Smith & Nephew plc (SNN) Q3 FY2025 Earnings Call Transcript & Summary

Good morning. Thank you for attending today's Smith & Nephew Quarter 3 2025 Trading Report. My name is Sarah, and I'll be your moderator today. [Operator Instructions] I would like to pass the conference over to our host, Deepak Nath, Chief Executive Officer. Please go ahead.

Thank you. Welcome to the Smith & Nephew third quarter results. As mentioned, I'm Deepak Nath. I'm the Chief Executive Officer, and joining me is John Rogers, our Chief Financial Officer. Today, we reported Q3 results that remain consistent with our expectations and support our full year guidance of both revenue growth and trading margin. Underlying revenue growth was 5% for the quarter in line with the run rate of H1, and that was driven by continued momentum in Sports Medicine and Advanced Wound Management. Orthopaedics growth reflected trends broadly similar to the prior quarter in our recon and robotics business. Strength in Hips in the U.S. helped offset softer performance in Knees while internationally, strong Knee sales balance more modest results than Hips. We had our strongest ever Q3 for core Replacements worldwide and global growth in Trauma and Extremities was also strong. Group growth was well balanced across geographies, and China headwinds are now beginning to abate. Excluding China, underlying revenue growth was 6.4%. Key product highlights for the quarter include strong double-digit growth in REGENETEN, Q-FIX KNOTLESS, EVOS, AETOS, FASTSEAL, CATALYSTEM and LEAF. These products are visibly driving the broader segment growth rates. Our operational improvements under the 12-point plan continue to flow through to the P&L. And we're seeing expected step up in profitability in the second half and that's supported by improved cost discipline, better mix and efficiencies across our commercial and manufacturing operations. Strong working capital discipline and a focus on operational efficiency also means we're ahead of our cash flow targets. As a result, we're raising our free cash flow guidance for the year for more than $600 million to around $750 million. Innovation remains central to our growth and later, I'll share recent developments that support our confidence in our longer-term outlook. For now, I'll hand you over to John to take us through the quarter in more detail. John?

