FITM Extended Interview: Alexander Sah

Alex Sah on what it actually takes for a practicing surgeon to develop new orthopaedic tools — from first idea to OR adoption.

An honest conversation about mentors, mistakes, AI, and knowing when to walk away from a collaboration.

Most surgeons spot problems in the OR daily and quietly adapt to the limits of existing tools. Alex Sah, a high-volume hip and knee surgeon in Silicon Valley and Chief Medical Officer at Think Surgical, has chosen instead to engage directly with industry — first as an evaluator, then as an advisor, and eventually as a design partner. In this conversation with Joe Schwab, he walks through how that progression actually works in practice, and why he thinks every surgeon with a good idea owes it to themselves to start the process now rather than later.

The discussion gets practical fast. Alex breaks down how to vet an idea with a mentor and a patent search, why timing and portfolio fit can make or break a great concept, how to set milestones that let you walk away gracefully from a stalled collaboration, and why the technologies that succeed are usually the ones that speak for themselves the first time a surgeon uses them. He also shares a small habit with big implications — keeping his OR team blinded when testing new products to neutralize the placebo effect that quietly distorts informal evaluations.

The conversation closes on AI's inevitable arrival in orthopaedics, the surgeon's role in shaping it before it gets shaped for us, and the AHF Shark Tank as a live laboratory for the From Idea to Market journey. If you've been sitting on an idea, or wondering whether to take that next call from a device rep with a prototype, this episode is a realistic map of the road ahead.

⏱️ Chapters:
00:00 Introduction and Silicon Valley innovation roots
01:02 Why surgeons should solve problems instead of adapting
03:25 Surgeon roles in product development
04:24 First steps for surgeons with no industry connections
05:41 Turning a clinical idea into a development concept
06:46 Setting milestones and knowing when to walk away
08:01 Lessons from working with Think Surgical
10:50 Evaluating new surgical technology objectively
12:14 Essential advice for first-time surgeon innovators
15:47 Why surgeons must help shape AI in orthopaedics
17:40 Inside the AHF Shark Tank for surgical innovation

Listen to the AHF Podcast on your preferred platform:
Buzzsprout: https://ahfpodcast.buzzsprout.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/ahf-podcast/id1749521487
Spotify: https://open.spotify.com/show/5CrGJyvRiQFTCU3FFFVvHc
LinkedIn: https://www.linkedin.com/showcase/ahf-podcast
YouTube: https://www.youtube.com/@anteriorhipfoundation
Homepage: https://anteriorhipfoundation.com

This podcast is intended for educational and informational purposes only.

The content discussed does not constitute medical advice and should not be used as a substitute for professional judgment. Clinicians should rely on their own training, experience, and clinical decision-making when applying information from this discussion.

#AnteriorHipFoundation #AHFPodcast #AlexanderSah #SurgeonInnovator #MedicalDeviceDevelopment #ThinkSurgical #Ospitek #OrthopaedicInnovation #JointReplacement #HipAndKneeSurgery #AIinSurgery #FromIdeaToMarket #MedTech #SurgicalRobotics

Transcript

Alexander Sah 0:26

My name is Alex Sah and I'm a hip and knee surgeon in private practice as medical co-director of the Institute for Joint Restoration in Fremont, California. I was past president of the Anterior Foundation and currently serve as Chief Medical Officer at Think Surgical and Chief Innovation Officer at Ospitek

Joseph M. Schwab 0:42

So you've gone beyond being an early adopter to becoming really a true collaborator in product development. For you, what was the initial spark or the moment or experience that really inspired you to become an innovator and actively engage with the medical device industry?

Alexander Sah 1:02

Joe Orthopedics and joint replacement specifically has historically been so intertwined with product development that it's a common interest among joint surgeons, but it's been traditionally limited to implant or instrument design. But in recent years, as you know, there's been an explosion of technologies and innovations available in our clinics and ORs. I'm in the heart of Silicon Valley, so I've been fortunate to be exposed to product development, new technologies as they're trying to find their ways in orthopedics. So engaging early with products like virtual reality products, trying to make an impact on education or novel pain management companies in the area that are trying to aim to extend local paid management out one to two weeks. These early experiences created a lot of excitement and interest. So it's really that initial spark that you refer to and inspired me to be involved in the process of bringing products to the orthopedic market. These companies often have incredible ideas, but they are in need of orthopedic surgeons to provide them guidance on the development and market expansion of their ideas. So it's a great opportunity to be involved.

