Good morning, everybody. Maybe we can take a seat. You can put down a little bit of volume. We are not so many people. Yeah, again, welcome to now rainy Basel. The sun from yesterday is gone. I'm very happy that you made it to our investor and media event around the FESSH, the world biggest hand congress. I'm so surprised. I love it when Fabian has also here our products on the table. By the way, the Sexy Nail is here. Some people who discussed yesterday night with me, they know about the Sexy Nail. It's our brand-new launch for the U.S. Some are looking, say, "What they are doing? Is this becoming a erotic shop?" No. Medartis is just becoming disruptive, different, and I hope you see this also throughout the FESSH. We have my strategy roadmap a little bit. Where do we stand by end of May? I think very interesting for you at 10:00 round with Marc Ammann, our EVP, Innovation, Digitalization, Research and Development. Marc speaking about our roadmap and the NX Nail. I'm very happy to welcome Dr. Daniel Herren from the Schulthess Klinik in Zurich. He's sitting there. We thought we should invite the pope of CMC1 because you are not only placed, I don't know how many, you will discuss it, you will say it, but you are also the renowned hand surgeon in Switzerland and in the world. We are very happy to have Daniel here to explain to you a little bit what is it about TOUCH. It's all about TOUCH, TOUCH, TOUCH. Wherever we are, we speak about TOUCH, but we will also speak about Medartis and our other group companies today. Daniel will provide us with a voice of the expert, and maybe some of you will become patients. Who knows? It starts with 40 years of age, especially in women, right? You will explain why. We have a Q&A session, very important. Therefore, we put the lunch here so that we have enough time. I think you will have questions. We do a flying buffet here and then off to the FESSH. From head to toe, nothing has changed. This is our strategy, our well-known strategy. In the meantime, literally from head to toe, we start with our legacy. We would like to become, and we see it more and more coming also with market share gains in the U.S., the world market leader in hand and wrist. In upper extremities is our focus, but it means also that lower extremities, foot and ankle, is an area where we are continuing to launch new products. Marc will speak about it. We have new products in the pipeline, AnkleFusion, for example, which will come also in the U.S. It's not an area where we will step out. If we look how big is the market potential in each segment and how big is our addressable market with our portfolio, you can see that we are in upper extremities quite close. Our portfolio in hand, wrist, up to the elbow is complete, is world-class, especially now with TOUCH. What is missing is shoulder. Shoulder, we have some portfolio gaps. It's an addressable market of CHF 1.7 billion. I could not care less that everybody says lower extremity is the fastest-growing segment. If you are in the fastest-growing segment, not present or with a market share below 5%, 6% present, you have no chance to win. What I said already in the beginning of 2025, we are here to win. Just to play in the market, this cannot be our ambition at Medartis. Therefore, we are focusing on our legacy, where we have a lot. If you see our competitors, what is very interesting, you see here that, for example, Stryker, they are stepping out of the CMF business. They are divesting in the CMF business. Of course, with all respect, we have also strong competitors. We have competitors like a German company from Tuttlingen who passed KLS Martin. They did a fantastic job over the last 10 years. They passed Medartis on the left and on the right. We still have opportunities to catch up. The same time they passed with CMF, they lost focus on hand and wrist, and they are now catching up. What we are catching up in CMF, they are catching up also in hand and wrist. Here we have an extremely good portfolio, and I think Daniel can confirm this later. The TOUCH prosthesis, when we speak about hand, is a logical addition. We have also wonderful other products. We are covering everything. We are covering. You know that Medartis comes from Art. Art in our logo was very prominent when Medartis was founded 29 years ago. Why Art? This is something I've learned in my 18 months now with Medartis still being a little bit a dental guy. I'm not yet the orthopedic guy, to be honest. What I've learned is that hand surgeons, in my eyes, with all respect, Daniel, you are artists. You are really doing artwork sometimes to reconstruct the hand. If you have a big trauma case, if you have an accident, the same applies to CMF. This is art. Reconstruction of a face, especially of tumor patients. This is art, and this is bringing back life to the patients. This is wonderful to see, but it's a very filigree part. Also placing a TOUCH is not so easy, so therefore, we have an education-based approach where when it comes to corrections and also when it comes to trauma cases, this is a little bit more tough, rough work when you go to an OR midnight after a car accident. We cover it everywhere within our Medartis Group. We became in 2025, in our transformation year, the Medartis Group. We focus with Medartis on our three big strategic pillars like CMF, the upper extremities, and also lower. We have this KeriMedical integrated and leave it standalone, a company with a unique touch prosthesis, where we say today, the hip for the thumb. We entered with 51% last year, the value segment with NeoOrtho, and I come back to this. What also changed is that we have now six production facilities. We will not do this each year. Six production facilities we are expanding, and this is an important information for you. Mario is here. If you have afterwards questions, everybody of my EMB members can answer when we have the Q&A session, not only myself. Peter is also here. When you have finance questions, better to ask Peter. Mario can explain the project FESSH. We are fully on track, and I'm very happy, Mario, that we passed very successfully a three-days FDA audit in our new production facility. The FDA audit finished yesterday night, passing an FDA audit is a big thing in the U.S. 70% until end of the year of the products needed in the U.S. will be produced in Warsaw next year, 2027, first to second quarter, 80% we will produce here fully on track. You see here the KeriMedical. This is a picture of the KeriMedical production facility in Archamps. I think Fabian, maybe next year, we can do such an event also to invite to Archamps to see where the famous TOUCH is produced. We are doubling this production facility currently, doubling the size to be prepared for the future. We need to do this today because we see all over the world a volume increase for TOUCH. We did 43,000 TOUCH last year. We will do 60,000 TOUCH this year worldwide, and it will kick in. Further, both the Archamps production facility and the Besançon production facility, we have no picture here, are doubled in the size. In Besançon, we will construct a brand-new facility. Doubling the size of the production, it does not mean only doubling the volume. This is more times three to four times pushing up the volume for TOUCH to be prepared. We have our brand-new CADskills production facility in Belgium, in Ghent, where and this is also interesting, you should know, and maybe this in our full year meeting here in March, or it came not over so well. This is a strategic acquisition. We got access now to 3D titan printing, and this is scalable. In Belgium, in Ghent, we will do the printing for personalized implants for CMF, but also for trauma cases for Europe. We will scale up and are in the process now to bring this production technology to Brazil because we are currently printing for Latin America and Argentina. Third party makes no sense. We will install it in Brazil. We will do it in Brazil. U.S. is not yet planned because you need FDA approval. This takes at least another year. We see by the end of 2027 to have also the personalized production in the U.S. We are sitting here in our headquarters in the main production facility. Let me say, it is very important that we are not only a Swiss company, that we are a Basel Stadt, Basel city-based company. This comes also from our legacy. This has a lot to do with Thomas Straumann. Yes, we analyzed moves. This is our obligation to see, are there other opportunities? Yes, it was a lot in the press, not by Mr. Schmocker, but by other people, the publishers. The others are moving to Arlesheim. Medartis might move to Arlesheim. I can tell you, we are committed to Basel Stadt, and we will stay here until 2039 at least, and we will expand our production facility here. Means we get additional space. Everybody from Basel. I know we have a lot of Zurich. They love Zurich here, also the people from Basel. This is for the Stücki Park also very important that we are staying here. We are very happy, and I think Mario is also happy to have the production here. Last but least, absolute record. In 14 months, our brand-new facility in Brazil, 12,000 sq m, the first step, first phase. Next phase is to come for our NeoOrtho production. I will not go and I will not do now, and I have no time because Fabian told me, "Matthias, you have maximum one hour." I could speak an hour about culture. I was asked also yesterday night from a few of you, do you feel changes? Yes, definitely. I would challenge you and say, please ask my team members if they feel changes, because they are longer here. If they see a difference, I feel a difference. There is a different vibe. There is a different focus. There is fun. We see smiling people also in Medartis headquarter. I think when we are smiling and when we have fun, the things are going easier. Our culture is a process which will never stop. Therefore, in each meeting, I'm touching it, but we have to measure it somehow. What we did is we did our Glint survey. The Glint surveyis an engagement survey. It's anonymous, done with all employees worldwide. The employees can participate. The Medartis employees have this done twice a year over the last, I don't know, seven, eight years. Twice a year, it makes no sense because in one year you don't change the results. We have done it now, and we expected rough feedback. I was not expecting a score of 79. This is, by the way, the highest score you see Medartis had in the history. I expected a lower score because the people know it's anonymous, and they know we had so many changes. Also the strategy implementation over 2025. I think this is very nice. What is very important are the details. That 87% participated, including production people. We gave them access, so we provided computers for them to answer. That 5,600 comments. The people all over the world, in Japanese, in Portuguese, in English, in French, they takes the time to comment, to write positive or challenging comments. My team, together with me, we are reading those comments. We are taking this very serious, and we are giving feedback, and then we are stepping up. We have areas, they are above 80. We have even areas they have scores above 90. It's for me, for the EMB, for us, it is a confirmation that the strategy is working, the strategy is showing results, and we are on the right way. It will never stop to improve it. This brings me to this high-performance culture and high-performance team. Only if we have a team based on this culture, believing in the culture, we can have the fundament for our strategic priorities. Each strategic priorities is owned by an EMB member. You can only have one owner of a priority, of a strategic priority. If you have two, you are missing already the focus and one can shy away from the other. One owner. You can imagine who are the owners, especially improving cash flow. This is with Peter, and we are all very relaxed. When Peter has a smile on his face, I know we are on track. If Peter is grumpy, then we have an issue. You see he has a smile on his face, Peter, no? We are never relaxed. We are in a very good shape. Accelerate the U.S. I'm very happy how things are coming together. I think that we are getting more and more traction in the U.S. We see positive momentum. We see the gap closing in Florida. It's quite a work. It's not yet there where I would like to see the U.S. Definitely not. Maybe I'm also a little bit too pushy and ambitious and really doing the things fast. I told you, and I will not provide so many figures today, that I expect the U.S. to grow minimum 20%, and we are fully on track. I think this is a good message, and let's see. Also in the future, of course, this will accelerate because in the future TOUCH will kick in more. We are still in the launch phase. When it comes to KeriMedical, we have here our Global Head of Commercial for KeriMedical, Loic. I'm really super positive. It was the right decision to leave this company standalone. Although the easiest decision would have been include, incorporate this company, and then it's all fine. Leaving the company standalone, you get frictions, you get discussions, you get different opinions. This is beautiful. I love it. I love it because it pushes us out of the comfort zone. Very happy with the performance, and I already said it to Loic, congrats. Also in Europe, the performance is sensational. You can say it, Loic, by end of May, Europe is growing by? More than 25%. More than 25%. Europe are the countries where we have nine, 10 years, 8 years, 5 years in Germany, Keri already on the market with high market shares. Value strategy, I'm coming to this. Regional share gains, I think the most difficult part is for Europe. Mareike, she's also here with her team. When you have already in big countries, 40%, 45% market share, you still have to increase your shares. This is new surgeons onboarding, new hospitals onboarding. We are well on track. Otherwise, Mareike and her team would not maintain this very ambitious growth rate, which I have showed already last year. Also here on track. Innovation and digitalization, this is never ending. Marc will speak with you about what we are doing, where we are going to, where our thoughts, definitely not the next plate and screw, what is coming in orthopedic. As I said already, a smile on Peter's face, improve cash flow. This is his pillar. All fine so far, on track. This is a girl from Ipanema, we are bringing together Switzerland and Brazil one more time. The wonderful panorama of Switzerland, the chocolate together with caipirinha. Is there something better? Definitely not. Those countries, those cultures can benefit so much. I think the Brazilians can learn so much from the Swiss, the Swiss can also learn a little bit from the Brazilian culture. This taking it easy, there are no problems. We will solve it, we will be fast, we will just do it. This and much more brings those both companies together. We have Medartis and NeoOrtho so much in common. The two