From Invention to Exit: Building Avitus Orthopaedics | LSI USA '24

This panel highlights the complete end-to-end journey and adaptability of Avitus Orthopaedics from the perspective of the founders.
Axel Strombergsson
Axel Strombergsson
, QuickVault, Veeva Systems
Maxim Budyansky
Maxim Budyansky
, Avitus Orthopaedics
Neil Shah
Neil Shah
, Avitus Orthopaedics

Axel Strombergsson  0:05  
Good afternoon, everybody. My name is Axel Strombergsson and I will be moderating this panel that he just mentioned. It's called from a mentioned to exit building Avitus Orthopedics. This is a 40 minute session and we plan for about 30 minutes here on stage. And after that we're gonna hand it over to guys and audience to ask our panelists some questions for that. So during the first 30 minutes, please think about some good questions to ask. With that I would like us to kick us off with having our panelists introduce themselves and give a little bit of an overview of Avitus. orthopaedics one. Neil, please kick us off.

Neil Shah  0:37  
Thank you, Axel. So as Axel mentioned, my name is Neil Shah, I was the co founder and CEO of Avitus orthopedics, maximum and I founded that out of graduate school in 2011. So that's pretty much 90% of my background right there. Prior to that did undergrad in Biomedical Engineering at Georgia Tech and a one year grad school program at Johns Hopkins in bioengineering, innovation and design. And also towards the early end of Aveda this also had a stint with the Johns Hopkins Coulter translational partnership as the deputy director to help clinicians and researchers take their projects and ideas and move them along the commercialization process and translating from bench to bedside to to bedside.

Maxim Budyansky  1:26  
My name is Maxim, Budyansky co founder and served as CTO for Avitus orthopedics. My background was mechanical engineering at University of Connecticut, and then did grad school at Hopkins where all this journey started for us. And in the past, in my past lives, I was involved in nuclear and hydroelectric energy spaces, as well as developing a laser microscope for cell mechanic detection for cancer cell diagnostics. And then I was involved in some projects overseas and Naipaul in India for antenatal screening and entered this entrepreneurship journey. And that's been the last 13 years or

Axel Strombergsson  2:07  
something. Thank you so much. Okay, so you mentioned that this journey started at Johns Hopkins and specifically within the CBT program. So tell us a bit more about that program, but also more specifically, what you learned about the importance of customer discovery?

Neil Shah  2:21  
Yeah, so the journey started, as Axl mentioned at C bid, which stands for the Center for bioengineering, innovation and design. It's a one year master's program at Hopkins. Maxim and I were the second cohort out of that back in 2011. And so we've had the benefit of seeing many alumni graduate from that program since then, and they've all gone on to do incredible things. Some of them have successfully exited startups, a lot of them spun out companies from their grad school program like we did. Some of them are still building incredible companies, many of them are here today. And I think what seabed did very well was reinforced the concept of bedside to bench to bedside. And what that means is don't start with a technology or solution and go finding a problem to apply it to, but really understand and unmet clinical need very well, all the stakeholders involved, and then build a technology and a solution around that need or those needs. And the way they really helped us do that was through this process of clinical immersion, where we got the opportunity to get thrown into the operating room, take off our engineering hats and just observe the flies on the wall and write down everything we saw what we thought worked well, what we thought didn't work well, questions we had. And then they coached us on really distilling that into concise, one sentence, unmet clinical needs statements, and then gave us audience with all the subject matter experts at this wonderful ecosystem of Hopkins. So we had the chiefs of different departments, we had hospital administrators, nurses, and we had the benefit of taking these unmet clinical needs, which just to give you a scope of it, there were 15 of us in this cohort, and we had 1000, unmet clinical needs statements that we came up with in a 10 week period. And so then we'd get into this room with all these chiefs of spine and ortho and OB GYN and general surgery and we could just rapid fire these need statements to them one by one, and they'd come back to us and say, you know, if you solve that problem, that's huge. That's a game changer for my practice. Or they'll say, you know, that might save my nurse five minutes, but it doesn't really move the needle for me. And then beyond that, we were given audience with folks from the FDA, reimbursement consultants, IP attorneys investors that told us, you know, yeah, there's a lot of money flowing into into that field, but not really into that field. And so we were able to take these 1000 needs that our group came up with and narrow them down to the top three to five needs that really passed all these steps. and filters that we felt were worth working on. And that was what we felt built a very strong foundation on which we could continue our journey or start our journey really. And the other key element there is they really drilled in to be solution agnostic when reviewing these needs, so don't muddy the waters, don't bias yourself with I'm going to solve this need this way. And, you know, highlight or do all this diligence with a solution in mind, but do it in a vacuum without any solution in mind. So you could really understand the need unbiased,

