Morning, everyone, and welcome to those joining on the webcast. I'm Emily Heaven, Head of Investor Relations. It's a pleasure to have you with us for our Expert Surgeon Insights event. We have a strong lineup this morning, including presentations from five renowned surgeons. During the breaks, I'd encourage you to visit our product fair next door. There'll be a light lunch for those able to stay after. Now let me hand over to our CEO, Deepak Nath. Thank you, Emily. Let me add my warm welcome to you all. It's great to have you with us here in London as we mark our 170th year, as a company to showcase our innovation that's driving better patient outcomes and ultimately supporting our growth. You'll hear from leaders across our business demonstrating the strength of our portfolio, and importantly, from surgeons themselves, the people using our products every day, about what truly differentiates our offerings in practice. As many of you know, our RICE strategy to accelerate growth and improve returns is focused on four priorities. First, reach. That's about reaching more patients by driving adoption of our differentiated portfolio across indications, settings, and geographies. Second, it's about innovate. It's advancing the standard of care through a strong cadence of new product launches and scaling our key platforms. The third is scale, which is prioritizing our investment into our highest growth and highest return opportunities. Finally, execute efficiently. That's about driving productivity and asset efficiency across the group, particularly in orthopedics, to expand our margins and improve returns. Together, these priorities underpin our ambition to deliver 6%-7% organic revenue growth and 9%-10% trading profit growth over the next three years. Now, through continued strong cash generation, we expect to reach over $1 billion in free cash flow by 2028 and ROIC of 12%-13%, which is comfortably above our cost of capital by 2028. Today's session focuses on innovation, the second of our four pillars. In that we showcase how we're stepping up R&D investment in sports and wound while maintaining a robust front-loaded pipeline across the group, including in orthopedics. Over the last three years, we've successfully launched 44 products, largely on time and within budget. We plan to increase launch cadence going forward with 14 new products in 2024, 15 in 2025, and expanded to 16 in 2026. We're also building on our two major scalable technology platforms, MTECH, where we just launched our next generation LEAF monitor for pressure injury prevention in wound. We'll be launching TESSA and Lumos in sports medicine. You'll hear more about that later today. We also have a rapidly evolving robotic platform to drive procedure innovation across all major joints in orthopedics. The second of our innovation platforms is in biologics. We'll build on our leadership with innovations like NexGenatin, very creatively named, which is our next generation of REGENETEN. With that, let's now look at some of our most exciting growth opportunities, starting with Cathy. Cathy Dalene, who will talk to you about unlocking the value in wound management. Cathy, would you come up? Thank you, Deepak. Good morning, everyone. My name is Cathy Dalene, and I lead global strategic marketing for the Wound division. At our capital markets day last year, we spoke about five large market opportunities that we are focused on. I'm excited to share greater detail of two of these opportunities and our innovative solutions to address those that will unlock further value for our business. Both opportunities create new markets by preventing wounds from occurring, by reducing the risk of pressure injury, or reducing the risk of surgical site complications. Today, pressure injuries are one of the most burdensome conditions in wound care, it's impacting around two and a half million patients in the U.S. each year alone. These injuries prolong length of stay by nine days, they take over 40% of nurse time, which leads to $27 billion financial burden on the U.S. healthcare system. We have two products to help prevent pressure injuries. The first is LEAF, a unique, fast-growing patient monitoring system, which has been shown to reduce the risk of pressure injuries by 94%. The second is ALLEVYN COMPLETE CARE. We have recently launched in the U.S., we are launching this quarter in Europe. ALLEVYN COMPLETE CARE is addressing with 51% better exudate management than the market leader. It also has four times more flexible and has a unique shear defense mode of action because it is the only dressing of its kind that has non-bonded layers. This feature means it has 55% greater ability to absorb friction and shear. We are excited about the opportunity to accelerate growth with ALLEVYN COMPLETE CARE. Three global wound KOLs were part of the pre-launch. Very early on, we had feedback from each of them highlighting key benefits of the new design. Dr. Kevin Wu recognized the impact of the high flex design, making the dressing contour better to the patient's anatomies. Wound ostomy and continence nurse, Catherine Milne, observed the impact of the change indicator, leading to less dressing changes. Last but not least, Dr. Alicia Smith saw less friction and shear translate to the skin of the patients that she was preventing pressure injuries on. Moving now to another key opportunity in wound care, surgical site complications. This is an area where we are uniquely positioned to set a new standard of care that will truly help improve patient outcomes. Surgical site complications are a significant underserved