founders, Thomas Straumann and Geninho Thomé, they don't speak the same language. Thomas doesn't speak Portuguese, and Geninho doesn't speak English, unfortunately. They understand. With a glass of wine or a caipirinha, they don't need the language because they have the same mindset. They are entrepreneurs par excellence. Both have created world-leading dental companies, Thomas with Straumann and Geninho with Neodent. Both found together in 2012, became friends, and figured out that they have created inside the dental company, another company, which was Medartis in Straumann, and which was NeoOrtho in Neodent, separated 2012 when Neodent was sold. Now it is coming again, and I say it every time, Geninho would not have sold NeoOrtho to any other company. He doesn't need the money. This is his passion. He did it because he knew the people behind Medartis. We have a fantastic basis. We are bringing them together next week for the first time again after many, many years because we are with the board in Brazil starting Monday, and we are Tuesday night opening the new production facility. Why we are doing this? We are addressing a Latin American market, which is predominantly value. Again, I have no time to explain value again, but value is not making a premium product cheaper. Value is a total different approach. You need high-quality products. You do not need the latest innovation. You do not need this top-notch IBRA Cadaver Lab Switzerland education, but you need education. You need an affordable price for the public health system, which is normally half of the price of a premium product. This means you cannot produce those products in Switzerland. You are normally producing a factor of three cheaper in Brazil with the same machines than in Switzerland. This is the overhead cost. You see the CHF 470 million addressable market we have in value in Latin America. Of course, the two biggest markets, it's Argentina and Brazil. Somebody told me, "Oh, Argentina." Argentina is booming. Argentina is the country at the moment. Hopefully, Milei makes it further. We're going there. This is the addressable market we have. What we are doing currently, NeoOrtho, of course, Brazilian-based currently. All what we do was Brazil. We now started the launch in Mexico through our own subsidiary. This is already going on. Here in Argentina, we are launching, we are still thinking opening next year, maybe an own subsidiary because you need control. If you run such a country with a distributor, you pay twice. You pay a commission to do the business, and you pay again when you would like to have your own business back. This is in Latin America, a little bit tricky and totally different to the rest of the world. Colombia, I put it for the moment on hold. It was planned after Argentina. We might go first to Peru because Colombia is very, very dangerous, very, very difficult at the moment. Not at all compliant. We have to wait now until the political situation is a little bit stable. It makes no sense to enter now Colombia. A very important market, so we might go to Peru and definitely Chile. Chile is the most European market in Latin America. The only thing missing there is that they speak German, but they are very European with the highest prices. You see also that still the value segment is only 72%. When a value segment is becoming above 60% of a whole market, it makes sense to enter. This is also the reason why we are not focusing with NeoOrtho currently on the U.S. The U.S. is still a premium-dominated market. This might change quickly over the next years, but at the moment, I would say the value segment in the U.S. is not bigger than 15%. Makes no sense to go in. I leave this decision to the regions. Mareike with the EMEA region is currently analyzing where to go, where are the countries to launch. We have a dedicated person doing this. Europe is on the agenda. We are currently doing the whole MDR and CE mark registration. Maybe a word when it comes to the portfolio. NeoOrtho has a portfolio which is very comparable to Medartis. They are very strong in face. It's called NeoFace. Our product's called MODUS. With NeoOrtho, it's NeoFace. They are very strong in hand and wrist, and normally in the value segment, you copy the best. If you see the plates from NeoOrtho today, you remind our first hand plates we had at Medartis as well. It's nice and it's normal. It's a compliment for Medartis that 10, 15 years ago, NeoOrtho copied the hand plates from Medartis, and it's a fantastic product. Sometimes you have problem to differentiate what was really Medartis, what is NeoOrtho because from the quality of the production is the same, but the different locking system different. We have spine with NeoOrtho, but the spine business is only in Brazil. We will not expand with the spine business. It's a totally different area. It's not something where Medartis will enter. It was present with NeoOrtho, and we will maintain it for Brazil. It's very important for our tender business. Also we have foot and ankle products for NeoOrtho. The new production footprint, as I said, I think it's a huge advantage to produce not only cost-wise, but also you have no tariffs in the Mercosur, in the Latin American area. You are very fast out of Brazil to all the markets. Yeah, now, we have lifted already once with another company. It's a perfect location also to get qualified people, well-trained people. A lot of the automotive industry in Curitiba, all the big players are there. Good people you get there. We have a very short ANVISA registration pathway because we have a local production, and we are continuously audited by ANVISA. ANVISA, and this is important once we go to the U.S., is cooperating very close with FDA. You have an accelerated FDA registration if you have ANVISA in your own production facility in Brazil. This is a big advantage, and I hope it will stay like this. Then, of course, we are now going into the other regions. This is a project, and I would like to. Some people, some guests here, they know me from the past. Please remember, what we are currently doing with NeoOrtho is much faster than the pathway we had with Neodent, but still we are in the beginning. This is not that in two years we are international all over the world. It took us 11 years with Neodent. It will not take us with NeoOrtho 11 years, but it is a time. You need registration. You need to launch. You need to prepare the market. It is coming, but in a good shape. It's also bolstering the Medartis business. I'm absolutely happy with the performance of Medartis in Latin America because value is value, premium is premium. Medartis is benefiting now from this structure we have, this common infrastructure, this back-office structure. The performance of Medartis in Latin America over the first five months of this year was really outstanding in my eyes. They have built a new team and bringing a lot of momentum in. Now, we are already touching TOUCH, strong growth. I told you 43,000 implants last year, and when Loic just mentioned over 25% growth year to date, end of May in Europe, mainly in Europe. You see that there are markets like France with 85% of market share where we are still growing. France is 29% of the overall European world performance for TOUCH, and we are still growing by 20% in France. How this is possible? This is patient marketing. We are driving patients to doctors to ask, "Hey, doctor, I have a problem. It hurts a little bit. What can we do?" And if they are lucky, they find professionals like Daniel Herren, and then it goes very quick, and they have a new life. No pain and easy movement. We see this in all countries, and we also see that you have a ramp-up time when you launch because it was us, Medartis, launching Germany, for example. You have to prepare the market. You have to start with education approach. Then when you are three, four years in the market, it kicks in, the volume are coming. Also, the patient marketing is helping because I launch it now also in Europe. You know before we acquired KeriMedical, we had three markets. We had Germany, we had Austria, and we had the U.K., where we were already responsible. Australia is still small because we are waiting for the reimbursement. It should come this year. We are doing 260 cases, but it's all paid out of pocket, so it will kick in when we have the reimbursement. On purpose, we have not put yet here the U.S., but of course, this will come very prominent in the future. The U.S. launch, it's running. Now I have to find the right words. I'm surprised. Let's say it like this. I would have expected more negative feedback maybe, more, "Ooh, let's wait, let's see." I think we are in a situation now with our courses in the U.S. that we can still, after five or six months, select the doctors we like to train. They are queuing up. They are registered to get the trainings. We are flying in European surgeons to train them. We will start in September to have the first U.S. surgeons to train U.S. surgeons, and we can still select the best. This helps us because we can select in which areas, in which regions we will be active with the training and what are the surgeons which will bring enough volume. The other hand, what we see also is the same, what we observed in Europe, that when the surgeon participate the training, he or she, they have already three, four patients selected, and they do within the week the first cases. This is also happening in the U.S. We see surgeons doing the first cases. We have already one surgeon, and I can tell you because on social media you will see it, who has done 100 cases since beginning of the year. This is Jonathan Tueting in Chicago, and you might meet him at FESSH. He's here. He's really breathing TOUCH. Four, five cases per day, very good. This does not mean, and please don't do the math now, that all we train, they are doing 100 cases, and then we end this year, I don't know with which number. This is not the case. We have also surgeons we have trained. They have not done one TOUCH yet because the reimbursement contract is not authorized in the hospital. We have also a clinical team and a reimbursement team behind, because with a reimbursement price of around $6,500, you can imagine that the hospitals are getting a little bit careful to get it in. Insurance company, not the hospitals, the insurance companies, to allow the procedure. For the hospitals, it's a win-win because they get a lot of money from the reimbursement. The insurance companies are getting careful. We have a team behind explaining the insurance company, doing this as an administration work, explaining also the fast recovery of the patient and the benefit of getting a TOUCH. It's all working fantastically, what we are doing in parallel, and it's all based on the learnings we got in Europe. Therefore, the team is expanding. We are hiring each month new people for our Keri team in the U.S. I aligned with Peter, what I also can tell you is that May was the first month we sold more than 150 TOUCH in the U.S. I think this gives you a little bit of sense that we are very confident that we will reach our target of 1,200 TOUCH this year. No, Peter? Yes. More I will not say. We are fully on track. Japan and Brazil are coming. We started the registration in Japan, and we are starting the registration in Brazil. Huge opportunity. Now, you see here, I would have thought, Fabian, that you give us the morning news from the U.S. Is this here? What should I do? Click? Sorry. Yeah, perfect. Super excited about this. This implant, it's been in Europe for a number of years, but we're excited that it's now in the U.S. We're able to be the first institution in Florida to put it in. I shouldn't say old way, but we used to take out the bone and suspend it, so this just allows patients to kind of get moving a little bit quicker, essentially. Thumb arthritis is incredibly common. It causes pain, stiffness, and weakness, making everyday tasks like opening jars or squeezing toothpaste frustrating and painful. For years, if non-surgical treatments like physiotherapy or painkillers didn't help, the only option was to remove a small wrist bone called the trapezium. Recovery could take up to a year, and the results were variable. Now that's changed. I offer a base of thumb joint replacement, a revolutionary procedure that's transforming the way we treat thumb arthritis. It uses a tiny artificial implant, like a mini hip replacement for the thumb, to restore smooth and pain-free movement. The procedure takes around an hour. Patients go home the same day, typically returning to driving within two weeks, and would wear a splint for six. I've been performing this surgery for several years, and I've carried out nearly 100 of these procedures with outstanding results and consistently faster recoveries. In my experience, this isn't just an upgrade. It's a real shift in how we help patients with thumb arthritis. People are getting back to daily life faster, with more confidence and far less pain. Having the pain in this area. It's this whole joint area. It started off with just one hand, and then over the course of maybe five years, then I'm like, "Oh, I'm having this pain in the other one, too. The symptoms threatened her dexterity and designs. That became almost impossible for me. We know biomechanically that when you pinch at the tip of your thumb, the force gets magnified dramatically by the time it gets to the base of the thumb. We definitely see a more likely arthritis in people that are doing a lot of repetitive pinch or grip or things under load. What's been a standard fix in Europe for a decade. How are you doing? Good. No pain? No pain at all. is now in the hands of some U.S. orthopedic surgeons. There's been some new technology that has allowed it to be successful where previously other joint replacements or attempts in the U.S. have not. Surprise. I told you I was going to make you a cake. Featuring a fondant replica of her new joint. That's crazy. You are so sweet. A sweet ending to a sweet story. Tricia plans to have her other thumb replaced next week. Back to you. This was only two examples, or one example on morning TV with Jonathan Tueting. The Rush University Medical Center in Chicago, where he's placing the TOUCH, they started early, and they are doing this media work. It's not sponsored by us. As you can see, it's also not mentioned TOUCH, not mentioned Medartis or KeriMedical. It should not be the case. Of course, it's clear it's the only product in the U.S. He's getting calls now from all over the U.S. People are flying in, getting the surgery, flying back at night. We have it also in Germany. Bild am Sonntag is not maybe the best newspaper, not every time the most serious one. When they speak about TOUCH, I love it. This is the Berlin Philharmonic, when Hakimi put him a TOUCH, and he could play again in the orchestra and gave an interview, and he was so emotionally that he spoke with the journalist, and they made a big story out of