Contents:

Chapter 1 Executive summary 3 Insights into the US and European hip and knee implants market 3 Hip & knee replacement market analysis 4 Market drivers 4 Market restraints 5 Future outlook 5 Chapter 2 Introduction 13 Scope of the analysis 13 Market segmentation 13 Hip & knee implants market background 14 Total hip & knee replacement 14 Revision hip & knee replacement 14 Bearing surfaces 15 Fixation procedures 15 Types of procedures 15 Hip market background 16 Metal-on-metal 16 Ceramic-on-ceramic 17 Metal-on-polyethylene 17 Crosslinked polyethylene 17 Total hip replacement 17 Indications for total hip replacement 18 Cemented implants 18 Cementless implants 19 Hybrid 19 Revision hip replacement 19 Indications for revision hip replacement 19 Endoprosthesis or partial hip replacement 20 Alternative procedures in hip arthroplasty 20 Hip resurfacing 20 Birmingham hip resurfacing (BHR) 21 Indications for hip resurfacing 21 Knee market background 21 Total knee replacement (TKR) 22 Indications for total knee replacement 22 Fixed knee prosthesis 23 Mobile bearing knee prosthesis 23 Posterior stabilized/cruciate retaining 23 Revision knee 23 Indications for revision knee 24 Unicondylar knees 24 Minimally invasive surgery 25 Minimally invasive surgery (MIS) of hip 25 Minimally invasive surgery (MIS) of knee 25 Key developments in the hip and knee market 25 Techniques 26 Computer navigation 26 Implants and materials 26 Titanium 27 Cobalt-chrome 27 Tantalum 27 Foam metal implants 27 Polyetheretherketone 28 Allograft prosthesis 28 Innovative ceramics 28 Chapter 3 Market overview 29 US and European orthopedic implants 29 Hip implants market 29 US hip market 32 Procedure trends 32 European hip market 33 Procedure trends 33 Knee implants market 34 US knee market 35 Procedure trends 35 European knee market 36 Procedure trends 37 Pricing and reimbursement of hip and knee replacements 38 US 38 Updated Center for Medicare and Medicaid Services (CMS) payment system 38 Europe 38 SWOT analysis for hip and knee implants market 39 Strengths 39 Patient demand 39 Newer implants and biomaterials 40 Marketing 40 Weakness 41 Downward pricing pressure 41 Rising costs 41 Opportunities 41 Baby boom population reaching retirement 41 Active younger patients seeking surgery 42 Awareness 42 Competition driven innovation 42 Threats 42 Risk of failure of implants 43 Rising costs of implants 43 Shorter product lifecycles 43 Alternative treatment options 43 Future trends in hip and knee replacement: growth in a mature market 43 US and European hip and knee replacement market 43 Strong growth to continue in a mature market 43 Growth will be driven by procedures and not price 44 Younger and broadening patient base to drive short- and medium-term growth 44 Baby boom generation set to drive long-term growth 44 Revision and partial replacement to drive segment growth 45 US hip and knee replacement market 45 Knee replacement to continue to outgrow hip replacement market 45 Minimally invasive surgery will find increased adoption rates 46 Favorable reimbursement rulings to push procedure growth 46 Cementless implants set to dominate fixation procedure growth 46 European hip and knee replacement market 46 Knee replacement procedures set to surpass hip replacement procedures 46 Cautious adoption of minimally invasive surgeryby surgeons 47 Cementless implants making inroads into the conventional cemented implants market 47 Surgeons choose implants that provide mobility and longevity and procedures that are bone-sparing 47 Chapter 4 Key market players 48 Key players 48 Hip replacement market shares 48 Knee replacement market shares 48 The US hip market share 48 European hip replacement market share 49 The US knee replacement market share 51 European knee replacement market share 52 Company profiles 53 Zimmer 53 DePuy 53 Stryker Corporation 54 Biomet 54 Smith & Nephew 55 Chapter 5 Appendix 56 Sources for reference 56 Journals 56 Government websites 56 Orthopedic associations 56 Scientific websites 56 Company websites 57 Broker reports 57 Abbreviations List of Tables Table 1: Total US & Europe hip & knee replacement procedures in 2005 3 Table 2: US & Europe hip and knee replacement revenues ($m), 2005 4 Table 3: Hip and knee replacement market segmentation 13 Table 4: US & Europe hip replacement procedures, 2005 30 Table 5: US & Europe hip replacement market revenues ($m), 2005 31 Table 6: US & Europe knee replacement procedures, 2005 34 Table 7: US & Europe knee replacement revenues ($m), 2005 35 Table 8: US hip replacement market shares (%), 2005 49 Table 9: Europe hip replacement market shares (%), 2005 50 Table 10: US knee replacement market shares (%), 2005 51 Table 11: Europe knee replacement market shares (%), 2005 List of Figures Figure 1: The US hip replacement market procedures, 2005 30 Figure 2: European hip replacement procedures, 2005 31 Figure 3: US knee replacement procedures 2005 36 Figure 4: European knee replacement procedure break-up, 2005 37 Figure 5: US hip replacement market shares, 2005 49 Figure 6: European hip replacement market shares, 2005 50 Figure 7: US knee replacement market share, 2005 51 Figure 8: European knee replacement market share, 2005 52

Companies Mentioned

Zimmer DePuy Stryker Corporation Biomet Smith & Nephew