All About Reverse Shoulder Devices: Analyzing the Factors Driving Their Popularity

The global market for small bone and joint orthopedic devices was valued at approximately $4.6 billion in 2022 and is projected to grow at a CAGR of 6.7% to reach nearly $7.3 billion by 2029.
 
The global market includes shoulder reconstruction and fixation devices, elbow repair devices, hand and wrist devices and foot and ankle devices. The market is segmented by anatomy, and each anatomy is specifically segmented further by implant types, particularly from total joint reconstruction to internal fixation and bone fusion.
 
The shoulder reconstruction market was the largest segment of the global small bone and joint orthopedic device market representing almost half of the global small joint orthopedic market.
 
Globally, the reverse shoulder replacement is the largest market segment within the shoulder market in terms of procedure and market value in 2022. The main driver for this type of procedure is that it can effectively relieve chronic shoulder pain and improve range of motion, and it is indicated for fractures and arthritis with positive surgical outcomes. Reverse shoulder arthroplasty has been increasingly utilized since its introduction over 30 years ago. Studies conducted in the last 10 years, showed greater improvements in the range of motion of patients. A majority of patients return to work after reverse shoulder arthroplasty at an average of two months postoperatively.

Reverse Procedures Globally

In the global market, reverse shoulder arthroplasty is by far the largest segment within shoulder arthroplasty in 2022.
 
This surgery was originally designed in the 1980s in Europe. The Food and Drug Administration (FDA) approved its use in the U.S. in 2003. In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm. It essentially re-creates the function of the torn rotator cuff. Rotator cuff tears and arthritis weaken the shoulder joint causing pain, loss of motion, and instability. With reverse shoulder replacement, the joint is strengthened and stabilized.
 
The ability to perform the reverse arthroplasty surgery in a variety of cases from fractures, arthritis, and massive rotator cuff tear, has driven the increase of their usage. In 2022, the majority of reversed shoulder procedures flowed from the shift from anatomic (total and hemi) implants towards reverse shoulder implants. Due to the fact that the entire rotator cuff is torn off in a fracture, reverse shoulder implants have been particularly recommended by surgeons as a more suitable solution for this injury, rather than hemi implants. Reverse shoulder implants have been increasingly used by surgeons in trauma cases. The success of the procedures performed in patients 70 years or older has led some surgeons to expand the procedure to younger patients.
 
Even though reverse shoulder replacement is a relatively new procedure, it has shown promising results so far. Some recent studies on reverse shoulder arthroplasty revealed that the reverse shoulder results in functional improvement with a low complication rate. Also, more literature reports showed an improvement in short-term pain and function scores following modern reverse shoulder arthroplasty in patients with cuff tear arthropathy. The success rate is defined as the percentage of patients who could return to their daily activities and play some sports within the first five months post-surgery.
 
There has been a rapid rise in the number of reverse shoulder devices being implanted, particularly high in North America and Western and Central Europe. Surgeons are switching from using partial shoulder implants to using reverse shoulder implants. This is due to the fact that hemi-arthroplasty implants tend to lead to deterioration of the glenoid, which causes more pain and limits motion. Due to the premium price of reverse shoulder implants compared to partial shoulder implants, the increasing popularity of reverse shoulder arthroplasty is driving overall market growth. The reverse shoulder implant market is expected to continue to grow because of its fundamental advantages over traditional shoulder implants for those with rotator cuff atrophy.

Main Players in the Reverse Shoulder Market

In the reverse shoulder market, DePuy Synthes leads the market, followed by Zimmer Biomet and Stryker.
 
DePuy competes in the reverse shoulder market with its DELTA XTEND Reverse Shoulder System. DePuy Synthes launched the GLOBAL UNITE Reverse Fracture Shoulder and the TRUMATCH Personalized Solutions Shoulder in 2018, continuing the expansion of its shoulder portfolio.
 
Zimmer Biomet extended its portfolio in 2018 with the augmented baseplate for its Comprehensive Reverse Shoulder System.
 
In November 2020, Stryker announced that it had completed the acquisition of Wright Medical Group to complement Stryker’s portfolio in trauma, lower and upper extremities surgical products for an aggregate purchase price of $4.1 billion. Stryker competes in the reverse shoulder market with the following products: Tornier Perform – Reversed Glenoid & Reversed Augmented Glenoid, Aequalis Reversed II, and Tornier BIO-RSA.
 
Other popular devices are SMR Reverse by Lima Corporate and AltiVate Reverse by Enovis.
 
SMR Reverse by Lima Corporate which is designed to support any kind of shoulder arthroplasty and was awarded with a 10A ODEP rating.
 
AltiVate Reverse supports four different stem length options (48 mm, 108 mm, 175 mm, and 220 mm) and two different shell sizes (36 mm and 42 mm).

Closing Thoughts

Reverse shoulder procedures are increasing in popularity for different reasons. The main driver for this type of procedure is that it can effectively relieve chronic shoulder pain and improve range of motion, and it is it is indicated for fractures and arthritis with positive surgical outcomes. Surgeons are switching from using partial shoulder implants to using reversed shoulder implants. This is due to the fact that hemi-arthroplasty implants tend to lead to deterioration of the glenoid, which causes more pain and limits motion.
 
The second driver is the ASP of reverse shoulder implants. Due to the premium price of reversed shoulder implants compared to partial shoulder implants, the increasing popularity of reversed shoulder arthroplasty is driving overall market growth globally.
 

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Federica Cogoni is a research analyst at iData Research. She develops and composes syndicated research projects about medical device industry, publishing the 2023 edition of the European Union Small Joints and Bone Reconstruction report, and the 2023 Global Small Joints and Bone Reconstruction report.
 
Kamran Zamanian, Ph.D., is CEO and founding partner of iData Research. He has spent over 20 years working in the market research industry with a dedication to the study of medical devices used in the health of patients all over the globe.