Table of Contents: JULY TH EDITION

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1 Table of Contents:

2 Table of Contents of the worldwide Orthopaedic Contract manufacturing Market & Top 100 player profiles 275+ pages 450+ exhibits July th edition I- Worldwide orthopaedic market, players, drivers & limiters and forecasts by 2021 Important notice Aim of the survey Table of contents Methodology Countries in the perimeter of the survey: five main countries The countries taken into account in the survey for Europe are the 17 strongest economies Methodology: 3 Dimensions operating model for orthopaedics end market Methodology: Manufacturing Operating model Methodology: Example of results from our operating model Synopsis Executive summary. 15 Orthopaedics Ecosystem Worldwide orthopaedic markets in 2016 by products The Worldwide orthopaedics market: Growth CAGR, CAGR, CAGR Worldwide implants market in 2016 in value (B$): Knee, hip, spine and by area, USA, Europe, Row Worldwide implants & Orthobiologics market in 2016 in value (B$): Trauma & CMF, extremities, Orthobiologics and by area, USA, Europe, Row Worldwide orthopaedic market in 2016: competition Worldwide competition by product in 2016: Market share Three types of Challengers competing with the Majors: type 1 (country leader), type 2 (country player), type 3 (local vendors) The challengers gained market share continuously: and hip, knee, spine, trauma & CMF Hip Europe market share : Depuy Synthes, Zimmer Biomet, Stryker, Smith & Nephew & other Knee Europe market share : Depuy Synthes, Zimmer Biomet, Stryker, Smith & Nephew & other Majors Vs Challengers : Revenues CAGR, market share Majors Vs Challengers: 2016 picture Challengers growing Vs majors Challengers growing Vs majors: the reasons Market Drivers Global population growth and people over 65 The market drivers: Demographic & Economic Ratio of hip & knee for 10,000 inhabitants by area: USA, Europe, Japan, Australia, South Korea, China, other countries Innovation and new products pull the market Innovative surgeons are looking for new products, % of the surgeons by category in each type of country Product Mix pulls the market up The revision driver: more and more people have more than one implant in their life The market limiters Reimbursement and pricing regulation HIP average price trend in Europe : France, Germany, UK, Italy, Average Europe Regulatory, Certification Reimbursement price decreases over the last 18 years Group purchasing in Europe in Germany, in France and Italy and in USA Knee Europe forecasted market share Hip Europe forecasted market share The life cycle of the orthopaedic products: Growth forecasts by 2020 for hip, knee, spine, extremities Worldwide orthopaedic market forecasts for hip, knee, extremities, trauma, spine, orthobiologics Contract manufacturing product segmentation: 11 segments & 40 sub-segments

3 Worldwide contract manufacturing market 69 Contract manufacturing market value chain OEM contract manufacturing strategy: Stryker Stryker facilities OEM contract manufacturing needs: Stryker OEM contract manufacturing needs: Stryker OEM contract manufacturing strategy: Depuy-Synthes Depuy-Synthes facilities OEM contract manufacturing needs: Depuy-Synthes OEM contract manufacturing needs: Depuy-Synthes OEM contract manufacturing strategy: Zimmer Biomet Zimmer Biomet facilities OEM contract manufacturing needs: Zimmer Biomet OEM contract manufacturing needs: Zimmer Biomet

4 OEM contract manufacturing strategy: Smith & Nephew Smith & Nephew facilities OEM contract manufacturing needs: Smith & Nephew OEM contract manufacturing needs: Smith & Nephew OEM contract manufacturing needs: Medtronic OEM contract manufacturing needs: Challengers OEM contract manufacturing needs: Challengers Forging Contract Manufacturing market Forging Contract Manufacturing market by products: hip stem, hip cup, tibial knee, Trauma locking Plates, Trauma LF Plates & vertebral disks & by customers : Depuy Synthes, Zimmer Biomet, Stryker, Smith & Nephew & other Forging Contract Manufacturing market share in 2016: Tecomet, Marle, Lisi, Orchid, etc. Forging Contract Manufacturing market: OEMs relationships with their suppliers Casting Contract Manufacturing market 2016 Casting Contract Manufacturing market by products: knee femoral, knee tibial, Hip cups & hip stems casted and by customers: Depuy Synthes, Zimmer Biomet, Stryker, Smith & Nephew & other Casting Contract Manufacturing market share in 2016: Orchid, Tecomet, Marle, etc. Casting Contract Manufacturing market: OEMs relationships with their suppliers Hip machining & finishing Contract Manufacturing market Hip machining & finishing Contract Manufacturing market by products : hip stems, hip heads, hip liners, hip cups (fully & secondary) & by customers : Depuy Synthes, Zimmer Biomet, Stryker, Smith & Nephew & other Knee machining & finishing Contract Manufacturing market 2016