Joseph M. Schwab 2:06

So many surgeons actually identify problems on a daily basis in their ORs, and a lot of them will just choose to adapt what they do to the limitation of existing tools. What made you decide to pursue solutions rather than just adapting?

Alexander Sah 2:24

I think Joe, really, it's simply that it's fun. It's different. We do our daily job as orthopedic surgeons, but here's something outside of what we are maybe trained in and and spent years of our life dedicated to. Here's a separate interest outside the operating room where we really have a chance to make an impact. It's certainly not for the money, and it's not because there aren't other things to do with the time, because remember, a lot of these projects just simply might not pan out. But being involved, you really can learn a lot during the process and it can lead to other opportunities. So in addition, rather than waiting for someone else to come up with the idea, it's rewarding to be part of that development process. I often think of Epic as an example. You know, I really wish an orthopedic surgeon was available during its development because I think it would be a really, a much better product for us. But now we're sort of stuck with it in its current form. So being involved gives you the chance to make an impact. It gives you an opportunity to interact with other KOLs and educate and learn from your peers. That's what makes it so much fun.

Joseph M. Schwab 3:24

So you frequently function as what I would call an adopter innovator and somebody in that role. How do you define what you do as part of a product lifecycle? Is it an advisor? Is it a, a validator, um, or is it a design partner?

Alexander Sah 3:44

There are many different roles when working with industry and new company, Joe, and really I started as a surgeon evaluator. So I think the easiest place for someone to get started is to evaluate someone else's idea, someone else's product that lets you generate relationships. It lets people know you're available to help validate new products, and then with experience, opportunities can become available to serve as an advisor. And with those connections and showing interest, you then may be approached by industry or peers to collaborate on a design and development of a product. So I think it's a stepwise fashion of being involved and, and you get experience with each different mode of activity. So I think it's important to do each of the steps that you just laid out.

Joseph M. Schwab 4:24

For surgeons who are interested in working with industry, but maybe lack industry connections, could you give a, a kind of a practical first piece of advice about a step they could take to explore those types of relationships?

Alexander Sah 4:40

I think the most important thing when someone has a good idea is to find a mentor. Find someone who can give you an objective evaluation of the idea, because there are a lot of good ideas out there, but for all you know, it might've been thought of already. It might've already come and gone. It might've been failed, or maybe someone else is working on it currently. So finding a mentor with experience in that realm. Get an NDA get an NDA sign. Obviously people, uh, have people sign that, get their, get their mentorship, get their ideas. Um, but, but do take that single evaluation with a grain of salt because it's obviously just one viewpoint, but at least you'll get a sense of potential weaknesses that might exist in your idea that you're not aware of. Often people get caught up in the excitement and have blinders on and don't realize there's some obvious right fault or issue with their idea. So it's always great to get an objective pair of eyes on the idea and then, you know, simply do a patent search. See if anyone else has thought of the idea, see if it already exists. Um, but that at least lets you know whether it's something you should pursue or not.

Joseph M. Schwab 5:41

So how does one successfully transition, say a good clinical idea into an an actionable development concept? Maybe they want to work with an engineering team or a large company. What? What are they gonna be looking for?

Alexander Sah 5:58

First, there has to be a need. There needs to be a market for adoption and timing is so important. A great idea at the wrong time might fail even though the idea is a great one. So often the interest of a large company will be based on how the idea fits in their larger portfolio. So again, you might have a fantastic idea. It might have a lot of potential to have impact, but if that industry partner doesn't see it fitting into what they're currently doing, it may or may not be adopted by them. So don't be discouraged. You might have to. Bring your idea to the third, fourth, maybe even sixth choice of partner just due to circumstance. So don't have your sights on only one single company partner, but you wanna have something where there's a need, a market need, and there's truly a market where they can adopt your idea or technology.

Joseph M. Schwab 6:47

When one is deciding maybe not to pursue an idea or to walk away from a collaboration that isn't working. How does one go about that? What are their, what are the factors they need to be considering?

