Overv iew of Ortho pedic J oin t Repl acement Ma rk et in Ind ia
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Table of Con tent s Executive Summary
11
Research Aim and Key Deliverables
12
MarketSegmentationandScopeoftheStudy
13
Current Market Size and Growth Trends
14
Key Market Drivers and Restraints
15
Future Growth Potential by Segment
16
Competitive Scenario and Conclusion
17
Research Method olog y
18-20
Research Scope and Defini tion s Study the Scope of Definitions
23
Common Indications for Joint Replacement
24
Types of Joint Replacement Surgeries
25-27
Material Used for Prosthesis
28
Abbreviations
29
Total Orthopedic Join t Replacement Marke t
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21 22
30
Overview
31-32
Market Segmentation
33
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Table of Cont ents (Con td …) Market Engineering Measurements Industry Challenges Key Market Drivers
38
Market Drivers
39-44
Key Market Restraints
45
Market Restraints Revenue Forecasts Future Growth Potential by Segment Life Cycle Analysis
46-49 50-51 52 53
Competitive Forces (Porter’s 5 Forces Model)
54-58
SWOT Analysis
59
Competitive Structure
60
Market Share Analysis
61
Factors Considered for the Selection of an Implant
62
Important Factors for the Selection of an Implant Knee Join t Replacement Market Overview
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34 35-37
63-66 67 68
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Table of Cont ents (Con td …) Market Engineering Measurements
69
Revenue Forecasts and Procedure Forecasts
70-72
Market Share Analysis
73
Hip Join t Replacement Marke t
74
Overview
75
Market Engineering Measurements
76
Revenue Forecasts and Procedure Forecasts
77-79
Market Share Analysis Recent Mergers and Acqui siti ons
80 81
Mergers and Acquisitions
82-85
Recommend ations and Conclus ion Recommendations
87-90
Conclusion
91
Company Profiles Leading Companies in the Total Indian Orthopedic Joint Replacement Market
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86
92 93
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Table of Cont ents (Con td …) DePuyMedicalPty.Ltd(Johnson&Johnson) Zimmer India Pvt Ltd. Stryker India Pvt Ltd
96
Smith & Nephew
97
Abou t Fro st & Su ll ivan
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94 95
98-102
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List o f Figure s TotalOrthopedicJointReplacement Market:Abbreviations (India),2010 Total Orthopedic Joint Replacement Market: Impact of Top Three Industry Challenges (India), 2011-2017
29 35
Total Orthopedic Joint Replacement Market: Market Drivers Ranked in Order of Impact (India), 2011-2017
39
Total Orthopedic Joint Replacement Market: Market Restraints Ranked in Order of Impact (India), 2011-2017
46
Total Orthopedic Joint Replacement Market: Revenue Forecasts (India), 2011-2017
50
Total Orthopedic Joint Replacement Market: Competitive Structure (India), 2010
60
Knee Joint Replacement Market: Revenue Forecasts (India), 2011-2017
70
Hip Joint Replacement Market: Revenue Forecasts (India), 2011-2017
77
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List o f Charts Total Orthopaedic Joint Replacement Market: Market Size and Growth Trends (India), 2010 and 2017 Total Orthopedic Joint Replacement Market: Key Drivers and Restraints (India), 2011-2017 Total Orthopedic Joint Replacement Market: Future Growth Potential by Segment (India), 2011-2017 Total Orthopaedic Joint Replacement Market: Competitive Landscape (India), 2010 Total Orthopedic Joint Replacement Market :Segmentation by Type of Joint replacement (India), 2010 Total Orthopedic Joint Replacement Market: Market Engineering Measurements (India), 2010
14 15 16 17 33 34
Total Orthopedic Joint Replacement Market: Key Market Drivers (India), 2011-2017
38
Total Orthopedic Joint Replacement Market: Key Market Restraints (India), 2011-2017 Total Orthopedic Joint Replacement Market: Revenue Forecasts (India), 2011-2017
45 51
Total Orthopedic Joint Replacement Market: Future Growth Potential by Segment (India), 2011 -2017
52
Total Orthopedic Joint Replacement Market: Life Cycle Analysis (India), 2011-2017
53
Total Orthopedic Joint Replacement Market: Competitive Forces (India), 2011-2017
54-58
Total Orthopedic Joint Replacement Market: SWOTAnalysis (India), 2011-2017
59
Total Orthopedic Joint Replacement Market: Company Market Share by Revenues (India), 2010
61
Total Orthopedic Joint Replacement Market: Important Criteria for the Selection of an Implant (India), 2010
63
Knee Joint Replacement Market: Market Engineering Measurements (India), 2010
69
Knee Joint Replacement Market: Revenue Forecasts (India), 2011-2017
71
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List of Charts (C ont d…) Knee Joint Replacement Market: Procedure Forecasts (India), 2010 and 2017
72
Knee Joint Replacement Market: Company Market Share by Revenues (India), 2010
73
Hip Joint Replacement Market: Market Engineering Measurements (India), 2010
76
Hip Joint Replacement Market: Revenue Forecasts (India), 2011-2017
78
Hip Joint Replacement Market: Procedure Forecasts (India), 2010 and 2017
79
Hip Joint Replacement Market: Company Market Share by Revenues (India), 2010
80
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Executi ve Summ ary
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Researc h Ai m and Key De li verabl es •
The aim of this research service is to present an analysis of the joint replacement market in India.
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The deliverables in this research service include: •
Quantifying the size and growth forecasts of the Indian joint replacements market from 2010 to 2017 by product segments
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Providing insight into the industry challenges, market drivers, and market restraints during the forecast period
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Identifying key participants of the market and quantifying company market shares by product
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segments Providing further insight into the competitive environment through a Porter’s analysis (Analyzing the impact of the 5 forces namely Bargaining power of suppliers, bargaining power of customers, threat of new entrants, threat of generic products and intensity of competition on the joint replacement market in India)
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Highlighting the orthopedic surgeons’ perspective on factors influencing selection of an implant
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Identifying opportunities and providing recommendations to current and new market participants based on a strength, weakness, opportunities, and threats (SWOT) analysis
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Mark et Segm ent ati on and Scop e of t he Stu dy Market Segmenta tion Indian Orthopedic Joint Replacement Market
Knee Joint Replacement Market
Shoulder and Ankle Joint Replacement Market
Hip Joint Replacement Market
Sco pe of th e Stu dy In this research service, only the knee and hip joint replacement markets are covered. The shoulder and ankle joint replacement market has not been covered in this study, as it does not make a significant contribution to the total orthopedic joint replacement market in India. This research service also does not include replacement market for trauma cases. Time fra me Details •
Study period – 2008-2017
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Base year – 2010
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Forecast period – 2011-2017
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Cur rent Mark et Size and Grow th Trends •
The joint replacements market in India is in a high growth stage, projected to grow at a rate over 25-30 percent over the next five to seven years.
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The total Indian orthopedic joint replacement market was valued at $80.4 million in 2010.
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The demand is growing due to a combination of factors such as increase in aging population (with its majority suffering from arthritis), fast and sedentary lifestyle making the younger generation susceptible to orthopedic ailments requiring joint replacement, booming economy leading to growing middle class with substantial disposable income, and gradual opening up of the insurance sector.
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In terms of revenues, over 75 percent of the total market is contributed by knee replacement segment, about 20 to 25 percent is by hip replacement segment and less than 5 percent is contributed by shoulder and ankle replacement segment.
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Total Orth opedic Joi nt Replacement Market: Market Size and Growt h Trends (India), 2010 and 2017
Over $400 Million
$80.4 Million
Next 5-7 Years
2010
2017
Over 65,000 Knee and Hip Replacements
Over 350,000 Knee and Hip Replacements
Note: All figur es are round ed; the base year is 2010 . Source: Frost & Sullivan
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Key Market D ri vers and Re st raint s Total Orth opedi c Jo int Replacement Ma rket: K ey Drivers and Restr aints (Indi a), 2011-2017
Word of mouth on success of joint replacement surgeries
Key Drivers Huge population affected by arthritis and other painful joint diseases
Expensive surgery and lack of affordability
Booming economy and improving healthcare infrastructure
Limited access to orthopedic joint replacement surgeries
Patient apprehensions and lack of awareness
Key Restraints P54D-54
Source: Frost & Sullivan
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Futur e Grow th Potential by Se gm ent Total Orth opedi c Joi nt Replacement Market: Futur e Grow th Potent ial by Segment (India), 201 1-2017 High
) $ ( e z i S t e k r a M t n e r r u C
Shoulder and Ankle Replacement
Hip Replacement
Knee Replacement
Low High Lo w Note: Size of bubble indicates market size ($) of segm ent
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Long Term Growth Potential
Source: Frost & Sullivan
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Competiti ve Scenario and Concl usio n •
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In 2010, over 95 percent of the market was occupied by major international companies such as Depuy Companies (Johnson & Johnson), Zimmer, Inc., Stryker, Smith & Nephew, Exactech, Inc., B Braun, and Maxx Orthopedics, Inc. Others included a mix of international and local companies such as Synthes GmbH, Biomet, Inc., Endolite India Limited, Anthrex, Inc., Indus Orthopedics, Inor Orthopedics, and Sushrut Surgicals, and so on.
Total Orthopedic Joint Replacement Ma rket: Competitive Lands cape (India), 2010 Others 5%
International Companies 95%
Note: All figur es are roun ded; the base year is 2 010. Source: Frost & Sullivan
With a hug e populatio n requiri ng joi nt replacement, and incre ase in awareness abou t the imp act of joint-related problems on the lives of patients and the importance of surg ical treatment pr oc ess for th em, the mark et for or tho pedi c im pl ants is li kely to beco me on e of the most rapi dl y gro win g segments in the Indi an medic al devic e marke t.
