Michael Barbella , Managing Editor03.23.16
Brian Thornes once envisioned a great future for himself.
In those yet-to-be-written tomorrows, Thornes fancied himself a gifted orthopedic surgeon, repairing bones with the grace and finesse of an accomplished sculptor. He’d be well-respected by patients and peers, perhaps even rising to the top of his field. He’d live quite the enviable (professional) life.
Barring any curveballs, of course.
Inevitably, though, the curveballs arrived, one after the other, sending Thornes’ fairy tale-like future into a futile tailspin. The first one came fast and hard, blindsiding Thornes during the summer of his sophomore year in college (1990). He was run over by a speedboat while water-skiing and cut his foot in two places, severely damaging the tendons and nerves in his ankle.
Despite the gruesome nature of the injury, Thornes was not seriously hurt. But in a bit of serendipitous circumstance, the accident ultimately led Thornes down a future path that was different from the one he’d imagined.
“I was always sort of destined to go into medicine,” he told Britian’s Sunday Times last summer. “[But] I was already hot-wired to be a gadgety inventing person.”
That inner circuitry—paired with a speedboat-inspired interest in ankle injuries—eventually prompted Thornes to create an ankle fixation system called TightRope. Long aware of the arguments among orthopedic surgeons about the number, size, and durability of ankle screws, Thornes’ solution uses a braided polyethylene cord rather than a rigid surgical screw to anchor the tibia and fibula together. The device works like an internal cufflink, pulled tight, to provide flexible but strong support in high-energy ankle fractures.
“The screw is the problem,” Thornes noted in the Times article. “So [I thought] let’s just design some other gadget that will hold things together and have a little bit of movement, and that is where I came up with the TightRope.”
Biomechanical testing and clinical trials have shown that TightRope improves patient outcomes by eliminating the need for revision surgery as well as complications from broken screws. In addition, the device was found to be equally as strong as surgical screws in anchoring bone and more than twice as durable as standard metal screws. Perhaps its most important advantage, however, is the flexibility it provides patients—an attribute that leads to faster recoveries and return to normal activities.
Thornes conceived the TightRope concept in 2000 and licensed it to Arthrex Inc. in 2003. He travelled the world promoting the device while undergoing surgical training, but hostility from local colleagues forced Thornes to re-evaluate his professional goals.
Curveball number two.
In 2005, Thornes quit his medical training and enrolled in an MBA program in Dublin, Ireland. He received his degree the following year but remained unemployed and professionally unfocused until life lobbed a third curveball his way.
That one came in 2007, as Thornes was mounting a television on an apartment wall with an expanding bolt.
“Soft bone is an eternal problem in orthopedics and you don’t have to be any whiz to know that,” he said. “I was using this expanding bolt and I thought, this would work well. I knew with a bit of thinking and gumption that I would get a reasonable solution. So I thought let’s just run with it.”
Thornes is aiming to sprint past the finish line soon with his latest invention, the X-Bolt. Designed to provide better fixation in osteoporotic hip fractures, the device is described as an “expanding bolt akin to a Chinese lantern with a central drive shaft.” Its opposing threads compress an expandable section from both ends to expand the wings perpendicularly to the shaft, without spinning, pushing, or pulling the hip’s femoral head. Used in more than 250 surgeries in the United Kingdom, Thornes claims the X-Bolt improves the efficiency of current hip fracture treatment, allows for faster operative times, and reduces hospital stays.
Clinical trials of X-Bolt began last year. The device is patented in Europe but not yet in the United States, where at least 250,000 hip fractures occur annually, according to the Centers for Disease Control and Prevention. That number is expected to double in the next quarter century as America’s aging population loses critical bone density.
Given such future growth potential, Thornes wisely is focusing on obtaining U.S. Food and Drug Administration (FDA) approval for the X-Bolt. His company, X-Bolt Orthopaedics, raised 1.8 million euros ($1.95 million) in seed funding from Ireland’s AIB Seed Capital Fund to finance the FDA application and fast-track global commercialization of the product.
