How antifragile is your company?

Orthopedics was blindsided by the unexpected pandemic. What’s next? Nobody knows, but there will be another one. There will be unexpected winds in the future – financial, regulatory, competitive, patents, pricing pressures, lawsuits, etc.

How will your company respond these unexpected winds?


Let’s apply Nasim Taleb’s principles to the resilience of orthopedic companies. There are three types of orthopedic companies – Fragile, Resilient, and Antifragile. Let’s look at three examples and how these three companies weathered unexpected lawsuits.

“Wind extinguishes a candle and energizes a fire.” –Nasim Taleb


A Fragile company is like a candle that blows out after a gust of wind comes up out of nowhere. Fragile companies have a hard time dealing with unexpected events.

A good example is Acromed that ultimately capitulated. Acromed was served up $100M in lawsuits over off-label pedicle screw use. After 15 years and reaching the top of the spine world, Dr. Steffee (founder and owner) folded up his tent. He agreed to sell his company to DePuy and to settle roughly $100 million in lawsuits.


A Resilient company is like a torch with a fuel reserve. An unexpected gust of wind my temporarily reduce the flame but after the wind passes, the flame returns to its original state.

A good example is Sulzer Orthopedics that fought back and survived. Sulzer Orthopedics was served up a $1.3B class action lawsuit after selling defective acetabular cops, but they survived the lawsuits, changed their name to Centerpulse and were acquired by Zimmer.


An Antifragile company is like a bush fire. An unexpected gust of wind “energizes” the flame. Antifragile companies actually benefit from unexpected events.

Danek is an example of a company that fought back and got stronger. Danek was served up a $1B lawsuit over off-label pedicle screw use. They fought and emerged stronger than before and became the #1 spine company in the world.

You can hear the antifragile tone in CEO’s voice (Ron Pickard) in the midst of the lawsuit. “The reason we have taken, from Day One, a firm, aggressive position to not settle or negotiate, but to defend the use of the products. . . is that unlike in other (medical device) litigation, this is the standard of care, being used today by the same surgeons in the same manner as when the litigation began. This is our business. We intend to be in the business a long time, and if we succumb to legal blackmail, where will it stop?”

How will your company respond these unexpected winds?