Axel Strombergsson  5:38  
very good, awesome program, very thorough with all the parts of that. That's really impressive. So one area that's really difficult, especially as specifically for first time founders, is sort of the lack of knowledge. Like you don't know what you don't know if you've never done it before. Right? And I guess the same was for you guys. What was some of the ways that you gained that knowledge that you can I needed to be successful, say with the FDA and third party manufacturing and other things of that nature?

Maxim Budyansky  6:05  
Yeah. That sentence, you don't know what you don't know. That was a mantra that was sustained throughout the entire journey of a Avitus for us. Were one of our early advisors, Terry kofi. That was something he told us, You don't know what you don't know. And the biggest challenge is the one that's right in front of you. So you're when you're an first time founder, no network, no money, no resources, how do you you can't hire people, you know? So how do you find that information, so tons of networking, attending seminars and conferences, eventually finding the right consultants to supplement your your operation. Going to finding those early suppliers, which is very hard to find the ones that want to work with a small volume startup company. But if you can find the ones who want to work with you, we learned a ton from them. And we also learned a ton from listening to their customers, we would always do referrals, we would always listen to people who have worked with those suppliers. And that would often uncover some really, bits of wealth of knowledge that would supplement our, our whole journey. So those are some of the things we did before having the funds to start bringing more resources and expertise in as funds allowed.

Axel Strombergsson  7:29  
Right, right. And, of course, another area where that is a challenge for startups. And that's why a lot of startups are here today is on the fundraising side of things. Right. But I know one area that you were very successful when it comes to that was grant funding. Tell us a little bit how you included grants into your fundraising strategy.

Neil Shah  7:49  
Yeah, so grants were grants were a big part of our fundraising strategy. They were crucial for us getting off the ground. So when maximum and I spun out a Avitus from our master's program. We jumped in with both feet. It started with three orthopedic spine surgeons coming to us with an unmet clinical need in their practice for a better way to harvest bone graft and marrow. And we spent a ton of time doing diligence, not just with our founding surgeons, but also surgeons all across the country where we were able to validate this need. And so there we were, fresh out of grad school, blessed with the with the bliss, of naivete, not knowing what we were getting ourselves into. And we had no working prototype at the time, we had $25,000 in the bank from a business plan competition that we won, that was our seed funding. And we were off to the races. So at the time, we pitched our butts off to angels and VCs, and we had very immature technology, we had no credibility to our name. So for first time entrepreneurs, grants have to play a big role in getting started. And for us, you know, the challenge was putting those puzzle pieces together. So grants come in all shapes and sizes. They have a lot of red tape around them. So some grants you can use for r&d, but not for operations. Some grants you can use to fund patent expenses, but not general legal counsel, some grants you can use to pay for consultants, third party consultants, but the money has to go directly to the consultant, it can't hit your bank account. So you know, these rules come up and you manage them. And I think one thing Max and I did a great job of was putting those puzzle pieces together in a way that allowed us to march down in a focused way to what we needed to do without really distracting us with some superfluous activities that were more of a distraction, and we were fine, walking away from Grants when we didn't need them. But throughout the journey we raised $2.8 million in non dilutive capital through various grants competitions. You know, the SBIR program was a big Part of that, but also, Connecticut, to its credit, had a lot of great programs that were available in the state of Connecticut and state by state that's going to vary. So we had that benefit. But there were also a lot of private organizations, nonprofits that we were able to leverage off of, as well. And I think one thing we we did really well it worked out for us was, we had a grant that got us an intern, that intern, one of the best interns we had her name was ora Penalosa, engineering intern, and we tasked her, her plate was full with engineering work. But then beyond that, we asked her to go scour the internet for grant opportunities, we call her the grant Hunter. And so every week, she'd come to us with a spreadsheet of hey, these are grant and competitions that we can apply to this is what the use of funds can be. This is what the eligibility criteria are. This is what the potential upside is, you know, this is a $5,000 grant, but this is $100,000. Grant, there's in kind services and so maximum, I could just kind of quickly go through that and triage, this is worth our time, this is not worth our time. And that that was a strategy that worked really well. For us.

