Smith+Nephew, the FTSE 100 medical technology group, has cut its full-year guidance after weaker than expected sales of hip and knee implants in the US.
Underlying revenue growth is now expected to be around 3%, down from around 4%.
Trading profit, its preferred measure of operating profit, is now forecast to grow about 4% to around $1.25 billion, half the 8% growth previously guided.
The previous forecast was around $1.3 billion.
Free cash flow is expected to be about $750 million, down from $800 million.
Adjusted return on invested capital is now seen at around 9%, against a previous target of more than 10%.
Slower growth in US orthopaedics is expected to continue through the fourth quarter.
Smith+Nephew also confirmed it had approached Johnson & Johnson earlier this year about its orthopaedics business, following press reports of a possible combination with J&J's DePuy Synthes division.
Those talks have now ended, but the board will keep exploring strategic options for the unit.
Revenue for the third quarter rose 3.4% to $1.55 billion, an acceleration from the second quarter.
Orthopaedics returned to growth, with sales up 2.5% to $590 million, helped by Europe, Japan and emerging markets.
In the US, knee implant sales fell 7.3%, reflecting customers lost in earlier periods and a softer market.
The market is moving towards cementless knees, which bond directly to bone rather than being fixed with cement, a gap the group is now filling.
Its new cementless LANDMARK knee received US regulatory clearance in September, with the first operations completed.
US hip sales fell 1%, held back by a shortage of instrument sets for its CATALYSTEM hip.
Sports Medicine & ENT sales rose 7.9%, with joint repair up 11.2%.
Advanced Wound Management was flat, as growth in devices was offset by an 8.8% fall in bioactives following changes to US reimbursement rules for skin substitutes.
Chief executive Deepak Nath said the group remained confident of "delivering profit growth ahead of revenue growth".
A $500 million share buyback is on track, with $250 million completed by the end of September.