Alexander Sah 7:00

That is a very important point, Joe, because there are so many ideas and so many collaborations and sometimes you just have to realize it's not working how you want to. So I think in the beginning of that relationship. You really want to think about setting some terms, whether it's six months of time or achieving certain milestones. 'cause many great ideas die in unproductive collaborations. So, and it can be difficult to remove yourself from them. So having that thought process in the beginning before starting, that collaboration with your partner is important. Again, setting either time limits or milestone limits, because like we said earlier. Sometimes that idea will, will be better with a different partner or with a different, uh, choice of industry to look at it. So you really have to know when to walk away as well. It doesn't mean the idea is not good, it just means your potential collaboration is not as fruitful as one would hope. So make sure you maintain some level of control and ownership that you have the options if the development pathway starts to go somewhere where you don't want to do.

Joseph M. Schwab 8:01

So let's take a concrete example of one of your collaborations. Think surgical. Can you briefly describe your involvement in the journey of its product? And specifically, what was the most valuable bit of feedback you provided as a surgeon that truly changed the product's final design or function?

Alexander Sah 8:20

As that example Joe working with Think Surgical has been an incredible experience because of relationship with the company and the engineers. I just got very lucky because they happened to be headquarters in my same town, but their interest in surgeon feedback, their rapid turnaround time. It's so rewarding in both optimizing the surgeon experience when using the technology, but it also validates our input and our contributions as it as advisors. Some of the larger product teams, it's more difficult to experience that because it's harder to move the needle when you're on large groups. But working with an advisor with a smaller, more nimble company has been very, very rewarding. So often I, I gravitate towards those types of relationships.

Joseph M. Schwab 9:04

What's the single biggest lesson you've learned from developing and testing new products that has maybe changed the way you practice medicine today?

Alexander Sah 9:14

There are a abundance of technologies and products available in our orthopedic ORs and even in our clinics now, and it's very hard to sort out which ones are gonna make a meaningful impact in our current. Practice of medicine. I would say that technologies are, products that are most impactful are the ones that speak for themselves. If a surgeon can use it, they can see the impact immediately. Then adoption is gonna be rapid. The new ideas that take a lot of explaining or training, or have other hurdles to adoption or have real challenges to change current practice. So I think simplicity and immediate and tangible benefit are really important to new products, trying to make a difference in our current practice today.

Joseph M. Schwab 9:55

So developing and collaborating with companies on these products is quite honestly time intensive. How do you balance your commitment to innovation with the demands of a high volume surgical practice?

Alexander Sah 10:10

It is a sacrifice, whether it's an evaluation or development or advisory roles, it takes a lot of time. So you really have to have enough interest to justify the time commitment to be involved, because it's gonna take time away from other things. I probably have no balance, Joe, but I truly do enjoy it. So I enjoy working with these companies, involved with these projects, but it certainly is a choice. Being a high volume sur surgeon certainly has its benefits because I can evaluate new technologies and products very rapidly. So there is some benefit of not being balanced, I suppose. But as of right now, it is just such a rewarding process to be involved that, uh, I choose to to do it.

Joseph M. Schwab 10:50

How do you ensure when you're working with these new technologies that you're able to evaluate them objectively? Are there criteria that you use to distinguish between say, a truly impactful innovation that's gonna change the way you think or practice to something that is maybe just novel?

Alexander Sah 11:10

That's a great question. There is a, uh, temptation to try to use some of these new technologies 'cause they're shiny and new and you wanna be on the forefront, but are they really making a clinical impact? That's the real, uh, important factor. And so if I can. I always try to use a, a new technology in tandem with my standard technologies or, or protocols. That way I can really compare them side by side. I think that's the first way I look at adopting something new. And then secondly is we have a very robust, uh, joint program involving anesthesiologists, nurses, therapists. I specifically try to not tell them when I'm using something new because I would really like to objectively hear their experience from their point of care Is what I'm adopting making a difference on their end? Meaning do the PACU nurses see a difference? Do the physical therapy see a difference if I tell them I'm doing something new? I found in my experience there's some element of a placebo effect. So they're gonna want to say that there's a difference. So I purposely try to not tell my team when I'm introducing something new so I can get their honest feedback.

Joseph M. Schwab 12:15

So to other practicing surgeons maybe who've identified a, a solvable problem and are now considering the path of, say, product development or starting a company. From your perspective, what's an essential or maybe the most essential piece of advice that you would give them to set up for success?

