Medartis Holding AG ($MED)

Yes. Again, welcome to now Rainy Basel. The sun from yesterday is gone. But I'm very happy that you made it to our investor and media event around the the world's biggest hand congress. And I'm so surprised, look what Fabian I love it when Fabian has also here our products on the table. And by the way, the here. Some people who discussed yesterday night with me, they know about the. It's our brand-new launch for the U.S. Some are looking to say what they are doing. Is this becoming a erotic shop? No, Medartis is just becoming disruptive, different. And I hope you see this also throughout the fash. We have my road map, my strategy road map a little bit where do we send by end of May, then I think very interesting for you at a turnaround with Marc Ammann, our EVP, Innovation, Digitalization, Research and Development. Marc speaking about our road map and the NX Nail and then I'm very happy to welcome Daniel Herren - Dr. Daniel Herren from the Schulthess Clinic in Suri, He's sitting there. And we thought we should invite the pulp of CMC processes, because you are not only placed, I don't know how many you will discuss it. You will say it, but you are also the renowned hand surgeon in Switzerland and in the world, and we are very happy to have Daniel here to explain you a little bit what is it about TOUCH. it's all about TOUCH, TOUCH, TOUCH. And wherever we are, we speak about at we will also speak about Medartis and our other company -- group companies today. So Daniel will provide us with a voice of the expert, and maybe some of you will become pensions. Who knows? It starts with 40 years of age, especially in women, right? And you will explain why. Then we have a Q&A session. Very important there, we put the launch here, so that we have enough time. I think you will have questions. We do a flying here and then off to the fresh. From head to toe, nothing has changed since our strategy, our well-known strategy in the meantime, literally from head to toe. We start with our legacy. We would like to become and we see more and more coming also with market share gains in the U.S., the world market leader in hand and wrist in Upper Extremities is our focus. But it means also that Lower Extremities, foot and ankle is an area where we are continuing to launch new products. Marc will speak about it. We have new products in the pipeline, ankle fusion, for example, which will come also in the U.S. So it's not an area where we will step out. But if we look how big is the market potential in segment and how big is our addressable market with our portfolio, you can see that we are in Upper Extremities quite close. Our portfolio in hand, wrist up to the elbow is complete, is world class, especially in TOUCH. What is missing is shoulder. Shoulder, we have some portfolio gaps. It's an addressable market of CHF 1.7 billion. I could less that everybody says Lower Extremity is the fastest-growing segment. But if you are in the fastest-growing segment, not present or with a market share below 5%. You have no chance to win. And what I said already in the beginning of 2025, we are here to win just to play in the market. This cannot be our ambitious at Medartis. And therefore, we are focusing on our legacy, where we have a lot -- and if you see our competitors, what is very interesting, you see here that, for example, Stryker, they are stepping out of the CMF business. They are debating in the CMF business. Of course, with all respect, we have all the strong competitors. And we have competitors like a German company from who passed Carles Martin, they did a fantastic job over the last 10 years. They passed Medartis on the left and on the right. But we still have opportunities to catch up. At the same time, they passed with CMF, they lost focus on hand and wrist, and they are now catching up. So what we are catching up in CMF, they are catching up also in hand and wrist. But here, we have an extremely good portfolio, and I think Daniel can confirm this later. And the TOUCH proceeds when we speak about hand is a logical addition, but we have also wonderful other products. So we are covering everything. We are covering and you know that Medartis comes from art. And Art in our logo was very prominent when Medartis was founded 29 years ago. Why art? And this is something I've learned in my 18 months now with Medartis still being a little bit a dental guy. I'm not yet the orthopedic guy, to be honest. But what I've learned is that hand surgeons, in my eyes, with all respect, Daniel, you are artists. You're really doing artwork sometimes to reconstruct the hand. Of course, if you have a big trauma case, if you have an accident, the same applies to CMF. This is art, reconstruction of a face, especially of patients -- of 2 more patients. This is art. And this is bringing back live to the patients. It is wonderful to see, but it's a very filigrain part. Whereas also placing a TOUCH, it's not so easy. So therefore, we have an education-based approach where when it comes to corrections and also when it comes to trauma cases, this is a little bit more tough, rough work when you go to an OR midnight after a car accident. So we cover it everywhere within our Medartis group. We became in 2025 in our transformation year, the Medartis Group. We focus with Medartis on our 3 big strategic pillars like CMF the Upper Extremities and also Lower. We have this KeriMedical integrated and leave it stand-alone company with a unique touch process where we say today the hip for the thumb. And then we entered with 51% last year, the value segment with NeoOrtho and I came back to this. What also changed is that we have now 6 production facilities. We will not do this each year. But 6 production facilities, we are expanding. And this is an important information for you. Mario is here. If you have afterwards questions, everybody of my EMB members can answer when we have the Q&A session, not only myself, Peter is also here when you have finance questions, it's better to ask Peter. But Mario can explain the project flash. We are fully on track. And I'm very happy, Mario that we passed very successfully a 3 days FDA audit in our new production facility, the FCA audit finished yesterday audit and passing an FDA audit is a big thing in the U.S. So we did this as well. until end of the year of the products needed in the U.S. will be produced in Warsaw next year 2027 first to second quarter, 80% we will produce here fully on track. You see here the KeriMedical. This is a picture of the KeriMedical production facility in Warsaw.And I think Fabian maybe next year, we can do such also to invite Warsaw to see where the famous TOUCH is produced. We are doubling this production facility currently doubling the size to be prepared for the future. And we need to do this today because we see all over the world, a volume increase for TOUCH. We did 43,000 TOUCH last year. We will do 60,000 TOUCH this year worldwide, and it will kick in further. So that both the Warsaw production facility and the soft production facility, we have no picture here are doubled in the size and, we will construct the facility. And doubling the size of the production, it does not mean only doubling the volume. This is more at times 3 to 4x pushing up the volume for TOUCH to be prepared. Then we have our brand-new Catskills production facility in Belgium and where -- and this is also interesting, you should know and maybe this in our full year meeting here in March or it came not over so well. This is a strategic acquisition. We got access now to 3D TITAN printing. This is scalable. So in Belgium, in Gent, we will do the printing for personalized implants for CMF, but also for trauma cases, for Europe. We will scale up and are in the process now to bring this production technology to Brazil because we are currently printing for Latin America and Argentina, third party makes some sense. We will install it in Brazil. We will do it in Brazil. U.S. is not yet planned because you need FDA approval. This takes at least another year. So we see by the end of 2027 to have also the personalized production in the U.S. Then we are sitting here in our headquarters in the main production facility. And let me say, it is very important that we are not only a Swiss company, that we are a Basel-Stad Basel City-based company. This comes also from our legacy. This has a lot to do with trauma. And yes, we analyzed moved. This is our obligation to see the other opportunities. And yes, it was a lot in the press, not by Mr. Schmoke, but by other people that is. The others are moving to Aesheim Medartis might move to, I can tell you. We are committed to Basel, and we will stay here until 2039, at least, and we will expand our production facility here means we get additional space. And everybody from Basel, I know we have a lot of surge. They love service here, but also the people from Basel. This is for the sticky park also very important that we are staying here. So we are very happy. And I think Mario is also happy to have some production here. And then last but not least, absolute record in 14 months, our brand-new facility in Brazil, 12,000 square meters, the first step, first phase, next phases to come for our NeoOrtho production. I will not go and I will not do now, and I have no time because Fabian told me, Matthias, you have maximum 1 hour. I could speak an hour about culture. But I was asked also yesterday night from a few of you. Do you feel changes? Yes, definitely. But I would challenge you and say, please ask my team members if they feel changes because they are longer here. If they see a difference. I feel a difference. There is a different vibe. There is a different focus. There is fun, fun. We see smiling people also in Medartis headquarter. And I think when we are smiling and when we have fun, the things are going easier. So our culture is a process, which will never stop. Therefore, in each meeting, I'm touching it, but we have to measure it somehow. So what we did is we did our clean survey. And the clean surveys and engagement survey, it's unanimous done with all employees worldwide. The employees can participate. The Medartis employees have this done twice a year over the last, I don't know, 7, 8 years, twice a year, it makes no sense because in 1 year, you don't change the results. We have done it now, and we expected rough feedback. I was not expecting a score of 79%. This is, by the way, the highest score you see Medartis had made in the history. I expected a lower score because the people now, it's unanimous and they know we had so many changes, so many also the strategy implementation over 2025. So I think this is very nice. And what is very important are the details that 87% participated including production people. We gave them access. So we provided computers for them to answer and that 5,600 people all over the world, in Japanese, in Portuguese, in English and French, that takes the time to comment to write positive or challenging comments. And my team together with me, we are reading those comments. We are taking this very serious, and we are giving feedback. And then we are stepping up. But we have areas they are above 80%. We have even areas that have scores above 90%. So it's -- for me, for the EMB, for us, it is a confirmation that the strategy is working. The strategy is showing results, and we are on the right way. But it will never stop to improve it. And this brings me to this high-performance culture and high-performance team only if we have a team based on this culture, believing in the culture we can have the fundament for our strategic priorities. Each strategic priorities is owned by an EMB member. And you can only have 1 owner of a priority of a strategic priority. If you have 2, you are missing already the focus and one can shy away from the other. So one owner -- and you can imagine who are the owners, especially improving cash flow. This is with Peter, and we are all very relaxed. And when Peter has a smile on his face, I know we are on track. If Peter is crumby, then we have an issue. And you see he has a smile on his face, Peter. We are never relaxed, but we are in a very good shape. So accelerate the U.S., I'm very happy how things are coming together. I think that we are getting more and more traction in the U.S. We see positive momentum. We see the gap closed in closing in Florida. It's quite a work. It's not yet there where I would like to see the U.S.? Definitely not. But maybe I'm also a little bit too busy and ambitious and really doing the things fast. But I told you and I will not provide so many figures today that I expect the U.S. to grow minimum 20%, and we are fully on track. So I think this is a good message. And let's see. And also in the future, of course, this will accelerate because in the future, touch will kick in more. We are still in the launch phase. When it comes to KeriMedical. We have here our Global Head of Commercial for KeriMedical. I'm really super positive. It was the right decision to leave this company stand-alone. It was not the easiest decision. Although the easiest decision would have been include, incorporate this company and then it's all fine. So leaving the company stand-alone, you get frictions, you get discussions, you get different opinions. And this is beautiful. I