Smith & Nephew plc (SN) Earnings Call Transcript & Summary

Great. Good afternoon, and good morning for those of you who are joining us by webcast in the U.S. I'm Deepak Nath, I'm the Chief Executive Officer of Smith & Nephew. And I'd like to welcome you to our 2023 Meet the Management Session. Thank you for taking the time to be with us today. So before we start, I'll read out the customary safe harbor statement. Certain statements in this presentation are forward-looking. And these statements are based on management's current expectations and are subject to uncertainty and changes in circumstances. Actual results may differ materially from those included in these statements due to a variety of factors. Some more information about these factors are contained in the company's filings with the SEC. So now with that out of the way. So for today's agenda, as you know, Smith & Nephew has been on a transformation journey. And today, there's an opportunity to go deeper into some aspects of that. In the next hour, you'll hear from me and the President of R&D and ENT, Vasant Padmanabhan. We'll be updating you on 2 important elements of our strategy, the 12-point plan and our innovation agenda including the acquisition of CartiHeal that we announced last week. After a short break, we'll move to a series of small group breakout sessions. For those of you who are in person, you should have received a group assignments and your schedule for the breakouts when you arrived this afternoon. So over the course of the day, each group will have a Q&A session with me, Anne-Francoise and Vasant and then in meetings with leaders from each of our business units to get into the detail of how we'll win in each part of Smith & Nephew. And to reassure those of you who are unable to be here in person, we will not be giving new financial disclosures or outlooks in the breakouts. So I'm sure you'll find it to be an informative day today and come away with a clear picture of how we're moving Smith & Nephew forward towards our goals. So to begin, I'd like to remind you of what Smith & Nephew is. We're a major global player in all of our key markets of sports medicine, orthopedics, advanced wound management. The portfolio is a typical model in medical devices, and it brings a range of benefits. It gives a level of scale, which covers costs and enables us to engage with customers where it makes sense in a cross business way. The portfolio also gives us stability. There are natural product cycles in each area of med tech, as many of you know, and diversification smooths out our outlook across those cycles. And it supports capital allocation. You've seen us investing in M&A when there are opportunities in particular categories in a way that would be financially challenging if these were stand-alone businesses. At the same time, operating on our new global business unit structure means each area has the focus, the accountability and the ability to move at pace that comes with dedicated leadership and clear lines of responsibility. Importantly, we have the right to win in all of our business units. In Orthopedics, we have a long history of good performance prior to COVID. There have been challenges, as you well know, in the last few years, with major product gaps and commercial delivery. But we're increasingly in a better place. The gaps have largely been closed and we're making good progress on fixing our execution. Beyond that, the right to win comes from our portfolio and our technology. On the portfolio, we now have a full product range across hips and knees with unique and differentiated implant technology. And then there's a robotic enabling technology platform, CORI, where we're still expanding the planned functionality and which you'll hear more about from Vasant in a moment. In Sports Medicine, we also have a complete offering with joint repair, the arthroscopic tower and close customer service. We have leadership position in the various segments, including being #1 in enabling technologies and in biologics. And we have scalable synergies with other areas such as through CORI and cross-selling, especially in the ambulatory surgical centers. And in Wound, we have the broadest portfolio, offering solutions across all key wound types, bringing together foams, devices, biologics, and increasingly digital offerings. We have a leading negative pressure platform with huge potential for market expansion. And we have a catalog of strong evidence across our categories, showing proven clinical outcomes and economic value. And this sets us apart from the low-cost segment of the market. You'll hear from the presidents later on how they leverage these strengths, together with consistent execution and new products to win in each of these areas. Putting that fundamental positioning together with the growth investments we've made and the actions we're taking to drive further performance leads us to our midterm targets, which remain unchanged. We're targeting underlying revenue growth consistently at 5% or higher and that's above our markets and significantly above where Smith & Nephew has been in the past. We're also targeting a trading margin of at least 20% in 2025 and in beyond. That increased growth and profitability represents an important step to a fundamentally stronger Smith & Nephew. The focus of today's plenary presentation will be on 2 aspects of how we are driving that. First, I'll cover the 12-point plan and specifically how our progress is translating into financial outcomes. You'll then hear from Vasant to talk about the role of innovation and driving consistently higher revenue and revenue growth at Smith & Nephew. That will include our innovation strategy, and some of the key platforms that we expect to drive performance, not only in the near term but in the years beyond. We'll finish with a summary of how we expect that to play out in the segments that we report to you. So I'll first start with the 12-point plan with what as a company we're fundamentally capable of. We can unlock a lot of value by addressing our remaining challenges. So we launched the plan in mid-2022 as a broad 2-year program designed to do exactly that as well as maintain performance in areas where we're already strong. The 12 initiatives are summarized on the slide, 5 are around regaining our previous momentum in Orthopedics across all of recon, robotics and, of course, trauma. The language we use of fixing orthopedics is purposefully direct. It conveys the depth of change we're making and our commitment to putting the business on a better path. Another 5 initiatives are to improve productivity across our manufacturing, procurement and value and cash processes. And they are an important part of improving returns. The design of the plan also recognizes the importance of nurturing businesses that are already doing well. The final 2 initiatives to accelerate sports medicine and advanced wound management reflect that. So 1 way to track our progress is through milestone completion. Slide 8 shows where we are today, for each group of initiatives, and for the 12-point plan as a whole. As when we last updated you on this in July, there are different levels of progress in the different areas. And that's to be expected. There will always be variation in a program of this scale. Some actions will take longer by nature such as manufacturing optimization and portfolio rationalization. You've heard me talk about that. And some have just moved very quickly through their project milestones like our order to cash initiative. However, when you take a step back, we are making progress right across the board. And the plant as a whole is well on track. 2/3 of the milestones are delivered now compared to just short of half when we last provided that update to you. And importantly, we're accumulating evidence that the project and the KPI delivery is starting to turn into financial outcomes. Many of the initiatives should lead to a wide range of commercial and financial benefits, but this slide spells out the most direct connections with metrics you'll be able to see in our financial reporting. The first outcome of the plan should be higher growth, better product availability, driving share with key ortho platforms, pricing, and continuing to drive wound and sports are all components of our revenue story and therefore, the operating leverage that comes with it. Alongside that, manufacturing and procurement initiatives should drive better efficiency on both fixed and variable costs. Taken together the benefits of growth, leverage and cost reductions are key elements that underpin our midterm revenue and trading margin goals. Those are the financial items that we guide on, but return on capital and cash flow are important too. And they're also being driven by the 12-point plan. For example, instrument sets are around half of our CapEx. So improving set utilization as a part of rewiring Orthopedics is an important lever for overall fixed asset intensity. On working capital, we have initiatives on both inventory reduction and receivables through our order-to-cash initiative. Looking at where we are with these outcomes, improvement in growth is already visible, both for orthopedics and for the company as a whole. On profitability, we've done some heavy lifting this year already. The reported trading margin should follow. And