Hello, everyone. My name is Yong Li, one of the MedTech analysts on the U.S. team. Welcome to day two of the Jefferies London Healthcare Conference. Really pleased to be hosting Enovis so closer to me, we have Matt Trerotola, CEO and Chair of the Board. And next to him, we have Ben Berry, CFO. Gentlemen, welcome to our conference, and thanks for coming.
Thanks for having us.
Thanks. Good to be here, you.
All right, so I guess, you know, since we have more of an international audience that might not be as familiar with Enovis, why don't we start a little bit high level, talk a little bit about, you know, where Enovis came from, how it's positioned today, and, you know, where it's going in the next few years.
Yeah, sure. So our company actually was founded by the Rales Brothers, who founded the enormously successful Danaher Corporation, a little before that. We were a diversified industrial for many years. Over the last handful of years, have really transformed into a focused MedTech player. We, you know, we've always really focused on compounding value through continuous improvement, you know, growth, margin expansion, acquisitions that compound value. You know, we divested our industrial businesses, acquired DJO, orthopedics leader in the MedTech space. Then we actually went through a separation a couple of years ago where we spun out our last industrial business, ESAB. So we were renamed Enovis a couple of years ago.
And now we're about $2 billion, about evenly balanced, between about $1 billion of recon business, reconstructive surgery business, in the orthopedic space, and about $1 billion of what we call P&R, prevention and recovery, which is leading positions in things like bracing and rehabilitation. And so that's the $2 billion portfolio that we have today, focused on growing that portfolio, high single digits organically, doing bolt-on acquisitions that advance our strategy, accelerate that growth, and driving the margins up step by step, over time to grow the business.
Okay. Great. Thanks for that. I guess from a financial perspective, at a high level, should we be thinking of Enovis as an organic, high single digit top line grower with 50 plus basis points of EBITDA margin expansion? And maybe can you deconstruct that a little bit for the ortho business and the P&R business?
Yeah, sure. So, yeah, our strategic goals are high single digit organic growth, really driven through innovation. Our you know, our weighted average market growth rate is you know, is probably more in the kind of 4%-5% range with the recon side higher and the P&R side a little lower. So focus on high single digit is to outgrow our markets through the innovation that we bring and the commercial excellence that our teams bring. Then to drive at least 50 basis points a year of margin expansion. We're around about 18% in our guide for the year. We see clear path to well into the 20s over time. That organic growth and margin expansion are the you know, the strategic premises.
To get to that high single digits, we've been growing our recon business historically, double digits, consistently. The P&R business typically grows in the 3%-4% range. We've now expanded the recon business a lot with some acquisitions, including a big one we closed this year. So, you know, we now see that recon business as a, you know, high single- to double-digit grower, depending on, you know, kind of where the markets are in any given year. PNR is still a healthy 3%-4% grower. That's how we get to high singles for the company.
Okay. Great. So, you know, you mentioned, Enovis has, you know, some Danaher DNA of growth through acquisitions. You know, you made 20 plus deals over the past three to four years. The Lima deal from late last year was the biggest in the standalone company's history. You know, how has the integration been going versus your initial plans? You know, what's going better or faster than expected? What were some of the key learnings from doing a deal of this type?
Yeah, thanks, so first, you know, we're very much focused on strategy as to what drives what acquisitions we do and how we do them, and really things that are going to accelerate the strategies of our businesses and or, you know, shape our company in a positive direction, and Lima is one of these. We had started to globalize our recon business, saw Lima as a tremendous opportunity to further globalize the business, bring some great technologies into the company as well that are complementary to the ones that we have, and so really a transformational deal for our recon segment. The deal's going very well. We closed the beginning of this year. We're tracking at or above all the goals that we had.
You know, we talked about having $10 to 15 million of cost savings this year. We're expecting to be at least at the upper end. We talked about getting to $40 million plus over time, and we still feel very comfortable with that. We talked about maximum $20 to 30 million of breakage in the integration. So about kind of one year of Lima growth would be, you know, kind of a growth drag during the integration. We're still comfortably within that, you know, more probably the lower half of that in terms of, you know, what some of the channel integrations have resulted in. Very happy with how the deal is going, outperforming our metrics there.
We've got, you know, some of the, you know, tougher parts of the integration behind us, in terms of putting the channels together. And so we expect to step into next year, you know, leaving behind some of the more revenue risks and things like that, continuing to get after the cost synergies, continuing to get after cross-selling synergies, and, you know, really accelerating our recon business, you know, back up well above market rates as you've started to see last quarter, and excited about next year and beyond for that business. You know, Lima was, again, maybe the 20th or 21st, as you said, and the biggest by far. But, you know, those acquisitions we've done over the last four or five years have really transformed our portfolio.
