The New Thinking in Orthopedics

I talk with orthopedic folks in different companies every day. It astonishes me how many people in our industry get caught up in the inertia of the successes of the 20th century. When business is healthy and growing, people fall back into historic business behaviors.

While these default orthopedic folks are sleeping, new disruptive orthopedics companies are challenging the status quo with a new thinking in orthopedics.

Let me share a few examples.


Old thinking – Our product is implants and instruments. Implants are made in a variety of sizes (like clothes). We sell implants and some disposables.

New thinking – Our product is the data that is captured by devices including diagnoses systems, imaging systems, tracking systems, and clinical outcomes systems. Implants are made on demand just-in-time for each patient. We will be selling data in the future.


Old thinking – Sales people need to make sure that the product is inside the right OR and is ready for use. Sales people should spend most of their day driving, working on case prep and case support. Reps should be inside the OR during the case to make sure there are no mistakes, and to keep the competition away.

New thinking – Reps will eventually be forbidden in most ORs for routine cases. Sales people should be focused on helping new customers only. Sterile-packed procedure kits are shipped to customers the next day. Asset/implant usage is tracked, automating the supply chain and providing data which enables more efficient resource allocation.  Digital surgery support is made available to the surgeon for routine cases. New customers are generated through direct-to-surgeon selling techniques and immersive training courses.


Old thinking – Orthopedic marketing should be focused on product features and the marketing output is physical marketing items with poor metrics – brochures, packaging, trade show booths, sales samples, cadaveric surgical training, and useless company websites.  This helps in relationship selling.

New thinking – Orthopedic marketing should be focused on solving problems for surgeons, hospitals and patients and the marketing output is digital content using sophisticated social media campaigns direct-to-surgeon and direct-to-consumer with mind-blowing real-time metrics. [more]

Product Pipeline

Old thinking – Startups must go WIDE and have a ton of complementary new products to compete. Sales reps need to have a multitude of products in their bag to cross-sell and up-sell in the OR.

New thinking – Startups can go DEEP into one procedure, create a monopoly and succeed – SpineTech, Kyphon, Treace Medical Concepts.


Old thinking – In order to be competitive, learn to quickly become a fast-follower of the newest technology trends. Compete in the hottest new space.  Spine yesterday, Robotics today.

New thinking – In order to be competitive, look past the trends. Innovate where nobody else is looking. Be contrarian. Create a brand new treatment category with zero competition. Read about contrarian company examples here.


Old thinking – Technology consist of anything that you can do mechanically with titanium, CoCr, SS, polyethylene, and PEEK.

New thinking – Technology consist of anything you can do digitally with imaging tools, sensors, digital tracking, 3D printing materials on demand, VR training, machine learning, and pattern matching. The implants and instruments are the by-product of our digital products.


Old thinking – Employees work for leaders in order to make them successful. Employees are tools of the business.

New thinking – Leaders work for the employees to create success. If leadership does a good job of empowering employees, everyone wins.

Getting Acquired

Old thinking – Startups must tease the strategics with their whiz-bang technology, patents, and early clinical data to get acquired.

New thinking – Startups must achieve the $40M-$75M annual sales with an impressive sales trajectory to get acquired. Today, the strategics do not buy technology because they are risk-averse, instead they buy sales growth and new customers.


Old thinking – Startups need to have a formal relationship with a “Strategic” as a key endorsement in order to drive help fund-raising.

New thinking – Startups do not need the Strategics anymore. Strategics DO NOT invest in early-stage orthopedics companies anyway. Startups with truly disruptive business plays can easily fund through angels and high-net-worth individuals. Recently, one ortho startup went through crowd funding, and another one was solely funded by the early adoption customers.

What did I miss?