Thornes’ company, founded in 2007, is based in the capital city of Dublin, a 1.27 million-strong metropolis with a thriving lifesciences sector. It is one of several medtech ”hotspots” in Ireland, and houses a significant number of the country’s 400 medical device firms, reports the Irish Medical Devices Association (IMDA), a business association within Ibec representing the medical devices and diagnostics sector.
“Global companies like Becton Dickinson were one of the first entrants into Ireland over 50 years ago,” noted Michael Lohan, head of medical technologies at IDA Ireland, the country’s industrial development agency. “Since then, our medtech sector has grown to include multiple activities across the full spectrum of manufacturing, R&D and services, from single-use [medical] products, plastics, and molding, to highly sophisticated combination products, drug delivery products, and orthopedic products. It really has evolved.”
And blossomed into quite a powerful economic engine: Ireland is one of Europe’s largest medical products exporters, sending 12.6 billion euros worth of merchandise to more than 100 countries annually. The country’s medtech sector employs 29,000 people and is home to 13 of the world’s top 15 device developers, including five of the 10 largest orthopedic companies.
Most of those musculoskeletal health firms are located in Cork, dubbed the “rebel city” for its history of political rebellions. Stryker Corp. is the largest employer there, retaining hundreds of people among two facilities (the company operates a third foundry in Limerick, 37.6 miles to the north). In late January (2016), Stryker bigwigs celebrated the opening of a Surgical Innovation Centre in Cork, a facility featuring unique design and collaboration workspaces, prototyping and testing areas, and a simulated operating room. The 44,000-square-foot center will develop new technologies and products to help improve patient safety/surgical outcomes, and increase operating room efficiency across various surgical specialties, including neurological, spinal, ENT, and general orthopedic procedures.
“It’s great to see this project come to fruition,” IDA CEO Martin Shanahan said at the facility’s opening. “It further consolidates the company’s presence in Ireland, and significantly boosts Ireland’s reputation as an excellent location for medical technology companies.”
Stryker isn’t the only character-builder, though. DePuy Synthes, NuVasive Inc., Tornier, and Zimmer Biomet have all helped enhance Ireland’s role on the lifesciences world stage, IMDA data indicate.
DePuy Synthes actually was the first of the large orthopedic OEMs to settle in Cork, establishing an artificial hip and knee manufacturing plant there in 1997. The site, which employs more than 600 people, also houses a global supply chain operation and a research/development innovation center. Several years ago, the company invested $36 million in its R&D program at that plant; the effort was designed to build core competencies in advanced processing technology, new materials development, and advanced process implementation.
The company invested another $59.8 million into its Cork manufacturing facilities last year to expand production capabilities there. The expansion included a new Medical Device Test Methods Center of Excellence lab to advance quality testing methods.
NuVasive, conversely, discovered the Emerald Isle’s charms only recently, announcing in 2014 plans to open an international operations center in Waterford (a city renowned for its crystal). “We are thrilled to be located in Waterford, with access to local talent to support our international operations,” NuVasive chairman and CEO Alex Lukianov said at the time. “...we are excited to grow our presence in the area and improve our international business.”
Future growth was a factor for Zimmer Biomet Holdings Inc. as well. The company followed its rivals’ lead in 2007, establishing a manufacturing facility in Shannon that currently employs 330 people. The 100,000-square-foot plant manufactures Zimmer Biomet’s best-selling knee replacement—NexGen—and the “anatomically accurate” Persona knee system, a product created through analyses of both genders and 1,500 different bone types from 26 different ethnicities.
Since first arriving in Ireland, however, Zimmer has grown through various acquisitions—the largest being last year’s $14 billion merger with Biomet. Thus, the company is expanding its Irish footprint too, spending more than $59 million on a new plant in Galway.
The facility will be used to manufacture orthopedic implants and also house Zimmer Biomet’s sales and marketing division for a direct sales force in Ireland, supplying hospitals and orthopedic surgeons with devices for hips, knees, extremities, spine, and trauma. The new plant is expected to create up to 250 manufacturing jobs over the next four years.
