Intellijoint Surgical has developed a miniature navigation system, intellijoint HIP, that makes hip replacement surgeries more accurate. Approved by Health Canada and cleared by the FDA, intellijoint HIP has been used in thousands of surgeries across the US and Canada. The company’s journey to scale not only showcases its pride in being Waterloo-based, but also its focus on a deep understanding of its market and a passion to give back to the ecosystem and community.
Unlike many other companies, Intellijoint never pivoted. CEO and Co-founder Armen Bakirtzian and his two co-founders have been laser-focused on hip replacement technology ever since Bakirtzian observed his orthopaedic surgeon father in the operating room for a hip replacement procedure in 2007. Bakirtzian learned that there was a lack of access to affordable technology that could help improve the accuracy of total hip replacements; orthopaedic surgeons were relying heavily on just their training and experience to accurately position the artificial implants. Up to 49% of patients though may have a percievable leg length discrepancy*, and up to 10% will experience dislocation following a total hip replacement**.
It was evident that this market was underserved and that technology advancements in this field desperately needed an upgrade. Bakirtzian and his two fourth-year engineering classmates, now co-founders, Richard Fanson and Andre Hladio, created a solution. They pitched the idea at Ontario’s Next Top Young Entrepreneur Pitch Competition in 2010 and won an initial round of investment. But just because there was an obvious need in the market did not mean the team did not face challenges.
Challenges with entering the market in Canada
“It was particularly hard to grow here [in Canada] because of how our healthcare system is set up—and this is not abnormal for Canadian medical device companies,” says Bakirtzian.
In the US, the number one reason orthopedic surgeons are sued is because of discrepancies in leg length following hip replacement surgery. Thus there is a high incentive to use more accurate technology and this facilitated intellijoint HIP’s entry into the market. In contrast, in Canada, incentives for accuracy are few and the healthcare system struggles to pay extra for technology upfront even if the cost-savings are greater down the road.
Gaining a deep understanding of the market
Intellijoint differs from many of the large life-science companies in Canada because its scope of activity is so broad. Working from their home base in Waterloo, the team does everything from scratch, from ideation to design to clinical trial programs to commercialization.
The company developed a strategy to hire young, hungry, intelligent Canadian talent to shadow experienced US consultants in order to build its core competencies in-house. It used this technique and navigated the US market by making a conscious decision to focus on two major cities, New York and Chicago. Within the first 12 months, Intellijoint had a deep understanding of its customer base and every stage of the adoption process.
“It was interesting to observe differences along the way from the early-adopter category to the early-majority, to [see] how they behave and interact with technology, and then learning the strategies once you get the adoption,” relates Bakirtzian. The team used these learnings to scale in more cities more efficiently, which ultimately lead to constant adoption. By being able to go deep within a market, the company was able to demonstrate long-term value to its investors.
Intellijoint applied for the Ontario Scale-Up Vouchers Program (OSVP) with a goal to expand its commercial success outside of Canada while continuing to operate in Waterloo. The funds will help them scale faster by hiring more people in a shorter period of time, allowing them to move quickly in the marketplace.
As Bakirtzian explains, “The faster we can get [intellijoint HIP] into our surgeons’ hands, the happier we are and the happier the patients are. This is why the OSVP project is significant for us. We’ve been very capital-efficient over the past couple years, and we hope to deliver many more multiples of value back to our country, people and community.”
Giving back to Waterloo
Although most of its success has been outside of Canada, Intellijoint is keen to give back to its home city. It is working toward building a life science campus in Waterloo that will provide an environment for companies to learn and grow. Ultimately, it aims to prevent two common outcomes:
- Companies staying local and failing as a result.
- Companies choosing to leave the country in order to scale.
Intellijoint’s vision is to build an ecosystem to further economic prosperity, job creation and intellectual property retention. “This is a foundational necessity to the benefit of our country,” asserts Bakirtzian. “There are many healthcare companies coming up behind us and it’s our position to share that [knowledge] with the ecosystem. To solve a medical problem and see it come to fruition and actually help people is extremely rewarding.”
Rewards and milestones
Bakirtzian recently had the opportunity to observe in the operating room at Mount Sinai Hospital in Toronto. With the use of intellijoint HIP, the surgical team was able to dramatically reduce the trauma of the operation and even retain some of the original implant—something that surgeons would not have been able to do without this technology.
To date, intellijoint HIP has been used in over 5,000 hip replacement cases, which is only about 1% of the total US market. The company recognizes there is a lot more work to be done. “We embody hunger and desire to do better. That is what drives us. We’re just getting started,” says Bakirtzian. “It’s so rewarding to see something you created making someone’s life better. What we do does significantly impact lives.”
Intellijoint Surgical, along with four other innovation intensive companies, was awarded a $1-million voucher from the Ontario Scale-Up Vouchers Program in March 2018.
About the Ontario Scale-Up Vouchers Program
The Ontario Scale-Up Vouchers Program is a four-year, $32.4-million initiative funded by Ontario’s Ministry of Economic Development and Growth and the Ministry of Research, Innovation and Science. It is delivered through MaRS, Communitech and Invest Ottawa.
The program aims to accelerate the growth rate of high-potential Ontario technology- and innovation-based firms into globally competitive firms that drive disproportionate growth in revenue, exports and employment.
*Ellapparadia et al. Leg length discrepancy in computer navigated total hip arthroplasty – how accurate are we? Hip Int. 2016 Sep 29;26(5):438-443.
*Sykes A, Hill J, Orr J, et al. Patients’ perception of leg length discrepancy post total hip arthroplasty. Hip Int. 2015;25(5):452–456.
**Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002 Dec;(405):46-53.