as we've indicated in our guidance, we expect a significant year-on-year uplift in H2. Finally, on capital intensity, inventory management is taking time to come through but we're still making progress on the other elements. I'll double-click on each of these in the next few slides, starting with some of the initiatives where you can already see the financial improvements. I'm particularly pleased with our progress on Orthopedics growth. When we initiated the 12-point plan in mid-2022, the franchise was in a difficult place. Product availability was below industry levels and we were not getting capital to customers in an effective way. And on top of that, we're just starting to work through the headwind of VBP in China. As part of addressing product availability, we introduced a new planning process in 2022. We brought in a higher cadence of interactions between commercial and manufacturing and improved forecasting and planning down to the SKU level aimed at better matching supply and demand in both overall volume and importantly, in mix attainment. At KPI, we've shared externally is non-set LIFR or a line item fill rate, which is the percentage of customer order lines that have been filled. And it's an indicator of how well we're meeting demand. That has continued to progress well and has now closed about 95% of the gap between the trough level and our target, which is being in line with industry standards. There's still more work to do. Implant availability is not yet consistent across all products. For example, with tight supply of JOURNEY II, we still need to increase instrument shipments, which is particularly important for U.S. knees. Even so, the broad progress is increasingly showing up in our reported numbers. When we look at our recon growth versus our peers, slicing that into the 4 subcategories of knees and hips in the U.S. and outside the U.S., all were behind the market at the start of the 12-point plan and that has improved to 3 of the 4 being at or above market in Q3 of 2023. The same drivers of product availability and set delivery are showing up clearly in trauma and extremities. We're winning market share with our EVOS plating system, is an initiative in its own right. The availability of trauma consumables has been good all year. And in Q2, we started to see a ramp in our KPI of set deployments. And that's being shown here on the EVOS large -- as EVOS large on the slide. Again, that's translating into better underlying revenue growth, which improved first to solid growth in Q2 and then to more than 10% in Q3. Within that, growth was higher again in core trauma in the U.S., where the EVOS rollout is more advanced. That platform has a good runway of growth ahead, and we'll come back to that later in the presentation. There's further to go in improving capital utilization and cash generation. But even so, some elements of our progress are also already visible externally. One area is around instrument sets, which has been a multifaceted program. We've worked on set health, which is now improving and on plan. We've improved last mile logistics to get sets to customers more efficiently with shorter turnaround times between procedures. We've redistributed slow turning and non turning sets to customers and sites with larger opportunity. And we have better governance around new set deployments, where we've gone from capital being essentially free to commercial teams to asset utilization, now being part of their incentives. All of that work is showing in our 12-point planned KPI of improving recon set terms. This is a bumpy metric by nature. But still, we've achieved an overall 25% increase in set turns from the start of 2022. And that's starting to appear in the metrics that you can see. Instruments are part of the reported PPE. And you can see in H1 financials that turns of reported PPE have also started to rise. On cash, overall, cash conversion remained slow in the first half. But there was still a bright spot with our order-to-cash initiative, where monthly days of sales outstanding is a 12-point plan KPI. DSOs had been rising, then they turned at the end of 2022 and have been coming down again, now standing at -- about 12% below the peak. Again, that was visible in our H1 report, with receivables growing below sales. As I said at the beginning, margin expansion and inventory improvement are not yet in the reported numbers, but we're confident that they're coming the underlying work is progressing, and we're seeing the planned KPIs that should be leading indicators starting to inflect. For example, our manufacturing optimization initiative is an important driver of the cost of goods sold element of the 12-point plan. The majority of the P&L benefit is expected to come in 2025, both from the actual work taking time and also from the delayed benefit as lower cost product first passes through our inventory. We do want more than that, of course, and an important metric for us is conversion costs, which is total direct and indirect cost to convert raw materials into finished goods as a percentage of sales. Encouragingly, our KPI stabilized in the first half of 2023 and is now beginning to fall. We're also making good underlying progress on inventory. Our chronic issue has been around orthopedics finished goods. And with the unusual combination of high and rising inventory and product availability challenges at the same time. Both of those challenges helped by better sales and operations planning, and as we go through planning cycles and iterate our process, our forecasting improves and the SKU mix of what we manufacture comes more into line. And also as overall product availability improves, both the sales force and customers become more confident that they will get what they order and the bias towards overordering falls away. The effect is that we have now stopped the bleeding. Days of orthopedics finished goods have leveled off and have been largely flat throughout 2023. Overall inventory days did increase in H1 of 2023, but that came from other temporary sources, which were wound inventory, particularly negative pressure, to support our growth plans and an increase in orthopedic sets, which were not yet deployed, and so we're still held in inventory. We expect to grow into wound inventory and although still up year-to-date, the trend had turned but the end of Q3. Instrument sets have also leveled off, and we expect that to fall as recon set deployments pick up, as I described earlier. Given how important our operations improvement is to overall performance, it's worth going into further level of detail here. Our main challenge was a misalignment between commercial and operations. Our sales, inventory and operations planning, or SIOP, was very flawed, particularly given the demands of Orthopedics. This led to overordering by commercial organizations and the creation of excess capacity by our operations organization. Coupling that with an ineffective inventory management process, we created a challenge for both cash and service management. We rolled out an improved and redesigned SIOP process in 2023, as I referenced earlier, supported with the leading-edge advanced planning solution. Additionally, we've upskilled leadership in multiple levels across planning, manufacturing and distribution. This has allowed us to dramatically improve service, both on new sets and in replenishment while driving an improvement in inventory days across Orthopedics. So having a better aligned supply and demand process has also enabled us to critically assess a manufacturing capacity. Over the last 2 years, we've reduced Orthopedics related CapEx without creating any issues on quality. We've also reduced hiring and taken a reduction in contingent workforce in our largest site in Memphis. From a network perspective, we've already exited the Lyon site. It was part of the Extremities acquisition, and we've more recently announced closures of our sites in Tuttlingen and in Beijing. This is a heavy lift. And while we've made a lot of progress, there's a lot more to do. As I said, it will be 2025 before we can show you the full benefit of the manufacturing initiatives in our P&L. But with improving KPIs and key steps taken on network, we have increasing line of sight that the improvement is indeed coming. What you're seeing develop across multiple metrics and areas of the company reflects the broad change that the 12-point plan has brought about. It's a vehicle for both operational and cultural change. The discipline we've driven through execution of the plan is driving new behaviors and creating a sustainable culture marked by customer centricity, agility and speed, execution rigor and consistently high-performing teams. So we'll now move to the second part of the presentation with Vasant Padmanabhan, President of R&D. For those of you who are yet to meet him, he has 25 years of global R&D leadership, previously, a Thoratec, which is now part of Abbott, and before that, Medtronic. Vasant has both an engineering and a commercial background, which he brings to his expanded role. Earlier this year, I asked him to take on added responsibilities as President of ENT on top of his roles as head of R&D. In this session, though, we will be focusing on innovation. So I'll hand you over now to Vasant to talk about this pillar of our growth strategy. Vasant?

