* based on 2011 full year financials
** private companies such as Globus Medical that do not report financials are omitted

1. Stryker ($8.3 billion). Stryker’s net sales were up 13.5 percent in 2011 over 2010. United States sales rose 9.9 percent in 2011 to $5.2 billion, with international sales up 20.2 percent to reach $8.3 billion all together. Spine sales showed 48.5 percent growth in 2011, to $1.4 billion, while neurotechnology jumped 134.4 percent to $750 million. Hip sales were up 6.4 percent while knee sales remained flat. During the first half of 2011, Stryker acquired Orthovita and received FDA clearance for its MDM X2 Modular Dual Mobility Mobile Bearing Hip System. The company announced it would close two locations of its subsidiary, Gaymar Industries, during the fourth quarter. In early 2012, Stryker President and CEO Stephen MacMillan announced he would step down from his post for family reasons.
2. DePuy Orthopaedics ($5.8 billion). Johnson & Johnson subsidiary DePuy Orthopaedics reported $5.8 billion in 2011, a 4 percent increase over 2010. The company’s United States sales dropped 1.7 percent to $3 billion, but the company offset U.S. sales with a reported 11.3 percent international sales increase. In 2011, Johnson & Johnson spent $521 million on the DePuy ASR Hip recall program, up from $280 million in 2010. The company launched six new devices recently at the American Academy ofOrthopaedic Surgeons annual meeting in 2012.
3. Zimmer Holdings ($4.45 billion). In 2011, Zimmer’s net sales grew 5.5 percent over 2010. The company attributes its success to above-market performance in European, Middle Eastern, African and Asian Pacific markets. The American market remained flat, with reported net sales at $620 million. In the fourth quarter, the company completed the ExtraOrtho acquisition. It’s kneebusiness saw a 2 percent increase in net sales overall, but in the American market net sales declined by 4 percent. Hip sales were up 7 percent worldwide while spine sales dropped 4 percent to only $225 million. During 2011, the company received FDA clearance on several devices and introduced the new CLS Brevius Hip Stem with Kinectiv Technology to the United States in December. The company acquired XtraFix External Fixation systems in November and presented the results of clinical trials at national orthopedics meetings.
4. Smith & Nephew ($4.2 billion). Smith & Nephew’s revenue was up 8 percent in 2011 over 2010. Smith & Nephew’s CEO Dave Illingworth announced his retirement early in the year and was succeeded by Oliver Bohuon. The company’s orthopedicsbusiness rose 2 percent to $2.1 billion. Fourth quarter revenues were flat in the United States and dropped by 7 percent in Europe after the company decided to take back management of some supply lines in Spain, but these results were offset by 10 percent growth in the rest of the world. The company’s sports medicinebusiness grew 7 percent in 2011 while orthopedic trauma sales were up 3 percent. Smith & Nephew introduced several new devices to the market in 2011, including the VERSAJET II for advanced wound care.
5. Synthes ($3.9 billion). Synthes revenue jumped 7.8 percent in 2011 to $3.9 billion, growth that comes on the heels of Johnson & Johnson’s intended acquisition, which was announced in early 2011. The acquisition is expected to become final sometime in 2012. In the mean time, Synthes reported $2.2 billion in North American sales and $942 million in Europe for the full year. The company had success with its trauma line, but the spine markethas proven more challenging. In 2011, Synthes reported its first quarterly revenue topping $1 billion and has continued to report growing profits after announcing the J&J acquisition. The company has received FDA clearance for several devices over the past year and partnered with Cranio-Maxillofacial Surgery to develop and distribute the company’s products.
6. Medtronic Spine ($3.4 billion). Medtronic’s spine businessreported $3.4 billion in 2011, with overall revenue for the company exceeding $16.4 billion. In addition to spine and biologics, Medtronic’s business lines include cardiac and vascular products, neuromodulation, surgical technologies and diabetes. One of the company’s most profitable spine devices, it’s recombinant bone morphogenic protein product Infuse, experienced a significant decrease in sales during the second half of 2011 after the product came under scrutiny for potentially having a higher complication rate than was initially reported. During the third quarter of fiscal year 2012, the company reported a 20 percent drop in biologics revenue, driven by lower U.S. sales of Infuse. However, the overall revenue experienced a 2 percent third quarter increase.
7. Biomet ($2.8 billion). During 2011, Biomet reported $2.8 billion in net sales. During the second quarter of fiscal year 2012, the company reported a 4 percent increase in net sales, but spine sales were down 5 percent worldwide. The company celebrated the 35th anniversary of its Oxford Partial Knee replacement and launched the Signature Personalized System for the Oxford Partial Knee. The company received FDA clearance for the Active Articulation E1 Dual Mobility Hip System and worked with OMeGA Collaborative to support graduate medical education.