problem. Complications can be devastating for patients and a huge financial burden on the healthcare systems. There are two known factors that increase the risk of surgical site complications. The first is patient factors like BMI or other comorbidities. The second is the procedure-related factors, such as time in the OR or, for example, emergency procedures. Surgical site infections are the most common complication of surgery with an incidence rate of over 5%. One infection alone can cost over $20,000. We have two main solutions to help reduce surgical site complications. The first one is ALLEVYN Ag+ SURGICAL. The second is PICO, our single-use negative pressure wound therapy device. We launched ALLEVYN Ag+ SURGICAL last year, featuring a faster and more sustained antimicrobial action than leading competitors. It has a superior reduction of the bioburden, and it has superior pad extensibility. Finally, the dressing can manage two and a half times more liquid than the market leader. With PICO, we are committed to transforming the standard of care for surgical site complications across key specialties like orthopedics, OBGYN, cardiothoracic, general surgery, and plastics. These high volume procedures represent a significantly under-penetrated opportunity to reduce complications and truly improve outcomes. Today, single use negative pressure only represents about 20% of the potential $1.7 billion addressable market opportunity. PICO is our first-ever portable single-use negative pressure wound therapy device. PICO protects the incision site, simulates the biological healing process in the surrounding tissues, and increases lymphatic drainage, reducing the incidence of infections and other complications. It was launched in 2011. We have continued to evolve the product ever since. In 2014, we launched a soft port. We continued our innovation cycle in the following years with PICO 7Y and PICO 14. In 2018, Professor Kirsner at the University of Miami published a key study proving the efficacy of PICO in open wounds, extending the indication range. In 2020, we reached an impressive milestone of 1 million units of PICO sold since launch, making it one of the fastest-growing brands across all of Smith & Nephew. We have consistently delivered double-digit growth over the last decade. I firmly believe we can maintain, if not accelerate, with the right investments and focused execution. With PICO, we can reduce the incidence of surgical site complications by up to 63%, and we can reduce the average length of stay by 1.75 days. In short, the benefit to the patient outcomes and the financial savings to the system are significant. Through our consistent investment in PICO, we have secured over 200 patents on both the pump and the dressing design, which together deliver a unique mode of action to stimulate the biological healing process. We have over 310 studies, 60 of which are RCT Level 1 studies, the highest quality and the most reliable evidence that you can get. The ultimate proof is the meta-analysis published in The Lancet, one of the world's most respected medical journals, which confirms, again, the effectiveness of PICO. Last but not least, we have guidance from the National Institute of Clinical Excellence, or NICE, here in the U.K., which recommends the use of PICO to reduce surgical site infections. NICE is a U.K. public body that validates both the clinical and the cost effectiveness of medical technologies. It provides a strong endorsement for our product. In conclusion, the right strategy for PICO is set. We will significantly expand the number of patients we can reach. We will accelerate innovation for PICO through our strong coming pipeline. We will build our leadership in single-use negative pressure wound therapy, and we will scale even further. We're investing in top talent to strengthen our selling capabilities in the OR and to drive more effective execution. Unmet need and the market opportunity is clear. Our strategy is set. I am confident that we have the right product and the right team to accelerate and to deliver on our ambition. Now, it is my pleasure to introduce our next speaker, Dr. Ravi Bashyal, Director of Outpatient Hip and Knee Replacement Surgery at Endeavor Health in Chicago. He is the Medical Director and Chief Hip and Knee Replacement Consultant for the National Basketball Retired Players Association. He holds an academic appointment as Clinical Assistant Professor of Orthopedic Surgery at the University of Chicago Pritzker School of Medicine. In his practice, he specializes in robotic minimally invasive hip and knee replacement and is performing approximately 600 ultra-minimally invasive total hip and knee replacements every year while still actively participating in clinical research and education. He has published extensively on reducing surgical site complications and infections. Please join me in welcoming Dr. Ravi Bashyal. Thank you, Cathy. Good morning to all of you. Really a great pleasure to join all of you this morning. I'm here to talk to you about what I call Destination Zero. You heard in Cathy's talk that the chance of developing a surgical site infection across all surgeries is about 5%. Within hips and knees, if we look at the AAOS's forward-facing patient website, it tells patients they have about a 1%-2% chance of developing an infection after their hip or knee replacement. I always say to myself, I got on a plane to get here from Chicago yesterday. If there was a 1% or 2% chance that something really bad was going to happen on that flight, I would be doing this virtually, okay. Destination