Copy to clipboard 
We recently unveiled the first look at our new enabling technology reporting segment. As a reminder, the new reporting category officially launches in early 2023. Our initial segment estimate is $1.6 billion in sales for 2021, or about 3% of the global orthopedic market.
There are few surprises among the ten largest orthopedic companies in the market. The list closely mirrors the top orthopedic players overall. However, this article looks at newer and smaller players in the enabling technology space and how they’re adding value with innovative approaches. As with most orthopedic innovations, much of the robotic, navigation and digital technology on the market today was developed by smaller firms and then acquired by established players.
Below we’ll take a deeper look at Accelus, OrthAlign, DirectSync Surgical (formerly Evoke Medical), Carlsmed, Proprio and OrthoGrid.
Enabling Technology Is More Accessible than Ever
Robotics has a proven ability to generate revenue in orthopedics. However, systems like Stryker’s Mako and Medtronic’s Mazor remain out of reach for large swathes of the market. Even with rental agreements and earn-out contracts gaining popularity, many facilities simply don’t have adequate surgical volumes.
“Robotics is growing very quickly, but we don’t yet see it taking hold,” said Rebecca Whitney, ZimVie’s Senior VP and President Global Spine. “Some of that is due to cost constraints, frankly. Smaller community hospitals are priced out, and globally it can be cost-prohibitive. It is very difficult for most surgery centers to acquire a robot,”
However, startups such as Accelus seek to make robotics more accessible to those sites of care. The company arose from the merger of Integrity Implants and Fusion Robotics. Its Remi Robotic Navigation System is ideally suited to the ASC with a small footprint, portability and 10-minute setup. Remi is about one-third of the cost of a system from Medtronic or Globus Medical.
Accelus President Kevin McGann said Remi’s performance compares favorably to the systems from the market’s leading players. Those systems can take up to an hour to prep, making Remi’s quick setup an excellent boon for capacity. McGann said Remi’s ability to be agnostic with any CT imaging system and 2D fluoroscopy capability is game-changing and unlike anything available on the market.
In the knee replacement market, OrthAlign is also seeking to bring the best technology to more patients. “We’re driven by that belief that everybody deserves exceptional healthcare,” said Nicolas Aldrich, OrthAlign’s Vice President of Marketing. “We’re committed to making empowering technologies accessible to all. How do we ensure that everybody has access to technology regardless of their race, geography or site of service? That’s what we’re after.”
The company’s Lantern product is a handheld navigation system for precise and personalized implant positioning. It builds on the 10-year legacy of the OrthAlign Plus system that has been used in over 250,000 surgeries and accumulated more than 20 clinical validations. Lantern includes an iPhone-like form factor with improved processing power to expand capabilities like Bluetooth and cloud connectivity.
OrthAlign envisions a future with technology in every case but questions the economic feasibility of a piece of capital equipment in every operating room. Distributed navigation solutions and technology like Lantern can fill that gap, drive down revision rates and lessen the long-term economic burden of healthcare.
Enabling Technology Could Improve Healthcare Economics
Several startups in the spine market used 2022’s Musculoskeletal New Ventures Conference to feature technologies that could significantly reduce costs incurred from failed spinal fusion surgeries. DirectSync Surgical said re-operation rates for spinal fusion are 20% at the 11-year mark compared to 10% for large joint replacement. The company estimates spinal non-unions incur an additional $6 billion in yearly healthcare costs.
DirectSync Surgical is developing a human-powered smart implant that harvests its charge from the patient’s natural walking motion. That energy powers small pulses of DC electrical stimulation to promote bone healing. The implant can sense and transmit load data to inform treatment decisions.
DirectSync Surgical Medical COO and Co-Founder Leighton LaPierre said, “That entails new 3D-printed technology, biologics, stem cells, BMPs and external or implantable stimulators. All these solutions have had their challenges. We’ve tried to put the proven electrical stimulation therapy at the site it is needed most in a form factor that the surgeon is used to.”
Carlsmed is a company using patient-specific surgical plans and devices to be the last spine surgery a patient needs. According to the company, 46% of adults with spinal deformity surgery have complications, and 26% require revision surgery. Only 51% of procedures achieve the pre-operative plan for alignment.
The company merged with Precisive Surgical in 2019 to develop an end-to-end personalized surgical workflow platform. Carlsmed’s aprevo interbody achieved FDA clearance and Breakthrough Device Designation in late 2020. The device received the third largest New Technology Add-On Payment ever.
The use of aprevo begins with CT and X-ray imaging to generate a surgical plan and patient-specific implants. The implants are 3D-printed, sterile packaged and sent to the hospital for surgery. Carlsmed neither uses nor owns any capital assets. The company builds everything on demand.
Carlsmed Founder and CEO Mike Cordonnier said, “With our superior healthcare economics, we’re delivering value to hospitals. In many cases, we’re decreasing their cost of care directly for every patient as well as developing value for the payors. Because of our unique business model, we can provide this technology at high gross margins and continue to drive the growth of this personalized technology model.”
