The Ongoing Transformation of the Orthopedic Industry

Orthopedics is shifting from a fragmented, consolidated, and platform-driven structure to an ecosystem-controlled industry where data, robotics, regenerative materials, extremities, and procedural integration matter more than simple hip and knee implant discussions. Companies that recognize this shift early will define the leaderboard in the coming years and beyond.

The global orthopedic market’s net worth will grow to an estimated $75 billion this year. More than 1.5 million hip and knee replacements are performed annually in the United States due to aging baby boomers, rising obesity rates (with GLP-1 medications creating a new population of slimmed-down patients either needing or wanting joint replacements to accommodate their more active lifestyles), accelerating ambulatory surgical center (ASC) migration, robotics-driven procedure growth, and an active biologics pipeline. There is also a quiet but important “battle for the body” underway in small joints and extremities, where market share is still very much in play. 

Stryker is the leading OEM both organically and inorganically, thanks to its robotic surgical system (Mako) and their continued aggressive M&A strategy/execution. Medtronic continues to dominate the spine sector and is leveraging its robotics solution (Mazor) into broader procedural integration. Zimmer Biomet Holdings, on the other hand, is placing meaningful bets on expanding its ROSA robotics platform through enabling technologies (knee replacement patients using the mymobility app, for example, can track their post-operative physical progress with the Persona IQ implant). DePuy Synthes will “stand tall again soon”; the planned separation from Johnson & Johnson is creating both uncertainty and opportunity, since capital deployment decisions will be different once the organization is on its own. Smith+Nephew is finding its lane in sports medicine and digital surgery and is looking for agile partners. Globus Medical Inc., meanwhile, is still adjusting its portfolio pathways after its $3.1 billion takeover of NuVasive Inc., and the combined entity is now a scale player across MSK.

Despite these differing focal points, OEMs are consolidating supplier relationships and fostering fewer, deeper partnerships. Approved vendor lists are being reduced by 20% to 40% and scale, certifications, and breadth of capability are now viable table stakes. And as always, innovation matters.

How Orthopedics’ Past Shaped the Present

To better understand the orthopedic landscape in 2026, it is necessary to examine the ways in which past decades have shaped the sector. The Megadeal Era (2013-2018) was all about scale as competitive defense and robotics; industry-defining deals included Zimmer Holdings’ $14 billion marriage with Biomet Inc. (2015), Medtronic’s $1.7 billion acquisition of Mazor Robotics in December 2018, and Stryker’s $1.65 billion purchase of Mako Surgical Corp. in 2013, which was the most strategically consequential deal of the era. During those six years, the industry averaged roughly 30 deals annually. 

The Stimulus Frenzy Era (2019-2021) generated a high of 42 deals in 2020. Enabling technology became the new battleground. Separately, private equity (PE) flooded the orthopedic practice space, going from 110 PE practice deals in 2015 to 459 in 2021 and 600 in 2022.

The inevitable correction to this brief period was the Recalibration Era (2022-2025), when deal volume fell to a 21-per year average due to four forces converging: rising interest rates pushing leveraged buyouts financing costs from roughly 3% to 7%; megadeal digestion (Globus-NuVasive, Enovis-LimaCorporate, Zimmer Biomet-Paragon 28) consuming integration bandwidth; viable targets delivering either immediate revenue accretion or differentiated technology; and healthcare EV/EBITDA (Enterprise Value to Earnings Before Interest, Taxes, Depreciation, and Amortization) multiples resetting from approximately 14.5x in 2024 to 11.5x in 2025. Sellers anchored to 2021 peaks found few takers. Within that period, 2023 was dominated by spine-led consolidation, 2024 was a platform-building year (a clear shift from product-based to procedure-based strategies—i.e., “own the procedure, not just the implant”), and 2025 was dominated by portfolio optimization, as leaders doubled down on extremities and ASC-aligned assets while divesting non-core businesses.

