TABLE OF CONTENTS Market 2015-2020 top 200 player profiles October 2016 4 th edition 1
manufacturing Market 2014-2018 Top 200 player profiles October 2016 4 th edition I- Worldwide orthopaedic market, players, drivers limiters and forecasts by 2020 1- Important notice 2- Aim of the survey 3- Table of contents 4- Methodology 5-3 Dimensions operating model for orthopaedics end market 6- Operating model 7- Example of results 8- The countries taken into account in the survey 9- Other countries 10- Executive summary 11- Worldwide orthopaedic markets in 2015 by products 12- The Worldwide orthopaedics market: Growth 2000-2010 CAGR, 2010-2012 CAGR, 2012-2015 CAGR 13- Worldwide implants market in 2015 in value (B$): Knee, hip, spine and by area, USA, Europe, Row 14- Worldwide implants Orthobiologics market in 2015 in value (B$): Trauma CMF, extremities, Orthobiologics and by area, USA, Europe, Row 15- Worldwide orthopaedic market in 2015: competition 16- Worldwide competition by product in 2015: Market share 17- Three types of Challengers competing with the Majors: type 1 (country leader), type 2 (country player), type 3 (local vendors) 18- The challengers gained market share continuously: 2013-2014-2015 and hip, knee, spine, trauma CMF 19- Hip Europe market share 2008-2015 : Depuy Synthes, Zimmer Biomet, Stryker, Smith Nephew other 20- Knee Europe market share 2008-2015 : Depuy Synthes, Zimmer Biomet, Stryker, Smith Nephew other 21- Majors Vs Challengers : Revenues CAGR, market share 22- Majors Vs Challengers: 2015 picture 23- Challengers growing Vs majors 24- Challengers growing Vs majors: the reasons 25- Market Drivers 26- Global population growth 1950-2050 and people over 65 27- The market drivers: Demographic Economic 28- Ratio of hip knee for 10,000 inhabitants by area: USA, Europe, Japan, Australia, South Korea, China, other countries 29- Innovation and new products pull the market 30- Innovative surgeons are looking for new products, % of the surgeons by category in each type of country 31- Product Mix pulls the market up 32- The revision driver: more and more people have more than one implant in their life 33- The market limiters 34- Reimbursement and pricing regulation 35- HIP average price trend in Europe 2003-2015 : France, Germany, UK, Italy, Average Europe 36- Reimbursement and pricing regulation 37- Regulatory, Certification 38- Reimbursement price decreases over the last 18 years 39- Group purchasing in Europe in Germany, in France and Italy and in USA 40- Knee Europe forecasted market share 2014-2020 41- Hip Europe forecasted market share 2014-2020 42- The life cycle of the orthopaedic products: Growth forecasts by 2020 for hip, knee, spine, extremities 43- Worldwide orthopaedic market forecasts 2015-2020 for hip, knee, extremities, trauma, spine, orthobiologics Market 2015-2020 top 200 player profiles October 2016 4 th edition 2
II- Worldwide orthopaedic Contract market, OEMs strategies, Contract Manufacturers position and market share and forecasts by 2020 44- Contract manufacturing product segmentation: 11 segments 40 sub-segments 45- Worldwide contract manufacturing market 46- Contract manufacturing market value chain 47- OEM contract manufacturing strategy: Stryker a. Stryker facilities b. Contract Rate c. Implants, instruments cases trays, coating, ceramics, packaging 48- OEM contract manufacturing needs: Stryker 49- OEM contract manufacturing needs: Stryker a. Spine Trauma machining In-House, number of pieces b. Spine Trauma machining Contract, number of pieces 50- OEM contract manufacturing strategy: Depuy-Synthes a. Depuy-Synthes facilities b. Contract Rate c. Implants, instruments cases trays, coating, ceramics, packaging 51- OEM contract manufacturing needs: Depuy-Synthes 52- OEM contract manufacturing needs: Depuy-Synthes a. Spine Trauma machining In-House, number of pieces b. Spine Trauma machining Contract, number of pieces 53- OEM contract manufacturing strategy: Zimmer Biomet a. Zimmer Biomet facilities b. Contract Rate c. Implants, instruments cases trays, coating, ceramics, packaging 54- OEM contract manufacturing needs: Zimmer Biomet 55- OEM contract manufacturing needs: Zimmer Biomet a. Spine Trauma machining In-House, number of pieces b. Spine Trauma machining Contract, number of pieces Market 2015-2020 top 200 player profiles October 2016 4 th edition 3