“We are delighted to be adding a new location to our Ireland operations,” Adrian Furey, general manager for Zimmer Biomet Ireland said. “We are looking forward to building on the success of our Shannon operation by expanding in Galway. Our Shannon facility will continue to be our flagship for Ireland and we will continue to invest in our operations there.”
Such reinvestment is sporadic at best in a (business) world ruled by profits, tax incentives/breaks, and minimal bureaucracy. Yet Ireland seems to have found a winning formula for repeat financing; since 2014, medical technology companies have reinvested roughly 266 million euros in existing facilities in the country, according to a February 2016 Medical Technologies Labour Review report from Irish human resources/recruitmant firm Collins McNicholas. Overall, the medtech industry has added more than 2,000 jobs and 960 million euros in investments during that time, the report states. In addition, the country secured one-third of all European medtech investment last year.
“It’s a common trend we see in Ireland that people not only invest but also reinvest. And that speaks volumes in terms of the performance they’re achieving in Ireland, the technical skills they’re getting in Ireland, and the ability to continue to grow their global business from Ireland,” Lohan noted. “We’re very proud of that track record of not just the initial investment, but more importantly, the repeat investment as well as investments in research and development.”
Fostering such high corporate loyalty are factors like R&D grants, tax incentives, relocation packages, an overlapping time zone, an educated workforce, and a cultural affinity with America. Ireland is also easily accessible to London, New York, and other major cities.
“A number of factors support companies reinvesting in Ireland, and they include the country’s pro business policies and environment. We also ensure that we have a continuous stream of talent needed to support the [medtech] industry,” Lohan continued. “Our educational system and our industry cohorts are very clear in having a collaborative approach to ensure that we have the skill sets that not only serve today’s needs but more importantly, we are developing talent for the future needs of the industry. It’s very easy to say these things. But we have demonstrated and delivered upon it and we continue to do that in an open and transparent manner. What companies want in terms of investment is certainty, clarity, and a proven track record. In Ireland, that’s exactly what they get.”
In those yet-to-be-written tomorrows, Thornes fancied himself a gifted orthopedic surgeon, repairing bones with the grace and finesse of an accomplished sculptor. He’d be well-respected by patients and peers, perhaps even rising to the top of his field. He’d live quite the enviable (professional) life.
Barring any curveballs, of course.
Inevitably, though, the curveballs arrived, one after the other, sending Thornes’ fairy tale-like future into a futile tailspin. The first one came fast and hard, blindsiding Thornes during the summer of his sophomore year in college (1990). He was run over by a speedboat while water-skiing and cut his foot in two places, severely damaging the tendons and nerves in his ankle.
Despite the gruesome nature of the injury, Thornes was not seriously hurt. But in a bit of serendipitous circumstance, the accident ultimately led Thornes down a future path that was different from the one he’d imagined.
“I was always sort of destined to go into medicine,” he told Britian’s Sunday Times last summer. “[But] I was already hot-wired to be a gadgety inventing person.”
That inner circuitry—paired with a speedboat-inspired interest in ankle injuries—eventually prompted Thornes to create an ankle fixation system called TightRope. Long aware of the arguments among orthopedic surgeons about the number, size, and durability of ankle screws, Thornes’ solution uses a braided polyethylene cord rather than a rigid surgical screw to anchor the tibia and fibula together. The device works like an internal cufflink, pulled tight, to provide flexible but strong support in high-energy ankle fractures.
“The screw is the problem,” Thornes noted in the Times article. “So [I thought] let’s just design some other gadget that will hold things together and have a little bit of movement, and that is where I came up with the TightRope.”
Biomechanical testing and clinical trials have shown that TightRope improves patient outcomes by eliminating the need for revision surgery as well as complications from broken screws. In addition, the device was found to be equally as strong as surgical screws in anchoring bone and more than twice as durable as standard metal screws. Perhaps its most important advantage, however, is the flexibility it provides patients—an attribute that leads to faster recoveries and return to normal activities.
