Medacta Group SA (MOVE) Earnings Call Transcript & Summary

March 25, 2025

SIX Swiss Exchange CH Health Care Health Care Equipment and Supplies earnings 49 min

Earnings Call Speaker Segments

Operator

operator
#1

Good afternoon. This is the Chorus Call conference operator. Welcome, and thank you for joining the Medacta Group Full Year 2024 Results Conference Call. [Operator Instructions] At this time, I would like to turn the conference over to Mr. Francesco Siccardi, CEO of Medacta Group. Please go ahead, sir.

Francesco Siccardi

executive
#2

Thank you, and good afternoon, everybody. Welcome to Medacta 2024 Full Year Results. I am here with Corrado Farsetta, Medacta CFO, and we will guide you through the presentation we released this morning. First of all, let's just remember our disclaimers. So the highlights of 2024 started with our revenue release that we already published a few weeks ago, a very good growth, over 16% in constant currency, surpassing EUR 590 million. And this is combined with a good excellent profitability with a 28% EBITDA margin in constant currency or 27.1% in euro, a good increase of 19.4% over 2023. The net profit as well increased by almost 54% to EUR 73 million roughly, and we are proposing a dividend of CHF 0.69 per share, which represents an increase of over 25% year-over-year. 2024 is now the fifth year of very, very strong growth. Between 2020 and 2024, the CAGR has been 18%, 18.1%. And this considerable above-market revenue growth is a result of our innovative products that have been and are able to often change the way things are done. The more innovation we put in the market, the more medical education is required to support the safe introduction of this innovation and safe adoption of this innovation by our customers. And we have the need to further penetrate the different geographies where we are present, and we do it by constantly expanding our sales force and team in the different regions where Medacta is active. We have already released the sales figures a few weeks ago. So I will not go too much into the details, but this growth was supported by all our geographies with a very strong performance in Europe, in North America, in Asia Pacific and in Latin America. And under a business line point of view, we had across all our lines, a 2 to 3 to 4x above-market growth for hip, knees, extremities and spine. We have been slightly changing the product mix compared to the past, and this is mainly related to the strong acceleration of knees, which is basically now at the same level of the hips. And extremities and spine represent roughly 8% to 9% each. The products related to those performances are very well-established product, very strong strategy on the hip still focusing on anterior minimal invasive surgery, which allows Medacta to grow more than 2x the market year-over-year. There's still a very, very strong interest in all over the geographies and of course, as well in the U.S. with ASC developing, so good need for minimally invasive procedures. Very, very good expansion of our knee portfolio with the GMK SpheriKA continuously rolling out. The GMK SpheriKA is the first and still today the only implant specifically designed for kinematic alignment, which is a new and better personalized way to implant a total knee replacement, which is now becoming more and more accepted with solid data and very good performance. The growth of the knee in 2024 has been more than 3x the market. Very good growth in spine as well, above 17%, more than 3x the market, combining here our implants with our technologies. And this is a very important element to differentiate our portfolio in a very crowded market, which is the spine market. And the highest growth, we had it once again in the extremities with a CAGR of 36.5% and basically a growth of 5x more than the market in 2024. And here as well is a combination of our very complete and competitive product portfolio in terms of implants supported by the NextAR technology, which is very unique in this space. All this growth comes in a very sustainable way. We did release this morning as well the 2024 sustainability report, where you can find a lot of information on our activities. But here, we picked some highlights for 2024. And once again, we were able to source 100% of our electricity in our manufacturing plants from renewable sources. We had 97% of our new supplier evaluated according to ESG indicators and 98% of our employees trained on health and safety matters. And then another KPI, which we are very proud of, 100% rate of return after maternal leave in our headquarter, thanks to the support we provide to our female employees. You will find more details about the different pillars of our ESG report, so caring for the environment, the supply chain control, caring for our people and caring for the community. A lot of KPIs here as well. A big one is definitely almost 44% of greenhouse gas emission reduction in the last years, and this is despite our very, very solid growth. We mentioned the responsible and reliable supply chain control. For our people, of course, we continue to professionally develop their careers. We have invested a lot in training hours for our employees, which has constantly increased. We recently finalized a company survey, and we had an outstanding 87% response and we're providing a lot of feedback. So we're very happy with the dialogue we have with our rapidly growing family in all our employees. And just to give you an idea, almost 30% of the new employees we hired last year did come from an internal employee referral program, which was introduced a couple of years ago. So very successful. And last, we know we have a big impact on our community. And with our Medacta for Life Foundation, we support a lot of initiatives starting from the MySchool Ticino, which enables us to support not only our employees, but as well to give support to our community on top of different humanitarian projects that rely on us to get implants support, people and know-how to help areas which are in need. Our commitments are listed here as well in terms on Slide 14 of adoption of Task Force on climate-related financial disclosures. More details, as I said, will be available or are available on our sustainability report. I would like now to ask Corrado to drive you through the financials in details, and I will be back with you for the conclusions.

