Ladies and gentlemen, welcome to the publication of half-year results 2022 conference call and live webcast. I'm Alice, the Chorus Call operator. I would like to remind you that all participants will be in listen-only mode and the conference is being recorded. The presentation will be followed by a Q&A session. You can register for questions at any time by pressing star and one on your telephone. Webcast viewers may submit their questions or comments in writing by the relative field. For operator assistance, please press star and zero. The conference must not be recorded for publication or broadcast. At this time, it's my pleasure to hand over to Fabian Hildbrand, Head of Communications. Please go ahead, sir.
Thank you, Chorus Call. Good morning or evening, ladies and gentlemen, and welcome to this audio webcast on the Medartis 2022 half-year results. We appreciate that you have taken the time to dial in despite your busy agenda. I'm joined by our CEO, Christoph Brönnimann, and our Chief Financial Officer, Dirk Kirsten. We will use the presentation slide deck, which was published this morning on our website, together with our press release and of course our half-year report. In particular, I would like to draw your attention to the disclaimer on slide two, which also applies to forward-looking statements made during this webcast. On the following slide, you can see today's agenda. At the end of the presentation, we will look forward to answering all your questions. We will start taking questions from attendees on the phone, and then we will move seamlessly to the webcast participants.
With this, I would like to hand over to Christoph for his opening remarks and the key highlights of the first six months of the year. Please, Christoph.
Thank you, Fabian, and good afternoon everyone on the phone and in the webcast. Really looking forward and thank you for taking the time to joining us on today's call. Let me start with the key facts and figures on page five. We have closed our H1 with CHF 88.4 million, which is a growth of 21.1% in constant exchange rates versus prior year comparable period. The underlying EBITDA margin resulted in 16.3%, and our headcount has grown to 832, which is a plus of 28.2% versus prior year, which also includes the NSI employees that joined in May, which were 98 headcounts.
To go on the highlight on page six, I'm very pleased and particularly pleased with the performance in EMEA and our LatAm business, especially that all markets in the EMEA region have recorded strong double-digit growth, meeting or exceeding our expectations, and we have gained market share in all of our business line, which is equally important. The APAC region was the region that was most affected by COVID still in the first half of this year, particularly the lockdowns in Japan and also the restrictions of the elective procedures in Australia and New Zealand have resulted in a gap versus our expectations. We continue to see shortages in the OR staff, mainly driven by COVID infections or isolations, which results in cancellation of cases, most of them elective, which applies to almost all the countries on a worldwide basis.
Following our strategic review and the assessment of the Chinese market and our Chinese business, we had to make the decision that we're gonna discontinue the operations in China in the course of the third quarter of this year. The U.S. market did not perform to our expectations, to our internal expectations. We have lost some of the growth momentum that we had during the initial phase of the integration of NSI. Also keep in mind that at the same period of this year, the U.S. market has grown at a very high level of 46% on constant exchange rates. I'm very happy and pleased with the new management team that has taken over, and we are very confident, and I will get back to you on the rationale.
I am confident to regain the sales momentum in the course of the second half of this year and beyond. Based on the U.S. and also Australian shortfalls in the first half of this year, and despite the anticipated acceleration, especially in the U.S. market, we have also slightly revised our full year 2022 outlook. The next page gives you an overview on the development of our headcount, which has strongly grown mainly through the acquisition of NSI with 98 employees. Still in the first half of this year, in a worldwide basis, we have hired 85 additional employees, most of the investments done in the market. The headcount in Switzerland has slightly grown to 284. With those opening remarks, I would like to hand it over to Dirk to guide you through the financial and business review.
Thank you, Christoph, and good afternoon also from my side. Let me give you an overview on the regions and the segment sales before going into the full P&L and the cash flow. Page nine gives you a summary of our year-on-year sales development. As you can see, net sales rose to a level of almost CHF 90 million, which is 20% more at CER levels than prior year.
