Capital Markets, SVB, Foot & Ankle Innovation

Startup capital is the fuel for innovation in foot and ankle surgery. There are several sources for capital with debt financing through banks representing one of them. Competition is good and the more banks willing to lend the more likely that new concepts, products, and creativity will appear in our operating rooms. But if there is trouble brewing in the capital markets, startup capital will become more difficult, and more expensive, to come by. 

 

SVB

Silicon Valley Bank was not a common name in the Orthopedic sector before last week. Now you'd have to be living under a rock to have missed its Twitter-fueled collapse.

 

Foot & Ankle and SVB

Nothing negative here for our industry. While Treace Medical had a relationship with SVB, by this report it has had no negative exposure to the collapse.

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Evolution, Not Revolution, in the Foot & Ankle Space

Several factors contribute to the foot and ankle market becoming the most lucrative across all orthopedic subspecialties. Following are five technologies primed and ready for acquisition.

 

1. RedPoint Medical 3D's Better Bunion is a hallux valgus correction system relying on pre-operative CT scans to form patient specific surgical jigs for several procedures, including bunions. Its cost is comparable to Treace Medical’s Lapiplasty, with less than half the steps.

2. From Novastep, Pecaplasty and Centrolock are minimally invasive hallux valgus correction systems that rely on jigs and guides designed by surgeons previously performing 3rd generation, minimally invasive chevron/akin procedures. At the end of 2022, new jigs were introduced to facilitate more accuracy and reproducibility for the system, especially for less experienced surgeons. 

3. Radian by Nvision is a minimally invasive hallux valgus correction system that does not rely on any intraoperative jigs. Rather, it is a low-profile buttress plate that stabilizes a transverse osteotomy with four screws.

4. SEAL's portfolio consists of an Illizarov external ring fixator, speed rail, mini rail, and pin to bar frame(s). One of the company's claims to fame is its easy-to-assemble, pre-built frames purported to save surgeons time, intraoperatively. 

5. Revolution T’s circular fixator and trauma frame offerings by Metalogix give surgeons fascile with external fixation a broader number of options intraoperatively that are simply not available using frames from larger companies. The company hasn’t reinvented the wheel, but a few of its innovations are undoubtedly unique.

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The Checklist

In his book, The Checklist Manifesto: How to Get Things Right(2009), Atul Gawande makes a compelling argument that we can do better, using the simplest of methods: the checklist. Adapted from other professions, including aviation, it helped socialize the concept of reviewing key attributes for a successful surgery, during the time-out, prior to initiating surgery.

 

Beyond the Checklist

Many complications are beyond the surgeon time-out with some estimates as high as 32% complication rate with inpatient cases. In the era of AI and EHR, can we do better without asking surgeons to scour patient medical records to assess risk factors? 

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MySurgeryRisk 

One of the first entrants is a University of Florida designed artificial-intelligence system called MySurgeryRisk, designed to help surgeons predict patients who are at higher risk for complications after surgery and need more attention or care during and after surgery.

 

Surgeons using this platform get risk profiles of their patients each day before they begin procedures. Delivered via mobile device, the profiles display the risks of postoperative complications, and how the patient compares to others with similar cases in the cohort. 

 

In a study to describe the prospective validation of the MySurgery Risk platform, surgeons made their own initial predictions, then compared them to the AI predictions. Compared with their initial risk assessment, the accuracy of the surgeons’ repeated risk assessment improved after interacting with the algorithm. 

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