The Total Joint pipeline is contracting in the US.
Let’s have some real talk about total joint procedure volumes in the US. The rise of GLP-1 receptor agonists like
Another Big Ortho player is in denial over GLP-1s.
Tiger’s Take: S+N Joins the “GLP-1 Denial” narrative. Their Q3 guidance cut and failed DePuy Synthes merger talks mask a
Have you noticed that everybody seems to have an Agenda?
Have you noticed this in our industry ? Every phone call. Every email. Every LinkedIn message. Every text. Somebody is
GLP-1s are the Elephant in the room – joint patients are electing to wait.
Tiger’s Take: Why did Stryker just missed their earnings ? I believe that there is a GLP-1 factor and that
[Tiger’s Weekly Intel] – Stryker Blames the Insurers, a $5.7B Bet on Surgery Centers, and the Shoulder Land Grab
The surgeons still want to operate. The patients still need new hips and knees. The insurers are saying no. That’s
🔴 Tiger’s Red-Hot Innovator of the Week: Dutch startup brings vertebral reconstruction to the US market this month.
Every Monday I share a startup that I really like.I call it the Red-Hot Innovator of the Week. If you
The Chain Reaction of Innovation in Orthopedics
Great innovation ecosystems in orthopedics are rarely born from academic theories or top-down economic planning; they are seeded by dynamic,
9 Finance Measurements that beat EBITDA for Ortho Companies
EBITDA can look fantastic while an orthopedic company is quietly bleeding cash. I’ve watched it happen more than once. You
What Is the Metabolism of Your Company?
Most companies talk about innovation.Very few can actually digest it. Metabolism is the speed and efficiency with which a company
DePuy + S&N talks collapsed because the logic was never real.
We all heard about the DePuy + S&N merger talks fell through last week. The media framed the late collapse
🔴 Tiger’s Red-Hot Innovator of the Week: Atlanta startup brings wireless mechanical tenotomy to the office.
Every Monday I share a startup that I really like.I call it the Red-Hot Innovator of the Week. If you
[Tiger’s Weekly Intel] – S&N and DePuy’s breakup over the corner office, PE’s efficiency bet, and BONESUPPORT’s margin model
The theme of last week was strategic consolidation, the hard truth about corporate governance, and the relentless flow of private
Why Contingency Recruiting Is Broken for the Roles That Actually Move the Needle in Your Business
I used to think contingency recruiting was the best—and only—way to find talent for an orthopedic company. But the experience
5 Historical Game-Changers That Rewrote Orthopedics
In order to predict the future game-changers in orthopedics, it can be helpful to look back at history. Let’s go
What happened at NASS ? The real signal, not the noise.
NASS just packed up in San Antonio, and the press releases are still landing. Most of it is noise. But
The Real AI Playbook for Orthopedic Practices
The low-hanging fruit of AI in orthopedics is not a robot. If the metric does not move, stop. Orthopedics does
🔴 Tiger’s Red-Hot Innovator of the Week: Florida startup introduces throwaway mini-robots for joint procedures
Every Monday I share a startup that I really like. I call it the Red-Hot Innovator of the Week. This
[Tiger’s Weekly Intel] – J&J’s spin signal, Stryker’s soft-robot move, and the patient-specific spine war
The theme of last week was big strategic repositioning and direct category combat. J&J reported Q3 ortho growth of 3.4%
Startup question – the Monkey or the Pedestal first ?
Most orthopedic startups die the same way. They spend years, and a lot of other people’s money, designing and manufacturing
Orthopedic Startup Funding – Q3 2026 (Guest post by Asher)
Sometimes my readers write great content, such as this substack article. Asher has did this. By cutting through standard industry
Your Surgeon isn’t buying your implants anymore—The hospital CFO is.
Selling Joints Under the New CMS Rules Medicare joint replacement is officially a permanent bundled-care market—not a pilot, not a
Understanding Stryker’s Strategic Move into Soft-Tissue Robotics
High-Level Strategy Stryker isn’t taking a standard gamble on soft-tissue robotics—it’s executing a calculated, low-risk breach into one of MedTech’s
🔴 Tiger’s Red-Hot Innovator of the Week: Portland startup eliminates the clamp in fracture surgery
Every Monday I share a startup that I really like. I call it the Red-Hot Innovator of the Week. This
[Tiger’s Weekly Intel] – Payment Reform, Leadership Handoffs, and the Public-Market Test
Summary This was a payment week dressed up as a leadership week. CMS announced CJR-X, a nationwide mandatory joint replacement
What you need to know about the Stryker CEO change.