love it. I love it because it pushes us out of the comfort zone. Very happy with the performance. And I already said it to Lloyd, congrats. Also in Europe, the performance is sensational. You can say, Lloyd, by end of May, Europe is growing by more than 25%. And Europe are the countries where we have 9, 10 years, 8 years, 5 years in Germany, Keri already on the market with high market shares. We our strategy I'm coming to this. Regional share gains. I think the most difficult part is for Europe. So Marc, he's also here with her team. When you have already in big countries, 40%, 45% market share, you still have to increase your shares. This is new surgeons onboarding, new hospitals onboarding. We are well on track other with and her team would not maintain this very ambitious growth rate, which I have showed already last year. So also here, on track. Innovation and digitalization, this is never ending. And Marc will speak with you about what we are doing, where we are going to, where are our thoughts? Definitely not the next plate and screw what is coming in orthopedic. And as I said already, a smile on Peter face improved cash flow. This is his pillar all fine so far, on track. This is from Panama. And we are bringing together Switzerland and Brazil one more time, the wonderful panorama of Switzerland to chocolate together with Ciperinia. Is there something better? Definitely not. And those countries, those cultures can benefit so much. I think the Brazilians can learn so much from the Swiss, but the Swiss can also learn a little bit from the Brazilian culture, this taking it easy, there are no problems. We will solve it. We will be fast, and we will just do it. And this and much more brings both companies together. And we have Medartis and NeoOrtho, so much in common. The 2 founders, Thomas Roman and Janine, they don't speak the same language. Thomas doesn't speak Portuguese, and Jenine doesn't speak English, unfortunately. But they understand with the class of or cyberinia, they don't need the language because they have the same mindset. They are entrepreneurs parcels, both have created world-leading dental companies. Thomas Roman and Janine with Neodent. Both found together in 2012, became friends and figured out that they have created inside the dental company, another company which was Medartis in Schauman, and which was NeoOrtho also in Neodent separated 2012 when Neodent was sold. And now -- this is coming again, and I say it every time would not have sold me NeoOrtho to any other company. He doesn't need the money. This is his passion. He did it because he knew the people behind Medartis. So we have a fantastic basis. We are bringing them together next week for the first time again after many, many years because we are with the Board in Brazil starting Monday, and we are Tuesday night opening the new production facility. And why we are doing this? We are addressing a Latin American market, which is predominantly value and then I have no time to explain value again, but value is not making a premium product cheaper. Value is a total different approach. You need high-quality products. You do not need the latest innovation. You do not need this top-notch Switzerland education, but you need education and you need an affordable price for the public health system, which is normally half of surprise of a premium product. This means you cannot produce those products in Switzerland. You are normally producing a factor III cheaper in Brazil with the same machines than in Switzerland, the overhead cost. And then you see the CHF 470 million addressable market we have in value in Latin America. And of course, the 2 biggest markets in Argentina and Brazil. Somebody told me, Argentina, Argentina is booming. Argentina is the country at the moment. Hopefully, Miley makes it further. But we're going there. This is the addressable market we have. So what we are doing currently? NeoOrtho, of course, Brazilian-based currently. All what we do was Brazil. We now started the launch in Mexico through our own subsidiary. This is already going on. Here in Argentina, we are launching -- we are still thinking opening next year, maybe in our own subsidiary because you need control, because if you run such a a distributor, you pay twice. You pay a commission to do the business and you pay again when you would like to have your own business back. This is in Latin America, a little bit tricky and totally different to the rest of the world. Colombia, I put it for the moment on hold. It was planned after Argentina. We might go first to Peru because Colombia is very, very dangerous, very, very difficult at the moment. Not at all compliant. We have to wait now until the political situation is a little bit stable. It makes no sense to enter now Colombia, but a very important market, so we might go to Peru and definitely Chile. Chile is the most European market in Latin America. The only thing missing there is that this big German, but they are very European with the highest prices. And you see also that still the value segment is only 72%. But when the value segment is becoming above 60% of the whole market, it makes sense. And to end here. And this is also the reason why we are not focusing with NeoOrtho currently on the U.S. The U.S. is still a premium dominated market. This might change quickly over the next years. But at the moment, I would say the value segment in the U.S. is not bigger than 15%. That makes no sense to go in, but -- and I leave this decision to the regions. the EMEA region is currently analyzing where to go, where are the countries to launch. We have a dedicated person doing this. And Europe is on the agenda. We are currently doing the whole MDI and CE Mark registration. Maybe a word when it comes to the portfolio, NeoOrtho has a portfolio which is very comparable to Medartis. They are very strong in phase. It's NeoFace -- our product called NeoOrtho, it's NeoFace. They are very strong in hand and wrist. And normally, in the value segment, you copy the best. So if you see the blades from the auto today, you remind our first hand plates, we had at Medartis as well. It's very -- it's a nice -- and it's normal and it's a compliment for Medartis that 10, 15 years ago, NeoOrtho covered the hand plates from Medartis, and it's a fantastic product. And sometimes you have problem to differentiate what was really Medartis, what is NeoOrtho because from the quality of the production is the same, but the different locking system different. Then we have spine with NeoOrtho, but the Spine business is only in Brazil. We will not expand with the Spine business. It's a totally different area. It's not something where Medartis will end. It was present with NeoOrtho, and we will maintain it for Brazil. It's very important for our tender business. And then also, we have foot and foot and ankle products for NeoOrtho. The new production footprint, as I said, I think it's a huge advantage to produce not only cost wise, but also you have no tariffs in the Mercosul in the Latin American area. You are very fast out of Brazil to all the markets. And yes, we have lifted already once with another company. So it's a perfect location also to get qualified people, well-trained people. A lot of the automotive industry in, all the big players are there. So good people you get there. We have a very short An Visa registration pathway course. We have a local production, and we are continuously audited by Visa -- and on Visa, and this is important once we go to the U.S., is cooperating very, very close with FDA. So you have an accelerated FDA registration if you have ANVISA in your own production facility in Brazil. This is a big advantage, and I hope it will still like this. And then, of course, we are now going into the other regions. This is a project, and I would like to people, some guests here -- they know me from the past. And please remember what we are currently doing with NeoOrtho is much faster than the pathway we had with. But still, we are in the beginning. This is not that in 2 years, we are international all over the world. It took us 11 years with Neodent. It will not take us with NeoOrtho 11 years, but it is a time. You need registration, you need to launch, you need to prepare the market. So it is coming, but in a good shape. And it's also boosting the Medartis business. I'm absolutely happy with the performance of Medartis in Latin America because value is value, premium is premium. Also Medartis is benefiting now from this structure, we have this common infrastructure is back office structure. So the performance of Medartis in Latin America over the first 5 months of this year was really outstanding in my eyes, they have built a new team and bringing a lot of momentum in. Now we are already touching TOUCH strong growth. I told you, 43,000 implants last year. And when -- when just mentioned, over 25% growth year-to-date end of May, in Europe, mainly in Europe, you see that there are markets like France with 85% of marketer, where we are still growing. And France is 29% of the overall European work performance for TOUCH, and we are still growing by 20% in France. How this is possible? This is patient marketing. We are driving patients to doctors to ask, hey, doctor, I have a problem, it hurts a little bit what can we do. And ECL, they find professionals like Daniel Herren, and then it goes very quick, and they have a new life. No pain and easy movement. So -- and we see this in all countries, and we also see that you have a ramp-up time when you launch because it was us Medartis launching Germany, for example. So you have to prepare the market. You have to start with educational. And then when you have 3, 4 years in the market, it kicks in. The volume are coming. And also the patient marketing is helping because I launched it now also in Europe. And you know before we acquired KeriMedical, we had 3 markets. We are Germany, we had Austria, and we had the U.K. where we were already responsible. Australia is still small because we are waiting for the reimbursement. It should come this year. We are doing 260 cases, but it's all paid out of pocket. So it will kick in when we have the reimbursement. And on purpose, we have not put yet here the U.S., but of course, this will come very prominent in the future. And the U.S. launch, it's running now to find the right words. I'm surprised. Let's say it like this. I would have expected more more negative feedback maybe more move, let's wait, let's see. I think we are in a situation now with our courses in the U.S. that we can still, after 5 or 6 months select the doctors we like to trade. So they are queuing up -- they are reduced to get the trainings. We are flying in European surgeons to train them. We will start in September to have the first U.S. surgeons to train U.S. surgeons, and we can sell select the best. This helps us because we can select in which areas and which regions we will be active with the training and what are the surgeons which will bring enough volume. On the other hand, what we see also is the same what we observed in Europe, that when the surgeon participated raining, he or she -- they have already 3, 4 patients selected and they do within the week, the first cases. This is also happening in the U.S. We see surgeons doing the first cases. We have already 1 surgeon, and I can tell you because on social media, you will see it, who has done 100 cases. since beginning of the year. This is Jonathan Heading in Chicago, and you might meet him at. He's here. So he's really creating touch. 4, 5 cases per day, very good. But this does not mean -- and please don't do the math now that all we train, they are doing 100 cases, and then we end this year, I don't know which number. No, this is not the case. We have also surgeons we have trained. They have not done 1 touch yet, because the reimbursement contract is not also rise in the hospital. So we have also a clinical team and a reimbursement team behind because with the reimbursement price of around $6,500, you can imagine that the hospitals are getting a little bit careful to get it in. And insurance company, not the hospitals, insurance companies, who allow the procedure. For the hospitals, it's a win-win because they get a lot of money from the reimbursement. The insurance companies are getting careful. We have a team behind explaining the insurance company doing this as an administration work, explaining all the fast recovery of the patient and the benefit of getting a TOUCH. It's all working fantastically what we are doing in parallel, and it's all based on the learnings we got in Europe. And therefore, the team is expanding. We are hiring each one's new people for our carrier team in the U.S. and I aligned with Peter. What I also can tell you is that May was the first month, we sold more than 150 TOUCH in the U.S. I think this gives you a little bit of sense that we are very confident that we will reach our target of 1,200 TOUCH this year. No, Peter, more I will not say, but we are fully on track. What is all in Japan and Brazil are coming. So we started the registration in Japan, and we are starting the registration in Brazil, a huge opportunity. And now -- you see here, I would have thought, Fabian, that you give us the morning news from the U.S. is this here? What should I do?