Axel Strombergsson  11:07  
That's really great. That was really smart to have someone to to find those opportunities, both whether you're local, or or national, I guess. But for the audience here that want to pursue grant funding and can achieve something similar, but haven't done it before. What are some other recommendations you may have in terms of, for instance, write a strong proposal and set yourself up for success?

Neil Shah  11:29  
Yeah, one, one thing we always did. So some grants, you know, five minutes, type in information about your company hit submit, and it's off to the races, the organization will decide whether or not to fund you this, this small amount of money. But there are going to be other grants that are way more intensive, dozens of hours of your time to put together this application. And in those cases, you know, generally they describe what the RFP the request for proposal, the the criteria online, we never just stopped there. We would, you know, think, all right, we could use this grant for A, B, and C, right, these three things are probably good use of funds for this grant. And then pick up the phone and call the organization. Try to ideally, find a reviewer, if not an administrator of the organization and just have a conversation, try to tease out what's their internal review process, like, pitch them the three different ideas you have, and see which one aligns more with what they like funding versus not funding. And, you know, to our, I think our track record was that doing that positioned our applications to give us a competitive advantage over someone who didn't pick up the phone and make that phone call. And, you know, just taking a step back grants, in general, being a part of an integral part of the fundraising strategy. A lot of times for maybe non first time entrepreneurs, it's like, it's a huge time saying it's, it's not something that we want to spend or burn the opportunity cost on, you have to put so much time into this. And you may or may not get funds on the other side. But you know, some of these more in depth involved grants required you to sit down and think about your unmet clinical need your market size, the describing the technology, what your what your team is, and most importantly, what are the objectives of this grant? And what are the step by step things you're going to do in deploying that capital and whether we got the funding or not. This forced me and Maxim to think through and talk through what do the next six months look like, if we want to get our company from here to there? What are the actual steps to do that. And so the benefits of tapping into grants for especially for first time entrepreneurs, is setting you up to better articulate what that future looks like to stakeholders, like potential investors, to your your vendors, your employees and other stakeholders as well. Just

Maxim Budyansky  14:02  
follow up that, especially like SBIR, NSF, I felt like it was a stamp of approval to a lot of investors. You know, that's a group of that's an organization a group of PhDs that said, this is good. And now you're coming to an investor trying to raise some money and you you've already de risked it for them. So it can only help.

Axel Strombergsson  14:20  
That's really good, you know, the risks, your your pitch plus detailed your, your business plan will get better. So moving along a little bit in time here. Through through FDA, you had a pretty swift process there, but you even had your clearance earlier than expected. But after that, you did have a slight delay before you actually went into your first surgical procedure. So what what could you have done differently to kind of be more in the ready to kind of start going as soon as you had your clearance as opposed to have a slight delay between there?

