The Tiger Dashboard – June 2026
“Most of the our industry is reading yesterday’s news. You’re about to read where Ortho is going.” I’m sharing the […]
The Ortho Founder’s Paradox: Are You an Explorer or a Mountain Guide?
Imagine a grueling expedition into uncharted territory. You have two distinct figures standing before the team. The first is the
Why the Person Reviewing Your Class III Ortho Device Is Terrified of Saying “Yes”
The Class III pathway in orthopedics brutally slow, opaque, and unpredictable. If you ask the industry, we point to the
The “ASC only” customer strategy for startups will work.
Why Read? This article explores a proven “ASC-only” strategy via an 8-step playbook for entrepreneurs, covering ASC-optimized product design, partnerships,
Hiring the “Big Ortho” Resume is a Costly Blunder for a Startup
The lure of hiring a seasoned executive from a “Big Ortho” powerhouse—like Stryker, ZB, S+N, or DePuy—is a trap that
How Spine’s material “distraction” became a $4B Cardio materials play
This is an attempt to explain the MiRus pivot to my ortho/spine readers. It’s hard to get your head around
Ortho companies can die by either Heart Attack or Cancer.
Ortho Companies die in two ways: acute failure or chronic decay. Heart attack or cancer. 1/ A Heart Attack is
The SI Joint Commodity Trap in 2026
If you’ve spent any time reading OrthoStreams, you know my core philosophy: Business Model > Product. When I first wrote
Why a lean funding philosophy produces winners
I wrote about the psychologic dangers of Too Much Money ! on OrthoStreams in 2019. Today I need to explain
Startup saving Orthopedic Distributors from six-figure logistics losses
For decades, the orthopedic logistics world has treated field inventory like a necessary evil: flood the market with expensive metal,
9 Hiring Tactics for Orthopedic Startups
In an orthopedic startups, talent isn’t just an asset—it’s your ultimate commercial engine. Every hire either accelerates your time-to-market or
Who will win the Spine Endoscopy land grab?
If you have been keeping your ear to the ground in the spine world, you already know that spine endoscopy
When “Product Is King” Kills the Company: Anatomy of an real life Ortho Zombie
How can a company with a truly great product turn into a zombie public company on life support? Today I
1-Way Doors: The Silent Killer of Ortho Startups
Let’s talk about the importance of two-way doors versus one-way doors. A one-way door decision is nearly impossible to reverse
New Trend: Payers have declared war on cervical cages
I try to follow trends in ortho. Some reimbursement trends, like this one, pop up out of nowhere. Reimbursement pressure
Why You Should Stop Hiring for Experience and Start Hiring for Scars
Recently I have been helping ortho startups fix their hiring mistakes. This got me to thinking. Why do startup leaders
The Disposable Dilemma: Is the ASC “Efficiency Engine” an ESG Liability?
In the high-velocity ASCs, the single-use instrument kit has become the “easy button” for throughput. By sidestepping the logistical nightmare
The NASS Pivot: Why the World’s Largest Spine Society is Betting Big on the “Underdog” Founder.
For decades, the narrative in spine has been dominated by the giants—big companies with deep pockets running roughshod over the
The Robotic Trojan Horse: How Big Ortho Smuggled a 10-Year Contract into Your OR
The image of a surgical robot “chained” to the OR floor serves as a perfect metaphor for the current state
The 5 career stages in the Orthopedics industry.
Your career in orthopedics isn’t a ladder; it’s a lifecycle, and most professionals are unknowingly trapped in a stage they
Spine startup – Join the discussion today May 7 — Inside the NASS “Financial Bridge” with NASS CEO, Eric Muehlbauer
The statistics are brutal: 95% of spine startups fail. Usually, it’s not because the technology is bad, but because the “Valley of
The Tiger Dashboard – May 2026
“Most of the ortho industry is reading yesterday’s news. You’re about to get next month’s edge.” I’m sharing the new
The “Robotics Tax”: Why Hospitals Are Losing Money on Every Case
I try to explore the truth here. Consistently I try to expose the false promise of most large robotics systems.
The $1.4 Million Rift: Is AR the “Good Enough” Revolution for the ASC?
The results from our reader poll yesterday are in, and the verdict is clear: Choice #5—the tension between “Big-Box” Robotics
Quick Poll
I want your opinion. There is a ton of change happening right now in ortho. Take a look at these
Real AI tools that any small Ortho company can leverage today for growth.