With that said, we directly go to page 10 summarizing EMEA and APAC. In EMEA, I'm very happy to present a very strong performance from the entire region. EMEA reports 21% growth for the first half of the year. This has been achieved by delivering double-digit growth from all direct markets. Specifically, strong year-on-year growth came from the U.K. and France after H1 2021 had been materially affected by COVID in both countries. Germany, our largest European country, was once again growing consistently despite a mild winter and thus less trauma business in Q1. It has further fostered its market leadership in upper extremities, also by strongly pushing KeriMedical products. Spain, only 18 months being a direct market for Medartis, is growing rapidly and the Spanish sales team is on very promising absolute run rate levels for the full year. Moving to APAC.
APAC growth in the first half in 2022 was 6% and that's clearly behind plan. The lower than expected sales can be fully explained by Australia, which since the second half of 2021 is still affected by COVID restrictions, quarantine isolation, reduced staff capacities in hospitals, and the postponement of elective procedures. We have recently seen some first signals that the situation is now improving, but the first half of 2022 was still materially affected. Our very strong growth and a very strong and experienced team in Australia was carefully navigating through these difficult times, further strengthening customer relationships as well as training and education in order to prepare for the recovery once it will occur. In Japan, we've grown more than 30% in our combined direct indirect business, also after introducing the new MODUS 2 system.
While we are very confident in the growth potential in this country for Medartis, the absolute size of Japan and our regional business portfolio is still small and thus couldn't make up for the COVID-related shortfall in Australia. In China, we will not continue our direct business as Christoph has already said. Significant changes in the regulatory environment as well as the new pricing regulations decided by the Chinese government make it almost impossible for small players such as Medartis to earn money in China. The strategic decision to leave the country is painful, especially as we have built a strong team and gained some initial momentum. Nevertheless, also with respect to preserving overall profitability, we will shut our operations by the end of the year and probably in Q3. Some product returns already booked in H1, also we've taken various exit costs through the P&L already.
LatAm, on page 11, reports 47% CER growth, mainly driven by both direct markets, Brazil and Mexico. While the comparison base from last year was low, we are convinced that our growth rates also reflect clear market share gains in the LatAm premium segment. We have very strong teams who are consistently increasing run rates while keeping good discipline on set efficiency and also credit management. With that, let me also spend some words on North America. This region reports 20% growth, including some sales from the acquired NSI. However, our own organic growth rate was only 10%, which is, as Christoph has said, clearly behind our own expectations for H1. Besides ongoing capacity restrictions in the U.S. hospitals, the lower than expected sales momentum is also due to the transition phase in which the U.S. currently is.
As already stated, after the acquisition of NSI, a new leadership team has taken over and realigned some responsibility through the organization. At the same time, new management, strongly supported by the CEO personally, have done extensive traveling throughout the country and visited customers and KOLs to explain the new US strategy, which will shortly include the launch of several NSI lower extremity products. First clinical cases have been conducted as part of the limited release with excellent surgeon feedback. The full launches of LapiPrep and Corkscrew are planned for Q4 and are expected to generate sales as from 2023. The new team will systematically expand our own franchise and invest in onboarding of new independent sales agents. Together with our own sales force and the improvement of sales execution and productivity, we expect to re-accelerate our momentum already this year.
We remain very confident regarding the growth potential ahead of us in the second-largest market. Page 12 shows the performance by business segments. As you can see, upper extremities is still the largest product segment for Medartis, which will change specifically in the U.S. after the acquisition of NSI. We've grown at similar growth rates for upper and lower extremities across all countries. In hand and wrist, we've clearly gained market share, especially in Europe. KeriMedical products were systematically leveraged for our German, Austrian, and recently also the U.K. franchise. Our newly introduced clavicular system is also making good progress in various countries. The progress of these products shows that Medartis can even hold high market share by delivering new innovation to our existing customers. Lower extremity growth was slightly behind our expectations in H1.
Reason for this is the ongoing OR restrictions for elective procedures due to capacity shortages in many hospitals. This was specifically tough in Australia, but was also observed in many European countries as well as in the U.S. It affects our lower extremity business more than the upper extremity business, as lower extremities are most driven or more driven by elective procedures. Nevertheless, we remain confident on the growth potential ahead, specifically in the U.S., where we will launch shortly NSI's new innovation. We intend to build systematically momentum in this very sizable market. The other business segment has mathematically grown 44% CER. This also includes the legacy business of NSI, CMF, and our screw business, which is included in this category as well, grew solidly in the reporting years. Nevertheless, also CMF was somewhat affected by hospital capacity restrictions.
