Orthopedic Surgical Robots and Surgical Robotic Assist Robots Market Shares, Strategies, and Forecasts, Worldwide, 2016 to 2022

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1 Orthopedic Surgical Robots and Surgical Robotic Assist Robots Market Shares, Strategies, and Forecasts, Worldwide, 2016 to 2022 Mountains of Opportunity Picture by Susan Eustis WinterGreen Research, Inc. Lexington, Massachusetts

2 CHECK OUT THESE KEY TOPICS Orthopedic Surgical Robots and Surgical Robotic Assist Robots Support Surgeon Accuracy and Provide Repeatable Joint Repairs Joint Surgical Robotics Knee Surgical Robotics Hip Surgical Robotics Orthopedic Surgical Robotics Robotic surgery Smart Instruments Medical Devices Healthcare Robotics Enabling Technology Robotic-Assisted Minimally Invasive Surgery Robotic Surgical System Minimally-Invasive Surgery, Robotic Surgery Equipment Surgical Robot Applications Next Generation Robotic Surgery Flexible Robot Platform Minimally Invasive Surgery MIS Orthopedic Surgical Robot and Surgical Robotic Assist Robots Growth Strategy: Orthopedic Surgical Robot and Surgical Robotic Assist Robots: Market Shares, Strategies, and Forecasts, Worldwide, LEXINGTON, Massachusetts (May 18, 2016) WinterGreen Research announces that it has published a new study Orthopedic Surgical Robots and Surgical Robotic Assist Robots: Market Shares, Strategy, and Forecasts, Worldwide, 2016 to The 2016 study has 156 pages, 64 tables and figures. Worldwide Orthopedic surgical robot and robotically assisted surgery markets are poised to achieve significant growth because the devices provide consistent, superior outcomes for clinicians. The accuracy provided by the robot is not reproducible by the human surgeon, so ultimately all surgeons will want to perform the orthopedic implants using this technology. Robot assisted medial knee arthroplasty: orthopedic surgical robots are poised to take knee and hip surgery quality far beyond what has previously been available. The quality of knee arthroplasty is improved with robotic capability. All the advantages of surgical robots carry into the Stryker Mako orthopedic reconstruction surgical products. When the knee and hip surgical robots are used, patients have less bleeding, reduction of post-operative pain, fewer re-admissions to hospital and faster recovery. Robots support high-precision surgery. A clinic in Switzerland, La Source, has reported a reduction in the average days of hospitalization from 10 to 6.

3 Surgical robots provide consistent reproducible precision. This capability is so significant for implant surgery that the robots are positioned to become the defacto standard of care for knee and hip surgery within five years. Any one getting a knee or hip replaced will demand clinician attention to quality of life, to maintenance of lifestyle provided by a robot when they have a joint replacement. As next generation systems, hip and knee robotic units provide a way to improve traditional orthopedic hip and knee replacement surgery. Total hip replacement surgery has evolved dramatically as advances in technology have brought improved surgical techniques. Surgical robots and robotic assist devices are a significant part of that advance. Once, the penetration achieves a 35% level, all orthopedic surgeons will demand that hospitals offer robotic orthopedic surgical capability because the outcomes are more predictable and better. If the hospital does not offer the robot, the surgeon will move to a more modern facility. Once some hospitals are offering superior outcomes, all hospitals must come up tot that standard, the good physicians will migrate to the good technology and the patients will follow. This market has exceeded the threshold of 100 paid successful installations, that is the watermark for strong technology growth. Knee and hip surgical robot procedures and robotically assisted surgeries have been impacted by the reduction in insurance payments. Payment reductions have forced hospitals to start acting as businesses. The cost of delivering care has become as much a factor as providing quality care when making decisions about patient improvement in condition. Cost-cutting has been made in the supply chain. Suppliers were examined closely for quality and cost. The number of suppliers is reduced to put pressure on the ones that remain. Those remaining are pressured to improve prices and efficiencies. Hospitals, physicians, and care providers have been financially incentivized to create accountable care organizations (ACOs). Coordinated patient care plans and value-based purchasing were rewarded. The med device buyer shifted from physicians to the ACOs and smart buying groups. Stryker has thrived in this cost efficient environment with a surgical robot that permits faster surgeries, more cost efficient surgeries. In addition, Stryker offers an integrated system. The ability to include a Mako total knee application with Stryker Triathlon total knee system is anticipated to increase market share for Stryker. Stryker market leading Triathlon total knee system is helped in the market by the robot simply by the improved surgical technique possible. Surgical robots are proving themselves in a variety of disciplines, lending credibility to the Stryker robotic initiative. According to Susan Eustis, lead author of the study, Use of the robot with the orthopedic implant represents a key milestone in reconstructive surgery. Robots provide an opportunity to transform orthopedics. By furthering the growth of robotic-arm assisted surgery, patients can get better treatment. By enhancing the surgeon and patient experience is is likely that the entire orthopedics implant market will grow more rapidly than it would otherwise.

