Abstract
Purpose
To characterize venture capital (VC) investments in orthopaedic surgery over the past 25 years to evaluate trends in global innovation.
Methods
All VC investments related to orthopaedic surgery between January 2000 and December 2024 were retrospectively evaluated using the PitchBook database (PitchBook Platform, PitchBook Data. Seattle, WA). The headquarter location of each company was reviewed. The year of each investment deal and investment size (US dollars) were aggregated. Deals were also evaluated with respect to funding category (surgical devices, biotechnology, drug discovery, hospital management/technology, medical equipment). Descriptive statistics, compound annual growth rate, 2‐sample t‐tests, and regression analysis were conducted.
Results
A total of $9.7 billion (in 2025 USD) in VC funding was invested in orthopaedic surgery, consisting of 1506 distinct deals. VC funding has steadily increased since 2000, most notably between 2020 and 2024, with 49.8% (750) of deals (P < .001) and 71% of total funding ($7.8 billion) (P = .024). Privately held companies made 98% (1481) of deals. Surgical devices led VC investment with 34% (514) of deals totaling $3.5 billion, with biotechnology following with 30% (457) of deals for $3.3 billion. These 2 categories saw significantly more investments than the remaining categories (P < .001). Orthopaedic companies physically based in the United States of America (USA) received the most funding (811 deals, $6.9 billion). China, Japan, the United Kingdom, Canada, and South Korea followed, though with significantly fewer investments than the USA (P < .001).
Conclusions
VC funding in orthopaedic surgery has steadily increased over the past 25 years, largely concentrated in the United States, with a dramatic increase in the past 5 years driven by interest in orthobiologic therapies and digital health.
Clinical Relevance
VC investment trends in orthopaedic surgery appear to mirror many of the broader macroeconomic forces seen in the health care sector and have a direct impact on future development, innovation, and clinical practice within orthopaedic surgery.
Venture capital (VC) is a critical source of private funding for early‐stage companies. 1 , 2 Financial capital and guidance are provided in exchange for equity in the developing company, with the intention of growing the company and its product for market commercialization or purchase. This funding can help early start‐ups perform advanced research and development, conduct clinical trials, navigate complex regulatory pathways, and scale operations to bring products to market. 3 , 4 VC funding in health care is increasing, with numerous private companies focused on biotechnology, therapeutics, devices, health care management, and artificial intelligence. 3 , 5 , 6 , 7
Private sector innovation and VC, though external to clinical practice, shape health care technologies. 1 Previous literature has characterized trends in VC funding in several surgical specialties, including urology and spine surgery, with the latter seeing a steady increase in the amount of VC funding over time. 8 , 9 Comprehensively characterizing VC funding in orthopaedic surgery is particularly important given the musculoskeletal burden of an aging population, increasing utilization of common surgeries, and the potential ethical implications of private sector innovation on clinical practice. 10 , 11 , 12 Recent macroeconomic factors, including technological advancements, global pandemics, and global regulations regarding digital health and artificial intelligence, have a significant impact on health care innovation and global trends in VC funding in this field 3 ; specifically, there was a surge in health care funding in the private and public sector during the COVID‐19 pandemic driven by digital health, with a notable contraction in 2023. 13 , 14
The purpose of this study was to characterize VC investments in orthopaedic surgery over the past 25 years to evaluate trends in global innovation. We hypothesized that there would be significant growth in private sector innovation in the latter end of the study period and that the majority of VC funding would be invested in the United States.
METHODS
Database
Data were collected from the PitchBook financial database (PitchBook Data, Seattle, Washington), which provides comprehensive financial data collected from global capital markets. The data offer insight into investors, companies, and funds involved in private investments. Proprietary algorithms allow PitchBook to collect real‐time information on finalized deals between investors and companies by evaluating regulatory filings, press releases, and company websites. Investors and associated personnel can also report transaction data directly to PitchBook. In this database, a VC‐backed investment was defined as an equity investment made into a start‐up or early‐stage company by a VC fund, regardless of the investment stage of the company (seed, early‐stage, or late‐stage). An investment deal was defined as a distinct, finalized transaction between companies and investors. For each deal, the amount of capital funded was noted.
