Orthopedic giant and ODT Top 10 champion Stryker Corporation proclaimed one of the largest medtech M&A announcements of last year on Nov. 4, 2019, announcing it would snap up Dutch firm Wright Medical Group N.V. to fortify its position in the trauma and extremities markets. Stryker knew it would be a while before the deal was completed, revealing to investors at the time that it expected the transaction to close during the second half of this year.

Stryker announced in late October that it was going to extend its offer period for outstanding Wright shares to Nov. 10, which delayed the earliest possible close of the deal over a year after it was revealed. This was the seventh extension since Stryker shared its plan to pay $5.4 billion for the company. Before the latest extension, the offer was planned to expire on Oct. 28.

From the get-go, Stryker expected there would be some time before the deal was finalized. Analysts predicted Stryker would likely experience antitrust concerns because of the ankle replacement devices already in its portfolio. And of course, a mere month after the deal came to light, stirrings of a novel coronavirus spreading through China gained media attention. (The events that followed need not be reported again.)

The pandemic stifled elective procedures from March to June as the U.S. scrambled to free up hospital beds for COVID-19 patients. In general, orthopedic procedures are elective with the exception of life-saving surgery for traumatic injuries. So orthopedic companies, Stryker largely included, felt the sting.

To say Stryker’s finances suffered during the worst of the pandemic (thus far) in Q2 is a gross understatement. Reported net sales dropped 24.3 percent to $2.8 billion. Each of its businesses—Orthopaedics, MedSurg, and Neurotechnology and Spine—respectively plummeted 29.9 percent, 17.3 percent, and 29.6 percent. Net earnings fell 117.3 percent. Most of the company’s businesses gradually recovered in June, but the pandemic had done its damage.

Stryker is not a stranger to multibillion-dollar M&A, but the company’s time-to-close has typically been much speedier. The company’s 2018 $1.2 billion acquisition of complex spine and minimally invasive solutions maker K2M closed in 71 days. Its $1.28 billion 2016 grab of automated external defibrillator and emergency medical response products maker Physio-Control took a mere 49 days to complete. And its $2.78 billion buy of Sage Products, which made products primarily used to prevent hospital-acquired infections, was finished in 60 days.

The time-to-close was most likely slowed by disruptions from the pandemic this year, in addition to divestitures needed to placate antitrust regulators. From the moment the deal was first announced, analysts pointed to Stryker’s STAR product line as likely to be the subject of scrutiny from antitrust regulators as the firm would be gaining Wright’s extremities products. U.S. regulators called out the overlap in Stryker and Wright’s ankle businesses at the end of last year, and U.K. regulators called out similar concerns this year.

To remedy this, in mid-October Stryker disclosed that to appease U.S. and U.K. regulators it would sell the STAR ankle line along with finger joint replacement products to Colfax subsidiary DJO Global. The agreement seems to be the final hurdle from U.K. regulators, with the U.K. Competition and Markets Authority (CMA) confirming the proposed sale satisfies concerns that might have necessitated a phase 2 investigation of the merger. DJO competes in many of the same markets as Stryker, including spine, hip, knee, shoulder, hand/wrist, and foot/ankle. DJO was not currently active in the ankle replacements market, CMA noted.

The impending closing of the Wright deal would be a welcome follow-up to Stryker’s third-quarter EPS, which demolished the consensus forecast. Q3’s $3.7 billion in sales grew the bottom line by 33.3 percent, and sales growth overall jumped 4.2 percent.

“We are pleased to have returned to growth in the third quarter and delivered strong adjusted earnings and cash flow in a challenging environment,” Stryker chairman and CEO Kevin Lobo told the press. “Our teams executed well in serving our customers, advancing innovations and preparing for the Wright Medical integration.”

However, Lobo tempered expectations during the company’s earnings call, saying uneven growth in the company occurred due to the COVID-19 pandemic and the environment still remains uncertain. As a result, Stryker declined to offer financial guidance for the full year at the time.

There is a bright spot—the pandemic hasn’t slowed orthopedic and spine specialists from moving forward with robotic surgery products. Robotic surgery rivals NuVasive Inc. and Globus Medical Inc. also reported Wall Street-beating earnings and revenue numbers in Q3.

Sales of Stryker’s Mako robot, which assists in knee and hip replacements, jumped 30 percent in the U.S. during Q3. The firm also topped the 1,000 installations mark for Mako and witnessed its highest number of quarterly installations in ambulatory surgical centers thus far. Stryker also reported that the European and Japanese markets lifted the second quarter pause in Mako’s momentum.

Lobo predicts Mako placements to keep accelerating in Q4, and the bold outlook is “really irrespective of competition.” He also addressed future applications for spine and shoulder surgeries, though offered little detail. When asked about spine—where the firm has technology from last year’s Mobius buy—Lobo said the company is actively working on an offering but isn’t ready to discuss it with the public. He also declined to share a timeline for implants to be used with the shoulder indication in progress.