2016 was a year of surprise and change in political circles, but that's nothing new for the medtech industry, which over a number of years has become accustomed to health care systems demanding different and ever-higher levels of service. Smart medtechs have been ahead of the curve, but the whole industry now factors in clients' wider needs in a holistic approach to patient care. Many companies' current M&A policies are already reflecting the changes to come.

The global medtech industry has a new leader, after a bulked-up Medtronic knocked Johnson & Johnson off its throne. But astute M&A deals, as well as divestments and knock-on impact from poor sales and negative currency effects, have also led to other movements in the medtech company rankings. Medtech Insight's 2016 edition of its annual league tables – MTI 100 and the Top 10 sector leaders – show who's climbed up and who's slipped down.

M&A deal activity dropped dramatically in November with a mere six deals in the medtech industry, making November the weakest month of the year so far. The biggest deal of the month recorded was Edward Lifesciences $690m acquisition of Israeli start-up Valtech.