Corrado Farsetta

executive
#3

Thank you, Francesco. Let's have a look now at the key figures of our P&L, and I would start with the gross profit. This year, the gross profit was equal to EUR 399 million with an increase of roughly 15% compared to the previous year. The gross profit margin was 67.6%. And I would say the net from transactional FX effect, the GP margin of this year was substantially in line with the previous year. Moving to the next one. Here, we see the adjusted EBITDA evolution over the last 5 years. Let's start with the 2024, where we have registered an EBITDA adjusted of EUR 160 million, which compared to the previous year, EUR 134 million represent an increase of more than 19% year-over-year. The adjusted EBITDA margin increased as well by 1.7% net from FX effect. You see this in the red line of this chart, passing from 26.3% to 28% net from translational effect in 2024. There is another line in this chart that we can have a look at, which is the highest line, the blue line, which illustrates the adjusted EBITDA margin evolution net from FX effect over the years. So you see that despite the reduction of the reported EBITDA margin, which is the yellow line, net from FX effect, this EBITDA margin was constantly around 30% with a nice jump in 2024 of 1.7%, as we just said. Moving to the next slide, we see that the net profit in 2024 surged as well, and we reached about EUR 73 million with an increase, as Francesco said before, of 54% compared to the previous year. Just a few comments about this jump. We say that the EBITDA margin expanded in 2024, but this improvement in the net profit is also explained from a better financial performance, which is primarily coming from intercompany balances largely benefiting from more favorable FX evolution, particularly U.S. dollar versus Swiss francs. And lower effective tax rate in 2024, which went down to 17%, starting from 19.4% last year. And this improvement is primarily attributable to the enter into force of the Swiss tax reform in 2025 -- 2024-2025. Moving to the next, you see the usual CapEx pie. And again, as usual, the largest chunk of this CapEx of EUR 99 million in 2024 is explained by growth investments. The biggest chunk is instruments, EUR 57.8 million. And the second chunk, the biggest chunk is composed by other tangible for EUR 23.8 million, and this number includes investments to expand the production facility here in Castel San Pietro and Rancate and the new logistics hub in Europe. Moving to the next. Here, you see the cash flow. In 2024, we were able to generate a robust cash flow from our operating activities of EUR 107 million with an increase of more than 40% compared to the previous year. And this robust cash flow generation was able to finance our strong investment plans of CHF 99 million and generate a positive, small but positive free cash flow of CHF 8.3 million. Moving to the next one. Here, you see the very low leverage as a result of our ability to generate cash. Over the last 5 years, the leverage was constantly around 1x the EBITDA. This year, 0.99, so very low. And moving to the next slide, you see here the dividend per share. As Francesco mentioned at the beginning of the presentation, the Board is going to propose a dividend of CHF 0.69 per share, representing an increase of 25% compared to the previous year. I believe that this concludes my part, and let me hand over to Francesco for the 2025 outlook and some final remarks.