it. This is patient traffic, and this is a part of this mouth-to-mouth communication. Maybe Daniel will explain it also, how his patients are coming to the clinic. This is bringing this vibe. Of course, if you're on TV, and we are constantly on TV, especially in the U.S., you can imagine how many million people are watching this, thinking, "Oh, I have a pain. Maybe I should ask." Then it is reimbursed. Yeah, it's something which is helping a lot and helping a lot also the growth in Europe. Now, IBRA. You know that we have here in our building on the sixth floor, and you might have seen it, the most modern installation in Europe to do orthopedic courses on cadavers. This is a top institution. It's our cadaver lab run by IBRA, and also rent out to other companies and doing other courses throughout the year, but mainly used worldwide by our surgeons. Education is so important. I asked Fabian now also in the future to add a chart, at least when we speak about education. Our education partner is IBRA. We are the industry partner for IBRA, but IBRA is so important to drive this community. IBRA grew in memberships last year. We have now 4,500 members. It's a growth of 18%. Because why? Because in 2025, we started to revamp IBRA. We became closer. We became really partners. Scientifically, we are not managing IBRA. IBRA scientifically needs to be standalone, and they have their own opinion. We will never step in and tell them what to publish, what studies to do, or what courses to bring. We are running our international education through IBRA. Actually, we should have 15,000 members, and we are in the process to revamp, so this will grow. We have a lot of professionals trained throughout the world, and we are expanding IBRA now all over the globe with the academy programs for young surgeons. I think young surgeons are the future of the industry, and we know when you start hand-in-hand with the young surgeons through a program, through an education program, through a fellowship, those surgeons stay with you. They have no reason why to change the system. We need to get them at the beginning of the career and to involve them into IBRA, to give them a stage to lecture for us. The same applies for women. Women in industry, it is so important. We are getting more and more female surgeons in the Schulthess Klinik as well. Well-educated, fantastic. They have another approach to the professional life, but they have also another approach using our instruments, for example. As an industry partner, we need to think about our instruments, for example. They are designed for a women's hand, or are they too big, too strong? Those things. IBRA will help us to get it open, to bring the women in, to discuss, to have courses for them, and also to have more and more women driving our educations program. We will have in Florida an education center in South Florida, hopefully starting in September, and we will have three education centers in Brazil, São Paulo and Rio for Medartis, and one in Curitiba across our production facility, a little bit the same like here in Basel, only for NeoOrtho, where we bring the surgeons for the courses, and then they come to the production, and then they can see our production and how the products are made. I think when you have seen this and when you have done the course, you are really close to the company and committed to the product. Finally, we have a new U.S. research and education committee. This is very important. A lot of new things, a lot of positive things will come with IBRA. I think it's also important not only to speak about the business, not only to speak about the marketing, not only to speak about the research and development, but also to speak about education. Education is the most important spending we do in this company, and not only for the TOUCH education. Education is the base of everything we do. Nice panels, nice charts, every marketing department can do. A proper education with a super professional partner like IBRA worldwide, this is not so easy, and here we are unique. What is also unique is that we have, and this department is reporting to Peter, we have an ESG department. We care. We care not only in Basel, we care worldwide. We have it also in Brazil, an ESG team, that we are really give our people an understanding what's ESG. What I say in each town hall is, and we speak about ESG like we speak about our culture. That ESG is not just putting some solar panels on a production facility or avoiding plastic bottles. By the way, we could do better. I see still plastic bottles here in this auditorium today. Peter, maybe we can take this up. This is okay, part of it. ESG is also the social responsibility we have. We did yesterday a charity bike ride during FESSH for Mercy Ships to help people who are not as fortunate as we are to get access to proper treatment and surgeries. We have a very important program with Philipp Honigmann and Florian Thieringer from the Uni Spital in Basel, Florian, a CMF surgeon with Nicaragua, where you have severe cases of reconstruction of faces of people, but they have no means. They have even not the plates and the screws. The products are not there. We are doing this. This is a drop on the hot stone, but if you would do nothing, it would be nothing. We are intensifying this. This is one thing. The other thing is inclusion, diversity in the company. We need to become more open. This is part of our culture. We need to become really diverse. The planet, this is very important. This is the future. We have this responsibility as a company. Overall, we have to have a governance on this, and we have to have really a team on this and not, this is now the most important part, not just publishing 30 pages in an annual report. You have to live it. When I saw first our annual report, I said, "Wow, we are publishing a lot." First, I would like to know who's reading this. Second, I would like to know who of our team here understands what we are publishing, and are we living it? This is now the sensibilization and the work Peter is doing with Alina to work on it. We have our targets. The important thing is you can put whatever you want on those charts. You have to live it, and you have to prove it. Team needs to live it, because otherwise, the only thing you will do, and there are many companies out there doing it, they are changing slightly the targets year by year. Yeah, you are getting closer, but you never reach it. It's very important as well. We have an ESG committee. Fabian is part of it. This is now part where really our departments are getting in and not this is just an exercise. No, we are living this. The 2030 roadmaps. We have responsible people. There's Bianca from Brazil, for example. They are international. We're doing volunteering. Means we are bringing our people also in Switzerland, and especially in the U.S. U.S. are world champions with this. We're giving them the time. You can go. You can help. Please volunteer. A lot of social projects, especially in the U.S. We are top 15 in EcoVadis. Honestly, I don't know what this mean, but they told me it's very good. We have a silver award. My question was: Can we get gold? Important is that we compare each other and that we are participating in these comparisons. Yeah, we have 100% renewable electricity, and we are also driving the first electric cars. Not myself, but we are getting to this, that we have electric cars. You will see at FESSH, and please, when you are going to FESSH, we have our bus there, our electric Volkswagen bus, the Medartis bus. It is reformed as a photo booth for you, so please take a picture and publish it in our electric car. This would be very nice. We care also about you. Now, the outlook, nothing has changed. We will see each other in August. 16%-18% organic growth. We deliver what we promise, and nothing changes. It is still the statement, very valid. We see August forward going. The high teens EBITDA margin, very happy with the development. We are on track because with that, we said from the very first beginning in 2025, you might remember, we are not only focusing on growth, top line growth. We are also focusing on profitability. We have a clear target internally also for us as an EMB. Yeah, Peter has a smile on his face, so I think we are on track. No, Peter? Yes, we are. We are. We have an aging population. It's a little bit, what are the growth drivers? I'm asked. I think, first of all, aging population, this is not only referring to TOUCH, but this is general. The population today is more active. My grandfather, when he was 65, he was sitting in an armchair smoking a cigar, but not riding a bicycle. Maybe a Vespa. Today, I'm not yet 65, but we are more active. I would say, Daniel, we are 20 years younger than in the past. You are playing soccer, you are doing things, you have accidents. You need to recover life. This is where we have huge opportunities in all markets, and there are still markets where we are not present. This means we are expanding our serviceable addressable market. The sum is a market with our products we can attend immediately and filling our gaps. Hand and wrist, we are complete, but we have other areas where and this is the work of Marc, but this is not something you can do overnight. Those projects normally take years, but with the sexy nail, it took us nine months. This was a record project also. This never happened in the history of Medartis, but it was a sexy project and it went fast. Nine months, but normally it took us some years also under, we get especially the FDA approval. We are going for the personalized implants. We believe this is definitely the future. Personalized implants is coming more and more, not only in the CMF area, not only for reconstructing faces, but it's a way we need to attend, and we can be fast. Being fast is maybe one of the attributes which is valid for us, for Medartis. We are faster than those mega competitors. If you have a huge animal, I call them the sharks of the industry, most of them are coming from the U.S. Normally, they are not very flexible. They have processes, and they have books of processes, which are very big. I know this from my time at Procter & Gamble. This is a big advantage to be agile, to be fast, to adapt fast, and to become disruptive. Not shying away to do things in the industry nobody has done so far and discuss crazy ideas. Why we should have our sets, this huge set still in 10 years. Why? Because many people say, "It was like this ever in orthopedics." We could not care less that it was ever. Is a new generation really using those sets? They cannot lift, they are so heavy. We have to analyze this. Is sterile packaging coming, yes or no? What is more ecological? Sterilizing each time the sets or throwing it away? There are a lot of studies that throwing away is better for our entire ESG than sterilizing, which is impacting heavily. We have to work on those disruptive things. You see here, we are already advanced. We have a different system now, guided surgery, the digitalization. AI plays a big part in this, AI will not replace a human. AI will not replace the robot. I'm very bold to say that we can do surgery planning. We can do based on an X-ray, the planning in the future of a treatment for a distal radius, that the system will tell you this plate and how many screws the surgeon need. I believe it will never happen that this without the influence of the surgeons will be adapted. The human being behind will remain very important, will not be replaced. If we do not challenge the status quo, I think we will swim only in the same water, and we will not advance. This is something we are doing, especially in our innovation area. This means also, and this is my last chart, and Fabian, I'm too fast. In 2030, this is our strategic plan. We are now adapting the strategic plan in August. We will start this and discuss with the board one year. We every time actualize. Next year, end of the year in March, I will present you the strategic plan 2031, it's the adaptation that we have a little bit a shift in the face of the company and the dynamics of the company throughout the next four years now. We are already in 2026, you see the segments are growing. Medartis will be definitely a different company throughout this journey until 2030. With this, question and answers we do later, I hand over to Marc. Thank you very much. Good morning, everybody. It's a big pleasure to be here and speak a little bit about innovation and what we're doing in our R&D departments all across the Medartis Group. Precision starts long before the procedure, and the IBRA provides the foundation. Relevant insights shared globally. Take the opportunity and gain deeper understanding to expand your own clinical knowledge. In our BioSkills labs, we turn evidence into practice. Join the exchange, advance the adoption of new techniques, and get better alignment of product use. Hands-on experiences led by world-class surgeons across more than 52 international courses in 2026. Building credibility together through clinical education for you as a representative. Take the next step with confidence. Supporting the next generation of surgeons with our scholarships. From the first course to a faculty role, an opportunity for you to build a stronger relationship with your customers. IBRA has fantastic courses that offer incredible lectures on the Friday afternoon and evening, and then we have a social dinner where we can mingle and even ask questions about practice and different practice situations. Saturday is an incredible cadaver lab where in the morning you get to play with instrumentation from the elbow to the fingertip, and then after lunch, you have an ability to fix a pre-fractured specimen, and you have a little competition amongst your peers to see who can do the best fracture fixation. Now we're taking the next step, expanding IBRA in the U.S. with our Florida Education Center in 2027, creating new opportunities for education, collaboration, and innovation. IBRA, preferred partner of Medartis for education and research. What that means is that IBRA is very important to us. IBRA is very important to us because the surgeons can try our products live at cadavers, fractured specimens. It's very important to do the education for the surgeons at the patient. Second, scientific backup. Having scientific data to back up your product is also very important to the marketing on the products and get them to the surgeons. Last but not least, with the IBRA institutes, we as an R&D department have a space to try and test stuff during our innovation cycle. That makes us really agile. We just can go downstairs, let instruments and implants produced go upstairs to the lab and try stuff out. That really speeds up also our cycles, and that's why IBRA is so important to us in innovation and R&D. To do really the products, you need to understand what the patient needs. The patient is always in the center. We need to understand the clinical