Good afternoon, everybody, and good morning to those of you calling in from the United States. I'm excited. I'm delighted to have the opportunity to talk about our innovation agenda. It is the lifeblood of our company. And I'm excited to talk about how it relates to the 12-point plan as well as the revenue for growth going forward. I'd like to start with 1 of the key takeaways regarding innovation. Over the last few years and especially over the last 3 to 4 years, we have increased our R&D investments. And more importantly, our investments in R&D and innovation have already contributed to the revenue growth for a few years. You may be familiar with some of our key growth platforms. CORI, our digital surgery robotics platform, our EVOS plates and screws platform in our trauma business. Our REGENETEN biologics platform in our Sports Medicine business. These platforms are not only contributing to growth today, but they also have multiyear runway still ahead of them. On this page, as you can see, in 2023, we have guided to 6% to 7% revenue growth. And of that 6% to 7% revenue growth, 50% of that growth is expected to come from new product launches that we have launched in the last 5 years. And then on top of that, another 10% comes from external innovation products that we have acquired through our M&A activities. And so you put it together, 60% of our revenue growth will come from our innovation pipeline as a whole. This is actually quite a healthy contribution to revenue growth. In 2023, we will be launching 25 new products that will continue to drive revenue growth in the midterm. Looking beyond 2023, as Deepak has discussed in his comments, we have guided to a 5% underlying revenue growth above our historic average and above the market growth for the markets that we participate in. In addition to the 25 new products we will launch this year, and when you combine it with the 50 products that we have launched already in the last 3 years, I believe we will continue to grow this company and the revenue in the midterm. Why are we confident of this trend continuing in the midterm? Well, there are 3 reasons, and I'm going to step through each of them 1 by 1. First of all, there are significant unmet needs that still remain in the market segments we serve. Secondly, Smith & Nephew has a history of meeting unmet needs with disruptive and transformative innovation. And finally, the innovation environment and technological trends or tailwinds and very well aligned to our innovation approach. Let's talk about unmet needs. First, and very importantly, we still have large unmet needs in the markets we serve. These needs can be for the patient either in terms of patient satisfaction or in terms of clinical outcomes or reduction in complications or it could be needs from the health care system either due to increasing costs for existing treatments or for costs due to unaddressed problems. Let me just take a few examples. If you look at knee replacement surgery, 80% of knee patients still say their knee feels artificial. If you look at shoulder repair surgery, almost 50% of patients experienced re-tears after rotator cuff surgery. And 1 out of 16 children undergoing total tonsillectomies have post-procedure hemorrhages that require them to go back to the emergency room. And then finally, from a health care system perspective, the treatment for surgical site infections costs the U.S. health care system alone more than $3 billion per year. So my message is that if we can address these innovative -- if we can address these unmet needs with innovative solutions, there are big clinical and financial opportunities for Smith & Nephew. The second reason why I believe innovation will drive growth in the midterm is our track record of doing exactly that. Over decades, we have repeatedly brought technologies to market that have disrupted traditional approaches and changed standard of care. Let me take a couple of examples to illustrate that. Let's take the example of Sports Medicine, the business that Scott leads and is going to be discussing with us later in the breakthrough session. Smith & Nephew has been at the forefront of our move to minimally invasive arthroscopic procedures. First, we came out with DYONICS and the arthroscopic mechanical resection capability. Then a few years later, we came out with arthroscopic meniscal repair, where we still hold a #1 position in that market and orthoscopic ACL reconstruction. And then we came out with COBLATION technology. Each of these was a clear departure from established surgical methods at that time. Each of these has clear patient benefits. Each of these has become a standard of care, and each of these has clinical evidence to support the utility of that procedure. Another quick example, we launched PICO in 2012, which is a simpler device for negative pressure therapy, 10 years later, PICO has been utilized in 2.3 million surgical site infections and is doing great in the marketplace and has disrupted how negative pressure therapy is delivered. And just a final example and kind of my -- 1 of my favorite ones is knee placement. We launched JOURNEY II in 2013, and and that knee still represents a new generation, whether you take motion, shape or position, it is a need that is closest to the natural knee and closer than any other conventional design that is out there. And it actually addresses that artificial feel that some patients referred to. And OXINIUM which is a material that we use in our knees remains an industry standard with leading performance and remains 1 of the best materials from a wear profile perspective with extensive data from registries collected over many, many, many years. The final reason why I believe innovation will continue to drive revenue growth is the innovation environment and the technological trends that are playing a key role in our goal of continuing to drive innovation. Many of these will be familiar to you, robotics and digital enable a degree of accuracy and personalization of procedures that has not been possible in the past. And I'll get into more details into how robotics and AI play into our innovation agenda. Equally important biologics and the biologics technology is developing rapidly and enables different types of treatments, including fully restoring tissue and function. Procedural innovation and Brad is going to talk a lot about procedure innovation in the orthopedics breakout section with less invasive and tissue sparing methods can improve the post-op experience, again, going to patient satisfaction, unmet need, including faster recovery times. And finally, the ever-increasing economic pressures on health care systems from aging populations and national budget pressures are making health economic benefits even more compelling. So with all of these tailwinds, let's talk a little bit about how we are driving innovation successfully. First, we have increased our investments in R&D. And we usually talk about the ratio of R&D spend to sales. And if you look at it that way, our R&D as a percentage of sales has risen by over 100 bps since 2017. It's even clearer when you look at the absolute spend. That's $300 million of R&D investment in 2022 is a 35% increase from where we were in 2017. And it really has enabled us with a different level and depth of projects in our organization. If you look at the projects by our business units, our spend is fairly similar to our business mix. And if you drill further down into the categories, you'll see that our investment is concentrated in high-growth segments and categories with all of these key segments growing well and ahead of our overall market, and all of these key segments aligned with the key technological trends that I just talked about. And underpinning all of this is our ongoing investment in clinical evidence that demonstrates the clinical value as well as the economic value of our innovation. Complementary to our organic innovation is external innovation, and we have also stepped up our investment in external innovation. Before 2019, we had a relatively low level of tuck-in M&A averaging about $90 million per year. More recently, we have targeted our investments to support the same strategic areas, both medicine and wound, have been the largest areas of investment. And within orthopedics, the key transactions have been in robotics and extremities. This slide here shows a few examples of the few transactions that we have had in the recent past and how they create value for Smith & Nephew. Let's take 1 of my favorite examples. Rotation Medical. Rotation Medical is a very clear example of our approach. We acquired REGENETEN, which is a novel regenerative technology for rotator cuff repair which is a procedure we were already supporting in our sports portfolio. And we were able to sell REGENETEN this high-potential device through our existing sales force. We have launched it in the United States as well as in several markets outside of the United States, and we have invested significantly in clinical evidence and new indications. 