Thank you, Deepak. So revenue in the quarter was $1.5 billion with 5% underlying growth and 6.3% reported, following a 130 bps tailwind from foreign exchange. Trading days were unchanged year-on-year. Geographically, the U.S. grew 5.5% and other established markets grew 3.9%. Emerging markets grew 5.4%. Orthopaedics grew 4.1% on an underlying basis. In Recon, we saw a continuation of the trends of the first half. In the U.S., Trauma and Extremities grew strongly and Hips grew above market again, which reflects both the sustained improvements in our commercial organization under the 12-point plan and the strength of our portfolio. Hip performance continues to be driven by strong uptake of CATALYSTEM, which has now been on the market for a full year. The market shift to direct anterior hips is accelerating, and we are well placed to benefit. We are increasing our CATALYSTEM set deployments to support growth in Q4. U.S. Knees remains soft as sales continue to be impacted by our ongoing portfolio rationalization efforts. While this is ultimately the right strategy for the business, it has led to some volume loss in the process. That said, we continue to win new customers and core replacements in the U.S. were strong in the quarter. We see Knee growth outpaces market growth in accounts where CORI is established, underscoring the potential of adoption growth. And as we continue to build out our portfolio, we expect Knee performance to improve just as we've seen in Hips. In OUS, knees, Hips, Trauma and Extremities, all delivered strong performance overall, except for some localized weakness in Hips in emerging markets. We launched CATALYSTEM in strategic sites in Japan, which will drive growth in the coming quarters. Trauma and Extremities grew 7.5% overall, an acceleration over the first half as expected. We continue to benefit from our EVOS plating system and AETOS shoulder. Our new TRIGEN MAX Tibia Nailing System is performing well ahead of expectations in the U.S., and we are awaiting regulatory approval in key international markets. Other Recon grew 9.7%. Placements were strong, but revenue growth was impacted by contract mix with fewer direct purchases this year versus prior year. We are pleased with the continued growth of CORI replacements in ASCs and teaching institutions. Sports Medicine & ENT grew 5.1%. We are seeing stability and a gradual recovery in China following the anniversary of the Joint Repair VBP. The AET and ENT VBP are still to come, but the headwinds will be much smaller given the relative size of the businesses. We have taken actions to manage our inventory ahead of implementation. Excluding China, joint repair growth was 13% up, maintaining the positive momentum we saw in the first half. REGENETEN and Q-FIX KNOTLESS , which launched in Europe this quarter were key drivers. AET growth was led by RF and FASTSEAL in the U.S. and strong emerging markets. ENT growth accelerated sequentially despite a continued soft tonsil and adenoid market in the U.S. Let's now look at Advanced Wound Management, which grew plus 6% in the quarter. Within that, Advanced Wound Care grew plus 1.1%. Good OUS sales growth was offset by some softness in the U.S. ahead of our ALLEVYN Complete Care product launch in [indiscernible]. We expect this to drive growth in the segment going forward. Outside the U.S., ALLEVYN performed well with significant tender wins in the UAE and Saudi Arabia. Turning to Bioactives, which was up 12.2% for the quarter, we again saw strong growth in SANTYL. This reflects easier comps given the supply chain challenges last year, which has stabilized and a recovery in underlying demand as customer confidence in supply returns. We continue to monitor developments around Medicare reimbursement and local coverage determination. At the end of last week, CMS issued the final update to Medicare reimbursement for skin substitutes in the physician office setting, which is broadly in line with the initial proposed rate. Based on what we know today, we anticipate that this will be a headwind to Advanced Wound Management sales and have a 25 to 50 bps negative impact from group trading, profit margin for 2026. However, there are still some unknowns, including how it will impact clinical practice and physician behavior, which will only become clear in the first few months or so after implementation. These results keep us on track to meet our previously raised outlook of mid-single-digit revenue growth for Bioactives for the year, even despite a tough Q4 comp. Advanced Wound Devices grew 6.7%. LEAF and PICO performed well, reflecting strong demand. PICO is benefiting from targeted initiatives in the surgical setting in the U.S. and similar efforts are now underway internationally. Growth in U.S. RENASYS moderated, reflecting some softness in the acute care channel while performance outside the U.S. remains strong. I'll finish with the outlook for 2025. Guidance remains unchanged, except for free cash flow, which we are raising, we continue to expect around 5% revenue growth and a trading margin within the range of 19% to 20% for the full year. Our increased focus on cash and capital efficiency has yielded better-than-expected free cash flow, and we now expect to deliver around $750 million up from our previous expectations of more than $600 million. This reflects the sustained progress we've made in working capital improvement, particularly within our Ortho business and the operational cost savings we've driven over the life of the 12-Point Plan. The impact of tariffs for 2025 remained a net headwind of around $15 million to $20 million, consistent with previous expectations and will compound further in 2026. We continue to look for ways to mitigate this impact. And we continue to expect to drive further margin expansion beyond 2025 through continued momentum and efficiency gains. And with that, I'll hand back to Deepak.

