Twenty Years of Change in the Orthopedic Device Industry

Time is a relative concept. Renowned physicist Albert Einstein suggested as much more than a century ago with his mind-bending, now-famous special theory of relativity.

At its basics, Einstein’s theory says time—or its passage, specifically—depends on the observer’s reference frame. He proposed that objects traveling at high speeds experience time more slowly, as massive objects distort the space-time fabric. 

Besides revolutionizing humankind’s understanding of space, time, gravity, and the universe, Einstein’s theory may also help enable a better understanding of another age-old mystery of the cosmos—why time seems to accelerate for the aged.

Duke University professor Adrian Bejan has proposed his own hypothesis on this enigma, though it isn’t as paradigm-shifting or impactful as Einstein’s space-time theory. He claims time appears to move faster for older folks because they process visual information at a considerably slower rate than their younger counterparts. Older brains, according to Bejan, process fewer “mental frames per minute.” Younger people, on the other hand, process more mental frames; this increased number of cerebral snapshots holds more data and creates more memories. As data and memory increase, time appears to slow down.

“The present is different from the past because the mental viewing has changed, not because somebody’s clock rings,” Bejan wrote in a 2019 paper published in European Review.
“…physical time is not mind time. The time that you perceive is not the same as the time perceived by another.”

Regardless of perception, age, or mental image processing capacity, time marches on—and 20 years have slipped by since Orthopedic Design & Technology published its first issue. In the two decades since its birth, the magazine has provided readers with a front-row seat to an industrial evolution that is changing the face of modern orthopedics. From the advent of 3D printing, the preference for minimally invasive approaches and customized implants, the wonder of robotic surgery, and the promise of artificial intelligence, ODT has chronicled the spirit of innovation and disruption that is changing patient outcomes for the better. To help the magazine mark its vicennial, ODT reached out to members of its Editorial Advisory Board and other experts. Their responses provide for a meaningful and insightful reflection at the orthopedic industry’s transformation over the past two decades.

Michael Barbella: In what ways has the orthopedic industry changed over the last two decades?

Linda Braddon, Ph.D., President, Secure BioMed Evaluations

From a regulatory perspective, the orthopedic industry has changed in the amount of testing and data that regulatory agencies require from sponsors.

Paul Bryant, Industry Consultant

I entered the orthopedic industry about twenty years ago and have witnessed remarkable change during that time. Advances in technology, shifts in health economics, and a more informed and engaged patient population have reshaped the landscape. Regulatory oversight has also tightened significantly, with increased clinical evidence requirements and post-market obligations. Meanwhile, surgeons are now more economically aligned, either through hospital employment or ownership in private practices or other areas.

Like many other industries, orthopedics has embraced the push toward personalization. Improvements in imaging, manufacturing, and digital technologies now enable patient-specific pathways, instrumentation and implants. One of the most transformative shifts has been the ability to return patients to their homes and back to daily activities more quickly. Many procedures that once required multi-day hospital stays are now performed in ambulatory surgery centers, supported by enhanced recovery protocols and multimodal pain management strategies.

While economic and social factors have certainly influenced industry, technology has been the dominant catalyst. Robotics, once experimental and even questioned, has become not only commonplace but essential in many practices. Portability and cost-effective solutions are driving broader adoption of enabling technologies across the continuum of care. The Internet of Things is creating new possibilities for connectivity, while the integration of data analytics, artificial intelligence and machine learning is unlocking predictive insights that promise even better patient outcomes in the years ahead.

Tobias “Toby” W. Buck, Executive Chair, Agiliant Life Sciences and Executive Partner, AEA Investors

The orthopedic industry has undergone a seismic shift since the early 2000s, driven by both technological innovation and evolving healthcare economics. We’ve seen the transition from volume to value-based care, a push toward outpatient and ambulatory surgery centers, and a massive consolidation of providers, device companies, and hospital systems. There’s also been a stronger regulatory environment post-2007, forcing greater transparency and compliance, particularly regarding physician-industry relationships. Additionally, patient expectations have evolved. Today’s patients are more informed, mobile, and demanding of quicker recovery and lower complication rates—and that has forced the industry to become more agile and patient-centric.

Patrick Fisher, Global President of Orthopedics, Orthofix

The orthopedic industry has become the gold standard for treating patients at a much younger age. I remember when I started my career in 2000, surgeons only wanted to implant hips and knees in patients 65 and older. This is much younger now and the indications have expanded exponentially.