Alexander Sah 12:36

To embark upon this process, I really recommend get help. Have advisors, it's generally a team effort. As much as you're tempted to wanna do it yourself, because it's a great idea, you wanna hold onto it yourself, it's unlikely to be successful unless you really surround yourself with good people. So whether it's a collaborator, an advisor, a patent lawyer, of course, or others, you're gonna have to have help because it's a very long and expensive process. So you have to find the right team, the right partners, because that's really critical to the success of product development.

Joseph M. Schwab 13:09

The path. Product from Idea to Market is, is really full of many hurdles. Regulatory funding, um, skepticism from the, the surgeons that it would be, um, targeted towards. What should a surgeon prepare for maybe emotionally or professionally before embarking on this sort of journey.

Alexander Sah 13:32

I think anyone involved with this would tell you it's gonna be a rollercoaster. There's gonna be ups and there's gonna be downs because as you said, Joe, there are so many different elements of bringing an idea to market that some portions will go very well and some will be incredibly frustrating or time consuming or costly. So just knowing and being prepared that it's gonna be physically and emotionally a roller coaster. Um, from. Filing a patent to funding, to bringing on partners, it's, it's simply, it's time and it's money. So be prepared that it may not succeed. I think that's one thing. Um, but if you really have a great idea, have patience, be persistent, um, know, know who your good partners are, and at the same time know when to abandon an idea. So it's just having that balance of what's realistic.

Joseph M. Schwab 14:17

Is there a common mistake that you see, uh, new surgeon innovators making? And if so, how can they avoid it? And I'll also ask, is there a commonality to the successful surgeon innovators that you see? And how can people foster that?

Alexander Sah 14:35

That's a great question. I think a common mistake for new surgeon innovators are sitting on an idea, you know, timing really is everything. So if you have a great idea, start the process and look, do a patent search. See if anyone else has come up with the idea or they're working on it, because odds are very high that if you've thought of a great idea. Probably someone has thought about it already before, and if they haven't patented already, they're probably working on it right now. So timing is really key. Um, I would say move on it and really try to, try to bring it to market as quickly as you can with, with the help of advisors, of course, because again, if you thought of it. Probably someone else has too. So that's probably the first common mistake of young innovators. And in terms of a commonality of those who are successful, I think it's those who have learned from their predecessors, those who have got, who have reached out to mentors, those who have reached out to people in the industry, because there are so many people who have already, um, you know, you don't wanna recreate the wheel. There are so many people out there who already been along the same path. So I think the really successful surgeon innovators are those who are collaborating with others who have also been successful because that way they can pave the way for you, uh, to bring your, your product to market.

Joseph M. Schwab 15:47

Looking ahead from your perspective, is there an emerging trend or idea that you're most excited about right now? And if so, how do you plan to be involved in shaping its development or in it being brought to market?

Alexander Sah 16:04

I think right now it's really the AI technology. It's everywhere. You can't turn your head around and not see AI somewhere. So it's gonna, it's coming. It's already here, but it's gonna be coming even more. It's gonna be everywhere in our operating rooms and in our clinic. So I think it's really important for us as surgeon surgeons to be involved. Again, similar to that epic analogy, I think it's important we're there during the development to make sure that these products are developed with. What our needs are, um, so that it can be most effective for us. So rather than waiting for someone else to force it upon us, sturgeons really should have an active role in shaping this technology. So whether it's AI helping make decisions in the, or how we're doing our procedures or ai, choosing which patients are surgical patients or how to treat them, you know, post-op in our clinics, AI's here and, and that's really something where we need to be involved.

Joseph M. Schwab 16:54

What continues to motivate you today, both in your clinical practice and for these purposes, your innovation journey.

Alexander Sah 17:05

Really, it's just, it's fun and rewarding. We all love operating. We're all orthopedic surgeons, but you can only do so many joints, replacements in a day. You can only do so much clinical work, so it's nice to have a, a hobby outside of the operating room, and it's a great way to be involved with industry, but also with other KOLs to discuss ideas and to learn from them. For those of us not in academics, it's a great opportunity again, to engage with our peers and to really make a difference by hopefully developing a product or technology that will help our patients. But also hopefully developing something that will help our surgeons colleagues do a better job as well.

Joseph M. Schwab 17:41

So our series is titled From Idea to Market. What does that phrase mean to you personally at this stage of your journey as a leading surgeon innovator?