Data Collection
This was a retrospective cohort study conducted using the PitchBook financial database. Institutional review board approval was not required. A search was performed to include all VC‐backed deals related to orthopaedic surgery from January 1, 2000, to December 31, 2024. Comprehensive search criteria were utilized to capture all investment deals related to orthopaedic surgery (Supporting Information).
Investment deals with undisclosed funding amounts were excluded. Data were collected on a single day in March 2025 to control for daily fluctuations in the database. Investments were quantified by the total number and value (in USD) of investments. Each deal was categorized into the following categories by 2 independent reviewers: surgical devices, biotechnology, drug discovery, hospital management, and medical equipment. Each category was evaluated by 2 independent observers and discussed with a more senior member to resolve any discrepancies. These categories were determined based on a previously published methodology as well as existing categories within the database. 8 , 15 Each investment deal was evaluated for ownership status and country of origin of the associated company receiving funding. Ownership status of companies was defined as privately held, in IPO registration, or publicly held.
The total amount of investment deals and capital invested (in USD) was evaluated for each year of the study period, category, and country of the company receiving funding. When examining capital investments across time, estimates were adjusted for inflation using the 2025 Consumer Price Index. 16 The investment deals made in the last 5 years (2020‐2024) were evaluated relative to the rest of the study period to capture the impact of the COVID‐19 pandemic. The compound annual growth rates (CAGRs) in both the quantity of investment deals and dollar amount invested were calculated over the total study period, as well as between several distinct time frames, including 2020 to 2024, the preceding decade 2010 to 2019, and the first decade 2000 to 2009. The top 5 largest deals in each category, as well as each state in the USA, were evaluated. The top 15 most active investors were identified and evaluated for the total deals and value invested over the study period. Active investors were ranked by those engaging in the most investment deals. The country of each investor's headquarters location was noted.
Data Analysis
Descriptive statistics were performed for the cohort (Microsoft Excel, Seattle, WA). For count variables, such as the number of investment deals made, a negative binomial regression was used, given that the data were overdispersed. For continuous variables, such as the total capital invested (USD), analysis of variance tests were conducted between countries and between categories. All statistical analysis was performed using STATA v18 (Stata, College Station, TX).
Ethical Approval
This work was exempt from institutional review board review because no private health information was accessed or reviewed as part of this investigation. This study utilized a financial database to gather data; there was no direct contact with humans or animals.
RESULTS
Over the study period, 2159 distinct investment deals across 415 companies were identified. After investment deals with undisclosed funding amounts were excluded, 1506 total investment deals were included for final analysis.
Trends of VC Funding Over Time
Total capital invested over the study period (USD) was $10,977,160,000; after adjustment for inflation to 2025 USD, this amount was $9,722,581,942. VC funding steadily increased globally over the study period and saw rapid growth over the last 5 years (Figure 1). This time period, 2020 to 2024, accounted for 49.8% (750) of total investment deals and 71.1% ($7.8 billion) of total capital invested. Total capital invested between 2020 to 2024 ($7.8 billion) was significantly higher compared with the 20 years prior, 2000 to 2019 ($3.2 billion), 71.1% vs 28.9% (P = .024). The total number of investment deals made was also significantly higher in this 5‐year increment than any other in the study period (750 vs 756 deals) (P < .001). While the total number of distinct investment deals peaked in 2020 (176 deals), with a steady decline over the remaining 5 years, the total amount of capital invested only peaked in 2023 ($2.2 billion).
FIGURE 1.
Global trends of VC investments in orthopaedic surgery. Investment deals are adjusted for inflation, using 2025 Consumer Price Index. (USD, United States Dollar; VC, venture capital.)
From 2000 to 2024, VC investments related to orthopaedic surgery increased at a CAGR of 133% for the dollar amount invested and 21% for the quantity of investment deals made. Between 2000 and 2009, CAGR increased at 414% for amount invested and 31% for quantity of investment deals; between 2010 and 2019, CAGR increased by 665% and 61%, respectively. For 2000 to 2024, CAGR increased at 6004% for capital invested but decreased 318% in the amount of distinct investment deals.