Super excited about this. So this implant, it's been in Europe for a number of years. We're excited that it's now in the U.S. We're able to be the first institution in Florida to put it in old way of -- I shouldn't say old way, but we used to take out the bone and suspend it. So this just allows patients to kind of get moving a little bit quicker essentially. . [Presentation] .

So you see -- and this was only 2 examples -- or 1 example on morning TV with Jonathan. The Institute in Chicago, where he's placing the Touch, they started early, and they are doing this media work. It's not sponsored by us. And as you can see, it's also not mentioned touch, not mentioned Medartis or carry medical, and it should not be the case. But of course, it's clear it's the only product in the U.S., and he is getting call now from all over the U.S., people are flying in, getting the surgery, flying back at night, but we have it also in Germany. This is not maybe the best newspaper not every time the most serious word, but let me speak about touch, I love it. This is the Berlin Fila Monica, when they -- when Hakimi put him a TOUCH, and he could play again in the orchestra and gave an interview and he was so emotion emotional lead that he spoke with the journalist and they made a big story out of it. This is patient graphic. And this is this mouse-to-mouse communication and maybe Daniel will explain it also how his patients are coming to the clinic -- this is bringing this wipe. And of course, if you own TV and we are constantly on TV, especially in the U.S., you can imagine how many million people are working with saying, "Oh, I have a pain, maybe I should ask. And then it is reimbursed. -- yes, it's something which is helping a lot and helping a lot also the growth in Europe. And now -- you know that we have here in our building on the sixth floor, and you might have seen it, the most modern in Europe to do orthopedic causes on cadavers. This is a top institution. It's our Caravela run by and also rent out to other companies and doing other courses throughout the but mainly used worldwide by our surgeons and education is so important. And I ask Fabian now also in the future to add a chart at least when we speak about education. And our education partner is IBRA. We are the industry partner for IBRA, but IBRA is so important to drive this community. IBRA grew in memberships last year. We have now 4,500 members. It's a growth of 18% because why because in 2025, we started to revamp IBRA. We became closer, we became really partners. But scientifically, we are not managing IBRA. Iba scientifically needs to be stand-alone and they have their own opinion. We will never step in and tell them what to publish, what studies to do or what causes to bring, but we are doing -- we are running our international education through IBRA. Actually, we should have 15,000 members, and we are in the process to revamp, so this will grow. We have a lot of professionals trained throughout the world. And we are expanding IBRA now all over the globe with the academic programs for young surgeons. I think young surgeons are the future of the industry. And we know when you start hand-in-hand with the young surgeons through a program, through an education program through a fellowship, those surgeons stay with you. They have no reason why to change the system. So we need to get them at the beginning of the career and to involve them into IBRA, to give them a stage to lecture for us, and the same applies for women. Women in industry, it is so important. And we are getting more and more female surgeons in the clinic as well, well educated, fantastic. They have another approach to the professional life, but they have also another approach using our instruments, for example. We need, as an industry partner, we need to think about our instruments, for example, they are designed for women's hand or are they too big, too strong things. And IBRA will help us to get it open to the women and to discuss, to have courses for them. And also to have more and more women driving our education program. We will have in Florida education center. In South Florida, hopefully starting in September, and we will have 3 education centers in Brazil. Sao Paulo and Rio for Medartis and 1 in Kuichiba across our production facility, a little bit the same like in Basel only for NeoOrtho, where we bring the surgeons for the courses and then they come to the production, and then they can see our production and how the products are made. And I think when you have seen this and when you have done the course you are really close to the company and committed to the product. And finally, we have a new U.S. research and education committee. This is very important. But a lot of new things, a lot of positive things will come with IBRA, but I think it's also important not only to speak about the business, not only to speak about the marketing, not only to speak about the research and development, but also to speak about education. Education the most important spending we do in this company. And not only for the education. Education is the base of everything we do. Nice, nice charts. Every marketing department can do. But a proper education super professional partner likeIBRA worldwide, this is not so easy. And here, we are unique. What is also unique is that we have -- and this department is reporting to Peter. We have an ESG department. We care not only in Basel, we care worldwide. We have it also in Brazil, an ESG team. that we are really give our people an understanding what's the ESG. And what I say in each town halls, and we speak about ESG, like we speak about our culture that ESG is not just putting some solar panels on a production facility or avoiding plastic bottles. By the way, we could do better. I see steel plastic bottles here in this auditorium today. So Peter maybe can take this up. But this is okay, part of it. ESG is also the social responsibility we have. We did yesterday a charity bike ride during fresh for Mercy Ships to help people who are not as fortunate as we are to get access to proper treatment and surgeries. We have a very important program with Philip Honingman and Florian from the pit and Basel, the CMF surgeon with Nicaragua, where you have severe cases of reconstruction of faces of people, but they have no means they have even not the blades and the screws. The products are not there. So we are doing this. This is a drop on the hot stone. But if you would do nothing, it would be nothing. So we are intensifying this is one thing. The other thing is inclusion, diversity in the company. We need to become more open. This is part of our culture, and we need to become really diverse. The planet, this is very important, is the future. And we have this respeability as a company. And overall, we have to have a governance on this. And we have to have really a team on this and not. And this is now the most important part not just publishing 30 pages in an annual report. You have to leave it. And when I saw first our annual report, I said, wow, we are publishing a lot. First, I would like to know who is reading this. Second, I would like to know who of our team here understands what we are publishing. And are we leaving it? And this is now the sensibilization and the work Peter is doing with to work on it. We have our targets. The important thing is you can put whatever you want on those charts. You have to live it and have you prove it. And you have to team needs to live it. Because otherwise, the only thing you will do and there are many companies out there doing it, they are changing slightly the targets here by year. And then you are getting closer, but you never reach it. So it's very important. As well, we have a committee. This is -- in Fabian as part of it. But this is now part where really our departments are getting in and not -- this is just an exercise -- now we are living this. The 2030 road maps, and we have a responsible with Banca from Brazil, for example, they are international. we're doing volunteering means we are bringing our people also in Switzerland, and especially in the U.S., U.S. are well champions with this. And we're getting them the time, you can go, you can help, please volunteer a lot of social product projects, especially in the U.S. We are top 15 in EcoVadis. Honestly, I know what this means, but they told me it's very good. And we have a silver award. And then my question was, can we get gold -- but important is that we compare each other and that we are participating in these comparisons. And yes, we have 100% renewable electricity, and we are also driving the first electric cars, not myself, but we are getting to this, then we have electric cars. And you will see at fresh and please, when you are going to fresh, we have our bus there, our electric Volkswagen bus, the Medartis bus it is reformed as a photo boost view. So please take a picture and publish it in our electric car. This would be very nice. So we care also about you. Now the outlook, nothing has changed. We will see each other in August, 16% to 18% organic growth. We deliver what we promise and nothing changes. It is still the statement very valid. And then we see August for going. The high teens EBITDA margin, very happy with the development. And we are on track because with that, we said from the very first beginning in 2025, you might remember, we are not only focusing on growth, top line growth, top line growth, top line growth. We are also focusing on profitability. And we have a clear target internally also for us as an EMB. And yes, we are Peter has a smile on his face. So I think we are on track No, Peter. We are. Yes, we have an aging population is a little bit what are the growth drivers? And I'm asked. So I think, first of all, aging population, this is not only referring to TOUCH, but the general -- the population today is more active. My grandfather, when he was 65, he was sitting in an arm here, smoking a cigar, but not riding a bicycle. Maybe a Vespa. Today, I'm not yet 65, but we are more active. I would say, Daniel, we are the years younger than in the past. So you are playing soccer, you are doing things. You have accidents. You need to recover life. And this is where we have huge opportunities in all markets, and there are still markets where we were not present. This means we are expanding our service addressable market, also the sum is a market with our products, we can attend immediately and filling our gaps, hand and wrist, we are complete, but we have other areas where -- and this is a work of Marc, but this is not something you can do overnight. So those projects normally take years, but with the NX Nail, it took us 9 months. So this was a record project. This never happened in the history of Medartis-- but it was a project, and it went fast and 9 months, but normally it took us some years, although until we get the especially the FDA approval. We are going for the personalized implants. I think this is -- or we believe this is definitely the future. Personalized input is coming more and more, not only in the CMF area, not only for reconstructing phases, but it's a way we need to attend and we can be fast. And being fast is maybe one of the attributes, which is valid for us for Medartis. We are faster than those mega competitors. If you have a huge animal, I call them the shocks of the industry, most of them are coming from the U.S. They are -- normally, they are not very flexible. They have processes and they have books of processes, which are very big. I know this from at Procter & Gamble. This is a big advantage to be agile, to be fast to adapt fast and to become disruptive, not shying away to do things in the industry, nobody has done so far and discussed crazy ideas, why we should have our sets this huge set still in 10 years. Why? Because many people say, it was like this ever in orthopedics. We could not care less that it was ever. It's a new generation really using those sets. They cannot live. They are so heavy. We have to analyze this. Is sterile packaging coming? Yes or no. What is more ecological, sterilizing each time the sets or throwing it away. There are a lot of studies that's throwing away is better for our entire ESG than sterilizing, which is impacting heavily. So we have to work on those disruptive things. And you see here we are already advanced. We have a different system now, but guided surgery. The digitalization, AI plays a big part in this, but AI will not replace a human, AI will not replace the robot. And I'm very bold to say that we can do surgery planning. We can do based on an x-ray the planning in the future of a treatment for distal radius that the system will tell you this plate and how many screws the surgeon needs. But I believe it will never happen that this without the influence of the surgeons will be adapted. The human being behind will remain very important, will not be replaced. But if we do not challenge the status quo I think we will swim only in the same order, and we will not advance. And this is something we are doing, especially in our innovation area. And this means also -- and this is my last chart and the Fabian, I'm too fast that in 2030, this is our strategic plan. We are now adapting the strategic plan in August. We will start this and discuss with the Board 1 year. We have a time actualized. So next year, end of the -- in March, I will present you the strategic plan 2031, but it's the adaptation that we have a little bit a shift in the phase of the company and the dynamics of the company throughout the next 4 years now, we are already in 2026, and you see the segments are growing. And yes, but this will be different -- will be definitely a different company throughout this journey until 2030. And with this question and the answers we do later, I hand over to Marc. Thank you very much.