Francesco Siccardi

executive
#4

Thank you, Corrado. Looking forward to 2025, we are targeting revenue growth in the range of 13% to 15% in constant currency and an adjusted EBITDA margin of around 27%. And this includes the recent Parcus acquisition and of course, is subject to any unforeseen events. In terms of midterm outlook, we reiterated the midterm outlook we provided during our recent Capital Markets Day with compound annual growth rate in constant currency expected to be in the low double-digit region and an adjusted EBITDA margin targeted to be around the 2024 reported EBITDA margin before any currency effect. In terms of key messages for 2024, very, very strong revenue growth, 16.2% year-over-year. This is linked to the very strong innovation impacting both patient outcome and health care system sustainability. This innovation is supported by medical education and personalized training of surgeons. And of course, it does require an expansion of our sales reps and team in order to support this growth. The expansion of the adjusted EBITDA margin this year has been exceptionally strong, 170 basis points to 28% constant currency year-over-year. A record net profit of almost EUR 73 million with an increase of -- sorry, with 12.3% of revenue. And as we said, a proposed dividend of CHF 0.69 per share, which represents an increase of 25% year-over-year. This concludes our presentation, and we can open the forum for Q&A. Thank you very much.

Operator

operator
#5

[Operator Instructions] The first question is from Dylan van Haaften, Stifel.

Dylan van Haaften

analyst
#6

So maybe the first question. So if we take -- if we look at the embedded assumption for ortho growth, if we take Parcus out of the guide, that would sort of imply maybe if you're growing 3x the market that you're expecting maybe around 4% base ortho growth. Is that sort of the right way to look at it? And does that also embed that some of the backlog that you guys have already talked about is fully out? It was already out in the second half. And for that reason, we're seeing base ortho growth kind of step down? And then after that, I've got a follow-up.

Francesco Siccardi

executive
#7

Yes. I would say if you look at Parcus number, probably alone, it is around 2%, 2.5% of 2025 guidance. Back to your market-related question, which speed is the market going to grow in 2025? I think we have a little bit less visibility as everybody else. 2024 was still, in my opinion, a little bit stronger than expected with maybe the market depending on the segment around 5%, 5.5%. And yes, I do expect the market to slow down a little bit. And -- but of course, we will benefit if the market stays stronger. So yes, maybe without Parcus, you remove 2% from our guidance and you have the, let's call it, core or pre-Parcus acquisition growth rate.

Dylan van Haaften

analyst
#8

Understood. And then maybe just on the instrument CapEx. So I think the instrument CapEx component grew in the 20s. So normally, I'd probably ask if we look then at the core growth guide versus then the current CapEx that is kind of going into the market, that would kind of indicate that you're also seeing a lot of opportunity at the same time. Could you maybe just give us some color about maybe how you're thinking about the opportunity. Last year, there was also an opportunity to be a bit more aggressive in the market and I think your current CapEx growth also kind of points that you might be seeing this in fiscal year '25 as well.

Francesco Siccardi

executive
#9

Yes. As you pointed out, the instrumentation is a very good proxy of what we think we're going to do, especially in H1 '25 because all the instruments we produced in the second half of '24 are going to be supporting our revenues in early '25. Typically, we do have for every dollar of growth, $1 in instruments or in CapEx, sorry. And this is more or less what you have seen in 2024 as well. So it's pretty much in line in terms of CapEx versus growth 2024 with the previous history.

Dylan van Haaften

analyst
#10

Yes, understood. And then just the final question for you, Corrado. Just -- because I didn't fully understand just on the financial income side, is there also a hedging impact? Are you guys now also hedging and that's kind of some of the offset? Or did I misunderstand?

Corrado Farsetta

executive
#11

But if you are -- if I understand correctly, question is about the financial results, right?

Dylan van Haaften

analyst
#12

Correct.