Stryker has had only three CEOs since 1977, and each one roughly doubled or tripled the company. John Brown built
Centinel to take the Disc Motion bet public
This is a big one for our industry. Centinel Spine will be testing the public markets soon. Below I will
Surgeon > Robot
Here we go again. Robots still don’t beat a good manual joint replacement. The UK just put a number on
The Ortho Scoreboard That Matters
Measuring the right metrics will help your company be successful. Surgeons will tell you they love the implant. Reps will
🔴 Tiger’s Red-Hot Innovator of the Week: Incisionless spine surgery.
Every Monday I share a startup that I really like. I call it the Red-Hot Innovator of the Week. As
[Tiger’s Weekly Intel] – SI-BONE Extends Granite Beyond the Pelvis, Dual Lumbar NTAPs Go Live, Chest Wall Crowds
Quick Summary before the Deep Dive and Tiger’s Takes. Sector Notable Move Key Strategic Implication SI / Compromised Bone SI-BONE
Why do Ortho founders keep choosing the hardest business models ?
Every week I talk with orthopedic founders who are raising money to fight the same three wars at once: inventory,
A Front-Row Seat into 1,000 Orthopedic Startups
Imagine if someone had visibility into all early orthopedic innovation. Even more specifically, if someone had early discussions with startups
The $11B Spine Market Is Not a Commodity. The Average Is.
ORTHOWORLD correctly estimated the worldwide spine market at $11.1 billion in 2025, up 3.3% from $10.8 billion the year before.
You Don’t Need the Whole Market. You Need a Small Circle of True Customers.
Every week I talk with orthopedic founders who are asking the wrong question: How do we get big enough? Big
🔴 Tiger’s Red-Hot Innovator of the Week: Startup brings a single Tissue Bank catalog. Fifteen Minutes. No Warehouse in Between.
Every Monday I share a startup that I really like. I call it the Red-Hot Innovator of the Week. As
[Tiger’s Weekly Intel] – OTA launches Trauma Metal, S+N Clears LANDMARK Knee, Regenerative Capital Prints
Ortho Conferences are still important, not for sales leads, but they tell us who launches. OTA in Nashville put pelvic
Stay out of the middle. Winners can own the edges.
Let me throw out a theory. Orthopedics is getting harder and harder for the small ortho company to gain market
Why Medartis Just Bought a Cadaver Lab — and Why Surgical Training Is How You Scale
Swiss extremity and CMF specialist Medartis Holding AG bought the M.A.R.C. Institute (Miami Anatomical Research Center) in Doral, Florida. The
“An Engineer Is Not an Engineer”
I hear this request all the time. Ortho executives call and say, “I need an Engineer.” That’s the wrong request.
The 6 PE Orthopedic Orphans
I wrote this article to better understand how our orthopedic Orphans ended up in such a no-man’s-land, why they cannot
🔴 Tiger’s Red-Hot Innovator of the Week: Dutch startup plugs the knee treatment gap
Every Monday I share a startup that I really like. I call it the Red-Hot Innovator of the Week. There
[Tiger’s Weekly Intel] – AOFAS launches; Extremity Metal; Spine Posts Receipts; Venture Stays Quiet.
Conference weeks are about what you can put in a tray, not what you can put on a slide. AOFAS
DePuy Synthes: Why a PE Buyout Beats an IPO
J&J announced an 18–24 month plan last October to separate Orthopaedics into a standalone public company under Namal Nawana. That
Q&A – the future of tissue preservation with Miach Ortho CEO, Sept 17 @ 3:00p EST.
Don’t miss this one. Jamal Rushdy, President & CEO of Miach Orthopaedics, joins us to talk about defining the standard
Reach Orthopaedics assets are for Sale – Oct 13 deadline
Disclaimer: I have no financial interest, just trying to help out an ortho startup with an exit. Eight years is
New therapy emerges to solve RA. The Ortho industry should pay attention.
This breakthrough caught my eye. Could have big ramifications to orthopedics in the future. In our industry, the landscape is
The Macro Reason: Why Your Ortho Startup Still Can’t Raise
I have watched orthopedic entrepreneurs beat their heads against the exact same brick wall since May 2022. That was the
🔴 Tiger’s Red-Hot Innovator of the Week: New Open AR Spine Guidance without a Lock-In
Every Monday I share a startup that I really like. I call it the Red-Hot Innovator of the Week. Spine
[Tiger’s Weekly Intel] – Strategics Bought Robots and Cuff Fixation; Specialists Stacked SKUs, Registries, and First Cases.
Consolidation cycles are about survival, not brand theater. What cleared a term sheet or a 510(k) this week had a
Apparently, Some Startups Can Still Fool Capital Allocators
Stack the right buzzwords and you can still raise capital—even twelve years after founding. Every deck needs a villain and