4 Stryker uses the Mako to perform partial knee resurfacing and is happy to add robotic capability to total knee resurfacing. Technology is enhancing a wide variety of procedures in many surgical specialties. Omni has had remarkable success with its robotic assist device. Joint stiffness and joint instability are eliminated with the use of the Omni device. The aging US population has supported demand, since the occurrence of health issues that require medical devices is higher in the elderly population. Buoyed by strong demand and sales, industry profit margins have increased considerably during the past five years. The aging of the population worldwide is anticipated to trigger further growth of these markets. Hospitals are adopting robotic surgical devices to improve their outcomes numbers. Hospitals are measured on outcomes, robots for surgery, when used by a trained physician are improving outcomes significantly. Hundreds of universities worldwide have research programs in robotics and many are awarding degrees in robotics. These roboticists are increasingly being hired by Global 2000 organizations to link mobile robots (mobile computers) into existing IT systems. Robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. Hip and knee orthopedic surgical robot device markets at $222 million in 2015 are anticipated to reach $5 billion by 2022 as next generation robotic devices, systems, and instruments are introduced to manage surgery. The complete report provides a comprehensive analysis including procedure numbers, units sold, market value, forecasts, as well as a detailed competitive market shares and analysis of major players success, challenges, and strategies in each segment and sub-segment. The reports cover markets for knee and hip robotic orthopedic surgery medical specialties and sub-specialties. WinterGreen Research is an independent research organization funded by the sale of market research studies all over the world and by the implementation of ROI models that are used to calculate the total cost of ownership of equipment, services, and software. The company has 35 distributors worldwide, including Global Information Info Shop, Market Research.com, Research and Markets, Bloomberg, and Thompson Financial. It conducts its business with integrity. WinterGreen Research is an independent research organization funded by the sale of market research studies all over the world and by the implementation of ROI models that are used to calculate the total cost of ownership of equipment, services, and software. The company has 35 distributors worldwide, including Global Information Info Shop, Market Research.com, Research and Markets, and Thompson Financial. WinterGreen Research is positioned to help customers facing challenges that define the modern enterprises. The increasingly global nature of science, technology and engineering is a reflection of the implementation of the globally integrated enterprise. Customers trust wintergreen research to work alongside them to ensure the success of the participation in a particular market segment.

5 WinterGreen Research supports various market segment programs; provides trusted technical services to the marketing departments. It carries out accurate market share and forecast analysis services for a range of commercial and government customers globally. These are all vital market research support solutions requiring trust and integrity. Key Words: Hip and Knee Orthopedic Surgical Robotics, Medical Devices, Healthcare Robotics, Enabling Technology, Robotic-Assisted Minimally Invasive Surgery, Robotic Surgical System, Medical / Surgical Delivery Robots, Surgical Assistive Technology, Hospital Robots, Robotic Surgery Equipment, Surgical Robot Applications, Next Generation Robotic Surgery, Flexible Robot Platform, Minimally Invasive Surgery, MIS. Companies Profiled Market Leaders Stryker / Mako Omni Smith & Nephew Market Participants Johnson & Johnson / DePuy Synthes Shenzhen Advanced Institute Spinal Surgical Robot Smith & Nephew Stryker / Mako THINK Surgical Wright Medical Technology Zimmer Biomet