So good morning, everybody. It's a big pleasure to be here and speak a little bit about innovation and what we're doing in our R&D departments all across the Medartis Group. [Presentation]

So what that means is that IBRA is very important to us. IBRA is very important to us because the surgeons can try our product life cadavers, fractured specimens. So it's very, very important to do the education for the surgeons at the patient. Second, scientific backup. So having scientific data to back up your product is also very important to the marketing on the products and get them to the surgeons. And last but not least, with the hybrid institutes, we, as an R&D department have a space to try and test or innovation cycle. So that makes us really agile. So we just can go downstairs, let instruments and implants produce, go upstairs to the lab and try stuff out. So that really speeds up also or cycles. And that's why IBRA is so important to us in innovation and R&D. And I mean, to do really the products, you need to understand what the patient needs. So the patient is always in the center we need to understand the clinical problem. So we need to collaborate with the surgeons like Daniel is one to really identify these needs the surgeons have treat the patient the best way. And that's kind of what really drives us within R&D. So working together with design surgeons and do the best for the patients. In terms of markets, we're really focusing on the fastest-growing segments like enabling technology, so digital solutions, we're at CMF. We kind of revamped CMF with MODUS 2 and now also with the acquisition, we're in extremities. So basically, Upper Extremities we're focusing on. We want to be a market leader and foot and ankle as well and the trauma segment with our fracture plates are also within our focus. So we're really focusing on the fastest-growing segments. And that gives us a service of addressable market of around CHF 5 billion currently. So that we still have a huge opportunity to grow with our product, with our services and with our customers. Matthias already touched on one. So becoming a market leader in hand and wrist is really crucial to us. So we have a pretty complete planning portfolio. We have nice crews to treat the patients. We now have to KeriMedical products. So it's not only TOUCH. It's also are KeriFlex and other products, which are delivering results to us. And we're expanding also that portfolio. So we're working on different stuff like solutions and things like that for the hand and wrist portfolio. Built on our legacy, that's also crucial. I touched it already, CAD skills expanding Modis 2 and growing within CMF. We're having a real good complete portfolio in CMF as well with MODUS 2, and now we're pretty complete as well in the patient-specific solutions. And foot and ankle, last but not least, we're also doing a lot of stuff in foot and ankle. Matthias touched it that ankle fusion is going to be a product that is being made available next year for the European markets and the U.S. market has kind of limited availability first and then for a full launch, but that's not the only product we're working on foot and ankles. So we got also there a couple of products. We kicked off and working on delivery products to the -- to our friends in the foot and ankle. Looking at what we're doing. So we're having kind of 3 main areas we're active in. So it's basically fracture fixation. So that's everything associated with plates, screws, other fixation techniques for trauma and for elective cases. We're working on joint replacements TOUCH is one of the examples. The TMR for CMF is another example. We're having now the radial heads, the event radial heads in the U.S. available. third example for the joint replacement segment and enabling technologies, starting with CMX, having the platform, but not stopping there. So going steps further in patient planning, fracture planning, also navigations are other topics we're heavily working on and getting products to the market very soon there as well. We're doing that mainly for hand and wrist, for CMF. And as said, we're also filling the gaps for Lower Extremities. Here kind of a short time line where you see what kind of product or in which segments we're bringing products to the market, but not only stopping with the implant solutions. So we're working on enabling technologies, expanding CMX services, working on delivery systems like sterile procedure packs, new sterile packaging, things like that, which are really important to be more efficient also in the OR. And then intraoperative navigation, that's a big topic. We're working together with our friends and to deliver their really nice products to the OR intraoperative navigation. So do directly the planning during your operation, not only preoperatively. And also looking at new segments. So we're not stopping just with having plates and screws. We're also looking into new opportunities like soft tissue fixation and things like that. Good. So there are 4 key points where we're focusing on when we're doing innovation. So we're trying to simplify procedures. So having an easier use of instrument saving time during the that are really important points to the customers. That's what we are thinking and what we're hearing, reducing costs also by reducing surgical time for the facilities. That's an important point. Preserving bone stock means that we're trying to preserve joints and bones in the body. One example could be radial fractures. A couple of years ago, they replaced it with the prosthesis or just took the bone out. We're having plates that makes it possible to reconstruct the radial head. So that really preserves the bone stock and keeps the joint in the patient moving. And last but not least, more predictable outcomes, half the patients and the surgeons being made able to plan the treatments. So CMX is one example. So these are elective cases. But again, we're not stopping there. So the goal is really also to provide services for fracture fixation, having more predictable outcome and also some recommendations there. A couple of examples, recent examples. First, coming to that a little later, that's the Titan nail by providing an easy implant, you don't need to be drill. You can insert it right like that. You don't need to have to reprocess the sets. You just bring it in sterile pack. So it really makes the whole procedure much faster. So the rep doesn't need to bring the set, reprocess it, bring it to the OR, he just brings the circuit to the OR. Preserved bone stock, I mentioned the example with the radial head. But I mean the most important one to us currently is the TOUCH prosthesis. Couple of years ago, the tropism was just removed. So incision, the bone was removed and the patient was kind of kept it that way. Now we're having a solution key parts of the tropism in and really have the full range of motion and very active patients afterwards, because they don't have pain anymore, they just go home. I mean the doctors even need to tell them not to move too much. Daniel. I'm sure he will TOUCH that as well. And then more predictable outcomes. CMX is definitely one of these examples, having very complex cases with deformities that are hard to treat providing a service there to have the planning for these cases and also the tools ready to have the interoperative support with guides, bone models and even custom-made and patient-matched implants. Kind of the 2026 lies for that year, we're providing. So having the nail. That's going to be a U.S. product only. So that's a fibrilla nail, which is used for febrile fractures. So that's going to kind of across with our trauma system. It's very innovative, so you can place the nail, you can rotate it. So it's kind of unique in terms of design as well. We're going to bring the proximal humorous. I'm going to show you a little bit more about that. We're going to bring line extensions for the clavicle systems. So some new plates like medial plates, longer plates and even a plate that most people think is not really that innovative hook plate. We made it again, innovative. So we changed the whole design of the plate. It's not like all the other plates, which are kind of replacing the AC joint and are hard to place. So our is really easy to be placed just with some small, nice changes on the whole implant design. It's patented, so nobody can do it then you can do it and to tighten there. So that's the products in the fixation groups we're delivering to the market. In terms of arthroplasty, definitely, it's TOUCH line extensions like titanium neck. We've been working -- or Keri team is working on the PE as well with vitamin E in it. And we're also providing now the TMR to our CMF friends. So we're now having a custom-made jaw joint for the CMF surgeons. In terms of enabling service, we're widening up the CMX portfolio in terms of really patient match devices. So that means by the end of the year, almost all of our customer plates or CE mark. So they're not only custom made. They're patient-matched CE mark, which gives us also the possibility to go to other markets and get the registration there as well. Just a quick one. We just received the Australian improvement yesterday morning for the CMX service, so which was really good news, so we can start in Australia also providing CMX services soon. We're having the whole portfolio of skills and another point which we're going to get to the limited availability CMX. You're going to see a little bit more about that soon. [Presentation]

So that's our new shoulder fracture plating system for the proximal humerus. It has some unique features on it. So we got a muscle sparing design of it. It's very anatomical and that golden thing you're going in there, we call it the spiral blade. So that gives additional medial support. These factors tend to kind of displace a little bit. So we're having additional medial support there. And we even have biomechanical proved that this is better than just with the classical fixation. So couple of innovations in that system, which we bring to the market to our customers, which are really unique. Titan Nail. We spoke about that now. Also the NX Nail, so sexy nail was kind of the -- working title in the company. Matthias kind of spoke a little bit with that and even drove the team to do some new stuff like new packaging designs and stuff like that. So we're having no nice designs, colorful designs all around the packaging. We've got a nice sterile pack kit with all the instruments inside. I'm just going to show you just open it, you're in the surgery. Everything is sterile used. You don't need -- do you trade anymore, you just unpack it, ready to use, drive the screws in and done. So that really saves a lot of time during the OR and just to you before that, the rep always needed to bring a kit like that or even a bigger one to the hospital, they needed to reprocess it. So cleaning, decontamination, cleaning, processing, sterilization, which took time then it's ready to be used in the OR. And after the surgery needs to be requested again. So we save all that time now with the sterile packaging, which is really, really great in terms of procedure time and even red time that we're saving. So it looks like that. You see all the instruments already to use. That's the implant packaging, so different sizes, you just do unpack, throw them into the patient and you're done. Then what we're doing is we're trying to build a whole ecosystem around the TOUCH. So we're driving Matthias told it, we're driving manufacturing, doubling the capacities there. We're having new line extensions to the TOUCH and obviously also scaling up the training and the accessibility in the U.S. market. But we don't stop there. we want to be ahead of all the other ones that could copy us in some time. So we're working on navigation. You saw a little bit on the left side. And to be honest, it's hard to navigate on that small tiny bone, the tropisium. So it's really a tiny, tiny bone. We manage that to get the registrations on that one and even to navigate on that one. we're having 2 concepts basically for navigation that what you have done is the more complex one for complex. So you need to do the kind of preoperative planning. We're also working on an intraoperative navigation system, which we can't tell you too much about it, but which would be really, really kind of disruptive because that doesn't exist currently on the market. We're also working together with the Keri teams. And that shows that the collaboration really is good. So on the navigation project, we're working with the current team from and and also on the salvage procedures. So we're having there also projects which Keri wants to incorporate our technology. So there's a close collaboration by both teams in doing these projects. We're also working on AI tools. So Trauma AI is a tool that gives the surgeon on the opportunity of uploading CT scans, then having kind of the reposition of the fracture. So you're having kind of the fractured situation, the reposition is done. And at the end, even some plates are put onto the reposition bone. You see this screw placement. So the surgeon can really check whether the implant he wants to have is the right one. We will provide some additional recommendations on the plan or different plate selections based on our indication matrix we're having with our plates, all on our CMX portal, so surgeon just locks in and he has after 1 or 2 days a recommendation and can then treat because usually, they wait about 3, 4 days by treating these fractures. So there's enough time to do the planning. That's what we're going to provide soon. So we're going to tee start at the fish the first time to our customers and by having the CE, which we expect in the next couple of weeks, we're going to make it available to the first customers. And then old products, the standard products, plates and screws are not enough. We're having the patient-specific solutions ready by CMX. So again, CMX, the portal, the service we're providing, the search and uploads the data, we're doing the planning. We're doing some kind of first draft, a surgeon looks at it. We're having Teams calls with them. They approve it, and then we manufacture the instruments and implants. So bone model, guides and also the plates and these delivered to the customers. And now we're having a short demo by Andre showing how that process looks like. Andres is one of our clinical product engineers working in the CMX team and doing some of the planning. He's kind of the master of mandible reconstructions. And I think that's the case, which you're going to see now. [Presentation]

So you have seen. So everything, the portal, that's a medical device. So that's approved by the notified body and the certification -- certification authority. So it's a medical device, everything that is kind of communicated to the surgeon is on the portal. They always can revisit the cases. They can go on the portal show the planning also to the patient, which is very important at some point. And they can do measurings and stuff like that on the portal as well. So there's a lot of features on it, and we're going to incorporate the Trauma AI also on the same technology as a one here. So -- and kind of a similar thing is skills. So by having the CMF strategy focused by last year. We just looked at what kind of possibilities do we have to really be fast in providing additional services and products to our customers. And we found basically CATCo. So we looked -- we went into the first discussions by September, October and we did the final closing by May 13. So also a pretty quick process with a full-fledged due diligence. What really unique with is they're controlling the whole procedure chain. So they're starting really with the raw material. They print everything. They do the reprocessing. There are only a few steps that are made by vendors outside. They even do in-house sterilization. So they provide their cost devices there to the surgeons or to the hospitals directly, which is pretty cool. And we're going to take that process and implement it also for our processes here. And as Matthias already mentioned, the goal is really to take all that process footprint and put it into other regions. As said, I mean, we're now having the approval in Australia. We're first going to provide the service from Basel. And at some point, we're definitely going to bring it also to APAC. We're going to bring it to LATAM and the U.S. on the 510(k) as well. CAD skills in terms of products, so the products are not what we've done before. So we've done guides, bone models and plates. What CATCo is doing is they're providing TMR. So that's the joint here. That's a fully patient-specific joint for the jaw. They're providing Orbital 4 implants, both in titanium and in peak. So they're providing both options depending on what the surgeon wants to have. We're having facial contouring implants. So to kind of change the appearance of patients whenever there is a orthognatic case or something like that. So they changed the. At some point, there needs to be some adjustments of the mandibular angle or stuff like that. So that we can do also with facial contouring implants in pet and in titanium. And we also got now the technology of doing subparestill implants. So really kind of implants that makes it possible to fix dental prosthesis on after tumor cases or really also kind of bone loss, so massive bone loss in the upper and lower jaw. So that gives us a huge opportunity that was missing for us to be very competitive in CMF and that's what we're having now. So the product, the service and the whole also planning technology behind that. So there's a highly skilled team also sitting in Gent similar to guys like Andreas we're having here, and they're doing all the planning and manufacturing in-house in Gent at CAD kills. And that was it in a nutshell.