Maxim Budyansky  14:55  
This one's fun. So we submitted The FDA process as early as we could to mitigate any submission risk, and yeah, we got it well, well ahead of us being as an organization commercially ready to actually put products into the field. There were quality reasons or operations reasons that we needed to build. But and that's a great problem to have. But the main setback happened when Neil and I were on the road fundraising. And our main supplier gives us a call says, hey, you know, that $25,000 designed for manufacturing agreement that we all agreed to, you know, that worst case cost estimate that we all agreed to, yeah, we're going to five exit. And that worst case turnaround time that we all agreed to, in that agreement, we're going to three exit. What's your what do you think? I'll tell you what we thought later. But, you know, we had to, we had to obviously pivot from from that supplier. But we later learned that that supplier just wasn't set up for small business. They didn't want to work with small businesses, and they weren't set up for disposables. They were a kind of a more kind of traditional orthopedic instrument manufacturer. And that played a role in that whole problem. But yeah, we went back to the drawing board, rebuilt a supply chain, rebuilt the you know, and got product out. And we estimate that that that setback was approximately maybe six to nine months of delay, and to any founders in the room. You know, we knew it was a very painful setback then. But eight years later, looking back thinking today, where our sales would be, if today was six to nine months on the ramp. It's it hurts even more. You know? And so what, what, what can we do? How can we mitigate that. So we actually did mitigate those later in our future product development cycles, where when we have more resources, where we're able to put multiple horses in the race, so any any special manufacturing process, you would have a one, two and a three, supplier, they're all kind of working in parallel, so that if one, you know something happens with one, you have another one to keep going to keep moving the product development forward. And that was kind of that plus bringing in team to to, once you have a team to work on some of these problems, you you are able to mitigate things sooner. And so our last two devices we did together, they were first of their kind, from idea to first in in human with regulatory was both of them happened in 18 months. So that's what happens when and the other benefit was we went into those products with an existing supplier network that had partnerships, right. So that also alleviates some of that, you know, because you have to find the right people and so forth. And we went into those with kind of a really nice Launchpad.

Axel Strombergsson  17:59  
All right, thanks. So talking about commercialization. So early, on commercial assignment station side of things, you did end up pivoting from spine surgeries into lower extremity surgery. So how does this do to indentify? This opportunity, and what made you do that pivots?

Maxim Budyansky  18:20  
Another fun one. We were piloting in spine. That's how we were our whole thesis going into the market was this was a spine product. That was all the feedback we had. But as we were piloting, simply put, we just were not getting the wow factor. You know, we were looking for something we call the Avitus experience and everything that we were doing. And we weren't seeing that happen, you know, every time. And as we continued our sales, networking and going to conferences, we started getting, I would say breadcrumbs or little clues from extremity surgeons that we're expressing interest, kind of for different market spaces. And we that interest eventually landed cases, surgeries that we started doing field surgeries with extremity surgeons, and there was there that we really felt we experienced the wow factor that we were looking for where we were getting pulled into those cases repeatedly. And once that happened enough, that was when we knew that we had to essentially pivot and walk away from spine and overhaul our, our entire existing spine distributor network. And now we're going all in on extremities. And that was a product market fit that we never looked back from.

Neil Shah  19:34  
And if I could add to that, you know, communicating that to stakeholders, investors, distributors, whoever, whoever that may be, the board, especially the board and investors was fairly easy for us because you know, pivots can be scary around the table. But from the beginning we set up pretty solid metrics, very clear identifiers of what success look like for our technology. IG in the operating room, it's got to perform XYZ in this much time and you know, harvest this much bone and you know, this much blood loss, whatever the case may be those elements, and also from just a use and traction metric. So how many surgeons are using it? How often are they repeat using it? How many facilities are they doing it at? And so, when we were in spine, again, it was underwhelming. We were tracking this data and we communicated this data monthly or quarterly, depending on, you know, is it a board member and investor. And once we started experimenting, and trauma and extremities, those same metrics that we had set up started popping off the charts. And so the data explained itself, and that made it very easy to communicate and kind of get everyone behind the fact that we were going to step away from spine for the time being and go into these other markets.

Axel Strombergsson  20:56  
Right. So moving along with and talk more about the strategy around your product portfolio expansion, and you talk a little bit about the products that you launched later. But how did the strategy come about? And also, if we look at it from the investor perspective, you know, investors typically just want you to focus on one product and push that hard and not be distracted by you know, other r&d activities. Can you speak a bit around that strategy around and how you manage those kinds of things?

