by: TigerPosted on:

All the ortho trends that I see right now.

Hey there, it’s Tiger Buford, your “go-to” retained recruiter in orthopedics who understands startups. I talk with ortho company leaders every day and compiled this comprehensive list of trends that I see, but I may have missed some. Let me know.

Buckle up because 2025 is shaping up to be a wild ride in our industry. We’re looking at a deal-making gold rush with strategic acquisitions set to skyrocket, while the private equity takeovers are cooling off. The Big Orthos, rolling in cash but starved for growth, are eyeing up the smaller, beaten-down public companies for mergers, thanks to a more lenient antitrust climate. Meanwhile, the Little Orthos are finding the moat around healthcare access getting deeper, with the Big 7 tightening their grip. Surgeons? They’re making less while working more, and more are turning into employees. But it’s not all doom and gloom; IPOs are back on the menu, and with AI, ASCs, and a shift from traditional trade shows to podcasts, we’re seeing some real innovation. And let’s not forget, the FDA’s eye is on cybersecurity and easing up on some regulations, which could shake things up. So, what’s the takeaway? This year, it’s all about doing more with less, leveraging AI, and navigating through these big changes. Stay sharp, stay informed, and let’s tackle this transformative year together!

Let’s get started with the Trends.

  • Deal Making Time: Buckle up because 2025 is shaping up to be a wild ride in our industry. We’re looking at a deal-making gold rush with strategic acquisitions set to skyrocket, while private equity takeovers are cooling off. The Big Orthos, flush with cash but struggling for growth, are eyeing up the smaller, beaten-down public companies for mergers, thanks to a more lenient antitrust climate. This trend reflects a broader shift towards consolidation in the sector, potentially reshaping the competitive landscape
  • More Access Hurdles for the Little Orthos: The Ortho Industrial Complex (aka the Big 7 Orthos – J&J MedTech, Medtronic Spine, S+N, Stryker Ortho, ZB, Arthrex, Glovasive) will continue to build a moat around healthcare providers, dominate access and continue to keep the little orthos out. Read – How the Big Orthos leverage Confusopoly to their benefit.
  • Lower Surgeon Compensation: The average orthopedic surgeon will earn less money while doing more work. US surgeons are slowing reverting to the EU surgeon mean pay.
  • IPO Time !: Public offerings will be back in 2025. We will see the first ortho IPO in many quarters. Read – Thoughts on the 2025 IPO Market for Orthos.
  • Veteran Sales Reps are Less Useful: As the orthopedic industry shifts towards specialization and technology-driven sales strategies, the traditional broad skill set of veteran sales reps is being re-evaluated. These experienced professionals, once valued for their generalist knowledge and problem-solving abilities, are now navigating a landscape where specialized product expertise and adaptability to digital tools are increasingly pivotal. This evolution suggests that while the core competencies of seasoned reps remain valuable, there’s a growing need for them to adapt or enhance their skills to align with current market demands. By 2025, this might lead to a transformation in roles rather than a decline in utility, focusing on mentorship, strategic account management, or transitioning into new areas where their experience can be leveraged differently
  • Surgeon Loss of Agency: In 2025, more orthopedic surgeons will become employees. Around 75% of US orthopedic surgeons are already W2s.
  • More ASC Migration: The ASC movement continues. Orthopedic procedures are increasingly being performed in outpatient settings like ASCs. This shift is driven by cost savings, improved efficiency, and patient convenience.
  • Trade Shows are Less Useful for Manufacturers: Major surgical conferences are witnessing a decline in surgeon participation, booth sizes, sales activities, and company-surgeon interactions, driven by shifts towards digital information channels and the pressures of practice demands. Read The decline of NASS: Why device companies are abandoning big conferences.
  • More Product Info from Podcasts: It might sound odd, but in 2025, surgeons will increasingly tune into podcasts for the latest product scoop. It’s all about catching up on the go, away from the sales pitch noise of the industry. 5 examples:
    • The Orthobullets Podcast: Rapid-fire review of key orthopedic topics, guidelines, and surgical techniques.   Podcasts.apple.com
    • JAAOS Unplugged: Informal conversations with leading orthopedic surgeons. Apple Podcasts
    • OrthoJOE: Apple Podcasts
    • The Ortho Show:Interviews with orthopedic surgeons and healthcare professionals on the latest advancements. Buzzsprout
    • Becker’s Healthcare — Spine and Orthopedic Podcast: Daily 15-minute episodes covering business and clinical topics in orthopedics and spine. Apple Podcasts | Spotify
    • BoneChat on YouTube: Startup leaders discuss best practices on innovating, funding, getting regulatory approvals, and selling. YouTube. https://bonechat.com/
  • AI Boosting Productivity: Productivity per employee will increase because of two major movements – super useful AI tools and medical device de-regulation.
  • AI Driving Diagnoses: More patients will self-diagnose their ortho and spine issues by using AI tools. Today, ANYONE can drop an x-ray, an MRI or diagnostic notes into an AI and get diagnosis and treatment advice. There are 4 great AI tools that are free – Grok on X (formerly Twitter): x.com, Google Gemini: Google AI Studio – Gemini , OpenAI: openai.com, Claude by Anthropic: claude.ai . This will force more innovative healthcare professionals to use AI for faster, and more accurate diagnoses.
  • VAC Shift: VAC committees have become one of the highest hurdles for selling new products. They are not going away, but many will drop the DEI criteria when evaluating new products. If you need help navigating VACs for your new products, best to contact Mark Copeland.