Paul Vasta, Ph.D., Chief Technology Officer, Gramercy Extremity Orthopedics

Although not specific to the orthopedic industry, I think one thing that has faded in significance over the years but was impactful at the time, was the passage of the Sunshine Act in 2010. Back then, it was a significant step in changing how drug and device manufacturers handle practitioner relationships because of the potential exposure to Anti-Kickback Statute violations. It affected everything from product development to marketing to sales and even M&A. Additionally, the gradual and continuing shift of common procedures out of hospitals and into ambulatory surgery centers has impacted the way OEMs approach new product development.

Joe Urban, Global President, Knees, Zimmer Biomet Holdings Inc.

We’re at an inflection point in orthopedics right now. More than 12,000 Americans turn 65 every day, and they’re not slowing down. We’re seeing more people staying active longer, and that’s driving sustained demand for joint replacement. We’re also seeing joint replacement procedures occurring earlier in life, with data showing that by 2030, up to 62% of total knee replacements will be for those under 65.¹ At the same time, the patient experience has been changing. There are over half a billion people globally living with some kind of arthritis, and it’s estimated that less than 5% seek treatment, while the rest struggle with pain. Expectations have also changed, as patients today want less disruption, faster recovery, and care that fits their lifestyle. 

That’s why we’ve been innovating on a number of fronts with the goal of improving patient outcomes and the patient experience, including Persona IQ The Smart Knee, which collects patient-specific data providing insights into recovery, our Oxford Partial Cementless Knee, which we refer to as the Pickleball Knee because it is an ideal option for more active patients, and our Persona SoluTion PPS Femur, designed to serve as an alternative for patients who may have allergies to cobalt-chrome (Co-Cr-Mo) and bone cement and our Persona Revision SoluTion Femur, a revision knee implant designed specifically for those with sensitivities to certain metals. 

For surgeons, there are three trends we’re seeing—increased adoption of robotics and artificial intelligence (AI), the use of minimally invasive techniques, and the incorporation of data-driven decision-making. If you think about access to technology in our personal lives and the shifts from even a decade ago, every day we carry a supercomputer in our pocket. Surgeons are embracing the influx of robotic-assisted knee replacements and the use of AI in the operating room (OR) for the benefit of patients, with the goal of improving outcomes and minimizing recovery time. 

We know that people are eager to stay active for longer in life. This means an individual may undergo several surgeries throughout their lifetime. Minimally invasive techniques, which use smaller incisions, help with recovery time and preserve soft tissue.² 

Surgeons love data. By capturing data throughout the episode of care—before, during, and after surgery—we can equip surgeons with recovery insights through products like Persona IQ, the ROSA robotic system, and our care management platform, mymobility. 

Where surgeries take place has also been changing, with more cases moving to Ambulatory Surgery Centers (ASC). We think this is a trend that will continue to grow, which is why we’re investing in a broad range of solutions well suited for the ASC, like our recently announced partnership with Getinge to distribute Getinge’s OR capital products to our ASC customers. This partnership allows ASC customers to access Getinge’s OR and sterile processing portfolio of solutions, including infection control with our implants and surgical robotics from a single source. 

Barbella: In what ways has orthopedic technology changed in the past 20 years?

Dr. Linda Braddon: The industry has certainly moved from a one-size-fits-all to patient-specific/customizable implants in order to better meet the needs of patients.

Paul Bryant: Over the past two decades, orthopedic technology has shifted toward more customized, patient-specific and procedure-specific solutions. Initially, manufacturers expanded size and shape offerings to better match patient anatomy. That evolution accelerated with the adoption of additive manufacturing (3D printing), which enabled designs that were either impractical or uneconomical with traditional methods. 3D printing also made it possible to integrate advanced porous structures directly into implants, reducing the need for secondary processes. Today, 3D-printed acetabular cups and spine implants are commonplace, offering improved osseointegration, design flexibility, and the ability to incorporate alternative materials.

Speaking of materials, advancements in metals, ceramics, polymers and coatings continue to pave the way for implant performance advancements over the years including extended implant life, reduced wear, and addressed concerns such as metal ion release. Examples include vitamin E–infused polyethylene for enhanced oxidation resistance, antimicrobial coatings for infection prevention and surface treatments to promote bone in-growth. Smith & Nephew’s Oxinium technology is a prime example of how material innovation can capture market share. As processing techniques and biologics continue to advance, the potential for new performance breakthroughs remains high, provided regulatory requirements don’t make the approval pathway prohibitively burdensome.