Zero is about really bringing that same mindset to orthopedic surgery and to surgery in general. Aviation has a spectacular track record of safety. There's no reason that with a little bit of focus and thought, we can't aim for better in orthopedics. Specifically, my practice is hip and knee replacement, and so many of the things that you will hear from me are in that context, but please understand that these are applicable across other specialties as well. I do about 600 hips and knees every year, as Cathy mentioned. I use PICO on every single one. The question is, how and why did I get there? It's not because I was going to have an opportunity to speak to all of you. I've been doing this for some time now, and it is because of this journey to try to get to zero. My number one fear as a hip and knee replacement surgeon in my practice is infection. It is devastating, and we'll talk about why and how, but it's horrible. My number two fear, persistent infection. That's an infection that we try to treat, but it doesn't go away. That happens more commonly than you might think. My number three fear is an SSC that's not infected yet. An SSC is a surgical site complication. These are simple things that may not seem like a big deal. A little bit of drainage in a wound, a hematoma, a seroma, a collection of fluid. Left untreated, those can then follow a cascade and end up as that devastating complication surgical site infection. Why? Why is this such a big deal? Why is this such a problem? It's because there's a huge patient impact when a hip or knee replacement patient develops an infection, both for the patient but also for the system. There's a cost element, and I use that word intentionally. There's a financial cost, but there's also a human cost. Here's some sobering data. As we've mentioned, about 10% of patients will develop some sort of SSC after surgery. I always say that they sign a consent form. When somebody comes to see me, they say, "Yes, I can have a heart attack, I can have a stroke, I can die." When they come to me for an outpatient total joint replacement, they're thinking about their friend who sent them to me who was playing golf in three weeks. They're not really signing up for that cascade, okay? Even though the consent form says so. Here's some sobering data. If you look at a survivorship curve, and this is what you usually see when people are talking about cancer, periprosthetic joint infection, or PJI, is on that list. You have a better chance of surviving some prostate, melanoma, and breast cancers than you do a periprosthetic joint infection. It is not an ear infection where you just take some antibiotics, you go home, and you're okay. It's a big deal. It's also a big deal from a cost standpoint. What you can see here is that cascade that I was talking about. 9% of patients may develop some sort of SSC. If that's not treated, they go on to some further wound complication, perhaps surgical site dehiscence, and if that doesn't get treated, you can develop a surgical site infection. This is, again, not just damaging to the patient, it's damaging to the system. We cannot afford to be paying $53,000 for every infected hip and $41,000 for every total knee. Now, we need to do that in order to take care of the patient, but that's not sustainable. I'll show you some numbers that demonstrate that. In 2024, we had 1.8 million total hip and knee replacements. The estimated cost to treat those infections in 2025, $3.3 billion. Assuming no inflation, no increase in cost, but just an increase in the volume of procedures, which we very clearly see is what's going on, that cost is going to be $5.6 billion in 2030. If we look at healthcare across the world and in the U.S., I don't think that anybody is prepared to give us $2.3 billion more dollars to treat complications in five years. It's not there. That's what's really interesting about this. We're going to talk about the clinical data and why this is better for patients. We have this confluence where what's better for the patient is actually better for the system financially. Oftentimes those two things are at odds. We want to do the right thing. The right thing sometimes costs more. We have to figure out how and when to implement it. This is a confluence. We're doing the right thing and the best thing for the patient. Decreasing their chances of having a detour on their journey is actually cost-effective and cost-savings. We'll show some numbers around that. Why are these things so expensive? You might say, "Doc, my kid had an ear infection. We went to the doctor, we did some pills, he's better. How can that cost $5.6 billion?" It's because surgical site infections and hip and knee replacements cannot be treated medically. You can't just take a pill. It requires an operation. If you have a deep infection, by definition, you are having a second surgery, at least. Okay? When you do this, you have to change out the parts. In its simplest form, you're just changing out one part. The more complicated it becomes, the more persistent it becomes, the more parts you have to change. The new parts are more expensive than the primary parts. This cost starts to go up. There's additional costs that we don't think about. Routinely, if somebody has an infected hip or knee replacement, they go home with what's called a PICC line, which is a permanent IV, and six weeks of IV antibiotics that's administered by home health. That is also extremely costly. Okay? There's all these downstream costs that occur. Oftentimes I just gave you the best case scenario. One washout, one quick change of