problem. We need to collaborate with the surgeons, like Daniel is one, to really identify these needs the surgeons have, to treat the patient the best way, and that's kind of what really drives us within R&D. Working together with design surgeons and do the best for the patients. In terms of markets, we're really focusing on the fastest-growing segments like enabling technology, so digital solutions. At CMF, we kind of revamped CMF with MODUS 2 and now also with the CADskills acquisition. We're in extremities, so basically upper extremities we're focusing on. We want to become market leader and foot and ankle as well, and the trauma segment with our fracture plates are also within our focus. We're really focusing on the fastest-growing segments, and that gives us a service of addressable market of around $5 billion currently. That we still have a huge opportunity to grow with our product, with our services, and with our customers. Matthias already touched that one. Becoming a market leader in hand and wrist is really crucial to us. We have a pretty complete plating portfolio. We have nice screws to treat the patients. We now have the KeriMedical product, so it's not only TOUCH, it's also KeriFlex and other products which are delivering results to us. We're expanding also that portfolio. We're working on different stuff like arthroscopy solutions and things like that for the hand and wrist portfolio. Built on our legacy, that's also crucial. I touched it already, CADskills, expanding MODUS 2, and growing within CMF. We're having a real good complete portfolio in CMF as well with MODUS 2. Now we're pretty complete as well in the patient-specific solutions. Foot and ankle, last but not least, we're also doing a lot of stuff in foot and ankle. Matthias touched it. AnkleFusion is going to be a product that is being made available next year for the European markets and the U.S. markets as kind of limited availability first and then for a full launch. That's not the only product we're working on foot and ankle. We got also there a couple of products we kicked off and working on delivery products to our friends in the foot and ankle. Looking at what we're doing. We're having kind of three main areas we're active in. It's basically fracture fixation. That's everything associated with plates, screws, other fixation techniques for trauma and for elective cases. We're working on joint replacements. TOUCH is one of the examples. The TMJR for CMF is another example. We're having now the radial head, the Avenger Radial Head in the U.S. available. That's the third example for the joint replacement segment. Enabling technologies, starting with CMX, having the platform but not stopping there. In going steps further in patient planning, fracture planning, also navigations are their topics we're heavily working on and getting products to the market very soon there as well. We're doing that mainly for hand and wrist, for CMF, and as said, we're also filling the gaps for lower extremities. Here, kind of a short timeline where you see what kind of products or in which segments we're bringing products to the market. Not only stopping with the implant solution. We're working on enabling technologies, expanding CMX services, working on delivery systems like sterile procedure packs, new sterile packaging, things like that, which are really important to be more efficient also in the OR. Intraoperative navigation, that's a big topic we're working together with our friends in Zurich Chamber of Commerce to deliver their really nice products to the OR intraoperative navigation. Do directly the planning during your operation, not only preoperatively. Also looking at new segments. We're not stopping just with having plates and screws. We're also looking into new opportunities like soft tissue fixation and things like that. Good. There are four key points where we're focusing on when we're doing innovation. We're trying to simplify procedures. Having an easier use of instruments, saving time during the OR, that are really important points to the customers. That's what we are thinking and what we're hearing. Reducing costs also by reducing surgical time for the facilities, that's an important point. Preserving bone stock means that we're trying to preserve joints and bones in the body. One example could be radial head fractures. A couple of years ago, they just replaced it with a prosthesis or just took the bone out. We're having plates that makes it possible to reconstruct the radial head, that really preserves the bone stock and keeps the joint in the patient moving. Last but not least, more predictable outcomes have the surgeons being made able to plan the treatments. CMX is one example. These are elective cases. Again, we're not stopping there. The goal is really also to provide services for fracture fixation, having more predictable outcome, and also some recommendations there. Couple of examples, recent examples. First, coming to that a little later, that's the TITAN Nail. By providing an easy implant, you don't need to pre-drill. You can insert it right like that. You don't need to reprocess the sets. You just bring it in sterile pack. It really makes the whole procedure much faster. The rep doesn't need to bring the set, reprocess it, bring it to the OR. He just brings the sterile kit to the OR. Preserve bone stock, I mentioned the example with the radial head, but the most important one to us currently is the TOUCH prosthesis. Couple of years ago, the trapezium was just removed. Incision, the bone was removed, and the patient was kind of kept it that way. Now we're having a solution to keep parts of the trapezium in and really have the full range of motion and very active patients afterwards because they don't have pain anymore. They just go home. The doctors even need to tell them not to move too much. Daniel, I'm sure he will touch that as well. More predictable outcomes. CMX is definitely one of these examples. Having very complex cases with deformities that are hard to treat. We're providing a service there to have the planning for these cases and also the tools ready to have the intraoperative support with guides, bone models, and even custom-made and patient-matched implants. Kind of the 2026 launches for that year we're providing. We're having the FibNail. That's going to be a U.S. product only. That's a fibular nail, which is used for fibular fractures. That's going to kind of across with our ankle trauma system. It's very innovative. You can place the nail, you can rotate it. It's kind of unique in terms of design as well. We're going to bring the proximal humerus. I'm going to show you a little bit more about that. We're going to bring line extensions for the clavicle systems. Some new plates like medial plates, longer plates, and even a plate that most people think is not really that innovative, like a hook plate. We made it, again, innovative. We changed the whole design of the plate. It's not like all the other plates, which are kind of displacing the AC joint and are hard to place. Our plate is really easy to be placed just with some small, nice changes on the whole implant design. It's patented, so nobody can do it, and then we can do it. The TITAN Nail. That's the products in the fixation groups we're delivering to the market. In terms of arthroplasty, definitely it's TOUCH line extensions like titanium neck. We've been working or KeriMedical was working on the PEEK as well with vitamin E in it. We're also providing now the TMJR to our CMF friends. We're now having a custom-made jaw joint for the CMF surgeons. In terms of enabling services, we're widening up the CMX portfolio in terms of really patient-matched devices. That means by the end of the year, almost all of our custom-made plates are CE marked. They're not only custom-made, they're patient-matched, CE marked, which gives us also the possibility to go to other markets and get the registration there as well. Just a quick one. We just received the Australian approval yesterday morning for the CMX service, which was really good news. We can start in Australia also providing CMX services soon. We're having the whole portfolio of CADskills and another point which we're going to get to the limited availability is CMX Trauma AI. You're going to see a little bit more about that soon. That's our new shoulder fracture plating system for the proximal humerus. It has some unique features on it. We got the muscle-sparing design of it. It's very anatomical. That golden thing you're going in there, we call it the spiral blade. That gives additional medial support. These fractures tend to kind of displace a little bit, so we're having additional medial support there. We even have biomechanical proof that this is better than just with a classical screw fixation. There are a couple of innovations in that system which we bring to the market to our customers, which are really unique. TITAN Nail, we spoke about that now. Also the NX Nail. NX Nail was kind of the working title in the company. Matthias kind of provoked a little bit with that, and even drove the team to do some new stuff, like new packaging designs and stuff like that. We're having now nice designs, colorful designs all around. The packagings, we got a nice sterile pack kit with all the instruments inside. I'm just going to show you that. Just open it during the surgery. Everything is sterile use, you don't need the huge tracer anymore. You just unpack it, ready to use, drive the screws in, and you're done. That really saves a lot of time during the OR. Just to show you, before that, the rep always needed to bring a kit like that or even a bigger one to the hospital. They needed to reprocess it. Decontamination, cleaning, reprocessing, sterilization, which took time. It's ready to be used in the OR, and after the surgery, it needs to be reprocessed again. We save all that time now with the sterile packaging, which is really, really great in terms of procedure time and even rep time that we're saving. It looks like that. You see all the instruments all ready to use. That's the implant packagings, so different sizes. You just unpack, throw them into the patient, and you're done. What we're doing is we're trying to build a whole ecosystem around the TOUCH. We're driving, Matthias told it, we're driving manufacturing, doubling the capacities there. We're having new line extensions to the TOUCH and obviously also scaling up the training and the accessibility in the U.S. market. We don't stop there. We want to be ahead of all the other ones that could copy us at some time. We're working on navigation. You saw a little video on the left side. To be honest, it's pretty hard to navigate on that small, tiny bone, the trapezium. It's really a tiny bone. We managed that to get the registrations on that bone and even to navigate on that one. We're having two concepts, basically, for navigation. That what you have seen is the more complex one for complex cases. You need to do the kind of preoperative planning. We're also working on an intraoperative navigation system, which we can't tell you too much about it, but which would be really kind of disruptive because that doesn't exist currently on the market. We're also working together with the KeriMedical teams, and that shows that the collaboration really is good. On the navigation project, we're working with the KeriMedical team from Medartis team, and also on the salvage procedures. We're having there also projects which KeriMedical wants to incorporate our technology. There's a close collaboration by both teams in doing these projects. We're also working on AI tools. Trauma AI is a tool that gives the surgeon the opportunity of uploading CT scans, then having the reposition of the fracture. You're having the fracture situation, the reposition is done, and at the end, even some plates are put onto the repositioned bone. You see the screw placement, so the surgeon can really check whether the implant he wants to have is the right one. We will provide some additional recommendations on the planning, so different plate selections based on our indication matrix we're having with our plates, all on our CMX portal. The surgeon just logs in and he has after one or two days a recommendation and can then treat, because usually they wait about three, four days by treating these fractures. There's enough time to do the planning. That's what we're going to provide soon. We're going to test that at the FESSH the first time to our customers. By having the CE, which we expect in the next couple of weeks, we're going to make it available to the first customers. When all these products, the standard products, plates and screws are not enough, we're having the patient-specific solutions ready by CMX. Again, CMX, the portal, the service we're providing, the surgeon uploads the data. We're doing the planning. We're doing some kind of first draft. The surgeon looks at it. We're having Teams calls with them. They approve it, and then we manufacture the instruments and implants, so bone models, guides, and also the plates. These are delivered to the customers. Now we're having a short demo by Andreas showing how that process looks like. Andreas is one of our clinical product engineers working in the CMX team and doing some of the planning. He's kind of the master of mandible reconstructions. I think that's the case which you're going to see now. Yeah. Thank you, Marc. Like Marc mentioned, I do the custom-made cases with the surgeon from the planning to the design and then give it to production. I will just show you it's really quick, so it's five minutes because the process is pretty easy. Can you see my screen? Yeah. Perfect. The process basically starts with our CMX portal, what Marc mentioned. If we are going on our Medartis page, we have here the CMX portal. If the surgeon is not registered, he goes on the page, and then he can register here by himself. Then it's pretty easy like an Amazon account or something where you register with your email. He gets approved from our customer service, and then he can immediately start creating cases. Here is this homepage. He goes in. This is our front view. He can start creating cases, like I mentioned. He can choose wrist, ankle, APTUS, MODUS or. I will just show you a MODUS case, a mandible reconstruction. He decide for a mandible reconstruction. He fills some data. He put on next. He has something missing. He will go get the case here. Good to see. He just have to upload the DICOM data. DICOM data is a CT dataset from the affected area. If he uploaded the DICOM dataset, we can start working. We take the CT data, we put it in a program, we create 3D models out of that. With the 3D models, we can start to do the planning. The planning normally looks like that we prepare us for the planning for the surgeon, and then we start the planning. For example, here is a 65-year-old male with a blastoma on the right side. In the planning, we determinate resection areas, which