Corrado Farsetta

executive
#13

Okay. So in this case, financial results are benefiting from a positive evolution of U.S. dollar versus Swiss francs. And as you may recall, we had a big amount of intercompany debt due to the specific situation of DACH, U.S.A. They had to buy inventory and assets. This generates intercompany debt in U.S. dollar. And depending on the value of the U.S. dollar at the 31st of December, you can have a positive or limited negative effect on that financial result. This year, what we implemented is -- was a reduction through several measures of this exposure. So thanks to this, we have this year had 2 different type of, say, benefits. First of all, a limited fluctuations of the results to the limited exposure and fluctuations. And second, thanks to the evolution of the U.S. dollar versus Swiss francs, a positive effect, which was the opposite last year. Last year, we had a bigger negative effect. This year, we have a smaller positive effect. And this justifies the very, very low financial result of roughly EUR 4 million compared to EUR 15 million last year.

Operator

operator
#14

The next question is from Sandra Dietschy, Octavian.

Sandra Dietschy

analyst
#15

I have one on the SpheriKA. Is this already approved? Or when can we expect regulatory clearance in Japan and Australia? And anything specific in these regions to consider? Or is it fair to assume that it could become also a key growth driver in these regions? And then I have another one on the investments, specifically in education. I assume you held last year kind of more events than usual due to the 25th anniversary. Or should we expect kind of a similar level of education events also this year? Or how do you plan for that?

Francesco Siccardi

executive
#16

Thank you, Sandra. Yes. So SpheriKA has been approved in Japan as well. And it is not yet approved in Australia. And so we are working on it. There are different requirements and different time points, we need to collect data for different countries. So Japan, yes, and Australia, not yet, but both countries are already adopting kinematic alignment with Sphere. And so we are already growing, if you want, as we did before SpheriKA in Europe, in Australia and in Japan. But now with SpheriKA in Japan, we will further expect to accelerate. In terms of marketing and investment in medical education, the 25th anniversary was a very good branding initiative to push the message of the company celebration, but we don't need the 25th anniversary to organize medical education events. And in fact, we are basically maintaining the same level because our educational events are organized in order to support the demand for medical education that the countries are collecting. And in terms of Medacta Direct medical education, we don't expect to reduce it at all.

Sandra Dietschy

analyst
#17

Yes, makes sense. Thank you for clarifying.

Francesco Siccardi

executive
#18

Thank you.

Operator

operator
#19

The next question is from Aisyah Noor of Morgan Stanley.

Aisyah Noor

analyst
#20

My first one is on pricing. So what was your estimated pricing growth for 2024? And what is embedded in the guidance for 2025? Second question is just a housekeeping one on Parcus. Do you expect any one-off costs associated with the integration? And then the third one is a similar question like to the first, which was around the market growth outlook for 2025. Clearly, the U.S. market was very strong in volumes for everyone, you and your peers. So does your guidance embed a more normal volume growth outlook for 2025? Or is there some comp effect from 2024, so a little bit slower for the market in '25?

Francesco Siccardi

executive
#21

Yes. I will take the -- on the pricing question, we do have in our plans a price erosion, so not a price growth. And this is pretty much in line with the historical price erosion, which has been a little bit slower than in the, let's say, pre-COVID years. It did stop. It did increase even a little bit in certain areas or reduced at group level, but we have approximately a 1% price erosion built in, in our models, if you want. In terms of market growth, I would say that we do expect a little bit slower market growth than in 2024 and our guidance incorporates this slower or, let's say, more normal growth of the market because I think 4% to 5% -- or actually almost 6% was expected in 2024, it's definitely significantly more than the historical growth rate of orthopedics pre-COVID for sure. On the Parcus side, maybe I can leave it to Corrado. There are some onetime integration cost marginal. But Corrado, if you want to give more color?

Corrado Farsetta

executive
#22

Yes, sure. Basically, what we have in our P&L, of course, is the effect of the acquisition of a company. This is expected to slightly dilute the marginality. There will be, for sure, some integration costs in our P&L. They have been already planned. And in 2025, what we expect to see is also an initial positive effect on the numbers coming from the -- some synergies that we are planning to implement and to see in order to, say, to fully integrate this company in our business. We believe that the integration cost won't be very, very significant. There will be, for sure, but we are not talking about something that could change the -- let's say, the face of our P&L significantly.