You must be exhausted. Too much information. Good morning. My name is Daniel Herren. It's a real pleasure to be here. Thank you very much for the invitation to have the opportunity to explain a little bit what's going on in the market from the front at the patient's line in terms of novelties in treatment. And one of those novelties, we already heard many, many times is the TOUCH prosthesis. And it's a great privilege that I can show you the experience we have with that implant might be exemplary what's going on. And for us, surgeons, it's a huge opportunity. You have such a new implant, which basically revolutionized the treatment of a very common disease. Where are we? Who I am? I'm Daniel Heron working in the Schulthess, natural clinic,; a big difference, a formable with names shots. We have been ranked by Newsweek as #1 in Europe for orthopedics, #4 worldwide, and we are pretty proud about that. You can -- we can talk hours about ranking. But nevertheless, we feel good, we take it. If it's bad, we just ignore it. I'm double certified in the hand surgeon and being in that clinic already 30 years. So overlooking a market despite the onflow of patient and constant disease pattern in these patients. However, we had a great shift from rheumatoid disease to degenerative disease treatment also in the hand. I'm the past President of the fresh. So this is a little bit my congress, honestly, because Basel was dedicated to give the Congress during COVID. So within a few months, we had to go from a live Congress in base to online con, and that's the reason why Basel got this congress again. Now post COVID, and I'm very happy that it happens now today. And those who have the opportunity to go there, we will see how we evolve. And as Matthias already said in the introduction, it seems to be the biggest and surgical congress worldwide. I'm a consultant for Medartis and KeriMedical for many, many years, the privilege to serve as a Board of Director member for 7 years during the IPO process, I don't have to tell you as being from the banking side that the first sessions I obtained, I didn't understand the word, but evolving over time and looking for new opportunities to enlarge the portfolio that could give some of those conclusions. We are -- meanwhile, looking back to 840 some implants in our clinic and in my team with an increasing number. We started very slow. I did a few first cases, telling to my partner, if it works, you are the next, then he took over. And when we saw how good the results were clinically. We just rolled it out to the rest of the team. So let me share a bit experience about that. This is a typical patient we see every day. let's call her Sinais 58 years old since already several years. That's typical usually starts off the age of 40, 45, especially in females. She has pain at the base of her thumb. She's very active. Works as a nurse has, believe it or not 6 grandchildren, has a positive family history, which is also typical for that disease, had so far 3 cortisone injections done. They worked for a while come the situation down, but it doesn't solve a mechanical problem. Osteoarthritis, degeneration of the cartilage is a mechanical problem and she wants a final solution. She's a bit tired of that. The x-ray. That's the base of the thumb. This is the so-called metacarpal one. This is the trapezium, the famous bone. It's called Moltangolos in Latin because it had several edges. It's a pretty complicated shape. And as you can see, as long as we see in the X-ray distance between the bone, in joints, this is cartilage. Cartilage has no calcium in it. So I don't see it in the X-ray,so that's good, that's bad. This means bone is rubbing against bone. So it's a typical feature of a so-called degenerative osteoarthritis. She is not alone by far not interestingly enough, if we are looking at -- the prevalence of osteoarthritis in different joints, we would think the hip might be the #1. It's not true. The hip is often affected, but not as often as we would think. And if you look, the hand is involved in 70% of the cases. From these 70%, 20% is the base of the thumb. The reason for that osteoarthritis. Number one are the digital joints here in the fingers. I don't know if any in the room has this problem already. And number two is indeed the base of the thumb. Why don't we have that many more operations than in the hip in the hands because especially the distal joint, but although the thumb tends to stiffen down over time. If we don't have cartilage anymore, the joint is just moving as it should. And it can be that it's different down to an amount when you don't have any movement anymore, we don't have any pain anymore. So this is the reason why we probably see much less patients than we should, theoretically. So again, when we look at the prevalence over the age of 80, more than 80% of patients have it. Again, that doesn't mean that they are symptomatic. There is a genetic disposition and it's almost always bilateral. These are the stages of the disease from normal cartilage wear, severe cartilage wear and so-called, so deformation of the bone as a reaction. And then Stage 4, this is a bit problem, Stage 4. This is the trapezium, the. So we not only have osteoarthritis on the base of the thumb, but we also have osteoarthritis in the rest. So the next joint is affected as well. That's important in the discussion of the treatment options. So what's unique? We all know that. Our position is purely made by the CMC 1 joint. So the joint makes the opposition is placing the thumb in the 3-dimensional space. That's why it has this unique anatomy. It looks like a carton joint, the double carton. It needs because of that shape, important ligament structures to hold it in place. That's one of the problems in osteoarthritis because they weakened down and it is -- it gives the so-called sublocation. So the joint dislocates out gives even more forces on specific points in the joint and hurts even more. That's a very high contact stress. So if we press here 1 kilogram, we might measure 10 kilograms at the base of the thumb. So for a man, I'm pretty strong in my hands. I pressed 15 kilograms. So every time I press completely, have 150 kilograms on that joint. That's a lot. What's the problem of seeing, if we look at her, it was not that extreme in that particular case, but these cases, we see quite often. We call it a chain reaction. You have this subluxation we call, so dislocation of the joint. The next joint is reacting, it hyperextens and at the end, we call it the set deformity. This is a compensation of the missing movement at the base of the thumb, very difficult to correct. If they pinch these patients, it gets even exaggerated and that's not an unusual case within our daily practice. So what's the outlook for the future for when she's are asking? Pain will remain very likely this rather young, very active. It becomes more and more unable in her situation because she's subluxating already. And of course, we will lose a lot of function in our hand. So what options do we offer? It's a pretty busy slide, but I break it down to 3 different possibilities. I call it the anatomical preservation solutions, giving basically injections. There's one surgical solution, which is called osteotomy, where you break the bone, you change the access outside of the joint, and then you unload the joint which is below osteotomy. It doesn't work that well in the sum. A and B, most patients have 2 advanced osteoarthritis that this option will make sense, because you need some preserved cartilage where you can change the load to that area. The next group is the so-called functional preservation. That's where all the implants are coming in, the TOUCH. There were implants or still implants on the market. So in the position discs, which separates the bone. The results are pretty mixed to dysfunctional preservation actions. And last but not least, I call it the joint destruction options. It's Fusion used the joint and come back in a second or resect to join, take it out. So Fusion, what does it mean? Imagine you have the base of the thumb fixed completely. You still have 2 other joints to move, but these joints are just doing fraction extension. So no way to put the thumb in the 3-dimensional space. That's Fusion. It's a rare indication where it makes sense, especially in manual workers where they need a lot of power and a lot of strength. This might be an option. But there is a fear if we use that segment, there's more load on that segment and maybe there's more degeneration in the future. Resection, we already heard it from Marc as well, take the bone out, the trapezium goes away as whole bone. And in order to give some stability, we put in a tendon graft in a different technique there are many techniques which has been described, but it's called resection, suspension, I suspend the metacarpal one bone and inter position. Coming back in a second to the details. And the famous joint replacement. So Fusion is not an option for Sina. We are talking about those 2 options to her and give her the perspective. What this is all about. The resection arthroplasty has been invented in the '70s. It's still considered as the gold standard in many markets. Why? Because it has been done for many, many years. with quite constant result. I don't say the results were hilarious, but they were not as bad as we could think about. There's a good pain relief. You have to be fair to that option, but there are significant deficits. You have seen this action construction, we call it like that, very difficult to correct with such an option. So all the functional deficits, which go along with the deformity, basically remain of the surgery. However, there's a low revision rate in our series about 2% to 3% in 10 years. So the chance the patient as a second intervention is pretty low. However, if he needs one, it's very difficult. The bone is away, the soft issue around a lot of scars, there's not an easy and good solution to that problem. Arthroplasty. Very interesting. We are talking about arthroplasty since many years. The big hype and the big wave of beginning of arthroplasty goes down to the 70s. Started with the hip, knee, all the other joints, including the same base. The thing is somewhat cultural and interesting enough, the big mark you have seen on the slide, French, Belgium, they were unique. They did their own thing. They had a high tradition in arthroplasty, but nobody to care about. We didn't even look at. How can you trust a nation which hangs up the x-rau;. By the way, the French and the Belgium are the only 1 in the world hanging the X-ray like that. because they say, men are standing in that position and not in that position. The only in the world, if you had a French Congress, you are all the time looking like that, because we are not used to see the X-rays in that regard. So nobody trusted them. These were the first implants and they're a pretty bad track record. This is a dislocation. So this long into here, it didn't hold. This is a so-called loosening. You see the bone around the implant is than the bone around the wrist, which means you have a big hole inside. So this track record, together with the fact that nothing was really published on it, made it that nobody took care about that. What changed? Changed a lot. I think we started to understand the biomechanics of that difficult and joint more better and better. The big breakthrough was the so-called double mobility, because the implant, you will have it, and I think it's tooling around, has a double mobility in terms of this is the polyethylene so-called liner, the head and this is the metallic head insight. So you have 2 heads moving against each other. And this double mobility enhances the circumference where the implant can move to a great amount. And this is one of the breakthroughs in that. We have better material. Just integration improved. Cup-shape is different. We have 2 different cup-shapes, which helps us to fix the implant much better here. The problematic zone is the trapezium. The fixation in the trapezium is the one which really is the difficult part. We have a stronger polyethylene, Marc talk about it. cross-linking, vitamin E. These are all things which improve the implant a lot. When we look at the results just an overview, looking at the different parameters, pain, pinch means strength, recovery time, durability, cost aesthetics complication. This is a rejection. It's cheap, reliable in pain reduction, but all the rest, recovery time is almost endless goes up to a year and the patient really record functioning. But again, is quite durable. If we compare that with the implant atroplastian, this is proven scientific given data -- we see a much spectacular reduction of recovery time. The sum looks normal again because I give that stability back, the deformity is corrected because we recentered the joint. The problem is the complication, but then coming back to that, dislocation almost disappeared, but maybe loosening implant cannibalize is an issue. It's a huge difference. This is a patient -- on one side, an ultra plastic on the other side, resection, you see the difference. This is the rejection side. So functionally, again, falls in that position. Here, there is much more stability and thus much more pinch strength in those patients. So what happened if it fails and both can fail, the resection can fail as well as the implant can fail. If the resection fails, sorry, there is no way back. The bone is away. Here was the space for the bone, it's completely missing. If we have a problem here, a, we can change part implants, we can change the neck. We can change the cup. And in the extreme, we can go back to resection very easily. And this was one of the reasons to start that intervention that knew we had a backup which was over still the gold standard in many markets. Again, comparison, what did we observed, and this is all published spectacular fast reduction of pain. After 3 months, patients are basically almost pain-free. -- spectacular regaining of key pinch things. Going up, no chance to resection. Our patient and last but not least, return to work much, much faster. And I almost never had an intervention where patients spontaneously said to me, "Doctor, I forgot I had surge. It's really impressive. What about the cost very interesting and very important in many markets. If you look, return to work again, spectacular own data published, we had the chance to get access to data from the insurance companies. And what we see that however, the metal costs are a bit higher, is a resection. This is implant. At the end, due to the fact that the return to work is much faster, it's highly cost effective. And I think this will be a driving force in many markets to persuade the company like in Australia, like in the U.S. to approve that type of intervention. When you are looking at this typical hype cycle of new technologies with the start, the euphoria, the value of disappointment and then we find out how to use it. I think in the CMC arthroplasty, we never had this value of disappointment. Nobody who started to adopt the technology from my colleagues change back to resection again. pretty impressive. These are numbers from France. This is a resection, the flat liner, there is still resection market. There are indications, the stages of very severe font still need a resection arthroplasty. But what you see is the tree growing in already mature market like in France. So it's not a red ocean, it's a blue ocean. -- means you enlarge the number of patients, patients got confident. They hear that there is an option to treat them very well, relatively easily for them in a fast time and this increases the market. So in our clinic, 2015, when we put in an implant any type, we had to explain and discuss that. Nowadays, we have to explain why we don't use an implant because the data are so much different. This is indeed my first patient I did together with a colleague from Geneva, who had more experience is a professional piano player, the player pretty famous into Switzerland. I saw in 2 weeks after surgery, just by chance in the clinic is how is it going? He said, spectacular, I already played Piano again, I said this is not possible. No, no, I show you. [Presentation]