bone he wants to remove. So how many distance you want keep safety from even if it's tumor or a blastoma. We decide, like here, we talk about the resection lines, and then we show it a resection. We speak about the reconstruction, which he already provides some information in the portal. So we already know which graft site you want to use or which graft. Is it fibula? Is it iliac, or is it scapula? It depends how many segments, which vessels connection, where they want. We speak about the segment placement, like here. We plate segments for reconstruction, and this is, for example, a fibula on the left side. Then it depends where he wants the skin flap or where he wants to connect the vessels on the right side, anterior, posterior. Then after that, we decide which or how many screws he wants. Looks like that. Then basically, the meeting is finished. After the meeting, we can start planning, and then we plan the implant, like here. The guides for the resection and for drilling and the harvest guide for the fibula. After that, we put the whole products and we do the planning almost everything with Dynabots. Dynabots, they do all, I would say 80%, 90% of the planning. It basically takes automatically, we have the products, we look at it that it's correct everything, we upload it again on the portal like here. The surgeon, here on the left side, we have the communication with the surgeon, he can go and look how the final product is looking. If he likes, if it's okay for him, he can approve like here. If he want to adjust something, he could just write in the chat, please take a screw more, or please remove something from the guide or something, then he approve. After the approval, we start production. Now the main asking question, how long does it take? After the approval, we need four days for production and one day for delivery in Europe. If he approve it on Monday, he has the product on Friday in the hospital. Yeah. That's it. Thank you, Andreas. Okay. Thank you, Marc. You have seen. Everything, the portal, that's a medical device. That's approved by the notified body and the certification authority. It's a medical device. Everything that is kind of communicated to the surgeon is on the portal. They always can revisit the cases, they can go on the portal, show the planning also to the patient, which is very important at some point. They can do measurings and stuff like that on the portal as well. There's a lot of features on it, and we're going to incorporate the Trauma AI also on the same technology as it's shown here. Kind of a similar thing is CADskills. By kind of having the CMF strategy focused by last year, we just looked at what kind of possibilities do we have to really be fast in providing additional services and products to our customers. We found basically CADskills. We went into the first discussions by September, October, and we did the final closing by May 13th. Also a pretty quick process with a full-fledged due diligence. What's really unique with CADskills is they're controlling the whole procedure chain. They're starting really with the raw material. They print everything. They do the reprocessing. There are only a few steps that are made by vendors outside. They even do in-house sterilization. They provide their custom-made devices sterile to the surgeons or to the hospitals directly, which is pretty cool. We're going to take that process and implement it also for our processes here. As Matthias already mentioned, the goal is really to take all that process footprint and put it into other regions. As said, we're now having the approval in Australia. We first going to provide the service from Basel, and at some point we're definitely going to bring it also to APAC. We're going to bring it to LATAM, and the U.S. is depending on the 510 as well. CADskills in terms of products. The products are not what we've done before. We've done guides, bone models, and plates. What CADskills is doing is they're providing TMJR, so that's the joint here. That's a fully patient-specific joint for the jaw. They're providing orbital floor implants, both in titanium and in PEEK. They're providing both options, depending on what the surgeon wants to have. We're having facial contouring implants to kind of change the appearance of patients whenever there is an orthognathic case or something like that. They change the bite. At some point, there need to be some adjustments of the mandibular angle or stuff like that. That we can do also with facial contouring implants in PEEK and in titanium. We also got now the technology of doing subperiosteal implants. Really kind of implants that makes it possible to fix dental prosthesis on after tumor cases or really also kind of bone loss, so massive bone loss in the upper and lower jaw. That gives us a huge opportunity that was missing for us to be very competitive in CMF, and that's what we're having now, the products, the service, and the whole also planning technology behind that. There's a highly skilled team also sitting in Ghent similar to guys like Andreas we're having here, and they're doing all the planning and manufacturing in-house in Ghent at CADskills. That was it in a nutshell. Thank you. You must be exhausted. No, no. Too much information. Good morning. My name is Daniel Herren. It's a real pleasure to be here. Thank you very much for the invitation to have the opportunity to explain a little bit what's going on in the market from the front at the patient line in terms of novelties in treatment. One of those novelties we already heard many times is the TOUCH prosthesis. It's a great privilege that I can show you the experience we have with that implant, might be exemplary of what's going on. For us surgeons, it's a huge opportunity to have such a new implant, which basically revolutionized the treatment of a very common disease. Where are we? Who I am? I'm Daniel Herren, working in the Schulthess, not Schulthess Klinik. It's a big difference. I had a former boss whose name was Schultheiss. We have been ranked by Newsweek as number one in Europe for orthopedics, number four worldwide, and we are pretty proud about that. We can talk hours about ranking. Nevertheless, if it's so good, we take it. If it's bad, we just ignore it. I'm double certified orthopedic and hand surgeon and being in that clinic already 30 years. I overlooking a market with quite a constant flow of patient and a constant disease pattern in these patients. However, we had a great shift from rheumatoid disease to degenerative disease treatment also in the hand. I'm the past president of the FESSH. This is a little bit my congress, honestly, because Basel was dedicated to give the congress during COVID. Within a few months, we had to go from a live congress in Basel to an online congress, and that's the reason why Basel got this congress again now post-COVID, and I'm very happy that it happens now today. Those who have the opportunity to go there, you will see how we evolved. As Matthias already said in the introduction, it seems to be the biggest hand surgical congress worldwide. I'm a consultant for Medartis and KeriMedical for many years. I had the privilege to serve as a board of director member for seven years during the IPO process. I don't have to tell you as being from the banking side that the first sessions I obtained, I didn't understand a word. Now evolving over time and looking for new opportunities to enlarge the portfolio, I could give some of those contributions. We are meanwhile looking back to 840 thumb implants in our clinic and in my team with an increasing number. We started very slow. I did a few first cases telling to my partner, "If it works, you are the next," then he took over. When we saw how good the results were clinically, we just rolled it out to the rest of the team. Let me share a bit experience about that. This is a typical patient we see every day. Let's call her Sina. She's 58 years old since already several years. That's typical. Usually starts off the age of 40, 45, especially in females. She has pain at the base of her thumb. She's very active, works as a nurse, has, believe it or not, six grandchildren, has a positive family history, which is also typical for that disease. Had so far three cortisone injections done. They worked for a while, calmed the situation down, but it doesn't solve a mechanical problem. Osteoarthritis, degeneration of the cartilage is a mechanical problem. She wants a final solution. She's a bit tired of that. That's her X-ray. That's the base of the thumb. This is the so-called metacarpal one. This is the trapezium, the famous bone. It's called the multangulum majus in Latin because it has several edges. It's a pretty complicated shape. As you can see, as long as we see in the X-ray a distance between the bone in joints, this is cartilage. Cartilage has no calcium in it, so we don't see it in the X-ray. That's good, that's bad. This means bone is rubbing against bone. It's a typical feature of a so-called degenerative osteoarthritis. She's not alone, by far not. Interestingly enough, if we are looking at the prevalence of osteoarthritis in different joints, we would think the hip might be the number one. It's not true. The hip is often affected, but not as often as we would think. If you look, the hand is involved in 70% of the cases. From these 70%, 20% is the base of the thumb, the reason for that osteoarthritis. Number one are the distal joints here in the fingers. I don't know if any in the room has this problem already. Number two is indeed the base of the thumb. Why don't we have that many more operations than in the hip, in the hand? Because especially the distal joint, but also the thumb tends to stiffen down over time. If you don't have cartilage anymore, the joint is just moving as it should, and it can be that it stiffens down to an amount. When you don't have any movement anymore, we don't have any pain anymore. This is the reason why we probably see much less patients than we should theoretically. Again, when we look at the prevalence over the age of 80, more than 80% of patients have it. Again, that doesn't mean that they are symptomatic. There's a genetic disposition, and it's almost always bilateral. These are the stages of the disease, from normal cartilage wear, severe cartilage wear, and so-called osteophytes, so deformation of the bone as a reaction. Then stage 4, this is a bit the problem. Stage 4, this is the trapezium, the multangulus majus. We not only have osteoarthritis on the base of the thumb, but we also have osteoarthritis in the wrist. The next joint is affected as well. That's important in the discussion of the treatment options. What's unique, we all know that opposition is purely made by the CMC1 joint. The thumb saddle joint makes the opposition. It's placing the thumb in the three-dimensional space. That's why it has this unique anatomy. It looks like a Cardan joint, a double Cardan. It needs, because of that shape, important ligamentous structures to hold it in place. That's one of the problems in osteoarthritis because they weaken down, and it gives the so-called subluxation. The joints dislocate out, gives even more forces on specific points in the joint, and hurts even more. There's very high contact stresses, so if we press here one kilogram, we might measure 10 kilograms at the base of the thumb. For a man, I'm pretty strong in my hands. I press 15 kilograms, so every time I press completely, I have 150 kilograms on that joint. That's a lot. What's the problem of Sina? If we look at her, it was not that extreme in that particular case, but these cases, we see quite often. We call it a chain reaction. You have this subluxation, we call, so dislocation of the joint. The next joint is reacting. It hyperextends, and at the end, we call it the Z deformity. This is a compensation of the missing movement at the base of the thumb. Very difficult to correct. If they pinch these patients, it gets even exaggerated, and that's not an unusual case we see in our daily practice. What's the outlook for the future for Sina when she's asking? Pain will remain very likely. She's rather young, very active. It becomes more and more unstable in her situation because she's subluxating already, and of course, she will lose a lot of function in her hand. What options do we offer? It's a pretty busy slide, but I break it down to three different possibilities. I call it the anatomical preservation solutions, giving basically injections. There's one surgical solution, which is called osteotomy, where you break the bone, you change the axis outside of the joint, and then you unload the joint, which is below. It's called osteotomy. It doesn't work that well in the thumb, A, and B, most patients have a too advanced osteoarthritis that this option would make sense. You need some preserved cartilage where you can change the load to that area. The next group is the so-called functional preservation. That's where all the implants are coming in. The TOUCH. There were implants or still implants on the market, so interposition discs, which separates the bone. The results are pretty mixed. These are functional preservation options. Last but not least, I call it the joint destruction options. It's fusion. Fuse the joint, I'll come back in a second, or resect the joint. Take it out. Fusion, what does it mean? Imagine you have the base of the thumb fixed completely. You still have two other joints to move, but these joints are just doing flexion extension. No way to put the thumb in the three-dimensional space. That's fusion. It's a rare indication where it makes sense, especially in manual workers, where they need a lot of power and a lot of strength. This might be an option. There is a fear if you fuse that segment, there's more load on that segment, and maybe there's more degeneration in the future. Resection, we already heard it from Marc as well. Take the bone out. The trapezium goes away as a whole bone. In order to give the thumb some stability, we put in a tendon graft in a different technique. There are many techniques which have been described, but it's called resection, suspension, I suspend the metacarpal one bone, and interposition. Coming back in a second to the details. The famous joint replacement. Fusion is not an option for Sina. We are talking about those two options to her and give her the perspective. What is it all about? The resection arthroplasty has been invented in the 1970s. It's still considered as the gold standard in many markets. Why? It has been done for many, many years with quite constant result. I don't say the results were hilarious, they were not as bad as we could think about. There's a good pain relief. You have to be fair to that option, there are significant deficits. You have seen this adduction contracture, we call it like that, very difficult to correct with such an option. All the functional deficits which go along with the deformity basically remain after surgery. However, there's