6 years later, we're still finding new legs of value with REGENETEN, and I'm very excited that we're looking to replicate that same model with the CartiHeal acquisition that we recently announced last week. Switching to Orthopedics and enabling technologies. We've also added new capabilities that we can build upon. The 2 acquisitions on this page are BLUE BELT and Atracsys. These brought to us our first-generation robotic system called NAVIO and the camera that goes with that product. And when we combine these acquisitions with our significant internal investments, these have become the foundational technologies for our second-generation system, CORI, that I'm going to talk about in a little bit more in detail. And we've been scaling some other high-growth categories as well, such as skin substitutes and wound after the acquisition of Osiris in 2019 and the Extremity Orthopedics acquisition from Integra as well. That acquisition immediately gave us more scale in extremities and a key development in AETOS, which I'm going to talk about as well as we go forward. Now let me try to bring it all together in what I call as the secret sauce as to what are our strengths that will take all of this and create value for the company. Firstly, we have several core competencies that help us with multiple applications across products and categories. These core competencies exist in our engineers and scientists that are very long tenured within the company. I'll give you an example. The Chief Technology Officer of Blue Belt joined us several years ago and still continues to drive innovation with CORI. Similarly, the Chief Executive Officer and a Chief Technology leader of an acquisition we made called LEAF joined us, and he is still with the company, driving our enabling technologies portfolio. And so these highly tenured scientists and engineers are able to work across the enterprise. Materials and robotics are familiar to you. OXINIUM has been used on multiple applications in Orthopedics. And as I said, we are the first company to bring a second generation robotic system. Image processing, computer vision, we don't talk about it that often, but it is becoming more and more of a key enabling technology, especially when combined with AI. And then finally, Biologics, where we already have great capabilities through our acquisition from Osiris and Rotation Medical were continuing to extend it further with CartiHeal. The second fundamental strength is we firmly believe in the importance of clinical evidence. We've completed multiple studies and meta analysis to build our clinical evidence portfolio. Just to give you a couple of examples. In Skin substitutes where there's increased payer scrutiny of clinical value, the clinical evidence of GRAFIX stands out. In fact, in 1 particular study in DFUs, we found and we showed that the GRAFIX membrane was the only dermal substitute determined to have high quality of evidence with no serious risk of bias. We ran a head-to-head study against our competitor, and we found that GRAFIX closed 63% of chronic wounds compared to 18% of a leading competitive product. And finally, 1 of my favorites, REGENETEN. We added this new technology to an existing procedure and we built the evidence to support the reimbursement of the added component. And again, we have shown the highest standard of evidence with blinded RCT against standard of care. In 1 study, a randomized study where we focused on full thickness tears compared to -- and we compared the re-tear rates in 2 arms. One arm got the REGENETEN product, the other arm got the standard of care. And there was an 86% reduction in retail rate between the REGENETEN arm and the control arm. So very, very, very excited about that. INTERTAN is also something where we've done a lot of clinical work. The design features with second-generation screw suggested different actions to other nails and we approved that as well. We demonstrated this with studies that found 66% lower risk of provision 71% lower risk of implant failure, 52% lower risk of hip and thigh pain compared to other intramedullary nails. And finally, proximity to customers. We work extensively with design surgeons, customer labs and academic partners to bring projects aligned with the market needs. And when we put all of this together, we are very proud of our results. We may not always have been first to market with a key technology, but when we leverage our strengths, and our investments, we're very proud of the differentiated industry-leading portfolio that we bring to our patients and surgeons. Now I'm going to switch and show you a little bit about the portfolio. This is a summary of the portfolio. There is a lot on here, and it doesn't represent our entire portfolio, but just a few highlights. These launches have come from different business units and subsegments with both consumables and enabling technologies. And you can go from hips and knees. You can see CORI, you can see our LEGION consolate launch in our Trauma and Extremities. You can see our digital TSF, you can see our AETOS system, of course, our EVOS platform. Same thing in sports medicine. You can see innovation coming through on the consumables side, both incremental innovation, transformative innovation, you could see with our Tower and with our INTELLIO tower that Scott will be covering as well. And then on the Wound side, you can see the LEAF innovation as well as our innovation in Biologics. These products represent both incremental innovation. We believe cadence of innovation is really important, and they also represent transformative innovations that either significantly shift standard of care with a potential for share gain or allow us to enter new categories entirely. I'm now going to highlight some key projects in 3 groups. I'm first going to talk about projects or programs or platforms that are driving revenue growth in 2023 and 2024. And those are CORI, REGENETON and EVOS. Next, I'm going to talk about projects that we are just getting ready to launch, and that will be AETOS, Agili-C from CartiHeal and RENASYS EDGE. And then I'm going to talk about what's going to come beyond 2025, platforms that we are investing in now that will realize in our portfolio beyond 2025. I'll start with CORI. The development of CORI in my mind, showcases our capabilities and strength that I just described. When we started to create a vision for CORI, we noted that competitive offerings where large SAW-based fixed arm system, essentially replicating how the procedure was already being done manually. But based on our assessment of the user needs and in collaboration with our surgeon customers, we decided to take a different approach, and we made a bold decision. We didn't follow our peers. We instead designed CORI to make robotics scalable, a small footprint, portable device that's easy to set up and suited to any OR. We decided to make CORI flexible with a modular design that's able to work with a range of hardware and software options so that we can evolve, be agile and help surgeons with their preferences and the needs of different procedures. We initially designed CORI to be image free for the patient that couldn't go get imaging, we didn't require imaging at that time. But you'll also notice that in the flexible design of CORI, we are able to also adapt the image free technology to image-based technology as well. These decisions are playing out in our growth strategy today. CORI is a leading brand in multiple geographies, including EMEA, and Brad will talk more about this as well. We're seeing good adoption both in ambulatory surgery centers as well as in academic medical centers where Smith & Nephew has historically been underrepresented. Our flexible design has helped us to create capabilities and unique value propositions. And I'll give you a couple of examples. We are the first and only FDA-approved knee revision system without the needs for imaging. Because if you already have a knee implanted a new, it's very difficult to do a CT scan prior to a revision procedure. We were also the first company to come up with the digital tensioner, which is a