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Researc h Metho dol og y
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Researc h Meth odo lo gy Secondary Research The research team conducted a comprehensive review of secondary information sources, including Frost & Sullivan in-house databases, previous research services, online databases, trade journals, and the Internet. The team then drew up a research plan on the basis of the research objectives and resources allotted. The research plan primarily consisted of the following.
Research Instru ments The best research instrument suitable for this project was identified as an open-ended questionnaire, developed separately for different types of target candidates, namely manufacturers, distributors, end users, and industry experts. These instruments were made and checked for clarity, thoroughness, and to find if they motivated the candidates to respond. Duplication and overlaps allowed corroboration and cross-checking of data.
Primary Research Frost & Sullivan obtained primary data directly from industry participants. The analysts' finely honed interviewing skills enabled the team to elicit valuable strategic information from industry participants. Using Frost & Sullivan's uniquely designed research techniques, the analysts were able to obtain information invaluable for identifying trends, threats, and opportunities in the marketplace. Primary research is focused on interviewing key personnel of relevant companies and organizations. In addition, the research team interviewed end users and industry experts from government and trade associations.
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Researc h Meth od olo gy (Con td …) 'Bottom-up' Approach Frost & Sullivan used a 'bottom-up' methodology to assess the market, where each final market measurement represents the sum of many detailed, bottom-rung measurements. Frost & Sullivan calculated the market size by interviewing each market competitor and deriving their revenues, average selling price, and unit volume. To calculate total market size, the analyst team first cross-verified all measurements and then added them to derive the final measurement of the total market
'Bottom-up' v ersus 'Top-down' Approach The 'top-down' approach is to ask a few participants to estimate the total size of the market, assess its growth rate, and make a forecast. These numbers are then averaged to make a final projection. This methodology is commonly used, but it is highly imprecise and can lead to serious problems when used to make strategic decisions. This approach assumes that the average market participant has a strong perception of measurements of an entire market segment or industry. Frost & Sullivan has found that it is often not so. It is very rare for a spokesperson to accurately portray the intricacies of his/her own company, let alone gauge the entire market segment or industry. Frost & Sullivan has, thus, chosen a 'bottom-up' approach to market measurement.
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Research Scop e and D efi ni ti on s
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Scope of the S tud y Market Scope This study analyzes the hip and knee joint replacement markets in India from 2008 to 2017. This research service does not include the analysis of shoulder and ankle joint replacement market. It also does not include the analysis of trauma, or minimally invasive surgeries. Base Year and Fore cast Period The base year for this research service is 2010, and the historic period is 2008-2009. The forecast period is 2011-2017. The forecasts are based on the estimates of future capacity additions and market conditions. They are calculated based on the impacts of industry challenges and market drivers and restraints. Market information for this period was collected through both primary and secondary research. Key trends and information on market share, market size, and other variables are based on the discussions with end users and manufacturers. Excha nge Rate $1 = •
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INR 46.0
All revenue estimates were calculated in INR and then converted to USD using the above-mentioned exchange rate (unless mentioned otherwise).
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Definitions •
Arth ri ti s: Arthritis is inflammation of a joint.
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Rheumatoid Arthritis: This is a chronic inflammatory disease of one or multiple joints.
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Oste oarthritis/D egenera tive Arthritis: This is a 'wear-and-tear’ arthritis affecting any joint.
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Durability : Durability is the characteristic of a material or object referring to its long-lasting strength and function.
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Arth op las ty of the Hip: This is the process of reconstruction of joint surfaces in the hip by replacing the femoral head and acetabulum with a plastic or metallic prosthesis.
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Arth op las ty of th e Knee: It is the reconstruction of joint surfaces in the knee by replacing the femoral condyles and tibial plateau with a metallic or plastic prosthesis.
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Unico mpartme ntal Kne e Arth opla sty : This process requires the removal of damaged parts, using minimally invasive surgeries
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Osteolysis: This is lysis of bone caused by disease, infection or inadequate blood supply.
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Minimally Inva siv e Surg ery (MIS): MIS is a surgical procedure carried out by allowing the surgical equipment to enter the body through the skin or through a body cavity or anatomical opening, thus allowing minimal damage to the body
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Comm on Indic atio ns fo r J oint Replace ments Following are the common indications associated with the joints that might require replacement: •
For patients above the age of 55 to 60 years, secondary osteoarthritis or rheumatoid arthritis in the knee joint is the most common indication.
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Incongruence of knee or hip joints after a traumatic surgery is another indication.
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Fractures resulting from avascular necrosis (resulting in secondary arthritis) in patients aged above 60 years and traumatic fractures damaging acetabulum for the younger ones are the most common indications for the hip joints that require replacement surgery. Total replacement is performed in
•
•
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India only in case of avascular necrosis. Tumor is one of the rare indications. In case of tumor, a surgeon needs to order an implant designed according to the patient’s requirements. Joint problems can be experienced even by young people. At present, several people aged below 40 years are suffering from arthritis due to fast-paced, sedentary city life.
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Types of Joi nt Repl acement S ur geries •
During a replacement surgery, either an entire joint or a part of it is replaced with an artificial implant known as prosthesis to improve and enhance the functioning of the joint.
Total Replacement Sur gery •
Tot al Replacement Surgery – The surgical procedure to replace a joint entirely with an artificial prosthesis is called as total replacement surgery. The total replacement prosthesis looks exactly like the human body joint.
•
Two types of replacement surgeries can be performed based on the type of implant used, as discussed below. Cemented - In the total cemented replacement surgery, artificial implant’s metal part is fixed on to bone by a type of epoxy cement called polymethyl methacrylate (PMMA). Cementless - The uncemented joint is a porous implant. After the surgery, the bone is expected to grow into and through the pores in the implant, thereby securing the implant.
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Types o f Jo int Repl acement Sur geries (C ont d…) Parti al Replacement Surgery Parti al Replacement Surg ery- Partial replacement surgery is performed when the damage is restricted to a single compartment of a joint. In such cases, the damaged area is shaved off and is replaced with an appropriate artificial component. This technique is less complicated and less invasive, and it enables a patient to perform the regular activities and recover much faster, even within six weeks. Artificial component used in this surgery can be either of the following two types, based on whether the surgery is done to the hip or knee joint. Unicompartmental Knee Arthroplasty (UKA) Prosthesis- This type of prosthesis is used when any one of the three compartments (medial, lateral, and patellofemoral) of a knee needs to be replaced. This type of prosthesis is called as uni-spacer, which is a metal disc in the form of an articular condyle. During surgery, the damaged bone is resected and resurfaced. The uni-spacer is then placed within the damaged bone to unload the diseased compartment. Bipolar Hip Joint Replacement Prosthesis - In this type of prosthesis, the set consists of two balls. The external ball matches the size of acetabulum, while the internal one matches that of femur head. The femoral component (internal ball) is fixed into bone, but the acetabular component (external ball) is not fixed in the acetabulum, thus allowing the cup to move freely in the socket. P54D-54
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Types o f Jo in t Repl acement Surg eri es (Con td …) Revisi on Replacement Surgery Revision Repl acement Surge ry– Usually, implants have a shelf life of 15 to 20 years. Hence, when a replacement surgery is done in younger patients, there are chances for the prosthesis to deteriorate. In such cases a revision surgery is done to replace a worn out prosthesis. This procedure is also called revision arthroplasty. Revision joint replacement surgery is often more complicated, with less predictable results.
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Materials Use d f or Pros th esis •
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The orthopedic prosthesis are made of different materials, mostly metal, plastic, and ceramic. Selection of a material depends on its qualities such as strength (weight-bearing capacity), biocompatibility, and wearing rate.
Metal on Plastic
This is one of the most commonly used types of prosthesis. In this prosthesis, head and stem of a joint are made up of metal, while the cup is made of plastic. The metals used include titanium, stainless steel, and cobalt chrome. The plastic is cross-linked polyethylene. Such implants can be used for both cemented as well as non-cemented replacement surgeries.
Metal on Metal
Both the bearing surfaces (the ball and cup component) on the metal-on-metal prosthesis are made of metal. These implants are more resistant than the metalon-plastic ones. Despite the low wear rates, metal-on-metal implants will not last longer. There are also concerns about the wear debris generated by these implants
Ceramic o n Ceramic
Ceramic-on-ceramic implants have the lowest wearing rate and are scratch resistant. These are also smoother than the metal-on-metal ones. Commonly used ceramics are alumina or zirconia ceramics. These implants are designed to be the most resistant among all available replacement implants. However, no long-term data are available on how well these implants work over time.
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Abbreviations Total Orthopedic Joint Replacement Market: Abbreviations (India), 2010
Abbr evi ation s
Exp ans io ns
UKA
Unicompartmental knee arthroplasty
CAS
Computer-assisted surgery
CAGR
Compound annual growth rate
R&D
Research and development
FDA
Food and Drug Administration
CNC RFP
Computed numerically controlled Rotating platform flexion
BPL
Below poverty line
INR
Indian Rupee
Pvt
Private
Ltd
Limited Source : Frost & Sullivan
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Total Orth opedic Joi nt Repl aceme nt Mark et
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Overview •
According to international statistics, joint-related diseases account for about half of all chronic conditions in people aged 60 years and more. Moreover, experts predict that the number of individuals aged above 50 years is expected to increase two-fold between 1990 and 2020, which will have a significant bearing on the burden of orthopedic diseases.
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It is estimated that more than 150.0 million Indians are suffering from joint-related problems. A study done in 2005 revealed that 22 to 39 percent of the Indian population seems to suffer from painful osteoarthritis, and about 50 percent of them feel that it has a significant impact on their life, work, and 1
•
•
finances . Despite this, orthopedic conditions do not receive the attention they deserve, both from the patient as well as doctors. "The lack of attention by the medical profession, policy-makers and the media is due to the perception that orthopedic diseases are less serious. Unlike cardiovascular disease, AIDS and cancer, they are largely chronic, non-fatal conditions and tend to be seen as an inevitable consequence of ageing” says Professor Lars Lidgren, Department of Orthopedics, Lund University Hospital, Sweden and Chairman of the International Steering Committee, Bone and Joint Decade. Rise in aged population may be one of the reasons for increasing orthopedic diseases, but it is not the only reason; an active lifestyle and high life expectancy also result in increased wear of joints.