Operator

operator
#23

The next question is from Sam England of Berenberg.

Samuel England

analyst
#24

Firstly, can you give us a bit more of an update on the GMK SpheriKA launch and the traction you've seen so far? In particular, has the momentum you saw in the second half of '24 continued in Q1? And then how is the conversion of the pipeline of new surgeons progressing in the U.S. and the EU where you've been in the market a bit longer? And then secondly, on ASCs, can you give us a bit of an update on the market and the share of procedural volumes for ASCs in the U.S. market and for yourselves? And then can you give us an update on your progress on single-use instrumentation sets? And are you seeing that supporting the traction that you're getting in the ASC market in the U.S.

Francesco Siccardi

executive
#25

Yes. So the GMK SpheriKA is rolling out extremely well. We have a very strong demand, and we expect the GMK SpheriKA to be our #1 brand already by the end of next year. So there is a lot of growth, some cannibalization of the Sphere knee, which remains in many markets for regulatory reason or simply for preference of surgeons, but the GMK SpheriKA is definitely taking over becoming our number knees expected, as I said, by the end of 2025. In the U.S., the ASC portion remains for us stable. So it didn't change from when we discussed it in January. It is almost, I would say, the double of the market. So we have a bigger share within ASCs than outside of ASCs. The reason is twofold. One is because our products are perfect for the ASC environment, so minimally invasive procedure, single-use instruments, very effective techniques and technologies, not only in hip and knees, but as well in spine and in shoulder. And this addresses, if you want, a little bit your last question about the Efficiency instrumentation, that's our single-use brand. GMK Efficiency is definitely an area where we are further focusing, further pushing because it's very appreciated in the market is differentiated in terms of service. There are a lot of advantages for the nurses, for the ASC, but as well for certain hospitals, which have an outsourced sterilization and related costs. So there are a lot of benefits for different stakeholders. And of course, there are benefits as well for us because it does reduce in a potentially significant way our need to invest in instruments and therefore, our CapEx and potentially further improving our cash flow. So yes, we are definitely focusing and pushing even more on this solution.

Operator

operator
#26

The next question is from Graham Doyle of UBS.

Graham Doyle

analyst
#27

Just 2 for me. Firstly, on the margin in H2, there was some pretty good leverage on the sales and marketing line. So growth like 8% or something in the second half. Is that sustainable? And have you just like invested and therefore, there's a bit less to go? Or is that just a little bit of a pause? And then secondly, on the hip side of things, we've seen some new entrants into the anterior market. Are you noticing anything there in terms of increased competition? Or is it just a little bit too late from less innovative players? It would be good to get your take.

Francesco Siccardi

executive
#28

Yes. Maybe I take on the anterior approach. So the anterior approach has always been covered by all our competitors in terms of having an instrument, having an implant that can be implanted with anterior approach. What they have often missed is the package, the light positioner and especially the focus and expertise of the sales force and the medical education element. So we don't see any new player in a significant way. The PO has always been there, DePuy Synthes, Smith & Nephew, Zimmer, Stryker, actually, they were there before us. So yes, they're all present and they've always been present. We can continue to outperform the market as you have seen with our 8-plus percent growth rate, which is probably 2x the market growth on the hip side. On the margins, yes. So last year, at the end of H1, our top line was around 14%. We did not have always excellent months. So we were a little bit careful about some of the expansion of OpEx, in particular, sales and marketing, but in particular, non-sales-related OpEx. And we then had a very positive increase of revenues, especially coming from the knee and very often as well or partially coming from hip customers shifting to knees as well or adopting knees as well with a much lower, let's call it, customer acquisition cost and sales force expansion cost, and that's where some of the incremental leverage did come through. Is this sustainable? Our guidance calls for basically a flat EBITDA margin around 27%, which is basically in line reported EBITDA of 2025. This includes as well Parcus acquisition, which definitely has some dilution. So probably without it would have been slightly better potentially. But it's -- we're very happy about the possibility to accelerate our extremities and Sports Medicine because we see a lot of midterm growth potential there. And therefore, we are very happy with the investment done and a little bit of the cost associated because the EBITDA remains very healthy.