unique system that measures soft tissue tension before making any bone cuts. And with respect to continued adoption of CORI, we have learned that even though a 1/4 of our U.S. knees are now placed with robotics, some surgeons would still like to use a saw to cut bone. So we brought that additional capability forward as an option with our recently launched Saw Solutions, which is our approach for efficient bone cuts without the need for additional incisions or traditional pins. Similar concept with pre-op planning that I just mentioned about. While not needed due to our image free design, we recognize that some surgeons have had imaging established as part of their workflow, and would like that as an option. We can now support that with CORI's flexible design, and we expect to bring that capability forward for both knees and then hip after that. And finally, in addition to knees and hips, I believe, CORI is uniquely positioned to support shoulder procedures that Brad and Craig will talk about as well. CORI is particularly suitable given limited access and the nature of the shoulder joint, and I'm very excited about bringing CORI to the shoulder space as well. The second platform that I've talked about and I want to talk about a little bit more is REGENETEN. It is our collagen-based bioinductive implant used for rotator cuff repair in Sports Medicine and it has already had a transformative impact on our patients and rotator cuff disease. As you all know, rotator cuff disease is progressive in nature, meaning small tears tend to grow in size and severity until they require surgery. There are currently several techniques to treat rotator cuff tears with physical repair, but there continues to be a significant risk of retear as much as 50%, as I discussed earlier in the unmet need section. With REGENETEN, once again, we have taken a different innovative approach. We have an implant that actually disrupts the progression of the disease biologically and supports the body's natural healing response and has proven clinical value in 85% of tear types. I mentioned earlier that REGENETEN is a good example of our tuck-in strategy working well. It's also a great example of our investments in clinical evidence. And I'd like to spend a little bit more time in what we've accomplished in this area. Without REGENETEN, data shows that up to 2 and 5 repairs retear and there's risk of poor outcomes and revision surgeries. We recently reported the interim analysis of an RCT that I alluded to earlier, where we showed a dramatic and statistically significant reduction in retail rates, the 86% reduction that I talked about. The retail rate at 12 months in the group of patients that got REGENETEN was 3.5%. The retear rate in the group, the control arm that did not get REGENETEN but got treated with standard of care had a retear rate of 25%, and that's the 86% reduction statistically significant reduction that I mentioned before. Other studies have also shown rapid postoperative recurring, reduced pain scores and enhanced quality of life. REGENETEN has been a great growth driver since 2018, but the good news is we've really only scratched the surface of the opportunity as Scott and Christie are going to talk to you in the breakout session. From a penetration perspective, there are approximately 1.2 million addressable rotator cuff procedures globally, growing 5% CAGR out to 2030. And today REGENETEN is still used only in a single-digit percentage. And also looking to expand the addressable market with new indications, the mechanism by which REGENETEN works for tendon repair is not specific to the shoulder, and we believe it has broad applications, and we're working on evidence to support a series of further indications, including Achilles repair and reconstruction on hip. I'd like to move to EVOS which is our plates and screws platform in trauma. EVOS is a brand you've heard about for some time, and you may be wondering why we're talking about it today. It's actually been a long commitment for us and investment for us on our EVOS platform. And we have recently delivered a solution that can compete effectively in the largest segment of trauma. Customers typically buy plates and screws as a complete solution rather than just components. So while our first launch was EVOS Mini a few years ago, we have built on that platform in stages with the launch of EVOS Large in 2022, we can now address all key needs with a single state-of-the-art system. EVOS is a differentiated platform. The plates themselves have good anatomic fit with a low-profile plate and screw designed to minimize irritation, which is a differentiator for us. A common design across the components simplifies procedures and improves workflow and additional targeting tools help accurate placement of the large plates against the bone and out of the surgeon's view. With the system complete, the main levers looking ahead are operational and commercial related, talk to Craig about it, and he'll be talking to you about it as well. Huge addressable market, $4.7 billion globally and going from a single point -- from a single-digit market share, we are really excited about our trauma business and the role of EVOS in the trauma business. Now these are 3 existing platforms. Then I'm going to move on to 3 launches that we are just getting ready for. First of this is AETOS, our second-generation shoulder system. We acquired this technology as part of the Integra deal in early 2021, and it enables us to effectively compete in 1 of the largest growing segments. What's unique about AETOS. It's been designed keeping in mind the needs of both patients and surgeons. For patients, the unique design of our stem minimizes bone resorption and it maintains patient anatomy. The cruciform shape and coding maximize stability and improve fixation and they're designed to restore range of motion for patients and help minimize arthritic shoulder pain. And with interchangeable anatomic and reverse options and given backwards compatibility with our previous generation shoulder called Titan, surgeons can now make flexible choices intraoperatively responding to the patient's need and condition as necessary. In addition, any combination of the procedure can be done by just 2 to 3 instrument trays which greatly simplifies the procedure for health care professionals, improves capital efficiency and streamlines workflow in the operating room. We recently launched the short stem in the United States in June, and we are well placed to commercialize AETOS. We are already calling on our joint replacement commercial organization, our sports medicine organization and trauma specialists. These are the groups that perform 2/3 of the shoulder replacements, and we are also expanding the channel for the remaining group of shoulder specialists. We're also continuing to develop the platform further. We're working on a stemless variant. And also on compatibility with CORI, like I talked about, which will further increase the optionality and attractiveness of our offering in this area. And as I mentioned earlier, to reiterate CORI's handheld design and precision milling capability make it uniquely suited for robotically enabled shoulder procedures and work on AETOS robotics is underway. We're still early in our launch of this product. and we are confident that it will contribute to evolving the standard of care once again for shoulder surgery. This is another strong example of our innovation strategy where we bring together external and innovation together to meet unmet needs. RENASYS EDGE is our next-generation traditional negative pressure wound therapy. As a reminder, the RENASYS family is 1 of our 2 negative pressure platforms. We have a traditional platform and the single-use platform. I already talked about PICO, which is the market leader in the smaller but rapidly expanding segment. The traditional negative pressure segment is complementary to the single-use segment. And it has a market size of $1.7 billion, Rohit and Cathy will talk about it. And this is where RENASYS EDGE sits. This segment consists of the larger pumps that often sit in the hospital and a reuse for multiple patients, dressings are what we sell rather than the whole unit. This segment is an established one, but there are still significant unmet needs. The fixed component -- the pump has a significant service requirement with costly and complex logistics and management. And in fact, our survey data showed that 78% of clinicians reported that traditional negative pressure management interferes with other tasks. Also, both practitioners