Thanks, John. As I mentioned, innovation continues to be a hallmark of our strategy. Importantly, more than half of our growth continues to come from products that we've launched within the last 5 years, reinforcing the strength and relevance of our innovation pipeline. We have several highlights this quarter. In Recon, following FDA approval earlier this year, we fully launched our LEGION medial stabilized knee in the U.S. this quarter. Medial stabilized inserts are designed to provide surgeons with stability and improved kinematics while aligning LEGION with the 3 major market trends in Knees, the shift to medial stabilized inserts, which are now used in over 30% of procedures and the trends towards robotics and cementless fixation. As we build out our Knee product portfolio, we remain confident that the acceleration we have seen in the rest of our Recon business will ultimately extend to Knees. In Sports Med, we established a new Category 1 CPT code for our CartiHeal AGILI-C cartilage repair implant. The implant received breakthrough device designation from the U.S. FDA and is the only FDA-approved device for this indication. The new code will streamline reimbursement processes for providers and payers and support the integration of CartiHeal and the standard clinical practice. We're already having positive conversations with payers and are working with early adopters to build a body of compelling evidence ahead of the new code becoming effective in January of 2027. In August, the AAOS revised its guidelines for shoulder rotator cuff repair to include a strong recommendation for the use of bioinductive implants. Bioinductive implant support the body's natural healing process of the tendon by inducing new tissue growth. We're pleased that REGENETEN is well aligned with these updated guidelines and are excited about its long-term potential. In Wound, we're launching ALLEVYN Complete Care, our new foam dressing, in the United States. This proprietary unbonded design defends against factors that contribute to pressure injuries and its multiway stretch technology improves conformability to the body's anatomy and ease of application. Early customer feedback has been positive. Overall, this was a solid quarter, which takes us almost to the right -- almost to the end of our 12-Point Plan. Our business is undoubtedly in a better place. The global business unit structure has allowed us to drive greater accountability, faster decision-making and execution and increased focus -- customer focus. You can see the benefits across the portfolio. Orthopedics remains on an improving trajectory, Sports Medicine and Advanced Wound Management are maintaining the strong momentum, and we are seeing a step-up in profitability, cash flow and ROIC. We recognize that U.S. Knees are not yet performing in line with our expectations, and it will take time to get there. But the sustained growth we're seeing in U.S. Hips, Trauma and Extremities serve as a powerful proof points that U.S. Knees will do the same. We've already made the changes that we believe are necessary to our commercial engine and manufacturing footprint. And we are gaining new customers while we're expanding our Knee portfolio. These actions position us for continued improvement in the coming quarters and beyond. As I've said before, 2025 is not the endpoint of our ambition. And I'm excited to have the opportunity to lay out the next phase of our growth at our Capital Markets Day in December. We are holding 2 events, in fact, in London and in New York. In London, we will introduce our new strategy following the conclusion of the 12-Point Plan, including our midterm priorities and financial goals. In New York, we'll follow up with greater detail on our growth drivers and share insights from our customers. I look forward to seeing many of you at either or both of these events, and I remind you that both will be webcast. With that, let's move to questions.

[Operator Instructions] Our first question comes from Jack Reynolds-Clark from RBC Capital Markets.

I have 3, please. The first is on revenue guide. So given kind of the -- I guess, the slowdown in Q3, do you think there's a risk that underlying growth for the full year comes in kind of slightly below that 5% mark you've guided to for the full year? And kind of what gives you confidence in the tick up through the remainder of the year? Then on margin guidance, you've talked before, I think about anchoring at the kind of the middle of the range of the 19% to 20% range. I guess does Q3 performance impact how you're thinking about that now? Kind of where are you and where do you suggest we anchor within that? And then regarding 2026 and the impact of the LCD. Can you talk through the assumptions around kind of the bottom and top end of the 25 to 50 bps margin impact you've guided to? And kind of what the driver will be where you come in that range?

Sure thing. So first of all, we feel confident about our revenue guide for Q4, that's informed by our funnel, our sales funnel in Q3, particularly on the back of the CORI placements, the new customers we have won over and they start to integrate our products into their practice. And obviously, we've got one full month of Q4 under our belt. So we are confident of our revenue guide. We're equally confident on our margin guide as well. We've said 19% to 20%, but we've led you into the midpoint of that range, and we are very confident about continuing to be there with a slight positive bias. And regarding the impact for LCD of 25 to 50 bps. As you know, the current reimbursement schedule really goes towards physician office. And it's not LCD per se. That's not what the ruling was about. It's really about reimbursement for the physician office channel. We still don't know about the hospital outpatient channel here. So there's still some uncertainty around how that will play out. That informs our range of 25 to 50 bps. The reimbursement level of [ 127 ] is in line with what was out there before [ 125 ]. And of course, there is the uncertainty around how practice patterns will adapt to these new guidelines. So the combination of these factors give us the range of 25 to 50 bps. So hopefully, that addresses your question.