VC Funding by Type of Company
Investment deals were primarily made in privately held companies, with 98.3% (1481) of deals totaling $10.6 billion (unadjusted). Publicly held companies made 0.5% (7) of deals ($32 million), and 1.2% (18) of deals ($318 million) were made in companies undergoing IPO registration at the time of data collection.
VC Funding by Category of Company
VC funding exceeded $3 billion for the top 2 categories, surgical devices ($3.5 billion) and biotechnology ($3.3 billion), with these 2 categories holding greater than 60% of total investment deals in both quantity and capital invested for the study period (Figure 2). Investment deals related to drug discovery accounted for 24% (364) of all deals, with $3.0 billion of capital invested. Hospital management followed with 8% (116) of investment deals ($802 million) and medical equipment with 4% (55) of deals ($286 million). Funding for surgical devices significantly exceeded all other categories (P < .001).
FIGURE 2.
VC investments by type of company. (VC, venture capital.)
Category Leaders
The companies involved in the top 5 investment deals of the surgical devices category encompassed a broad range of capabilities, from purely hardware for trauma (Coventus Flower Orthopedics, USA) and joint replacement (Star Sports Medicine, China) to a blend of software or biotechnology with custom hardware (Augmedics, USA; Decans Medical; China Orbital Therapeutics, USA). Leading companies were based in the USA or China.
All 5 of the top investment deals in biotechnology over the total study period (Capstan Therapeutics, Cerapedics, Aspect Biosystems, Satellite Bio) were made with companies in North America, with a focus on cell therapy or regenerative medicine. Similarly, the drug discovery category was predominantly dominated by companies based in the USA (Caeregen Therapeutics, Progentos Therapeutics, CellPhire Therapeutics, and DiscGenics) with an overarching focus on tissue regeneration and targeted drug delivery. The top 5 investment deals of the hospital management categories were made with companies in the USA (Cellino, HebeCell) and China (Changmugu Medical, Bang‐Er Orthopedic), with the top 2 deals aimed at artificial intelligence development. The medical equipment category was led by multiple deals by 1 USA‐based company (Seaport Diagnostics, Boston, Massachusetts [MA], USA).
VC Funding by Country
Investment deals occurred in 36 countries globally. The top 5 countries receiving VC funding were the USA, China, Japan, the United Kingdom, and Canada, with these 5 countries accounting for 81.4% of the total deals and 91.0% of total capital invested in the last 25 years (Figure 3). The United States led the cohort both in the number of investment deals (811, 53.9%) and in total capital invested ($6.9 billion, 63.3%), with all other countries receiving significantly less funding in comparison (P < .001) (Table 1). Compared with its closest competitor, China, the USA received higher amounts of investment deals and capital invested over the entire study period and more closely influenced global trends (Figure 4). However, when compared with 2025 gross domestic product, these investment deals were modest proportions: 0.023% and 0.008% of US and China's gross domestic product, respectively. Within the United States, companies in 32 states received VC funding. Of these, MA received the highest amount of capital invested with $1.6 billion, which accounted for 23% of all funding received by the USA during the study period (Table 2). However, California had a higher number of investment deals comparatively, 17.5% (142) versus 10.2% (81) in MA, with a comparable amount of capital funding ($1.5 billion, 22.1%).
FIGURE 3.
Global distribution of VC funding in orthopaedic surgery, 2000 to 2024. (VC, venture capital.)
TABLE 1.
Top 5 Countries With VC Funding in Orthopaedic Surgery, 2000 to 2024
| Country | Number of Deals (N, %) | P Values | Total Investment (Millions $, %) | P Values |
|---|---|---|---|---|
| United States | 811, 53.9% | ‐ | $6943.54, 63.3% | ‐ |
| China | 111, 7.4% | <.001 | $1539.95, 14.0% | <.001 |
| Japan | 114, 7.6% | <.001 | $577.28, 5.3% | <.001 |
| United Kingdom | 138, 9.2% | <.001 | $524.1, 4.8% | <.001 |
| Canada | 52, 3.5% | <.001 | $409.73, 3.7% | <.001 |
Note: Data compared to 1506 deals and $10.9 billion of funding.