There's another example from a friend of mine from Spain. He is fighter pilots. osteoarthritis at the base of we had to go for a slight again in order to get ready to fly and believe it or not, and I think military planes the sign [Technical Difficulty]. We got the approval to impressive. The tons of these examples. This by chance in hotel in England, we had indeed a TOUCH course and this was at the reception. I couldn't believe it. And it was confirmed that the company didn't die. Very interesting. So to sum it up. There is a silent revolution going on in that regard of a disease, which is extremely frequent, which needs a lot of patient treatment and the standard now is going to shift from resection to implant arthroplasty very convinced convincing results, more and more publication saying all the same fast we have normal function and strength. An interesting phenomena, there's also peer pressure those colleagues who are not offering it, they lose patients. That's a classic and they might not feel it now, but the worst to mouth from patients to patients is much more powerful than we think. And I've never seen a new technique on the market which was so quickly adopted by the general practitioners. Now after 1 year when we started that, I got the first referral saying -- would this be a case for an implant arthroplasty, if I'm a general practitioner. So they realize things are going on, and this is very unusual. So and what I already said, nobody from my colleagues who started that technique change back to the resection anymore. We still do it again. There is still a low number of patients which need that. So I really can say after 30 years of hand surgeon and nothing has changed a greater impact my practice more than the this new implant on the unsettled joint. It's really nice to be on that journey. So coming back to SINA, indeed, just chosen together with a search in the CMC implant. It was a straightforward procedure had almost no pain postoperative, I think she took 2 pain pills on a low level, extremely quick recovery. She worked back again after 6 weeks, but she did everything after 2 weeks, and she's extremely happy and grateful she is now 3 or 4 years out. By the way, it's my wife. Just the last word. Lancet said, very famous scientific journal said, the operation of the center is the joint replacement of the hip. And I think they are basically right. In orthopedics, this is absolutely true. I think we might be in a phase to say at least it could be the operation of the DK, the CMC arthroplasty. We have the same phenomena of collective enthusiasm you have the same phenomenon that there is a real change of in terms of treatment. We are now working already, as Marc said, on revision strategies because patients are coming back. It's a mechanical device. It will fail sooner or later and we must have strategies to solve them. And it's -- I'm very enthusiastic to be on that journey and very happy about that. Thank you very much. Looking forward to your questions.

Thank you very much. Peter? Yes. Daniel, Thank you very much. And first of all, sorry, it's a Schulthess Clinic. Schultheis is a German to this in our heads. This is a small thank you to you. And I think nobody better than him as a surgeon and we see a wife and the patient explaining the advantage because we could speak yes, ours and now is about TOUCH, but it's on the same like you. You also showed a little bit the advantages, disadvantages, I think there are a lot of questions. Let me say something before we start the Q&A. With artists will not become a monoproduct company. I think at this point and Daniel is not the only one who mentions this invention of the decade is change of orthopedics of a decade now like it was -- it's now the touch for the sum. This will not mean that we will lose focus on our Medartis core business. I think this is very important to you to know. This might become bigger than Medartis. Yes, we know, but we still have a focus on Medartis because we believe that hand-in-hand in hand, this is working. So no I would like to.

I want to confirm that. I think the TOUCH is a clear door opener. That's absolutely. And especially like in the U.S., it's the only implant which has been approved. You mentioned it. I think we will have an advantage of 5 to 7 years. Other companies, of course, we're aware of the success of that implant, which is going on because it's so enthusiastic. If you look at the program of the fresh, the main subject, which is discussed is CMC. It's interesting if you observe over the years what the subjects are, how they change, but CMC1 at the moment. And I just got the last week a mail from our most important journal is the journal of handset European edition is impact -- we had 3 payers most cited last year. just about the subject of CMC. So also scientifically, it's just an enthusiasment there. We want to know how the patients are doing. We have in our clinical prospective registry where all the patients are registered before the intervention and in typical interval. So we gained a lot of insights. So just a -- for the company, it's certainly at.

Yes. Great. So now I would like to ask for the Q&A, Peter, please, because I believe financial questions or in anyway. And Marc. This is Andreas. He's working with Fabian's team. They are multiple purpose, our team members. Thanks a lot, Andreas. So questions. There's 1 other throw ?

We need to get the microphone up there. We need a second microphone. Just before we start, I haven't heard Daniel Herren, who of you think that his wife, his partner, is spent should get. with arthroplasty instead a touch instead of a suspension plast. Raise your hand, please. .

Yes. I have a couple of stats here. Well, the big difference after resection or implant is, you can pull it up much faster than before.

Almost you could in it as well. Good. So the first question.

with CCB. As you see, I'm already a big supporter. I'm wearing. I actually have a question for you. I mean I think you convinced all of us that the is like better solution now. What you choose the Medartis product instead of a competitor's product?

Honestly, I've chosen KeriMedical. very medical No, you think there were -- there's an evolution of that implant. And at the stage where we decided to step into that, One of the decisions was the double mobility because we have already seen first publication showing that the dislocation so that the joint really dislocates and gets out was basically disappearing. We fear that because that's that's not a very pleasant complication. So when they started to have that and then the first company offering the implant was called movies. -- this was from the same engineering background. And then Covia and movies was sold to Stryker, Stacker didn't have an interest, they must be morning. And then Kerry came with a kind of evolution of moves with the double mobility. And at the moment, the Double Mobility was -- the only implant was available was that one. Meanwhile, there are 2 implants on the market with double mobility. What is the 1 the Myer process from the group and they look very similar. But the advantage of the Keri, and this is really neutral. They have 2 different cups we have 2 different shapes of cups. So surgical wise, you still can choose the ideal solution for that specific patient, which the Maya doesn't offer. So that's why I have chosen that implant.

Yes, microphone please. will help, please. No, it's okay. Yes, women's first.

Sandra from Octavian. I have also 2 questions on Keri TOUCH. So the first is on the payer side. You mentioned, Matthias, that kind of the preapproval process from the payers is a hurdle to adoption. So can you elaborate a little bit more on that? Or how -- what's the percentage of cases that is being approved? Or is it more a problem of the time for the -- to get the pre-approval or are payers pushing back to lower-cost treatments. So how is that in the U.S. currently?

We expected at the beginning, much more rejection, much more pushback from the insurance companies. We are still early in the process. I would say we see the first cases rejected, but much less than we expected. To put this in numbers, I would say at the moment, 90% is going through, 10% is pushed back and needs a discussion and our team stepping in. We have a team and we have an agency helping us on this. But we have to observe this. If this number goes a little bit higher. It depends also on the institution. And it also depends on the -- and the surgeon, he has a very important role. He can have some influence. As more of the surgeon is explaining the benefits and the faster recovery and less OR time for TOUCH for this. I think, Daniel, you did not mention how long it takes to you. How long it takes to put a TOUCH on average.

The shortest was 28 minutes.

28 minutes. So although this is a much shorter procedure time than with the sector with...

Trapeziectomy.

Trapeziectomy, so 10% roundabout.