a low revision rate. In our series, about 2%-3% in 10 years, the chance that the patient has a second intervention is pretty low. However, if he needs one, it's very difficult. The bone is away, there's soft tissue around, a lot of scars. There's not an easy and good solution to that problem. Arthroplasty. Very interesting. We are talking about arthroplasty since many years. The big hype and the big wave of beginning of arthroplasty goes down to the '70s. Started with the hip, knee, all the other joints, including the thumb base. The thing is somewhat cultural, and interestingly enough, the big markets you have seen on the slides, French, Belgium, they were unique. They did their own thing. They had a high tradition in arthroplasty, but nobody took care about. We didn't even look at it. How can you trust a nation which hangs up the X-ray like that? By the way, the French and the Belgium are the only one in the world hanging the X-ray like that because they say men are standing in that position and not in that position. The only in the world. If you are at a French congress, you're all the time looking like that, because we are not used to see the X-rays in that regard. Nobody trusted them. These were the first implants, and they had a pretty bad track record. This is a dislocation, so this belongs into here. It didn't hold. This is a so-called loosening. You see the bone around the implant is blacker than the bone around the rest, which means you have a big hole inside. This track record, together with the fact that nothing was really published on it, made it that nobody took care about that. What changed? Changed a lot. I think we started to understand the biomechanics of that difficult carpal joint better and better. The big breakthrough was the so-called double mobility. The implant, you will have it, and I think it's turning around, has a double mobility in terms of this is the polyethylene so-called liner, the head, and this is the metallic head inside. You have two heads moving against each other. This double mobility enhances the circumference where the implant can move to a great amount, and this is one of the breakthroughs in that. We have better material. The osseointegration improved. Cup shape is different. We have two different cup shapes, which helps us to fix the implant much better here. The problematic zone is the trapezium. The fixation, the trapezium is the one which really is the difficult part. We have a stronger polyethylene, Marc talk about it, cross-linking, vitamin E. These are all things which improve the implant a lot. When we look at the results, just as an overview, looking at the different parameters, pain, pinch means strength, recovery time, durability, cost, aesthetics, complication. This is resection. It's cheap, reliable in pain reduction. All the rest, recovery time is almost endless. Goes up to a year until patient really recover functionally. Again, it's quite durable. If we compare that with the implant arthroplasty, this is proven scientific-given data, we see a much spectacular reduction of recovery time. The thumb looks normal again because I give that stability back. The deformity is corrected because we recenter the joint. The problem is the complication. I'm coming back to that. Dislocation almost disappeared. Maybe loosening, implant failure, mechanical-wise is an issue. It's a huge difference. This is a patient. On one side, an arthroplasty. On the other side, a resection. You see the difference? This is the resection site. Functionally, again, he falls in that position. Here, there's much more stability and thus much more pinch strength in those patients. What happened if it fails? Both can fail. The resection can fail as well as the implant can fail. If the resection fails, sorry, there is no way back. The bone is away. Here was the space for the bone. It's completely missing. If we have a problem here, A, we can change part of the implant. We can change the neck, we can change the cup, and in the extreme, we can go back to resection very easily. This was one of the reason to start that intervention, that we knew we had a backup, which was, or still, the gold standard in many markets. Again, comparison. What did we observe? This is all published. Spectacular, fast reduction of pain. After three months, patients are basically almost pain-free. Spectacular regaining of key pinch strength. Going up, no chance to resection. Our patients. Last but not least, return to work much, much faster. I almost never had an intervention where patients spontaneously said to me, "Doctor, I forgot I had surgery." It's really impressive. What about the cost? Very interesting and very important in many markets. If you look, return to work, again, spectacular. Own data published. We had the chance to get access to data from the insurance companies. What we see that, however the medical costs are a bit higher, RSCR is resection, this is implant. At the end, due to the fact that the return to work is much faster, it's highly cost-effective. I think this will be a driving force in many markets to persuade insurance company, like in Australia, like in the U.S., to approve that type of intervention. When you are looking at this typical hype cycle of new technologies, with the start, the euphoria, the valley of disappointment, then we find out how to use it. I think in the CMC arthroplasty, we never had this valley of disappointment. Nobody who started to adopt the technology from my colleagues changed back to resection again. Pretty impressive. These are numbers from France. This is resection. It's a flatliner. There is still resection on the market. There are indications. The stages of very severe deformity still need a resection arthroplasty. What you see is the incredibly growing in a already mature market, like in France. It's not a red ocean, it's a blue ocean. Means you enlarge the number of patients. Patients got confident. They hear that there is an option to treat them very well, relatively easily for them, in a fast time, and this increases the market. In our clinic, 2015, when we put in an implant, any type, we had to explain and discuss that. Nowadays, we have to explain why we don't use an implant because the results are so much different. This is indeed my first patient I did together with a colleague from Geneva who had more experience. He's a professional piano player, a boogie woogie player, pretty famous in the Switzerland. I saw him two weeks after surgery just by chance in the clinic. I said, "How is it going?" He said, "Spectacular. I already played piano again." I said, "This is not possible." "No, no. I'll show you." Which side? It's the left side. Pretty impressive. There's another example from a friend of mine from Spain. He had a fighter pilot with osteoarthritis at the base of the thumb, and he had to go for a check flight again in order to get ready to fly. The difficulty is moving the controls with arm and hand. Believe it or not, for that reason, engineers designed a throttle and a stick with buttons and levers that can be activated with fingers are much more under control than even the civil avionic flying. After 30 days from surgery, he got the approval to fly a jet again. Consequently, on both hands, the pinch is between thumb. Pretty impressive. There are tons of these examples. This by chance in a hotel in England. We had indeed a TOUCH course, this was at the reception. I couldn't believe it was confirmed that the company didn't buy it. Very interesting. To sum it up, there is a silent revolution going on in that regard of a disease which is extremely frequent, which needs a lot of patient treatment, and the standard now is going shift from resection to implant arthroplasty with very convincing results. More and more publications saying all the same. Fast rehab, normal function and strength. An interesting phenomenon is there's also peer pressure. Those colleagues who are not offering it, they lose patients. That's a classic. They might not feel it now, but the word-of-mouth from patients to patients is much more powerful than we think. I've never seen a new technique on the market which was so quickly adopted by the general practitioners. After one year when we started that, I got the first referral saying, "Would this be a case for an implant arthroplasty? I'm a general practitioner." They realize things are going on, this is very unusual. What I already said, nobody from my colleagues who started that technique changed back to the resection anymore. We still do it again. There is still a low number of patients which need that. I really can say after 30 years of hand surgery, nothing has changed or a greater impact my practice more than this new implant on the thumb saddle joint. It's really nice to be on that journey. Coming back to Sina, indeed, she has chosen together with her surgeon the CMC implant. It was a straightforward procedure. She had almost no pain postoperative. I think she took two pain pills on a low level. Extremely quick recovery. She worked back again after six weeks, but she did everything after two weeks, and she's extremely happy and grateful. She's now three or four years out. By the way, it's my wife. Just the last word. The Lancet, very famous scientific journal, said the operation of the century is the joint replacement of the hip. I think they are basically right. In orthopedics, this is absolutely true. I think we might be in a phase to say at least it could be the operation of the decade, the CMC arthroplasty. We have the same phenomena of collective enthusiasm. We have the same phenomena that there is a real change of paradigm in terms of treatment. We are now working already, as Marc said, on revision strategies because patients are coming back. It's a mechanical device. It will fail sooner or later. We must have strategies to solve that. I'm very enthusiastic to be on that journey and very happy about that. Thank you very much. Looking forward to your questions. Daniel. Daniel, thank you very much. Is it working? Is it working now? Peter. Yeah. Daniel, thank you very much. First of all. Quick question Sorry, it's a Schulthess Klinik. Schulthess. As a German, Schulthess is in our heads. This is a small thank you to you. Thank you very much. I think nobody better than him as a surgeon, and with your wife as a patient, explaining the advantage because we could speak hours and hours about TOUCH, but it's not the same like you. You also showed a little bit the advantages, the disadvantages. I think there are a lot of questions. Let me say something before we start the Q&A. Medartis will not become a mono-product company. I think at this point, Daniel is not the only one who mentions this invention of the decade, this change of orthopedics of a decade now, like the hip it was. It's now the TOUCH for the thumb. This will not mean that we will lose focus on our Medartis core business. I think this is very important to you to know. This might become bigger than Medartis. Yes, we know. We still have a focus on Medartis because we believe that hand in hand this is working. Now I would like to ask. I just want to confirm that. Yes. I think the TOUCH is a clear door opener. Yeah. That's absolutely. Especially like in the U.S., it's the only implant which has been approved, you mentioned it. I think we will have an advantage of five to seven years. Other companies, of course, were aware of the success of that implant which is going on because it's so enthusiastic. If you look at the program of the FESSH, the main subject which is discussed is CMC1. It's interesting if you observe over the years what the subjects are, how they change. CMC1 at the moment. I just got last week a mail from our most important journal. It's the "Journal of Hand Surgery," European Edition, with the highest impact. We had three papers most cited last year just about the subject of CMC arthroplasty. Yes It's just an enthusiasm there. We want to know how the patients are doing. We have in our clinic a prospective registry where all the patients are registered before the intervention and in typical intervals. We gain a lot of insights. I just want to confirm. We need one more table, Fabian. For a company, it's certainly a door opener. Yes. Great. Now I would like to ask for the Q&A, Peter, please, because I believe financial questions are coming anyway. Marc is there. Mario. If you have a Flash question, Mario, come, please. This is Andreas Richter. He's working in Fabian's team. They are multiple purpose, our team members. Thanks a lot, Andreas. Questions. There's one in the first row, Matthias. We need to get the microphones up there. We need a second microphone. Just before we start, having heard that presentation from Daniel Herren, who of you thinks that? His wife, his partner, his husband should get- Antonietta, can you help with the microphone? A CMC1. Please Arthroplasty, a TOUCH instead of a suspensionplasty. Raise your hand, please. Yeah. I have a couple of stocks, TOUCH stocks here. You as well? Tanya? Wells? Fix, yeah. The big difference of the resection or implant is you can pull it up much faster than before. Thomas, you believe you need as well, huh? Thomas. Good. The first question? Yeah. Hey, Fabian. I go over there. Hi. Give us one microphone here. Hello. Does it work? Yeah. Yeah. Hi, my name is Michelle. I'm working with ZKB. As you see, I'm already a big supporter. I'm wearing the socks. Very good. I actually have a question for you. I think you convinced all of us that the prosthesis is the better solution now. What made you choose the Medartis product instead of a competitor's product? Honestly, I've chosen KeriMedical. Oi. KeriMedical. Yes. No. There's an evolution of that implant, and at the stage where we decided to step into that, one of the decisions was the double mobility because we have already seen first publication showing that the dislocation, so that the joint really dislocates and gets out, was basically disappearing. We feared that because that's not a very pleasant complication. When they started to have that, the implant was called Moovis, but this was from the same engineering background. COVID came, and Moovis was sold to Stryker. Stryker didn't have an interest. They must be now mourning. Keri came with a kind of evolution of the Moovis with the double mobility. At the moment, the double mobility, the only implant available was that one. Meanwhile, there are two implants on the market with double mobility. As you know, there's the one, the MAÏA prosthesis from Groupe Lépine, and they look very similar, but the advantage of the Keri, and this is really neutral, they have two different cups. We have two different shapes of cups. Surgical-wise, you still can choose the ideal solution for that specific patient, which the MAÏA doesn't offer. That's why I've chosen that implant. Thank you. Yeah. Microphone, please. Are there more questions here? Antonietta will help, please. Thank you. It's Sandra Dietschy. Oh. No, it's okay. Yeah, women's first. Sandra from Octavian. I have also two questions on TOUCH. The first is on the payer side. You mentioned, Matthias, that kind of the pre-approval process from the payers is a hurdle to adoption. Can you elaborate a little bit more on that? What's the% of cases that is being approved or is it more a problem of the time to get the pre-approval, or are payers pushing back to lower cost resection treatments? How is that in the U.S. currently? We expected at the beginning much more rejection, much more pushback from the insurance companies. We are still early in the process. I would say, we see the first cases rejected, but much less than we expected. To put this in numbers, I would say at the moment, 90% is going through, 10% is pushed back and needs a discussion and our team stepping in. We have a team and we have an agency helping us on this. We have to observe this. If this number goes a little bit higher, it depends also on the institution and it also depends on the surgeon, he has a very important role. He can have some influence. As more the surgeon is explaining the benefits and the faster recovery and less OR time for a TOUCH prosthesis. I think Daniel, you did not mention how long it takes to you. How long it takes to put a TOUCH on average? The shortest was 28 minutes. 