We were a little over a billion-dollar business that was over 70% P&R and 30% Recon and mostly U.S.-based, and now, you know, we've reshaped our company into a $2 billion-plus company, about 50/50, as I said, much more global, and in addition to globalizing Recon, we built a whole $100 million-plus foot and ankle business that grows very, very fast there, and we also did some nice smaller deals that shaped the growth rate of P&R in a positive direction.
Okay. Excellent. Yeah, I mean, it was so much focus on the Lima acquisition, Lima integration this year. You know, now that you did a lot of the heavy lifting, I guess the follow-up is, you know, what does that mean for 2025?
Yeah, we're excited about 2025. You know, this was an important year in terms of doing the integration well, and we continue to move the ball forward in all of our businesses this year. As we turn into 2025, we'll leave behind some of the integration dis-synergies. I'd also say, I think, you know, the orthopedics markets have been okay this year, but maybe a little bit below normal, and we expect as we step into next year, we'll be in a normal and healthy orthopedic market environment. We're certainly seeing a nice trajectory to the finish of the year in terms of how the markets are playing out, and we're encouraged about what that says about our markets for next year. We feel like we're in great shape in terms of execution and building momentum into next year.
And so, we should accelerate nicely from this year into next year and continue to, you know, climb up that margin expansion curve.
Okay. And then I guess if you were to, you know, strip out Lima or not focus on it as much, how has the rest of the business been performing this year, just given there's so much focus on Lima?
Yeah, I think it's been a good year. Now, obviously, you know, we grew 8% last year, and we're, you know, a little over 5% this year, with, you know, 1% or so drag from the acquisition. So, you know, you compare the 8% last year to maybe 6% underlying this year. And, you know, definitely last year was a healthier market environment. You know, some extra tailwind in the market this year, as I said, maybe a little bit of headwind. And so, you know, we feel like each of those are sort of, you know, high single digit sort of underlying performance in a normal market. And so, we're excited about what the other businesses are doing.
We've had some really important product launches across both in recon and PNR that are helping this year some, but we really expect to have even more impact from those next year. And so, looking forward to finishing up the year strong here and stepping into next year with really good momentum.
Okay. And then, you know, your leverage, it's in the, you know, high threes. Thoughts on when you are more comfortable going back and doing some deals, the size of them, target end markets?
Yeah, I think our focus right now is to make sure that we're finishing the integration of Lima well, in terms of keeping the organization focused. I think from a M&A deal activity standpoint, we have a robust funnel that we're constantly evaluating. I think from a smaller bolt-on opportunity, there are plenty of opportunities for us to be able to execute without putting ourselves in a leverage position that is too uncomfortable. In terms of leverage targets, I get this question a lot. I think our view is that we are going to continue to run our offense, which is M&A connected to strategy.
And I think our view would be we don't want to live over four times leverage for any given period of time. I think we need a clear path to deleverage, you know, quickly, but we're comfortable, you know, levering up to be able to do the right deal as long as it's connected to our strategy of helping support sustainable high single digit growth with gross margin expansion capability as well. So overall, I think you'll still see us be active, maybe smaller in the near term, given the fact that we're really focused on making sure that the integration is behind us from a Lima standpoint. And then we'll open the aperture a little bit more as we get into 2025 and beyond as we look at continuing to strengthen and shape the company towards our strategic goals.
Okay. I guess maybe pivoting a little bit, wanted to talk about products a little bit more, so you know, at a high level, what are some of the key unique differentiated products within the Enovis portfolio that's enabling above market growth or elevated market shares?
Yeah. So in Recon, we've got our AltiVate Shoulder, has been a pioneer, really, pioneered the reverse shoulder and the lateralized and inferiorized design, which has really proven to be the shoulder that creates the best range of motion for patients. And so, we've been able to take a lot of share over time with our AltiVate Shoulder and the various different variations that we've brought out over time and expect to be able to continue to.
We've now complemented that with a lot of great other offerings in shoulder, some really good anatomics that came in through Mathys, an acquisition we did three or four years ago, something called the SMR, which is a convertible that came in with Lima, and something called ProMade, which is a custom implant for very difficult revisions, not just for shoulder, but for all anatomies, and so we definitely feel very good about those, that kind of advantage product line and shoulder that'll help us to continue to take share in shoulder. You know, in knee, we've had something, our EMPOWR 3D Knee is a knee that is a dual pivot knee that really feels more like your normal knee.
It's something that has created really high patient satisfaction, and that surgeons really appreciate when they put it into their patients. So again, we've taken quite a bit of share over time. It's, you know, a knee that sets up better to the normal kinematics of the body. That's something that surgeons are getting more and more interested in, really serving, you know, keeping the body as kinematically normal as possible. So that EMPOWR knee has been terrific. We also have, you know, moved into revision in a pretty heavy way, again, both through our own product launches and through some of the products that came from Lima. So getting to participate and gain share in that revision space, as well, which is an attractive part of the knee market.
