...Welcome, and thank you for joining the Medacta Full Year 2025 Preliminary Unaudited Revenue Conference Call. As a reminder, all participants are in listen-only mode. After the presentation, there will be an opportunity to ask questions. Should anyone need assistance during the conference call, they may signal an operator by pressing star and zero on their telephone. At this time, I would like to turn the conference over to Mr. Francesco Siccardi, CEO of Medacta. Please go ahead, sir.
Thank you very much, and good afternoon or good morning. Welcome to Medacta Full Year 2025 Preliminary Unaudited Revenue Conference Call and live webcast. The slides of today's presentation can be found on the Medacta Investor Relations website, along with the media release. I would like to remind all participants that the presentation includes forward-looking statements, which are subject to risk and uncertainties. Listeners and readers are therefore encouraged to refer to the disclaimer on Slide 2 of today's presentation. So after the housekeeping remarks, I will now turn to Slide 4 and start with the highlights of today's publication. We are very, very pleased with our continued outstanding growth performance across all geographic markets and business lines against a strong prior year comparable.
The growth of Medacta surpassed 18.5% in constant currency and slightly above EUR 683 million reported. The key drivers of our growth remain the same. Very strong focus on differentiating innovative product pushed into the market and sustained by very personalized and effective medical education, and constantly expanding our team, both in the markets and in our headquarters. Last year, we hired 258 new employees net. If we move to Slide 5, we could see how the performance of 2025 has been even stronger than the group revenue CAGR, which was 17.4% between 2021 and 2025.
This performance represents very good growth, basically 4.3 x the market growth. So very, very pleased with this overall performance. As I mentioned, the key pillars are extremely relevant for our forward-looking performance, and we continue to focus on differentiating innovation, education, and personalized training of surgeons and team expansion, and this is true across all our portfolio. On Slide 7, you can see the geographical mix growth. The European market, EMEA, grew above 15%, North America around 19%, 23% in Asia Pacific, and over 42% in Latin America. All those growth rates are in constant currency. The geographic mix remains pretty much stable.
48% of our revenues are generated in EMEA, 30% in North America, 20% in Asia Pacific, and 2% in Latin America. If we now look at the business line performance, once again, we have we're very pleased with the overall performance across the business line. Almost 12% growth in constant currency for our hip portfolio, over 20% for our knee, over 46% for our extremities, and over 12% for spine. 2025 has been the very first year where Medacta knee sales surpassed hip sales. So in terms of mix, we have 42% of our revenues associated with knees, 40% with hips, 10% with extremities, and 8% with spine.
On Slide number 9, we can see a little bit more in detail the strategy behind our hip growth. It remains anchored in our AMIS experience. It is anterior minimally invasive surgery. It is definitely a procedure that continues to drive growth in the market, and we have seen especially an outstanding growth in Asia Pacific and North America, with almost 3x market growth in 2025. On Slide number 10, we can see the same analysis on the knee. Over 20% year-over-year growth, and this is linked to our strong focus on kinematic alignment and the introduction of the GMK SpheriKA, the first and only KA-optimized implant so far.
We have seen a very, very strong performance in North America and in EMEA, closely followed by Asia Pacific, and this growth represents 4.6 x the market. So very, very good performance on the knee side as well. In spine, we did grow at over 12% year-over-year. We have been focusing our strategy on technologies. So selling our hardware, our screws, our cages, really by using technology as a key driver for our market penetration. NextAR, NextAR Rod Optimizer, MySpine, all those are key elements behind our growth in spine. And this growth, again, represents 3.5 x the market growth. So it's, again, a very, very good performance.
Last segment of our business is extremities. We had a very strong acceleration compared to the CAGR of last year. This has been impacted as well by the acquisition of Parcus, which has been closed this year. It does contribute only in this subcategory. 46% year-over-year growth. Medacta Shoulder System is definitely a key element of this segment, and a combination of our implants with our technology, NextAR again and MyShoulder, are key pillar of our strategy. The sports medicine portfolio strengthened a lot with the acquisition of Parcus, and both segments recorded sales more than 3x the market growth in 2025.
The outlook, we put it here just to remind, for those that are not familiar with the 2025 outlook, we had a 16%-18% in constant currency. We are very happy to end up the year slightly above our outlook. And as usual, we will communicate future outlook in March, together with full year results of 2025. The key messages for this call are very clear, and we've been able to continue to grow above market for 2025, with a revenue growth of 18.5% in constant currency. And this result, again, is driven by the three main pillar of our growth: differentiating products that improve patient outcomes and healthcare sustainability.
