Moximed pivots to sales, education for newly OK'd shock absorber for the knee

Nov 11, 2023

After spending 15 years designing, building and testing an implantable shock absorber for the knee, an East Bay company is taking on a new kind of pressure: selling the medical device for osteoarthritis patients.

Moximed Inc. co-founder and CEO Anton Clifford said his Fremont company is rolling out a strategy to get the device to the right patients — ones who want to beat back debilitating knee pain to stay active — at the right time. That foregoes short-term revenue, he said, for the long haul.

The company's Misha knee system device works similar to a cylinder-and-piston system in a car shock absorber. But instead of being positioned behind the tires, Moximed's pinkie finger-sized implant attaches to the femur and the tibia with titanium screws and quarter-sized metal plates. That positions it outside the joint itself but reduces contact forces by about 30%.

Misha zeroes on the roughly 9 million Americans living with degenerative knee osteoarthritis. It won Food and Drug Administration clearance in April.

Since that regulatory OK, Moximed has focused on educating and training 28 surgeons across the country, expanding to 40 doctors. Then it will concentrate on engaging patients, who Clifford said already are starting to apply for insurance coverage for Misha.

The device, implanted in outpatient procedures lasting 30-80 minutes, costs between $10,000 and $40,000, the outside part of that range matching the cost of cartilage implants.

"We could (market) broad right away. I've seen failures in that setting," Clifford said. "They go too broad, too quickly and don't do the foundational work on what this is, which patients are the right patients, which ones are the wrong patients, and who are the right surgeons."

Who's the right patient? Someone who's still active — the age range in Misha clinical trials was 22 to 65 — but suffers mild to moderate knee pain that is starting to cut into their activities. They're too young, by most measures, for knee replacement surgery, and in the dozen or so years it takes to exhaust nonsurgical interventions would likely remain ineligible for knee replacement.

"Our patients typically want to be active. They work multiple shifts back to back. They want to continue to ski. They play pickup basketball games. And they're concerns about joint replacement that could lead to early failure," Clifford said. "It's about the ability of a joint replacement to meet the demand of these patients."

Misha appears durable, Clifford said, with the longest-term user now approaching their ninth year with the device. What's more, 85% of Misha patients, according to Moximed, will avoid arthroplasty.

An FDA clearance and a broad customer base is typically the time when medical device makers typically look to sell their companies to the industry's big players, like Johnson & Johnson, Boston Scientific, Stryker Corp. and others. But Moximed's controlled rollout, Clifford said, was built around the idea of keeping the company independent as it investigates using the device in other types of joints.

"This isn't about demonstrating adoption at a couple small centers then get into M&A activity," Clifford said. "Investors think of exit strategies; I really don't."

The company has raised more than $180 million from Advent Life Sciences, New Enterprise Associates, Morgenthaler Ventures and others.

Misha's rollout with a direct sales team and a clinical support group has meant Moximed has grown from less than 20 employees to 27. It will have 40 by the end of the year and plans to have 75 employees by the end of next year.

Moximed's design-build-educate strategy is how Clifford and serial medical device entrepreneur Josh Makower, who runs the ExploraMed incubator in Mountain View, drew up the business in 2007.

"This is a patient population in real need, and when we looked at them — they were younger, active and they didn't have a lot of options," Clifford said. "Fifteen years later, the options for those patients are the same if you take Misha off the table."