Foot and ankle, I talked about, we've been growing well above market. We've got a number of terrific products there. One of them are flagships, our DynaNail. It's just a terrific product that uses Nitinol alloy. It stretches it like a rubber band and then releases it once the nail is put into the patient. It creates a constant, positive pressure to create better fusing of the bone, you know, better patient outcomes. We've taken a lot of, you know, converted a lot of surgeons to that product over time alongside a number of other great products we've got in the foot and ankle space. So, a lot of great things have driven that above market growth in Recon, and we're confident can continue to.
All right, great. I guess, you know, sort of a higher level question. I mean, the hip and knees market, it's somewhat mature. It has four much larger competitors. You know, where does Enovis fit within the large joints market? You know, are there unique characteristics for your hip and knee surgeon customers? You know, you mentioned all the product differentiation, but, you know, is that the key to sustaining the multiples of market growth rate going forward?
Yeah. So we're around about a three-share player in hip and knee globally, two or three in the US, and I think that's a nice. It's a huge market, right? So that's a nice position to be, and I think it's about $20 billion of the global hip and knee market, and so we've got a nice position in that, you know, we are big enough now to have a pretty full and powerful product range and have a strong channel position. But at the same time, we don't have to take a whole lot of share every year to grow that business multiple times market growth rate. And that's what we've been doing over time. Our and our knee line has been very strong, and then our hip line is now getting stronger.
We brought some good, good technologies in with the acquisitions we've done. We're also about to launch a couple of additional hip technologies that are going to put our hip into a strong place as well. So a lot of room to go as a three-share player. You know, we gain a, say, a quarter of a point a share a year, and we're growing 10%, right? So it's, you know, there's a lot of running room in hip and knee for us, over time, not just in the U.S., but around the world.
Okay. And then I guess on shoulders, I mean, you have outsized market share there. Can you update us on what you share currently? And, you know, there's new products being launched there. Also just a lot more focus on that business from competitors, including with some robotic solutions. How do you feel you stack up versus the competition in shoulders?
Yeah, yeah, we're a leader in shoulder, you know, a leader in terms of market share as well as in terms of the innovations that we've brought to the market over time and that we continue to bring to the market. You know, I think, you know, we're in kind of 10% to 15% share range on a global basis. Number two outside the U.S., number three in the U.S. So, definitely that top tier position. I talked about some of the great innovation we brought over time with our AltiVate Shoulder. You know, more recently we launched an AltiVate Reverse Glenoid. So, our ARG, which is really for, you know, helping, you know, when there's been bone loss, having, you know, different devices that you can use to fill in the bone loss.
And that's something that's creating a nice boost to the business. And we expect it to help us in the coming years as well in shoulder. And, as I said, ProMade is a pretty neat thing that came in with Lima. And they had a whole really approach around personalization, not custom implants, although ProMade is custom for difficult cases. But really more of a sort of a personalized design philosophy, because Lima is a leader in 3D manufacturing and 3D design with metal. They've been able to develop products that have size ranges that are defined based on databases of patients and what would be the right set of size ranges to more personalize the offering, versus kind of standard size ranges.
So we're really excited about the innovation we've been doing in shoulder alongside of that personalization approach that has been really an advantage that Lima has brought. Then finally, you talked about enabling technology. You know, we have had a terrific planning and patient-specific instrumentation capability in our Match Point technology. We've now launched our ARVIS augmented reality guidance technology in the US. We're in initial launch, getting great feedback.
In shoulder, we're convinced that, you know, while planning has been the standard for the last five years or so, navigation is going to become, you know, quite important in the shoulder, as well, as really the core capability for surgeons to be able to use to, you know, do the procedure more and more precisely and, you know, make decisions over time about, you know, where you have navigation. It's pretty easy to hang some automation on the backside of that, but the navigation is the core that you got to get right if you want to have, you know, that kind of next step of enabling tech in shoulder. We're excited to have ARVIS out there in the marketplace, getting some great feedback on it.
You know, we'll be learning and iterating on that to make sure that we remain a strong leader in shoulder.
Okay. And then I guess to follow up on that, so, you know, still early in ARVIS, but what are your expectations for it in 2025? You know, when do you think contribution revenue will be more meaningful for that business?
Yeah. So we launched ARVIS in knee a couple years ago, and it's been, you know, in iterative development there. You know, this year have a couple dozen surgeons using our ARVIS knee, and got a lot of great feedback throughout the whole year, and have a next version coming out the early part of next year. We've also launched a traditional nav alongside of ARVIS in knee. We expect to go from, you know, a few dozen, you know, to say a hundred plus surgeons next year in knee, and then, you know, build and grow from there. You know, shoulders, you know, coming a little bit after knee. We're now in the initial launch phase this year with shoulder, you know, a very limited amount of surgeons.
