Monogram Orthopaedics Founder Dr. Douglas Unis on the Future of Joint Replacements

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.

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!

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.

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.

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.

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.

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.

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.

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.

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.