VC, venture capital.
FIGURE 4.
(A) Trends of VC investments in the United States of America. (B) Trends of VC investments in China. Investment deals are adjusted for inflation, using 2025 Consumer Price Index. (VC, venture capital.)
TABLE 2.
Top 5 States Receiving VC Funding in United States of America, 2000 to 2024
| State | Number of Deals (N, %) | Total Investment (Millions $, %) |
|---|---|---|
| California | 142 (17.5%) | $1536.05 (22.1%) |
| Massachusetts | 81 (10.2%) | $1606.72 (23.1%) |
| North Carolina | 80 (9.9%) | $359.16 (5.2%) |
| Florida | 60 (7.4%) | $405.36 (5.8%) |
| New York | 70 (8.6%) | $202.85 (2.9%) |
Note: Data compared to 811 deals and $6.9 billion of funding.
VC, venture capital.
Most Active Investors
The top 2 most active investors were based in Japan, led by Kyoto University Innovation Capital (13 deals) and Mitsubishi UBJ Capital (12 deals) (Table 3). Investors from China (Legend Capital, 9 deals), the United Kingdom (Parkwalk Advisors, 8 deals), and Belgium (European Innovation Council Fund) followed in that order. Six investors from the United States were among the top 15 most active investors in this study (Alexandria Ventures Investments, Alumni Ventures, F‐Prime Capital, DEFTA Partners, Spray Venture Partners, BOLD Capital Partners).
TABLE 3.
Top 15 Most Active Investors of VC Funding in Orthopaedic Surgery, 2000 to 2024
| Investor Name | Number of Deals | Capital Invested (Millions, $) | Country of Origin | |
|---|---|---|---|---|
| 1 | Kyoto University Innovation Capital | 13 | 53.98 | Japan |
| 2 | Mitsubishi UBJ Capital | 12 | 121.58 | Japan |
| 3 | Legend Capital | 9 | 165.87 | China |
| 4 | Parkwalk Advisors | 8 | 59.64 | United Kingdom |
| 5 | European Innovation Council Fund | 8 | 31.87 | Belgium |
| 6 | Alexandria Ventures Investments | 7 | 766.50 | USA |
| 7 | Alumni Ventures | 7 | 154.76 | USA |
| 8 | F‐Prime Capital | 7 | 99.72 | USA |
| 9 | DEFTA Partners | 7 | 97.75 | USA |
| 10 | Spray Venture Partners | 7 | 95.82 | USA |
| 11 | YuanBio Venture Capital | 6 | 165.21 | China |
| 12 | BOLD Capital Partners | 6 | 99.26 | USA |
| 13 | Meltwind Advisory | 6 | 43.76 | United Kingdom |
| 14 | UK Innovation & Science Seed Fund | 6 | 29.59 | United Kingdom |
| 15 | Shenzhen Capital Group | 4 | 67.02 | China |
VC, venture capital.
