Globus Medical has spent years as the name to beat in spine robotics. Now it wants to pull off the same trick in the knee, where Stryker has home-field advantage. Its play is ExcelsiusFlex, which the company markets as “Next-Generation Robotics,” and the pitch is one plenty of surgeons have been asking for: let the robot help, but put the surgeon back in charge of the case.
The timing is interesting. Globus’s spine business is on a roll, but capital equipment sales have been up and down for more than a year.
What ExcelsiusFlex brings
The FDA cleared ExcelsiusFlex for total knee arthroplasty in June 2024, and cleared the ACTIFY 3D knee implant at the same time. The system guides bone cuts based on the implant position planned before surgery, but it doesn’t force the surgeon into cutting jigs or lock down the saw. The surgeon makes the cut.
Globus leans hard on flexibility. The platform supports both CT-based and imageless workflows, stores each surgeon’s preferences and sits on a compact, floor-mounted base. During the cut, the arm adjusts its position if the patient’s leg moves, which happens in the OR more often than anyone likes to admit.
ACTIFY 3D rounds out the offering. It’s a 3D-printed implant with a porous structure designed for cementless fixation, and it can be placed robotically or by hand.
Some hospitals have already signed on. In June, Holy Name Medical Center in New Jersey announced it had bought ExcelsiusFlex and billed itself as the only hospital in the world running the full Excelsius ecosystem. Its surgeons were already doing spine cases with ExcelsiusGPS and Excelsius3D, so the knee was the obvious next step.
An ecosystem built to pull through implants
Globus has been adding pieces for close to a decade. The Excelsius family now includes ExcelsiusGPS for spine and cranial procedures, Excelsius3D for intraoperative imaging, ExcelsiusHub for navigation, ExcelsiusXR for extended reality and, now, ExcelsiusFlex for the knee.
Nobody in the industry is fooled about the business model. An installed robot means years of implants, disposables and service contracts, and Globus knows that better than most, with close to 130,000 robotic procedures under its belt. CEO Keith Pfeil has told analysts repeatedly that robotics pull-through remains one of the company’s key growth drivers.
Europe is part of the plan too. In September, Excelsius3D picked up its CE mark.
The 2026 numbers
Globus expects revenue of $3.18 billion to $3.22 billion this year, up 8.2% to 9.6% from 2025. The trouble spot is Enabling Technologies, the unit that sells the robots, which has been on a roller coaster for more than a year.
| Quarter | Total sales | Enabling Technologies | Year-over-year change |
|---|---|---|---|
| Q2 2026 | $789.6M | $26.1M | −25.8% |
| Q1 2026 | $759.9M | $26.9M | +21.1% |
| Q4 2025 | $826.4M | $55.6M (record) | +18.5% |
| Q3 2025 | $769M | $28M | −27% |
Management has admitted 2025 was a lumpy year, with deals taking longer to close and hospitals favoring leases over outright purchases. Rather than fight that trend, Globus has decided to lean into it. It’s offering more flexible ways for hospitals to get a robot and counting on making the money back later, one case at a time. The company says that shift explains the second-quarter drop.
In the meantime, the rest of the business is carrying the load. Excluding Nevro, the base business grew 13.2% in the first quarter, and trauma and neuromonitoring each grew more than 30% in the second.
Rivals with a head start
In knees, Globus is late to the party. Stryker’s Mako has been in operating rooms for years, and DePuy Synthes’ Velys and Zimmer Biomet’s ROSA have their own installed bases. Globus can’t win that fight on the robot alone.
Its real advantage lies elsewhere. Plenty of hospitals already run spine cases on ExcelsiusGPS, and for them, adding knees on a platform they know is a far easier sell than bringing in a second ecosystem from another vendor.
About Globus Medical, Inc.
Globus Medical, Inc. is a leading global musculoskeletal technology company dedicated to solving unmet clinical needs and changing lives. We innovate with inspired urgency, provide world-class education and clinical support, and advance care throughout spine, orthopedic trauma, joint reconstruction, biomaterials, and enabling technologies. Additional information can be accessed at www.globusmedical.com
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