8. DJO Global ($1 billion). DJO Global reported net sales of $1 billion for the first time in the company’s history, which represents a $35 million increase over net sales in 2010. In 2011, the company launched the Exos range of upper extremities products and Reaction knee brace. Over the past year, Gary Fischetti was appointed company group chairman for the DePuy Family of Companies and Andrew Eckdahl was named the company’s new president during the first half of the year. The company acquired several businesses over the past year, including Elastic Therapies and Circle City, which contributed to the sales growth. During the fourth quarter, the company reported a slight increase in surgical implant sales.
9. Orthofix ($579 million). Orthofix reported approximately $14 million more in 2011 than in 2010. During the fourth quarter, the company experienced a 5 percent increase in net sales, leading its CEO Robert Vaters to dub the year “transitional” for the company, which is now poised for long term revenue growth across the regenerative and repair platforms. The company reported flat spine sakes during the fourth quarter, but orthopedics and sports medicine grew by 16 and 11 percent, respectively. These increases were led by sales of Orthofix’s external fixation products and growth in the international market. The company also promoted Bryan McMillan as president of its Spine GroupBusiness Unit.
10. NuVasive ($520.5 million). Full year revenues for NuVasive were up in 2011 by 13 percent. The company attributes its success to a “market-share taking strategy,” which drove an increase in revenue despite a challenging spine market. In the fourth quarter, the company saw a 16.2 percent increase in net sales over the same period in 2010. The company pioneers a minimally invasive lateral access spinal surgery system, and feels poised to gain market share as minimally invasive technology becomes more prominent over the next few years. The company acquired Impulse Monitoring to increase its NeuroVision use and tangoed with Medtronic over alleged patent infringement lawsuits last year.
11. Wright Medical Group ($512.9 million). Wright Medical Group’s net sales were slightly lower in 2011 than in 2010, when the company reported $518.9 million. Domestic sales dropped by 4.5 percent in 2011, which drove the 1.2 percent overall decrease in sales. International sales increased by 3.8 percent, but wasn’t enough to offset poor U.S. sales. The company’s extremities product sales grew by 8 percent, while its hip, knee and biologics product sales fell by 2 percent, 3.8 percent and 12.4 percent, respectively. The company will focus on its foot and anklebusiness over the next year, but still expects 2012 sales to fall below the 2011 numbers.
12. ArthroCare ($345.9 million). ArthroCare’s revenues dropped from $355.4 million in 2010 to $345.9 million in 2011. For the full year, the company’s sports medicine sales declined to $228.3 million in 2011 from $231.9 million in 2010, and represented 68.5 percent of net product sales. Total product sales in the international market were up by $10 million to $104.7 million in 2011, while sales in the Americas dropped by $10 million to $233.6 million. Spine sales were also down for the company. The company received FDA clearance for multiple devices in 2011, including the SpeedLock Knotless Fixation Device, and penned a supply and distribution agreement with Wright Medical Group to distribute its line of tissue fixation devices. ArthroCare sold its Parallax and Contour products to NeuroTherm in July 2011.
13. Exactech ($205.4 million). The company experienced an 8 percent sales increase in 2011 over 2010. Full year knee implant revenue saw a 5 percent increase to $80.1 million while the hip implant revenues increased by 17 percent to $33.7 million. However, the largest business line growth was in the extremities business, which increased by 33 percent to $39.9 million. Exactech’s successes in these markets off-set a 13 percent drop in the biologic and spine segment during 2011. Despite the annual increase, the company’s fourth quarter revenues only rose by 2.5 percent and the spine and biologics revenue dropped by 21 percent. The company launched its Gibralt Spinal System in December and received FDA clearance on several devices throughout the year.
14. Alphatec Spine ($197.7 million). The company reported an increase in total revenue from 2010, when their revenue reached $171.6 million. Domestically, the company reported $133.8 million in revenue, an 11.6 percent increase. However, international growth was much higher, at 23.5 percent over 2010 revenue. The company introduced three new products during the fourth quarter at the North American Spine Society annual meeting, but still only saw a 2 percent increase in U.S. sales over the fourth quarter of 2010. Over the next year, the company will focus on streamlining and strengthening its operating fundamentals. In 2011, the company responded to an FDA letter on its PureGen product for spinal fusions and elected former DJO Global leader Leslie Cross as non-executive chairman of its board of directors.
15. MAKO Surgical ($84.5 million). Full year revenue in 2011 experienced a 91 percent increase over 2010. In the fourth quarter alone, the company’s revenue grew by 122 percent to $32.9 million, due in part to the addition of the MAKOplasty total hip arthroplasty applications during the second half of 2011. The company reported its THA application accounted for 44 percent of the domestic commercial installed base in 2011. There were 6,932 MAKOplasty procedures performed in 2011, a 99 percent increase over 2010. The company reported selling eight RIO systems during the fourth quarter, bringing the number of systems installed around the world to 133. In March 2011 the company signed a distribution agreement with Corin Group to use the Metafix Hip System and Trinity Acetabular Shell System with MAKO’s RIO Robotic Arm Interactive Orthopedic System.