The integration of digital and enabling technologies has brought yet another leap forward. Robotics, navigation systems, mixed reality, wearables and “smart” surgical tools now provide surgeons with more actionable information before, during, and after procedures. These technologies also enable deeper data capture and integration. Platforms like Stryker’s Mako in total joints and Globus Medical’s ExcelsiusGPS in spine have demonstrated how enabling technology can shift market share, while Zimmer Biomet’s Persona IQ connected knee implant highlights the potential of implantable ‘smart’ devices. Increasingly, orthopedic companies are leveraging artificial intelligence and machine learning to link pre-, intra-, and post-operative data, creating predictive models that personalize care and drive better patient outcomes.

Tobias Buck: Implant design has become smarter, more personalized, and more durable. We’ve moved from one-size-fits-all to patient-specific instrumentation, 3D-printed implants, and even bioactive coatings. The introduction of porous titanium, additive manufacturing, and customized cutting guides have enhanced implant longevity and surgical accuracy. On the manufacturing side, just-in-time inventory models, robotic-assisted production, and AI-driven quality control have made processes leaner and more reliable. Furthermore, digital surgical planning tools and intraoperative navigation have transformed how surgeries are prepped and executed. The line between orthopedic device and digital tech company is beginning to blur—and that’s a good thing.

Patrick Fisher: 3D printing and custom implants are quickly becoming a go-to option for surgeons. This is also helping to revolutionize the implant manufacturing process and eliminating significant waste and time. Implant designs are also made for specific subspecialties. I remember when we first started in foot and ankle, the surgeons used elbow plates in the foot, as an example. Now there are literally hundreds of foot-specific plates. 

Paul Vasta: Additive manufacturing has gradually created a space in product development that is finally showing signs of how impactful it can be. Also, the introduction of robotics in surgical procedures from arthroscopy to joint replacement, while years in the making, has created an avenue for minimally invasive instruments and implants. One of the slower-moving areas that is finally gaining momentum is the incorporation of technology that includes augmented reality, remote patient monitoring, IoT, and of course, artificial intelligence.

Shaun Braun, Senior Vice President, Chief Information and Technology Officer, Zimmer Biomet

Innovation is driven by experts that understand the anatomy, see needs for and have ideas for ways of improving a procedure or have an idea for a new device or technology. It’s amazing to see how far we’ve come during the last 20 years with the use of robotic assisted technology – this and AI and VR (virtual reality) are revolutionizing orthopedic technology. 

There have been tremendous advancements in medtech innovation that make it easier and faster to recover from joint replacement surgery. We now have the ability to combine data from multiple sources: robotics, wearables, implants, and create a cohesive system with a data-driven feedback loop empowering surgeons and care teams to personalize and optimize care treatment. 

Additionally, significant innovation is coming from the integration of smart implants and personalized treatment solutions. Today’s knee replacements are vastly different from people’s grandparent’s or even parents’ knee replacement: from partial and total knee implants to cementless, alignment philosophy and smart knee implants like Persona IQ, we have led the optimization of knee replacements.

The Persona IQ Smart Knee implant, through our mymobility solution, collects patient-specific recovery data such as gait and range of motion allowing surgeons and their care teams to remotely monitor recovery and tailor treatments to individual needs. 

While there has been incredible innovation in the industry, we believe there are four key challenges facing the medtech industry today that we continue to solve for—awareness, safety, efficiency, and clinical outcomes.

Barbella: How have patient outcomes changed over the past two decades? 

Dr. Linda Braddon: The implants last a lot longer for patients. Advancements in materials and designs have changed the lifetime of an implant in a really positive way for patients.

Paul Bryant: Over the past two decades, patient outcomes in orthopedics have steadily improved, driven by advances in surgical techniques, implant and instrumentation design and more effective preoperative preparation and postoperative rehabilitation. While earlier goals often focused on simply reducing or eliminating pain, today’s patients expect to regain high levels of function in addition to being pain-free. Advances in imaging and enabling technologies have enhanced preoperative planning and intraoperative precision, resulting in more accurate implant placement and fewer outliers in alignment and performance. Looking ahead, the integration of big data with artificial intelligence and machine learning promises to deliver even more predictable and personalized outcomes, ensuring each patient receives care tailored to their unique anatomy, activity level and recovery goals.

Tobias Buck: Outcomes have generally improved across the board. Complication and readmission rates are down, length of stay has decreased significantly (with many procedures now done same-day), and implant survivorship has increased, thanks to better materials and surgical techniques. Enhanced recovery protocols, improved pain management strategies, and better preoperative risk stratification have all contributed. However, disparities still exist depending on geographic region, payer mix, and access to advanced care—an area we must continue to address.

Patrick Fisher: Patients are returning to daily activities much faster—days now instead of weeks and months. Outpatient total joints is a good example.