56- OEM contract manufacturing strategy: Smith Nephew a. Smith Nephew facilities b. Contract Rate c. Implants, instruments cases trays, coating, ceramics, packaging 57- OEM contract manufacturing needs: Smith Nephew 58- OEM contract manufacturing needs: Smith Nephew a. Spine Trauma machining In-House, number of pieces b. Spine Trauma machining Contract, number of pieces 59- OEM contract manufacturing needs: Medtronic a. Spine Trauma machining In-House, number of pieces b. Spine Trauma machining Contract, number of pieces 60- OEM contract manufacturing needs: Challengers Challengers 61- OEM contract manufacturing needs: Challengers a. Spine Trauma machining In-House, number of pieces b. Spine Trauma machining Contract, number of pieces 62- Forging Contract market 2015-2020 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 63- Forging Contract market share in 2015: Tecomet, Marle, Lisi, Orchid, etc. 64- Forging Contract market: OEMs relationships with their suppliers 65- Casting Contract market 2015-2020 by products: knee femoral, knee tibial, Hip cups hip stems casted and by customers: Depuy Synthes, Zimmer Biomet, Stryker, Smith Nephew other 66- Casting Contract market share in 2015: Orchid, Tecomet, Marle, etc. 67- Casting Contract market: OEMs relationships with their suppliers 68- Hip machining finishing Contract market 2015-2020 by products : hip stems, hip heads, hip liners, hip cups (fully secondary) by customers : Depuy Synthes, Zimmer Biomet, Stryker, Smith Nephew other 69- Knee machining finishing Contract market 2015-2020 by products: knee femoral, knee insert, knee tibial (fully secondary) by customers : Depuy Synthes, Zimmer Biomet, Stryker, Smith Nephew other Market 2015-2020 top 200 player profiles October 2016 4 th edition 4
70- Spine and Trauma implants machining finishing market 2015-2020 by products : Fusion lumbar, trauma screws, trauma plates, cervical screws cages, cervical plates by customers : Depuy Synthes, Zimmer Biomet, Stryker, Medtronic, Smith Nephew other 71- Instruments Contract market 2015-2020 by products: hip instruments, knee instruments, spine instruments, trauma instruments by customers : Depuy Synthes, Zimmer Biomet, Stryker, Medtronic, Smith Nephew other 72- Instruments Contract top 20 market share in 2015: Tecomet, Greatbatch, Paragon, etc.. 73- Cases trays Contract market 2015-2020 by products: hip cases, knee cases, spine cases, trauma cases, and by customers Depuy Synthes, Zimmer Biomet, Stryker, Medtronic, Smith Nephew other a. Cases trays Contract top 15 market share in 2015: Tecomet, Greatbatch, Paragon, etc.. 74- Ceramics Contract market 2015-2020 by products: hip head, hip liner, and by customers Depuy Synthes, Zimmer Biomet, Stryker, Smith Nephew other 75- Coating Contract market 2015-2020 by products: hip stems, knee femoral, knee tibial, hip cups and by customers Depuy Synthes, Zimmer Biomet, Stryker, Smith Nephew other 76- Coating Contract market share in 2015: DOT, APS Materials, Eurocoating, etc. 77- Marking Packaging Sterilization MPS- Contract market 2015-2020 by products: Knee MPS, hip MPS, Spine MPS, trauma MPS 78- Contract market value chain 79- Contract Manufacturers worldwide orthopaedics revenues in 2015 (in M US$): Top 20 players, revenues in orthopaedics, other revenues 80- Contract competitor ranking dispersion: Top 15 analysis, top 16-100 analysis, from 101 to 1000 analysis 81- Heavy trend: The OEM facility disinvestments 82- More outsourcing is a heavy trend for all the orthopaedic companies 83- Outsourcing rate of the