New Survey Reveals Top Foot and Ankle Suppliers

According to a recent survey of 2, 000 orthopedic and podiatry surgeons, Wright Medical Technology, Inc., Arthrex, Inc., Synthes, Inc., Stryker Corporation , Biomet, Inc. and DePuy represent roughly 80% of this important orthopedic segment with two firms dominating—Wright Medical and Arthrex—and one firm likely to enter the elite ranks this year—the combined Synthes and DePuy.

It’s Not About the Dollars

From the surgeon’s point of view, according to survey results, it isn’t about the dollars.  What surgeons want is superior service and loyalty.  So this survey did not measure sales levels but rather looked at a number of components that build long-term customer loyalty like:

• Sales force product knowledge

• Sales force dependability

• Comprehensiveness of the product offering

• Innovation

• Product/Procedure training services

• Loyalty to the surgeon customer

• Service responsiveness

The survey, which was conducted by PearlDiver Technologies, Inc. senior analyst Scott Ellison, was sent to 2, 000 geographically diverse orthopedic and podiatry surgeons in the United States.  The survey was conducted between January 2012 and March 2012.  Fifteen percent of those surveyed responded—which is a strong rate.

Table 1 - Geographic Distribution of Surgeons Surveyed

Source: PearlDiver Consulting Services

The survey, which was sponsored by Wright Medical, was conducted independently of the firm. The list of surgeons surveyed, for example, was obtained from SK&A Marketing Services and is not affiliated in any way with Wright Medical.

Each surveyed surgeon was asked 17 questions concerning their experience with and opinion of each supplier of foot and ankle surgical products.  The PearlDiver Independent Survey is designed to serve as a barometer of surgeon opinions, awareness and issues regarding each supplier’s sales force, products, reputation and other key factors.

Table 2 - Medical Specialty of Respondents

Source: PearlDiver Consulting Services

Ranking Suppliers to Foot and Ankle Surgeons

The survey results paint a picture of an industry with, essentially, three tiers of suppliers—Elite Suppliers (there are two), Solid Suppliers (there are 5) and the Up and Comers (there are 4). 

According to the survey there are only two Elite Suppliers—Wright Medical and Arthrex.  These two suppliers received consistently high marks from surveyed surgeons and were the most commonly mentioned firms.  Wright Medical received 24.2% of the aggregated survey responses and Arthrex received 21.4% of the aggregated survey responses. The next closest firm is Synthes at 13.8%, so there is a clear gap between the elite suppliers and the rest.

The Solid Supplier tier is comprised of Synthes (13.8%), Stryker (8.8%), Biomet (4.9%), DePuy (4.7%) and Smith & Nephew plc (8.8%).

The Up and Comer tier is comprised of Integra LifeSciences Holding Corporation (3.3%), Tornier N.V. (3.0%), Small Bone Innovation Inc. (2.4%) and Acumed (2.3%).

Chart 1 - Most Commonly Mentioned Suppliers

Source: PearlDiver Consulting Services

Most Knowledgeable and Dependable Sales Force

Which companies have the most knowledgeable and dependable sales forces?  According to the PearlDiver survey of 2, 000 foot and ankle surgeons, 32.1% identified Wright Medical’s sales force as the most knowledgeable in terms of understanding the needs of foot and ankle surgeons.  Arthrex was selected by 25.2% of the survey respondents as most knowledgeable, followed by Synthes (17.5%) and Stryker (9.9%). 

Knowledge is one thing, but what about dependability? 

Here again, Wright and Arthrex took the number one and two spots, respectively.  Of the 279 surgeons who answered the question, 26.2% said that Wright Medical’s sales people were the most dependable followed by Arthrex at 24.7%.  Two other firms reached double-digit levels in this category—Synthes (17.9%) and Stryker (13.6%).

Most Performed Surgeries

No surprise, there is price to pay for beauty.  The surgeons surveyed said that their most commonly performed surgery was excision repair of bunion (40.4%).  It’s all those high heels!  The second most performed surgery was hammertoe correction (27.9%) followed by wound debridement (19.6%) and ankle fracture repair (10.4%).

Among the entire group, the top surgeries performed were:

• Excision/Repair of Bunion (40.4%)

• Hammertoe Correction (27.9%)

• Wound Debridement (19.6%)

• Ankle Fracture Repair (10.4%)

• Plantar Fascia Release (2.5%)

• Flat Foot Surgery (2.5%)

• Tendon/Soft Tissue Reconstruction (2.1%)

• First MTP Fusion (1.8%)

• Ankle Fusion (1.1%)

Surgeons who identified themselves as members of American Orthopaedic Foot & Ankle Society (AOFAS) reported ankle fracture repair as 23.4% of performed surgeries. 

Who Do You Think Is #1?

When surgeons were asked, “Which company selling foot and ankle surgical products do you believe to be the market leader?” they pointed to three companies:

1. Wright Medical at 32.3%

2. Arthrex at 23.4%

3. Synthes as 22.7%

The next highest after Synthes is Stryker at 7.8%.

Comprehensiveness and Innovation

In terms of comprehensive offering of products for foot and ankle surgeons, the three leading companies were no surprise, Wright Medical at 35.8%, Arthrex at 27.2% and Synthes at 16.5%. 