28 minutes. Also this is a much shorter procedure time than with a trapeziectomy. Trapeziectomy. Trapeziectomy. Also 10% around. About that. I may add, maybe because with the discussions, I just came back from Atlanta from a training course, and we had a lot of discussion. This reimbursement issue obviously is a problem or a discussion point. In the U.S., a lot of surgeons are partners of outpatient surgical center. It's a question of volume and negotiation with the insurance company, how much they get from that. It's a completely different market compare what we know from Switzerland or in other European countries. It highly depends on the negotiation from one to one company. It's amazing. Again, it's different if you do it in a hospital or you do it in an outpatient surgical center. Second thing is, Jonathan Tueting, the first contact we had with him was here in Basel. He was sitting in the front row like that, and he has Viking roots. I thought he will kill me immediately. He was so critical about that implant we could demonstrate here in the IBRA lab. Now he's the one who is really pushing these things forward and gives lectures. He comes into the TV. He did it that way. He's a high-volume surgeon for that Rush hospital in Chicago. The hospital realized, the manager, okay, at the moment this might be a deficit. For purposes of public recognition and everything is important, and he's a high-volume surgeon. That's why he gets all the approvals for that. It's very local and very individual. Yeah. It will come. I think to add this, the Rush institute from Tueting in Chicago, they were supporting the first implants end of last year free. There was no reimbursement in place. They paid it out of pocket from the hospital. Just to make the medias and the marketing, because they believe in a huge opportunity for the future. Super. Very helpful. Thank you. Good. I have a question for Peter, on profitability. By when or which revenue level is needed in the U.S. from TOUCH to make that business break even on a fully loaded cost, including the investments in Florida and the field experience, et cetera? I'm not sure we are not building a completely separate infrastructure up with a completely separate organization to distribute and sell TOUCH in the U.S. We can also leverage our existing distribution channels that we have, either the direct ones or the indirect ones. What we are building up is a team of specialists, so-called field specialists that are supporting, on the one hand, our salespeople or our partners, but who are also supporting and consulting the surgeons in the operating room at the end of the day. I would expect profitability for the U.S. business itself of TOUCH in next year. Tanya Hansalik, UBS, or- Andreas, you have to be careful not to forget him. He was the first to raise their hand. Okay, go ahead. I'm sorry. Yeah. I have two questions. One is, you mentioned a run rate for TOUCH of 150 for the first time in the month of May. If I keep this going for eight months, you're already at the 1,200 cases that you targeted for the year. Maybe can you frame your guidance, what's baked into the upper end of the guidance, and is there, I guess, upside potential? This is the reason why we are so careful. Each single number you give, they're already extrapolating and calculating. Matthias, you are too cautious. Yeah, you are right with your calculation. Yeah, I'm cautious. I think in August, we have then also June and July run rate. I said it was the first month of above 150, which is good. We have no doubts to reach the 1,200 this year. Let's see. I think the positive message I wanted to give is that the acceptance in the U.S. is there. This is the first thing. That we have top surgeons in the U.S. who got educated, Daniel, for example, who is now in Atlanta, who's taking this knowledge from Europe. This is the second thing. The third is that we are now starting to prepare U.S. surgeons. You said it once in an interview, Daniel, how many surgeries a surgeon should have done before he could teach others? We published on that scientifically. It needed about 30 cases to get a stable proficiency in terms of produce the intervention on a standard level. This is in accordance to other joints like the shoulder or the knee. Yeah. It's always a question of time, of course. If you do 30 in 30 years, it's not the issue, but in a given time. Yeah. The thing is, the challenge is, and I've never seen a program or been involved in a program which invests so much into education. It's not a difficult intervention, but it's not an easy intervention, too. There are tips and tricks like everything in life, which changes, and we are still a learning system. I think the rolling out of the education is key here also for the numbers. Personally, as a surgeon, I'm pretty proud also of the company in terms of they take their responsibility. They could have trained already 10 times more surgeons. We already realize now at the moment that we are probably leveling up. We had the top U.S. surgeons at the beginning, and now, don't take it wrong, we are probably already approaching the second league, and we see that on the table when we instruct. They need more support. They need more supervision. I think that's extremely important that the company's investing in that also in the future. Other than that, you can ruin a really good implant if people are just using it wrong. Correct. This is important. What you asked Sandra before is we are building Florida education not only because of TOUCH. This will be an IBRA center. It's not only TOUCH. The education is so important. Let me explain to you one thing. We have at the moment around 70 surgeons, 70 trained in the U.S. on TOUCH. We have only around 49 using TOUCH already. Why? Because hospitals are delayed in the contract, or the hospitals are delayed with the reimbursement getting in. Those surgeons we are training again before they do their first TOUCH cases. It's very important. We are only training surgeons where we believe they can do at least two TOUCH cases per month. They should do around 24 to 25 a year. This is very important to maintain the practice. Of course, I said it because it's already published. You will not find all Jonathan Tuetings who are doing 100 in 5 months. This is not the standard. This is a little bit the heavy users. We have some also in Germany. We have them all over, but this is not the standard. The standard should be a user who's doing two TOUCH per month, at least who's keeping traction. As Daniel said, if you figure out, and therefore our field specialists are so important, if you figure out that there is a surgeon who has done nothing in six months, we have to be careful. Today in social media's time, the worst thing, even if it's not a failure of the prosthesis, is negative image on social media. A patient complaining because there are problems, and it's a surgical mistake. Did I answer your question? Yes. Thank you. You still have to do some math. My second question was on the rest of the Medartis portfolio, which I think is also key for the growth story. You mentioned Keri being the door opener in the U.S. to get into contracts. Can you maybe talk about some evidence you've seen of this, or are we still in the early stages here? We have a super sales excellence team in the U.S. We have a person already before we started all this. Ted is already long time in the organization. We have a lot of data, and we are using more and more this data to drive also our commercial team. I can tell you that we have already gained 28 out of all the trained surgeons became new Medartis users already. There are only a few. I mentioned 68 were trained, 49 used TOUCH already, but 28 of them are already using also for the first time the Medartis hand or wrist portfolio. Yeah. They have not used because we got into the hospital. Is this now an indication that the 28 will continue with all the trained, but we see a positive impact, and we have to stick on this. We are also now more flexible in our own training centers to speak about Medartis. For example, I spoke yesterday with Daniel coming back from Atlanta. I asked him, I said, "Was Medartis touched really?" He said, "No, there was not enough time." If we have rented training center cadaver labs, they are so expensive that there's sometimes no time to speak about Medartis. The Medartis products are only showcase. In the future, we will have this also as a part of the education. We will speak about TOUCH. The trainer who is there will teach TOUCH but will speak about Medartis hand and wrist portfolio. We are internalizing this. Yeah. Okay. Yeah. That's Samuel from Skovborg. Probably my question goes also to Mr. Herren. You showed this slide against resection and at complication and durability, it was still a little bit behind with the implants. Do you think this could change over the time with increasing experience of the surgeons with this procedure, or you think this is really perhaps a disadvantage? No, absolutely. Taking just the bone and put a little bit tendon in, it sounds easier than it is. It has a lot of room in terms of surgical techniques. You cannot do a lot of mistakes. The complications come from the nature of the procedure itself. The bone subsides, takes contact with the next bone, is rubbing again, pain again. This is a typical complication we see in resection arthroplasty. The moment you put in something which is more complex like an implant, the likelihood of a complication is higher. I have a talk this afternoon about our complications in implant arthroplasty. The vast majorities are simple complications. We have to put that in a perspective. When I say here complication potential is higher, this includes every type of complication. We define a complication is an event after the intervention, which you might expect, but happens and needs further treatment. A lot of these complications are treated by an injection. It's the tendonitis and inflammation of the tendon. We have 3% of tendonitis after TOUCH. This is by far the highest complication we have. Dislocation is down to 0.7%. The real complication associated to the implant itself is lower than what I was talking about. Again, it's a mechanical implant, so the likelihood something happens to that mechanical device is naturally higher. Thank you. I would have a second question. I think more to the company. Health economic study specifically for the U.S., how important is that, and what are you planning in this direction? For the TOUCH, sorry, for TOUCH implant. You mean how important the TOUCH sales in the U.S. are for the economics in the U.S. itself? No, health economic study. I think we saw something also from Mr. Herren on European data, I guess. It's Schulthess Klinik data. Schulthess Own patients. Yes, with data from insurance company like Helsana and CSS. These are real data comparing those two procedures in a working-age population, so completely comparable. Sex and age matched. Yeah. These were the data. Yeah. The question, how important would this be that you show something similar in the U.S. for longer-term ramp-up of this procedure? We are doing this. We started immediately. First of all, we have one study which we are obliged to do from the FDA. This is really to control each TOUCH placed on a long-term success rate, and if there are no complications, it's one thing. The other thing is we are now doing in the U.S. with the U.S. surgeons from TOUCH one in the U.S., really a follow-up. Also getting the patient input to show afterwards data, how fast the recovery is, how fast the people are back to work, how much money you can save. Daniel mentioned it, how much physiotherapy you have to take out with another procedure, how long it takes to be back really mobile. All this you can figure out in numbers and in figures to show the insurance companies the benefit of a higher-priced procedure, but on a long run, it's cheaper. I think the patient feeling and back to life and this happiness of the patient, you cannot pay in money. This is something you cannot put in a study. Unfortunately, there are some patients also in the U.S., they are not willing to be fast back at work, but you have this also in Europe. This is another problem. We are doing this study. Not only in the U.S., we're also looking into other markets like Germany and other markets to do these type of studies. Hello. Daniel Jelovcan, ZKB. Also to Dr. Herren, as you are here and one of the top surgeons, we have the possibility to talk to you. First one is, I guess your penetration of TOUCH in Schulthess must be very high, 80%, 90% of all procedures. Is that the correct assumption? No. Unlike the hip guys and the knees in our clinic, we have a much wider variation of interventions we are doing. We increased the number of treated CMC joints, yes, indeed. We almost doubled it because word of mouth, again, GPs who are sending us patients. In joint replacement, it's by far the most often performed procedure at our clinic. We were the first started in the Swiss German-speaking part. We published after one year on the Congress of the Swiss Society, our first impression and results, and from then on, it just ramped up. It was extremely impressive. I was proud to see that people had confidence in us. We have a scientific board which was completely independent from us, so we don't do the measurements. The measurements of these patients' data are all done by professionals out of us with standardized measurements. Our registry file was the file which was approved by the FDA for the FDA approval of the implant in the U.S. We had to send all the raw data of our patient's registry to the