Those products are supported by medical education and personalized training of surgeons, and we continue to penetrate the market by further expanding our sales rep and the team. Our aim continue to be the same, so to continue to outgrow the market for the years to come. Before opening the floor to Q&A, I would like always to thank our employees, our customers, our suppliers, and partners worldwide that sustained this outstanding performance and tremendous growth. Thank you very much. Thanks.
This is the Chorus Call conference operator. We will now begin the question and answer session. Anyone who wishes to ask a question may press Star and One on their touchtone telephone. To remove yourself from the question queue, please press Star and Two. Please pick up the receiver when asking questions. Anyone who has a question may press Star and One at this time. First question is from Sam England, Berenberg.
Hi, guys. Can you talk a bit about the ex-U.S. rollout of GMK SpheriKA and how traction is looking with surgeons there? I'm interested to know if interest in Kinematic Alignment as a technique is the same as it has been in the U.S. and whether the surgeons funnel is evolving in a similar way to the U.S. And then the second one, just around the hip business, can you talk a bit about the drivers of the continued elevated growth there, why you think growth continues to be above the market? And whether we should expect similar dynamics in 2026. And then also on hip, if there's anything in the innovation pipeline there that you think can sustain that above-market growth beyond 2026 as well. Thanks.
Yes. Thank you, Sam, for the question. Concerning SpheriKA and KA, which are very much linked, we do see tremendous interest on a global scale, in the U.S., of course, but actually was even stronger in Europe. So despite the fact that KA has been invented by a U.S. surgeon, it did really gain more traction at first in Europe, then it's coming back to the U.S. Australia and Japan are extremely focused on that technique and that philosophy. So I would really consider KA and SpheriKA a global trend, and we are starting to see some of our emerging markets showing a lot of interest. India, for example, where we are starting... We are about to start. We see a lot of potential there.
On the hip side, there are several effects. I would say number one, there is a pull-through effect that the knee does to the hip. We experienced exactly the same effect back in the years when we were leading with anterior approach and AMIS. Many customers, then they were following on the knee side. Now, our sales force, which is the same sales force and very often the same customer for hip and knee, they are leading with a Kinematic Alignment and SpheriKA. The hip portfolio is very robust. There is quite a lot of innovation, the Triple Taper Stem, NextAR Hip, which has been just approved in the U.S. and Australia.
So the pipeline is robust, is rich, and there is a very nice pull-through effect, driven by the sales force and by the surgeons accepting our our products in one or the other portfolio. Anterior approach remains a key driver. There are still markets where anterior approach is definitely under-penetrated, and I think Medacta is very well known to be very very strong player when it comes to anterior approach with medical education, with a package of implants and instruments and services, very well trained and focused sales force. Medical education is second to none. So those are the key drivers behind our hip sustained growth as well.
Great. Thanks very much.
Thank you.
Next question is from Edward Hall, Stifel.
Good afternoon. Thank you for taking my questions. I have a couple here. Actually, back on the large joint and hip and knee, I was wondering if you could sort of drum into the drivers of growth when we're talking about the, the surgeons. We're thinking about the incremental surgeons being recruited versus continued support from your, let's say, your current base that are already adopted. That'd be my first question. And then just on U.S. and penetration into the ASCs versus the broader market, I'd be curious to hear your thoughts here, and how your P&L is positioned, and then what you see the outlook of the ASC versus the rest of the market in the midterm. Thanks very much.
Yes, thank you. Thank you, Edward. So the reason when we come- when we talk about growth, new surgeons versus existing surgeons growing, we always create or divide our growth, our budgets into two buckets: the new surgeons and the surgeons that are started the previous year, and they're ramping up. In 2025, of course, we had both those effects, but the new surgeons are contributing more, if you want, to the following year, and the carryover is what contributes the most to the 2025 year. This is the case as well, probably for 2026.
So in 2025, we've seen a very strong adoption and ramp-up of new surgeons, but the largest contribution is always coming by the one that started in 2024. But this is a cycle, and we are very keen in keeping our buckets of new surgeons full. The pipeline is very full, and we're very pleased with the interest that we see in the market when it comes to hip and knees and knees in particular. If we talk about the U.S., ASC versus hospital-based business.
