Orthopedics is primed for mass customization of implants thanks to advancements in additive, AI and robotics. Fully leveraged, the technologies can produce patient-specific implants that achieve clinical benefit, decrease cost and maintain O.R. workflow. Founder and Chief Medical Officer of Monogram Orthopaedics, Douglas Unis, M.D., shares his reimagined vision of personalized joint replacement implants and just-in-time inventory solutions.

2. Orthopaedics
Reimagined

3. “…take an image and send out an instrument set and an implant that is going to fit perfect; it could dramatically
improve the efficiency of how we deliver these products to our customers.”
David Illingworth
CEO, Smith & Nephew
2011
THE INDUSTRY SEES THE
FUTURE

4. THE MONOGRAM SOLUTION

6. Why Orthopaedic Robotics Has Not Gone Away
Perfect X-rays
Better clinical results
Improved survivorship

7. BUT GEN 1 ROBOTS STILL HAVE ISSUES
Too expensive
Too slow
Too disruptive
Too big

8. GEN 1 NAVIGATION

9. GEN 1 POINT CLOUD REGISTRATION

10. | 44
GEN 1 IN PRACTICE

11. Less Disruptive – Smaller/Lighter
Faster (No haptics, streamlined registration)
Less Expensive – Moore’s Law
But still…Robots are being used
to drive sales of the same old implants.
BIG PLAYERS NOW
INVESTING IN GEN2

12. Gen 3 Orthobot
Faster, less disruptive, less costly,
and safer than Gen 2
AND
Designed for patient specific implants
that solve clinical problems

14. 3D Printed “Quick-Point” Guides for Rapid Registration

15. REIMAGINING
KNEE IMPLANTS

16. REIMAGINING
KNEE IMPLANTS

17. NOVEL IMPLANTS
SOLVING REAL CLINICAL
PROBLEMS

18. Monogram Stryker
Percentage
Difference
Axial Subsidence Drift (mm) 0.01206 0.03269 171%
Axial Subsidence Cycle Range
(mm) 0.09306 0.14035 51%
AP Motion Drift (mm) 0.00886 0.01245 41%
AP Motion Cycle Range (mm) 0.02870 0.03250 13%
IE Rotation Drift (deg) 0.00563 0.00875 55%
IE Rotation Cycle Range (deg) 0.03220 0.05723 78%
AP Tilt Drift (deg) 0.01683 0.00555 -67%
AP Tilt Cycle Range (deg) 0.02455 0.06448 163%
VV Tilt Drift (deg) 0.00253 0.00937 270%
VV Tilt Cycle Range (deg) 0.01886 0.02209 17%
ML Drift (mm) 0.01017 0.00656 -36%
ML Cycle Range (mm) 0.00866 0.00330 -62%
Tibial Micromotion Study
Summary:

19. REIMAGINING
HIP IMPLANTS

20. NOVEL IMPLANTS SOLVING
REAL CLINICAL PROBLEMS
GENERIC
BONE CONTACT
9X MORE
ACCURACY
1.4CM OFF-CENTER vs. MONOGRAM
STABILITY
6.3X BETTER
ROBOTIC MANUAL
PATIENT
MATCHED
=

21. Femur Micromotion Study Results:
Average Monogram 14.302 5.544 0.764 8.272
Average Standard 66.798 71.23 33.68 40.258
Percentage Difference 367% 1185% 4308% 387%
The Zimmer Biomet ML Taper implant had on average
634% higher final cyclic displacement

22. Mechanical Testing: Femoral Component
7206-4-Axial Compression Fatigue 7206-6-Neck Fatigue

23. Intellectual Property
International Publication Number (WO 2017/177182 Al) - APPARATUS, METHOD AND SYSTEM FOR PROVIDING
CUSTOMIZABLE BONE IMPLANTS
Provisional Patent Number (62/811,811,855) - CUSTOMIZED TIBIAL TRAYS CONTACTABLE WITH
AN UNDERLYING CORTICAL BONE, METHODS, AND SYSTEMS FOR KNEE REPLACEMENT
Provisional Patent Number (62/834,692) - CUSTOM HIP DESIGN AND
INSERTABILITY ANALYSIS
ROBOT MOUNTED CAMERA REGISTRATION AND TRACKING SYSTEM
FOR ORTHOPEDIC AND NEUROLOGICAL SURGERY
A SYSTEM AND METHOD FOR INTERACTION AND DEFINITION OF TOOL PATHWAYS FOR A
ROBOTIC CUTTING TOOL

24. ECONOMICS: INVENTORY
HIP ARTHROPLASTY
Actual Case Quantities:
80 Stems: $53,089
30 Boxes of Heads: $7,781
10 Shells: $3,429
60 Liners: $13,129
For cost approximations, manufacturing COGS generally
30% of ASP
$77,428 of implant inventory for
$4,949 of revenue
Approximately 7 trays of underutilized
instrumentation that needs to re-sterilized every
case
THIS DOES NOT INCLUDE:
The average S&P 500 company turns over it’s inventory 6.6
times more than the average large orthopedic company.
6.6 times
$1,565 of implant inventory for $100
of revenue

25. ECONOMICS: MARGIN ANALYSIS
3D Printed Stem: $525 (approx. 85% utilization)
Machine/finish/package: $200-300
Coated Acetabular Cup: $265-400
Poly Hip Liner: $100-300
Femoral Head: $110-175
* Forge/Machine/Finish/Package: $280-380
$445 unoptimized cost delta
Total Hip Arthroplasty ASP1 (2017): $5,136
THA
3D Printed Stem: $670 (approx. 65% utilization)
Machine/finish/package: $170-300
Femoral Component: $250-500
Poly Insert: $120-250
Patella: $60-135
* Forge or cast/Machine/Finish/Package:
$250-380
TKA
Total Knee Arthroplasty ASP1 (2017): $4,547
$590 unoptimized cost delta

26. 26
HIP DISTRIBUTORS INVENTORY
INVENTORY
TURNOVER
ZIMMER BIOMET $2bn 1.0x
SMITH & NEPHEW $1.2bn 1.0x
STRYKER $2.2bn 2.0x
EXACTECH $66m 1.2x
DJO SURGICAL |
DEPUY SYNTHES
- PRIVATE COMPANIES -
THE MARKET IS READY FOR
JUST-IN-TIME INVENTORY!
DISTRIBUTORS CAN EASILY HAVE 40+
IMPLANTS ON HAND FOR ONE PROCEDURE
MASSIVE COST OF INVENTORY
MANAGMENT
WHAT IS A 30%+
INVENTORY
REDUCTION
WORTH?

27. Good to the Bone