Data Is Everywhere Inside the Operating Room
Artificial intelligence (AI) is becoming more prevalent in orthopedics and has a chance to become a transformative tool for device companies and healthcare providers. Medtech startup Proprio is developing a surgical navigation system that combines AI, computer vision, augmented reality, virtual reality and robotics.
Neurosurgeon Samuel Browd, M.D., Ph.D., is the company’s Co-founder and Chief Medical Officer. He said, “Data is everywhere inside the operating room but has been severely underutilized. We have a huge opportunity to capture it, segment it into strategically informed action and ultimately improve patient outcomes through enhanced surgical insight, performance and feedback.”
According to Dr. Browd, companies should focus on developing intelligent, intuitive imaging technologies that collect clean, informative datasets to fuel truly effective AI. While the use of AI within surgical robotics dominates the conversation, Dr. Browd believes data must enable surgeon performance first.
OrthoGrid shares that performance-first ethos. The company developed an AI-powered ecosystem that detects and tracks specific anatomical landmarks through a sophisticated grid network. The software helps surgeons achieve the desired anatomic and implant alignment. The system uses AI to minimize direct interaction with the software from the surgeon or staff, thereby tightening the surgical workflow.
OrthoGrid’s three FDA-approved apps cover total hip replacement, open reduction and internal fixation trauma procedures, as well as hip preservation surgery. The system is about the size of a standing human being, carries a small IT footprint and connects to the hospital’s existing O-arm. Those features create a compelling economic case for healthcare systems.
Edouard Saget, Co-founder and Co-CEO of OrthoGrid, said, “We’re very committed to the value equation of better outcomes over cost savings. Hospitals are looking at where they spend their money. What item can be used by as many surgeons as possible? We believe we have a model that is competitive in cost savings. We have a 98% retention rate over five years.”
Enabling technology startups find themselves in a favorable position. Technology adoption is rapidly accelerating in orthopedics, creating a strong demand signal. The largest players in the space are disproportionately funneling research and development investments toward digital solutions. Those companies seek to acquire innovative platform technologies, like some of those mentioned above, to leverage across an entire portfolio.
We recently unveiled the first look at our new enabling technology reporting segment. As a reminder, the new reporting category officially launches in early 2023. Our initial segment estimate is $1.6 billion in sales for 2021, or about 3% of the global orthopedic market.
There are few surprises among the ten largest orthopedic companies in...
We recently unveiled the first look at our new enabling technology reporting segment. As a reminder, the new reporting category officially launches in early 2023. Our initial segment estimate is $1.6 billion in sales for 2021, or about 3% of the global orthopedic market.
There are few surprises among the ten largest orthopedic companies in the market. The list closely mirrors the top orthopedic players overall. However, this article looks at newer and smaller players in the enabling technology space and how they’re adding value with innovative approaches. As with most orthopedic innovations, much of the robotic, navigation and digital technology on the market today was developed by smaller firms and then acquired by established players.
Below we’ll take a deeper look at Accelus, OrthAlign, DirectSync Surgical (formerly Evoke Medical), Carlsmed, Proprio and OrthoGrid.
Enabling Technology Is More Accessible than Ever
Robotics has a proven ability to generate revenue in orthopedics. However, systems like Stryker’s Mako and Medtronic’s Mazor remain out of reach for large swathes of the market. Even with rental agreements and earn-out contracts gaining popularity, many facilities simply don’t have adequate surgical volumes.
“Robotics is growing very quickly, but we don’t yet see it taking hold,” said Rebecca Whitney, ZimVie’s Senior VP and President Global Spine. “Some of that is due to cost constraints, frankly. Smaller community hospitals are priced out, and globally it can be cost-prohibitive. It is very difficult for most surgery centers to acquire a robot,”
However, startups such as Accelus seek to make robotics more accessible to those sites of care. The company arose from the merger of Integrity Implants and Fusion Robotics. Its Remi Robotic Navigation System is ideally suited to the ASC with a small footprint, portability and 10-minute setup. Remi is about one-third of the cost of a system from Medtronic or Globus Medical.
Accelus President Kevin McGann said Remi’s performance compares favorably to the systems from the market’s leading players. Those systems can take up to an hour to prep, making Remi’s quick setup an excellent boon for capacity. McGann said Remi’s ability to be agnostic with any CT imaging system and 2D fluoroscopy capability is game-changing and unlike anything available on the market.
In the knee replacement market, OrthAlign is also seeking to bring the best technology to more patients. “We’re driven by that belief that everybody deserves exceptional healthcare,” said Nicolas Aldrich, OrthAlign’s Vice President of Marketing. “We’re committed to making empowering technologies accessible to all. How do we ensure that everybody has access to technology regardless of their race, geography or site of service? That’s what we’re after.”
The company’s Lantern product is a handheld navigation system for precise and personalized implant positioning. It builds on the 10-year legacy of the OrthAlign Plus system that has been used in over 250,000 surgeries and accumulated more than 20 clinical validations. Lantern includes an iPhone-like form factor with improved processing power to expand capabilities like Bluetooth and cloud connectivity.