I may add maybe because with the discussions, I just came back from Atlanta from a training scores, and we had a lot of discussion. This reimbursement issue obviously is a problem or a discussion point. In the U.S., a lot of surgeons are partners of outpatient surgical center. So -- and it's a question of volume and negotiation with the insurance company how much they get from that. So it's a completely different market compared what we know from Switzerland or in other European countries. So it highly depends on the negotiation from one to one company. It's amazing. And again, it's different if you do it in a hospital or you do it in an outpatient surgical center. Second thing is Jonathan Titan, who he was probably -- the first contact we had with him was here in Basel. He was sitting in the front row like that. And he has Viking roots. I thought he will kill me immediately. He was so critical about that implant we could demonstrate here in the lab. And now he's the one who is really pushing his things forward and give lectures and comes into the TV. He added that way. He's a high-volume surgeon for that Rush Hospital in Chicago. So the hospital realized the manager, okay, at the moment, this might be a deficit, but for purposes of public recognition and everything is important and he is a high-volume surgeon that's why he gets all the approvals for that. So it's very local and very individual, But it will come.

Yes. I think to add this, the Rush Institute, from Keating in Chicago, they were supporting the first implants end of last year free. There was no reimbursement in place. They bought -- they paid it out of pocket from the hospital. So just to make the media and the marketing because they believe in a huge opportunity for the future.

Very helpful. And I have a question for Peter on profitability. By when or which revenue level is needed in the U.S. from Keri TOUCH make that business breakeven on a fully loaded cost, including the investments in Florida and the field experts, et cetera.

Well, we I'm not sure -- yes, we are not building a completely separate infrastructure a completely separate organization to distribute and sell touch in the U.S. So we can also leverage our existing distribution channels that we have, either the direct ones or the indirect ones. What we are building up is a team of specialist so-called field specialists that are supporting on the one hand, our salespeople or our partners, but we are also supporting and consulting the surgeons in the operating room at the end of the day. But I would expect profitability the U.S. business itself of touching next year.

Tony like UBS.

We have to -- Andrea, you have to be careful not to forget him. He was the first who raised your hand. Yes. Okay. Go ahead.

Yes. So I have 2 questions. One is you mentioned a run rate for touch of 150 the first time in the month of May. So if I keep this going for 8 months, you're already at the 1,200 cases that you targeted for the year. So maybe can you frame your guidance, what's baked into the upper end of the guidance and historic or upside potential?

This is the reason why we are so careful. Each single number you give, they are already extrapolating and calculating and Matthias, you are too cautious. Yes, you're right with your calculation. Yes, I'm cautious. I think in August, we have then also June and July run rate. I said it was the first month of above 150, which is good. So we have no doubts to reach the 1,200 this year. Let's see. But I think the positive message I wanted to give is that the acceptance in the U.S. is here. This is the first thing. We have top surgeons in the U.S., who got educated. Daniel, for example, who is now in Atlanta, who's taking this knowledge from Europe. And this is the second thing. And the third is that we are now starting to prepare U.S. surgeons. You said it once in an interview, Daniel, how many surgeries a surgeon should have done before he could teach others?

We published on that scientifically. And we had -- it needed about 30 cases to get the stable provisions in terms of produce the intervention on a standard level. This is in accordance to other joints like the shoulder or the knee. It's always a question of time. Of course, if you do 13, 30 years, it's not the issue, but in a given time. The thing is not the challenge is, and I've never seen a program of being involved in a program which invest so much into education. We can do -- it's not a difficult intervention, but it's not an easy intervention too. There are tips and tricks like everything in life, which changes and we are still a learning system. So I think the rolling out of the education is key here also for the numbers. And personally, as a search and I'm pretty proud also of the company in terms of they take the responsibility. They could have trained already 10x more surgeons. But we already realized now at the moment that we are probably leveling up. We had the top U.S. surgeons at the beginning. And now don't take it wrong, we are probably already approaching the second league. And we see that on the table when we instruct. They need more support. They need more supervision. And I think that's extremely important that the company is investing in that also in the future other than that we can rein a really good implant if people are just using it round.

Correct. And this is important. And what you said as before is we are building Florida education, not only because of touch. This will be center and it's not only touch. But the education is so important. And let me explain you one thing. We have, at the moment, around 70 surgeons, 70 trained in the U.S. on TOUCH. But we have only around 49 using TOUCH already. Why? because hospitals are delayed and the contract or the hospitals are delayed with the reimbursement getting in. And those surgeons, we are training again before they do their first TOUCH cases. It's very important. And we are only training surgeons where we believe they can do at least 2 TOUCH cases per month. So they should do around 24 to 25 a year. And this is very important to maintain the practice. Of course, I said it because it's already published. You will not find all Jonathan who are doing 100 in 5 months. This is not the standard. This is a little bit the heavy users. We have some also in Germany. We have them all over, but this is not the standard. The standard should be a user who is doing to touch per month. at least who's keeping traction. And as Daniel said, if you figure out, and therefore, our field specialists are so important. If you figure out that there is a surgeon who has done nothing in 6 months, we have to be careful. Because today in social media's time, the worst thing, even if it's not the failure of the process is negative image on social media. Patient complaining because the problem and it's a surgical mistake. Did I answer your question?

Yes.

You still have to do some math, but...

And then my second question, was on the rest of the portfolio, which I think is also key for the growth story. You mentioned Keri being the door opener in the U.S. to get into context. Can you maybe talk about some evidence you've seen of this? Or are we still in the early stages here?

We are -- we have a super sales excellence team in the U.S. We have a person already before we started all this. That is already a long time in the organization. So we have a lot of data, and we are using more and more of this data to drive also our commercial team. I can tell you that we have already gained 28 out of all the trained surgeons became new Medartis users already. And then there are only a few. I mentioned 68 were trained, 49 use TOUCH already, but 28 of them are already using also for the first time, the Medartis hand or risk portfolio. Yes, they have not used because we got into the hospital. It's this now an indication that the 28 will continue with all the trend, but we see a positive impact, and we have to stick on this. We are also now more flexible in our own training centers to speak about Medartis. For example, I spoke yesterday with Daniel coming back from Atlanta. I asked him, I said, was Medartis touched really? Although he said, no, there was not enough time because if we have rented training center [indiscernible], they are so expensive that there's sometimes no time to speak about Medartis. So the Medartis products are only showcase. But in the future, we will have this also as a part of the education. We will speak about TOUCH. The trainer who will teach TOUCH, but will speak about Medartis handed risk portfolio. So we are intent rising this.

[indiscernible] from Sobak. Probably my question goes also to Mr. Herren. You showed this slide with -- against resection and at complication and durability, it was still a little bit behind with the implants. So do you think this could change over the time with increasing experience of the surgeons with this procedure? Or you think this is really perhaps a disadvantage?

No, absolutely. I mean it's much more taking just to own and put a little bit tendon in, I mean, it sounds easier than it is. But it has a lot of room in terms of surgical techniques. You cannot do a lot of mistakes. So the complications come from the nature of the procedure itself. The bone subsides, takes contact with the next bone is rubbing, pain again. This is a typical complication within resection arthropathy. If you -- at the moment you put in something which is more complex like an implant, the likelihood of a complication is higher. I have talked this afternoon about our complications in implant arthroplasty, the vast majorities are simple complications. So we have to put that in perspective. When I say here, complication potential is higher. This includes every type of complication. We define a complication is an event after the intervention which you might expect, but happens and needs further treatment. So a lot of these complications are treated by an injection. It's the tenontitis and inflammation of the tendon, which is the -- we have 3% of tenontitis after TOUCH. This is by far the highest complication we have. Dislocation is down to 0.7%. So the real complication associated to the implant itself is lower than what I was talking about. But again, it's a mechanical implant. So the likelihood something happens to that mechanical device is naturally higher.

I would have a second question. I think more to the company. Health economic study specifically for the U.S. How important is that? And what are you planning in this direction for the TOUCH implant?

You mean how important the TOUCH sales in the U.S. for the economics...

No, economic study. I think we saw something also from Mr. Herren on European data, I guess?

It's shortest clinic data. It's our own patients with data from the insurance company like and CSS. So these are real data comparing those 2 procedures in a working age population. So completely comparable, sex and age matched. So these were the data.

How important would this be that you showed something similar in the U.S. for longer-term ramp-up of this procedure?

We are doing this. We started immediately. First of all, we have one study which we are obliged to do from the FDA. This is really to control each TOUCH placed on a long-term success rate. And if there are no complications, it's one thing. The other thing is we are now doing in the U.S. with the U.S. surgeons from TOUCH one in the U.S. really a follow-up, also getting the patient input to show afterwards data how fast the recovery is, how fast the people are back to work, how much money you can save? Daniel mentioned it. How much physiotherapy you have to take out with another procedure, how long it takes to be back, really mobile. So all this, you can figure out in numbers and in figures to show the insurance companies the benefit of a higher priced procedure, but on the long run, it's cheaper. And I think the patient feeling and back to life and this heaviness of the patient, you cannot pay money. This is something you kind of put in the study. Unfortunately, there are some patients also in the U.S., they are not willing to be fast back at work, but we have this also in Europe. But this is another problem, but we are doing this study.

And not only in the U.S., we're also looking into other markets like Germany and other markets to do these type of studies.

Daniel Jelovan, ZKB. Also to Dr. Herren, as you are here and one of the top surgeons, we have the possibility to talk to you. So first one is, I guess, your penetration of TOUCH in short must be very high, 80%, 90% of all procedures. Is that the correct assumption?

No, no. Unlike the hip guys and the knees in our clinic will have a much wider variation of interventions we are doing. We do a lot of -- we increased the number of treated CMC joints, yes, indeed. We almost doubled it, because word of mouth, again, GPs who are sending us patients. But it's in joint replacement, it's by far the most often performed procedure at our clinic. We were the first started in the Swiss German-speaking part. We published after 1 year on the Congress of the Swiss society, our first impression and results. And from then on, it just ramped up. It was extremely impressive. I was proud to see that people had confidence in us. We have a scientific Board, which was completely independent from us. So we don't do the measurements. The measurements of these patients that are all done by professionals out of us with standardized measurements. Our registry file was the file, which was approved by the FDA for the FDA approval of the implant in the U.S. So we had to send all the raw data of our patient registry to the U.S. and U.S. that decision analyzed it again and they proved that, obviously, we didn't do a lot of [indiscernible], which is for us a measure of quality of the data we are collecting.

But the number of TOUCH procedures versus fusion versus the other one the...

Yes. Absolutely.

But you've done a lot of trapeziectomies before the...

We published -- you notice change replacement is our core business from clinic and the history of the clinic. And we published already a lot about some at the resection arthroplasty. So this was our field of competence. So that's why we can now compare our patients before with the old technique with the new technique now. And again, the difference is rare to do a resection arthroplasty. And honestly, I liked the resection arthroplasty because we mastered it at the end in a way that it was an easy procedure for us. I mean while hated. It's technically such a difference to replace a joint instead of just taking a bone out, which is a very brutal intervention at the end of the day.