Thornes conceived the TightRope concept in 2000 and licensed it to Arthrex Inc. in 2003. He travelled the world promoting the device while undergoing surgical training, but hostility from local colleagues forced Thornes to re-evaluate his professional goals.
Curveball number two.
In 2005, Thornes quit his medical training and enrolled in an MBA program in Dublin, Ireland. He received his degree the following year but remained unemployed and professionally unfocused until life lobbed a third curveball his way.
That one came in 2007, as Thornes was mounting a television on an apartment wall with an expanding bolt.
“Soft bone is an eternal problem in orthopedics and you don’t have to be any whiz to know that,” he said. “I was using this expanding bolt and I thought, this would work well. I knew with a bit of thinking and gumption that I would get a reasonable solution. So I thought let’s just run with it.”
Thornes is aiming to sprint past the finish line soon with his latest invention, the X-Bolt. Designed to provide better fixation in osteoporotic hip fractures, the device is described as an “expanding bolt akin to a Chinese lantern with a central drive shaft.” Its opposing threads compress an expandable section from both ends to expand the wings perpendicularly to the shaft, without spinning, pushing, or pulling the hip’s femoral head. Used in more than 250 surgeries in the United Kingdom, Thornes claims the X-Bolt improves the efficiency of current hip fracture treatment, allows for faster operative times, and reduces hospital stays.
Clinical trials of X-Bolt began last year. The device is patented in Europe but not yet in the United States, where at least 250,000 hip fractures occur annually, according to the Centers for Disease Control and Prevention. That number is expected to double in the next quarter century as America’s aging population loses critical bone density.
Given such future growth potential, Thornes wisely is focusing on obtaining U.S. Food and Drug Administration (FDA) approval for the X-Bolt. His company, X-Bolt Orthopaedics, raised 1.8 million euros ($1.95 million) in seed funding from Ireland’s AIB Seed Capital Fund to finance the FDA application and fast-track global commercialization of the product.
Thornes’ company, founded in 2007, is based in the capital city of Dublin, a 1.27 million-strong metropolis with a thriving lifesciences sector. It is one of several medtech ”hotspots” in Ireland, and houses a significant number of the country’s 400 medical device firms, reports the Irish Medical Devices Association (IMDA), a business association within Ibec representing the medical devices and diagnostics sector.
“Global companies like Becton Dickinson were one of the first entrants into Ireland over 50 years ago,” noted Michael Lohan, head of medical technologies at IDA Ireland, the country’s industrial development agency. “Since then, our medtech sector has grown to include multiple activities across the full spectrum of manufacturing, R&D and services, from single-use [medical] products, plastics, and molding, to highly sophisticated combination products, drug delivery products, and orthopedic products. It really has evolved.”
And blossomed into quite a powerful economic engine: Ireland is one of Europe’s largest medical products exporters, sending 12.6 billion euros worth of merchandise to more than 100 countries annually. The country’s medtech sector employs 29,000 people and is home to 13 of the world’s top 15 device developers, including five of the 10 largest orthopedic companies.
Most of those musculoskeletal health firms are located in Cork, dubbed the “rebel city” for its history of political rebellions. Stryker Corp. is the largest employer there, retaining hundreds of people among two facilities (the company operates a third foundry in Limerick, 37.6 miles to the north). In late January (2016), Stryker bigwigs celebrated the opening of a Surgical Innovation Centre in Cork, a facility featuring unique design and collaboration workspaces, prototyping and testing areas, and a simulated operating room. The 44,000-square-foot center will develop new technologies and products to help improve patient safety/surgical outcomes, and increase operating room efficiency across various surgical specialties, including neurological, spinal, ENT, and general orthopedic procedures.
“It’s great to see this project come to fruition,” IDA CEO Martin Shanahan said at the facility’s opening. “It further consolidates the company’s presence in Ireland, and significantly boosts Ireland’s reputation as an excellent location for medical technology companies.”
