and Ankle Orthopedic Device Market, by Product Type, US (USD), 2018–2028
Top 3 Foot and Ankle Orthopedic Device Indications, by Segment, US, 2018
Market Growth Drivers
Competitive Dynamics
- Compared to the broader trauma device and reconstructive implant markets, where MNCs are indisputably dominant, the competitive landscape for these devices (as well as sports medicine devices) in the foot and ankle space is somewhat distinct. In particular, the top 3 competitors in the foot and ankle orthopedic device market account for a much smaller proportion of the revenues generated in that space than those generated in the overall trauma device and reconstructive implant markets.
- This presents a substantial opportunity for smaller players, evident by the fact that such players (those outside the top 6 competitors) held over 25% of the foot and ankle orthopedic device market in 2018, which is a somewhat unique trend among orthopedic markets.
- On November 4, 2019, Stryker announced that it had reached an agreement to acquire Wright Medical for $4.7B.
- With this acquisition, Stryker will close the gaps in its small-joint replacement portfolio, becoming the largest player in the foot and ankle orthopedic device market and substantially bolstering its position in the global trauma device and small-joint implant markets.
- In January 2020, it was reported that a Wright Medical shareholder sued to block the acquisition, and that the FTC had increased its scrutiny of the acquisition and whether it violates any anticompetition guidelines, indicating that the companies may be forced to enact some measures before the acquisition can proceed. Subsequently, all assumptions regarding the impacts of this acquisition are reliant on the outcome of FTC findings.
Foot and Ankle Orthopedic Device Revenue Market Shares, US, 2019
Reconstructive Implants
Within the reconstructive implant market, total ankle replacements are slowly replacing ankle fusion surgeries as the preferred gold standard for ankle arthritis patients due to:
- A large body of foot and ankle specialists that are trained to perform these complex procedures in the US,
- Continual improvements to reimbursement coverage for total ankle replacements, and
- The launch of newer-generation total ankle implants that offer better designs and longer pain relief.
Trauma Devices
In the trauma device space, smaller companies are attempting to compete with large market leaders by targeting niche indications, such as syndesmosis disruptions, Lisfranc fractures, and talus fractures, leading to the development of new products for such indications.
Sports Medicine Devices
In the sports medicine device space, companies continue to focus their product development on:
- Minimizing implant footprints,
- Maintaining high pull-out strength, and
- Improving surgeon convenience and procedure durations.
Key Takeaways for Foot and Ankle Orthopedic Device Players
Looking forward, medtech companies in this space should look into the following strategic considerations:
- Mergers, acquisitions, and partnerships are key strategies for companies in this space. For larger companies, inorganic expansion represents a cheaper option than investing resources to internally develop a product for niche indications; for smaller companies, entering into distribution agreements and strategic partnerships offers a good means of increasing their market penetration.
- Commercial targeting is critical for companies in this space, particularly smaller players, that are looking to optimize their resources during pre-launch and post-launch phases. Companies with smaller portfolios must identify where their patient pool is located, which surgeons in particular are using their products, and the nature of competing procedures that use different devices.
- It is becoming increasingly important for companies to demonstrate the value-based outcomes associated with their devices; devices and products with high ASPs, in particular, will now increasingly require strong clinical data and evidence of long-term cost savings, reduced revision rates, and other positive outcomes measures in order to justify the high cost and increase penetration.
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Mohith Unny
Associate Consultant
Decision Resources Group