Maxim Budyansky  21:26  
Yeah, so, you know, at a Avitus, our product strategy started with our entire vision and the ethos to why we exist which is to solve unmet needs. We were only interested in in producing solutions that were first of their kind than that, that we knew were not there before. Our vision for Avitus overall we viewed the entire company as the product. So whether distributors working with us hostage the way hospitals pay with the pay accounts payable, every vector of the business to us was a part of the product for us and part of what we kept saying the Avitus experience. We started with the first problem, which was minimally invasive, autologous bone marrow harvesting, and we were focused on extremities. We were doing nonunions infusions, and it was working great. We were getting tremendous feedback from the surgeons, patients were coming back doing well. And it was surgeons that started utilizing our suction Qura Taj device to start removing bad bone. So this was a whole new kind of use case that once enough of that came back from the field we went back to the FDA expanded our product portfolio of by expanding the indication, and that is how we got into bone infection treatment. And so now we're utilizing our suction Curia college for joint arthroplasty, revision procedures, ortho oncology, doing it to remove bone tumors, osteonecrosis removals and so forth. And this was growing a whole nother vector of our business. And all while this is happening, you know, you have this section of orthopedics that's minimally invasive and arthroscopy, arthroscopy focused. And those surgeons that were using us for bone harvesting, were telling us, Hey, we love the bone graft we're getting with your product, but we don't have a way to get it percutaneously delivered into some of these very challenging percutaneous applications. And that's what led to the development of our latest products, which was the dragon wing and the Artemis, which were percutaneous delivery technologies also, first of their kind. So how did we convince investors to that we weren't just having a field day make an awesome products. I felt that, you know, we avoided to give our investors like just a quick, you know, we weren't shooting darts. Okay, we had a very strategic path. We knew we were a small business, we had to keep innovating. And we had to keep producing innovation to maintain attention from our sales network, right? I mean, the more value we could deliver, the more value we would get in return. And we knew that we needed to do that. And it was the way we presented the I would say the business case to our investors in terms of what this could do what this can unlock for us from a business standpoint, and to help grow our sales because we knew we needed to continue growing our sales and we needed we knew that innovation would would serve that purpose.

Axel Strombergsson  24:24  
Right. Well, that's good. And speaking about sales and revenue growth, one arrow that you did also see some challenges. It's around your distributors, right. So for the audience who are looking to leverage distributors for their products. What are some key things that you can share that increased your likelihood for success over time?

Neil Shah  24:45  
Yeah, first of all, distributors in the med tech space are so diverse, so I think I can only speak to the experience we had with orthopedic surgical rep specifically. And we found out pretty early on Then once we got on the market that the independent distributor sales rep is one of the most important stakeholders in designing your business and your product, kind of the totality of it, if you could have a great product, it could save the hospital a bunch of money. But if it's hard for your sales rep to sell that, or if they're not getting compensated commensurate to the amount of time and effort that they are spending on your product, you're gonna have some major headwinds. And so to give you a scope, at the time of exit, we had over 110 distribution partnerships signed on. So we saw a ton of distributors and these fell on a pretty broad spectrum of the DNA makeup of this distributor. On the one hand, you had a mom and pop distributor, it's one person, maybe two people that have really close ties with five to six surgeons in a specific city, or maybe even just in a particular hospital network. On the other end of that spectrum, you've got $100 million organization that's got hundreds of sales reps, and they cover either state or multiple states in their geography, and they're, you know, tied to a major manufacturer like a Stryker as EB diffusivities. And then they carefully curate three to four ancillary products that they think are complementary, but not competitive to their other products. And so a Avitus could have been one of those products, right. And so we had over dozens, hundreds 1000s of interactions with our distributors, as we grew our network from the bottom up, tried to find a one size fit all strategy. But with distributors that fall on such a broad network, it's difficult to do that. But some fundamentals that really arose from all these interactions were put yourself in the shoe of in the shoes of the individual sales rep, not the distributor organization, but the sales reps that are actually in there, making the sale in the operating room. And think number one follow the money, the amount of that they are getting paid for each sale that they make with your product. How does that compare it to the amount of money they're making for a sale of another product in their bag? And how much are they getting paid for how much time they have to spend on making that sale, right. So if it's, the rep goes into the room, they convinced the surgeon they convinced the hospital, the hospital stocks, 10 of them on the shelf. And now every time that the surgeon needs it, someone on the staff just goes and pulls it off and opens it up. And then they reorder and the rep doesn't have to do anything that's called mailbox money that is the holy grail for the sales rep. And if you have a product that is mailbox money for the rep, you have a cash cow in the medical device space, often that is possible. And we saw a lot of elements of that with the various technologies we had. But these are surgical products. And oftentimes the rep has to be in the room for each surgery to train the scrub tech to train the surgeon to train the resident. And so we had to think about even through our packaging, development and design through our training protocols. What is the rep doing? And how easy or can we make it for the rep providing the Avitus experience to the rep in the room. And so, you know, those are a lot of the elements that we kept in mind and figuring out how to succeed with our distributor network. And then another big part of it is one of our reps told us the squeaky wheel gets the grease, these reps have or they're inundated with 1000s of just, Hey, have you talked to surgeon X for my product? Why haven't you hit your sales quota for this month, they've got 10 different products, not just yours, and you have to keep their attention. And so there's got to be a cadence and a relationship built with each and every one of these distributors and reps to make sure that you know, they feel the love. You're investing time and money traveling into their region. Doing road shows with them helping them win and succeed so that you're building building a long term partnership and, and loyalty.