components, six weeks of IV antibiotics. When you have an infection, your chance of getting a recurrent infection is dramatically higher than your primary infection rate. Now we're talking about surgeries that might have a 10% or 20% failure rate, meaning that patient stays persistently infected. If we think about meetings like this one or talks that my colleagues and I go to, we in arthroplasty or hip and knee replacement, love talking about technology, the newest implant, the newest robot, because those things are really sexy to us. That's what we're about. We really want to put in the best of the best. When we think about the wound, it just remains secondary. Part of that is because we just haven't paid attention to it. We say, "That's the cost of doing business." It turns out that with some really simple interventions, it's not. I can use the best Smith & Nephew implant with the best robot, which you're going to hear about, and we have. That Smith & Nephew has, rather. If that wound becomes infected, if that patient has that devastating complication, none of that matters. It all goes out the window. We're in rescue mode. We're like, "Let's save this guy's leg." That's really sobering. As I said, there's been this status quo of, "Hey, we're surgeons. We're going to get infections. If 1%-2% is the quoted rate and I'm doing a half percent, I'm doing pretty good. I don't need to worry about that." If you're told that 1%-2% is the baseline and you're at a 0.5%, you feel like you're doing pretty good. You don't need to target anything lower. That's what Destination Zero is about. We need to target zero because if we don't, we're not going to get any better from where we are. If we look at the rest of orthopaedics and how that's evolved over the past 20 or 30 years, it's incredible. If we look at infection rates, they're essentially the same as they were 20 or 30 years ago. That's just not acceptable, especially now that we know with the data that about 60% of SSCs are preventable when you use negative pressure, and that we simply just cannot afford this burden from a financial standpoint any longer. My own journey and evolution on this was that, hey, as I said, there's a quoted 1%-2% infection rate. I'm at about a 0.5%. I'm doing great. I'm a leader. I'm the best infection guy or low infection guy in my hospital. That mindset has to change, and that's sort of what my academic work has been focused on, is the prophylactic prevention of these infections. A lot of attention gets paid on how to treat these infections once they occur, which is critically important. We do need to take care of those folks. How about stopping it from happening in the first place? In my own practice, we've had this nice four-year window now where I'm at zero. My colleagues always say, "Don't say it, don't say it. You're going to get one when you get home." I'm okay saying it because it's true. We've published it. It's been a game changer. When you have a 0.5% infection rate and you're doing 600 cases a year, that's three people a year. When you have a 0% infection rate, it's zero a year. That change has been transformational for my practice and sort of my thought practice around it. We know we can do better than the status quo. We have to aim for zero, and we must do everything we can to manage outcomes and costs. We care about our patients primarily and most importantly, but we live in an environment where we have to be cost-conscious. If I'm going to invest in a technology, it has to have an output that's going to be responsible, and that's what this is about. How does this work? These are just some examples. PICO is a very simple dressing. It's not complicated. You don't have to go to a course to learn how to use it. You just put it on the wound, and it does well. This is one of my outpatient knees in his 80s, and he's got a nice-looking scar. Not only is the scar really nice-looking, what's going on underneath is great. There's increased perfusion, decreased lymphedema, decreased inflammation. This patient's able to get back to his life more quickly. Okay? In medicine, we are driven by research, right? We say evidence-based medicine is how we make our best choices. I won't belabor the point, if you believe in evidence-based medicine, you have to believe that using negative pressure on a closed incision decreases the risk of that incision having a complication. That's not under debate or refute anymore. There's a pyramid of evidence that has demonstrated this. We can certainly go into detail on that, but it's there. Most people have accepted this. The real question is implementation. Where and how do I utilize this technology? Because there's a cost associated with it. There's some arthroplasty data specific that shows its effect in hip and knee replacements. Here's my data. This was looking at our run of patients. We have one-year follow-ups. This is at 2 years. We presented this at The Hip Society. Again, we're seeing a 0% infection rate. Statistically significant. As I said, we've had this four-year window from December 1st, 2021, to December 1st, 2025, where we have had a 0% rate of infection. Admittedly, that last group, we're still doing the one-year follow-up, but they're doing fine. That zero, being able to say that and being able to publish that, has really been enabled because of PICO. That's why I use it on all of my patients. I don't think that every single surgical patient in the world requires negative pressure. I think that every single practice, every doctor, every surgeon, has some patient in their practice that would benefit from negative