Major OEMs increases continuously: 2000-2020 Outsourcing rate of different orthopaedic component by manufacturing process 84- Orthopaedic Contract concentration by acquisition: Tecomet, Orchid, Greatbatch 1963-2015 85- The risk of moving to LLC by 2020: Developed countries Low Labor Cost countries for the following products, Generic orthopaedic instruments, Complexes customized Orthopaedic instruments, Implants forging casting, Implants hip knee machining, Spine trauma implants machining 86- Contract LLC impact: OEM point of views, Stryker, Biomet, Depuy Synthes 87- Contract LLC impact: CM point of views, Orchid, Greatbatch, Paragon, Intech 88- Contract price range dashboard Europe a. Europe: Forging all products b. Europe: Casting all products c. Europe: machining all products d. Europe: Spine Trauma machining all products e. Europe: Instruments all products f. Europe: coating all products 89- Contract price range dashboard USA a. Europe: Forging all products b. Europe: Casting all products c. Europe: machining all products d. Europe: Spine Trauma machining all products e. Europe: Instruments all products f. Europe: coating all products Prices Dashboard 90- Contract market historical revenues forecasts (M US$): 2010-2020 Implants, instruments, cases trays 91- Orthopaedics Contract market is growing faster than In-house manufacturing: 2010-2020 Orthopaedics Contract (B US$), 2010-2020 Orthopaedics In-house (B US$) 92- Additive for orthopaedics 93- Number of implants produced using Additive 94- FDA clearance for medical devices using Additive in USA 95- Additive in 2015 96- Additive impact on forging and casting 97- Market growth 2013-2021 in USD billion for metal Additive 98- Executive Summary (3) Market 2015-2020 top 200 player profiles October 2016 4 th edition 5
III- Contract manufacturing competitor ranking, Top 200 profiles and SWOT analysis of the leaders: Example of profiles : Marle Business Forging casting machining http://www.marle.fr/ CONTACTS STY HQ Address: NOGENT - France 1964: Creation date by Maurice Marle Mr Antonio GIL CEO President 1978: His son, Bernard become the CEO and President 11 employees 1980 s: Strategic decision to forge orthopaedic implants (Depuy: the Corail hip contract) +33 3 25 31 85 79 2008: New plants in Nogent 2010: Almost 100% of revenues are from orthopaedic business agil@marle.fr 2011: Acquisition of ATS (casting machining) July 2014: Marle invested in plasma coating technologies using atmospheric plasma spray (APS) and vacuum NUMBER OF EMPLOYEES plasma spray (VPS) systems, but also in cleanrooms and in packaging production lines 530 employees in 2015 February 2016: Entered in the additive manufacturing market by the acquisition of Finortho Installation of a separate production line fully dedicated to polymers PEEK for spine cages and knee tibial inserts (215 m²) Bemis PRODUCTION PLANTS 2001: Acquisition of HMP 5 plants dedicated to orthopaedic with 30 000 m² of production facilities: 2009: Carlyle Group acquires 80 % shares in Marle 1. Marle SA- NOGENT-France-Forging and machining 150 employees Business Packaging 2011: Acquisition of SEEP (machining), ATS Stellite (casting) including Sferic (precision grinding) 14 500m² October 2015: acquisition of Finortho (polyamide cuttinghttp://www.bemis.com guides - 36 employees and 2,6 MUS$ of revenues) 2. HAUTE-MARNE PARACHEVEMENT (HMP)-SARREY-France- Finishing and polishing implants but May 2016: IK Investment Partners acquired Marle from The Carlyle Group also rasp machining - 40 employees- 2 000 m² CONTACTS STY 3. SEEP-Sorbiers - France- Machining, coating, cleaning and packaging - 25 employees- 2 000 m² HQ Address: Neenah, Wisconsin - USA 1858: Mr. Judson Moss ACTIVITIES Bemis founded J.M. Bemis Company in St. Louis, Missouri to serve the flexible packaging 4. SFERIC Menars France Machining 90 employees - 4 000 m² Mr. Terri Groth - Marketing Communications Manager market 5. ATS Ales France 122 employees - 