Axel Strombergsson  29:07  
Right, right. So I'm, after being on this journey for about 13 years. Last year you got acquired, so congratulations to to that exit. But however, you weren't really actively looking for an acquisition. As a matter of fact, you were here with LSI last year to raise another round to grow and scale your business. So tell us how that came about came about and your thoughts around sort of looking or chasing an acquisition, as opposed to focusing on building a solid and long lasting business?

Neil Shah  29:40  
Yeah, it's so much of running a startup is navigating and managing competing interests of your stakeholders. And the question of an exit is a perfect example. So an investor asks you, what's your exit strategy? What's your acquisition, you know, when are you going to get acquired? Are every investor ask that and what they're asking is, hey, when am I getting my money back? What's my ROI going to be? And you can say, hey, I'm going to double your money in six months. And they're going to be like, Here's your check. Or the, you know, you could say, I'm going to double your money in six years, and they're gonna say, take a hike. On the other hand, same exact question. Distributor asks you, what's your exit strategy? When are you going to get acquired what they're asking? And what they're saying is, I'm about to spend all this time and energy and opportunity cost and political capital, getting my surgeons to become aware of your technology, and build myself a book of business, are you going to get acquired next year, and they're gonna come in and cancel my distribution rights and take over? So Maxim and I had a pretty steadfast men mantra towards all of this, which is we are planning to grow but prepared to sell. So we had our nose to the grindstone everything was about how do we get the next customer? How do we hire that a player? How do we put together this marketing piece that's going to be killer for our audience? And at the same time, we were always open to conversations, we were always open minded about conversations strategics, and not specifically for the, you know, with with the end goal of getting acquired, but is there a distribution partnership and an area of the country where our distributor network is weak? Or is there a product out there that complements our technology very well. And we see it over and over again, across the country that these products are being used together. Maybe there's a cool marketing strategy out there that we can work with. And so our point of keeping our pulse on the market was Was this not for chasing an acquisition, it just allowed us to constantly keep in mind and have a pulse on this ever changing industry and how Avitus fits into that industry. So we went into last year, you know, it's January 2023. Our board is very excited about the progress we're making both on the commercial side, the team that we've put together and the team has was also putting some kickass products on the market in the next six months, we were about to launch to game changers. And so they wanted us to go out and fundraise because we wanted to, we wanted the capital to make sure we kept fueling that growth. And the board was at our lead investors were in, you know, they they were going to be investing but they wanted us to find a syndicate. And so a couple days before the last LSI I actually for the first time learned about LSI and didn't know about it before then came here and had some phenomenal meetings with investors and some strategics. And all those conversations were in the context of financing, fundraising, and one of those conversations we carried on after the meeting. And it started evolving from financing to maybe a stronger partnership, a deeper partnership and six months after that Avitus Orthopaedics became a Zimmer Biomet company.

Axel Strombergsson  32:58  
That's great. Congratulations again. Yeah. So we're at the point here of this session that we want to open up for questions from the audience.

Speaker 1  33:06  
Hello, this is Ben from astral man attack. And thank you so much for the great presentations. I'm wondering how to initiate that first conversation with strategics. And and how do you stand out from those probably 2000 company there scene?

