Five Technologies Reshaping Orthopaedics in 2026

Part of the Franklyn Health series on innovation in the musculoskeletal space

Written by Rob Bedford

Orthopaedics has never stood still. From the first total hip replacements of the 1960s to today’s robotically-assisted joint reconstruction, the field has continuously evolved in response to clinical need, material science advances and the relentless demands of an ageing global population. But the pace of change is accelerating. A convergence of technologies: artificial intelligence; novel biomaterials; sensor miniaturisation; and additive manufacturing is creating genuine inflection points across multiple sub-disciplines simultaneously.

The pace and scale of this change are remarkable. The companies and clinical teams working at these frontiers are redefining what a medical device can do, what it means to plan a surgery; and how we monitor patients long after they leave the operating theatre.

This article opens our three-part series on innovation across the musculoskeletal space. It sets out the five areas we believe represent the most significant opportunities in orthopaedics over the next decade; and it shines a light on the technologies running through them that appear throughout the pieces that follow. Those articles go deeper into specific territory: first sports medicine and soft tissue repair, then reconstruction of the skeleton across joint replacement, trauma and spine.

1. Next-Generation Biomaterials and Bioresorbable Implants

For decades the orthopaedic implant has been a permanent fixture, a titanium or stainless-steel structure designed to last a lifetime. That paradigm is changing.

The problem with permanent implants in fracture fixation is well established. Titanium is significantly stiffer than cortical bone and the resulting mechanical mismatch disrupts natural load transfer, drives stress shielding and in some cases impairs healing. Removing hardware after a fracture unites requires a second surgical procedure, adding cost, risk and patient burden. The scale is substantial. The global prevalence of fracture non-union is estimated at around nine million cases each year, set against a steadily rising worldwide fracture burden.[1,2]

Biodegradable magnesium alloys have emerged as promising alternatives to permanent metallic implants, combining mechanical compatibility with bone and complete resorption, which addresses the persistent problems of stress shielding and secondary removal surgery.[3] The clinical data is beginning to catch up with the promise. A 2024 clinical study reported that magnesium screws implanted in paediatric fractures fully resorbed within 18 to 24 months, coinciding with complete bony union and no instances of metallosis.[4]

Beyond magnesium, biodegradable polymers and cements that release drugs directly into the surgical site over a controlled period, including antibiotics, anti-inflammatories and bone growth factors, represent a further generation of implant design.[5] Some of the most compelling near-term work sits where additive manufacturing and bioresorbable materials meet, in printed scaffolds engineered to support the repair of complex and large bone defects before the body gradually remodels them away.[6]

Where the field is heading. The next decade will see bioresorbable materials move from niche paediatric and small-bone applications into mainstream long-bone trauma and, in time, load-bearing joint replacement components. The regulatory pathway for novel biomaterials remains demanding, with ISO 10993 biocompatibility testing, long-term in vivo degradation data and novel clinical endpoints all required. The commercial and clinical case is increasingly hard to ignore.[3,5]

2. Surgical Robotics and Autonomous Assistance

Robotic-assisted surgery has moved from a novelty to a standard of care expectation in joint replacement. The global surgical robots market was valued at USD 12.93 billion in 2025 and is projected to grow at a CAGR of 16.5% through to 2035, reaching USD 59.55 billion.[7] The open question is how far the technology will go.

The current generation of systems, including Stryker’s Mako, Smith+Nephew’s CORI and Johnson & Johnson’s VELYS, is fundamentally surgeon-directed. The robot constrains the surgical field based on a pre-operative plan and does not act autonomously. The major manufacturers continue to expand these portfolios, with new robotics for hip, knee and shoulder showcased at AAOS 2026.[8]

The more disruptive opportunity lies in moving beyond constraint-based assistance toward genuine intraoperative intelligence. Johnson & Johnson MedTech has announced development of robotics systems that use physical AI and simulated virtual operating room environments to accelerate product innovation and optimise clinical workflows.[9] Real-time adaptive robotics, systems that modify the surgical plan based on intraoperative tissue data, remain nascent and represent the logical next step.

A strategic question now shaping the market is whether robotics platforms stay tied to a single manufacturer’s implants or move toward implant-agnostic systems that work across multiple implant brands. Health economics may ultimately favour the latter, which would reshape competitive dynamics across the sector.

