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Reverse shoulder arthroplasty represents about 70% of the total shoulder replacement volume, according to Rob Ball, Shoulder Innovations’ CEO. He said the global market is valued at just over $3 billion and reported to be growing at least 8% annually. In the U.S., he added, reverse shoulder arthroplasty is about a $1 billion market opportunity.
Shoulder Innovations, which makes advanced implant systems and planning software for shoulder arthroplasty, generated $31.6 million in 2024 with gross margins of nearly 80%. In July, the company filed with the SEC to raise up to $100 million in an initial public offering and closed a $40 million convertible notes financing by Fidelity Management & Research Company. The additional funding will support the company’s systems for anatomic and reverse total shoulder arthroplasty.
“We’re focused exclusively on the U.S. market,” Ball said. “With roughly a 2% market share in such a high-growth, high-margin space, the U.S. offers plenty of opportunity before we consider expanding internationally.”
Fighting for Market Share
Ball said Shoulder Innovations’ portfolio covers about 85% of shoulder arthroplasty procedures. The InSet Reverse Shoulder Arthroplasty System is at the core of the company’s shoulder replacement offerings and was developed to address loosening of the glenoid component on the scapular side.
The system minimizes stress at the bone/implant interface to optimize fixation mechanics, increase joint stability and limit micromotion and integrates with the company’s ProVoyance Shoulder AI-enabled preoperative planning solution.
According to Ball, the drivers of growth in shoulder arthroplasty mirror those in other joint replacement markets: an aging population with higher expectations for activity and quality of life. But additional factors stand out for him.
“Enabling technologies are reshaping decision-making in shoulder procedures,” he said. “Nearly 90% of Inset platforms that are implanted are preoperatively planned with our software, which directly influences implant choice, sizing and positioning.”
Ball also highlighted the accelerating transition of shoulder replacements to ASCs, a growing movement fueled by CMS authorizing reimbursement for the procedures in that setting as of January 1, 2024. He said the InSet portfolio was designed from the start to meet the needs of customers in the outpatient setting.
“Our goal was to equip operating rooms with just two trays of instruments for the entire product line, and we’ve succeeded,” he said. “Streamlined instrumentation has been a major advantage as shoulder arthroplasties increasingly shift to ASCs, where efficiency and cost-effectiveness are critical.”
Shoulder arthroplasty still lags behind other total joint replacements in long-term outcomes. Ball said knees and hips typically show implant survivorship in the mid- to high-90% range, but shoulders remain in the mid- to high-80% range. “The gap highlights significant opportunities for innovation because surgeons want solutions that address persistent clinical challenges,” he said.
Ball said that Stryker, Zimmer Biomet, Arthrex and Enovis represent about 75% of the shoulder arthroplasty market share.
“We’re often asked how we plan to compete in a market dominated by four major players,” Ball said. “The answer lies in what surgeons are considering. With new insights into the shoulder’s biomechanics and the ongoing market transition, many are rethinking which implants they choose.”
Looking ahead, Ball sees several important initiatives underway that should push Shoulder Innovations’ margins into the low-80% range. “With a strong syndicate and fresh capital, we’re well positioned to continue driving growth well above the market average,” he said.
Reputation for Success
When Enovis acquired LimaCorporate in January 2024, the company leveraged Lima’s salesforce in the shoulder replacement space to build on its strength in the market. The added scale created momentum for Enovis in markets outside the U.S., according to Louie Vogt, Group President of the Reconstructive Business Group for Enovis.
Vogt said Enovis spent 2024 integrating the two companies by aligning back-end systems, training sales teams and building an effective sales channel footprint. This year, the company has executed growth strategies by capitalizing on cross-selling opportunities and expanding the reach of the company’s portfolio.
“The inlay reverse total shoulder has dramatically reshaped arthroplasty trends with the market shifting away from anatomic and toward reverse,” Vogt said. “Being the original inlay shoulder arthroplasty company put us on the map. That identity remains central to who we are. We believe the mechanics of our approach provide patients with greater range of motion and improved outcomes. While competitors have moved in this direction, our portfolio still holds a distinct edge.”
Tim Czartoski, President of U.S. Surgical and Global Product and Enabling Technologies at Enovis, said the company has been building on that foundation with new solutions for shoulders with significant bone loss, a fast-growing area of the market.
Enovis’ AltiVate Reverse Glenoid, which was introduced to the market last year, has gained traction in the market thanks to a bone-sparing approach to reverse shoulder arthroplasty.
“The timing is ideal, as the shoulder market continues to grow at a healthy pace,” Czartoski said. “Hips and knees still represent large categories, but face tighter competitive pressures. Shoulders are expanding rapidly, mostly because of surgeon confidence in reverse techniques. There’s a lot more surgeon comfort with reverse shoulders now, and that’s an area where we have a strong position.”