Neil Shah  33:21  
So the question is, how do you initiate a conversation with a strategic and stand out? So, as I mentioned, in our, in our particular case, we had conversations throughout, right? So the first conversation should never be, hey, we're looking to get acquired, or that should never be the conversation. Because if you're looking to get acquired, that means you're not growing or they're, you know, you're not focused on your mission. So for us, it was relationship building. And it was figuring out areas or ways that could be interesting, could be partnerships outside of acquisition that can evolve or grow into deeper relationships, and you're at trade shows all the time you're at, for us, specifically in the orthopedic orthopedic space, the foot and ankle shows the traumas shows, the orthopedic shows. And there, you would start building relationships with the business development folks, as well as the clinical and the sales folks. And you're really just showing them all the progress that you're making. And that's how that relationship builds, whether it's an investor or a strategic, no one's going to invest or pull the trigger on anything with a single data point, they're going to want to see a trend over time. And so I think one thing we did really well was, especially with our investors and other questions about strategics, but with our investors, we had a periodic newsletter that we sent out and no matter how big or small, small the winds, were, we, on a steady cadence made sure that we updated prospective investors Isn't everyone with the updates that we had. And eventually, when we were ready to raise, there were a bunch of people that had been tracking us for so long. And they came to us with interest. strategics. Similarly, right.

Maxim Budyansky  35:14  
And in terms of the acquisition, it's a lot easier when your technology or your solution basically speaks for itself. If if you have users and it's performing, it's doing what it needs to be doing, you're saving costs for hospitals. And you align that with a strategic need, where this is fitting a portfolio, a bigger portfolio where you're solving a problem for their business at the same time, you're in a good, you're in a good spot.

Neil Shah  35:42  
And I also want to add on acquisitions, as we all know, are very rare. And it has just as much to do with the progress you're making as a company, hitting your milestones, growing sales, growing the team getting new hospital accounts, as it does with where the strategic is at that time, do they have a need for something that your company can solve? And that can that may not be a product need, it may be a market need, it may be something out of your control, and there are so many different points on which alignment needs to happen for a partnership like that to move forward. And a lot of times, it's timing. Awesome. Do we have another question from the audience? Back there

Speaker 2  36:32  
very inspirational. Thank you. I've been building our company for the last nine years. And so hearing 13 gives me some peace. But what is it? You know, for anyone young starting out or older? Feeling like energy? How did you stay motivated over those 13 years? Like if you could pinpoint a couple of things that helped you go through the highs and the lows, what would they be?

Maxim Budyansky  36:58  
Overall, I think it's the problem that you're choosing to solve has to get you out of bed. Like it's just that simple. You have to really believe in what you're doing. And I think that for us was like the underlying mission, knowing everything else in between, like to get to that patient result to get to that surgeon singing your praises, or whoever your user is, whatever that end result is, that's what it's all really for. It's for this impact. And everything in between that, yeah, some of its hurts, some of it's painful, blood, sweat, tears, everything, but there, it's kind of this symphony that creates this result. And then you know, more practically to, to maybe, maybe you're speaking towards possibly burnout or managing burnout as well, which is, you know, that's a real thing for entrepreneurs and you're you're slinging heat, you're hustling, you do have to take care of yourself as a leader. It is important to allow yourself as a leader to get the recharges, you need to be able to go attack all these problems every day. 25 Seven, and still perform at a remarkable level for your your team and the field and everything in between. But I really think it's the kind of the, the fundamental purpose of your business that has to just do it for you.

Axel Strombergsson  38:23  
Awesome. All right, we're up here on the last minute. So before for wrapping this up, and thanks, of course, to both of you for sharing this exciting journey has been really inspirational. But um, so with all these experiences and things that you have now in your in your baggage, what is next for you? Where do you go from here?

Maxim Budyansky  38:43  
Love that 13 years, we then next day, what's next? So, you know, right now, you know, we are, you know, four months, so in the chasm after acquisition, and we've been embracing active recovery. And we certainly have are looking forward to continue to support Zimmer in various capacities to help them continue being successful with our products. We're also using this time to connect with other founders, companies, investors, helping in various forms, advisory boards, so forth. We enjoy solving problems and we enjoy helping others do the same. So any way we can provide value that's always of interest. But ultimately, our fundamental nature's to solve problems, like I mentioned, and I think we're very much listening for the next problem to solve. So you know, if anyone has a good problem to solve, and you need a founding execution team that can do invention to sales. Let us know. Awesome.

Axel Strombergsson  39:51  
Okay, give this guy these guys center bottom applause for


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