In Japan, our MODUS 2 line was successfully introduced throughout the year and has won strong initial market appreciation. With that one, let me move towards page 13. Our reported gross margin was 83.7% in H1 2022, which at the first glance looks unchanged versus prior year. However, this year's margin was temporarily diluted by the initial consolidation of former NSI and also by China exit-related product returns. Excluding these effects, the underlying gross margin improved by circa 60 basis points, mainly through higher product or production efficiency. The country mix impact was negative as countries with specifically high margin, for example, Australia and the U.S., grew below the average. This should revert in the future again. On page 14, you find some information on our OpEx developments. Medartis has established a clear cost management program already during the difficult COVID times.
This program has been maintained until today. On the other hand, we have intentionally continued to invest into markets which during the COVID crisis needed to reduce their customer activity. In Europe and LATAM, this spending has been rewarded with very good growth. In Australia, we're convinced of the recovery to come and therefore didn't slow down spending so far. Some countries, such as Germany, for example, are already very efficient and are delivering rich profitability. Other countries being younger within the Medartis's portfolio, for example, Spain or Japan, have still relatively high OpEx ratios relative to the smaller size. If you exclude the U.S., the aggregate of all of our countries delivers a contribution margin of somewhere around 40%-45% of sales. Almost all of the country costs are related to sales and marketing, training and education. Essential G&A is kept at lowest levels wherever possible.
The U.S. is currently in a specific situation. First, we're expanding the organization to fuel our anticipated growth. This has increased costs for sales management, marketing, and logistics. In addition, our trade spend level is higher as it includes also costs for product development, regulatory quality assurance from the former NSI. For an interim period, the combined cost base is too high on a relative basis versus sales. However, once the absolute sales level rise, we will have implemented some efficiency gains through the combined U.S. organization. Margins are expected to normalize also in the U.S. again. This half of 2022, we additionally had to book some extraordinary costs which are related to the M&A transaction and the technical NSI implementation. These costs are for legal, for financial audits, IT and similar.
We expect that most of these transaction related costs have gone through the P&L now and will not materially increase in the second half of the year anymore. As a result of all these points, our regional costs have increased CHF 11 million year over year. At the same time, and with the exception of R&D, all of the central costs have been kept on the same level or even slightly higher, lower. If one excludes the NSI specific factors and also takes out some China-specific exit costs, our year-on-year OpEx ratio was almost unchanged versus prior year, despite higher absolute spending in all regions. On page 15, you see how the aforementioned gross margin development and the OpEx management came down to an EBITDA level. Our reported EBITDA was CHF 9.9 million for H1.
EBITDA margin as reported was 11.2%, about 600 basis points lower than last year CER. This is in line with our guidance, which we have given earlier this year. As mentioned before, the year-on-year variance can be fully explained by the NSI direct costs as well as the NSI related transaction and integration costs. Like for like, our underlying core margin was 16.3% including and even 17.3% excluding China. The latter is almost the same level as CER as in H1 2021. Now moving to page 16. The aggregated financial result was zero for the first half of the year. We still recorded some FX gains despite FX headwinds, mainly driven by a weaker euro. However, our interest expense has increased in H1 2022 and are expected to further increase for the next few years.
Background for this is the transaction structure of NSI, which includes the so-called contingent liability for future milestone payments. This liability gets discounted and non-cash interest expense go through the financial results. After tax, which this year also included some deferred tax elements, we report a flat net profit for the first half of 2022. Besides the impact on the financial result and tax, the variance versus last year's net profit can be fully explained by the recent NSI acquisition. My final slide is on cash. As you can see on page 17, cash has come down to CHF 33 million at the end of June. The main variance versus 2021 year-end comes from the cash outflow of NSI, of our NSI. We also increased slightly our stake in KeriMedical, of which we hold almost 30% now.
Next to this M&A related cash outflows, we continue to invest in inventory and debts also to hold or even increase our customer delivery promises in times of increasing supply chain challenges. This and the temporary increase of accounts receivable has led to a higher cash outflow from operations. We aim to revert this number to a positive result as from 2023, which together with our existing cash reserves and some existing credit lines, fully backs up the planned growth ahead. With this, let me hand back to Christoph again.