Where the field is heading. The near-term competitive battle is around expanding robotics into shoulder, extremities and spine, where current penetration is lower than in hip and knee. The longer-term prize is closed-loop surgical systems that integrate pre-operative imaging, real-time biomechanical data and outcome databases, moving from constraining the surgical field toward genuinely augmenting clinical decision-making. Clinical evidence requirements for these systems will grow in complexity as their autonomy increases.[10]

3. Smart Implants and Remote Patient Monitoring

The implant of the future generates data. Embedding sensors into orthopaedic devices to monitor healing, load transfer, gait and implant integrity in real time is one of the most consequential shifts in the field. The global smart orthopaedic implants market was valued at USD 2.6 billion in 2025 and is projected to reach USD 10.7 billion by 2034, a CAGR of 17.4%.[11]

Post-operative complication detection currently relies on patient-reported symptoms and periodic clinical review, a system that is reactive and episodic. Smart implants offer continuous, objective data: load through a fracture fixation device, range of motion following arthroplasty, early biochemical markers of periprosthetic joint infection. Zimmer Biomet’s Persona IQ, the world’s first commercially available smart knee implant, can measure range of motion, step count, walking speed and other gait metrics from within the implant itself.[12]

The pipeline is broadening beyond the knee, with sensing approaches in development for fracture fixation, soft tissue repair and spinal fusion monitoring.[13,14]

Where the field is heading. The hardware is largely solved. Sensor miniaturisation, wireless power transfer and biocompatible packaging are all advancing. The real bottleneck lies in clinical workflow integration and the regulatory framework for the software and data components. These devices are combination products. The implant, the sensor system and the data analytics platform each carry regulatory obligations. Clinical validation of the monitoring claims themselves, alongside the implant’s structural performance, will be essential. Reimbursement pathways for remote monitoring data in orthopaedics also remain inconsistent across markets.[11,12]

4. Artificial Intelligence in Surgical Planning and Implant Design

AI is embedding itself across the entire surgical workflow, from diagnosis and pre-operative planning through to intraoperative guidance and post-operative outcome prediction. In orthopaedics, where image data is rich and procedural variability is high, the opportunity is substantial.

AI models for implant selection have demonstrated femoral and tibial component size prediction accuracy of 82.2% and 85.0% respectively, compared with 68.4% and 73.1% for conventional manufacturer default plans.[15] That may sound incremental, though in the context of revision surgery, where implant mismatch is a significant contributor to failure, the downstream clinical and economic impact is considerable.

Machine learning algorithms can now analyse patient-specific features including bone mineral density, mobility patterns and biomechanical characteristics to inform orthopaedic implant design.[16] The integration of AI with digital twin technology is a further frontier. Virtual replicas of a patient’s anatomy and physiology allow surgeons to test multiple treatment approaches before implementation.[17] Beyond planning, AI is beginning to affect intraoperative decision-making, with real-time image processing, integration with robotic systems and adaptive feedback enhancing accuracy across joint replacement, spine and trauma surgery.[15]

At the large-company level, Johnson & Johnson’s use of NVIDIA Isaac for virtual operating room simulation signals where major players are directing R&D investment.[9]

Where the field is heading. The regulatory treatment of AI-driven planning tools as Software as a Medical Device is still evolving. Under EU MDR and the FDA’s developing framework for AI and machine-learning based software, post-market performance monitoring of AI models, including the handling of algorithm updates, creates ongoing obligations that many device companies have not yet fully scoped. Clinical validation of the AI’s specific claims, in addition to its general performance, will be essential.[16]

5. Additive Manufacturing and Patient-Specific Implants

Three-dimensional printing has been used in orthopaedics for some years, and the technology is now mature enough to move beyond anatomical models and surgical guides into production-grade patient-specific implants at commercial scale. Additive manufacturing allows the creation of patient-specific implants with porous architectures closely resembling natural bone, enhancing osseointegration, while surface engineering techniques including bioactive coatings and antimicrobial layers address persistent problems at the implant-tissue interface.[10]

The clinical case for patient-specific implants is strongest in complex revision arthroplasty, oncological reconstruction and craniomaxillofacial surgery, cases where off-the-shelf implants are anatomically inadequate. 3D printing enables the creation of custom acetabular cups and spinal cages using titanium, PEEK and specialised polymers that improve surgical fit and outcome.[18]