Our next question comes from Veronika Dubajova with Citi.

I will keep it 2, please. My first one is just actually going back to Jack's question around the revenue guide. I think when you had previously talked about the shape of the year, you had always kind of cautioned us around the fourth quarter and how difficult the comparison base was and sort of -- I think the messaging from you as always, this is something that we should expect the fourth quarter to be weaker. Obviously, with where Q3 has progressed and your comments, Deepak, just right now and how you feel about the rest of the year. Just curious if your thinking on that has changed and maybe what's driven that? Is it a phasing of revenues through Q3 and Q4? Just if you can talk through that, that would be super, super helpful. And the new SMEs, I hate to be the person to ask this question, but I have to, just -- obviously, we are still seeing a very, very wide gap between you and the market. I know you are continuing to work through the portfolio rationalization, but I was hoping maybe you can give us a little bit of the financial impact of what the portfolio rationalization meant from a sort of actual sales basis points of growth? And then how you're thinking about sort of when we might see this gap narrow somewhat from where we are at the moment? And is this really sort of a 2026 event? Is this a Q4 2026 event or 2027? Just your updated thinking on that.

Sure. Thanks, Veronika, for the question. I'll lead off and I'll hand it over to John to talk through the shape of the year. So let me pick up your U.S. Knees point. As you rightly point out, we are behind the market within that. We've acknowledged that, and we've -- there's a number of factors, but one we call out really as the most important of them is the ongoing portfolio rationalizations, particularly relative to GENESIS, which is the relevant platform within the U.S. This is a line that we've long straddled as we've gone through the 12-Point Plan program in terms of how aggressively to address this, particularly with our focus on capital efficiency, and really driving the business in a more efficient fashion than we have historically. It is a line we've tried because go more aggressive, then we put top line at risk being more conservative and that obviously impacts the returns in the business. And so while we've recognized that inherent kind of attention there, we have gone forward with that effort. So what gives me confidence? So first of all, to anchor everyone, U.S. Knees is about 9% of the group. As I look ahead, I'm very encouraged by the pace of CORI placements. We called out, it was a record Q3 for us. I'm particularly encouraged by where we're placing CORI; teaching institutions where historically, we've been somewhat under-indexed and there's quite a bit of effort we've put into kind of strengthening our presence which has been good to see. Our placements into ASCs have also been very, very encouraging. And as we called out, where we placed CORI, we see above market levels of utilization and where we also placed CORI, we see great uptake. So all of those are very encouraging. The introduction of LEGION medial stabilized inserts is a factor we're just now getting going. Actually, in the final month of Q3 was where we fully launched, and we look at the pipeline into Q4. We feel very good about the uptake, particularly into competitive accounts. So you put all of these things together, while the shape is not exactly as we had expected. Q4 is actually shaping up to be a reasonable quarter for us. So hopefully, that gives you a little bit of the texture behind U.S. Knees? And John, do you want to comment on the financial.

