Unbundled: How the Top 10’s Great Reshaping is Remaking Orthopedics

During his State of the Industry presentation at the ODT Forum this past spring, Dave Sheppard provided attendees with a bullish outlook on the orthopedic industry. His perspective stemmed not from the industry’s past but rather from the transformation currently reshaping it.

That transformation is clearly evident in this year’s Top 10 Companies report, an analysis we always read closely for the insight it provides into the choices these organizations make as well as their impact on downstream players—the OEM suppliers, contract manufacturers, and emerging device makers. In 2026, the most consequential story in the Top 10 is not a new implant or a faster robot; it is structural. After two decades in which orthopedics was folded into ever-larger diversified medtech, the direction has reversed. The category is being unbundled—set free from its conglomerate parents, rolled up around its fastest-growing niches, and increasingly defined by the kind of enabling technology a company owns. For anyone who designs, builds, or supplies orthopedic products, understanding this reshaping is no longer optional.

Orthopedics, Set Free

The biggest development among the Top 10 can be found within the second-place company’s report. Last fall, Johnson & Johnson announced its intent to separate DePuy Synthes—its $9-billion-plus orthopedics business—into a standalone company, effectively unwinding the $21.3 billion Synthes acquisition that once was medtech’s largest deal. By early 2026, the separation had gone dual-track: J&J is preparing a spinoff while also exploring an outright sale reported at more than $20 billion, with large buyout firms circling. One J&J executive summed up the logic bluntly, noting the move is “all about shrinking to grow faster.” In other words, orthopedics—within the confines of a large medtech conglomerate—grows too slowly to keep pace with the cardiovascular and surgical robotics ambitions of a conglomerate like J&J. However, it can be argued that orthopedics at DPS will grow very well when it’s set free to make its own decisions and not constrained by J&J’s “let’s take a year to think about it” corporate mentality.

DePuy Synthes is not alone, though. Smith+Nephew (ranked No. 4) is under sustained pressure from activist investor Cevian Capital—now its largest shareholder with a 14.01% stake (crossing that threshold in July)—to either fix or spin off the very orthopedics franchise that anchors its business. CEO Deepak Nath’s turnaround plan is squarely aimed at regaining hip and knee share, but the market has openly floated a break-up. The message from the top of the list is unmistakable: The conglomerate era is ending, and pure-play orthopedics is coming back into fashion. Let’s pause on that thought for a moment of applause!

The Roll-Up of the High-Growth Edges

If the giants are shedding orthopedics, a second tier is aggressively consolidating it—but selectively, around the segments still growing well above the market. Biologics, foot and ankle, extremities, and sports medicine are areas in which the capital is flowing.

Zimmer Biomet (No. 3) closed its ~$1.2 billion acquisition of Paragon 28 in April 2025, buying instant credibility in the ~$5 billion foot-and-ankle market that is growing 7% to 8% annually. Enovis (No. 8)—the former DJO, now a pure-play orthopedics company—vaulted into the top tier of the extremity market through its LimaCorporate deal, one of more than 20 acquisitions since 2019. Globus Medical (No. 7) transformed itself from a spine specialist into a diversified musculoskeletal power through its ~$3.1 billion merger with NuVasive Inc., then pushed into neuromodulation with the roughly $250 million purchase of Nevro. Even Embla Medical (No. 9)—the rebranded Össur—rounded out its orthotics-and-prosthetics portfolio with a majority stake in Streifeneder, a prosthetics manufacturer.

The most surprising buyer may be Arthrex (No. 6). Fiercely private and famous for growing through internal innovation and surgeon education rather than M&A, the sports-medicine pioneer agreed in early 2026 to acquire U.K.-based Corin for approximately $330 million, vaulting it into total joints and robotic-assisted reconstruction overnight. For a company that “never buys,” that is a signal worth reading.

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The Enabling-Technology Arms Race

Running beneath the deal-making is the real dividing line of modern orthopedics: enabling technology, and above all, robotics. The Top 10 increasingly compete less on the implant than on the ecosystem that places it.

Stryker (No. 1) still sets the pace, extending its market-defining Mako platform from knees and hips into shoulder and spine while pressing its installed-base advantage. Medtronic’s Cranial & Spinal Technologies (No. 5) counters in spine with the deepest stack in the business—its AiBLE ecosystem tying together Mazor robotics, StealthStation navigation, O-arm imaging, and UNiD planning to pull through implants. Globus fields its Excelsius ecosystem, including a new knee robot; Zimmer Biomet runs ROSA and has partnered with Monogram Technologies on a path toward the first fully autonomous orthopedic robot; Smith+Nephew has its handheld CORI; and the newly independent DePuy Synthes will have to prove its lagging VELYS platform can keep up. The question for the decade is no longer whether a company has a robot, but whether that robot pulls through enough implants—and enough recurring revenue—to justify the investment.

What It Means for the Industry

For the orthopedic ecosystem, this reshaping changes the ground rules in three ways.

First, every carve-out becomes a new competitor and a new customer. A standalone DePuy Synthes, freed from J&J’s balance sheet but also stripped of its deep pockets, will have to make its own decisions about suppliers, sourcing, and technology partnerships. Newly independent orthopedics companies, several backed by private capital, tend to be hungrier and faster-moving buyers than the divisions they replaced.

Second, capital and premium valuations are migrating toward the declared growth lanes—foot and ankle, extremities, biologics, sports medicine, and, above all, enabling technology. When the largest players publicly concentrate on robotics and high-growth niches, they are signaling exactly where strategic demand—and the richest multiples—are heading. Suppliers and OEMs (think Integer, Viant, Exalta, Ametek, Tecomet, and their peers) that can serve those priorities will find themselves increasingly valuable.

Third, the buyer universe is widening. With the strategics reshaping and, in some cases, stepping back from orthopedics entirely, private equity has moved in as a fast follower—evident in the roll-ups at Enovis, the sponsors circling DePuy Synthes, and the activist pressure at Smith+Nephew. And Viscogliosi Brothers LLC’s acquisition of Stryker’s spine portfolio is the ultimate example of this PE transformation as part of the go-forward industry. For an emerging orthopedic company weighing its future, the most likely partner may no longer be the incumbent it once assumed.

The Bottom Line

The 2026 Top 10 Companies list is less a ranking than a map of an industry transforming itself in public. The biggest names are being unbundled from their conglomerate parents; a hungry second tier is rolling up the fastest-growing niches; and enabling technology is quietly deciding who leads. For the designers, engineers, manufacturers, and suppliers that make orthopedics work, the reshaping at the top is not distant corporate news—it is a direct signal about where the industry, and their own opportunities, are heading next. The OEM supplier companies that read the map early will be the ones best positioned when the next wave of consolidation and divestitures arrive. There will be opportunities for all those who stay poised and ready to capitalize on this fundamental shift.

More from these authors: The Ongoing Transformation of the Orthopedic Industry

Florence Joffroy-Black, CM&AA, is a longtime marketing and M&A expert with significant experience in the medical technology industry, including working for multi-national corporations based in the United States, Germany, and Israel. She is currently CEO at MedWorld Advisors and can be reached at [email protected].

Dave Sheppard, CM&AA, is a former medical technology Fortune 500 executive and is now focused on M&A as a managing partner at MedWorld Advisors. He can be reached at [email protected].