Stryker isn’t the only character-builder, though. DePuy Synthes, NuVasive Inc., Tornier, and Zimmer Biomet have all helped enhance Ireland’s role on the lifesciences world stage, IMDA data indicate.
DePuy Synthes actually was the first of the large orthopedic OEMs to settle in Cork, establishing an artificial hip and knee manufacturing plant there in 1997. The site, which employs more than 600 people, also houses a global supply chain operation and a research/development innovation center. Several years ago, the company invested $36 million in its R&D program at that plant; the effort was designed to build core competencies in advanced processing technology, new materials development, and advanced process implementation.
The company invested another $59.8 million into its Cork manufacturing facilities last year to expand production capabilities there. The expansion included a new Medical Device Test Methods Center of Excellence lab to advance quality testing methods.
NuVasive, conversely, discovered the Emerald Isle’s charms only recently, announcing in 2014 plans to open an international operations center in Waterford (a city renowned for its crystal). “We are thrilled to be located in Waterford, with access to local talent to support our international operations,” NuVasive chairman and CEO Alex Lukianov said at the time. “...we are excited to grow our presence in the area and improve our international business.”
Future growth was a factor for Zimmer Biomet Holdings Inc. as well. The company followed its rivals’ lead in 2007, establishing a manufacturing facility in Shannon that currently employs 330 people. The 100,000-square-foot plant manufactures Zimmer Biomet’s best-selling knee replacement—NexGen—and the “anatomically accurate” Persona knee system, a product created through analyses of both genders and 1,500 different bone types from 26 different ethnicities.
Since first arriving in Ireland, however, Zimmer has grown through various acquisitions—the largest being last year’s $14 billion merger with Biomet. Thus, the company is expanding its Irish footprint too, spending more than $59 million on a new plant in Galway.
The facility will be used to manufacture orthopedic implants and also house Zimmer Biomet’s sales and marketing division for a direct sales force in Ireland, supplying hospitals and orthopedic surgeons with devices for hips, knees, extremities, spine, and trauma. The new plant is expected to create up to 250 manufacturing jobs over the next four years.
“We are delighted to be adding a new location to our Ireland operations,” Adrian Furey, general manager for Zimmer Biomet Ireland said. “We are looking forward to building on the success of our Shannon operation by expanding in Galway. Our Shannon facility will continue to be our flagship for Ireland and we will continue to invest in our operations there.”
Such reinvestment is sporadic at best in a (business) world ruled by profits, tax incentives/breaks, and minimal bureaucracy. Yet Ireland seems to have found a winning formula for repeat financing; since 2014, medical technology companies have reinvested roughly 266 million euros in existing facilities in the country, according to a February 2016 Medical Technologies Labour Review report from Irish human resources/recruitmant firm Collins McNicholas. Overall, the medtech industry has added more than 2,000 jobs and 960 million euros in investments during that time, the report states. In addition, the country secured one-third of all European medtech investment last year.
“It’s a common trend we see in Ireland that people not only invest but also reinvest. And that speaks volumes in terms of the performance they’re achieving in Ireland, the technical skills they’re getting in Ireland, and the ability to continue to grow their global business from Ireland,” Lohan noted. “We’re very proud of that track record of not just the initial investment, but more importantly, the repeat investment as well as investments in research and development.”
Fostering such high corporate loyalty are factors like R&D grants, tax incentives, relocation packages, an overlapping time zone, an educated workforce, and a cultural affinity with America. Ireland is also easily accessible to London, New York, and other major cities.
“A number of factors support companies reinvesting in Ireland, and they include the country’s pro business policies and environment. We also ensure that we have a continuous stream of talent needed to support the [medtech] industry,” Lohan continued. “Our educational system and our industry cohorts are very clear in having a collaborative approach to ensure that we have the skill sets that not only serve today’s needs but more importantly, we are developing talent for the future needs of the industry. It’s very easy to say these things. But we have demonstrated and delivered upon it and we continue to do that in an open and transparent manner. What companies want in terms of investment is certainty, clarity, and a proven track record. In Ireland, that’s exactly what they get.”