The capital that did move indicates where the industry is headed. Spine fell from 30% of orthopedic M&A transactions in 2016-2020 to 24% in 2021-2025 as the segment matured. Orthobiologics more than doubled, rising from 9% to 20%, and was the only segment with an increased absolute deal count. Foot and ankle has emerged as the fastest-growing area, expanding 7% to 8% annually due to several factors: including validation of the Zimmer Biomet/Paragon 28 union and growth of the Stryker Wright Medical combination, their compatibility with ASCs, and their attractive margins. Median orthopedic device transactions are priced at approximately 3.8x (last 12 months) revenue, with 84% of 2025 medtech deals involving commercial-stage, revenue-generating companies. Orthopedics now accounts for 25% of medtech M&A volume, even though it represents only 14% of the addressable market—a meaningful indicator of where capital sees opportunity. And, Spine cannot be counted out just yet because the repositioning of its players will likely lead to innovations in that segment.

Technology and Capital Flow

The technology drumbeat has not slowed. Robotic-assisted surgery is presently on track to represent more than 40% of joint replacements by 2027, translating directly into demand for tighter component tolerances, robotic end-effectors, and redesigned sterility and packaging systems. Biologics, advanced biomaterials, AI-enabled digital twins, and 3D printing are increasingly becoming the differentiators at the implant-tissue interface and in the operating room workflow.

Underneath all of that, the regulatory environment is tightening. The U.S. FDA Quality Management System Regulation that took effect in February aligned U.S. quality system requirements with ISO 13485, thus making design controls and risk management explicit obligations. EU MDR continues to create documentation burdens that are reaching deep into the supply chain, and AI and Software as Medical Device guidance is bringing IEC 62443 and 62304 cybersecurity expectations down to the component level.

From a capital flow perspective, the 2026 year-to-date picture is materially different from 2024 and 2025. Breakups and carve-outs are unlocking value: J&J is preparing to divest DePuy Synthes, Stryker carved out VB Spine and continues to acquire in adjacencies, and PE is re-entering at scale. PE-backed supplier platforms are scaling into the $500 million to $1 billion range and acquiring captive manufacturing assets as tariff dynamics make domestic and near-shore footprints strategically valuable. Macro tailwinds are improving, too: Inflation is moderating toward 3% or less, financing conditions are easing, large-cap balance sheets are being cleared of integration overhangs, and PE “second bite” exits are beginning to materialize.

For orthopedic OEMs, the priorities are ASC optimized platforms and the “battle for the body” (including both upper and lower extremities). PE and the practice market, by contrast, favor second-bite exits, new platform formation, and physician supergroup consolidations. We project orthopedic M&A volume to selectively rebound in the 25 to 35 deals per year range. Looking further ahead, six themes will define the industry through 2028 and beyond: implant-tech-data convergence, regenerative biologic materials, OEM supplier mega-platforms built by PE in a CDMO-style model, ASC-driven consolidation, continued divestiture activity creating pure-play orthopedic platforms, and geographic expansion in both directions.

In summary, the $75 billion orthopedic market is growing, but pricing pressure throughout the supply chain is intensifying. OEM consolidation is accelerating while robotics and advanced biomaterials are reshaping what OEMs need from supply partners. Regulatory change is now a supplier qualifier, not just an OEM burden and the ASC shift is real and accelerating. The suppliers who win this cycle will be strategic partners—embedded in design, compliant ahead of requirements, and relentlessly innovative. The industry has moved out of the recalibration phase. The companies and capital providers paying close attention now will define the leaderboard in 2028 and transform the orthopedics industry for decades to come.

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Florence Joffroy-Black, CM&AA, is a longtime marketing and M&A expert with significant experience in the medical technology industry, including working for multi-national corporations based in the United States, Germany, and Israel. She is currently CEO at MedWorld Advisors and can be reached at [email protected].

Dave Sheppard, CM&AA, is a former medical technology Fortune 500 executive and is now focused on M&A as a managing partner at MedWorld Advisors. He can be reached at [email protected].