But maybe let me -- I know where your question is going on, Daniel. I think it's also important that Switzerland, unfortunately, it's not a direct market for us. So it's not our team or Medartis region selling Switzerland, we have a distributor taken over from Keri Medical, longtime partner of Keri Medical I think we could do more in Switzerland if it would be in our hands very honestly. It's -- now it's also not the biggest market. They get a good service, but it's around 3,000 TOUCH per year in Switzerland. I think it could be a little bit more because you can also have some demographics, how much people living in the country and how much TOUCH by age and whatever. It's around 3,000.

Okay. Other my question was the more I'm sure you talk to your other colleagues in other countries, obviously. And so your colleagues in Spain or in the U.K., which is only 5% of your sales in touch and you are more or less the only one. Where does it go in other countries. So the penetration must be very low.

Exactly the same. It's increasing. But as we already discussed, the reimbursement is a big issue. There are laws. I'll just give you an example in Scotland. So far, it was not allowed to put in an implant in a patient, which is older than 65 and not working. Believe it or not, that's -- it's no longer part of Europe, but believable. But I just learned 2 days ago on a dinner from a colleague from Scotland that they are changing the policy. So and the government realized we are missing an opportunity to bring back people early to work and the quality of life is increasing dramatically faster. So there's pressure from different sites. It's amazing. So you cannot compare that market to that. So the driver of the markets are sometimes out of the medical indication.

And last question, a stupid big question maybe forgive me, but what about the other fingers? I mean the index finger is also quite important with together with the sorry, but...

The first finger I would let me amputate is the index finger. It's completely overrated. Just to wake you up. It's true. If we have something on the index finger, you can compensate with the other rings. So that's no. MCP, just short, I don't know if we have time...

Yes, we have still have an hour.

MCP joined this joint year. This was the classical joint patients suffering rheumatoid arthritis with the tons of that. Since the new medication was introduced about 20 years ago, the numbers are almost to 0. So we rarely implant an MCP joint anymore. DIP to the other end, these joints here we tend to fuse them. We did a series of silicon implants here. It is certainly not good in the index and in the middle finger because we are pinching with the thumb. So there is a lot of deviation forces. So an implant is not a good solution. So we do fuse these points here. Their fusion is a good option. And then we are on the PIP joint market, and there are 2 implants on the market which are in used, but the PIP joint is a more delicate and the more difficult joint to treat it with a bit more unpredictable results than the CMC. We always compare it. This is the knee and this is the hip and not only looking because if you look at the PIP joint, the 2 component PIP joint, it looks like a knee joint. If you look at the CMC here, it looks like a little hip, I always talk about the barbie hip to the patients, they love it. Since the Barbie movie, we can do that. So this is -- and then we have the rest and the rest is, I say personally a non-self-problem. There are implants, but is heavily debated, very complex one.

Edward from Stifel, apologizing on behalf of being Scottish NHS system.

Sorry about that.

A couple of questions on -- well, actually, the majority of TOUCH. I mean I think you talked about it being a Barbie hip and obviously, replacement rates in the hips are there. I mean, from your experience, is there a certain replacement rate when it comes to the touch prothesis, that would be my first question.

I didn't get it completely, sorry.

In terms of certain operations, there are replacements that need to go on from your experience, is there a certain -- a similar, let's say, replacement rates with hip -- with TOUCH or not the case?

I definitely think so. The numbers are suggesting that. Again, what I said, it's not ready. It's a blue ocean, which means we are increasing the market. Patients, if you talk to a patient and tell him I take out the bone and stabilize it with their own tendon, and that's what we do. They are afraid of that intervention. And then they hear from a neighbor, it took me a year. It's fine. The pain away, but you know I have no power in my hands, blah, blah, blah. That's a completely different ball game. So I think we're really increasing the market, yes, definitely.

That makes sense. And maybe just on the other side, obviously, a similar sort of question just on sort of bone infection. How significant is bone infection within the thumb joint compared to maybe other large joints and sort of bacterial infections and what are the current methods of which you would treat that?

Infection is an implant autopsy disaster. We hate it. And you take it personally if you have an infection. What is the infection rate to put it in a perspective, the international numbers for hip and knee infections, primary implantation are around 3.5% to 4%. In our clinic, it's also proven from the registry 0.8%. So there's room for improvement. And honestly, the rate is among the highest in the U.S. The most costly health care system has the highest infection rate. So the first question I got in Atlanta is where was from the colleagues, how many infections did you have? So it was together with the colleagues from the Netherlands. He overlooks 500, we overlook almost 900 implant, and both of us set spontaneously independent zero, because we had 0 infections. In the hand, the hand is not very prone to get an infection. Usually, it's in very complex situation, trauma whatever. So that's not -- and resection arthroplasty, we have 0 infection as well. So it's -- that's not the issue. So we don't even think about infection.

Perfect. And then final question would just be on reimbursement. The CAT 3 code in place. And I guess, I'd be curious to hear your thoughts on what is required to convert that to a CAT 1 code and sort of the time lines of how we should expect that?

Well, we have now, let's say, we need our studies for this also. We have now a peace of mind. We discussed it, average 6,500. This is also we calculated in our estimations and our analysis and our plans with a lower reimbursement code. So we are cautious. But if the studies confirm all the information which we have delivered before, we got the reimbursement code, it will be prolonged. It will continue. And there is no reason on what Daniel also said that the studies in the U.S. show the same results we have in Europe since 10 years. So all fine. But there is -- you can imagine there is a team working on this, although this is not a one-man show in the U.S., it's really a professional team. Our own team together with agency teams working on this because as higher the reimbursement code remains as more attractive it is. But also, I tell you, this 4,500 reimbursement would be also directly because the reimbursement in Switzerland or in -- yes, we are a multiple down.

Yes, we are about 2,500, but...

In Switzerland?

Yes. No, France and Germany are much lower. So Switzerland is still kind of -- within Europe, an attractive market. But yes, but will be interesting. Japan is interesting in reimbursement, Australia.

Yes, Australia but not even coming close to the U.S.

No, no, we are talking about 8,000 to 10,000 in the U.S.

Yes. Yes. So it's also attractive for the money the hospitals get for the treatment. And I think what is important, and we cannot answer, but even if you would know it, what we don't know is the overall potential, this blue ocean. And coming back to what we said last year, we said we know that 150,000 surgeries are taking place in a year. We would catch with this CMC 1 procedure, 10%, 15,000 case. But honestly, we have no clue. It could be multiple hundred thousands of cases possible. It's...

Yes. Maybe one question on the product road map presented by Mark. So on the CMX, can you please maybe tell us why are larger players living this market? And also, what are the economics on the new solution, patient-specific and scalability of that?

What do you mean about leaving this market?

Big players are not playing anymore. That's what...

What I said that specifically Stryker is going out of some of the markets, but they're not pushing -- Andreas elaborated a little bit on that one. We're working with -- now doing the planning. And there's a high level of automation already done by the team, so we can scale the cases also by doing kind of automated segmentation and all that stuff. So it's really scalable. And in terms of manufacturing, the team of Mario has a huge experience in scaling, manufacturing processes. So also there, we're pretty confident that we can scale the business in and regionalize it also because that's important, right? Keeping lead times low and patients matched or custom-made services is really important because surgeon doesn't want to wait like 4, 5, 6 weeks on a case. They want to have it as Andreas said, in like 4 to 5 days, being ready, especially in these tumor cases where the tumor can grow. So you need to be very fast in delivering the products.

So on the production side, this is done with 3D titanium printers?

We have several options of manufacturing. So some of the implants we're printing now with other ones we're milling kind of conventionally because we have tri-lock in it. So we anyhow need to go on a milling machine. So there are several options of manufacturing the implants depending on what type of implant it is.

But maybe, Mario, you can just say a word. I think the 3G branding of titanium that also with [indiscernible] have still to install a milling machine. It's not coming out of a printer and then it's ready to use, maybe in a few words is process how this has worked.

So yes. So here in Basel, we are still milling out of the blanks. This is our process, and we can -- the cases that you saw before, they are milled here in Basel. They're not 3D printed. CAT skill print from 3D, but we are planning to also add some milling capabilities there for locking features. So we are extending also our capabilities in CAT skills. And hence, as was mentioned before, we are we are lending to scale this technology also globally to additional markets.

I just can add, we are talking about 2 different things. The numbers of these procedures will always remain low. It will remain a niche special indications. I don't know in the CMF, but no, it's not a thing we would like to roll out like an implant arthroplasty. It will be dedicated to a few centers who do a significant case load, but it's not like a thing which will popularize, everybody does it. So I think -- but what it is, definitely it is. It's -- that's the classical door opener. We, surgeons, like that. And when I saw back how I did the corrections 20 years ago and now, I mean, I would never step back again. It's like having a a horse or Ferrari. It's completely different ball game.

Exactly. And I think this is -- therefore, Medartis is so well known also so respective that we are -- we have this specialty, and we are taking the time to offer the best solution for the patient and for the surgeon. Where others, when I mentioned they are stepping out trying to divest a little bit in this area, they are too big to fail. They are selling so much hip and knee. For them, it's not important to have the specific patient approach, which we do. And yes, we believe also it's part of our future, it's part of our DNA.

Probably another comment. I mean we see other competitors coming in to the patient-specific market, it's very important to provide all these services and indications where we're active because otherwise, other comes in. And as I said, it's a door opening, right? So they try to sneak in then their standard portfolio. So it's very important to provide these services to the customer to also protect and grow our legacy business.

And by the way, to end that, you're collecting data, which are extremely because you always do CT scan from both sides. So you take the reference of the healthy side. So you're collecting a huge amount of data of healthy bones in the hand, which further helps to develop new implants and find new solutions. So I think it's always the side effects, which needs to be also taken into consideration.

And that's an important point. It also helps us for all these digital services like trauma AI because we then have the data to base on all these services, so.

So before Matthias closes down, maybe a word also -- thank you also, I don't know if you can see you in a camera, I would also thank the people that have participated online. And before I handle back to Matthias for the closing remarks. So we have food prepared for your drinks. The experts are still around, and then we would leave at 12:15 with bus, which is departing over there. Also, the ones who have signed up for the factory tour that will start at the reception at 12:50. And the ones who have a yellow sign or have signed up for the Congress, the ones black and white, are for the company tour, if at all. Thank you very much. Matthias, closing comments.

Okay, now from my side. Thank you very much. Also the online attendance, I forgot that we have a camera upfront, hope we involved you a little bit. Thank you for joining here. And yes, thanks for your interest in Medartis. And we see each other latest, I think it's the 18th of August for our half year. I don't know if we see each other or we speak each other, what is planned. I love to see you. But okay, yes, enjoy fresh, nice you see a little bit where the orthopedics is coming from. When I say where we are coming from, where we are heading to. Thank you very much.