pressure. To Cathy's earlier point, that's what we're missing. It's underutilized. There are some people that don't know much about this, that aren't using it in their practice. The available amount of folks that we have that are undertreated is massive, and that's really what we're targeting. If we look at this, we know that every surgical practice has some opportunity to increase their usage of this. As the data is coming out, that is what's happening and evolving. The bottom line here is that we know that surgical site complications are costly, and again, I use that word intentionally, to patients, providers, and systems. We know that some SSCs are preventable. We have a problem. We have a piece of technology that we know fixes that problem, and we know that there's clear data to show us that this technology decreases the rate of the complication that we're most fearful of getting. I'm going to share a quick patient story with you, and then we'll move on to the Q&A. This is a patient that changed my practice from, "Hey, I'll use it sometimes when I think somebody is high risk. I'll try to guess to see where I need to put this device on." J.S. was medically a 54-year-old active male with severe right knee arthritis, no significant past medical history. I'm going to do my outpatient, minimally invasive total knee on him. From a medical standpoint, this guy's the lowest risk. He doesn't need anything. He's going to do great. Odds are he's going to do really, really well. I don't need to do anything special for him. Who is he really? He was a former NBA basketball player that was sent to me by his former teammate that I did a successful knee on. He's now a business leader. He's a C-suite guy. He's running around, traveling. He loves playing sports with his three kids. He's a coach, he's a golfer, and he's healthy enough for an outpatient total knee. He wants to have what his friend had. He signed that same consent form, he wants what his friends had. Get home the same day, play golf in a few weeks, back to his life. This was not a revision case. This patient is not morbidly obese. He doesn't have any major risk factors, that doesn't mean the consequence of his failure is any lower than somebody that does have those risk factors. Right? Particularly within the hip and knee replacement world. What he came for was this, right? This great little package that I can offer everybody. Here's what happened. He had early wound drainage. I said, "We got to look at this." He comes in. To prove infection in the hip or knee, you got to take fluid out of it, so I aspirated his knee. Sure enough, you have an infection. We had to go to the operating room. This was early, I just washed it out and changed out the plastic. He gets his IV antibiotics, gets his PICC line. The cultures came back positive for MRSA. All right? He gets PICC line, IV antibiotics. We washed it out. We're hoping for the best. Comes off the antibiotics, still has an infection. Now we have to go in and put in what's called a spacer, and that's no fun to have. It's a temporary knee replacement you're supposed to live with for two or three months. We come back, still infected, which can happen with MRSA. He gets another spacer, all the while on IV antibiotics, and he's not doing any of those things that I told you defined who he was. He's just trying to cope with his knee, sitting at home with IV antibiotics with a spacer in his knee. We did finally eradicate his infection, about a year and a half later, he got a revision knee replacement. As I said, that's not what he signed up for. Legally, he said that he knows that those things could happen, that's not what he wanted. I like the term high consequence. Instead of risk stratification, I consequence stratify my patients. Every single primary hip and knee replacement that we do is high consequence. We cannot afford for that patient to get an infection, financially or from an outcome standpoint. Again, his routine pathway, that's what we were aiming for, that's what we got instead. Along with that came increasing cost. The dressing that I use, PICO, was slightly more expensive than a standard dressing, that wasn't the expensive part. Him having this complication was the expensive part. There's more and more data showing us that's going to be forthcoming that demonstrates that this case is proven on an economic standpoint as well. This is his life for a year and a half. None of you would want to get on that airplane. As I said, it's not the dressing that's the expensive part. The human and financial cost is what's expensive here. For me, all elective total joint replacements are high consequence. To answer that question that I asked at the beginning, that's why I use it on every patient. He wasn't supposed to get an infection, he still did. If I just risk stratified my cost, all that stuff, I would have still paid that price for him. He would have still paid the price. In this case, he did. For four years, I haven't had to pay that price in neither of my patients. To me, that's really been practice changing. Thanks for your time, I think we're going to take some questions. Do we have a microphone or? Perfect. Yes. Morning. Kane Slutzkin, Deutsche Bank. You mentioned you're obviously using it on every case, clearly you're a believer and sort of implying that others could do more. I'm just wondering what is the sort of number one factor preventing broader adoption? Two, what do you think differentiates PICO from other systems? Great question, I'll try to answer it briefly. There's a few things that were packed in there. What is preventing