6 Orthopedic Surgical Robots and Surgical Robotic Assist: Market Shares, Strategies, and Forecasts, Worldwide, 2016 to 2022 Report Methodology This is the 676th report in a series of primary market research reports that provide forecasts in communications, telecommunications, the Internet, computer, software, telephone equipment, health equipment, and energy. Automated process and significant growth potential are a priority in topic selection. The project leaders take direct responsibility for writing and preparing each report. They have significant experience preparing industry studies. They are supported by a team, each person with specific research tasks and proprietary automated process database analytics. Forecasts are based on primary research and proprietary data bases. The primary research is conducted by talking to customers, distributors and companies. The survey data is not enough to make accurate assessment of market size, so WinterGreen Research looks at the value of shipments and the average price to achieve market assessments. Our track record in achieving accuracy is unsurpassed in the industry. We are known for being able to develop accurate market shares and projections. This is our specialty. The analyst process is concentrated on getting good market numbers. This process involves looking at the markets from several different perspectives, including vendor shipments. The interview process is an essential aspect as well. We do have a lot of granular analysis of the different shipments by vendor in the study and addenda prepared after the study was published if that is appropriate. Forecasts reflect analysis of the market trends in the segment and related segments. Unit and dollar shipments are analyzed through consideration of dollar volume of each market participant in the segment. Installed base analysis and unit analysis is based on interviews and an information search. Market share analysis includes conversations with key customers of products, industry segment leaders, marketing directors, distributors, leading market participants, opinion leaders, and companies seeking to develop measurable market share. Over 200 in depth interviews are conducted for each report with a broad range of key participants and industry leaders in the market segment. We establish accurate market forecasts based on economic and market conditions as a base. Use input/output ratios, flow charts, and other economic methods to quantify data. Use in-house analysts who meet stringent quality standards.

7 Interviewing key industry participants, experts and end-users is a central part of the study. Our research includes access to large proprietary databases. Literature search includes analysis of trade publications, government reports, and corporate literature. Findings and conclusions of this report are based on information gathered from industry sources, including manufacturers, distributors, partners, opinion leaders, and users. Interview data was combined with information gathered through an extensive review of internet and printed sources such as trade publications, trade associations, company literature, and online databases. The projections contained in this report are checked from top down and bottom up analysis to be sure there is congruence from that perspective. The base year for analysis and projection is With 2011 and several years prior to that as a baseline, market projections were developed for 2012 through These projections are based on a combination of a consensus among the opinion leader contacts interviewed combined with understanding of the key market drivers and their impact from a historical and analytical perspective. The analytical methodologies used to generate the market estimates are based on penetration analyses, similar market analyses, and delta calculations to supplement independent and dependent variable analysis. All analyses are displaying selected descriptions of products and services. This research includes referencde to an ROI model that is part of a series that provides IT systems financial planners access to information that supports analysis of all the numbers that impact management of a product launch or large and complex data center. The methodology used in the models relates to having a sophisticated analytical technique for understanding the impact of workload on processor consumption and cost. WinterGreen Research has looked at the metrics and independent research to develop assumptions that reflect the actual anticipated usage and cost of systems. Comparative analyses reflect the input of these values into models. The variables and assumptions provided in the market research study and the ROI models are based on extensive experience in providing research to large enterprise organizations and data centers. The ROI models have lists of servers from different manufacturers, Systems z models from IBM, and labor costs by category around the world. This information has been developed from WinterGreen research proprietary data bases constructed as a result of preparing market research studies that address the software, energy, healthcare, telecommunicatons, and hardware businesses. YOU MUST HAVE THIS STUDY

