The small joint and extremities reconstruction market is growing faster than the hip and knee replacement market. New advanced technologies will help this specialty market grow at a CAGR of about 9 percent over the next few years. Compared to replacement of large joints, small joint reconstruction is a far less common procedure, although the devices have been around for the last few decades. A steady stream of innovations, many developed by the surgeons themselves, underscores the urgent need to meet growing patient demand. The US and Europe account for the predominant share of the small joints replacement market. Emerging healthcare markets are currently focused on large joint replacements, although small joint procedures will soon catch up. Key trends and characteristics in this market include: Joint diseases will continue being the leading cause of disability in older people. Growth of this patient base is accelerating as populations around the world age, and rates of chronic inflammatory diseases, osteoarthritis and obesity soar. Despite the high complication rate, clinical studies from all over the world show that arthroplasty can be used to successfully treat degenerative diseases and repetitive motion injuries caused by sports and occupational tasks. Patient demands are also changing with increasing life expectancy. People with end-stage arthritis are looking for treatment alternatives to arthrodesis that restore mobility and offer a greater quality of life. Shoulder replacement or arthroplasty devices are the most common type of small joint replacements, accounting for almost three quarters of the $917million market in 2011. Elbow and ankle replacements offer high growth potential due to high rates of injury. There are only a handful of ankle replacement devices leaving a wide open field for new entrants. Extremities reconstruction, namely digits, comprises the smallest segment of this market, due in large part to procedural complexity. The severe shortage of trained surgeons is a major restraint needing to be addressed. More successful technologies are critical in clearing regulatory hurdles, improving reimbursement, and patient acceptance. The market is dominated by well-established joint reconstruction specialists such as DePuy, Tornier, Zimmer and Biomet, closely followed by other orthopedic giants like Stryker, Smith and Nephew and Wright Medical. These companies compete fiercely for high-end products with highly reputed niche players such as Integra Life Sciences and Small Bone Innovations.

1. Small Joints and Extremities Reconstruction
(Arthroplasty) Devices Markets Worldwide
Report Highlights
2012

2. Report Benefits
This report can help in:
• Assessing the world market for small joints and extremities
reconstruction (arthroplasty), growth segments and
opportunities.
• Understanding market drivers and restraints, market
segmentation, market shares and competitive segmentation.
• Strategic planning and competitive strategy.
• Identifying opportunities for partnerships and alliances.
© 2012 Marketstrat, Inc., All Rights Reserved 2

3. Key Takeaways
• The world market for small joint and extremity reconstruction (arthroplasty) is estimated
around approach close to $1 billion by the end of 2012. This market will grow at a CAGR of
about 9 percent over the forecast period.
• Key product segments: The shoulder replacement is the largest product segment; the US is
the largest geographic segment.
• Key Drivers: Prevalence of disabling joint diseases in aging populations and young people
engaging in sports and fitness; new technology, patient awareness and demand for treatment
options that offer an alternative to arthrodesis are important drivers. Skyrocketing rates of
co-morbidities such as diabetes and obesity are adding to the risk of developing degenerative
joint diseases.
• Key Restraints: High rate of complications, failure and revision have plagued the small joint
replacement market. Other restraints include a severe shortage of trained surgeons,
reimbursement restrictions and regulatory hurdles.
• Leaders: Well-established orthopedic specialists such as DePuy, Biomet, Tornier and Zimmer.
Mid-tier players are Stryker and Smith & Nephew and Wright Medical. All these providers
also offer the top brands of hip and knee replacements. Highly reputed niche players in small
joint replacements are Integra Life Sciences and Small Bone Innovations.
© 2012 Marketstrat, Inc., All Rights Reserved 3