Our products are particularly well suited for the ASC market because we have developed those products basically starting from Europe, where the healthcare system is definitely more under pressure when it comes to efficiency, to pricing, et cetera. And we naturally see a lot of success in the ASC, but I would say that the reason why our ASC penetration is faster and higher than a hospital is basically access. So the surgeons that are convinced to use our product, they very often work both in an ASC and in a hospital.
In an ASC, they decided to try our product, and the process to enter the ASC is significantly shorter than the process to enter into a hospital, which is mainly driven by maybe contract negotiation, reduced vendors numbers, making trials, and so the bureaucracy is much, much stronger. But, we see a good penetration in hospital as well, both with our efficient solution, with our technologies. I mean, our offering is working extremely well on both ends, and we think we can continue to enter into both segments of the market in the future.
Yeah, and maybe just one follow-up would just be on the... you talk about expansion of sales reps and teams. What would that look like in terms of headcounts, or SG&A growth?
Yeah, we always say that if you take the number of new employees that we share with the market, let's say a rough calculation is 50% is in the country, and 50 is in the headquarters. And this gives you a rough idea, although, as you probably know, in the U.S., we do have a hybrid sales force, so there are both direct and agents, and so a portion of our market penetration is not visible in the headcount expansion because it's simply achieved through new agents. So that's an important additional information that you should consider.
That's really fair. Thank you very much, and congrats on the print.
Next question is from Sandra Dietschy, Octavian.
Yes, good afternoon, and thank you for taking my questions. I also have two. The first is on the single-use instruments in the—which appear to be a clear differentiator, and I assume they're also an important growth driver for the knee segment. Now, could you share your perspective on the current adoption levels of these single-use instruments, and also how significant you expect them to be in driving the knee growth going forward? And then my second question is on the spine business. My understanding is that the spine business is currently transitioning in the U.S. from an agent-based model to a direct sales force. To what extent did this transition contribute to the deceleration we have seen in growth in the second half of last year? And how is the transition progressing these days?
And then, of course, I would be keen to hear what level of profitability or place we should expect once the transition is complete? Thank you.
Thank you, Sandra. So I will start with the single-use instruments. It is a very unique offering in the market. Despite the fact we've been developing this product almost 10 years ago, we have been refining it quite a lot. The knee is growing fast. The share of single use is following quite a bit. Around 25% of our knees are today implanted with efficiency, which means it's growing at a high pace as well. Our goal is to further increase the utilization of single use because we see quite a lot of value for customers, for the ASCs, for the company as well. We gain flexibility in delivering instruments to the market which are not always forecasted. So we...
Under a supply chain point of view, it's a very nice tool to have. As I said before, it's very unique. It works extremely well, even when coupled with technology, because only few instruments are then required, so the surgeons, they see even more value there. So we're very pleased, and we continue to expect further expansion and utilization, and we are constantly fine-tuning and improving those instruments because there are really a lot of surgeons using it. On the spine side, what you have mentioned about going from agent to direct, I think we need to give a little bit of additional color here.
So this is happening in the US and in the US only, because in the other markets, we are already only direct. It is a transition that we experienced as well on the joint side. When we started, we were 100% through agents, and now we have this hybrid configuration. The spine was exactly the same. We were 100% through agents. And now, by refocusing on the technology, we are not abandoning our indirect channels, especially the good agents that we are working with, and we want to continue to collaborate with. But we are focusing our expansion more using technology, which has to be well supported by the company. And if we do so, we want to go direct in those accounts. And by doing that, we have more control.
We can probably better focus our or increase our revenue per case, which is very important in spine, because often agents they have more than one company in spine, while if it is a Medacta employee, we can try to focus as much as possible on Medacta products only. And then if we drive technologies, we can we can really differentiate ourselves. And last but not least, we can definitely decrease the cost of sales, which in spine they can be as high as 40% of commissions, which is something many of the small and mid-sized companies they pay in order to make sure they get attention and priority for their products. And this is something you have to do when you don't have differentiated products.
While if you focus on technology, you can definitely drive better cost of sales. So this is the reason. I know there are companies that have more than $200 million in revenues in spine in the US, and they don't even break even. As you know, we don't like this philosophy. We want to grow in a profitable way, and this strategy is going into this direction. It might slow down a little bit, for a while, but we are confident because we have seen it on the joint, that in the long term will pay back.
Okay, very clear. Thank you.
Thank you, Sandra.
As a reminder, if you wish to register for a question, please press star and one on your telephone... For any further questions, please press star and one on your telephone. Next question is from Michelle Büchler, ZKB.
