Years of intense physical activity and an aging population are driving increased demand for knee replacements, with robotic-assisted surgery becoming a key factor in the evolving landscape of joint replacement procedures. Smith & Nephew, a UK-based medical equipment company listed on the FTSE 100, is intensifying efforts to compete in the growing market for knee replacement robots, which is currently dominated by US firms.

Jim Sweeney, a 60-year-old financial executive based in London, exemplifies a growing segment of younger patients undergoing knee replacements. After years of running ultra-marathons during his time in Hong Kong, Sweeney experienced severe knee pain leading to a partially replaced left knee earlier this year. His surgery employed Stryker’s Mako robotic system, the market leader in robotic knee replacement technology. Stryker’s Mako platform, launched around a decade ago, has been used in over one million procedures globally, enabling surgeons to perform quicker, more precise operations often completed within an hour.

The global knee replacement market sees over three million procedures annually, with the United States accounting for more than one million of those. Advances in robotic-assisted surgery have contributed to this growth by improving precision and fostering new methods such as cementless implants, which encourage bone growth around the prosthesis rather than relying on cement. Stryker’s Mako system epitomizes these technological and procedural innovations but comes with a high price tag—estimated at $1 million per robot—often offset by agreements that tie robot use to implants supplied by Stryker.

Smith & Nephew, which ranks fourth globally in orthopaedics behind Zimmer Biomet, Stryker, and Johnson & Johnson's DePuy Synthes, has faced challenges in this shifting environment. The company’s knee replacement division has seen declining revenues, contributing to sluggish overall growth. Share prices have dropped about 20 percent in the past year amid investor pressure and calls for strategic change, including potential spin-offs of its slower-growing orthopaedic business to focus on areas like sports medicine and wound care.

In an attempt to regain market share, Smith & Nephew recently received US regulatory approval for its new artificial knee implant called Landmark, designed to more closely mimic natural knee movement and suit a younger, more active patient demographic. The Landmark knee is implantable through Smith & Nephew's Cori robotic system, a handheld, smaller, and less expensive alternative to larger, more complex platforms like Mako. The company aims to attract hospitals and outpatient surgical centers, particularly in markets such as the US and UK, where adoption of robotic surgery by the National Health Service (NHS) has been slower.

Smith & Nephew’s previous product, the Journey knee system introduced two decades ago, struggled due to its surgical complexity, leading many surgeons to prefer faster, simpler options offered by competitors. Now, the company faces stiff competition from the likes of Zimmer Biomet’s Persona knees combined with the Rosa robotic system and Stryker’s Triathlon implants.

Despite these challenges, Smith & Nephew’s leadership sees opportunity as the average knee replacement patient becomes younger and more active, with many in their forties and fifties seeking longer-lasting solutions. Landmark’s design aims to meet these demands, enhancing longevity and functionality for patients expected to outlive older implants.

For patients like Jim Sweeney, robotic knee replacement offers renewed mobility, enabling a return to active lifestyles after recovery and physiotherapy. While Smith & Nephew’s recovery in the knee replacement market may take time, it reflects the broader competitive dynamics of a rapidly evolving medical technology sector driven by innovation and demographic trends.