Alexander Sah 17:56

I love the series and idea to market and love hearing all the perspectives of all the other guests you've had, Joe, and really what it makes me think of is it's a journey, right? Great ideas are plentiful. And if you think about Shark Tank at the Anterior Hip Foundation meetings, think about how much excitement, interest it generates. I think all of us get very excited about the possibilities of where technology or new products can bring us, you know, in our professional lives, in the clinics and the ORs. I think. From idea to market is really a great, uh, concept of how to help surgeons make that journey together and how to really make an impact on our surgeons, uh, colleagues and on our patients. Uh, it's just something great to be involved with and the, Anterior hip foundation just one a great example of how to make a difference, um, working together.

Joseph M. Schwab 18:44

Tell me a little bit more about the AHF Shark Tank and how it can impact both the surgeon's involvement in innovation, but also the surgeon as innovator.

Alexander Sah 18:57

The Shark Tank at the Anterior Hip Foundation has been one of the most popular segments of our annual meeting, and it has. Been fantastic to be a part of, whether as a surgeon presenting an idea or just being in the audience and getting to evaluate it. Because the way the setup is like Shark Tank on television, we have surgeon innovators presenting their ideas, but also leading industry decision makers who are evaluating those technologies. And so you learn so much just by seeing how great ideas may have benefit or may have some. The, um, difficulties, right? Coming to market, it might be the world's best idea, but it's just too difficult to spread across adopters or maybe doesn't have the return on investment or doesn't have the ability to generate, uh, you know, real value for these companies. And so it's really interesting to hear that perspective. And so the, it is often the most, uh, exciting part of the meeting 'cause everyone is involved and interested. And I can remember some of the prior sessions we've had where we've seen technologies really. Revolutionary technologies. I'm thinking of, uh, advanced scanners or VISIE now, Joe, that you'll see at Aus and Academy and see these basically tracker list technologies that can follow the, the knee, uh, throughout space and, and help potentially with robotic surgery. But it's interesting to see it at shark tank. Three years ago, um, and then see where it's developed each year since and where it's going. So that's just one example of where, uh, a HF has really led the way in bringing new technologies and offering surges and opportunity to bring their ideas, uh, to market. So, um, I look forward to that every single year.

Joseph M. Schwab 20:36

Is there an advantage to doing this sort of shark tank in front of an audience, meaning in front of the, the participants of the conference versus just having these conversations in a back room with an executive somewhere?

Alexander Sah 20:51

I think these shark tanks are a great opportunity because number one is it's free to them often to try to get this type of information or feedback. You're paying someone or taking a lot of time to try to organize, but here you have the benefit of the. The audience who can help evaluate your product, but also those four to five industry leaders who are gonna give you a real honest feedback of. How good the idea is and how likely it is to make an impact on market. Because remember, those are two very different things. You can have a great idea, but it just isn't applicable to how the market is today. So these good ideas have to be profitable. I mean, that's the bottom line. And getting this kind of honest feedback from, from four industry leaders is really, uh, rewarding and, and unique.

Joseph M. Schwab 21:38

So the sharks in our shark tank are, as you said, industry leaders and they're typically higher ups in larger companies. What is it? Uh, what for surgeon in a. Who are looking to bring their own company to market and produce their own product and not necessarily sell or license to a large company. Is there still value for them?

Alexander Sah 22:02

A hundred percent I think because these industry leaders, they've been there before, they know and have seen many of these ideas, and they've probably passed on ideas that are very similar to what's being presented, but they'll explain why. They'll explain what the challenges were in similar type products that they previously evaluated. So I think it's definitely important to get that perspective. And then secondly, it's also important to understand what these large industry partners have in their portfolio, why a great idea might not fit in what they're looking to do today. Meaning your idea might be a great idea, but if these large industry partners see the industry moving a different direction, and if that does not include your idea, it might be important to realize that the environment is changing. Your idea is still a good one. It's unfortunately just not where the market is going. So it's a unique perspective to, to be able to hear from these, uh, very, uh, important executives and decision makers at large companies of, of what they see the market is today and tomorrow.

Joseph M. Schwab 23:02

Alex, thank you for joining me today.

Alexander Sah 23:06

My pleasure, Joe. Thank you so much.