4. Sample Data Table
World - Elbow Reconstruction Devices Market - Revenue Forecasts by Country/Region - 2010-2018 ($ Million)
2010 2011 2012 2013 2014 2015 2016 2017 2018 CAGR
USA ($mill) $38.6 $42.5 $46.9 $51.7 $57.1 $63.2 $70.0 $77.6 $86.2
GROWTH (%) 10.2% 10.2% 10.3% 10.5% 10.6% 10.8% 10.9% 11.1% 10.6%
EUROPE ($mill) $16.9 $18.4 $20.0 $21.8 $23.8 $26.0 $28.4 $31.0 $33.9
GROWTH (%) 8.8% 8.9% 8.9% 9.1% 9.2% 9.2% 9.3% 9.3% 9.1%
JAPAN ($mill) $7.7 $8.2 $8.7 $9.4 $10.1 $10.8 $11.7 $12.6 $13.6
GROWTH (%) 6.9% 6.9% 7.2% 7.4% 7.6% 7.7% 7.9% 8.1% 7.5%
ROW ($mill) $21.7 $22.8 $23.9 $25.1 $26.3 $27.7 $29.1 $30.7 $32.3
GROWTH (%) 4.9% 4.9% 5.0% 5.1% 5.1% 5.2% 5.3% 5.3% 5.1%
TOTAL ($ Million) $84.9 $91.9 $99.5 $107.9 $117.3 $127.7 $139.1 $151.8 $166.0
GROWTH (%) 8.2% 8.3% 8.5% 8.7% 8.8% 9.0% 8.6%
Notes:
1. Includes implants for elbow reconstruction
2. ROW includes all countries/regions other than USA, Europe and Japan
3. Data are at the manufacturer level
Source: Marketstrat™
© 2012 Marketstrat, Inc., All Rights Reserved 4

5. Sample Data Table
Japan - ANKLE RECONSTRCUTION MARKET - UNIT SALES FORECASTS (2010 to 2018)
Year UNIT SALES Growth (%)
2010 1,038
2011 1,104 6.3%
2012 1,173 6.3%
2013 1,247 6.3%
2014 1,326 6.4%
2015 1,411 6.4%
2016 1,503 6.5%
2017 1,601 6.6%
2018 1,708 6.7%
CAGR 6.4%
Notes:
1. Includes implants for ankle reconstruction
2. Data are at the manufacturer level
Source: Marketstrat®
© 2011 Marketstrat, Inc., All Rights
June 12 5
Reserved

6. Sample Data Chart
USA -ANKLE RECONSTRUCTION MARKET - REVENUE FORECASTS ( $ Million, 2010 to 2018)
$60.0 8.7%
8.6%
$50.0 8.5%
illio )
R en es ($M n
$40.0 8.4%
ro th
8.3%
%G w
$30.0 8.2%
8.1%
ev u
$20.0 8.0%
$10.0 7.9%
7.8%
$0.0 7.7%
2010 2011 2012 2013 2014 2015 2016 2017 2018
REVENUE FORECASTS ($ Million)
Source: Marketstrat®
© 2012 Marketstrat, Inc., All Rights Reserved 6

7. Report Stats
Category Detail
Regions Covered US, Europe, Japan, ROW
Product Segments • Digits (Fingers, Toes)
• Wrist
• Elbow
• Shoulder
• Ankle
Company Profiles 21 Companies
Market Estimates/ Forecasts Revenues ($) and Unit Sales for 2010-2018
Report Code 332-12
Price $2995 (single-user license); $5990 (corporate license)
No. of Pages 192 pages; 63 data tables; 56 charts
Publication Date July 2012
© 2012 Marketstrat, Inc., All Rights Reserved 7

8. About Us
Marketstrat specializes in Medical Market Research. We assist companies
with market, technology, and best practice strategies & intelligence,
through a unique combination of published reports, solutions, and
services.
Our strengths include: a deep understanding of the medical devices value
chain, state-of-the-art data collection tools, and a robust research
methodology.
4695 Chabot Drive, Suite 200
Pleasanton, CA 94588, USA.
Email : info@marketstrat.com
Phone: 925-263-4455
Fax: 925-263-4456
www.marketstrat.com
© 2012 Marketstrat, Inc., All Rights Reserved 8

9. © 2012 Marketstrat, Inc., All Rights Reserved 9