Graham Doyle

analyst
#29

Okay. That's really helpful. Maybe just one quick one on cash because it's one of the areas we get a little bit of pushback from being constructive on is -- this like kind of over time growth in share of single-use instrumentation for you guys is like you sort of flagged earlier as being, I suppose, cash accretive or beneficial. Could you maybe explain how it's like basically cash accretive and beneficial to the business as you go forward rather than reusable instruments. It would just be good to better understand that maybe.

Francesco Siccardi

executive
#30

Yes. It's relatively simple. So for every single new instrument, you have to invest roughly EUR 40,000 instead if somebody is using single-use instruments, you are selling those instruments basically at the cost which is equivalent to the depreciation cost per case of an instrumentation. So under a pure P&L point of view, you would see a slightly higher cost of goods and definitely smaller depreciation portion, but you have a very big impact on the cash flow because you save the instrument-related cash contribution of EUR 40,000 per instrument. So this is the general rule. We think that the cash flow will potentially improve if single-use instruments will increase. And in the midterm, you will see probably a significant improvement of cash flow once our other tangible investment will decrease a bit as well because those are steps, the manufacturing when you build a building, which is what we are doing right now for '24, '25, you will still see a bit. But then you start to fill it up with machines. So yes, you have some portion of other tangibles, which will continue, but significantly less for 2, 3 years, depending on the company growth rate that we're going to see. But those 2 elements, so CapEx, other tangibles and single-use instruments on the instrument side, both of them should contribute to a significant increase of free cash flow. while the operating cash flow, I think you have seen has been quite phenomenal this year with a very good increase.

Graham Doyle

analyst
#31

That's super helpful. No, the inventory was pretty impressive.

Francesco Siccardi

executive
#32

Yes, thank you.

Operator

operator
#33

The next question is from Maria Vara, Bryan Garnier.

Maria Vara Fernández

analyst
#34

The first question will be on Parcus acquisition. I was just wondering if you could elaborate a bit more on what drove this acquisition. Any key products bringing into the pipeline and how this combines with existing offering?

Francesco Siccardi

executive
#35

Yes. Thank you for the question. So Parcus is a pure sports medicine player. They have a product portfolio of soft tissue anchors, which compete in the field with Smith & Nephew, with Arthrex, with Stryker, and they were particularly strong on the shoulder-related sports medicine soft tissue anchors. Medacta is -- was developing those product lines while we started our sports medicine venture, mainly focusing on the knee side. And so this accelerates significantly our ability to have a full product portfolio and therefore, the ability to invest in a dedicated sales force and accelerate our commercial penetration in many markets, especially in Europe. because we could skip the long and frustrating often phase of the medical device regulation -- regulatory step. So having a lot of CE product -- CE mark products readily available in a very good design, very competitive in Europe, in U.S., in Australia, where we have direct operations was a very good opportunity. So it's mainly a product range acquisition and expansion with an existing sales force in the U.S. of agents on which we could, of course, distribute our existing sports medicine line as well. So a lot of synergies there as well. Outside of the U.S., Parcus was present only through stocking distributors, while Medacta is present with -- in a lot of countries with direct operations. So we could take control where appropriate of our destiny, if you want, and accelerate the Parcus product presence in Europe, in Australia and in Japan. And last but not least, Parcus has a manufacturing plant in Florida. The Medacta Sports Medicine line, given its size, was completely outsourced so we have the opportunity to have a vertical integration in this line, which was not yet needed given our size. But it does provide, of course, the possibility to expand margins rapidly and control once again, the full supply chain from manufacturing to sales within the Sports Medicine line. So it's a good acceleration. It was a fantastic opportunity, very small infrastructure to be integrated, so relatively simple, basically an ERP and very little else in terms of people. We see a lot of opportunities to really accelerate in the $7 billion sports medicine market.