8 Orthopedic Surgical Robot and Surgical Robotic Assist Market Shares, Strategy, and Forecasts, 2016 to 2022 Table of Contents Orthopedic Surgical Robots and Surgical Robotic Assist Robots: Executive Summary The study is designed to give a comprehensive overview of the orthopedic surgical robots and surgical robotic assist equipment market segment. Research represents a selection from the mountains of data available of the most relevant and cogent market materials, with selections made by the most senior analysts. Commentary on every aspect of the market from independent analysts creates an independent perspective in the evaluation of the market. In this manner the study presents a comprehensive overview of what is going on in this market, assisting managers with designing market strategies likely to succeed. Table of Contents KNEE AND HIP SURGICAL ROBOTS MARKET SHARES AND MARKET FORECASTS 13 Knee and Hip Surgical Robot Market Driving Forces 13 Knee and Hip Surgical Robot Market Shares 16 Knee and Hip Surgical Robot Forecasts KNEE AND HIP SURGICAL ROBOTS MARKET DESCRIPTION AND MARKET DYNAMICS Knee and Hip Surgical Robots Reduction In Payments Med Device Industry Stryker Positions to Assist Hospital Capital Investment in Knee and Hip Robotics Stryker Flex Financial Provides Assistance in the Financing Of The Surgical System Purchase Knee and Hip Surgery Three Dimension High-Definition Visualization with Robotic Arm Osteoporosis Impact On Hip KNEE AND HIP SURGICAL ROBOTS MARKET SHARES AND MARKET FORECASTS Knee and Hip Surgical Robot Market Driving Forces Knee and Hip Surgical Robot Market Shares Orthopedic Surgical Robot Market Shares, Units and Dollars Knee and Hip Surgical Robot Unit Analysis Stryker MAKO Platform Expansion Omni OMNIPlasty Total Knee Replacement Robotic Surgery OMNI Life Science OMNIBoics Smith & Nephew Navio Think ROBODOC Surgical Assistant Wright / Tornier Surgical Robot and Surgical Assistive Robot Forecasts Knee and Hip Surgical Robotic Procedures Forecasts Hip and Knee Orthopedic Surgical Robot Market Segment Forecasts Consequences of Mal-Positioning Knee and Hip Surgical Robot Regional Analysis KNEE AND HIP SURGICAL ROBOT PRODUCTS 60

9 3.1 Stryker Mako RIO Robotic Arm Stryker MAKOplasty Robotic Arm Hip Replacement Solution Stryker MAKOplasty Surgical Robotic Total Hip Arthroplasty Stryker MAKO Surgical Knee Replacements Stryker s Mako Total Knee Application Receives FDA Clearance Stryker Knee and Hip Surgical Robot Products Benefits Stryker / Mako Omni OMNIPlasty Robotic Surgery OMNIPlasty Total Knee Replacement Procedure OMNIBotic Surgery Provides Increased Accuracy OMNIBotics Bone Morphing OMNIBotics Virtual Implant Planning Omni NanoBlock Smith & Nephew Navio KNEE AND HIP SURGICAL IMPLANT COMPANY DESCRIPTIONS Orthopedic Implant Surgical Companies DePuy Synthes / Johnson & Johnson Depuy Knee Replacement System Stryker Knee Replacement System Zimmer Biomet Smith&Nephew Smith & Nephew Knee Implant Systems Smith & Nephew Hip Implant Systems Smith & Nephew Bearing Surfaces KNEE AND HIP SURGICAL COMPANY DESCRIPTIONS Omni Shenzhen Advanced Institute Spinal Surgical Robot Smith & Nephew Smith & Nephew Revenue Smith & Nephew Navio Stanmore Stryker / MAKO Surgical Stryker Business Segment Operations Stryker Revenue Stryker Hip Recall: $1.4 Billion Settlement Stryker Revenue Stryker Results Of Operations Stryker Segment Orthopaedics Stryker Regional Revenue Segment Stryker Robots Stryker / MAKO Surgical Stryker / Mako THINK Surgical THINK Surgical TPLAN 3D Planning Workstation THINK Surgical TCAT Computer Assisted Tool Think Surgical Think Surgical Robodoc Wright Medical Technology Wright Revenue Wright Medical Group NV Revenue Wright Medical Group N.V. Revenue for 2015 Third Quarter Wright / Tornier Zimmer Biomet 147 Figure ES-1 13