and patients find existing systems complex to use requiring training. We designed RENASYS EDGE to meet these unmet patient and customer needs. It's user-friendly interface, is easier to learn and troubleshoot for both professionals and patients. For hospitals, the self-testing functionality removes the need for routine annual servicing and private data maintenance, and the modular design means a streamlined process for minor repairs. For patients, RENASYS EDGE gives the convenience of a small portable device with a hidden canister that keeps exudate out of the general view. We've already been gaining share with our current generation. And with the upgrade with RENASYS EDGE, we will continue that current momentum. And finally, I'm delighted to discuss the latest addition to our innovation portfolio. As you know, we announced the agreement to acquire CartiHeal and an existing biologics platform called Agili-C. What is Agili-C? It is a porous biocompatible and resorbable scaffold which promotes natural regeneration of cartilage and restoration of its underlying bone. FDA granted Agili-C breakthrough designation in 2020 and premarket approval in March 2022. Agili-C is indicated to treat a wide patient population, including those with lesions and knees with mild to moderate osteoarthritis, which is a previously unaddressed condition as well as about 700,000 patients that currently receive treatment for cartilage repair annually in the United States. When Agili-C is inserted into the lesion, the implant gets infiltrated by osteoblasts and stem cells from the surrounding areas, leading to formation of new bone within the scaffold. The top surface promotes migration and growth of chondrocytes from the adjacent cartilage leading to cartilage regeneration at the top of the implant. In short, it provides an optimal environment for both bone and cartilage regeneration. I'd like to go into a few more details regarding Agili-C's superior outcomes and advantages for our surgeons. Data from a 2-year randomized controlled trial published in 2021 showed superiority over current surgical standard of care, which is microfracture and debridement. The primary endpoint of this study was a change in a composite outcome score, which included subscales of pain, other symptoms, quality of life, activities of daily living and sports. From a similar baseline, patients treated with Agili-C had statistically significant improvement in their overall score. What was exciting is that these improvements were across patient groups with better outcomes regardless of the degree of osteoarthritis, age or lesion size. And as the study continues at the 4-year follow-up, it shows continued good improvement of the outcome scores and low surgical reintervention. There are advantages to surgeons as well. Agili-C indication is for Grade 3 or above lesions and includes mild to moderate osteoarthritis, which is currently an unaddressed condition. It is efficient and easy to use, 1 step off-the-shelf application, no refrigeration or preparation required. Overall, it's a great fit for the Smith & Nephew portfolio and our innovation approach. It's an area we know with existing surgeon relationship. It's a disruptive approach. It's a departure from what's already been done and it's backed by outstanding clinical evidence. And finally, I'm going to wrap with the waves of innovation that's coming forward. And I'd like to now talk about something that we're working on beyond 2025 and in particular, 2 technology platforms with application across our businesses. I'll start with enabling technologies and close with biologics. We think of enabling technologies as a fundamental component of our product portfolio and central to this is the transformative power of AI. And when it comes to incorporating AI into our products, we see AI as a mean to address unmet needs and solve real-world problems rather than thinking of AI as a hammer looking for nails. We're very strategic in our application of AI, as I said. Our approach to AI and enabling technologies is anchored in 2 broad areas: personalization and automation. And across the entire spectrum of Smith & Nephew's offerings, we are integrating AI to more efficiently deliver personalized solutions, whether it's in Surgery, Wound Care or Sports Medicine, our goal is to tailor our products and services to meet the unique needs of each patient ensuring that their care is individualized and personalized. And we're also leveraging automation to help streamline care delivery. Automation is not only something that enhances product efficiency but also reduces cognitive load and resource demands on our health care partners. For example, in the area of preoperative planning for knee, hip or shoulder, it's very important that we create the model of the patient's anatomy, whether it's a knee or a hip accurately and include bony structures that are quite easy to identify from images as well as soft tissue like cartilage that are very important, but harder to identify from images. And this is where AI comes in. We use AI for image segmentation so that we can create an accurate 3D model of the patient's anatomy, having a better model allows us to create a better plan, a plan that is personalized to the patient and exactly what the surgeon wants. We're also using AI models to help predict surgical complications and suggest appropriate mitigation strategies from our Wound portfolio. For example, AI models can predict a patient's risk of surgical site complication. And in an evidence-based manner, we can guide the use of targeted interventions like our negative pressure wound therapy or our dressing therapy to improve patient outcomes. We're also focused on leveraging the power of sensors. For example, LEAF sensor technology. It's currently aimed at preventing pressure injuries in hospitalized patients. It has broader potential applications such as informing orthopedic surgical plans. For example, we can analyze a patient's baseline activity data using the same LEAF sensor and that can enable personalized implant selection and surgical approaches. This sensor-based personalization can extend beyond the operating room and we can collect continuous postoperative monitoring with sensors like Leaf that can provide data on patient recovery, and we can feed this data back into our AI models. By integrating patient data across the continuum of care, our AI models get increasingly better. Looking ahead, our vision with AI is to create what I call an intelligent portfolio where our digitally enabled products contribute to a unified knowledge ecosystem, which in turn leads to increased personalized and automated care solutions. And finally, I'm very excited about how we're using enabling technologies to transform arthroscopy using video-based navigation and computer vision technologies we believe we can help Sports Medicine surgeries in the same way we use enabled technologies in arthroplasty. I like an AI-enabled arthroscopy to Google Maps for Sports Medicine, if you will. And it will enable surgeons with decision-making and guidance for tasks like tunnel placement in ACL. That's a great example. In addition to enabling technologies, we believe that our Biologics portfolio is well positioned to meet the large unmet needs. As you all know, Biologics are biomaterials and tissue engineered implants that allow us to restore, repair damaged tissue as well as organs. And when we think of our biologic strategy, we categorized it into 3 broad areas: bioactives, tissue engineered implants and cell therapies. When we look at bioactives, which are basically substances that facilitate advanced healing, we have SANTYL and GRAFIX in our own portfolio in that area. Our innovation approach is to develop a next generation of bioactives that can be even more effective. When we look at tissue engineered implants like REGENETEN, our approach is to combine externally available platforms with our core competencies, like we have with REGENETEN and with the Agili-C bioinductives scaffold. In fact, some of you may already know this, but our human body is made up of 90% type 1 collagen, the same substance that's used to REGENETEN. And so we believe that the REGENETEN platform can be used to treat and restore other tissues and organs as well. And when it comes to cell therapies, we're fairly early in our innovation approach and looking to see how we want to make progress there. That concludes kind of my comments on innovation and our innovation agenda, and I hope you could see the link to our revenue growth strategy, and I'll hand it back to Deepak.