Thank you, Dirk. Let me comment on the outlook for the update on the 2022 priorities and then to the outlook. It's important that our strategy and our key priorities 2022 remain unchanged. We continue to play in a very attractive market that is expected to grow 4-6 percentage points per year, mainly driven by demographics. Medartis still aims and has the ambition to position itself as a CMF and pure extremity play company that differentiates itself through innovation and technology. We're focusing on becoming the innovation leader in key indication, while we also address the regional needs in our solutions and technologies. Investing and continue to invest in the expansion of our sales force and in the training of our sales force to deliver high-quality service to our surgeons. Targeting investments in key markets or investments in key indications with a high potential.
Which leads to the priorities that we have set as innovation, the acceleration and the broadening of our R&D platform, top-line growth, and winning in all our business segments, in all our markets, with the priority on the U.S. market. Third, the cultural journey to build, as we believe, a strong foundation for the mid and long-term success of the company. Some selected highlights and priorities in the second half year. We have started and made some first clinical experiences with the disposable Lapidus Cut Guide that received excellent feedback from the first clinical cases, mainly in regards to accuracy and efficiency as it allows the surgeon to continue with his procedure without any changes. We focus on growing market share on the recently launched products, mainly clavicle, ankle trauma, and also the CCS screws.
I was very pleased also that we have reached now the EU MDR certification, and in the meantime as well, the certification for the newly established UKCA certification as a result of the Brexit in the UK. We are also rapidly expanding our digital CMX platform with the launch now of the autograft and the distal tibia osteotomy indications, and also looking for the beta launch to start in the second half year for the LapiPrep and also the StealthFix. In product development, the collaboration between Basel and Warsaw has already started to yield some synergies. We have spent times together with both teams to consolidate the pipeline, the project roadmap, and I am stunned and very pleased with the number of innovation projects that we are delivering to the market over the next 12-18 months.
The collaboration between Warsaw and also Basel has yielded synergies in terms of leveraging technology competence in indications, and the collaboration drives an innovation funnel, which has been significantly enlarged. During the second half year, we are expecting to continue the beta launch and then going into the full launch of the Lapidus Cut Guide. As I mentioned, the beta launch of the StealthFix, the LapiPrep, and also the CalcShift, which we will gain some first clinical feedback on some of the key technologies that we have been acquiring through the NSI acquisition. On page 22, we have spent quite some time in the initial phase of the integration to bring both organizations, the former Medartis and the former NSI organization together under the leadership of Rod K. Mayer, the former CEO of Nextremity. We had an opportunity to assess the talents that we have in both organizations.
We have appointed new leaders, and we have built capabilities in almost all functions. I must say, during my travels and interaction with both teams, I've been impressed by the talent and also by the motivation that both organizations bring together. For the integration going forward in the U.S., we are focusing on the organization development, commercial activities, and the operational processes. Going from left to right in the organization development, of course, it's the assessment of the people, the talents bringing and onboarding of the new management and the NSI team. We are going to continue to expand our sales network. We have built some additional capabilities, especially in the marketing and in the commercial activities. In 2023, the focus will shift slightly towards an improvement of the cost efficiency of the North American organization.
We'll further improve the sales execution, sales force productivity, and accelerate and continue to accelerate the innovation process to faster deliver innovation in our innovation funnel to the market. The commercial activities, Lapidus Cut Guide is in the preparation for full launch. We have also received FDA clearance on the KeriFlex. That's one of the joint prosthesis in the finger for the finger joints that is now also approved for marketing in the U.S. This launch is planned for the fourth quarter of this year. We are also expanding and focusing on expanding our contracts, especially with larger healthcare institutions across the U.S. market. In 2023, we will be fully dedicated and focused on the launch of the foot and ankle product pipeline, as I mentioned before.