1: A Mahajan et. Al, July 2005, “Osteoarthritis”, JAPI, Vol. 53, pg. 1
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Overv iew (Cont d…) •
The advancements in the field of orthopedics treatment in India are in the same pace of that in other developed countries. The latest techniques and equipment to handle this probable epidemic are also available in India, and today/at present, world-renowned surgeons are practicing the latest surgery techniques in our hometown/the country.
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India is expected to be the forerunner in terms of research, treatment options, and revenue generation in the orthopedic segment, in the time to come.
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The orthopedics market in India has witnessed a major boon, mainly due to the increased spending
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On the surgical front, main revolution is minimal invasive approach aided by computer guided surgery, which means less morbidity and lesser hospital stay for patients. Dr. Parag Sancheti, Medical Director, Sancheti Institute of Orthopedics and Rehabilitation, Pune, says “ The accuracy in surgery can be increased by using computer navigation and longevity is increased by using better metals and polyethylene for prosthesis. Minimally invasive techniques are being used to improve the surgery outcome and also to enable the patient to return to work early.“
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There is a growing trend among patients and family members to seek alternate opinions and ask specific product-related queries to their surgeons prior to decision-making. The task for orthopedic implant suppliers and healthcare service providers is, therefore, to create awareness and make patient-surgeon communication effective.
capacity of the Indian population.
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Market Segmentation Total Orthopedic Joint Replacement Market: Segmentation by Type of Joint Replacement (India), 2010
Indian Orthopedic Replacement Market
Knee Joint Replacement Market
Primary
Revision
Shoulde r and Ankle Joint Replacement Market*
Unicompartmental
Primary
Hip Joint Replacement Market
Revision
Partial/Bipolar Source: Frost & Sullivan
*The
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shoulder and ankle joint replacement market is not analyzed in this study as it forms less than 5 percent of the total market.
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Mark et Engi neeri ng Measurements Total Orth opedi c Joi nt Replacement Market: Market Engineerin
Measurement Name
g Measur ements (India), 2 010
Measurement
Market age
Growth stage
Revenues
$80.4 million
Potentialrevenues(maximumfuturemarketsize)
$426.2million
Base year market growth rate
25.0%
Trend Increasing Increasing Increasing Increasing
Compound annual growth rate Price sensitivity
26.7% High
Increasing Increasing
Competitors(activemarketcompetitorsinbaseyear)
Around30
Increasing
Market concentration (percent of base year market controlled by top 4 competitors)
About 80.4%
Decreasing
Degreeofcompetition
8
Increasing
Customerloyalty
7
Stable
Unit’s shelf life
15-20 years
Stable
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sulli van
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Industry Challenges Total Orth opedi c Jo int Replacement Ma rket: Imp act of Top Thr ee Indu str y Challenges (Indi a), 2011-2017
Challenge
1-2 Years
3-4 Years
Lack of awareness about joint replacement surgeries
High
High
Patient apprehensions slow market penetration of joint replacement procedures
High
High
Brandloyaltyandclientrelationships
Medium-High
Medium-High
5-7 Years Medium-High Medium-High Medium-High
Source: Frost & Sullivan
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Indus tr y Challenges ( Contd …)
Lack of Awareness about Join t Replacement Surgeries
Patient Apprehensions Slow Market Pene tration of Joi nt Replacement Procedures
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The awareness about joint replacement surgery is very low in India. Many people approach doctors only at an advanced stage of when the bones would have incurred most damages. A few small surveys conducted in urban areas reveal that, only about 10 percent of people are aware about detection and prevention of joint related problems such as osteoporosis. In Tier II, Tier III cities and rural areas the awareness level is much low. Low awareness is also a concern withinthe thesigns medical fraternity itself. Physicians and specialists often neglect at the initial stage rather than immediately recommending the patient to an orthopedic surgeon. Arthritis generally affects people aged 55 years and above. It is one of the leading causes of disability among those people. However, not many people are willing to undergo surgery for treatment of arthritis, mainly due to their fear of whether the surgery will be successful, the risks involved, and prolonged recovery period. Most patients prefer alternative treatment methods or other non-surgical procedures such as physiotherapy, exercises, or yoga. As a result, the penetration of joint replacement products in the market is limited.
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Indus tr y Challenges ( Cont d…)
Patient Apprehensions Slow Market Pene tration of Joi nt Replacement Procedures (Contd…)
Brand Loyalty and Client Relationships
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Joint replacement surgery is believed to be associated with complications, including infections. Many patients are unconvinced to undergo this surgery because of the risk of implant failure. Any foreign material that is implanted into the body has a chance of being rejected by the patient’s body. There have been cases in which a knee implant recipient developed blood clots in the leg vein. This can prove to be dangerous, as it blocks blood flow in leg. For this reason as well, the patients opt for other non-surgical procedures such as physiotherapy, exercises, or yoga. This reduces the number of patients undergoing the joint replacement surgery. Surgeons’ decisions play an important role in purchase of an implant. They are usually loyal to a specific brand of implant primarily due to their familiarity with it. This helps them to deal with any complication during a surgery. Client relationships between joint replacement suppliers and surgeons also play a crucial role in product loyalty and preference in the market. This can be a challenge for new companies seeking to gain a foothold in this market.
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Key Market Drivers Total Ort hop edic Joi nt Replacement Market: Key Market Drivers (India), 20 11-2017
Revision joint replacement surgeries
Increase in the coverage of insurance policies
Advancements in Surgery
Note: Size of bubble indicates the level of impact
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Increasing medical tourism
Word of mouth on success of joint replacement surgeries
Huge population affected by arthritis and other painful joint diseases
Booming economy and improving healthcare infrastructure
Source: Frost & Sullivan
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Mark et Driv ers Total Ortho pedic J oin t Replacement Market: Ma rket Drivers Ranked in Ord er of Impact (India), 201 1-2017
Rank
Driver
1-2 Years Very High
3-4 Years
1
Booming economy and improving healthcare infrastructure
2
Huge population affected by arthritis and other painful joint diseases
3
Word of mouth on the success of joint replacement surgeries
Very High
Very High
4
Advancementsinsurgery
VeryHigh
VeryHigh
5
Increase in the coverage of insurance policies
6
Revisionjointreplacementsurgeries
7
Increasingmedicaltourism
VeryHigh
High High Medium-High
Very High
5-7 Years Very High
VeryHigh
VeryHigh
Very High VeryHigh
Very High
Very High
High
High
Medium-High
Medium-High
Source: Frost & Sullivan
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Mark et Drivers (Cont d…) While the huge population base is the single largest driver of the orthopedic joint replacement market in India, the underpenetrated silver age population (aged less than 55 years) which constitutes 7 to 12 percent of the total population, represents the scope for growth in the market. India’s growing economy is driving urbanization and creating an expanding middle class, with more disposable income to spend on healthcare. As a result, demand for improved health services and surgical expertise has been growing rapidly in the Booming Economy and Improvi ng Healthcare Infrastructure
country. Healthcare infrastructure in the metros and Tier I cities is rapidly increasing, with major corporate hospital groups such as Sterling, Apollo and Wockhardt among others, making significant investments in setting up state-of-the-art hospitals in major cities which also include orthopedic specialties. Though the government has not taken sufficient steps to cater to the huge population of arthritis needing joint replacements, the only positive step is to help indigenous manufacture of consumables and implants is the import duty waiver for manufacture of orthopedic implants.
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Mark et Drivers (Cont d…)
Huge Population Affected by Arthritis and O ther Painfu l Joi nt Diseases
Word of Mouth on the Succe ss of Joi nt Replacement Surgeries
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An significant part of the Indian population is either suffering from or are susceptible to arthritis and other painful joint-related diseases. An estimated 150.0 million Indians, comprising about 15 percent of the country's population, suffer from arthritis. This figure was projected at the Madras Institute Of Trauma in the meeting held in conjunction with World Arthritis Day in 2005; this number is on rise. Some of the major reasons for such rapid spread of these diseases include increase in aging population (above 55 to 60 years) susceptible to arthritis, younger age group (40 years and above) with fast and sedentary lifestyle, which includes imbalance in the diet, rest, and exercise, and side effects of unprescribed drugs. Companies and surgeons are increasingly taking efforts to conduct programs to increase the awareness about the very existence and benefits of the joint replacement surgeries. Word of mouth on the success of these surgeries and pain-free life after surgery influences more people to undergo these surgeries. Increase in awareness about benefits of joint replacement surgeries especially among the urban population in metros and Tier I cities is likely to drive this market.
41
Mark et Drivers (Cont d…) Growing number of Indians have started realizing the importance of a surgical treatment as an approach to cure knee and hip joint problems. Advancements in surgical techniques are also one of the main reasons for the same, especially the minimal invasive approach aided by computer guided surgery, which means less morbidity and lesser hospital stay for patients. Says Dr. Parag Sancheti, Medical Director, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, "The
Advancem ent s in Surgery
accuracy in surgery can be increased by using computer navigation and longevity is increased by using better metals and polyethylene for prosthesis. Minimally invasive techniques are being used to improve the surgery outcome and also to enable the patient to return to work early.“ With the availability of networking systems that link operating room (OR) facilities at different locations, supported with a range of integrated surgical equipment and lights, offers novel experience to the operating surgeons. These systems are useful as they can exchange MRIs, Xrays, live pictures and other kinds of information between ORs, doctor's offices, and teaching institutions located anywhere in the world.
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42
Market Drivers (Con td …)
Increase in th e Coverage of Insurance P olic ies
The insurance sector in India is poised for tremendous expansion. Its growth in the recent years has been significant. In 2007, the health insurance market was worth $680.0 million (INR 33.00 billion) with over 4.0 million policies, and it is expected to grow at a rate of 25 to 35 percent in the next five years. The State and Central Government run insurance schemes and most importantly, private insurance schemes are significantly increasing the affordability for orthopedics implants, in turn driving the market.