Thank you, Vasant. So as he indicated, I hope you're able to see why it is that with the depth and breadth to which of Vasant has gone, we're so excited about our pipeline. So I'll just take a couple of minutes now to summarize how this connects to our growth outlook, both based on the 12-point plan and, of course, our portfolio of innovation. Just to recapitulate, as Vasant said out, innovation is already a central pillar of our growth in 2023. As he indicated, in the 6% to 7% growth -- underlying growth for this year that we've guided to around half of that comes from products we've launched in the last 5 years with an additional 10% from those we've acquired. With better execution in the 12-point plan and clearly defined areas of focus and accountability of each business unit, it will enable us to get the value from this new technology as we continue to drive the contribution also of our legacy products. Our targets also imply that we expect our midterm growth to remain higher than in the past. And this slide gives an indication of where we expect that growth to come from. We've highlighted 5 areas of the portfolio. Those are Trauma and Extremities, other recon, just CORI, ENT, Sports Medicine, excluding the headwind as we move through VBP and of course, advanced wound devices. The key projects and products Vasant presented are important parts of how that's delivered. We haven't talked about ENT today, but in the near term, the business should be driven by continued penetration of tympanostomies with Tula building over time. An important observation to take away from this is that we expect our acceleration versus the past to be broad-based. Our plans do not rely on any single product or segment taken as a whole, around 50% of group revenue in these areas with an outlook for higher growth. The rest of the portfolio is still important, maintaining the improvement in wound over the last few years is a major building block of our midterm growth story. And we have exciting longer-term projects in next-gen biologics mechanisms and dressings that will become new components of that growth story that will be further out. As I touched on at the beginning, recapturing our past momentum and hips and knees is another important goal through the mechanism of the 12-point plan. So what you should take away from today is that we're seeing the return on that higher investment coming through in the form of a revitalized portfolio at a greater contribution from new growth -- from new products. We have a series of assets, both internally and externally sourced that can keep driving growth in the coming years. And all of that is backed by a stronger culture and improved commercial delivery in our business units. So the breakouts for the rest of the day will give an opportunity to talk about those plans in each business unit in more detail. Our presidents and the other business unit leaders will go through how we will win in each area, the key products and innovations that fuel that. But before I go into Q&A, I'd like you to introduce the people that you'll meet in the breakout sessions. So first is in orthopedics. It's held by Brad Cannon, Brad's a 30-year industry veteran in med tech. He was a key architect of our success in sports. It didn't come for free. He's built a great culture in sports, balanced scorecard-based selling and the kind of momentum you see in growth is in large part due to his contribution in building up that organization, which Scott is now taking over. So what we're looking for is Brad to bring that magic into orthopedics and has been doing that over the last 2 years. Along with Brad in the breakout session, you'll see Paul Connolly. Paul has been with us for about 3 years. Two, he says, he wants to make sure. He's been with us for 2 years. Paul brings a breadth of experience in ops. He is a consummate ops leader. He spent a great deal of time at J&J in the orthopedics world plus other parts of J&J. And he also spent time at Goodyear, where sense matter in a commodity business like that. So he brings a great ops mindset and great familiarity with orthopedics into his role. And he's brought a great deal of leadership into that area. It's recruiting and talent from within this industry to address some of the important challenges that we face in orthopedics. We've got Craig Gaffin, who leads our trauma and our extremities business. He comes to us from Stryker. And in previous to that, he worked at Amgen. Craig has an infectious passion for this business. It comes through not only to his team and colleagues in Memphis, but those of us who are on the 12-point plan calls every 2 weeks. So great passion, great excitement. I think you'll see that come through in the Orthopaedics business. And you'll have Andy Russell. Andy is the CFO for the Orthopedics business. Andy spent a career and then some at KPMG, where he led their health care M&A areas in the U.K. Andy also stepped in to be the leader of EMEA after the leader of EMEA departed our business. And so not only is he a finance leader, but it's actually wears a second husband wearing a commercial leadership hat as well. So he will be an important part of the team that you'll meet and interact with the orthopedics session. Next up is Sports Medicine. As I mentioned, it's held by Scott Schaffner. Scott is a 30-year med tech veteran, I know he doesn't look at. But 30-year in med tech, you spent a significant amount of time with us starting with 2013, 2014, with as it came through the ArthroCare acquisition. And prior to that, he spent time at Abbott, Abbott Spine and at Zimmer. He's a consummate med tech commercial leader. We promoted him to be on the ExCo earlier this year, taking the baton over from Brad, who's been a mentor to him. And Scott has an MBA also from Stanford. And with sports -- in the sports team is also Christie Van Geffen, who has spent a little over 20 years with us. She a leader in marketing. She spent in a variety of marketing roles within the sports business. So this is what she does day in and day out and where she spent the bulk of our career initially in Europe and has been leading the global marketing organization in sports. So you see the depth of leadership in each of our businesses. Leaders who are not only great, leaders in their own right, but have spent significant time in these domains, which is an important part of how we're bringing this business, how we're transforming the culture within our company. The third up is our Wound business. We've got Rohit Kashyap, who's been with us for 3 months, a little over 3 months. Rohit comes to us from MIMEDX , where he spent a couple of years, knows the biologics portfolio well. But he spent the majority of his career at Acelity, where he was the key architect of Acelity's negative pressure business, not only from an M&A and corporate development standpoint, but actually leading that business culminating his role as the Chief Commercial Officer there, but also prior to that leading the U.S. business, leading the EMEA business. So he is a wound leader through and through. There's not too many of them are in the industry, but he's been 1 of the absolute leaders in this space. So we're fortunate to have him part of the wound team. We're also fortunate to have Cathy Dalene who's been with us for 3 years. She comes to us from MoInlycke where she led the wound business for MoInlycke, which has, as you know, a strong presence in foams and dressings. Prior to that, she spent a significant time at J&J. Actually in the Orthopedics business. So she led the company's offerings all across Nordics prior to her going to MoInlycke. She leads global marketing for wound. So we've got, as you can see also in our wound business, folks who are drawn from that business who are passionate about that business and bring that sense of depth of expertise and broader leadership experience. So this is the team that you'll interact with today, and I'm sure you'll have robust conversations there. Before we break, we're literally just on time. And we've got a 15-minute break lined up. But if you have a couple of questions here, I'll take those. You'll have an opportunity to, of course, interact with Anne-Francoise, who's been very quiet, uncharacteristically so. But she won't be in the Q&A session and Vasant and myself here in this forum. And then, of course, you'll have the opportunity to break out. So with that, Hassan?

It's Hassan Al-Wakeel from Barclays. I've got 3, please. Firstly, you talked about winning market share in orthopedics. The gap has improved in Q3. There is still a gap over the prior year, and absolute R&D still lags your larger peers. To what extent do you think that you can maintain this momentum into 2024 as the market is perhaps less buoyant than in 2023? Secondly, maybe 1 for Vasant. Of the 25 new products in the pipeline in the short term, can you help us understand the mix of incremental versus transformational launches? You talked about the importance of cadence of launches. So I wonder how you think you benchmark on this point versus your peers? And then finally, on M&A, could you talk about your thoughts here in the pipeline and where you see the most attractive bolt-ons by segment and how you're thinking in terms of process and hurdles?