Yes. Just on the shape of the half, I think, Veronika, you're right, Q3 was a little bit softer than expected. But Q4, we expect to be a little bit stronger. So in around the 2-player draw and we're very comfortable with the guidance of around 5% for the full year. And just to reiterate, we expect to be in the middle of the range on the margin with a slight bias to the upside, which is what we said previously. So really no change to what we said on guidance. But let me give you a little bit of color behind that shape. I mean I think in terms of Q3, a little bit softer. There are a number of drivers. China was probably a little bit worse than expected. We talked about 150 bps impact of China for the full year. We think that will be probably end up being about 160 or 170 bps. I mean, impacts to China may be a little bit worse than expected. Obviously, ENT was a little bit soft in the quarter; U.S. Knees, a little bit soft; AET, a little bit soft, explaining why Q3 was slightly lower than perhaps we had anticipated. That said, as I just said, Q4, we expect to be stronger. We've got one extra trading day. We've got the benefits of new product launches in CATALYSTEM, where we're deploying new sets that will drive growth hard there in Q4. We've got the launch of the leaving Complete Care coming through in the U.S., where we expect to see some upside. We've got the benefits of LEGION MS inserts coming through in Q4. So there's a number of reasons to believe why we think Q4 will be a little bit stronger. And as Deepak said at the beginning, not that I like to get drawn into talking about individual trading periods within a quarter, but we've gone through P10. P10 is actually our biggest period of the quarter. And we can see those numbers already. So that -- all of those things combined give us complete confidence in delivering our guidance for the full year, as I've just set out.

Our next question is from Hassan Al-Wakeel from Barclays.

A couple, please. Firstly, as you look into 2026, what are the key pulls and pushes on the margin? And to what extent there's continued softness in Knees next year, hold back your margin expansion potential in this business and overall versus what you might have thought at the start of this year? And then secondly, if you could please elaborate on the Hips weakness outside of the U.S., how much of this was down to China? And is that market or share or both? And how are you thinking about the future of this business?

Great. Hassan, thanks for the question. So first of all, for '26, we've outlined a couple of factors that work against us in terms of headwinds. But the overall message is that we expect to deliver margin expansion beyond where we exit in 2025. So that's the headline. In terms of Knees, the combination of Knees and Hips hasn't played out exactly as we had expected at the beginning of the year, but the overperformance in Knees and the softness -- sorry, overperformance in Hips and the softness in Knees actually allow us to still deliver margin in line with expectation, certainly for 2025. And as we go into 2026 as well, actually, that combination works for us. So despite kind of where we are with Knees, that doesn't impact for us just because of the strength in Hips where we expect to outturn in Orthopedics in terms of margin for '25 or indeed for '26. In terms of Hips OUS, the reason is China and actually softness in the distributor markets. There's nothing particular about either market or share to call out there, there are quarterly fluctuations, particularly in the distributor market. So there isn't anything noteworthy that we would call out around Hips OUS.

And Hassan, just to maybe give you a little bit of color on 2026. Clearly, we're going to set this out in a little bit more detail at the Capital Markets Day and obviously provide specific guidance at our prelims in February of next year. But as you rightly highlighted, there's a number of headwinds going into 2026, which we called out in the release. So tariffs being an obvious one. Skin subs pricing being another and we provide a specific guidance there. VBP on ENT and the annualization of AET coming through. And then there's a little bit on the inventory rebound as well as a result of lower manufacturing costs. So there's a couple of headwinds that we've got to take account of going into 2026. That said, we've always been confident of the benefits of the actions we've taken on the 12-Point Plan coming through. So the manufacturing benefits that we expect to drive margin accretion in the second half will continue to come through in 2026. We've got further saving opportunities to deliver in 2026. So when you add all these things together, in the round, we continue to expect to drive further margin expansion into 2026 beyond from 2025. So we'll set that out in a lot more detail, of course, as I said, at the Capital Markets Day and the prelims, but that just gives you a little bit of a flavor for the direction of travel going into 2026.

Very helpful. And the future of the China business?

Look, we constantly evaluate where we choose to make investments. And we're committed to building a sustainable business in China, and we'll continue to evaluate product line by product line where it makes sense for us to do that. Just to remind this group, Trauma, for example, be -- post the implementation of VBP, that wasn't a profitable business for us. So we chose to exit the market. And so a decision like that we expect to make across all product lines. So the key is to build a sustainable business and we'll continue to keep evaluating that on an ongoing basis.

Our next question comes from Graham Doyle from UBS.

