In this solo podcast, Tiger Buford outlines the evolution of orthopedic medicine and device industry through three distinct eras. He defines Orthopedics 1.0 (circa 1960) as the era of pain‑relief focused prostheses with limited sizes and materials, exemplified by Sir John Charnley’s low‑friction hip and Dr. Marmer’s early total knee. Orthopedics 2.0 (starting in the 1980s) introduced surgical optionality, proliferating implant sizes, left/right variants, and minimally invasive techniques, driven by surgeon demand and resulting in higher procedure complexity and cost. The current phase, Orthopedics 3.0, is framed as an automation‑driven transformation powered by data and AI. Buford lists concrete examples: AI‑based fracture diagnosis, tele‑health consultations, patient‑specific implants (including genomic considerations), automated inventory and logistics, AI‑assisted surgical planning, VR‑based training, virtual medical education and conferences, avatar‑guided physical therapy, remote and distributed workforces, virtual hiring, and wearables‑derived clinical trial data. He positions these changes as a response to COVID‑induced acceleration and a push for less human touch, greater efficiency, and faster, more flexible device‑company operations. The episode ends with a call for listener feedback and a reminder to subscribe.
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Brought to you by Tiger Buford. Okay, welcome back to Inside Orthopedics. This is Tiger, your orthopedic industry insider and retained recruiter for early-stage orthopedic companies. This is episode number 36 titled The birth of Orthopedics 3.0. This year I realized that we are entering a whole new world in orthopedics. I call this Orthopedics 3.0. So let me take you down the pathway of Orthopedics 1.0 and 2.0 and show you how 3.0 is different. Enjoy Inside OrthoPeaks. Here we go. So it's been a crazy year so far, to say the least. COVID has accelerated change everywhere. Many industry sectors are turned upside down— retail, restaurants, tourism, travel, leisure, casinos, live entertainment, sporting events. Ultimately, somewhere around 50 million Americans will find new ways of making a Living this year. Fortunately for us and the orthopedics device community, orthopedic care is still in huge demand, and elective surgeries are coming back online mid-year. However, the orthopedics industry is going through a metamorphosis. I call this phase Orthopedics 3.0. But first, let me walk you through some quick history of Orthopedics 1.0 and 2.0 before before I introduce 3.0. Orthopedic care has been around a long time. You probably know the history of— it became— it started as fracture repair back in the Middle Ages, then evolved to casts and crutches. But I would really peg the beginning of modern orthopedics around 1960 with the advent of Osteoarthritis treatment and the very first prostheses. So that would be orthopedics 1.0. Orthopedics 1.0 was conceived with a focus on pain relief. In 1960, Sir John Charnley ushered in what he called low-friction arthroplasty with stainless steel and Teflon hips. Later changed to polyethylene. Charnley implanted his first stainless steel monoblock hip stems with PMMA cement and poly cups in the 1960s. The Charnley hip was available in one size. Then on the knee side, Dr. Marmer brought the first total knees into the world in the '70s with 3 sizes. Marmer implanted a side-by-side, 2 unis, to create the first total knee. Very few materials were available, very few sizes, and there was no rights or lefts. Surgeons just had to make the implant fit the patient. Sounds barbaric, but that's the way it was back then. During Orthopedics 1.0, the device companies concentrated on improving materials, improving kinematics, and decreasing bone conservation. And then the FDA started regulating orthopedic devices in 1976. So I consider that the first phase. Orthopedics 2.0 was born with a focus on surgical optionality. This started around 1980 with the surgeon's insatiable need for More choice, more anatomic sizes, rights and lefts, more technology, more constraints, more surgical approaches, MIS, etc. Device companies like Biomet started making customs for each surgeon in the 1980s. The more implant choices, the better. Choice became an addiction. The surgeon demanded every possible implant and instrument option in surgery to provide the best treatment for the patient. A new crop of practicing surgeons were trained on optionality in Orthotics 2.0, and they became hooked on optionality. Device companies were happy to deliver more choices. The result of 2.0 focus was increased procedure complexity, increased product availability for each case, and higher costs. This year, we've entered Orthopedics 3.0. The new focus is automation. This is driven by the need for less human touch, greater efficiencies, and less burden on hospitals. Ortho 3.0 is focused on all processes that touch the healthcare system, whereas Ortho 2.0 was primarily focused on the surgical event. From the device company point of view, this new metamorphosis affects Everything. R&D, testing, marketing, training, medical education, clinical studies, finance, operations, selling, marketing, service, inventory, logistics. The goal of Orthopedics 3.0 is seamless integration of all touchpoints throughout orthopedic care with less human touch. The revolution in automation is driven by data this time, not humans. The cost of automation is decreasing each year. Speed and flexibility will win the day for the device companies that move quickly in this new era. So what are some examples of the changes in Orthopedics 3.0? Let me list a few. In 3.0, orthopedic diagnoses will become more AI-driven. You may have seen the FDA approved an AI diagnosis for wrist fractures. Patient consultations will be done more over telehealth. On-call orthopedic consults will provide immediate triage and support. We're already seeing that. Implants will become more patient-specific. I've written about this a lot. Each patient will receive a unique implant based on their bony anatomy, their kinematics, and eventually their genome. Google BodyCAD for more information about that. Inventory, logistics, shipping, and delivery will become more automated. Preoperative surgical planning will become more automated. Sales support will become less human touch. Google Avail.io or Enhatch RepVision for more about that. Surgical training will become more VR-based. Google Precision OS for more about that. Medical education will become more virtual and more on-demand. Medical conferences will also become more virtual. For instance, the CCJR went virtual in May. Physical therapy will become more coached by avatars at home. And less coached by physical therapy professionals in a rehab facility. Go to OrthoStreams and search for Virtual PT. Then let's talk about work. The work done by employees of device companies will become more remote and more distributed. I've seen more and more companies that have gone to a more distributed model. Hiring will become faster and more virtual. Device companies will start to look for exceptional talent once they've removed the constraint of their physical locations. This is already happening. And clinical trials will derive more data seamlessly from wearables and less from nurse or doctor follow-ups. And so on. That's the end of my list so far. Send me a note and tell me what I've missed. Okay, that's a wrap for this podcast. Hope you enjoyed the explanation of the new orthopedics phase we're entering. As always, don't forget to subscribe and keep innovating, my friends.