OrthAlign envisions a future with technology in every case but questions the economic feasibility of a piece of capital equipment in every operating room. Distributed navigation solutions and technology like Lantern can fill that gap, drive down revision rates and lessen the long-term economic burden of healthcare.
Enabling Technology Could Improve Healthcare Economics
Several startups in the spine market used 2022’s Musculoskeletal New Ventures Conference to feature technologies that could significantly reduce costs incurred from failed spinal fusion surgeries. DirectSync Surgical said re-operation rates for spinal fusion are 20% at the 11-year mark compared to 10% for large joint replacement. The company estimates spinal non-unions incur an additional $6 billion in yearly healthcare costs.
DirectSync Surgical is developing a human-powered smart implant that harvests its charge from the patient’s natural walking motion. That energy powers small pulses of DC electrical stimulation to promote bone healing. The implant can sense and transmit load data to inform treatment decisions.
DirectSync Surgical Medical COO and Co-Founder Leighton LaPierre said, “That entails new 3D-printed technology, biologics, stem cells, BMPs and external or implantable stimulators. All these solutions have had their challenges. We’ve tried to put the proven electrical stimulation therapy at the site it is needed most in a form factor that the surgeon is used to.”
Carlsmed is a company using patient-specific surgical plans and devices to be the last spine surgery a patient needs. According to the company, 46% of adults with spinal deformity surgery have complications, and 26% require revision surgery. Only 51% of procedures achieve the pre-operative plan for alignment.
The company merged with Precisive Surgical in 2019 to develop an end-to-end personalized surgical workflow platform. Carlsmed’s aprevo interbody achieved FDA clearance and Breakthrough Device Designation in late 2020. The device received the third largest New Technology Add-On Payment ever.
The use of aprevo begins with CT and X-ray imaging to generate a surgical plan and patient-specific implants. The implants are 3D-printed, sterile packaged and sent to the hospital for surgery. Carlsmed neither uses nor owns any capital assets. The company builds everything on demand.
Carlsmed Founder and CEO Mike Cordonnier said, “With our superior healthcare economics, we’re delivering value to hospitals. In many cases, we’re decreasing their cost of care directly for every patient as well as developing value for the payors. Because of our unique business model, we can provide this technology at high gross margins and continue to drive the growth of this personalized technology model.”
Data Is Everywhere Inside the Operating Room
Artificial intelligence (AI) is becoming more prevalent in orthopedics and has a chance to become a transformative tool for device companies and healthcare providers. Medtech startup Proprio is developing a surgical navigation system that combines AI, computer vision, augmented reality, virtual reality and robotics.
Neurosurgeon Samuel Browd, M.D., Ph.D., is the company’s Co-founder and Chief Medical Officer. He said, “Data is everywhere inside the operating room but has been severely underutilized. We have a huge opportunity to capture it, segment it into strategically informed action and ultimately improve patient outcomes through enhanced surgical insight, performance and feedback.”
According to Dr. Browd, companies should focus on developing intelligent, intuitive imaging technologies that collect clean, informative datasets to fuel truly effective AI. While the use of AI within surgical robotics dominates the conversation, Dr. Browd believes data must enable surgeon performance first.
OrthoGrid shares that performance-first ethos. The company developed an AI-powered ecosystem that detects and tracks specific anatomical landmarks through a sophisticated grid network. The software helps surgeons achieve the desired anatomic and implant alignment. The system uses AI to minimize direct interaction with the software from the surgeon or staff, thereby tightening the surgical workflow.
OrthoGrid’s three FDA-approved apps cover total hip replacement, open reduction and internal fixation trauma procedures, as well as hip preservation surgery. The system is about the size of a standing human being, carries a small IT footprint and connects to the hospital’s existing O-arm. Those features create a compelling economic case for healthcare systems.
Edouard Saget, Co-founder and Co-CEO of OrthoGrid, said, “We’re very committed to the value equation of better outcomes over cost savings. Hospitals are looking at where they spend their money. What item can be used by as many surgeons as possible? We believe we have a model that is competitive in cost savings. We have a 98% retention rate over five years.”
Enabling technology startups find themselves in a favorable position. Technology adoption is rapidly accelerating in orthopedics, creating a strong demand signal. The largest players in the space are disproportionately funneling research and development investments toward digital solutions. Those companies seek to acquire innovative platform technologies, like some of those mentioned above, to leverage across an entire portfolio.
You are out of free articles for this month
Subscribe as a Guest for $0 and unlock a total of 5 articles per month.
You are out of five articles for this month
Subscribe as an Executive Member for access to unlimited articles, THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT and more.
ME
Mike Evers is a Senior Market Analyst and writer with over 15 years of experience in the medical industry, spanning cardiac rhythm management, ER coding and billing, and orthopedics. He joined ORTHOWORLD in 2018, where he provides market analysis and editorial coverage.