Revision joint Replacement Surgeries
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Artificial joint replacements do not last lifelong. As a result, patients with joint replacements need to revisit their treatment options, and recipients of artificial implants in the last few years will be in need of revision surgeries in the next few years. The revision joint replacement market is expected to grow at a rate of over 20 percent in the next five to seven years.
43
Mark et Dri vers (Con td …)
Increasing Medical Tourism
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India is emerging as a hub for medical tourism, which is one of the major external drivers for growth in the Indian healthcare sector. According to a study, Indian medical tourism was valued at $350.0 million in 2006. The market is growing by 30% a year and has the potential to grow into a (approximately over) $2.00 billion industry by 2012. The growing recognition of the competence and skills of Indian surgeons as well as the emergence of world-class hospitals in the corporate sector has provided a stimulus to medical tourism.
44
Key Ma rk et Rest raint s Total Ort hop edic Joi nt Replacement Market: Key Market Restraint s (India), 201 1-2017
Expensive surgical procedures and lack of affordability
Limited access to orthopedic joint replacement surgeries
Price war bringing down cost of implants
Unregulated market scenario
Note: Size of bubble indicates the level of impact
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Source: Frost & Sullivan
45
Market Re st raint s Total Orth opedi c Jo int Replacement Ma rket: Market Restrain ts Ranked in Ord er of Imp act (India), 20 11-2017
Rank
Restraint
1-2Years
3-4Years
5-7Years
1
Expensives urgicalp rocedures andl acko fa ffordability
High
High
Medium-High
2
Limiteda ccesst oo rthopedicj ointr eplacements urgeries
High
Medium-High
Medium
3
Pricew arb ringingd ownc osto fi mplants
Medium-High
Medium-High
Medium-High
4
Unregulated market scenario
Low-Medium
Low-Medium
Low
Source: Frost & Sullivan
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Mark et Rest raint s (Con td …)
Expensive S urgi cal Procedures and Lack of Affordab il it y
Affordability of joint replacement surgeries continues to be hurdle. Total cost of a joint replacement surgery includes hospital expenses such as expenses of operation, stay, and many other charges apart from the implant. The minimum cost of any replacement surgery is above $4500 to $5,000. India’s per capital income is $1,030 and the country is ranked 139th in the world. Though the insurance sector is fast growing, current penetration of health insurance is very moderate; at present the patients to variation bear such medical expenses by themselves. Moreover, there is need a wide in surgical costs across hospitals, because there is no fixed price in the private sector and most medical aid schemes do not cover the total costs.
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Market Re str ain ts (Cont d…)
Limited Acce ss to Orthope dic Joint Replacement Surgeries
Price W ar Bring ing Down Cost of Implants
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Though healthcare infrastructure in India is growing at a fast pace, the penetration of orthopaedic joint replacement surgeries is limited to tertiary care and super-speciality hospitals in metros and Tier I cities. These facilities are still not accessible to a large section of the population living Tier II-Tier III cities and rural areas. Moreover, currently, there are only about 750 to 850 surgeons in the country who perform joint replacement surgeries.
About 10 to 15 years ago, only a few companies offered orthopedic implants. However, at present several international and indigenous companies are offering a wide variety of implants, which increases the bargaining power of customers which include not only the private hospitals and super-specialties, but also the Government hospitals as well. Therefore, companies are forced to reduce their prices, thus allowing a lower profit margin. Moreover, this is a customer driven market and works more on relationship with hospitals & surgeons.
48
Market Re str ain ts (Cont d…) India does not have a well-developed laboratory for certifying these implants nor regulatory guidelines for manufacturing or quality check laboratories for orthopedic products. On the contrary, by an amendment to the Drug and Cosmetic Act of 1940, orthopedic implants are currently classified as drugs. As a result, the manufacturers and importers at present need to register orthopedic implants with the Office of the Drug Controller General of India, prior to import, manufacture, or sale in the Indian market. Unregulated Market Scenario
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Lack of approvals such as the Food and Drug Administration or European Conformity mark allows domestic participants to sell lowquality implants at a price that is less than half of the price of goodquality implants manufactured by international participants. This hampers the market for good quality implant manufacturers, and may also increase the fear and apprehension among the users once those low-quality products do not yield expected results.
49
Revenu e For ecast s Total Orth opedi c J oin t Replacement Market: Revenue Forecasts (Indi
Year
Revenues ($ Millio n)
2008
51.6
2009
64.3
a), 2011-2017
Revenue Growth Rate (%) -24.6
2010
80.4
2011
100.9
25.0 25.4
2012 2013
127.0 160.5
25.9 26.4
2014
203.6
26.9
2015
259.3
27.4
2016
331.6
27.9
2017
426.2
28.5
Compou nd Annu al Growt h Rate (201 1-2017): 26.7% Note: All figures are rou nded; the base year is 2010. Source: Frost & Sulli van
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Revenu e Forecast s (Con td …) •
The total orthopedic joint replacement market in India was valued at $80.4 million in 2010.
•
About 76.8 percent of the total market share was held by knee replacement and the rest by hip replacement.
•
•
•
This market is expected to grow at a CAGR of 26.7 as per the figure in the previous slide percent from 2010 to 2017. Currently, more than 90 percent of the total customers for this market are the private corporate hospitals and superspeciality hospitals. Less than 10 percent of the total market is Government or Public hospitals. With private insurance segment experiencing rapid growth and the various state and central Government reimbursement schemes for below poverty line families, the huge unaddressed arthritis population becomes potential target for the orthopedic implant manufacturing companies.
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Total Orthopedic Joint Replacement Market: Revenue Forecasts (India), 2011-2017 450.0
29.0
CAGR (2010-2017): 26.7%
400.0
28.0
) 350.0 n o lli i 300.0 M ($ 250.0 s e u 200.0 n e v 150.0 e R100.0
27.0 26.0 25.0 24.0
50.0 0.0
) (% e t a R h t w o r G e u n e v e R
23.0 22.0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year Revenues ($ Million)
Revenue Growth Rate (%)
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sullivan
51
Futur e Grow th Potential by Se gm ent Total Orth opedi c Joi nt Replacement Market: Futur e Grow th Potent ial by Segment (India), 201 1-2017 High
) $ ( e z i S t e k r a M t n e r r u C
Hip Knee Replacement Replacement
Shoulder and Ankle Replacement
Lo w Lo w
High Long Term Growth Potential
Note: Size of bubble indicates the comparative size of the segment in terms of revenues generated
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Source: Frost & Sullivan
52
Li fe Cycle Analys is Total Orth opedi c Jo int Replacement Ma rket: Lif e Cycle Analysis (India), 2 011-2017 e u l a V t e k r a M
•
Knee Replacement
population, increased confidence in procedures due to more successful clinical results after operations and the growth of insurance sector.
Hip Replacement
Shoulder and Ankle Replacement
Development
The knee joint replacement market in India is in a high growth phase. It was valued $61.8 million in 2010, and is likely to grow at a CAGR of 28.2 percent from 2010 to 2017. Opportunity for growth is high due to a significant population being aged above 55 years , active life style of the younger
Growth
•
The hip joint replacement market in India was valued at about $18.3 million in 2010, and is expected to grow at a CAGR of 20.7 percent from 2010 to 2017. The market is shifting focus from cemented to uncemented hip implants due to better results.
•
Shoulder and ankle replacement formed less than 5 percent of the total market and is at a very nascent stage of development. Maturity
Decline
Time
Source: Frost & Sullivan
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Com petit ive For ces (Por ter’s 5 Forces Model) Total Orth opedi c Jo int Replacement Ma rket: Com petit ive Forces (Indi a), 2011-2017
• The bargaining power of customers in the Indian joint replacement market is very high.
Threat of Substitutes
• During the past 10 to 15 years, the number of companies offering a wide range of implants at different price ranges has increased rapidly. • Moreover, penetration of insurance being moderate, patients have to pay out of pocket for these surgeries, which not only include the cost of the implants but also the cost of hospital stay and other expenses. • Furthermore, insurance schemes do not cover the total cost of prostheses; patients have to pay the difference of more than 40 percent of the cost of surgery or sometimes even more. • The affordability of these products for these customers determines the ability of suppliers to market them. Therefore, suppliers may modify their prices to retain their positions in the market. P54D-54
Lo w Medium High
Intensity of Competition Bargaining Power of Suppliers
Bargaining Power of Customers
Threat of New Entrants
Source: Frost & Sullivan
54
Com petit ive Forces (P or ter’s 5 For ces Model) ( Con td …) Total Orth opedi c Jo int Replacement Ma rket: Com petit ive Forces (Indi a), 2011-2017
• The threat of new entrants in the Indian orthopedic joint replacement market is high. • This market has a huge untapped potential. In the past five years, several notable companies have entered this market and made their presence felt; a few prominent companies include Smith & Nephew, Exactech and Maxx Orthopaedics. • With the market expected to grow at a rate over 20 to 25 percent in the years to come, many major international giants companies such as Biomet and Wright Medical are planning to enter this market in a huge way. • The new entrants need not necessarily take away the share of the existing market participants; they could create their own market or customer base without dislodging the existing established participants, as the market provides sufficient scope of growth.
Threat of Substitutes
Intensity of Competition Bargaining Power of Suppliers
Bargaining Power of Customers
Lo w Threat of New Entrants
Medium High
Source: Frost & Sullivan
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Competit iv e For ces (P or ter’s 5 For ces Model) ( Contd …) Total Orth opedi c Jo int Replacement Ma rket: Com petit ive Forces (Indi a), 2011-2017
• The bargaining power of suppliers in the Indian orthopedic joint replacement market is low.