U.S. U.S. statistician analyzed it again. They proved that obviously we didn't do a lot of mistake, which is for us, a measure of quality of the data we are collecting. The number of TOUCH procedures versus fusion versus the other one. Trapeziectomies is probably the majority, right? Yes, absolutely. You've done a lot of trapeziectomies before the TOUCH. Joint replacement is our core business from the clinic and the history of the clinic. We published already a lot about the thumb subtlety around at the resection arthroplasty, so this was our field of competence. That's why we can now compare our patients before with the old technique, with the new technique now. Again, the difference is rare to do a resection arthroplasty, and honestly, I liked the resection arthroplasty because we mastered it at the end in a way that it was an easy procedure for us. I meanwhile hate it. It's technically such a difference to replace a joint instead of just taking a bone out, which is a very brutal intervention at the end of the day. And- Maybe I know where your question is going on, Daniel. I think it's also important that Switzerland, unfortunately, is not a direct market for us. It's not our team or Mareike's region selling Switzerland. We have a distributor taking over from KeriMedical, longtime partner of KeriMedical. I think we could do more in Switzerland if it would be in our hands, very honestly. It's also not the biggest market. They get a good service, but it's around 3,000 TOUCH per year in Switzerland. I think it could be a little bit more because you can also have some demographics, how much people living in the country and how much TOUCH by age and whatever. It's around 3,000. Okay. No, my question was then more, I am sure you talk to your other colleagues in other countries, obviously. Your colleagues in Spain or in the U.K., which is only 5% of your sales in TOUCH, and you are more or less the only one, where does it go in other countries? The penetration must be very low. Exactly the same. Exactly the same. It's increasing. Okay. As we already discussed, the reimbursement is a big issue. There are laws. I just give you an example. In Scotland, so far, it was not allowed to put in an implant in a patient which is older than 65 and not working. Believe it or not, it's no longer part of Europe, but unbelievable. I just learned two days ago on a dinner from a colleague from Scotland that they are changing the policy. The government realized we are missing an opportunity to bring back people early to work. The quality of life is increasing dramatically faster. There's pressure from different sides. It's amazing. You cannot compare that market with that. The driver of the markets are sometimes out of the medical indication. A last question, a stupid question maybe, forgive me, but what about the other fingers? I mean, the index finger is also quite important together with the thumb. The first finger I would let me amputate is the index finger. It's completely overrated. It's just to wake you up. It's true. If you have something on the index finger, you can compensate with the other finger. No. MCP, just short, I don't really have time. Yeah, we have still half an hour. Yeah. MCP joint, this joint here, this was the classical joint. Patient suffering rheumatoid arthritis. We did tons of that. Since the new medication was introduced about 20 years ago, the numbers are almost to zero. We rarely implant an MCP joint anymore. DIP, if you go to the other end, these joints here, we tend to fuse them. We did a series of silicone implants here. It is certainly not good in the index and in the middle finger because we are pinching with the thumb, so there is a lot of deviation forces, so an implant is not a good solution. We do fuse these joints here. Their fusion is a good option. We are on the PIP joint market, and there are two implants on the market which are in use. The PIP joint is a more delicate and a more difficult joint to treat it with a bit more unpredictable results than the CMC. We always compare it, this is the knee and this is the hip. Not only looking, because if you look at the PIP joint, the two-component PIP joint, it looks like a knee joint. If you look at the CMC here, it looks like a little hip. I always talk about the Barbie hip to the patients. They love it. Since the Barbie movie, we can do that. We have the wrist, and the wrist is, I say personally, an unsolved problem. There are implants, but it's heavily debated. Very complex joint. Ed Hall from Stifel, apologizing on behalf of the English/Scottish NHS system. Sorry about that. A couple of questions, well, actually the majority on TOUCH. I think you talk about it being a Barbie hip and obviously replacement rates in the hips are there. From your experience, is there a certain replacement rate when it comes to the TOUCH prosthesis? That'd be my first question. I didn't get it completely, sorry. Just in terms of obviously certain hip operations, there are replacements that need to go on. From your experience, is there a certain or a similar, let's say, replacement rates with hip, with TOUCH or not the case? I definitely think so. Yeah. The numbers are suggesting that. Again, what I said, it's not a red, it's a blue ocean, which means we are increasing the market. Patients, if you talk to a patient and tell him, "I would take out the bone and I stabilize it with their own tendon," that's what we do, they are afraid of that intervention. They hear from a neighbor, "It took me a year. It's fine. The pain is away, but I have no power in my hands," blah, blah. That's a completely different ballgame. I think we're really increasing the market. Yeah, definitely. That makes sense. Maybe just on the other side, obviously, similar sort of question just on sort of bone infection. How significant is bone infection within the thumb joint compared to maybe other larger joints and sort of bacterial infections, and what are the current methods of which you would treat that? Infection is an implant arthroplasty disaster. We hate it. You take it personally if you have an infection. What is the infection rate, to put it in a perspective? The international numbers for hip and knee infections, primary implantation, are around 3.5% to 4%. In our clinic, it's also proven from the registry, 0.8%. Yeah, there's room for improvement, and honestly, the rate is among the highest in the U.S. The most costly healthcare system has the highest infection rate. The first question I got in Atlanta, I swear, was from the colleagues, "How many infections did you have?" I was together with a colleague from the Netherlands. He overlooks 500, we overlook almost 900 implants, and both of us said spontaneously, independent, "Zero," because we had zero infections. In the hand, the hand is not very prone to get an infection. Usually, it's in very complex situation, trauma, whatever. Resection arthroplasty, we have zero infection as well, so that's not the issue. We don't even think about infection. Perfect, thanks. Final question would just be on reimbursement, the Category III code in place, and I guess, be curious to hear your thoughts on what is required to convert that to a Category I code and sort of the timelines of how we should expect that. Well, we have now, let's say, we need our studies for this also. We have now a year in peace of mind. We discussed it, on average $6,500. This is also, we calculated it in our estimations and our scenario analysis and our plans with a lower reimbursement code. We are cautious. If the studies confirm all the information which we have delivered before we got the reimbursement code, it will be prolonged, it will continue. There is no reason on what Daniel also said, that the studies in the U.S. show the same results we have in Europe since 10 years. It's all fine. You can imagine there is a team working on this, although this is not a one-man show in the U.S., it's really a professional team. Our own team, together with agency teams working on this, because as higher the reimbursement code remains, as more attractive it is. Also, I tell you, this CHF 4,500 reimbursement would be also attractive because the reimbursement in Switzerland. We are a multiple down. Yeah. We are about 2,500, but in- In Switzerland. Yes. France and Germany are much lower, so Switzerland is still within Europe an attractive market. Yeah. Will be interesting. Japan is interesting in reimbursement. Yeah. Australia. Yeah, Australia as well, but not even coming close to the U.S. No. We are talking about- Yeah 8 to 10,000 in the US. Yeah. It's also attractive for the money the hospitals get for the treatment. I think what is important, and we cannot answer, but even if we would know it, what we don't know is the overall potential, this blue ocean. Coming back to what we said last year, we said we know that 150,000 surgeries are taking place in a year. We would catch with this CMC-1 procedure 10%, 15,000 case. Honestly, we have no clue. It could be multiple hundred thousand of cases possible. Yeah. Maybe one question on the product roadmap presented by Marc. On the CMX, can you please maybe tell us why are larger players leaving this market? What are the economics on the new solution, patient-specific and scalability of that? What do you mean by leaving this market? Big players are not playing anymore. Yeah. Yeah. I think that Stryker. Specifically Stryker is going out of some of the markets. They're not pushing back from all their patient-specific or CMX solutions. It's really, in some markets, they're stepping out because of reimbursement. Scalability, we think it's really heavily scalable since, with all the automation, a lot of the planning can be done just by the computer. Andreas elaborated a little bit on that one. We're working with bots doing the planning, and there's a high level of automation already done by the team, so we can scale the cases. Also by doing kind of automated segmentation and all that stuff. It's really scalable. In terms of manufacturing, the team of Mario has a huge experience in scaling manufacturing processes. Also there, we're pretty confident that we can scale the business and regionalize it also because that's important, right? Keeping lead times low in patient-matched or custom-made services is really important because the surgeon doesn't want to wait like four, five, six weeks on a case. They want to have it, as Andreas said, in four to five days being ready, especially in these tumor cases where the tumor can grow. You need to be very fast in delivering the products. On the production site, this is done with 3D titanium printers? We have several options of manufacturing. Some of the implants we're printing now with CADskills, other ones we're milling kind of conventionally because we have TriLock in it, we anyhow need to go on a milling machine. There's several options of manufacturing the implants depending on what type of implant it is. Maybe Mario, you can just say a word. I think this 3D printing of titanium, that also with CADskills, we have still to install a milling machine. It's not coming out of a printer and then it's ready to use. Maybe in a few words, this process, how does this work? Yeah. Here in Basel, we are still milling out of the blanks. This is our process, and the cases that you saw before, they are milled here in Basel. They're not 3D-printed. CADskills prints from 3D, but we are planning to also add some milling capabilities there for locking features. We are extending also our capabilities on CADskills. As was mentioned before, we are planning to scale this technology also globally to address additional markets. I just can add, we are talking about two different things. The numbers of these procedures will always remain low. It will remain a niche, special indications. I don't know in the CMF, no, it's not a thing we would like to roll out like an implant arthroplasty. It will be dedicated to a few centers who do a significant caseload. It's not like a thing which will popularize, everybody does it. What it is, definitely it is, that's the classical door-opener. Yeah. We surgeons like that. When I thought back how I did the corrections 20 years ago and now, I would never step back again. It's like having a horse or a Ferrari. Yeah. It's a completely different ballgame. No, exactly. I think therefore Medartis is so well-known and also so respected that we have this specialty, and we are taking the time to offer the best solution for the patient and for the surgeon. Where others, when I mentioned they are stepping out, they are trying to divest a little bit this area. They are too big to fail. They are selling so much hip and knee that for them, it's not important to have this specific patient approach, which we do. Yeah, we believe also it's part of our future, it's part of our DNA. Probably another comment. We see other competitors coming in to the patient-specific market. It's very important to provide all these services and the indications very active because otherwise, others come in, as said, it's a door opener. They try to sneak in then their standard portfolio. It's very important to provide these services to the customer to also protect and grow our legacy business. Yep. By the way, to end that, you are collecting data, which are extremely because you always do CT scan from both sides, so you take the reference of the healthy side. You are collecting a huge amount of data of healthy bones in the hand, which further helps to develop new implants and find new solutions. I think it's always these side effects which need to be also taken into consideration. That's an important point. It also helps us for all these digital services like Trauma AI, because we then have the data to base on all these services. Yeah. Good. Good. Before Matthias closes down, maybe a word also. I don't know if I can see you in the camera. I would also thank the people that have participated online. Before I hand it back to Matthias for the closing remarks, we have food prepared for you, drinks. The experts are still around. We would leave at 12:15 P.M. with a bus, which is departing over there. Also, the ones who have signed up for the factory tour, that will start at the reception at 12:15 P.M. The ones who have a yellow sign or have signed up for the congress, the ones with black and white are for the company tour, if at all. Thank you very much. Matthias, closing remarks. Okay. From my side, thank you very much. Also, the online attendance, I forgot that we have a camera up front. Hope we involved you a little bit. Thank you for joining here. Yeah, thanks for your interest in Medartis. We see each other latest, I think it's the 18th of August for our half year. I don't know if we see each other or we speak each other, Fabian, what is planned. I love to see you, but okay. Yeah, enjoy FESSH. Nice congress, you see a little bit where the orthopedics is coming from. When I say where we are coming from, where we are heading to. Thank you very much