broader adoption? I think some of it is a lack of awareness of how simple and easy this is to use. I think that surgeons in general are focused on the operation, the implant, the technology, this has fallen a little bit by the wayside. Through medical education, we're attempting to improve and grow that. As I said, I think that there is some sense of, "Hey, this is the cost of doing business. We can't do any better." The data is showing us more and more that we can. This is where the cost is actually going to drive. If a surgeon says that he has a 1% infection rate and he's doing fine, at some point, the system is going to say, "We can no longer afford this, and we need to move it that way." I really do believe that in the next couple of years, the finances are going to push that awareness and adoption, even though we're working on that from a medical education standpoint. In terms of why it's different than competitive products, and this is critically important. PICO is set at negative 80 millimeters of mercury as a pressure setting. All of the data that I kind of went through quickly, all the clinical benefits that we've seen, including increased perfusion, decreased edema, decreased inflammation. These are all studies that are done at minus 80. More or less is not necessarily going to have the same effect. Until other products can prove that they can do that, PICO is still the leader in this space. I always encourage surgeons to look closely at the data. Just because it looks like a PICO or sounds like a PICO doesn't mean it's a PICO. Thank you. I think we have one. Yes. Hi. Thanks. David from JPMorgan. I just wondered how the number of SSIs have trended over time. Is it sort of up, down, sideways? What are your thoughts on the impact of robotic surgery on infection rates? Do you buy into the thesis that the longer surgery times required by robots increases infection risk? That's a fact that longer surgery time does increase infection risk. I think that within robotics, the platforms are evolving to become more time neutral. I think you're going to hear some things about the CORI robot, specifically on that track. I don't think that that's driving up infection rates. I don't think robotics is driving up infection rates. To your first question, that's what keeps me up at night. SSI rates and hip and knee replacements have been the same for about 20 or 30 years. They've remained baseline because we've just stopped focusing on that. We've said 1% - 2% is good enough. Just follow up. Do you absorb the cost of PICO, or do you get your payers to pick up some of that cost? Within our system, the bundles coming in the U.S., it will be absorbed within that. We have some data that we're looking at that would suggest that long-term, routine use of that will actually still be a cost savings over time, versus an extension of spend. Thank you. Any other questions? Okay. Okay. That's it. That's it. Thank you. Thank you, Dr. Bashyal. Oh, Christie. Yes. There's Cathy. Okay. Thank you, Cathy and Dr. Bashyal. Hello, everyone. My name is Christie Van Geffen, and I lead global strategic marketing for sports medicine. It is my pleasure to present to you on our sports medicine business. Today's focus is on what we call the big four. All category-defining technologies, each at a different stage in unlocking their potential. REGENETEN, our bioinductive implant, has been available now for over 10 years and is the established leader in biologic healing. Tendon Seam, from our recent acquisition of Integrity Orthopaedics, is at the start of a very exciting growth journey and can significantly improve repair strength when compared to a traditional rotator cuff repair. The CARTIHEAL AGILI-C implant offers a new treatment option for patients with damaged cartilage, including those with mild to moderate osteoarthritis, which is a large and underserved population. Lastly, TESSA, our tracking-enabled spatial surgery assistant, is pioneering dynamic real-time arthroscopic video-based navigation. It is currently under review with the FDA, pending commercial launch. These four platforms are sports medicine driven by our focus in innovation and commitment to market development. This is underpinned by sustained investment in clinical evidence, market ACTIS, medical education, and commercial execution. Together, we expect the big four to drive a significant portion of our growth over the next five years. Let's dive into rotator cuff repair. The rotator cuff consists of a group of muscles and tendons that come together to drive stability and move the arm around. Rotator cuff tears are extremely common, with an estimated 1.2 million tears that are surgically treated per year globally. Most often, the tendons tear as patients age, and unfortunately, about 25% of rotator cuff surgeries fail due to poor tissue quality and the tendon's inability to heal back to the bone. Smith & Nephew is changing the standard of care in rotator cuff repair with not just one but two technologies that address both pillars of healing, the biologics and the biomechanics. Let's start with our REGENETEN bioinductive implant, a novel way to address biological healing of tendons. It is a type 1 collagen scaffold placed over the tear, which aids postoperative healing and thickens the native tendon. It has been shown to reduce re-tear rates by 65% at the two-year follow-up mark in a randomized control trial. A key driver of its adoption is the simplicity of surgical technique. The implant is delivered via a well-designed insertion device, which goes in, unfurls, and is then fixed to the tendon and