And just 2 questions for me on margins. Firstly, just, John, in terms of the guide for this year, we've only got 2 months left, and it's a pretty wide margin range. So can you maybe remind us why kind of November, December could be quite broad in terms of the impact of the business and why you haven't got better visibility on that at this point? And then just on next year. So obviously, the numbers could be wrong. I look at ENT, AET, the Wound you described and tariff, I guess like 150 bps of margin headwinds next year. So is it realistic to assume a modest margin uplift against that? Or do you think you can do something a bit more similar to this year?

Sure. I'll take both of those. So in relation to the guidance on margin, I think we've been very clear that we expect to be in the middle of the range with a slight bias to the upside. So that gives you a sort of indication of the direction of travel for the full year. There's obviously always lots of moving parts, not least of which Q4 is a big quarter. But nonetheless, 19.5% with a bias towards the upside gives you a little bit of a narrowing of the overall range. In terms of for next year, again, we're not going to get drawn today on giving specific guidance. We sort of set out for you what we see as being the key headwinds, and we also set out where we think we can offset those through operational efficiencies and then various savings coming through in the P&L such that for 2026, we would expect margin accretion year-on-year. But we'll clearly provide a lot more color on that in the detail, both at the Capital Markets Day and of course, when we give specific guidance for '26 in our prelims in February.

Our next question comes from Kane Slutzkin from Deutsche Bank.

Sorry, I think most have been answered. But just a quick one on the U.S. Knees. It sort of picked up yesterday from one of your competitors talking about a sort of soft or a slowdown in the U.S. revision market. I don't know if you had any comments on that. And just on the sort of U.S. Recon piece, I mean, you're sort of saying you're quite confident in the Q4 number. Just wondering, the comp is pretty tough, isn't it? And would it be right to say most -- a lot of that would be in the U.S. sort of the higher-margin stuff in Q4 in terms of the comp?

Yes. So I'll take that, Kane. So U.S. Knees provision, yes, there was a modest effect that we saw as well, but we called out the dominant factor for us in terms of the softness. And in terms of U.S. Recon, obviously, we know how -- what our comps look like. And when we talk about how we're positioned and our ability to hit the full year numbers, we've taken that into account. You're right. The U.S. was a strong quarter for us last year in U.S. Recon. We've obviously taken that into account when we express this confidence. But the one other thing, as John highlighted, we have one extra trading day as well, but we've been quite transparent with you about full reported numbers and also ADS as well so you can judge for yourself how we do. So we've taken these things into account when we have reiterated our confidence in that.

And the sort of target for market growth, is that still the end of this year? You haven't changed that, have you?

We have not. Yes, for exit, we've always said exited market, and that remains very much within reach. The shape of it that maybe looks a little different than we had thought, better performance in Hips versus Knees. But when you add that together in terms of a better U.S. Recon level as we said, we expect to be exit end market and that remains within region.

Okay. So I guess a bit of legwork maybe will be done by Hips. And there's nothing really to call out there in terms of any potential sort of headwinds that could sort of derail the overall kind of U.S. Recon piece? I'm -- just you talking about U.S. Recon now?

Yes. Look, it's a dynamic market, right? So there's always moving pieces, but we factored that into our confidence and expression of where we expect to outturn the year.

Our next question comes from Julien Dormois from Jefferies.

I have 2. The first one relates Bioactives. You were kind enough to provide a margin guidance for next year as to how it will impact you. But just curious whether you could do the same in terms of sales headwind that would be into; 26 and also how you see this change in reimbursement impacting the competitive landscape and whether you expect to gain some share over the medium term? And the second question relates to the pricing in Ortho and particularly in Recon, we've seen an inflection in the pricing trends that has been reported by U.S. peers since the beginning of the year and again in Q3. So how should we think about the Hip and Knee market growth into '26 and beyond, if there is the return of structural price pressure?

