What a cutting guide taught a young engineer

The demonstration that changed how I work took place in 1999, in a training theatre outside Grenoble. A senior surgeon was trying a tibial cutting guide I had helped to design. Every tolerance on the drawing had been met. He still needed three attempts to seat it, because the locking lever sat exactly where he wanted to hold the bone. He was polite about it. I went back to the office knowing that my specification had described the part and not the work it had to support.

I grew up in Grenoble with an Italian mother and a French father, and studied mechanical engineering at the Institut polytechnique de Morvessan, graduating in June 1998. That September I joined Chalvenne Instruments Chirurgicaux, a family company making instruments for orthopaedic and spinal surgery. For more than four years I designed and tested cutting guides, impactors and trial components, and I learnt to spend time in theatres and sterile-services departments rather than only at a drawing board. A tray that is hard to clean, or an instrument with eleven parts where seven would do, is a cost carried by a nurse at the end of a long day.

In 2003 I moved to Turin as a product manager for hip systems at Valtorsa Ortopedia. My scope widened from one instrument to a whole product: stems, cups, liners, heads, the instruments, the surgical technique and the evidence behind them. I learnt how much of an orthopaedic product is its record. Surgeons asked what arthroplasty registries showed, how long a design had been implanted and what we would do if a problem appeared years later. I also learnt that the pressure to add sizes and options never stops, and that every option added is one to stock, support and eventually justify.

Merlicourt recruited me to Namur in 2008 to manage knee systems. It was then a smaller family business with a loyal following among Belgian and French surgeons and a portfolio that had grown by accumulation. I managed two knee systems, then the whole knee portfolio, and in 2013 I began the conversations that became our recovery programme. Physiotherapists told us that patients went home with photocopied exercise sheets and a telephone number few of them used. Our first pilot, in 2016, was clumsy. It assumed that every patient owned a smartphone and wanted daily reminders. Many did not.

We launched the recovery app in 2018 after that pilot in six hospitals. I made mistakes in the early versions. We included a step-count leaderboard that some patients treated as a competition in the first fortnight after knee surgery, when physiotherapists wanted them to rest as well as move. We removed it within a year. The episode left me wary of features that measure enthusiasm rather than recovery.

I became chief product officer in March 2020, days before elective surgery stopped across much of Europe. For months hospitals used the app to stay in touch with patients whose operations had been postponed, a purpose we had never designed for, and we had to decide quickly what we could safely support and what we should refuse. The MDR then came into application in May 2021, and with it the question of which older products deserved the cost of certification under the new rules.

My role sits between surgeons, physiotherapists, our engineers, the commercial teams and our regulatory colleagues. I do not decide whether a design is clinically acceptable; our quality system, our regulatory team and the surgeons who advise us do. I decide what we develop, what we stop, what we claim and in what order. I present the portfolio plan to our board each quarter and attend its quality and product-safety committee when product matters are discussed. I have never held a directorship.

Colleagues would probably say that I ask to see a thing being used before I discuss it. I try to attend one theatre list and one physiotherapy session a month. I read the complaints file. I ask how many trays were opened and never touched. In product reviews I want the person who will support a feature in five years in the room, not only the person who wants it launched.

The three cases I have chosen concern withdrawal and restraint: a knee system we stopped selling, a messaging feature we ended and a sales argument we surrendered so that more patients could use the recovery programme. Each had real costs and colleagues who disagreed for good reasons. I would bring that experience to a board as a habit of asking what a product commits the company to for its whole life, not only what it adds this year.

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