For the past seven years, the compound annual growth rate (CAGR) of China's orthopedic market has been hovering around 20%. Last year, there were 270,000 joint replacement procedures performed in the country. To provide a sense of scale, each year in the United States, more than 400,000 joint replacement procedures are performed. Overall, the international orthopedic contract manufacturing is growing at a rate of approximately 11%, according to Huidian Research. The top three product segments in China are trauma devices, spinal devices, and artificial joints. Both spinal devices and trauma devices represent a larger market in China than joint replacements do. In 2012, there were 420,000 incidences of spinal device implantations and millions of cases requiring trauma devices. The rapid growth in China's orthopedic market is fueled by the country's rising middle class and aging population. While the average selling price for orthopedic products has risen slightly as a result of a growing penetration of high-end devices, cost pressures in the country remain high and a substantial proportion of the population is unable to cover the out-of-pocket costs for procedures like joint replacements. Chinese orthopedic companies are also growing in size and influence, Last year, the Chinese orthopedics firm China Kanghui Holdings was snatched up by Medtronic for $816 million. Other companies active in the market include Xian Airfoil Technology, LINK Orthopedics, and Beijing Montagne Medical Device Co.Orthopedics-related research is also growing. In 2006, the country began hosting the International Congress of Chinese Orthopaedic Association. The Chinese Orthopaedic Association (COA) itself has grown quickly and, in 2010, had 12,000 members. Recent evidence of the country's rise in orthopedics research can be seen in a recent announcement from Peking University Third Hospital. The facilitate has succeeded in developing a novel 3-D printed orthopedic implant that have shown promise in clinical trial. "We started the clinical trial to test those implants last year, and all the patients participating in the trial are recovering well," said Liu Zhongjun, director with the department.