DISCUSSION
This study shows that the United States received the highest amount of VC funding related to orthopaedic surgery over the past 25 years, through analysis of a globally representative cohort. The capital invested in orthopaedic surgery–related ventures is substantial, exceeding $9 billion (adjusted for inflation) since 2000, with major growth seen in the last 5 years. Orthopaedic surgery investments are greatest in the surgical devices and biotechnology sectors and are most concentrated in the United States, specifically MA and California. The global rise in VC funding is reflective of increasing private sector involvement in the practice of orthopaedic surgery and health care overall. 17 , 18 , 19 The PitchBook database is one of the most comprehensive datasets of private funding; thus, we hope that this analysis will educate surgeons on how VC investments influence global innovation in orthopaedic surgery and help anticipate how the private sector will influence clinical practice in the future. 3 Previous literature has characterized VC funding in the United States but did not encompass global events that may have uniquely impacted private funding and innovation, such as the COVID‐19 pandemic, or analyze international trends. 15
VC funding received by companies in the United States far exceeded that in any other country, followed by China and Japan, respectively. Within the United States, the highest quantity of VC deals occurred in California. This may be in part explained by the robust ecosystem of VC firms and start‐up accelerators in Silicon Valley that have a growing interest in health care. More specifically, in the past 2 years, there has been a remarkable increase in early‐seed funding in companies innovating at the intersection between biopharmaceuticals, orthobiologics, and artificial intelligence. 20 , 21 MA, which received the highest amount of capital invested, also has a strong concentration of highly ranked academic institutions as well as state and private sources of funding with a strong focus in life science. 22 The results of this study suggest that US‐based companies lead global innovation in orthopaedic surgery and receive a large proportion of associated private VC funding. Cwalina et al. conducted an examination of only US‐based investments in orthopaedic surgery between 2000 and 2019 using the Capital IQ database and found 673 investments totaling nearly $3.5 billion; funding was more concentrated in the second decade, though with a decline in the latter half, which is corroborated by our results. 15
The steady increase in VC funding related to orthopaedic surgery is reflective of an overall increase in health care investment over the last 2 decades, which is also seen in various surgical subspecialties. 5 An examination of VC investments in urology, which also utilized the PitchBook database, reported funding of $1.1 billion between 2011 and 2021, without significant fluctuations in the quantity of deals or funding over this time period. 8 In the same time frame, orthopaedic surgery saw significantly greater deals and funding, with 993 deals totaling $5 billion versus 191 deals totaling $1.1 billion in urology. The majority of the VC funding examined in this current study was focused on surgical devices, which is also shown in other surgical specialties; a study examining VC investments in therapeutic devices in otolaryngology, also utilizing the Pitchbook database, showed funding totaling $1.2 billion through 210 investment deals over 2008 to 2017. 23 Other studies have also shown that health care–related VC funding is largely concentrated in surgical devices, therapeutic devices, and biotechnology, which is consistent with our results. 24 , 25 , 26 The medical implant market, as of 2024, is dominated by orthopaedic implants, with orthobiologics specifically being one of the fastest growing products in the market, which has strong implications for sports medicine and arthroscopy alike. 27 The global orthopaedic implant market is expected to show a CAGR of 3.8% to 5.3% over the next 5 years, with the United States already taking the majority market share in 2023 at approximately 55%. 28 This market, valued at about $26 billion globally, is driven by arthroplasty, spine, and more recently, sports injury–related implants, suggesting that it may be contributing to the significant increase in VC funding in 2020 to 2024 and, once again, led by investments based in the United States. 29
However, the magnitude of funding, in terms of the quantity of deals and capital invested, in orthopaedic surgery anecdotally exceeds most other surgical specialties. One possible explanation for this trend may be the diverse range of opportunities for innovation available in orthopaedics, including regenerative medicine, mechanical engineering, biomaterials and orthobiologics, and physical rehabilitation. This renders an optimal environment for continued investment growth. Certain orthopaedic subspecialties, such as spine and adult reconstruction, are known revenue drivers, via high patient utilization and innovative surgical implants. 11 , 30 VC investments made by US firms in spine surgery companies in the last 2 decades are predominantly driven by devices and biotechnology and are arguably one of the strongest revenue generators related to orthopaedic surgery in the private sector. 9 Growing interest in cartilage restoration and orthobiologics, such as platelet‐rich plasma, stem cells, bone marrow aspirate, and autologous chondrocytes, is likely to be a strong sources of revenue in orthopaedic surgery and, consequently, to pique the interest of VC investors. 31 , 32 This fairly recent trend is particularly applicable to sports medicine and arthroscopy, given the rise of orthobiologics (such as a platelet‐rich plasma and hyaluronic acid) as standalone therapies or adjuncts to arthroscopic procedures. 31 , 33 This particular VC trend reflects a growing shift toward tissue healing and restoration over pure mechanical repair for sports medicine–related injuries and suggests that sports medicine and arthroscopy may become even stronger revenue drivers within orthopaedic surgey with strong potential for private sector involvement. Further studies examining global VC investments by orthopaedic subspecialty as well as the impact of regulations governing international sources of funding may elucidate more granular trends.
