In this solo episode of the Inside Orthopedics podcast, Tiger Buford, an orthopedic industry insider and retained recruiter, defines "sacred cows" as entrenched, rarely‑questioned beliefs that create blind spots capable of harming companies. He illustrates the danger with Kodak’s refusal to embrace digital photography, then outlines seven specific sacred cows in orthopedics and the corresponding blind spots he sees emerging. The first cow is the reliance on sales of implants, disposables, and capital equipment, overlooking software as a new product. The second is the use of standardized implant sizes, while patient‑specific 3D‑printed implants are on the horizon. The third assumes biologic products need no outcomes data, yet companies that provide such data will win. The fourth dismisses genomics, but falling sequencing costs will enable DNA‑guided, personalized treatments. The fifth claims total joint replacements have excellent long‑term outcomes, despite a 16% revision rate in the US, indicating room for improvement. The sixth urges manufacturers to follow trends like robotic surgery, whereas contrarian innovators may capture the biggest gains. The seventh holds that sales reps must be present in the OR to ensure quality, but reps are being excluded and will likely be replaced by software. Buford closes by inviting feedback and encouraging listeners to subscribe and keep innovating.
Chapters
Brought to you by Tiger Buford. Hello, orthopedic leaders. Welcome to Inside Orthopedics. This is Tiger, your orthopedic industry insider and retained recruiter for early-stage orthopedic companies. This is episode number 30. Titled Sacred Cows in Orthopedics. Okay, a quick definition here. A sacred cow is a firmly held belief that is rarely questioned and is exempt from criticism or opposition in an industry. Every industry has its own sacred cows. Sacred cows create blind spots that can actually kill companies sometimes. In a most famous example in the photography world, we all watched the market leader in photography fall victim to a sacred cow mindset— Kodak. Kodak had actually invented the first digital camera, but instead of marketing the new technology, They went on the defense. They buried digital in order to protect their lucrative film business, and they continued to bury digital even after digital products started to reshape the photography market. Eventually, Kodak declared bankruptcy in 2012. It's probably one of the most famous Examples of sticking your head in the sand. So what happened? Well, fundamentally, Kodak just asked the wrong question. Management asked the question, "How do we sell more products?" instead of, "What business are we actually in?" There's a great lesson here for leaders in orthopedics today. I think the big orthos are not immune to a defensive mindset driven by short-term financial goals like a Kodak. Most big orthos are driven by 90-day financial cycles, and thus they are asking the wrong question: How do we sell more products next quarter? So I started thinking about this and I came up with 7 sacred cows in orthopedics. Let's jump in real fast. Sacred cow number 1: we sell implants, disposable instruments, and capital equipment. Our sales and profits come from these tangible implants disposable instruments, and capital equipment. So here's the blind spot: software is now becoming the product, not the tangibles. And this is happening faster than every— everyone realizes right now. All right, sacred cow number 2 in orthopedics: Implants come in a variety of sizes, shapes, constraints, angles, coatings for the best fit and function for the patient. It's been that way for decades. We've all been in surgery when the surgeon declares, "I think she is a size 7," and the circulating nurse or the rep grabs a size 7. Here's the blind spot. The future is moving towards single printed implant for each patient. All right, sacred cow number 3: selling biologic products really doesn't require clinical studies or outcomes evidence. A bone graft is a bone graft. Here's the blind spot. Biologics companies that provide outcomes data will definitely win in the future. A bone graft is not a bone graft. Okay, sacred cow number 4. A patient is a patient. The diagnosis is the diagnosis. We don't need to know the patient's genome in order to figure out the best treatment for a fusion, a joint replacement, or fixation. So here's the blind spot. Genomics is advancing so fast and the price for genomic mapping is dropping so fast that I believe all future orthopedic patients will receive individual treatments to solve their musculoskeletal problem based on their DNA profile for the best outcome. All right, sacred cow number 5. Total joint replacements are very successful procedures with excellent long-term outcomes. Just go to any orthopedic conference and watch the total joint clinical results presented you will see they are dominated by good and excellent results. Here's the blind spot. In the US each year, roughly 160,000 out of a million total joint surgeries are revisions. That's 16% revisions. I think there's a lot of room for improvement in total joints. Sacred cow number 6: device manufacturers should follow industry trends in order to be successful. Today the trend is robotic-assisted surgery, so you better get on board. Here's the blind spot: some of the biggest wins for orthopedic companies come from looking beyond the trends. Watch the contrarians. They will be the big winners in the future. And lastly, Sacred Cow #7: Sales reps are the last line of defense to ensure quality in the hospital. Reps should be inside the operating room during the case to make sure there's no mistakes. And to also ward off the competition. Here's the blind spot. Today, reps are getting kicked out of the operating room all across the country, and tomorrow reps will largely be replaced by software. That's it. That's all 7 sacred cows that I see. Which sacred cow struck a chord with you? Which cow did I miss? Send me a note. That's a wrap. Hope you enjoyed this review of 7 sacred cows in our industry and how they may be challenged in the future. Don't forget to subscribe and keep innovating, my friends.
