The orthopedic industry has spent more than a decade chasing enabling innovation, and much of that pursuit can be traced to a single, defining moment—Stryker Corp.’s $1.65 billion MAKO Surgical acquisition in 2013. This deal did far more than introduce robotics at scale into a major orthopedic portfolio—it reset the playing field across the industry. Competitive advantage no longer was incremental; rather, it was platform-based, procedural, and existential.

What followed that transaction was an acceleration that reshaped orthopedics. Robotics programs multiplied, navigation and digital surgery platforms emerged, and imaging, sensors, planning software, smart instruments, and workflow tools all rushed toward the operating room. Enabling technology innovation became synonymous with relevance.

In many ways, it worked. While not yet ubiquitous, orthopedic surgery has become more precise, more data-enabled, and more technologically sophisticated than ever before.

Moving forward, as the industry enters 2026 and orthopedic procedures are migrating from hospitals to ambulatory surgical centers (ASCs), the operating room itself has become a scarce resource, which triggers a more sobering question about the factors dominating some decision-making in healthcare systems: Does this technology actually help the operating room run better or does it simply demand space within it?

Considering the speed at which the world’s population is aging, the modern orthopedic operating room—whether in a hospital or an ASC—is not short on innovation. It is short on capacity. The OR is full.

Since the MAKO acquisition legitimized robotics as a strategic platform, nearly every major OEM has felt compelled to secure its own position in the enabling-technology stack. Zimmer Biomet acquired Medtech S.A., the French developer and manufacturer of ROSA, to advance its robotic strategy. Johnson & Johnson MedTech acquired French surgical robotics firm Orthotaxy in 2018 to keep DePuy Synthes in the game with the VELYS Robotic-Assisted Solution. Mostly independent players such as THINK Surgical have pursued alternative approaches like handheld solutions while sensor-enabled solutions (Canary Medical, for instance) embed data collection directly inside implants themselves. 

Comparatively, each of these technologies brings legitimate value. The problem is not innovation quality but rather, accumulation.

The modern orthopedic OR has an interesting conundrum to meet its growing needs in a finite space:

• One primary robotic platform
• Perhaps one navigation or planning layer
• Limited screens, carts, and physical footprint
• A shrinking appetite for additional delivery systems
• While increasingly requiring more precision instruments created through innovations like additive manufacturing

Everything else must integrate invisibly, replace something already there, or quietly fail.

ASCs impose even harsher constraints. Lean staffing models, limited storage, tight block schedules, and unforgiving economics leave no room for optional operational complexity.

The orthopedic industry does not currently lack innovation, it lacks oxygen in the OR. That fact is interesting, considering orthopedics used to be more profitable than it is today, but that topic is worthy of its own ODT column.

So how does orthopedics maintain or regain its past momentum? By using throughput as the ultimate benchmark. In this crowded healthcare environment, surgical throughput has emerged as the industry’s most effective and least negotiable filter.

As most industry professionals understand, the OR (whether in the hospital or ASC) can be costly by the minute. Five to 10 minutes saved per case can determine whether an ASC adds another procedure to the day. Optimized and bespoke trays to meet the patient specific instruments can reduce sterilization burden and setup time. Moreover, standardized workflow can minimize staff dependence and onboarding friction, which is important with current healthcare staffing trends.

Assuming they are successfully implemented, these gains can compound quickly. They also can determine the types of technologies that earn a permanent place in the OR and those that are squeezed out. As stated by one industry expert, “In an overcrowded orthopedic OR, technologies do not compete against each other—they compete against time, delivery systems, tolerance, and footprint.”

An early 2026 trend signals a shift in orthopedics away from implant differentiation and toward procedural discipline. Historically, orthopedic competition centered on implants. Geometry, materials, coatings, and biomechanics drove differentiation. While implants remain foundational, minor tweaks are no longer sufficient to be competitive. 