The COVID‐19 pandemic led to a significant acceleration of both private and public investment into the health care industry, driven by a rising demand for digital health, health infrastructure, rapid diagnostic testing, mRNA vaccines, and associated biotechnology. 13 , 14 Moreover, funding in digital health companies nearly doubled in 2020, to approximately $20 billion. 34 Legislative factors, such as the Coronavirus Aid, Relief, and Economic Security Act, passed in 2020 in the United States, eased geographic and facility requirements for providing health services and increased Medicare/Medicaid reimbursements, thus allowing telehealth start‐ups to have stronger revenue models. 13 It is likely that this digital health trend specifically carried over to the increased VC funding noted in orthopaedics, with a relatively much higher CAGR observed in capital invested between 2020 to 2024 as compared with other intervals in the study period. Interestingly, the CAGR of quantity of deals made during this 5‐year interval decreased, suggesting a trend toward fewer investment deals with larger capital invested. Telehealth alone cannot explain this strong inflection point in VC investments given that it has limited integration in orthopaedics; given the importance of in‐person physical examination in this specialty, telehealth has a niche application, often most useful for immediate postoperative visits after arthroplasty. 35 , 36 Perhaps another contributing factor is indicated by the significant deals made with biotechnology companies in this time frame, suggesting that innovations in the biotechnology sphere have carried into further personalized medicine and biologic therapies in the orthopaedic surgery space.
Despite the observed acceleration from 2020 to 2023, there was a steep drop‐off observed in orthopaedic VC investments globally in 2024. This reflects an overall trend in the health care industry—bullish enthusiasm for digital health waned with the pandemic. 37 VC funding in telehealth and digital health infrastructure did not translate to meaningful changes in clinical outcomes or widespread implementation. 38 , 39 In 2024, market forecasts heavily devalued the digital health sector after noting that the hype in these companies exceeded the demand for their services. 37 , 40 This shows that trends in VC investments in orthopaedic surgery, like health care in general, are noticeably influenced by macroeconomic forces. 3 With these considerations in mind, surgeons should interpret trends in the private sector with caution and be critical of whether the surgical services and products backed by VC funding translate to clinically meaningful care. Future studies should investigate the rate at which VC‐backed companies successfully exit the orthopaedic space through acquisition or public IPO. This would yield valuable insight into an objective metric of successful VC investments.
Limitations
This study has several limitations. First, funding information listed in the PitchBook Database may not be a comprehensive representation of foreign funding markets, as shown by the high number of deals with undisclosed investments that were excluded from our analysis. This may lead to underestimating the true amount of VC investments related to orthopaedic surgery. Second, while we have a globally representative sample of investment, this may not capture nuances in funding within countries with more strict sociopolitical frameworks. Additionally, some countries may not disclose their domestic or international investments at all. To deliver these insights, our method identifying all investments related to orthopaedic surgery across the globe within PitchBook was intentionally broad and may introduce some bias. More granular examinations within subspecialties are warranted to further elucidate nuanced differences in orthopaedic funding. Lastly, our categorization of investments was based on prior methodology, but inherently involved subjective judgments, as some companies produce products and services that could fit into multiple categories.
CONCLUSIONS
VC funding in orthopaedic surgery has steadily increased over the past 25 years, largely concentrated in the United States, with a dramatic increase in the past 5 years driven by interest in orthobiologic therapies and digital health.
SUPPORTING INFORMATION
Additional supporting information can be found online in the Supporting Information section.
DISCLOSURES
The author (F.P.) declares the following financial interests/personal relationships, which may be considered as potential competing interests: F.P. receives royalites from Exactech: IP, and is a paid consultant or paid presenter or speaker for Stryker and Exactech. The other authors (M.S., C.F.W., P.W., L.B., J.Y., L.W., A.R.J.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
FUNDING
Luke Barry, Ph.D., was partially supported by the National Library of Medicine of the National Institutes of Health under grant T15LM013976.
Supporting information
Supplementary Material
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