10 Stryker MAKO Surgical Robots 13 Table ES-2 14 Knee and Hip Surgical Robot Market Driving Forces 14 Table ES-3 15 Innovative Knee and Hip Surgical Robot Features 15 Figure ES-4 18 Orthopedic Surgical Robot and Robotic Surgical Assist Devices, Market Segments, Dollars, Figure ES-5 20 Orthopedic Surgical Robots and Surgical Assistive Robots Market Forecasts, Dollars, Worldwide, Table Stryker Positions to Assist Hospital Capital Investment in Orthopedic Surgical Robots 24 Figure Osteoporosis Impact on Hip 26 Table Causes of Knee and Hip Deterioration 27 Figure Stryker MAKO Surgical Robots 28 Table Knee and Hip Surgical Robot Market Driving Forces 29 Table Innovative Knee and Hip Surgical Robot Features 30 Figure Orthopedic Surgical Robot and Robotic Surgical Assist Devices, Market Segments, Dollars, Table Orthopedic Surgical Robot and Surgical Robot Assist Devices Market Shares, Dollars, Worldwide, Table Orthopedic Surgical Robot Market Shares, and Installed Systems Units and Dollars, Worldwide, Table Orthopedic Surgical Robot and Surgical Robot Assist Market Shares, Units and Dollars of Shipments, Worldwide, Table Medical Surgical Robot Joint Reconstruction and Joint Replacement Market Installed Systems, and Units and Dollars of Shipments, Worldwide, Figure Orthopedic Surgical Robots and Surgical Assistive Robot Market Forecasts, Dollars, Worldwide, Table Orthopedic Surgical Robot and Assistive Surgical Robot Market Segment Forecasts, Dollars, Worldwide, Table Hip, Knee, and Other Orthopedic Surgical Implant Market Segment Forecasts Units, Dollars, and Dollars per Unit, United States and Worldwide, Table Knee Orthopedic Surgical Implant Market Segment Forecasts, Units, Dollars, and Dollars per Unit, United States and Worldwide, Table Hip Orthopedic Surgical Implant Market Segment Forecasts, Units, Dollars, and Dollars per Unit, United States and Worldwide, Table Other Orthopedic Surgical Implant Market Segment Forecasts, Units, Dollars, and Dollars per Unit, United States and Worldwide, Table Hip, Knee, and Other Orthopedic Surgical Implant Market Segment Forecasts Dollars,

11 Worldwide, Figure Knee Implants Market Forecasts, Dollars, Worldwide, Figure Hip Implants Market Forecasts, Dollars, Worldwide, Figure Other Implants Market Forecasts, Dollars, Worldwide, Figure Orthopedic Implants Market Forecasts, Dollars, Worldwide, Table Orthopedic Surgical Robot Regional Market Segments, Dollars, Table Orthopedic Surgical Robot Regional Market Segments, Dollars, Figure Stryker Mako Advanced RIO Robotic Arm 61 Figure Stryker MAKOplasty Robotic Arm Solution 62 Figure Stryker MAKOplasty Hip Arthroplasty 63 Figure Stryker MAKOplasty Hip Arthroplasty 64 Table Stryker MAKOplasty Surgical Robotic Total Hip Arthroplasty Features 65 Figure Stryker Hip Joint Kinematics 66 Figure Stryker RIO Robotic Arm Interactive Orthopedic System 67 Figure Stryker MAKOplasty 68 Figure Stryker Mako RESTORIS Hip System Components 69 Table Stryker Mako Diverse Family of RESTORIS Hip Implant Systems 70 Figure MAKO Surgical Maker Of Robots To Assist In Knee Replacements 71 Figure Stryker Mako Robotic Stations for Surgery Planning and Bone Cutting 73 Figure Stryker Knee and Hip Surgical Robot For Bone Cutting 74 Figure Stryker Knee Surgical Robot Precision Cutter Decreases Need For Bone Resurfacing 75 Figure Stryker Mako Surgical Preoperative and Post Operative Knee Surgery Images 77 Table Stryker Mako Surgical Robot Knee Arthroplasty Benefits 78 Figure Omni OMNIBotics Station 80 Figure OMNI Life Science OMNIBoics 81 Figure OMNIBotic Procedure Bone Morphing 82 Figure OMNIBotics Bone Morphing Femur Planning Technology 83

