How Avitus Orthopaedics Built, Scaled, and Successfully Exited to Zimmer Biomet

For medtech entrepreneurs, the road from invention to acquisition is anything but straightforward. Few companies navigate it successfully, and even fewer first-time founders make it to the finish line. Avitus Orthopaedics, co-founded by Neil Shah and Maxim Budyansky, is one of those rare success stories.

During a panel at LSI USA ‘24, the two founders sat down with Axel Strombergsson to discuss their company’s evolution—from a concept developed at Johns Hopkins to their acquisition by Zimmer Biomet. They shared key lessons on clinical immersion, funding approaches, regulatory strategies, and how they stayed adaptable in the face of unexpected challenges.

Building Avitus Orthopaedics: From Concept to Product

Avitus Orthopaedics’ journey began in Johns Hopkins’ Center for Bioengineering Innovation and Design (CBID), a program that pushes students to identify unmet clinical needs before developing technology.

“We got thrown into the operating room, took off our engineering hats, and just observed,” said Neil Shah. “CBID drilled into us the importance of understanding clinical needs first—before thinking about a solution.”

That philosophy led them to develop a novel approach for bone graft and marrow harvesting, an essential but inefficient process in orthopedic surgery. Through extensive customer discovery, Shah and Maxim Budyansky validated the problem with surgeons across the U.S. and built a strong foundation before launching Avitus Orthopaedics.

Overcoming the “You Don’t Know What You Don’t Know” Problem

First-time founders often face a daunting challenge: they don’t know what they don’t know. Without prior experience, Shah and Budyansky had to navigate FDA regulations, manufacturing hurdles, and commercial strategy from scratch.

“You don’t have a network, you don’t have money, and you don’t have resources,” Budyansky explained. “So, how do you get the information you need? Networking, attending medtech conferences, finding the right consultants, and learning from early suppliers.”

These relationships were critical to overcoming hurdles—especially when their first manufacturing partner dramatically increased costs and timelines, forcing them to pivot. “We lost six to nine months because of that mistake,” said Budyansky. “If you can’t afford delays, you need backup suppliers lined up.”

Funding the Business: Leveraging Grants for Non-Dilutive Capital

Fundraising is another challenge for first-time entrepreneurs. While early attempts to raise venture capital were unsuccessful, Avitus secured $2.8 million in non-dilutive grant funding, which allowed them to advance their technology without giving up equity.

“We weren’t in a position where investors took us seriously,” Shah said. “But grant funding gave us the credibility to show investors that the government and other organizations believed in our tech.”

The founders even hired an intern as a “grant hunter,” whose sole job was to find and vet funding opportunities. “Every week, she’d come to us with a list of potential grants, and we’d prioritize them based on fit,” Shah said. “That strategy worked incredibly well.”

Regulatory Success and Commercialization Challenges

Unlike many medtech startups, Avitus had a swift regulatory clearance process, obtaining FDA clearance ahead of schedule. But instead of celebrating, they faced a new challenge: they weren’t commercially ready to launch.

Then came an even bigger shift—pivoting from spine surgery to lower extremities.

“We weren’t getting the ‘wow’ factor in the spine market,” Budyansky recalled. “But when extremity surgeons started using our device, they were amazed at the results. That was our signal to shift.”

This pivot led Avitus to overhaul its distribution network, refocusing on surgeons and cases where their technology had the most impact. “It wasn’t just a gut feeling,” Shah added. “We had clear performance metrics, and the data made the decision obvious.”

Scaling Through Product Expansion and Distribution Strategy

Avitus didn’t stop with its first product. As surgeons found new uses for their technology, the company expanded into bone infection treatment, joint arthroplasty revisions, and ortho-oncology.

“We were solving problems that didn’t have existing solutions,” Budyansky said. “When surgeons asked for a way to deliver grafts percutaneously, we developed the Dragon Wing and ArchiMIS. That’s how we maintained momentum.”

They also learned valuable lessons about working with distributors—a critical piece of the medtech commercialization puzzle.

“Distributors have multiple products in their bag, and if your product isn’t easy for them to sell, it won’t move,” Shah explained. “We focused on compensation, usability, and training to ensure reps prioritized our product.”

Avitus Orthopaedics’ Acquisition: A Case Study in Staying Ready

Despite its success, Avitus wasn’t actively looking to sell when Zimmer Biomet came calling. In fact, they came to LSI USA ‘23 planning to raise a growth round.

“We were focused on fundraising and growth,” Shah said. “But when we engaged with Zimmer Biomet, the conversation evolved—from financing to partnership to acquisition.”

The deal closed just six months later, demonstrating the value of staying prepared.

“Our philosophy was always to plan to grow but be prepared to sell,” Shah added. “We kept conversations open with strategics—not because we were chasing an acquisition, but because we wanted to understand the landscape.”

Lessons for Medtech Founders

Reflecting on their 13-year journey, Shah and Budyansky shared key takeaways for other medtech entrepreneurs:

• Validate the unmet need first: “Start with the problem, not the solution.”
• Leverage non-dilutive funding: “Grants can be a game-changer, especially early on.”
• Expect unexpected hurdles: “Plan for supply chain and regulatory setbacks.”
• Be data-driven with pivots: “The numbers will tell you where to go.”
• Build strong distributor relationships: “Sales reps need incentives to push your product.”
• Keep strategic conversations open: “Acquisition timing is about market need and alignment, not just your milestones.”

Final Thoughts: The Impact of Avitus Orthopaedics’ Acquisition

Now that Avitus Orthopaedics’ acquisition by Zimmer Biomet is complete, its founders are taking time to advise startups, support Zimmer, and recharge.

But one thing is certain: their passion for solving big problems hasn’t faded.

“We’re listening for the next big problem to solve,” Budyansky said. “If anyone has a great challenge that needs an execution team, let us know.”

For medtech founders, Avitus Orthopaedics’ story is proof that persistence, adaptability, and data-driven decision-making can pave the way from invention to exit—even when the road is unpredictable.