Zimmer Biomet

Zimmer Biomet makes knees, hips, sports-medicine devices, and the ROSA robotic system used to prepare bone for its own implants. The spine and dental business was spun into ZimVie, so the remaining company is centered on reconstruction.

Stryker's Mako is the robotic system most often cited against ROSA, and Johnson & Johnson's DePuy Synthes and Smith & Nephew bid the same implant contracts. Surgeon preference and the instrument trays parked at a hospital decide which company's box is opened.

Orthopedic distributors still employ reps who stand in the operating room, a selling model that ties a surgeon to a tray system. Bundled payment for joint replacement pushes hospitals to narrow vendors, which is when a ROSA placement either sticks or gets displaced by Mako.

ROSA placements are intended to anchor Zimmer knee and hip volume at that hospital.

Instrument trays and loaner sets are a logistics moat that a new vendor has to duplicate.

GPO and bundled-payment contracts can override a single surgeon's preference if the hospital consolidates brands.

Surgeons notice a vendor change as a different set of instruments and a different rep in the room.

Patients receive whichever implant the hospital and surgeon have already standardized.