bone. Within six months, the implant is replaced by tissue, which promotes tendon healing. REGENETEN has been used in over 250,000 patients globally to date, delivering fantastic patient outcomes. However, great technology is not enough. To unlock reimbursement and drive adoption, you must also prove its value through clinical evidence. We have been committed to a 10-year market development journey to do this. Our evidence is unmatched, including three randomized control trials with over 30 studies from multiple sites published in high-tier journals, all showing consistent positive outcomes. This is now shaping clinical practice, and we are very proud that last year the American Academy of Orthopaedic Surgeons issued a strong recommendation to use bioinductive implants in rotator cuff repair based solely on the evidence generated from REGENETEN. This will open doors with payers and will embed REGENETEN into everyday clinical practice. We see significant opportunities to expand the use of REGENETEN in other tendons beyond the rotator cuff. It has already been used in hip tendons and in the foot and ankle, like on Achilles tears. Most recently, we received clearance to use REGENETEN for the repair of ligaments, which can be leveraged in the hip capsule closure, which Dr. Ranawat will talk about later. Turning back to biomechanics, traditional biomechanical repairs rely on multiple individually delivered anchors with sutures managed at discrete fixation points. These complex constructs remain vulnerable to gap formation during rehabilitation and can lead to potential repair failure. TendonSeam reimagines this approach, drawing inspiration from textile engineering to create a continuous medial seam construct with connected but individually locked points of fixation. This unique system delivers a stronger, more stable repair that significantly minimizes gap formation and supports the repair through the healing period. With Tendon Seam's disruptive technology to strengthen the initial repair construct and REGENETEN's proven ability to promote biological healing over time, we can present surgeons with a more complete repair strategy that addresses both the biomechanical and the biological drivers of successful cuff repair. Together, these can change the standard of care and set a new bar for patient outcomes. We look forward to Dr. Klifto sharing his experience with both of these later on this morning. Let's turn to AGILI-C, and its use in cartilage repair. The knee is made up of three core tissues, ligaments, meniscus, and cartilage. Cartilage is avascular, so it doesn't heal well on its own and can cause significant pain. Damage can occur in various forms, cartilage alone, cartilage with bone, known as osteochondral defects, or cartilage damaged in the presence of osteoarthritis. Current methods of repair have limitations. Microfracture isn't very durable beyond two years. Cell-based therapy requires two surgeries and donor tissue. Osteochondral allograft transplants are limited by donor tissue availability in the U.S. and even more so globally. Enter the AGILI-C implant. This is a new treatment option designed to help the body regrow healthy cartilage and heal damaged bone in the knee. It's highly effective with twice the pain reduction relative to the current standard of care, microfracture. Versatile, since it can be used across a variety of sizes, and uniquely, it is the only cartilage repair technology that can be used in the presence of mild to moderate osteoarthritis. It's also convenient because it can be implanted in one surgery without any donor tissue. Last year, a new category 1 CPT code was created that we can leverage starting in 2027. This code is essential for future revenue growth. It gives us the opportunity to work with U.S. payers to access broader reimbursement coverage while leveraging the clinical data and our surgeon advocates in parallel. CARTIHEAL stands apart from other technologies with a level 1 randomized control trial and five-year follow-up published early this year in the peer-reviewed American Journal of Sports Medicine. Dr. Ranawat will get into greater detail later, but I'd like to highlight key findings. Twice the reduction in pain when compared to microfracture or debridement. Significant improvements in overall KOOS scores, which is a patient-reported outcome looking at knee health symptoms and functional abilities. Consistent results regardless of osteoarthritis status. Over an 80% reduction in relative risk of patients progressing to knee replacement. This underlines that the CARTIHEAL implant is having a sustained positive impact on patients' lives. A great new option for our surgeons and patients alike. Let's talk about the last of the big four, TESSA. Anterior cruciate ligament, or ACL reconstruction surgery, is all about visualization and tunnel placement. Where you can't see well, it can be challenging to get good results. In fact, 34% of ACLR failures are caused by technical error. The first ACL reconstructions were done as open procedures. In the early 1970s, camera-based visualization was introduced, creating the field of arthroscopy, where a surgeon would insert a scope and watch on the monitor. Since then, arthroscopic surgery has barely changed until TESSA. This is the first of its kind, arthroscopic video-based navigation system that provides guided visualization and advanced imaging. Everyone remembers using a physical map, but now we can all use Google Maps because it is digital, dynamic, and has real-time updates. TESSA applies that to arthroscopic surgery. If the surgeon is the journey