I'd expect that to then branch out to, again, a few dozen next year as we continue to get good feedback on the product and dial it in to be a tremendous product, and then, you know, grow from there.
So, fortunately, the things we've learned in knee, you know, at least half of them apply, you know, some things are anatomy specific, but some things are more about the technology and, you know, the hardware for the head and, you know, the way that the software works, the way that, you know, the way that the positioning and navigation works and those kinds of things we've been able to kind of iron out on knee and now we'll immediately port them over on shoulder, but then it'll take a couple revs here on the shoulder side to make sure that we get the anatomy specific things in a great place.
Okay. Great. Excellent. So maybe just pivoting a little bit, ASCs, that's been a pretty hot topic and continues to take more and more share and grow more and more. You know, what's your current exposure to ASCs? What are some of the differentiations in the product that you offer for ASCs? And, you know, what do you see as the outlook for that ASC part of the business?
Yeah. So our U.S. business, which is around about half of our recon business, you know, knee is the one that we track the most closest and that you get, you can find kind of the most in industry data about it. And, you know, we are in the sort of 20+% ASC and knee and, you know, the best industry data we can get is that the industry is probably at 10% to 15% or something like that. So we are over indexed to the ASC and that's a positive thing because that's the fastest growing part of the market.
And as we look at other anatomies, we're seeing a similar dynamic play out in terms of kind of our exposure to the ASC expanding, you know, to you know kind of a larger portion than the market. So why is that? Well, you know, we've worked hard over time to have the simpler instrument sets that the ASCs appreciate, you know, given the limited space that they have. In knee, our knee is a knee that sets up well for the more active patient. And that's often the patient that's being selected into the ASC. And we are often in the ASC if they have a rehab clinic or an ortho clinic. We are often there with some of our P&R products. And so they're aware of us.
Also, the contracting is usually kind of new and more flexible in the ASC. And so while the hospital contracts might be a little more concentrated, the ASC, you know, creates a fresh spot, you know, for a fast growing, you know, great service player like us. And so, a lot of reasons that we've gotten to the higher ASC position that we have. And then now as we're bringing enabling tech into the marketplace with ARVIS, we've tried to make sure we're focused on something that is small, space efficient, cost efficient, time efficient, and is really going to fit the needs of that ASC environment, which is a cost sensitive, smaller environment than the inpatient hospital environment. And we're getting really good feedback and reception there. So we've done very well in the ASC.
We've tried to make sure we got the right set of offerings to continue to do well in the ASC, and expect that piece of the market in the US to grow very fast. We're also finding that outside the US, while there's not as much of an ASC type of trend and environment, there's some, but there's really more of a situation there. In many cases, the hospital environments outside the US have less space, less money than the hospitals in the US, and so that cost sensitivity around whatever enabling tech you're going to bring to the market is similar to the ASC environment in the US.
And so we think the things we've been driving strategically to win in that environment in the US, we think are going to help us outside the US in a number of markets as well as we expect to get ARVIS approved outside the US in 2025.
Okay. Great. Yeah, it sounds like there's definitely some synergies between P&R and recon in that segment. Maybe just in the last minute we have, talk a little bit about margins. You know, most of the growth levers are coming, the margin expansion levers are coming from gross margins and SG&A. Maybe for Ben, if you can talk about the areas of focus to expand gross margin and, you know, how it can get more leverage out of SG&A.
Yeah, I think this has been a really positive journey for us over the last few years since we separated and became Enovis in 2022, about a 14% EBITDA margin player. Now if you look at our latest guidance, closer to 18% this year, getting a benefit from bringing in an accretive Lima on top of, you know, being able to execute against the synergies there, is giving us a really nice boost in terms of our margin expansion here in 2024. I think for us, we've built a positive mix of our business that's going to continue to help drive margin expansion just through the growth drivers of our business being more on a higher margin base. On top of that, we continue to scale up acquisitions that we have done over the past that we talked about, a little bit today.
And then, on top of that, there's just leveraging our business system and continuous improvement around productivity and leverage growing high single digits as a company, so overall, we've got plenty of levers to continue to grow our margins. What we've said is at least 50 basis points or more a year, some years more outsized than others, given you know the dynamics at play or the accretion or dilution from deals, but overall, we're on a path to where you know we see 20% plus line of sight here in the near term, and on top of that, we don't think that that's ceiling. We see an opportunity for continuous margin expansion year over year from now into the future.
All right. Great. That's all the time we have. Thank you so much for the.