Threat of Substitutes
• Currently, the major buyers or customers of these implants are the corporate hospitals and the private superspeciality hospitals. With several companies offering implants of different types and costs, hospitals and surgeons a wide variety of the options to select the have best available implant market which matches their expectation in terms of both quality and price. The competition being intense, companies often need to reduce the prices to sustain in the market. • In the public sector, the Government determines the purchasing and reimbursement terms of the joint replacement products for their market. The supplier that meets these standards will be awarded the contract for product provision. This environment inhibits the bargaining power of suppliers. P54D-54
Intensity of Competition Bargaining Power of Suppliers
Bargaining Power of Customers
Lo w Medium High
Threat of New Entrants
Source: Frost & Sullivan
56
Competit iv e For ces (P or ter’s 5 For ces Model) ( Contd …) Total Orth opedi c Jo int Replacement Ma rket: Com petit ive Forces (Indi a), 2011-2017
• The threat of indigenous unapproved product in the Indian orthopedic joint replacement market is medium. • These products that have been manufactured either locally or imported from other markets are thriving due to the absence of medical device regulation. Therefore, they constitute a threat to better quality, higher-cost products. • The reason behind the threat of generic products being classified as medium and not as high is that most orthopedic specialists tend to opt for high-quality and branded products. • A few companies manufacture devices without registration and do not follow regulatory codes of conduct. Low price of generic products is one of the major reasons for these products to persist in the market.
Lo w Medium
Threat of indigenous Products
High Intensity of Competition Bargaining Power of Suppliers
Bargaining Power of Customers
Threat of New Entrants
Source: Frost & Sullivan
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Com petit ive Forces (P or ter’s 5 For ces Model) ( Con td …) Total Orth opedi c Jo int Replacement Ma rket: Com petit ive Forces (Indi a), 2011-2017
• The intensity of competition in the Indian orthopedic joint replacement market is high..
Threat of indigenous Products
• In India, more than 150.0 million people are suffering from arthritis and only about 70,000 joint replacements are done every year. Therefore, a substantial portion of the market continues to remain untapped. • Companies are using various means and strategies to tap this huge untapped potential, such as by creating awareness among people and surgeons on the importance and benefits of joint replacement surgeries. Relationship with the hospitals and surgeons also plays an important role in this market. • With the private insurance sector opening up and the Government’s reimbursement packages for families below poverty line, intense competition is expected between the companies, not only among the existing ones but also the companies planning to enter.
Lo w Medium High
Intensity of Competition Bargaining Power of Suppliers
Bargaining Power of Customers
Threat of New Entrants
Source: Frost & Sullivan
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SWOT An alysi s Total Ort hopedi c J oin t Replacement Market: SWOT Analysis
(India), 20 11-2017
Strengths
Weakness
• Booming economy and increasing middle class population with substantial disposable income
• Lack of availability of trained surgeons performing joint replacement surgeries
• Increasing awareness replacement surgeries
• Facilities performing orthopedic joint replacement surgeries concentrated in metros, Tier I cities, and a few Tier II cities
on
benefits
of
joint
• Innovations are constantly introduced into the market; specialists follow innovations closely • Waiver of Customs Duty for import of implants
• Low rate of implementation of Government reimbursement schemes; lack of affordability among lower middle income group living in Tier II-Tier II cities and rural areas
Opportunities • Huge arthritis population • Opening up of private insurance sector • The expansion of age group of patients susceptible to orthopedic ailments requiring joint replacement surgery to include the population aged about 40 years, due to their fast and sedentary lifestyle
Threat • Decreasing profitability
prices
affecting
companies’
• Orthopedic joint replacement surgeries often being done by surgeons in certain areas without receiving proper training and infrastructure.
• Huge potential for revision surgery market Source: Frost & Sullivan
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Competiti ve Stru ctu re Total Orthopedic Joint Replacement Market: Competitive Structure (India), 2010
Number of Companies in the Market
Around 30
Key International Companies
DePuy Companies, Zimmer, Inc , Stryker, Smith & Nephew, Exactech, Inc., B Braun, and Maxx Orthopedics, Inc.y, Zimmer, Stryker, Smith & Nephew, Exactech, and B Braun
Type of Competitors
Approximately 90 to 95 percent dominated by the international companies
Distribution Structure
Distribution is done mostly through distributors and dealers; less than 5 percent of the hospitals buy implant in bulk directly from the manufacturer
Tiers ofCompetition
Tier1–D ePuyCompaniesandZimmer Tier 2 – Stryker, Smith & Nephew, Exactech and B Braun Tier 3 - Other companies (Local and international)
KeyEnd-user Groups
Privatehospitalsandclinics Public hospitals Source: Frost & Sullivan
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Market Sha re An alys is •
The total Indian orthopedic joint replacement market Total Orth opedi c Joint R eplacement Market: Company Market Share by Revenues (India), 201 0 was valued at $80.4 million in 2010.
•
DePuy, the orthopedic division of Johnson & Johnson Ltd., led the market in 2010 with 48.1 percent market share. Established in the Indian market for a very long time, its aggressive marketing and strong relationship built with surgeons and hospitals are some of its key success factors.
•
•
•
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The second largest participant in 2010 was Zimmer with a market share of 21.4 percent, followed by Stryker with 10.0 percent. Smith & Nephew that held nearly 8.1 percent market share in 2010, had grown almost three times from 2009; some of the key state Government deals were won by this company in 2010. Other notable international companies include Exactech and B Braun with a cumulative market share of 8.4 percent in the same year.
Revenues - $80.4 milli on
4.6% 3.8%
4.0%
8.1% 48.1%
10.0%
21.4% Depuy
Zimmer
Stryker
Smith&Nephew
Exactech
BBraun
Others Note: Others includes international and domestic companies such as Synthes GmbH, Biomet, Inc., Endolite India Limited, Anthrex, Inc., Indus Orthopedics, Inor Orthopedics and so on
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sullivan
61
Facto rs Consi dere d for the S election of an Implant Parameters for the Se lection of an Impl ant Technology, design, and type of an implant, its cost, patient’s need, product delivery, durability of a product, training offered, previous experience, and brand reputation are the parameters considered while selecting an implant. Calcul ations (for One Modality) Every respondent was asked to rate the above-mentioned parameters on a scale of 1-8, depending on the importance given to them while purchasing an implant. (1 stands for the least important criteria, while 8 stands for the most important criteria.) For every criteria, percent of response for each rating was calculated. For example, out of 15 respondents, 31 percent gave ‘patient’s need’ a rating of 6. For a particular criterion, the rating given by a majority of respondents was considered and plotted on the spider chart. For example, product delivery was given a rating of 5 by a majority of respondents (42.0 percent). Hence, it was given a rating of 5. Sample Size – For the purpose of this study, about 15 orthopedic surgeons (who perform joint replacement surgeries) across India were interviewed.
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Impor tant Fa cto rs for the S election of an Implant (C ontd …) About “73.0 percent of the respondents rated technology, design, and type of implant as the most important criterion. Cost of an implant and patient’s need followed it. Total Orthopedic Joint Replacement M arket: Important Criteria for the Selection of an Implant (India), 2 010 Maximum Response
Technology, Design and Type of Implant 73.0% 73.0% respondents rated it as most important criteria Cost of an Implant 53.0%
Brand Reputation 42.0% 8 7 6 5 4 3 2 1 0
Patient's Need 31.0%
Previous Experience 42.0%
Training Offered 58.0%
Durability of a Product 32.0% Product Delivery 42.0% Source: Frost & Sullivan
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Impo rtant Fa ctor s for the S election of an Implant (C ont d…) Techn olo gy, Desig n, and Type of an Impl ant •
Technology, design, and type are the most important factors considered while selecting an implant. Some implants are complicated, while the others are very easy to use. Hence, selection also depends on the surgeon’s level of comfort with an implant. For instance, a cemented implant is not suitable for younger patients, as the chances of cement wearing out are high. Hence, it is used mostly for older patients who perform less activities. Uncemented implants can be easily replaced through the revision surgery; hence, they are used for younger patients.
Cos t of an Imp lant Cost of an implant is the second-most important criterion according to surgeons. Adopting new technology becomes difficult, especially when its cost is very high when compared to the existing one.
•
•
Uncemented implants are more expensive than the cemented ones, hence are preferred by medium to high income group of patients. Though patients are less involved in the process of selecting an implant, their affordability also determines the type of implants.
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Impor tant Fa ctor s for the S election of an Implant (C ont d…) Patient’s Need •
The next important factor is the patient’s need. Any implant is selected after the patient’s physical examination based on the extent of damage caused to the bone and age. For example, uncemented implants are selected depending on the bone strength of a patient. If the bones are strong, which is mostly the case with younger patients, uncemented implant is preferred over the cemented one.
Prod uct Delive ry •
Speedy product delivery is another criterion considered during selection. An implant is expected to be delivered within 24 hours. Speedy delivery is important especially in trauma cases. A surgery in this case is not planned, hence, an implant is expected to arrive as early as possible.
Dura bil ity of a Prod uct •
The quality of an implant is also considered while selecting an implant. Quality includes the grade of material used and its finishing; the material used should wear less. A good-quality implant should have a shelf life of 15 to 20 years.
Training Offered •
Training for new technologies, in the form of live demo or whole model training, helps a surgeon to become familiar with them. This, to some extent, influences the decision regarding the selection of an implant. Some companies offer cadaver trainings abroad.
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Impor tant Fa cto rs for the S election of an Implant (C ontd …) Previous Experie nce •
Previous experience with a vendor influences the decision of purchase of an implant. Most of the surgeons become comfortable with an implant while being trained on its usage. For example, DePuy was the first orthopedic implant company to be established in India. It trained many surgeons to use its implants; hence, they are accustomed to them. This results in them being loyal to the company.
Bran d Reputa tion •
According to the surgeons (42.0 percent), brand reputation is a less important criteria when compared to the other factors listed during the selection of an implant. Most of the companies provide references either from a previous case study or a renowned surgeon or hospital.