Hello. Thank you for taking my questions. Could you provide more details on the expected FX impact for 2026? Are you implementing on hedging some of that? And also you mentioned some new automated warehouse in Italy. Could you see a meaningful impact on the margins anytime soon? And then my last question would be: could you give some more color on the rollout of the GMK in Japan, Canada, and the UK? And what is your strategy for ramping up these markets?
Yeah, if you don't mind, I will start with the last question. The GMK SpheriKA you're referring to has been rolled out in Japan and the UK this year. It's really behind the growth we are seeing in those markets as well. Japan in particular is a market where if you actually think about the Japanese population and their leg alignment, they they're very often in the varus, so this kind of alignment that benefits the most from kinematic alignment, and we see a very, very big traction there. UK, the same. Canada is a small market.
SpheriKA specifically is, I'm not even sure if it is introduced already, but is definitely not something that is going to impact heavily our PNL. Concerning margins expansion effects of hedging, we will go definitely more in details in our next conference call in March, where we will analyze in detail the effects on 2025. There are some actions which have been already implemented in 2025, and some in terms of hedging, but in terms as well of operational activities that will increase the natural hedging to the US dollar. And the last qualitative aspect you touched upon is the new automatic warehouse in Italy, which is not yet up and running.
But we do expect and we do see the potential to definitely go in the right direction of decreasing distribution costs in the southern part of Europe, at least. And again, I would defer additional comments on the marginality and operations to our March call.
Perfect. Thank you so much.
Thank you, Michelle.
Next question is a follow-up from Edward Hall, Stifel.
Hi, guys. Just a couple follow-ups from me. I think one's more qualitative, but just given obviously the outstanding growth you've seen this year, and just contextualizing it with your midterm guidance, is there anything to dictate that we would see a slower rate of growth for this year, or should we see an updated midterm guide? And then just finally on pricing in APAC. I know Australia has been really weak in quite recent years. Has this been impactful or sympathetic to growth in 2025? Thanks.
Yeah, I mean, APAC, and we have seen Australian dollar, the Japanese yen weakening over time. Of course, when you talk about reported numbers, you do see a negative impact. There's a little bit we can do in terms of hedging there as well, but not so much. Overall, those are markets where we still see a lot of room for for growth, a lot of interest for our products, and then the effects we have, we have to deal with it. In terms of midterm guidance, we are going to talk about 2026 and the midterm guidance in in March.
So as you said, as you have seen, we have been performing extremely well, and we had to upgrade our guidance for the last two years in midterm, mid-year. And we will come back to you with updates on the midterm guidance and 2026 guidance in few weeks. So, give us a little bit of time, and we will answer 100% to your questions.
Perfect. Thank you very much.
Next question is a follow-up from Sandra Dietschy, Octavian.
Yes, thank you. Also have a quick follow-up on Latam, where you had a very strong performance of more than 40%. I appreciate that this is coming off from a relatively low base, but could you elaborate on the key drivers behind this performance? In particular, to what extent was the growth driven by geographic expansion within that region?
No, I would say it's primarily driven by further market penetration in the key markets where we are already present. We did add a few smaller markets, but the key markets in Latin America are Brazil and Mexico. And then, of course, you have Argentina, Chile, all the smaller markets. But we are actually mainly, I would say, expanding into those large markets with a marginal contribution from expansion into new geographies. What we are doing as well is introducing new product lines, which were not available into those markets. I'm thinking about the shoulder, I'm thinking about the spine. And very often in those regions, the regulatory path is quite demanding, and ANVISA, which is the regulatory body in Brazil, is one of the toughest.
Once you go through, you have, you have a, really, a, a good market to, to penetrate. And, we use the same strategy, the same products that, we are using in, North America and Europe and Asia Pacific, so those are very well-performing products, with strong strategy. And we are probably entering into segments where other companies are, are, maybe less, focused on, and they tend to sell, maybe slightly more, less innovative products. We don't do that, and, maybe that's the part of our success in those markets. But as you pointed out, we start from a small base, so it's, slightly easier to have those, stellar, growth rate. So next year we will see what, what we can do.
But a small base, high percentages. I always tell my guys that they don't have to get overexcited because the base is small.
Great. Thank you.
Thank you, Sandra.
For any further questions, please press Star and One on your telephone. Mr. Siccardi, there are no more questions registered at this time.
Then, I would like to simply thank everybody for your time today. Once again, I would like to thank our employees for the really fantastic performance of 2025, our clients and customers for their support, and suppliers and partners worldwide that supported our growth. So thank you very much, everybody.