12 Figure Omni NanoBlock 84 Figure Smith & Nephew Navio Surgical System 85 Figure Smith & Nephew NAVIO Surgical Partial Knee Robotic Assist System 86 Table Smith & Nephew Navio Assisted Robotic Surgery Benefits 87 Table NAVIO Robotics Unicondylar Knee Replacement Functions 88 Table Zimmer Biomet Musculoskeletal Healthcare Offerings 93 Figure Smith & Nephew Product Line 94 Figure Omni OMNIBotics Station 100 Figure Smith & Nephew Laser Surgical Instrument 102 Figure Stanmore Bone Implant Hydroxyappatite Collars 106 Figure Stryker Joint Implants 118 Figure Stryker Patient Specific Pre-Operative Planning 119 Figure Stryker Patient Specific Pre-Operative Planning 120 Table Stryker Better Fit Orthopedics 120 Table Stryker Osteoarthritis Affects Compartments Of The Knee 121 Figure Stryker / MAKO Surgical RIO Robotic Arm Interactive System 122 Figure MAKO Surgical Restoris 129 Figure THINK Surgical TPLAN 3D Planning Workstation 132 Figure Think Surgical TSolution 510K Clearance 133 Figure THINK Surgical TPLAN Workstation 133 Figure THINK Surgical TCAT Computer Assisted Tool 135 Figure Think Surgical Planning 137 Figure Think SurgicalRobodoc 138

13 ABOUT THE COMPANY WinterGreen Research, research strategy relates to identifying market trends through reading and interviewing opinion leaders. By using analysis of published materials, interview material, private research, detailed research, social network materials, blogs, and electronic analytics, the market size, shares, and trends are identified. Analysis of the published materials and interviews permits WinterGreen Research senior analysts to learn a lot more about markets. Discovering, tracking, and thinking about market trends is a high priority at WinterGreen Research. As with all research, the value proposition for competitive analysis comes from intellectual input. WinterGreen Research, founded in 1985, provides strategic market assessments in telecommunications, communications equipment, health care, Software, Internet, Energy Generation, Energy Storage, Renewable energy, and advanced computer technology. Industry reports focus on opportunities that expand existing markets or develop major new markets. The reports access new product and service positioning strategies, new and evolving technologies, and technological impact on products, services, and markets. Innovation that drives markets is explored. Market shares are provided. Leading market participants are profiled, and their marketing strategies, acquisitions, and strategic alliances are discussed. The principals of WinterGreen Research have been involved in analysis and forecasting of international business opportunities in telecommunications and advanced computer technology markets for over 30 years. The studies provide primary analytical insight about the market participants. By publishing material relevant to the positioning of each company, readers can look at the basis for analysis. By providing descriptions of each major participant in the market, the reader is not dependent on analyst assumptions, the information backing the assumptions is provided, permitting readers to examine the basis for the conclusions. WinterGreen Research is positioned to help customers facing challenges that define the modern enterprises. The increasingly global nature of science, technology and engineering is a reflection of the implementation of the globally integrated enterprise. Customers trust wintergreen research to work alongside them to ensure the success of the participation in a particular market segment. WinterGreen Research supports various market segment programs; provides trusted technical services to the marketing departments. It carries out accurate market share and forecast analysis services for a range of commercial and government customers globally. These are all vital market research support solutions requiring trust and integrity. ABOUT THE PRINCIPAL AUTHORS Ellen T. Curtiss, Technical Director, co-founder of WinterGreen Research, conducts strategic and market assessments in technology-based industries. Previously she was a member of the staff of Arthur D. Little, Inc., for 23 years, most recently as Vice President of Arthur D. Little Decision Resources, specializing in strategic planning and market development services. She is a graduate of Boston University and the Program for Management Development at Harvard Graduate School of Business Administration. She is the author of recent studies on worldwide

14 telecommunications markets, the top ten internet equipment companies, the top ten contract manufacturing companies, and the Top Ten Telecommunications market analysis and forecasts. Susan Eustis, President, co-founder of WinterGreen Research is a senior analyst. She has done research in communications and computer markets and applications. She holds several patents in microcomputing and parallel processing. She has the original patents in electronic voting machines. She has new patent applications in format varying, mulitprocessing, and electronic voting. She is the author of recent studies of the Solar REnewable Energy, Wind Energy, Thin Film Batteries, Business Process Management marketing strategies, Internet equipment, biometrics, a study of Internet Equipment, Worldwide Telecommunications Equipment, Top Ten Telecommunications, Digital Loop Carrier, Web Hosting, Web Services, and Application Integration markets. Ms. Eustis is a graduate of Barnard College. Worldwide Who s Who named her Top Female CEO of 2012.