Maria Vara Fernández

analyst
#36

That's very helpful. And then last question on your current collaboration with THINK Surgical. I was wondering if you could provide any color, any kind of traction you're already seeing from this side as you got approval in August last year. And whether you are also considering other strategic opportunities on the space of enabling technologies for the rest of your pipeline to combine together with your NextAR?

Francesco Siccardi

executive
#37

So THINK Surgical is a very good partnership. It's basically an opportunity to offer a robotic platform for those customers that are interested in using Medacta products. So we did start to have cases done in different locations in the U.S. At the moment, the agreement is only for the U.S. simply because the THINK Surgical is not present outside of the U.S. And every single customer that we can gain, thanks to this collaboration is a customer that we would not have had without. So there's only positive elements associated with this collaboration and definitely welcome the opportunity. It is an open platform. So it is often interesting for hospitals to lean over this solution instead of being linked to a specific vendor that then is forcing you to use one implant over the other. And especially if you have multiple surgeons in the same location, open platforms can be a good solution, and we see that happening in the U.S. We do, of course, remain very interested in the enabling technology segment. There are a lot of ongoing projects to further enforce our NextAR offering and some come in form of new software, new application and potentially new hardware in the near future. But this is probably not enough meat on the bone for me to share at the moment, and I will come back to you when it's appropriate.

Operator

operator
#38

Next question is from Daniel Jelovcan, ZKB.

Daniel Jelovcan

analyst
#39

Two questions, please. The first one, I remember last year, you had some tailwinds from supply chain issues of your peers, which were mostly focused on, I think, the U.S. and Japan and the European market was a bit neglected and you had enough capacity. So is probably that tailwind a bit over, so to say, that's why you are a bit more conservative for this year as well? Is that also an element? Maybe I just ask the first one.

Francesco Siccardi

executive
#40

Yes. I would say the market growth in general, we see it slowing down to a more normalized level. The tailwind we had last year was -- is definitely not expected. I think they had almost 2 years of supply chain disruption, and they managed to control their supply chain better now. But still, our guidance with 13% to 15% remains a very aggressive guidance, as we said, 3x the market at least. And we want to make sure we meet our guidance. So that's basically the rationale for the outlook.

Daniel Jelovcan

analyst
#41

Okay. And the second one, I mean, last year, you reorganized the U.S. spine sales force, which already had a much better second half, I think, versus first half. I guess it's not done overnight, but if you can give us an update about the U.S. sales force for spine.

Francesco Siccardi

executive
#42

Yes. I would not use the word reorganization because it's probably too much of a -- too big of a word. What we have been doing is basically to start to put in parallel to the current strategy of growing spine through distributors as well to grow directly with our direct sales force in spine in the U.S., which is exactly what we've been doing 10 years ago on the joint side. So we remain very opportunistic in the way we add sales force to our businesses in the U.S., both on the joint side and in the spine. But the spine was before this implementation of strategy, 100% done through independent agents or distributors. And now we have started to do exactly what we did on the joint side, which can leverage our differentiating products better. We can invest in certain territories directly, so we have more control over growth rate and as well cost of sales. And we can especially tell the story the way we want, focusing on medical education and specialty products. So that's why I wouldn't use the word reorganization, but simply adapt our sales force expansion to a trajectory that has been very successful on the joint in the past.

Operator

operator
#43

[Operator Instructions] Gentlemen, Mr. Siccardi, there are no more questions registered at this time. I turn the conference back to you for any closing remarks.

Francesco Siccardi

executive
#44

Yes. Thank you very much. Thank you all for your interest and your questions. I would like as well to thank all our employees, all our clients, suppliers, and partners worldwide for the great support they provided in 2024 and look forward to continue our journey in 2025 and beyond. Thanks again, and hope to see you soon in person. Bye.

Operator

operator
#45

Ladies and gentlemen, thank you for joining. The conference is now over, and you may disconnect your telephones.

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