Sure. I'll take that. So we've disclosed margin impacted Bioactives. Obviously, there's an associated sales impact, but we've not been explicit about that just for competitive reasons. So that's the first part of your question. In terms of the competitive landscape evolution, obviously, what we've got now is reimbursement. The LCD, there's been no update to that since the announcement was made some time ago. And if the LCD remains in place as it is, clearly, there will be a fewer number of competitors, and we expect to benefit from that. And of course, if that changes, then we'll have to adapt. But putting the pieces together, I feel good about how we're positioned in the Bioactives landscape. And clinical data has always been a key part of our value proposition. We invest behind not only the product but generating clinical evidence, and we expect to stick to our knitting with that. And so I feel good about how we're positioned in this landscape, clearly a dynamic one. In terms of ortho pricing, we've had favorable pricing until recently. I've always said that we expect that to moderate and revert to kind of more normalized levels, and we're seeing that in our business, right, when you look at kind of the [indiscernible] of -- picture. And as we go into 2026, I expect that to continue in terms of going back to historical levels of pricing. There's obviously the shift in dynamic in terms of site of care from hospitals to ASC and that has an impact as well. So putting all these pieces together, it remains a dynamic and a competitive market, but we feel well positioned to compete in that on the back of, a, the improvements we've made in terms of our wiring and Orthopedics, the improvements we made to our commercial engine and our portfolio that has gotten better and better and actually we're positioned to make even more enhancements, particularly to our Knee portfolio, which we'll detail out in the Capital Markets Day. So we feel -- I feel very good about how we're positioned within this competitive market.

And just to give you a little bit of color on the Orthopaedics pricing. We're seeing sort of improvements year-to-date roughly around just below 1%, which as Deepak said, would be slightly above the norm. That's year-to-date impact. And in Q3, that probably drops to about 0.7% in Q3. So we're seeing the trend that Deepak describes. And I would imagine that for next year, we'll probably see a benefit on pricing of around 0.5% or so starting to get back to more normalized levels.

[Operator Instructions] our last question comes from David Adlington from JPMorgan.

Maybe just on other Recon, where it was certainly a bit of a slowdown there. I think on CORI placements and mix. Maybe just give us some further color and your expectations for Q4 would be great.

Sure. Just to remind you, David, in terms of other Recon, we put all of the robotics consumables in Knee. So we've kind of detailed that out previously. So what we have in other Recon is effectively the impact of cash sales of CORI placements -- of CORI's. As I remarked and John as well, we are very pleased with the placements of CORI. And as I've historically commented, it's placements and utilization. And I'm very happy with where we're replacing them across a range of institutions, normal hospitals, academic medical centers where historically, we've been under-indexed and we've done a lot to improve upon that, as I said. And then actually ASCs were the increasing volume growth is. And I'm very, very comfortable with those placements there. And second is utilization. And roughly where we place CORI, we see in steady state utilization of greater than 50% of our knees, and that's actually a pretty good number. And where we place CORI, we tend to see above market levels of growth in Knees. So you put these points together, both in terms of placement, in terms of utilization, in terms of where we're replacing them. The story is very good. And as I said, we had a record Q3. And when you look at the funnel for Q4, that's shaping up very nicely as well.

I think, David, the reason for the relatively low number in Q3 was as we explained, is basically the mix of contracts. So if you're on the cash side or on the volume-based side, to Deepak's point, this Q3 was actually a record Q3. We have never had a stronger Q3 in terms of CORI placements. So we feel very positive about that. And actually, we expect to see the other Recon line bounced back in Q4 to a similar level that we saw in Q2. So we're very happy with the momentum and direction of travel.

Thank you. There are no questions at this time. I'll turn the call over to the management team for closing remarks.

Great. Thank you very much for your questions. We're looking forward to seeing you all at our Capital Market events in London and in New York and looking forward to telling you about the next chapter of this Smith & Nephew journey and kind of what that looks like. So looking forward to seeing you all. Thank you very much for your engagement today.