Knee and hip replacement surgery is a painful and expensive process. Furthermore, there are many risks associated with these surgeries — including infection, improper healing, and failure of the replacement material. There is a clear market need for better joint replacements and better surgical procedures.
Monogram Orthopaedics was founded to address this need. The company is developing personalized orthopedic implants using 3D printing and robotic surgery. We reached out to founder Dr. Douglas Unis to learn more about this exciting medical advancement.
Note: This interview was conducted over phone and email. It has been lightly edited for clarity and length.
Can you give us a brief elevator pitch for your company?
Monogram is a medical technology company ushering in the future of joint reconstruction. We are developing a product solution architecture to enable mass personalization of orthopedic implants by linking 3D printing and robotics via automated digital image analysis algorithms. We are designing our state-of-the-art surgical robot and implants to mitigate the risks of poor placement, fracture, and subsidence to give surgeons confidence that they can install implants that fit every patient — perfectly.
What inspired you to take the leap and build this company?
Joint replacement technology has, in many ways, remained the same for 40-to-50 years. Often crude and finicky instruments like saws and jigs are used to prepare the bone for geometric and rigid generic implants that don’t accurately fit. Insertions are often eyeballed and subject to proper surgeon execution. We saw a massive opportunity to completely shift the paradigm and bring orthopedics into the 21st century — and we took it!
What past experiences prepared you to start, build, and lead your company?
Starting a company is difficult because you have to have a mastery of so many things. That’s where having a varied and qualified team that can combine skill sets and experience comes in. Our combined knowledge of engineering, project management, medicine, and capital markets allowed us to build Monogram from the ground up.
What is your vision for the future of the industry you are operating in?
According to Millennium Research Group, by 2027 514,000 knee procedures and 104,000 hip procedures will be robotic. Today, only 8% of knees are uncemented versus 95% of hips. Approximately 1 in 5 patients are not satisfied with their knee replacement. We believe that orthopedics’ future is patient-optimized 3D printed implants that leverage robotics capabilities to improve accuracy and minimize the risks associated with placement. We see these trends on the horizon, and we want to accelerate their mass adoption to help improve the patient experience long term.
Who is on your team and how did you come together?
The Monogram c-suite includes a board-certified orthopedic surgical technologist with extensive experience with orthopedic robotics and surgical procedures as well as a Caltech trained engineer with comprehensive finance and sales experience. We have recruited a high caliber engineering team with expertise in orthopedic robotics and Medtech product development and commercialization. Both founders agreed about the shortcomings of current orthopedic technologies and the opportunity to address those shortcomings with improved technology solutions.
Do you have any competition, if so, how do you differentiate?
The orthopedic joint replacement market is oligopolistic, with the four largest players representing 76% of the market. In orthopedic robotics, it’s even more consolidated, with Stryker enjoying an 87% market share. These companies have extensive distribution networks and are well-capitalized, but their size and segmented market approach impede new product development and innovation. These companies do not compete based on insurmountable IP or technology barriers, which will be the basis for our differentiation. We plan to compete with better products that we can deliver more cost-efficiently.
What does your business model look like?
The money in orthopedics gets made on the implants — all of the ancillary equipment that facilitates the procedure is the cost of doing business. The more differentiated that ancillary equipment is, the better, but it’s not where the money gets made. It’s more of a Trojan horse that facilitates the implant sales. We plan to use it as such — we will leverage Moore’s law, which drives the commoditization of robotic hardware, and aggressively discount our hardware to focus on placing our high margin, highly differentiated patient optimized implants. Our CT based planning and 3D printed manufacturing process will help us streamline inventory utilization.
What brought you to equity crowdfunding and how do you intend to use the money you raise this round to scale the business?
Disrupting the orthopedic market was always going to be tough. We are going up against giants with entrenched market positions worth billions. But, with crowdfunding, we can swarm the competition and overwhelm the market with our simple message that the status quo isn’t good enough. We want to share our story with thousands and thousands of advocates worldwide to make patients and other stakeholders aware that the current state of technology in orthopedics isn’t the best it can be. Our message will empower patients to demand more of their surgeons and ultimately get better orthopedic outcomes. We plan to use our proceeds to develop and commercialize our implants and robotics, and by crowdfunding, we will already have thousands of Monogram advocates for our market launch.
What do you want potential investors to know about you and/or your company?
We have a differentiated product solution, protected with numerous patent applications for a large and growing market. We have a best in class team that is well supported, high caliber surgeon advocates, and excellent product-market fit. We are addressing serious clinical pains that we think we can solve with improvements in technology. Finally, we think we will be early to market with a navigated, multi-joint actively milling robot arm for patient optimized 3D printed implants, which will be the first of its kind.
As you think about the business 5-10 years down the road, what do you see exit opportunities looking like? have you set any future goals for the company?
Our plan is to build the company for an IPO — and if we get an attractive offer prior to that, we will put shareholder interests first and certainly consider it. As long as an offer represents what we think the company is worth, we will certainly consider it. There are plenty of companies in orthopedics that are well-capitalized for large transactions. With Stryker enjoying an 87% market share in orthopedic robotics and outperforming in knees, there is mounting pressure on large strategics to find ways to compete, and that may be through acquisition. Nothing is off the table.
We at KingsCrowd are excited to see where Dr. Unis and his team take the company. Monogram Orthopaedics is currently raising on StartEngine.
About: Olivia Strobl
Olivia comes to KingsCrowd with a background in venture capital and technology. She spent time at Glasswing Ventures, an AI-focused venture fund in Boston, before joining the KingsCrowd team. There she helped develop machine learning algorithms for the opportunity qualification of preseed and seed-stage startup companies. Prior to her time at Glasswing, Olivia worked in a lab studying the neural correlates of attention. She holds a degree in Neuroscience from Wellesley College.