5 800 m² +1 920-527-7047 1873: The company s name became DESIGN Bemis Bro. FGING Company and the company FINISHING continues to grow COATING CLEANING tvgroth@bemis.com 1965: Bemis Bro. Bag Company became Bemis Company, Inc. CONCEPTION CASTING POLISHING TREATMENT PACKAGING Main plant in Nogent: 41 000 m² total land. 1990s: Bemis entered into the medical industry with the birth of the company s medical packaging division, known ATS plant in Ales: 20 000 m² total land. as Cur*Med. Cur*Med has since become part of Bemis subsidiary, Perfecseal. NUMBER OF EMPLOYEES 2014: Investment of US$ M 25 in Oshkosh HQ in healthcare packaging facility, to double the facility's size Bemis Company Inc. : 17,500 employees (incl. Bemis Healthcare Packaging) MAIN SERVICES MAIN PRODUCTS Design, forging, machining, finishing, polishing, Forging hip stem, rasps, knee tibial plates, trauma. Lisi Medical 1965: Curwood was acquired testing, regulatory mainly for implants Main know-how: Corail hip forging machining (the PRODUCTION PLANTS knee, 1990s: Bemis made ten acquisitions: Milprint in 1990, Banner Packaging in 1995, and Perfecseal biggest worldwide in 1996. hip blockbuster). n 2 worldwide Bemis Company Inc. : 61 sites in 12 countries around the world Marle forging facility in Nogent Business hip, spine, trauma 2000s: Bemis made nine acquisitions: Viskase Shrink Films in 2000, Walki Films and Clysar for stem in 2002, forging and Dixie and n 1 Toga in Europe. dental, shoulder (Brazil) in 2005 MAIN SHAREHOLDERS May 2016: Bemis acquired MAIN CUSTOMERS packaging operations http://www.lisi-medical.com/ of SteriPack Group (65 MUS$ in 2015 4 facilities worldwide 450 In May 2016, IK Investment Partners acquired d the majority stake in Marle from The Carlyle people) Greatbatch Medical, DePuy Synthes, Medacta, Mathys, Zimmer, Smith Nephew, Biomet and Wright Group which initially invested in Marle in 2009 Medical CONTACTS STY ACTIVITIES HQ Address: Miribel- France 2006: LISI group (automotive, aerospace) decided to diversify to medical industry Mr. Olivier Worldwide LeBars CEO 2015 TOTAL REVENUES RANGE (912007: MUS$) LISI MEDICAL has been established with the acquisitions of several medical Contract DESIGN FGING FINISHING COATING CLEANINGREVENUES BY SERVICES (2015) +33 2 31 46 33 20 manufacturing companies: Hugueny (France), Jeropa (USA), Seignol (France), Intermed Lixus (Maroc) orthopaedic Contract olivier.lebars@lisi-medical.com 73 82 90 2010: Acquisition 91 of Stryker forging CONCEPTION plant in Herouville-France CASTING US$ M 9and 5 years contract POLISHING with Stryker TREATMENT (yearly PACKAGING Finishing 5% Coating, MPS 6% contract > 60 M US$) NUMBER market OF EMPLOYEES 2011-2015: Looking for customer diversification for the Herouville plant report Implants Machining 11% 538 employees in 2015 LISI Medical represents 5% of MAIN the Revenues revenues SERVICES of the total group (10 900 employees 1,617 MAIN MUS$) PRODUCTS 2015-2020 Flexible and rigid packaging for implants and Mainly custom pouches bags, sterilizable and Autocam Medical Forging 54% instruments Instruments PRODUCTION PLANTS form-stable containers 2007: Hugueny in January April: Jeropa (13.7 M$ in 2010), Bemis Healthcare Packaging expansion in Oshkosh in 2014 US$ M 82 > 20 000 m² for medical production in 4 locations. December 2007: Seignol and Intermed Casting 24% Implants instruments September 2010: acquisition of Stryker forging plant in Herouville-France sept-12 Business sept-13 machining sept-14 sept-15 1. LISI Medical-Herouville profiles - France MAIN - Forging SHAREHOLDERS orthopaedics, hip, knees, shoulder, instruments MAIN CUSTOMERS Source: Marle 300 2013: Complete integration of SJ http://www.autocam-medical.com/ Industrie by Seignol Hugueny 2016 employees Bemis Company AVICENNE- Inc. is a public 2016 company BMS-NYSE April 2016: Acquisition of RTI REMMELE All the majors Medical ( challengers 70 M US$ rev.in and all 2015) the contract from