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66
Kn ee Jo in t Repl acement Mark et
67
Overview •
•
Knee replacement surgery, also known as knee arthroplasty, can help relieve pain and restore function in severely diseased knee joints. During knee replacement, a surgeon cuts away damaged bone and cartilage from the thighbone, shinbone, and kneecap and replaces those with an artificial joint (prosthesis) made of metal alloys, high-grade plastics, and polymers. Knee replacement can improve knee problems associated with osteoarthritis, rheumatoid arthritis, and other degenerative conditions, such as avascular necrosis, a condition in which obstructed blood flow causes the death of bone tissue.
•
Knee arthroplasty procedures are categorized as primary or revision.
•
Primary and revision surgeries unicompartmental (partial) or total.
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are
Knee Joint Replacement Market
Primary Knee Re placement
Unicomp artmental Knee Replacement Revisi on Knee Replace ment
broadly either
68
Market Engi neeri ng Measur ements Knee Join t Replacement Market: Ma rket Engi neering Measurement s (Indi a), 2010
Measurement Name
Measurement
Market age
Growth stage
Revenues
$61.8 million
Potentialrevenues(maximumfuturemarketgrowth)
$355.5million
Baseyearmarketgrowthrate
27.2%
Compound annual growth rate
28.2%
Price sensitivity
High
Competitors(activemarketcompetitorsinbaseyear)
About30
Market concentration (percent of base year market controlled by top 3 competitors)
About 79.5%
Degreeofcompetition
8
Customerloyalty
7
Unit’s shelf life
15-20 years
Trend Increasing Increasing Increasing Increasing Increasing High Increasing Decreasing Increasing Stable Stable
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sulliv an
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Revenu e For ecast s Knee Joi nt Replacement Market: Revenue For ecasts (Indi a), 2011-2017
Revenue Growth Rate (%)
Year
Revenues ($ Millio n)
2008
38.3
--
2009
48.6
26.9
2010
61.8
27.2
2011
78.8
27.4
2012 2013
100.6 128.8
27.7 28.0
2014
165.3
28.3
2015
212.7
28.7
2016
274.5
29.1
2017
355.5
29.5
Compou nd Annu al Growt h Rate (201 1-2017): 28.2%
Note: All figures are rou nded; the base year is 2010. Source: Frost & Sulli van
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Revenu e Forecast s (Con td …) •
The Indian knee joint replacement market was valued at $61.8 million in 2010.
•
Over 50,000 knee replacement were performed in 2010 of which, 85 to 90 percent were total knee replacement; 9 to 10 percent were revision knee replacement, and less than 2.0 percent were unicompartmental knee replacement.
•
•
At present, almost all the types of knee replacements in India performed are cemented ones; the cementless types are yet to penetrate the market. The Indian knee joint replacement market is expected to grow at a CAGR of 28.2 percent from 2010 to 2017. New materials used for bearing surfaces are rapidly changing the average age of patients who undergo knee replacement surgeries, with younger patients becoming more common. As a result, a 40 to 50 years old patient can enjoy the benefits of improved implant longevity.
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Knee Join t Replacement Market: Revenue Forecasts (India), 2011-2017 360
30.0
CAGR (2010-2017): 28.2%
320
29.5
)) n ) 280 n o in io lilllio lli 240 M M M 200 ($ ($ ($ ss e 160 e u u n n e 120 e v ve e 80 R R
29.0 28.5 28.0 27.5 27.0
40 0
26.5 26.0
)) ) % ((% (% e tee tt aa a R R R thh t th w w w o roro r G G G ee e uu u nn n ee e vv ev e e R R R
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year Year Year Revenue ($Million)
Revenue Grow th Rate (%)
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sullivan
71
Pro cedur e For ecast s •
•
Of the over 50,000 knee procedures done in. The total knee replacement segment accounted for approximately 88.0 percent share in 2010, and is expected to grow to about five to six times from 2010 to 2017. The revision knee replacement segment is also expected to grow at an equally high rate to attain 17.0 percent market share in 2017 from 10.0 percent in 2010. The Indian unicompartmental knee replacement segment is at a very nascent stage of growth. In India, people generally go to the physician at a very late stage of the disease. By then, their ailment would have crossed the stage of partial knee replacement. Therefore, the potential for growth of this market is moderate.
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Knee Joint Replacement Ma rket: Procedure Foreca sts (Indi a), 2010 and 2017 s re u d e c ro P e e n K f o r e b m u N
1.7%
9.9%
88.4%
2010 Primary Knee Replacement
3.0%
17.0%
80.0%
2017 Revision Knee Replacement
Unicompartmental Knee Repalcement
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sullivan
72
Mark et Sha re A nalysi s •
The Indian knee joint replacement market was valued at $61.8 million in 2010.
•
In 2010, DePuy Companies dominated this market with 47.5 percent share, followed by Zimmer, Inc. and Stryker with a market share of 22.1 and 10.5 percent, respectively.
•
•
•
Smith & Nephew had increased its market share to 8.4 percent in 2010, acquiring the shares of a few other companies. Alignment of human resources, products, and pricing are some of the reasons for this growth. Exactech with a share of 4.9 percent and B Braun with a share of 2.8 percent in the same year were some of the other prominent international participants. Due to the high volume of potential population requiring knee joint replacement in India, more international and local companies concentrate on this market as compared to those on the hip joint replacement market.
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Knee Joint Replacement M arket: Company Ma rket Share by Revenues (India), 2010 Revenues - $61.8 milli on 2.8% 4.9% 8.4%
3.8% 47.5%
10.5%
22.1% Depuy Stryker Exactech Others
Zimmer Smith&Nephew BBraun
Note: Others include international and domestic companies such as Synthes GmbH, Biomet, Inc., Endolite India Limited, Anthrex, Inc., Indus Orthopedics, Inor Orthopedics and so on
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sullivan
73
Hip J oi nt Replaceme nt Market
74
Overview •
•
•
Hip joint replacements are essential when the hip joints degenerate. It is the surgical process of replacing the existing ball and socket joint with artificial ones. Hip joint replacement is usually considered only when other therapies, such as pain medications, have failed. There are three types of procedures for hip replacements: primary, partial, and revision. Primary
hip
joint
implants
include
an
array
Primary Hip Replace ment
of
components that replace the ball and socket hip joint. Manufacturers supply these parts as individual pieces or as a complete hip system. •
Hip Joint Replacement Market
Revision hip prosthetics are endowed with design features to augment the fixation of the implant in an increasingly bone-deficient environment. When a primary total hip arthroplasty loosens, the orthopedic surgeon is likely to consider the removal of the prosthesis and its replacement with a new prosthesis.
Parti al Hip Replacement*
Revisi on Hip Replaceme nt
*Partial Hip Replacement Market is not considered as a part of this study. This is a highly f ragmented market with a lot of local manufacturers and distributors.
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Mark et Engi neeri ng Measu rements Hip Joint Replacement Market: Market Engineering Measurements (India), 2010
Measurement Name
Measurement
Market age
Growth stage
Revenues
$18.6 million
Potentialrevenues(maximumfuturemarketsize)
$70.7million
Base year market growth rate Compoundannualgrowthrate
18.4% 20.7%
Price sensitivity
High
Competitors
About 30
Market Concentration (percent of base year market controlled by top 3 competitors)
About 78.6%
Degreeofcompetition
8
Customerloyalty
7
Unit’s shelf life
15-20 years
Trend Increasing Increasing Increasing Increasing Increasing High Increasing Decreasing Increasing Stable Stable
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sulli van
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Revenu e For ecast s Hip Jo int Replacement Market: Revenue Forecasts
Year
Revenues ($ Million )
(India), 201 1-2017
Revenue Growth Rate (%)
2008
13.3
2009
15.7
-18.0
2010
18.6
18.4
2011
22.1
18.9
2012 2013
26.4 31.7
19.4 20.1
2014
38.3
20.8
2015
46.6
21.7
2016
57.1
22.7
2017
70.7
23.7
Compou nd Annu al Growt h Rate (201 1-2017): 20.7% Note: All figures are rou nded; the base year is 2010. Source: Frost & Sulli van
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Revenu e Forecast s (Con td …) •
The Indian hip joint replacement market was valued at $18.6 million in 2010.
•
Of the total 15,000 to 20,000 hip replacements performed in India during 2010, cemented hip replacements formed about 44 to 45 percent, while uncemented formed about 49 to 50 percent ; the rest 6 to 7 percent were revision hip replacements.
Hip Joi nt Replacement Market: Revenue Forecasts (India), 2011-2017
80.0
23.0
20.0 10.0
18.0 17.0
-0.0
16.0
R
•
The Indian hip joint replacement market is expected to grow at a CAGR of 20.7 percent from 2010 to 2017.
•
The hip replacement cases in India are low as compared to the knee replacement cases.
•
Uncemented hip replacements are growing at a faster rate when compared to cemented hips due to better results and shorter recovery time.
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24.0
CAGR (2010-2017): 20.7 %
) 70.0 n )o lil 60.0 n i o lilM i$ 50.0 ( M s $ (e 40.0 u e n u e 30.0 n v e ve R e
22.0 21.0 20.0 19.0
2008 2009 2010
2011 2012 2013
2014 2015 2016
) ) (% te(% ae t R a h tR w h o rtw G o er uG ne eu vn e e v R e R
2017
Year Year
Revenue ($ Million)
Revenue Grow th Rate (%)
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sullivan
78
Pro cedur e For ecasts •
•
•
•
Of the total 15,000 to 20,000 hip replacement procedures a in 2010, the type of uncemented implant constituted 49.0 percent and is expected to increase to 60.0 percent in 2017. The uncemented implants is gaining popularity and their share is expected to increase due to benefits like increased longevity, shorter operation time (there is no need to wait for bone cement to dry), and an easier revision process in the future. Cemented replacement is likely to experience a decline in usage from 44.0 percent in 2010 to 25.0 percent in 2017. However, it will still hold a substantial portion of the market, because cemented replacements are preferred over cementless ones for older, less active people and people with weak bones, such as those who have osteoporosis.