Hospitals and ASCs increasingly evaluate procedures as systems, asking questions like (1) How many trays are required? (2) How predictable is case duration? (3) How easily can staff support multiple surgeons? and (4) How quickly can a site be activated?

Innovation that improves one step but complicates three others struggles to survive. Anyone who has tried to sell a procedural change—even one that improves outcomes—knows it’s an uphill climb. In today’s environment, the likely winners are those that collapse steps, standardize execution, and stabilize outcomes with minimal disruption.

This shift reframes the role of enabling technologies—and separately elevates additive manufacturing from novelty to necessity. Additive manufacturing (AM) has been a part of orthopedics for years, most visibly in porous implants and patient-specific solutions. What has changed is why it is now being deployed.

In 2026, AM is increasingly used to (1) consolidate components and eliminate secondary instruments; (2) integrate features that simplify surgical technique; (3) reduce implant and instrument variation without sacrificing coverage; (4) rapidly iterate designs around ASC workflows, and (5) create bespoke patient specific instruments to increase precision and patient outcomes without sacrificing time.

In spine particularly, AM-enabled interbody devices and instrumentation have supported predictable placement, simplified alignment, and bolstered outpatient feasibility for procedures previously confined to hospitals.

Once considered a niche solution, AM is now gaining ground—not because it adds capability, but because it removes complexity upstream. The saturation of enabling technologies has created an unexpected advantage for additive manufacturing by enabling procedural redesign without adding footprint.

Rather than introducing another cart, console, or screen, AM allows OEMs to rethink systems holistically:

1. Fewer implants covering broader indications
2. Smaller, simpler instrument sets 
3. Unique delivery systems that allow for customization while still being designed around flow, not redundancy

In ASCs, where space and staffing are constrained, simplicity is often the best differentiator among competing solutions. “In an era of OR congestion, the most valuable innovations are the ones that disappear into the workflow,” MedWorld Operations Director Estelle Black observed.

With M&A practitioners among both OEMs and CDMOs, it is interesting to observe the waterfall impact of these shifts on the industry’s CDMOs.

OEMs increasingly are looking to partners that can (1) translate procedural intent into manufacturable reality; (2) align additive manufacturing with instrumentation and tray strategy; (3) support high-mix, lower-volume ASC-oriented systems; and (4) balance innovation with regulatory and operational discipline.

This context helps explain some of the strategic logic behind the Jan. 14 merger between Tecomet and Orchid Orthopedic Solutions. The deal signals that additive manufacturing, when paired with orthopedic depth and operational scale, can become a platform itself rather than simply a capability solution.

One impact of the past decade’s trends is that OEMs are no longer defining ecosystems alone; instead, they are asking CDMOs to help architect them.

For tray and instrumentation manufacturers, OR congestion changes the definition of value. Winning in 2026 requires:

1. Earlier engagement in procedural and system-level design
2. Tray configurations optimized for ASC turnover, not hospital redundancy
3. Alignment with AM-enabled implant and instrument consolidation
4. Enforced configuration discipline across surgeons and sites
5. Data-driven proof of setup, turnover, and sterilization impact

Delivery system strategy is no longer a downstream decision. It is a throughput lever. More than a decade after Stryker’s MAKO acquisition ignited orthopedics’ race toward enabling innovation, the industry’s next inflection point is clear: winning will no longer be defined by who innovates first, but by who operationalizes innovation best (literally).

For the industry’s CDMOs, the future winners will not be defined by capacity or cost alone, but by their ability to co-engineer procedures—where trays, instruments, and additive manufacturing converge to unlock surgical throughput and outcome precision. Helping their OEM customers win remains the best strategy for success.

Throughput is the new currency of innovation, and procedural optimization, enabled by additive manufacturing combined with enabling technologies, is where orthopedics will truly win.

MORE FROM THESE AUTHORS—Breaking Away: The Business and Human Impact of Orthopedic Divestitures

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 currently is CEO at MedWorld Advisors and can be reached at florencejblack@medworldadvisors.com.

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 davesheppard@medworldadvisors.com.