Five manufacturers at the centre of the bribery ring have been fined $311m (lb150m) by the US Department of Justice.
The companies admit paying "many" orthopaedic surgeons "consulting fees" that ranged from $10,000 to hundreds of thousands of dollars every year.
Of the five companies, four have been handed the fines; the fifth, Stryker Orthopedics, co-operated with the US's attorney office and was not punished.
The four were Zimmer, which was fined $170m, DePuy Orthopedics, fined $85m, Smith & Nephew, fined $29m, and Biomet, fined $27m.
Investigators discovered the pay-outs were common practice between 2002 and 2006. As well as receiving "consulting fees", the surgeons were also treated to lavish trips and expensive gifts.
(Source: British Medical Journal, 2007; 335: 1065).