Hip Jo int Replacement Ma rket: Procedure Forecasts (Indi a), 2010 and 2017 s e r u d e c o r P t n e m e c la p e R p i H fo r e b m u N
6.4%
15.0%
47.6% 60.0%
46.0%
2010 Cemented Hip Repalcement
25.0%
2017 Uncemented Hip Replacement
Revision Hip Replacement
Note: All figures are roun ded; the base year is 2010. Source: Frost & Sullivan
Revision surgeries are expected to grow from 7.0 percent in 2010 to 15.0 percent in 2017, as most of the patients who underwent replacement surgery 10 to 15 years back will need revision surgery and same is the case in future.
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Market Share Analysis •
The Indian hip joint replacement market was Hip Joint Replacement M arket: Company Ma rket Share by Revenues (India), 2010 valued at $18.6 million in 2010.
•
DePuy led this market with a share of 50.3 percent in 2010, followed by Zimmer, Inc. with 18.7 percent.
Revenue - $18.6 Million
•
DePuy’s metal-on-metal hip implants, ASR, were recalled from the market last year due to their failure and several complaints from patients. This
5.3%
7.0% 3.5% 7.0%
50.3%
8.2%
affected the company’s share globally in the hip replacement market. •
18.7%
Stryker with a share of 8.2 percent was the third largest participant in this market in 2010.
Depuy
Zimmer
Stryker Exactech
Smith& Nephew BBraun
•
Smith & Nephew and B Braun both held 7.0 percent share each in that year.
Others
•
Exactech, Inc. which is not present in the cemented knee implant segment, held a market share of 3.5 percent in that year.
Note: Others include international and domestic companies such as Synthes GmbH, Biomet, Inc., Endolite India Limited, Anthrex, Inc., Indus Orthopedics, Inor Orthopedics and so on.
Note: All figures are roun ded; the base year is 2010. Source is Frost & Sullivan
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Recent M erg ers and Ac qui sit io ns
81
Mergers a nd Acqu isi tio ns DePuy Orthop edics’ Acquisi tion of Finsb ury Orthop edics •
In December 2009, DePuy Orthopedics acquired Finsbury Orthopedics, which is a manufacturer of orthopedic devices. With this acquisition, DePuy strengthened its position in the hip and knee joint replacement markets by gaining proprietary, advanced high-performance hip bearings, and products with the ceramic-on-ceramic and metal-on-metal bearing technologies.
Zimme r Acquire d Chine se Ortho pedic Impla nt Compa ny Beijing Monta gne Medica l Device Co., Ltd. •
In December 2010, Zimmer completed acquisition of Beijing Montagne Medical Device Co., Ltd. The acquisition will provide an expanded product line in hips, knees, and powered surgical instruments designed according to the Chinese market. This move is expected to provide Zimmer with an access to additional research, development, and manufacturing capabilities in China.
Zimm er Annou nce d Acqui sit ion of SoPlus Orth opa edic Surg ica l Powe r Tool s Comp any •
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In December 2010, Zimmer announced acquisition of Sodem Diffusion S.A., the manufacturer of SoPlus Orthopaedic Surgical Power Tools based in Geneva, Switzerland. The company will be renamed Zimmer Surgical, S.A., and will be a part of Zimmer Surgical, headquartered in Dover, Ohio. Adding SoPlus's innovative small and large bone product lines to Zimmer’s portfolio is expected to expand Zimmer’s offerings in the orthopedic power equipment market.
82
Mergers and A cqui siti ons (Contd …) Zim mer’s Acq ui si ti on of End iu s Inc . •
In early 2007, Zimmer acquired Endius Inc., which is a Massachusetts-based company and a leading developer of minimally invasive instrument kits and associated implants for spinal fusion. Endius Inc. is at present wholly owned by Zimmer. This acquisition has helped Zimmer to broaden its product line by incorporating the minimally invasive technology, which has increased the company’s revenues in the growing spine replacement markets.
Zimm er’s Acqui sit ion of ORTHOsof t Inc •
In November 2007, Zimmer acquired ORTHOsoft Inc, which is a developer of medical software, instruments, and computerized systems. This acquisition added the FDA-approved, patented navigation software solutions of ORTHOsoft Inc to Zimmer’s computer-assisted surgery (CAS) product line. CAS has gained popularity in India, and this acquisition has helped Zimmer to hold a stronger position in this segment.
Stry ker’s Acq uisit ion of OstiM ed •
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In November 2009, Stryker completed its acquisition of OstiMed, which is a CAS softwaremanufacturing company. These software help surgeons to achieve better alignment during replacements. This acquisition will allow Stryker to include CAS software in its product line as well as enhance its existing knee joint replacement product line. It is likely to enhance Stryker’s growth, as CAS is becoming popular in India. 83
Mergers and Ac quis iti ons (Cont d…) Exacte ch Annou nce s Acquisi tio n of Bri ghton Partn ers, Inc •
In May 2010, Exactech announced acquisition of Brighton Partners, Inc., the sole source supplier of the direct compression molded polyethylene bearings used exclusively in Exactech’s flagship product, the Optetrak® knee replacement system. Direct compression molded polyethylene bearings are a key component of Exactech’s knee replacement system. By this acquisition, Exactech aims to protect this proprietary technology, that represented more than $75.0 million of its total 2009 revenues.
Exactec h Acquire s VertiF lex, Inc •
In August 2010, Exactech announced acquisition of VertiFlex, Inc., a developer of minimally invasive and motion preserving spinal surgery technologies. With this acquisition Exactech aims to tap the spine industry with products implanted through a surgical approach designed to reduce the length of hospital stays and shorten overall patient rehabilitation time.
Exacte ch’ s acqu isi tion of Alti va Corp ora tio n •
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In January 2008, Exactech announced acquisition of Altiva Corporation Orthopedics Altiva, which offers a spinal fusion product line with implants and instrumentation that address major spinal pathologies. Altiva has multiple development projects underway, most notably a collaboration with a leading group of spinal surgeons focused on the rapidly emerging motion preservation market.
84
Mergers and Ac quis iti ons (Cont d…) Exacte ch Acquire s of France Medica SAS •
In April 2008, Exactech, Inc., announced the acquisition of the stock and assets of France Medica SAS, a French importer and distributor of orthopedic products and surgical supplies. This is expected to enable the establishment of a direct sales operation in France and strengthen its competitive position, improve service to its customers in France and to grow its European business.
Biom et’s Acq uisit ion of Cartili x •
In 2009, Biomet (which develops solutions for knee disorders) acquired Cartilix, which develops cartilage repair and regeneration solutions and products, including a proprietary cartilage regeneration technology for the repair of knee cartilage (yet to be launched). This acquisition allowed Biomet to increase its sports medicines portfolio.
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Recomm endations and Conclu sion
86
Recommendations Prod uct Diffe renti ation and Customiz ation
Companies should align their products to cater to the demand of different sections of the society (such as the very premium end, the mediocre and not so affordable class of population) as well as to a larger section of the population. With fierce competition in the market compelling participants to bring down the prices of implants, it can be difficult for the international companies to offer the products below a certain price to realise the bottom line. Reducing Manufacturing Costs
Products should be customized to meet the needs of Indian patients without compromising on the quality. All these factors may call for bringing down the cost of manufacturing an implant in order to realise the margin of profit. Therefore, with raw material cost being fixed, to reduce the overhead cost of manufacturing, some companies are in process and a few are planning to open manufacturing centres in countries such as China where labour cost is low.
Joint Venture Agreements
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Alternatively, another solution can be to seek joint venture agreements or acquisition of a local or indigenous manufacturer, who meets the ISO/GMP/international standards. The global leaders will require local market knowledge and distribution networks and will also be attracted by lower manufacturing costs. Reduced price of implants could increase the reach to various classes and sections of the population, thereby creating an opportunity for a wider customer base.
87
Recommendations (Contd…) Educa ting the Users •
A large section of the population is either unaware of the problem and seriousness of joint–related diseases or is reluctant to undergo joint replacement surgery due to fear of surgery and the post–surgery trauma.
•
There is a need to raise awareness of arthritis in all its forms among the medical community, arthritic patients, and the general public. Increasing the awareness about the disease and educating patients on the various treatment options available will significantly help in fighting this severe disabling disease as
•
well as will drive the orthopedic joint replacement market. Conferences and meetings should be held were people suffering or even not suffering from arthritis are invited to spread awareness/knowledge regarding arthritis, its prevention and management.
•
This is to ensure all people with arthritis and their caregivers are aware of the vast support network available to them.
•
Operated patients with joint replacement should be made to interact with those affected with arthritis.
•
This builds confidence and positive attitude toward the treatment process. This can help millions of patients who suffer acutely and lose hope of becoming well and enjoying life.
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Recommendations (Contd…) Trainin g Surgeon s •
About 800 – 850 orthopedic surgeons, who can perform replacement surgeries, serve the entire population of India. This is because there is less opportunity for orthopedic training in India; most surgeons go overseas to learn, and many of them do not return.
•
Surgeons need to be trained on the new products in the market. Most of the young and experienced surgeons should be trained through seminars and conferences arranged by a company; live telecast of a surgery and dry bone exercise could also be arranged.
•
The trainings should start right from the time the medical schools and should be a part off college curriculum. For post graduate students, special courses should be offered. Level of these trainings can vary at different orthopedic joint replacement centers.
•
Relationship with the surgeons forms a very important decision making criteria while purchasing an implant. These trainings allow a manufacturer to interact with surgeons and change their perception about a particular implant. Younger surgeons and post graduates should be awarded with special training.
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Recommendations (Contd…) Promo tion al Act ivit ies and Advertisi ng Channels •
Updating the surgeons on the latest advancements frequently on the new technologies through advertising channels such as journals, conferences, seminars, Webinars, medical newsletters, portals, and so on, is necessary. This will help the companies to strengthen the relationship with the surgeons who are one of the most important decision makers while purchasing an implant.
