With the acquisition of Wright Medical, Stryker will have some decisions to make in terms of product line redundancies from both an inventory and legal perspective in the near future. The plates, screws, and biologic offerings will sort itself over time as Stryker will want to limit the disruption of any sales immediately post acquisition. However, the FTC will likely force the sale of one of their primary ankle replacement prosthesis prior to the completion of the deal. 

According to Wells Fargo, Wright Medical currently owns about 70% of all total ankle market share in the US. Leaving the STAR, Integra’s Candence and Salto, Exactech’s Vantage, and the Zimmer TM to make up the rest of the replacement volume. Wright currently offers a “full continuum of care” from low profile (Infinity), to large deformity (Inbone 2) to their revision platform (Invision). In addition, Wright’s Prophecy preoperative planning software is compatible to all 3 of those systems seemingly making the aformentioned TAR systems untouchable. Therefore, it is assumed that the STAR would be on the move similar to when the Salto was sold to Integra at the time of the Wright/Tornier merger back in 2015. 
So who are the contenders for the STAR ankle?

Arthrex: Never known for acquisitions this doesn’t seem like something in Reinhold’s wheelhouse. Do not see this as a priority for the team down in Naples, however picking up an ankle at a discount could be something they could build from while developing something I house. Arming Arthrex with an ankle replacement is probably not a top priority for Stryker at this point. Yes, they need to dump it to get the deal done, but Arthrex would be the last place I would sell it if I were Stryker. Still, it may be a possibility.

Depuy/Synthes: With the Agility retired the STAR may fit nicely in their bag, but who would cover these cases? Depuy/Synthes recently axed their foot and ankle rep division and reverted back to the Synthes Trauma Teams handling the bulk of Foot and Ankle cases in most geographies. Having these experienced reps with doctors who are loyal to the product would seem like an easier transition in comparison to some of the other players. They have the cash, and this could really help fortify there extremity bag, but do they even want to get back into the TAR space?

Zimmer/Biomet: ZB is currently building up its direct Foot and Ankle sales force and seems to be pumping resources into becoming a bigger player in the Foot and Ankle market. It has been rumored for a while now that they have an anterior ankle project ready to launch alongside their lateral TM. Would picking up an ankle with existing business make more sense based on where they are at now with their current project?

Smith and Nephew: News of Smith and Nephew making a late bid for its Memphis neighbor popped up in January, but nothing came of it and the deal between Stryker and Wright is happening. S&N is sort of in Foot and Ankle limbo. Nationally, they are more trauma focused when it comes to hardware so it may not make much sense for them. On the other hand, it may be the perfect place for Stryker to bury the STAR.

Extremity Focused Other Guys: This group would include – Accumed, Orthofix, Nova Step, Trilliant, Medline, Medshape, CrossRoads, Extremity Medical, Medartis, Flower Orthopedics, among a few others. These companies are mainly distributor based and handled by teams with an extremity focus across many product lines. These groups are knowledgeable and would love the ability to leverage the STAR’s hospital approvals with some of their own products. Depending on the asking price, it could make sense for any one of these guys to jump into the mix. 

LEFT OUT:

P28 and In2Bones: I2B’s ankle was just announced prior to ACFAS and P28 has an ankle ready to go pending FDA approval. We will take a look at both of these systems as well as the DT MedTech Hintegra H2 (also being shopped) in the near future when more information is available.
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