We have invested and will continue to invest and leverage the training and education of our sales reps and our surgeons, mainly focusing on fellowship centers and align the education and professional education activities with IBRA. In the operations and process, we continue to work on the integration, especially IT, the ERP system, bringing together the regulatory and quality processes and dock on NSI to the Medartis supply chain network, which are important prerequisites for the launch of the products in beginning of 2023. The ERP integration in 2023 of manufacturing will basically be an integration of the third-party manufacturer, Lakeland. We'll also design the know-how transfer or start the design transfer for the local production of domestic plate and screw production earliest in 2024 in Warsaw. On the next slide, you can find an overview of the U.S. market opportunity, which accounts for about $5 billion.
The total market that we're playing in amounts to about $11 million. On the left-hand side, the breakdown in the U.S. upper extremity market accounts for about $3.7 billion market. The shoulder part includes also the shoulder arthroplasty, which is the biggest part of the upper extremity market in the U.S. Our focus will be to continue to gain share, especially in the hand and wrist, but also in the elbow segment, where we have a competitive, complete portfolio, where our focus will be to continue to build the sales and expand our sales network and increase our training and education activities in order to drive the market share gain in the upper extremities. The lower extremity market accounts for about $2.2 billion.
Our focus in the lower extremity addressing this market will continue to build sales force, launching the new NSI technologies to complete our lower extremities portfolio, focusing on key indications like fracture fixation, hallux valgus, bunion, flat foot, and over time, also Charcot. I have spoken about my confidence of accelerating and regaining the sales momentum in the U.S. I would like to comment on why and where I built my confidence on. First of all, I'm impressed by the leadership team that has taken over. They have assessed the roles and responsibilities, and we have also done an assessment of the leadership across the organization, also addressing underperforming and strengthening our commercial capabilities. Rod has clearly shifted the focus and sharpens the focus on sales execution. By reviewing the performance of the independent sales network, we have made some changes in the independent sales network.
We have partially aligned but also continue to onboard new, fully dedicated independent agents in order to continue to build our network of sales independent agents. We have also started to focus on the sales productivity and search and conversion. The team has clearly sharpened their target list for search and conversion, given, led by the priority indications that we have. We also have made large investments in the rollout of additional sets, which we expect to be delivering and supporting the growth and acceleration in the second half year of this year. When we look at all the leading KPIs, I think Rod and the team are working on the right levels. They're all pointing in the right direction.
This is the foundation of my conviction that we will see acceleration to our expectation in the second half year in the U.S. market. Talk about the culture journey. We have now rolled out our modified values which state that everyone counts, that we embrace a collaborative and inclusive environment. Want to foster an eager to learn environment by learning not only from experience and from each other, but also learning in bringing new capabilities into the organization. Excellence in our DNA in terms of technology and high quality solution. Speed and agility, what we wanna remain, that we can adapt flexibly to the environment and that we keep a high sense of urgency. The fifth value is make it happen, living a can-do attitude, maintaining our entrepreneurial spirit as we grow the company.
Those are the five values that we build the entire culture journey on it, where we have rolled out and started to have the same terminology, what and how do we understand our values, how do we live our values. We have started to roll out tools supporting learning, giving feedback, and also coaching. We'll incorporate all those values also all the way from the hiring, the onboarding of employees, of the development of employees, during the time at Medartis. We will also link it to the performance management so that we have a building that we build a strong growth mindset and a high performance culture within Medartis. This is what we believe is the basis for our mid to long-term success. The outlook in 2022.
We have slightly modified and changed our outlook, which is basically due to the gaps that we have seen in the U.S. market and the Australian markets due to COVID. Given the economic environment, we feel that despite the acceleration that we expect in the second half year, we'll reach the run rates that we have planned for this year. We believe that we may not be able to compensate the gap that we have experienced now during the first half. This is the reason why we have slightly adjusted our guidance for a full-year sales growth at constant exchange rate in the high teens range. We plan to optimize and adapt our cost structure to the reduced top line, and the lower sales level will impact reported and underlying EBITDA margin by about 1-2 percentage points.
In the medium to long term, we still believe and hold up to our plans that we have communicated earlier in terms of growth and also profitability. With that, I would conclude my presentation, and I would suggest we open it up for Q&A.