•
Conferences or seminars may allow a platform for surgeons to get their queries clarified such as success rate, results, previous references, and so on. These activities may also help a company to change a
surgeon’s preference for a particular implant. Stron g distr ibut ion Network •
An implant is usually chosen by a surgeon according to the surgeon’s comfort, the requirement of a surgery, and cost of the device.
•
Hospitals and surgeons prefer to buy implants from distributors. This provides them the advantage of having to pay only for the used component. Distribution networks in India are extremely dense, layered, and difficult to penetrate without connections and experience. Therefore, finding the right partner is essential, and lack of due diligence can significantly affect the distribution process.
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Conclusion •
The total market for orthopedic joint replacement market in India was valued at $80.4 million. Of this, over 75 percent contribution was from knee replacement market, about 20 to 25 percent was from hip replacement market and less than 5 percent of the total market revenues were contributed by shoulder and ankle replacement market.
•
For the manufacturers of orthopedic implants, the Budget 2010-11 has proposed an exemption of specified inputs for the manufacture of implants from import duty. These incentives will drive the already fastemerging medical devices and equipment sector in India.
•
India has one of the fastest growing medical devices market. In the coming years, healthcare may be the largest user of technology and also the largest employer. The growth rate of the orthopedic implants is estimated to be over 25 percent per annum at least for the next five to six years.
•
Growth of the Indian joint replacement market is likely to be driven by a combination of factors such as increasing affordability of the middle class population with substantial disposable income, spreading word of mouth on successful joint replacements, and opening up of the insurance sector, among others.
•
Currently, over 70,000 hip and knee replacements are performed every year. A significant percent of the Indian population is either suffering from or susceptible to orthopedic joint ailments, requiring replacement surgeries. With a large potential population requiring joint replacement and increase in awareness about the impact of joint problems on the lives of patients and the importance of a surgical treatment approach to cure it, the market for orthopedic implants is likely to become one of the most profitable segments in the Indian medical device market.
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Comp any Pro fi les
92
Leading Companies in the T otal India n Ortho pedic Joi nt Repl acement Mark et •
•
•
The total Indian orthopedic joint replacement market is growing at a high rate and has a number of participants that provide a variety of products. However, it is dominated by international participants. Some of the active international participants include Zimmer, Inc., Stryker, DePuy Companies (Johnson & Johnson), Smith & Nephew, Exactech, Inc., B. Braun and Maxx Orthopaedics. These are wellestablished companies with a wide range of products, and they account for a major share of the market revenues. Some local implant manufacturers such as Indus and Inor are also well-known companies that have a prominent presence in the total Indian orthopedic joint replacement market. Many other companies export implants to small-scale prosthesis manufacturers of unknown quality as well.
•
•
Indian surgeons prefer imported prosthesis over the ones manufactured in India. About 95 percent of the joint replacement implants used by Indian surgeons are imported, because of their superior quality and instrumentation. In comparison to international countries, Indian manufacturers use semi-Computed numerically controlled (CNC) based machinery, which means that certain manufacturing procedures are operated manually, while others are automated.
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DePuy Medic al Pty. Lt d (Johns on & Jo hns on) Web si te - http://www.depuy.com/ Headquarters - DePuy Orthopedic s, Inc. 70 0, Orthopedic Drive, W arsaw, I N 46582 Local Hea dquarters - DePuy In dia, DePuy Medical Pri vate Li mit ed, 30 Forj ett Street, Mumb ai 400 036,
Tel: + 91 22 2386 1431 •
Established in 1895 as DePuy and later acquired by Johnson & Johnson in 1998, DePuy Orthopedics was the first commercial orthopedics company to enter the Indian market. The company conducts business virtually in all countries across the world through its dense network of dealers.
•
DePuy imports orthopedic products from Europe and the United States for the Indian market. In India, it offers products such as innovative orthopedic implants for hip, knee, and shoulder joint replacement.
•
DePuy offers a number of products for hip and knee joint replacement, including total knee and hip joint replacement systems, CAS products, cemented and uncemented hip systems, partial knee joint replacement systems, and revision hip and knee systems.
•
The recent product launches further extend its product line in the hip joint replacement, knee joint replacement, and navigation system segments. These products are likely to drive the company’s growth in the Indian market, as they have novel technologies.
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Zimmer India P vt Lt d. Web si te - http: //ww w.zimmerindia.com/z/ ctl/op/glo bal/action/1/id/9 016/template/ CP Headquarters - P.O. Box 708 , 1800 West Cente r Stre et, Warsa w, IN 46581-0708 , Tel: +1-800-613-6131 Loca l headqua rters - Vanij ya Niku nj, 7th Floo r, Enk ayTowe rs, Udyog Viha r, Phase V, Gurg aon,
Haryana – 122 016, INDIA. •
Founded in 1927, Zimmer Holdings, Inc. (Zimmer) designs, develops, manufactures, and markets reconstructive orthopedic implants, including joint and dental, spinal implants, trauma products, and related orthopedic surgical products. It operates in more than 25 countries around the world and sells products in more than 100 countries.
•
By the company's estimates in 2007, it was the leader in the global hip and knee joint replacement markets with revenue shares of 26 percent ($1.30 billion) and 28 percent ($1.60 billion), respectively.
•
In 2009, Zimmer’s global sales were $4.10 billion; its revenues in the Asia Pacific knee and hip joint replacement markets were $230.0 million and $214.0 million, respectively. In 2010, the company expects its revenues to increase by 3 to 5 percent globally.
•
Zimmer’s product line includes total knee and hip joint replacement systems, cemented and uncemented hip systems, and revision knee and hip systems.
•
The company recently launched gender-specific implants systems, which are likely to gain high popularity in the Indian market.
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Stryk er India P vt Ltd . Web sit e - http://www.stryker.com/en-us/index.htm Headquarters - 2825, Airv iew Boul evard, Kalamaz oo, MI 49002, The United States. Local Headquarters - Stryker India, Vatika Towers, Bloc k A, 1st Floor, Golf C our se Road, Sector 54,
Gurgaon •
Established in 1941, Stryker is the 12th-largest medical technology company in the world. The company's products include implants used in the joint replacement, trauma, craniomaxillofacial, and spinal surgeries, surgical, neurologic, ear, nose, and throat, and interventional pain equipment, endoscopic, surgical navigation, communications, and digital imaging systems. It is known for a variety of innovative, highquality products and services.
•
Stryker is active in the hip as well as knee joint replacement segments.
•
The company’s global revenues were $6,723.0 million, and its orthopedic products yielded approximately $3,570.0 million, in 2006.
•
According to the company’s reports, its orthopedic implants sales reported 15.0 percent growth in 2007. The sales of hip and knee implants grew by 9 and 16 percent, respectively.
•
Stryker’s product line includes total knee and hip joint replacement systems, cemented hip systems, and revision knee and hip joint replacement systems.
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Smi th & Nephew Web sit e - http://global.smith-nephew.com/master/india_19530.htm Headquarters
-
Smith
&
Nephew
Surgical,
19-25
Khartoum
Rd,
North
Ryde
NSW
2113
Tel: +61 2 9857 3999 Loc al Headquarters - Smi th & Nephew Healt hcare Pvt. Lt d, B-203, Dynasty Bus iness Park, J. B. Nagar, An dheri Ku rl a Road, Andh eri East , Mumbai - 400 059, Tel: + 91 22 2386 1431 •
For over 150 years, Smith & Nephew has been developing advanced medical devices for healthcare professionals around the world. The company operates in 32 countries and offers a wide range of orthopedic joint reconstruction services. It manufactures products in three global business units to cater to the orthopedics sector – reconstruction, trauma, and clinical therapies.
•
In 2009, the company generated a profit of $503.0 million in the global orthopedics sector and witnessed a growth rate of 2 percent. The revenues generated from the hip and knee joint reconstruction segments were $176.0 million and $158.0 million, respectively. The knee and shoulder repair products sales grew by 12.0 percent.
•
Smith & Nephew is active in the hip and knee joint replacement segments, and it offers products for total hip and knee joint replacement, partial hip joint replacement, and revision knee joint replacement.
•
The recent launches of the next generation of existing products are likely to drive Smith & Nephew's growth in the Indian market.
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About Frost & Sullivan
98
Who is Fros t & Sulli van The Growth Cons ulti ng Comp any Founded in 1961, Frost & Sullivan has over 45 years of assisting clients with their decisionmaking and growth issues Over 1,700 Growth Consultants and Industry Analysts across 32 global locations Over 10,000 clients worldwide –emerging companies, the global 1000 and the investment community Developers of the Growt h Exce lle nce Matrix – industry leading growth positioning tool for corporate executives Developers of T.E.A.M. Methodology , proprietary process to ensure that clients receive a 360o perspective of technology, markets and growth opportunities Three core services: Gro wth Partn ersh ip Servi ces, Gro wth Cons ult ing and Career Best Practices
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What Makes Us Uniq ue •
Exclus ive ly Focus ed on Growth
•
TM
Global thought leader exclusively focused on addressing client growth strategies and plans – Team actively engaged in researching and developing of growth models that enable clients to achieve aggressive growth objectives. •
Ind ustry Bre adt h Cover the broad spectrum of industries and technologies to provide clients with the ability to look outside the box and discover new and innovative ideas.
•
Glo bal Perspect ive 32 global offices ensure that clients receive a global coverage/perspective based on regional expertise.
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360o Perspective Proprietary T.E.A.M. Methodology integrates all 6 critical research methodologies to significantly enhance the accuracy of decision making and lower the risk of implementing growth strategies.
•
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T.E.A.M. Metho do lo gy •
Frost & Sullivan’s proprietary T.E.A.M. methodology , ensures that clients have complete “360 Degree Perspective” from which to drive decision-making. Technical, Econometric, Application, and Market information ensures that clients have a comprehensive view of industries, markets and technology. Technical
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