Small Ortho companies have NO EXCUSES any longer. For Small Ortho, the “low-hanging fruit” lies in AI tools that reduce
How Startup Funding Works, a Simple Illustration
Startup founders often ask me about how to best fund their new venture. There is no single answer. Every company
The Silicon Valley of the Spine: The History of Orthopedics in Memphis
I have previously written about the birthplace of modern ortho in Warsaw, or Why Warsaw? here. Today, let’s dive into
The New Currency of Successful Ortho Startups
The orthopedic industry is currently undergoing a violent but necessary cleansing. We have officially exited the “FOMO” era of easy
71 Ways an Ortho Startup can Die
On both the OrthoStreams blog and newsletter and the BoneChat private community we talk alot about what a startup should
The Regulatory Trap: Why Your Orthopedic Innovation is Stalling (and How to Fix It)
In our industry, we’re great at bending metal, perfecting coatings, and obsessed with “smart” everything. But there is a silent
Is Orthofix prepping to “boot” its Spine Division ?
In the popular monthly Tiger Dashboard (found at the top of OrthoStreams for those lucky subscribers) I have predicted for
The “KOL Shortcut” is Dead in 2026
I remember the “Good Old Days.” In that era, the blueprint for an orthopedic startup was as predictable as a
The Generalist’s Creed: Orthopedics 2026
In the ortho offices of 2026, the most dangerous phrase a professional can utter is, “That’s not my department.” The
How to Move Up the Food Chain in Your Orthopedic Career
In our industry, “moving up” isn’t just about a loftier title or a bigger paycheck; it’s about increasing your professional
The Ortho IPO paradox: Will there be any oxygen left in the room for ortho in 2026 ?
The IPO window has opened up for orthopedics this year. Read more here – A detailed look at the positive
Why “Big Ortho” Still Matters (and Why We Need Them)
If you read my stuff, you know that I frequently argue that a Startup Ortho is the superior environment for
Join the discussion today with Hyperflex Medical on BoneChat – 3:00p EST.
No bone cuts. No fusion. Just correction. Traditional bunion surgery often requires aggressive bone trauma and weeks of recovery, but
Clinical Data Theatre in Orthopedics
In the sterile hallways of orthopedic conferences, “Level 1 Evidence” is treated like the holy grail. Sales reps carry tablets
Why Mid-Cap Orthopedics is Facing a Historic Valuation Crisis
The investment landscape for orthopedic innovation is shifting under our feet, and to get a clear view of the damage,
From “Wow” to “Flight”: The 5 Stages of an Orthopedic Life
I notice trends. After decades of startups, recruiting, podcasting, and pattern-matching across thousands of conversations in this industry, I’ve realized
What a 510(k) actually costs in 2026… because nobody tells you the real number until you’ve already spent half of it
Guest post by Lisa Voronkova, Founder & CEO of OVA Solutions and author of the “Hardware Bible.” Follow Lisa’s free
The Rise and Fall of the Bunion King: Making sense of the Treace Medical collapse
What happened? Many people have asked me this question over many quarters. It’s complicated, but I am going to do
The Tiger Dashboard – April 2026
Sharing the best monthly DASHBOARD in the ortho industry to the lucky OrthoStreams Subscribers ($1/day) – no-ads, no bias, just
An Ortho Startup’s insight into the VC Mindset
Most orthopedic founders view Venture Capital as a black box or, worse, a necessary evil. But if you want to
Big Ortho execs, it’s time to look in the mirror. You should be ashamed of yourselves.
Employees working at Big Orthos should be more financially literate and read the public disclosures each quarter. What we are
How to develop your new Orthopedic product idea.
This is a public service announcement for orthopedic entrepreneurs. The funding climate is frosty, but investors are still writing checks—they’ve
An inside look at a successful startup – Ellipse Technologies
The acquisition of Ellipse Technologies by NuVasive for $410 million—representing a staggering 10x sales multiple—remains a gold standard for orthopedic
The Orthopedic Monopoly: Why Being “The Only” Beats Being “The Best”
In our orthopedic industry, we often talk about innovation. But true success isn’t just about a slightly better screw; it’s
5 Historical Game Changers in Orthopedics
Let’s go back in history to look at five game-changing innovations in orthopedics and see how they originated. These five changed