Yes. Thank you, Christoph. Thank you, Dirk. This concludes the presentation part. As customary, we'll now first answer the question from the webcast line and then transition to the telephone line. If you want to anonymously ask a question, please use the Q&A field in the lower right corner of the webcast. Operator, or because we established the webcast, let me read off the first question myself. Sandra Dietschy from Vontobel has asked the question: The full year revenue growth implies a slowdown as we bring down the guidance from 20% to 17%-19%, the high teens. While at the same time, and Christoph elaborated on that, we see a positive momentum in the US coming through in the second half of the year. What are the underlying assumptions?
Do you want me to take up this question?
Yeah, please. Yeah.
Sandra, thanks very much for the question. It's Dirk here. I think you should distinguish between absolute and relative here. Absolute sales, we are planning for same or even higher run rates for the second half of the year, so we're increasing. Relative sales, please keep in mind that the second half of last year was a much stronger comparison basis in many countries, especially in Europe, but also Latin America, than the first half of the year. Especially, you know, for Europe and for Latin America, remember we had a situation in H1 last year where it was very affected by COVID, and then that normalized towards the second half of the year. Which means technically speaking, and on CER terms, year-and-year percentage points, the growth from a comparison basis comes slightly lower. This is the explanation for it.
It's due to Europe, it's to Latin. On the flip side, we see upsides from the U..S, Christoph has talked about it, where we think that run rates will increase significantly and we also do have a little bit of upside potential from Australia because that was already affected in the second half of the year, last year. I hope that explains the question.
Thank you, Dirk. The next question comes from Dylan Van Haaften from Bryan Garnier. Actually has two questions, so let me start off with the first one. That's, there's a technical part to it and a business-related part, which I would like to address with Christoph. On the CMF business, on our craniomaxillofacial business, is it right to assume that there is an elective backlog through the COVID phase, and as we enter the more normalization phase, will that stimulate the growth in the future period? Then, Dylan, for the related question to this particular half year, the first six months of the year, you should bear in mind that the growth rate actually was also driven by, because the line is called CMF and others, and we book the CHF 1.5 million contribution from NSI into that line.
On a reported basis, at constant exchange rate, growth was 44%. On an organic basis, or excluding NSI, it was 28%, but still above the group level. Christoph, what do you see in the business for CMF?
Well, I take the CMF part. It's true that we have certainly last year seen that CMF was almost the business unit most affected by the elective procedure. Therefore, the comparable basis is certainly a smaller one. There is some pent-up demand on the lower basis that drives the growth this year in CMF. What I would also like to mention CMF is we are now in the rollout phase of MODUS 2, which drives growth in the markets where we had started last year, which is mainly the DACH markets. In addition, we have also started with CMF in Japan with a new distributor, which also adds to the growth. Overall, it's a combination of pent-up, but also entering into new markets and the launch of MODUS 2.
Thank you, Christoph. The first question from Dylan is related to also the momentum and the phasing throughout the year. So if you look at the growth trends and the adjustment growth outlook that we communicated this morning, can you read into this that we have seen some weakening in the exit rates in June, July? Dirk, Christoph, who wants to answer the question?
I can answer very shortly. No. We're not seeing any softening in June, July. I would even say the opposite, that the first signals which we get out of the U.S., now, you know, in the late summer are positive. That makes us confident.
Okay. Maybe Christoph, do you think that the COVID stuff related shortening or the backlogs that we have, or you know, the lack of personnel in ORs, is that gonna last? What's been in your assumption for the guidance?
Unfortunately, I'm afraid COVID is gonna remain, and we will see personnel shortages in the OR going forward. We have built and we expect actually that Australia now comes out of the more restrictive environment so that more and more electives will be done as well. I think that's certainly the upside. I think going forward, we will see postponements or cancellations of ORs due to the staff restrictions, but maybe also due to patients being sick. I think there will be continuation of the situation as it is.
Thank you, Christoph. Just looking through the Q&A line, there are no more questions from the internet. Maybe Chorus Call, can you remind people how to ask a question through the telephone line?
Sure. As a reminder, if you wish to register for a question on the telephone, you may press star and one.
We understand this is a very busy day. There's several companies reporting at the same day, even some at the same time. We'll wait for another few seconds and see if there's any other question coming through. Otherwise, we will. Yes, there's another question from. Yes. Good morning or good afternoon, also Daniel Jelovcan from the Zürcher Kantonalbank (ZKB), yeah. I'm reading off his question. Could you give an update on the number of the sales rep hired in the U.S. in 2022, so in the first six months of the year?