  • Lean Sales Teams: Ortho device companies are learning to do more growth with fewer employees. The Big Orthos have achieved record sales with fewer employees by adopting strategies like automation, outsourcing, and data-driven decision-making, learned from the necessity of efficiency during the Covid period. Read – Doing more with less.
  • FDA Stepping Back Policy on DEI: FDA will drop the DEI criteria proposed during the Biden administration when advising new clinical studies. Read – I’m not making this up… The FDA will be mandating DEI for ortho clinical studies.
  • Implant Prices Dropping: While the dramatic drop in implant prices may be leveling off, a combination of heightened competition, the shift to ASCs, increased cost-consciousness, pricing transparency, declining reimbursements, and the negotiating power of hospitals are driving down orthopedic and spine implant prices.
  • FDA Stepping Up Policy on Cybersecurity: The FDA is increasingly concerned about cybersecurity in medical devices due to their growing connectivity. As more devices integrate with networks and the internet, they become potential targets for cyberattacks, which could compromise device functionality, patient safety, and data security. The FDA recognizes that vulnerabilities in these devices can lead to unauthorized access, data breaches, or even manipulation of device operations, posing significant risks to patient health. Consequently, the FDA is taking a stronger stance, emphasizing the need for manufacturers to incorporate robust cybersecurity measures from design through to post-market surveillance, ensuring that devices are resilient against evolving cyber threats
  • Prompt Engineering is the New Skill: Everyone will have to learn “prompt engineering” this year to better use the new AI tools.
  • More Digital Marketing for Small Orthos: Small orthopedic companies will increasingly leverage digital marketing strategies to reach surgeons and hospitals directly. This trend is driven by the declining effectiveness of traditional trade shows and the rise of digital information channels like podcasts and online platforms. Expect to see smaller orthos investing more in targeted online advertising, social media engagement, content marketing, and search engine optimization to build brand awareness and generate leads in a cost-effective manner. Read- The 10-Step Marketing Playbook for Startups.
  • Adaptive Algorithms Guidance: FDA will write a guidance document around “adaptive” algorithms (algorithms that change with each new patient data set and each new decision made).
  • The Quest for More Clinical Data: Even Class II devices cleared under 510(K)s need more and more data and post op reporting. VAC committees will increasingly ask for this also. The newest ask is “economic analysis” data.
  • GLP-1s Impacting Elective Surgeries: A growing percentage of would-be elective ortho patients will avoid or delay surgery by taking GLP-1s dropping 15% of their body weight and off-loading joints and spine. Read – The GLP-1 revolution will shrink orthopedic surgeries.
  • AI+Data Integration: Let me explain this one. AI on its own is promising, but when integrated with data, it provides intelligence at the point of decision, giving clinicians a superpower to do more, more intelligently, and faster. AI isn’t just an individual platform; it’s integrated into every aspect of healthcare, much like the internet has been. The key for healthcare professionals is to understand, deploy, and use AI in their daily work.
  • FDA Deregulation: The FDA’s anticipated changes in 2025 could streamline orthopedic device approvals, fostering innovation but also introducing significant risks regarding safety and regulatory alignment. Read The FDA 2.0
  • More Personal Executive Security: Big Ortho Executives will ramp up personal security and crisis management teams because of the murder of the United Healthcare CEO.
  • More Robots: While the jury is still out on whether robotic surgery definitively improves patient outcomes compared to manual surgery , the aggressive adoption of this technology by major orthopedic companies suggests an ulterior motive . By providing hospitals with robots at reduced costs or with minimal usage commitments, these companies are essentially employing a “razor-and-blades” strategy . They aim to lock hospitals into their ecosystem, ensuring a steady stream of revenue from the sale of proprietary implants designed for use with their robotic systems.
  • Autonomous Robotics: In 2025, surgical robotics is poised for a significant leap forward with the development of autonomous systems that use imitation learning to perform complex surgeries with minimal human intervention.
  • Expansion of Treatment Modalities: Private practices are beefing up their service menus to keep patients in-house. It’s no longer just about peripheral nerve stimulation for pain; if you can treat it, why send your patients elsewhere? This year, expect a broader range of treatments under one roof.
  • AI and ML: Slow at first, but AI and ML will revolutionize diagnostics, treatment planning, and patient management by providing predictive analytics and personalized medicine.
  • 3D Printing and Custom Implants: Customized implants for better fit, functionality, and potentially faster recovery. The use of 3D printing for both implants and instruments will grow, with advances in biomaterials. restor3D has a chance to lead this movement.
  • More MIS Surgery: Driven by smaller incisions, less trauma, and faster recovery, MIS techniques will advance, particularly in spine surgery, with the support of robotics, real time imaging and specialized instrumentation.
  • Biologics and Regenerative Medicine: Interest in therapies promoting tissue healing and regeneration will grow, potentially avoiding major surgery. Expect more sophisticated biologics and active research.
  • Data Analytics and Outcome Tracking: Value-based care emphasizes the need for data to demonstrate treatment effectiveness. More sophisticated platforms will track outcomes and refine techniques.
  • Digital Health and Remote Patient Monitoring: Wearables, telehealth, and mobile apps will allow for remote monitoring, aiding in early detection of complications and enhancing patient care.

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