What was especially notable, we think, was Arthrex’s strong showing as product innovator.  When asked, which company do most foot and ankle surgeons identify as being the most innovative? Arthrex was named #1 by 36.1% of the survey’s respondents.  Wright Medical was #2 at 28.1%, followed by #3 Synthes at 10.6%.

Best Product/Procedure Training

The companies with the best product/procedure training programs for foot and ankle surgeons were Arthrex at 30.3% of the total respondents to this question followed by Wright Medical (25.7%) and Synthes (14.2%).

In many ways this question is related to the innovation question.  Companies with a steady stream of innovative products must, in order to be successful, develop strong training programs.  And that certainly appears to be the case here with Arthrex, which was identified as the most innovative company also hitting the top marks in terms of training.

STAR Perceived Ankle Replacement Leader

One company—aside from Wright Medical, Arthrex or Synthes—broke into the top four in any category. That was Small Bone Innovations (SBi) which made a big impact for those surgeons who perform total ankle replacement procedures.

Surveyed surgeons identified SBi's STAR ankle replacement system as the overwhelming market leader (55.4%), followed by Wright's InBone (24.4%), Tornier's Salto (13.4%) and DePuy's Agility (8.5%).

When identifying which ankle replacement systems the surgeons were trained on, InBone ranked first (56.6%), STAR was second (55.4%), Salto was third (50.6%), while DePuy's Agility system came in fourth (36.1%).

AOFAS Ankle Replacement Focus

When asked whether the surgeon’s practice performs ankle replacement surgeries, only 30% of the total respondents answered yes. However when those surgeons identifying themselves as members of AOFAS, they responded overwhelmingly (63.5%) positively to the question.

Wright: Perceived Market Leader

Since Wright was the survey’s sponsor, it is suspect on its face that Wright would also be the most consistently ranked #1 company.  But the survey was conducted independently of Wright and used surgeon names from an independent source.  We think that Wright agreed to pay for the survey primarily because they had a fairly good idea that the results would be favorable to them.  And they were.  Wright is clearly the leader among foot and ankle surgeons.  Arthrex is a strong #2 and leads in the all-important categories of innovation and surgeon training.

Based on these survey results, Wright Medical and Arthrex are clearly the elite companies in the foot and ankle market with Synthes coming on strong. We would note, of course, that DePuy is acquiring Synthes so there will likely be a third company (DePuy) entering the Elite category in 2012.

Scott Ellison, the senior PearlDiver analyst conducting the survey, said that when looking at the previous survey conducted on the foot and ankle market at the beginning of 2010, the total population surveyed responded 29.41% of the time that Wright Medical was the perceived market leader. As of the beginning of 2012, this percentage had increased to 32.3%.

“This indicates to me Wright is doing a very good job of holding their position as the perceived market leader, ” said Ellison.

When asked, “Which company comes to mind when you think about foot and ankle products, ” the largest number of responses indicated Wright Medical (34.4%), followed by Synthes (26.0%).

Responses to this question solely from those surgeons who identified themselves as members of AOFAS indicated Wright Medical (37.5%) followed by Arthrex (33.3%).

While Wright and Arthrex finished first or second in every category of survey questions, surgeons who identified themselves as members of AOFAS or ACFAS (American College of Foot and Ankle Surgeons) consistently gave the two companies slightly higher marks than their non-society member colleagues.

Questions

The categories of questions included: most knowledgeable sales force, most dependable sales force, most comprehensive offerings; most innovative, best training programs; most committed to the specialty and best service.

Here are the summaries of categories and questions:

Identified Medical Specialty

• Surgical Podiatry (49.3%)

• Foot & Ankle Orthopedics (31.8%)

• General Podiatry (21.2%)

• General Orthopedics (5.1%)

Company That Comes to Mind

• Wright Medical (34.4%)

• Synthes (26.0%)

• Arthrex (25.6%)

• Stryker (15.4%)

Most Knowledgeable Sales Force

• Wright Medical (32.1%)

• Arthrex (25.2%)

• Synthes (17.5%)

• Stryker (9.9%)

Most Dependable Sales Force

• Wright Medical (26.2%)

• Arthrex (24.7%)

• Synthes (17.9%)

• Stryker (13.6%)

(Note: AOFAS members rated Arthrex number one in this category at 31.6%)

Most Comprehensive Offerings

• Wright Medical (35.8%)

• Arthrex (27.2%)

• Synthes (16.5%)

• Stryker (9.7%)

Most Innovative

• Arthrex (36.1%)

• Wright Medical (28.1%)

• Synthes (10.6%)

• Stryker (7.3%)

(Note: AOFAS members rated Arthrex and Wright equally at 36.2%)

Most Committed to Specialty

• Wright Medical (41.4%)

• Arthrex (26.3%)

• Synthes (10.2%)

• Stryker (7.9%)

(Note: SBi bumped Stryker among AOFAS members and tied with Synthes at 8.8%)

Best Service

• Wright Medical (28.7%)

• Arthrex (23.2%)

• Synthes (16.2%)

• Stryker (11.0%)

For more information and to engage PearlDiver’s survey services, contact Scott Ellison at scott@pearldiverinc.com.