Yes, sure. So first off, I feel good about our prospects. And hopefully, Today, we've given some substance to why I feel good about it, right? So you've heard me talk about it in earlier analyst calls and so forth. So this has not just come for free. There's a reason for it, and that reason comes from the breadth of our pipeline to fuel our growth. But it's not just the pipeline, right, where we've lagged historically is our commercial execution orthopedics hasn't been up to snuff. So hopefully, what you've seen in the 12-point plan where we spelled out commercial execution and improvement in that as 1 of the key levers we're bringing in intentionality and focus in improving key areas of commercial execution, it spans multiple areas. It's incentives. It's our commercial process. It's our talent and it's the discipline of how we go after this, right? And now with the portfolio gaps that we've had that have been largely closed, an innovation pipeline behind it and enthusiasm in the market around robotics, we're well positioned to do this. But it's not just any 1 thing. These things have to come together. As I've also indicated in the past, we're not counting on great terms on buoyant market, right? We're not counting on tailwind in the market to make our numbers. In fact, our guidance was based on basically normalized kind of market levels. And so the tailwind such as it exists for as long as it exists, would be upside, if you will, for us, right? And as you know, in 2022, there was a good market. We weren't able to capitalize on growth in the market. We're better able to do that in '23. As you note, there's still a gap that remains, although we've narrowed the gap. We're looking to further narrow that and start to kind of put points on the board in 2024. So Brad will detail that out and go into that with them in terms of how he's bringing that to life. And I'll answer the third question, and I'll turn it over to Vasant since you directed the pipeline question to him. In terms of M&A, we've -- you saw us do the CartiHeal, right? It was a great bull tuck-in acquisition within the sports world. I think you can see the synergy. You can see the complementarity. So we've also said M&A is part of our growth strategy, right? And so we've got a process where we evaluate opportunities right across the businesses. What is important for us is to make sure we're nurturing all of our businesses, right? Orthopedics is in fixed mode, right? And there's a lot that's going for orthopedics, we recognize our position there. But at the same time, we've -- we are delivering in sports, and we actually are delivering in wound. And the idea is to make sure that we're giving those businesses what they need to be successful. We're operating from a leadership -- a position of leadership in sports. It's about building on that leadership. And I think you see with our entry into the cartilage space, how we're doing that, right? In wound, we've got the broadest portfolio in the industry. We see opportunities there, too, of all different sizes. And when the time is right, and we can deliver value, we will be appropriately, I would say, aggressive. Maybe that's not the right word, but we're monitoring opportunities right across the space. Okay. With that, I'll turn over to Vasant.

Yes. I'll take your question. Of the 25 new products that are -- several that are incremental innovation, several that are disruptive, this term of incremental versus disruptive is a subjective one. Kind of 1 person's incremental innovation could be another person's transformative. But I'd say roughly about 70% of our products, I'd like it to be kind of incremental innovation and 30% disruptive. This year, I'm actually quite excited by the number of disruptive products, AETOS, I think, is a disruptive shoulder product for us that we recently launched. The CORI digital tensioner is a disruptive product because it allows surgeons to do ligament balancing. Arthroplasty is becoming more and more about ligament balancing and less about cutting bone. And I think the CORI tensioner is a transformative product. And then the RENASYS EDGE, just to take an example from the wound portfolio as well, it's a product that comes after many years in the traditional negative pressure, and that's transforming the market for us. And benchmark, I think when we compare, we work with Gartner to get competitive data, we feel that we are known for more innovative products, more creative products and more transformative products from what I can tell from the benchmarks.

So I'll take 1 quick question, Lisa, maybe from you and then in the interest of having -- making sure you guys have a bio break before you get really deep into the sessions. We'll take 1 more. Lisa?

Lisa Clive from Bernstein. Just a question about generating clinical data, that's obviously much more important for med tech than it was 10, 15 years ago. Vasant, during your presentation, you mentioned clinical efficacy. There's often an analysis around health economics head-to-head comparisons. And then with REGENETEN, you mentioned sort of incremental reimbursement. So is your R&D budget today enough to do what you need to do in all these areas? And are there any of those areas where you think you can do more? I mean it is interesting that REGENETEN, you actually mentioned that you've got incremental reimbursement. That's quite unusual in the segments that you operate in?

Yes. Do you want to take that, Vasant?

Yes, I'll take that. Listen, you're not going to meet too many R&D leaders that say they have enough money.

We've just been through our budget process. That was not what he said to me.

So having said that, I do feel that we have a laser-focused process of prioritizing our investments and prioritizing it in a way that we put it where we get the highest return. So am I confident that the money that we have, the $300 million, we're spending it in the right places? Absolutely. And in some ways, kind of having some kind of constraint on your spend allows you to make those trade-offs, requires you to make those trade-offs, understand customer needs better and the market better. And these are the trade-offs that we are making. We're making more investments in REGENETEN as an example, and we'll make more investments in Agili-C as we go forward.

And we does force that prioritization on you, Lisa. I think that's a great question. The composition of R&D, we provided a breakdown by businesses and Vasant also talked about kind of where we're invested. So orthopedics shifting towards robotics, right? And some of the areas that we talked about, along with that shift also comes where you invest, right? So now in sports is increasingly about evidence generation not only just clinical benefit, but also health economic benefit, right? And as you know, it's easy to say, but we've got to develop that capability. And part of why we felt good about Agili-C is we've been down this road with REGENETEN. We're kind of down the story. We didn't really talk about Tula, but we're actually down the road actually for some of the in particular [indiscernible] right now, but Tula. So there is some accumulated evidence experience. Some of it is positive, someone is not so positive that we apply to how we bring to bear. But -- as you well know, I'm back to Hassan's questions around kind of scale of R&D, right? I mean there is something to be said for dollars in R&D, right? Even in us, the $100 million extra that we've spent from 2017 forward, we've, I think, put it to good use, and it matters, right? Because you can be more in depth in your programs. But that said, not all of the innovation is responsive to dollars, right? I mean there's a level of inspiration that you need to draw a level of focus and prioritization. I think there, while we have not always been first, and many of you have kind of pointed that out in your interactions with me, we acknowledge that. But hopefully, what you were able to take away today is underneath that headline is we've actually brought some really good innovation to bear, and we've done that consistently in space after space. So what we've not had necessarily in being first all the time everywhere we have made up for in kind of the level of innovation where we've chosen to compete. And I think you'll see us continuing to do that as we move forward. Okay. So I'm sure there's a lot of questions. Please bring those into the sessions. We'll take -- and I'm looking at Andrew, I'm not sure where he is, may be we will take an extra 5 minutes borrowing into the session. So we'll come back at 5 past the hour in to your assigned breakout areas. Thank you.