The way I see the trends in 2023.

Profitable > Unprofitable

You want to work inside a break-even business or profitable business. Unprofitable ortho businesses are under extreme stress and have very few resources for new capital.

AI > Imaging/Nav > Extremities > Robotics > Biologics > Spine > Joints > Trauma

Your company should find a way to work in the AI or Imaging/Nav space today for max growth potential. The other areas have had their disruptive decade and have run their course. The other areas have too many competitors and too much price pressure with the exception of Extremities nearing the end of its golden years.

Software > Hardware

Example: You want to innovate in navigation instead of innovating in robotics, because its the future, because software is nimbler that hardware, because navigation can be agnostic as opposed to robots that are procedure-specific.

Small > Big

You want to work in a small orthopedic company for your career.

Disposable > Reusable

You want to be in the single-use disposable business, not the reusable instrument tray business, for better use of capital, better tracking of inventory, and less manual labor in the field.

Seed > Series A > Series B > Series C

In the this tight financial market, you want to seek funding as early as possible in your company. Fund-raising gets more and more challenging as you business matures. Extend your runway now, because the next round may be pushed way out. Read – Tightening.

Equity > Salary

You want to have more of your pay in equity and less in salary.


You want to figure out AR as a future technology to turn an average surgeon into a God-mode surgeon. VR is for training, not surgery.

Class II > Class III

You want to develop Class II innovations, as the FDA and Investors have all but shut down Class III innovation businesses.


You want to sell first in the US, as the future reg pathways and margins in the EU have created friction there.

Small conferences > Big conferences.

Your company will have more productive business results at the smaller conferences. Read – NASS and AAOS are slowing dying.

On-site > Remote

You actually should want to work on-site rather than remotely to accelerate your career.

Flexible > Rigid

There are less open roles in orthopedics than there are available talent right now. Read The great talent reshuffling of 2023 . You want have multi-dimensions skills in this job market, not just one skill like many.

Dataset Building > AI programming

Garbage in, garbage out. The big opportunity in orthopedics is building the best dataset, not the AI.

ASCs > Hospitals

You want to sell to ASCs and service ACS, rather than traditional hospitals, because of the ease of selling, the ease of servicing and higher margins.

Uncomfortable > Comfortable

You want to work in a culture that challenges you daily to get outside your comfort zone. A comfortable culture will make you weak.