The combination of additive manufacturing with novel biomaterials is particularly compelling. Porous structures that mimic trabecular bone architecture can be printed in titanium, Nitinol or degradable polymers with precise control over porosity gradients, a design space that is simply impossible to access through conventional manufacturing. Investment in production-scale additive manufacturing facilities is rising, a sign of growing confidence in the technology as a route to volume manufacturing rather than prototyping alone.[19]

Where the field is heading. The near-term growth is in expanding the indications where patient-specific implants are cost-justified and reimbursed. The medium-term opportunity is in combining patient-specific geometry with smart materials and embedded sensors, implants tailored to the patient’s anatomy, stiffness-matched to their bone and capable of reporting on their own performance. Generating the clinical evidence to support these combination claims will require thoughtful study design from the outset.[10,18]

A Note on Clinical Evidence

Across all five of these areas, the companies that will succeed are those that treat clinical evidence strategy as a first-principles design question from the very outset. Novel biomaterials need long-term in vivo degradation and biocompatibility data. Smart implants need clinical validation of their monitoring claims, in addition to their structural performance. AI planning tools need prospective evidence that their outputs improve patient outcomes, going beyond mere correlation with surgeon decisions. Combination products, implants paired with software, sensors or drug elution, require integrated clinical strategies that address each component and the interaction between them.

These are solvable problems. They require deep familiarity with the orthopaedic evidence landscape, regulatory expectations in both the EU and US and the practical realities of running clinical investigations in this specialty.

At Franklyn Health, orthopaedics sits at the heart of what we do. Our team have worked at the bench and corporate level with some of the world’s largest orthopaedic companies, including Stryker, Smith+Nephew and DePuy Synthes, and we have brought that experience to bear for emerging companies across joint reconstruction, trauma, spine and craniomaxillofacial surgery. If you are building in this space and thinking about your clinical and regulatory pathway, we would be glad to talk.

We are based in Leeds, a city with a legitimate claim to being the birthplace of the modern orthopaedic industry. When Sir John Charnley pioneered total hip replacement at Wrightington Hospital in 1962, a procedure now performed over one million times annually worldwide, it was Chas F. Thackray Ltd, a Leeds-based manufacturer founded in 1903, that made it a clinical reality.[R1, R2] Thackray began manufacturing the Charnley hip system in 1963 and it remains the best-selling cemented hip system in the world. The company was eventually acquired by DePuy, now part of Johnson & Johnson. That lineage, from a Leeds pharmacy on Great George Street to the global orthopaedic market, is a thread that runs directly through the history of the specialty. The University of Leeds continues that tradition today, hosting the NIHR Leeds Biomedical Research Centre, home to the largest international academic facility for preclinical testing of joint replacements, and the Leeds Institute of Rheumatic and Musculoskeletal Medicine, a recognised EULAR Centre of Excellence.[R3, R4] It is the right place to be doing this work.

This is the opening article in our three-part series on innovation across the musculoskeletal space. The pieces that follow examine sports medicine and soft tissue repair, then reconstruction of the skeleton across joint replacement, trauma and spine.

References

R1. John Charnley Trust. Transforming Hip Surgery. Total Hip Replacement pioneered at Wrightington Hospital by Sir John Charnley, 1962. https://johncharnleytrust.org/transforming-hip-surgery/

R2. Gomez PF, Morcuende JA. A historical and economic perspective on Sir John Charnley, Chas F. Thackray Limited, and the early arthroplasty industry. Iowa Orthopaedic Journal. 2005;25:30-37. https://pmc.ncbi.nlm.nih.gov/articles/PMC1888784

R3. NIHR Leeds Biomedical Research Centre. Musculoskeletal Disease Research. Host to the largest international academic facility for preclinical testing of joint replacements. https://leedsbrc.nihr.ac.uk/musculoskeletal-disease/

R4. University of Leeds. Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM). Recognised EULAR Centre of Excellence. https://medicinehealth.leeds.ac.uk/leeds-institute-rheumatic-musculoskeletal-medicine

Franklyn Health is an employee-owned medical device and diagnostics CRO based in Leeds, UK. We work exclusively in medical devices and in vitro diagnostics. For enquiries, contact us at hello@franklynhealth.com.

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