Paul Vasta: I do think that advancements in surgical techniques driven by the devices (implants and instruments) have reduced the recovery time of many procedures. One of the most obvious is total joint replacement. Morbidity is well understood to be negatively correlated with rapid return to mobility, so I believe the reduction in recovery time due to less invasive techniques has led to improved outcomes. 

Joe Urban: Following the large-scale adoption of smartphones, patients can be more actively engaged in their recovery journey by accessing recovery data to track their progress and communicating with their care teams more easily through direct messages and virtual visits via mymobility. Additionally, studies suggest that robotic knee replacement surgery tends to lead to faster recovery times, lower complication rates, and improved functional status post-surgery.^3,4 

For example, studies comparing conventional knee replacement surgery to knee replacement surgery with our ROSA Knee System found that ROSA Knee resulted in a faster recovery following total knee arthroplasty (TKA) for range-of-motion, Knee Society Scores, and KOOS JR scores when compared to conventional TKA.^5-7

Barbella: What has been the most revolutionary technological advancement to impact orthopedics since 2005? In what ways has it specifically impacted the industry?

Dr. Linda Braddon: In my opinion, the ability to use additive manufacturing to make custom patient implants. This allows incredible flexibility and customization, resulting in enhanced patient outcomes. 

Paul Bryant: While many might point to computer-assisted navigation (CAS) and robotics as the most revolutionary advancement in orthopedics since 2005, I believe the true game-changer has been the leap in microprocessor and chip technology. Advances in processor power and energy efficiency have fueled breakthroughs in imaging resolution, software sophistication, hardware miniaturization, and connectivity, thus forming the foundation for much of modern orthopedic innovation. These gains have also accelerated manufacturing advancements such as 3D printing, enabling faster, more precise and highly customized implants and instrumentation. When applied to CAS and robotics, this computing power has shifted orthopedic surgery from a primarily “feel-based” craft to a data-driven discipline, delivering greater accuracy, reproducibility, and patient-specific customization. The real revolution lies not only in the surgical tools themselves, but in the computational capabilities that make them possible.

Tobias Buck: Robotic-assisted surgery and digital navigation systems have arguably been the most revolutionary. These platforms allow for sub-millimeter precision, better soft tissue balancing, and more consistent outcomes. They’ve also created a new arms race among manufacturers and providers to demonstrate differentiation. Importantly, they’ve introduced data capture into the OR—which is laying the groundwork for predictive analytics and real-world evidence. That said, the cost-benefit conversation is ongoing, and we still have work to do in demonstrating long-term ROI at scale.

Patrick Fisher: Trabecular porous coatings and better plastics.

Shaun Braun: Robotic surgery has helped improve patient outcomes while reducing complications and enhancing surgical precision.⁸ Robotic-assisted surgery has had a significant impact on orthopedics in the last 20 years.

Our ROSA Robotics System provides surgeons with real-time insights and greater precision with the goal of improving outcomes. 

For example, studies comparing manual total hip arthroplasty (THA) with robotic-assisted THA (RA-THA), using the ROSA Hip System, found that patients treated with ROSA Hip saw greater improvements across all pre- versus post-operative HOOS scores (including pain and physical function) compared to patients who underwent manual THA one-year post-op.⁹ Additionally, patients treated using ROSA Hip had lower post-operative opioid use in the immediate peri-operative period, compared to manual techniques.¹⁰ 

Additionally, studies comparing manual total knee arthroplasty (TKA) with robotic-assisted TKA, using the ROSA Knee System, found that patients treated with ROSA Knee had less pain and better patient satisfaction at six months follow-up than those with manual TKA.¹¹

We recently announced a definitive agreement to acquire Monogram Technologies, which has developed a CT-based, semi-autonomous, AI-navigated total knee arthroplasty robotic technology that received FDA 510(k) clearance in March 2025. Monogram is also developing a fully autonomous version of the technology, which we believe will have the potential to change the standard of care.

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC2745453/
2. https://pubmed.ncbi.nlm.nih.gov/22507716/
3. bit.ly/4m3ncuj
4. https://josr-online.biomedcentral.com/articles/10.1186/s13018-025-05518-4
5. https://boneandjoint.org.uk/Article/10.1302/1358-992X.2023.2.043
6. https://pubmed.ncbi.nlm.nih.gov/35552475/
7. https://pubmed.ncbi.nlm.nih.gov/36801477/
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC10784205/
9. https://pubmed.ncbi.nlm.nih.gov/38400899/
10. https://pubmed.ncbi.nlm.nih.gov/37924164/
11. https://pubmed.ncbi.nlm.nih.gov/35552535/