ALCOA manufacturers for 102 M US$ 2. LISI Medical Jeropa-Escondido- USA Bemis - Spine, Healthcare CMF, dental, Packaging cardio, is part extremities, of Bemis Company, instruments, CONTACTS MANAGEMENT STY Inc trauma, reconstruction (Hip, shoulders...) - 85 employees HQ Address: Kentwood, MI 49512 USA 2008: Foundation ACTIVITIES 3. LISI Medical Fasteners - Neyron - France - Spine, CMF, dental, Mr. John Kennedy Worldwide Founder CEO 2015 TOTAL REVENUES RANGE 2011: (4.1 Autocam BUS$) Medical had 23 employees and sales of $4.5 million extremities, instruments, trauma, orthopaedics (hip, shoulders...) 2015 THOPAEDIC REVENUES (90 MUS$) +1 781-389-8095 orthopaedic Contract Ali MADANI 2012: Entered into a strategic partnership DESIGNwith Jewel FGING Precision FINISHING COATING CLEANING 125 employees jkennedy@autocam-medical.comphone: + 33 1 47 78 46 00 2014: Autocam posted 80 M US $ revenues CONCEPTION for 2014CASTING POLISHING TREATMENT PACKAGING 4. LIXUS - Tangiers Morocco- Dental, spine, trauma US$ M 9 119 2015: Projected 2015 sales of the companies will total approximately $100 million and CMF implants - 21 employees HEADCOUNTS 2015: Plans to open end of 2015 a production facilities in China (2 000 m²) market report Orthopaedics 350 employees 85 Certifications: 90 ISO 13485:2003 MAIN (in 2015),ISO SERVICES 9001:2008 (in 2015), FDA REGISTERED and VISA MAIN BRAZIL PRODUCTS IMPLANTS 2015-2020 LISI Medical started to develop their own product RD, Prototype, Forging, metal machining, plastic Hip stem, cup, liner, knee tibial, plastic parts, PRODUCTION FACILITIES (generic implants) Feb. 2014: Autocam Medical acquired machining SET finishing (Southeastern and polishing Technology,, coating, Inc.) cleaning trauma spine implants, ortho instruments, LISI Medical in Hérouville Saint Clair INSTRUMENTS 13 000 m² for the 6 sites No acquisition in 2015 packaging, anodization, Laser marking shoulder, dental implants, cardio plastic parts former Stryker forging 2012 2013 2014 2015 US$ M 81 Michigan-Kentwood profiles Corporate MAIN HQ SHAREHOLDERS (4000 m², 90 pers) Source: Avicenne estimates based on historical data, nb of headcounts, etc MAIN CUSTOMERS John Kennedy (Founder CEO) Plymouth, MA (2 500 m², 90 LISI pers.) Group is a public company AVICENNE- (LISI FII 2016 FR 0000050353-Euronext Paris) Stryker (first customer), Medacta, LDR, Alphatec Spine. Hayward, CA (1 000 m², 70 pers) Avicenne: We believe the LISI group could be open to disinvest the medical part in mid-term. Others: Aston Medical, Biotech, Global D, S14, Maxx Orthopedics, Signature Orthopaedics, C2F Murfreesboro, TN (5 000 m², 125 pers) ACTIVITIES Implants, Zimmer dental, Samo, Adler Ortho, XNOV, Tornier Newclip Technics Worldwide São Paulo, Brazil (500 m², 5 pers.) Suzhou, China 2015 TOTAL REVENUES RANGE (83 MUS$) DESIGN FGING FINISHING 2015 COATING THOPAEDIC CLEANING REVENUES (83 MUS$) orthopaedic Contract Ali MADANI 76 85 94 83 Phone: + 33 1 47 78 46 00 CONCEPTION CASTING POLISHING TREATMENT PACKAGING 121 M US$ 19 market report MAIN SERVICES Revenues MAIN PRODUCTS IMPLANTS 2015-2020 and prototyping for implants, Instruments and ortho Implants (mainly spine and instruments and cases trays trauma) Ophthalmic devices, oncology, dental and INSTRUMENTS Autocam Medical facilities: Kentwood, near Grand Rapids Michigan cardiovascular devices 2012 2013 2014 2015 M US$ 64 profiles MAIN SHAREHOLDERS Source: LISI MEDICAL MAIN CUSTOMERS John Kennedy (Founder Orthopaedic OEMs AVICENNE- CEO) 2016 Worldwide 2015 TOTAL REVENUES RANGE (95 MUS$) orthopaedic Contract Ali MADANI 24 Others Medical Phone: + 33 1 47 78 46 00 20 market report 2015-2020 12 Orthopaedics 15 60 71 30 23 2012 2013 2014 2015 profiles Source: Autocam Medical 2016 AVICENNE- 2016 Source: Autocam Medica 2016 2015 THOPAEDIC REVENUES (71 MUS$) US$ M 14 US$ M 57 IMPLANTS INSTRUMENTS 122 Ali MADANI Phone: + 33 1 47 78 46 00 123 Market 2015-2020 top 200 player profiles October 2016 4 th edition 6