I think as we shared in the full year presentation of last year back in March, we had reached a sales force in the strength of about 160 sales reps in the U.S. The goal or the plan is to slightly continue to expand it towards roughly 200-220 by year-end. So far, we are on track. We continue to train sales reps, and we are continuing to onboard new independent agents, but we are on track on our plan.
Okay. Thank you, Christoph. Maybe the next question for Dirk. How much does China represent in your APAC segment? How much revenue do we generate in China?
We have never been so precise on countries. I can tell you that it's a low single-digit million CHF sales number for China, which came out even. A negative sales year. Also on the P&L, it's a small number. It's about CHF 1 million which we have.
Okay. Not very substantial. The next question also from Daniel Jelovcan. He would like to know how important, how relevant, how substantial these three NSI products that coming on the market already in 2022 will be for revenues and in general, I guess? Christoph Brönnimann.
Well, I mean, those technologies that we bought from NSI are strategically important, especially as they help us to build our portfolio in the lower extremities on key indications like Lapidus, hallux valgus. I think that is certainly one of the key indications that we need to continue to build our portfolio, which is the Lapidus Cut Guide, LapiPrep, also the StealthFix, can be used in the Lapidus. It gives the surgeon an option to use a fixation which is either through screws only, screws and plate, or an intraosseous compression device as the StealthFix. That basically broadens our portfolio in the fixation, giving the surgeons the options to choose whatever the best fixation option will be for his patients. Therefore, I think it is important technologies to give more options to our surgeons.
Good. Perfect. Then the fourth question, and then we have one question from the telephone line, is also from Eduard. A very good question, by the way, from all participants. Should we expect Medartis to raise additional financing in 2022? So still this year. Or I guess that's a question for Dirk. For example, a bond.
Well, you shouldn't expect it. We do not have any concrete plan to do it. Opportunistically, we're always looking at, you know, how the market is and whether there are some opportunities for us. Also, I would like to stress out that we don't need any financing for operations. We have existing cash, we have credit lines, so that makes us very confident also with the expected cash flow which comes from operations. Where we, if we want to do M&A, for example, then this could become a topic again. Currently, that's not really the focus for us because we're currently absolutely focuses on making NSI happen, the integration. We need more manpower and really resources and management and processes and all of these things rather than money.
With respect to that, other than M&A, I do not have any need for additional financing at this point of time.
Okay, thank you, Dirk. That was crystal clear. Now, Chorus Call. Can we have the first question from the telephone line, please?
The first question from the telephone line comes from the line of Carla Bentele with Van Lanschot Kempen. Please go ahead, madam.
Hello, and thanks for taking the question. Just on the U.S. again, I would be interested to know which month was the low point in the U.S. now in H1, and also to get a bit the feeling of the growth rate in the U.S. in July? Just that we can put a bit into perspective that we are so positive from this second half recovery and maybe then also on this whole management change. Did you also lose some key sales people apart from the leader, the past leader? Just to get a bit better feeling of what's going on there. Thanks.
Thank you, Carla, for the question. If I repeat, summarize what was the trough month? How was July? And did you lose some sales rep in that transition?
Okay. For Bentele, thank you.
The July growth rate in U.S., please?
July, I mean, it's very early in the year, but I can assure you we see an acceleration in July.
Okay. Thank you.
Thank you, Christoph. Any follow-up question from Carla or anybody else? We wait a few more minutes before then we terminate the call otherwise.
Once again, if you have a question, please press star and one.
Thank you. There are no more question, Chorus Call. Is that correct?
Correct. There are no more questions on the telephone.
Perfect. We don't want to keep you away from your other work unnecessarily. I'll pass back to Christoph for his closing remarks.
Let me thank you for your engagement, the excellent questions, and your interest in Medartis. Before we close this webcast, let me draw your attention to our calendar on slide 31. We hope to meet as many of you as possible in person during the roadshow or one of the listed conferences. For now, thank you very much for your interest, and I wish you all a pleasant and good day. Thank you very much and goodbye.