5 Knee machining & finishing Contract Manufacturing market by products: knee femoral, knee insert, knee tibial (fully & secondary) & by customers : Depuy Synthes, Zimmer Biomet, Stryker, Smith & Nephew & other Spine and Trauma implants machining & finishing market 2016 Spine and Trauma implants machining & finishing market by products : Fusion lumbar, trauma screws, trauma plates, cervical screws & cages, cervical plates & by customers : Depuy Synthes, Zimmer Biomet, Stryker, Medtronic, Smith & Nephew & other What are orthopaedic instruments? Spine orthopaedic instruments - product segmentation Knee orthopaedic instruments segmentation The Major OEMs have a different outsourcing strategy Vs the challengers. The challengers outsource almost all their instruments Instruments life cycle: New OEM projects lead to instruments set manufacturing. When an OEM postpones the launch of its new projects (for example during the 2008 & 2011 crisis), it also drastically reduces its instruments manufacturing Instruments machining Contract Manufacturing market 2016 Instruments machining Contract Manufacturing market by products: hip instruments, knee instruments, spine instruments, trauma instruments & by customers : Depuy Synthes, Zimmer Biomet, Stryker, Medtronic, Smith & Nephew & other Instruments Contract Manufacturing top 20 market share in 2016: Tecomet, Greatbatch, Paragon, etc.. Cases & trays Contract Manufacturing market 2016 Cases & trays Contract Manufacturing market by products: hip cases, knee cases, spine cases, trauma cases, and by customers Depuy Synthes, Zimmer Biomet, Stryker, Medtronic, Smith & Nephew & other Cases & trays Contract Manufacturing top 15 market share in 2016: Tecomet, Greatbatch, Paragon, etc.. Ceramics Contract Manufacturing market Ceramics Contract Manufacturing market by products: hip head, hip liner, and by customers Depuy Synthes, Zimmer Biomet, Stryker, Smith & Nephew & other Coating Contract Manufacturing market 2016 Coating Contract Manufacturing market by products: hip stems, knee femoral, knee tibial, hip cups and by customers Depuy Synthes, Zimmer Biomet, Stryker, Smith & Nephew & other Coating Contract Manufacturing market share in 2016: DOT, APS Materials, Eurocoating, etc. Marking Packaging & Sterilization MPS- Contract Manufacturing market 2016 Marking Packaging & Sterilization MPS- Contract Manufacturing market by products: Knee MPS, hip MPS, Spine MPS, trauma MPS Contract Manufacturing market value chain.119 Contract Manufacturers worldwide orthopaedics revenues in 2016 (in M US$): Top 20 players, revenues in orthopaedics, other revenues Contract Manufacturing competitor ranking & dispersion: Top 15 analysis, top analysis, from 101 to 1,000 analysis Heavy trend: The OEM facility disinvestments More outsourcing is a heavy trend for all the orthopaedic companies Outsourcing rate of the Major OEMs increases continuously: Outsourcing rate of different orthopaedic component & by manufacturing process Orthopaedic Contract Manufacturing concentration by acquisition: Tecomet, Orchid, Greatbatch The risk of moving to LLC by 2020: Developed countries & Low Labor Cost countries for the following products, Generic orthopaedic instruments, Complexes & customized Orthopaedic instruments, Implants forging & casting, Implants hip & knee machining, Spine & trauma implants machining Contract Manufacturing LLC impact: OEM point of views, Stryker, Zimmer Biomet, Depuy Synthes Contract Manufacturing LLC impact: CM point of views, Orchid, Greatbatch, Paragon, Intech Contract Manufacturing price range dashboard Europe Europe: Forging all products Europe: Casting all products Europe: machining all products Europe: Spine & Trauma machining all products Europe: Instruments all products Europe: coating all products Contract Manufacturing price range dashboard USA Europe: Forging all products Europe: Casting all products Europe: machining all products Europe: Spine & Trauma machining all products Europe: Instruments all products Europe: coating all products Prices Dashboard

6 II- III- Contract Manufacturing market historical revenues & forecasts (M US$): Implants, instruments, cases & trays Orthopaedics Contract Manufacturing market is growing faster than In-house manufacturing: Orthopaedics Contract Manufacturing (B US$), Orthopaedics In-house Manufacturing (B US$) Additive Manufacturing & Trabecular in Orthopaedics 135 Additive Manufacturing & Trabecular in Orthopaedics Additive Manufacturing history in Orthopaedics Story of Zimmer and Trabecular Tantalum Zimmer, Trabecular Metal related implants Metal Additive Manufacturing: Technologies and major competitors Arcam EBM installed base for orthopaedic industry Beijing AK MEDICAL Illustrative build-up speed and resolution of selected Metal Additive Manufacturing systems: Electron Beam Melting Vs Selective Laser Melting Smith & Nephew uses Additive Manufacturing for customized cutting blocks Stryker s History of 3D Printing: STRYKER scheduled to build 3-D printing manufacturing facility for $400 million to $450 million in 2016 Stryker current products made by 3D printing Depuy Spine uses Additive Manufacturing for prototyping of complex surgical tools DePuy Synthes has acquired 3D printing technology from Tissue Regeneration Systems Inc. XILLOX Equipment suppliers for Orthopaedics: Installed base per customer and per supplier Addressable market should increase with lower Additive Manufacturing cost Additive Manufacturing is attractive for the revision hip cup (addressable market) to accelerate and improve osteointegration. The AM cups will impact slightly the forging and casting Number of implants produced using Additive Manufacturing FDA clearance for medical devices using Additive Manufacturing in USA Additive Manufacturing represented in 2016 only a small % of all orthopaedic products manufactured Additive Manufacturing cups and impact on forging and casting in 2016 Cages Raw Materials in the five main countries in Europe: When Peek and Titanium lose market share, Additive Manufacturing cages will increase dramatically Conclusion: Additive Manufacturing for orthopaedics Synopsis Contract manufacturing competitor ranking, Top 200 profiles and SWOT analysis of the leaders.159 Example of profiles :