and the surgeon is driving the car, TESSA gives the surgeon real-time assistance to stick to the surgical plan he or she has created at the beginning of the surgery, making sure that the surgery is completed as planned. TESSA takes surgeons away from basic analog imaging to digital dynamic augmented reality that is personalized to the patient. The first application is going to be femoral tunnel drilling, but this technology is a platform for further surgical arthroscopic applications. From here, we'll move on to tibial drilling, then to increased applications in the knee, shoulder, hip, and beyond. I hope you've enjoyed learning more about the sports big four and how we are committed to accelerating innovative technologies and capitalizing on our expertise in market development. In summary, I want to underline that our purpose is to help people live a life unlimited, and that patients are truly at the center of everything we do. These are two patient stories where we helped Chris get back to walking his dog and running to work after being treated with CARTIHEAL, and Nick, who was treated with REGENETEN in his shoulder so that he could get back to doing what he loves, which is being a coach and a great dad to his kids. That's what gets me up every morning and excited. Working here at Sports Medicine, my team and I get to impact millions of patients' lives every day globally. With that, I'd like to introduce Dr. Anil Ranawat, who is an orthopedic surgeon from HSS New York, focusing on hips and shoulder and knee. He is constantly pushing state-of-the-art advancements in joint restoration, including both non-operative and operative management of these conditions. He serves on numerous orthopedic boards, including AOSSM and EOA, and lastly, is the orthopedic surgeon for the New York Rangers ice hockey team. Dr. Ranawat will share with us his perspective on three of the big four technologies in terms of how they are used in his practice today and their potential in the future. Dr. Ranawat, it's a delight to welcome you here today, and I cordially invite you to the stage. Thank you. Thank you, Christie. I want to thank Deepak and Scott, and it's really an honor to be here. We give a lot of talks. I don't usually even look at slides anymore. I just talk to the audience. But these are more unique talks. In the last year or two, I've given this one in New York at Bank Capital Markets. Also with TESSA, we presented with Brian to the FDA. That was a fascinating little endeavor. I'm really enjoying this journey as we're all calling it, and it's a team journey. My father, my late father, was a very famous orthopedic surgeon. He did arthroplasty, like our other colleagues here, and he said a couple things. First, work with a company to really help patients. There's this new philosophy that working with companies are bad, and we create conflicts of interest and all this stuff. It's actually the only way we can really drive technology, when our incentives are aligned. Our incentives is to help the patient. What wakes Christie up in the morning when she sees her company can help people, and that's all I want to do for you guys, is to show us how our efforts and their efforts can help people. These are my disclosures. They're not relevant. I'll talk about my background, where I'm from, my experience with Smith & Nephew, and then three of the big four. Just my full disclosure is I am a hip and knee surgeon. I do a little shoulder. Klifto will talk more about the shoulder. Any shoulder operation has a French word, l'arc or remplissage, I don't know because I don't speak French. That's where I end and begin. I've been an attending surgeon at HSS for now almost 20 years. I'm the chief of the hip and knee sports department. HSS has 160 surgeons at HSS. We've 50 surgeons in the sports department. We have as many sports surgeons as most orthopedic departments have in the world. It's a pretty big place. We actually call it the big house, and we have a lot of my colleagues here to talk about the big house. I'm a medical director of various different off-sites in the system. I am a dukie too, and I did a lot of fellowships, and one of the fellowships I did was actually, although we are American, I try not to be an arrogant American. I did one year in Pittsburgh. I learned this kind of organization called ISAKOS, an international organization. I went and spent six months at the SchultHaas Klinik in Zurich, and I spent three months here in the U.K. at Exeter, Oxford, Cambridge, and up the street at King's College. I learned a lot of different ways to skin a cat. That's one of the things I love about Smith & Nephew, global company, global ideas, global change. These are my affiliations. I do take care of a lot of professional athletes. It's fun. I'm not really a football professional athlete. I'm talking more about hockey and baseball, but I take care of a lot of athletes. I also take care of a lot of Average Joes, and you have to recognize what's the disease ahead of you? Is this a disease of an athlete that has to get back really quickly, or is this a disease of an aging tendon that doesn't actually have an injury, it's just more deterioration? It's a very different treatment algorithm based on what you see before you, and sometimes it can be both. That's really what I do. I want to prevent degradation. I want to fight God. God usually wins. It's a hard battle. What I don't want to do, I want to get you guys all running around on the Thames and enjoying your life. I never wanted to be a general patient surgeon. That was like blasphemy for my father, because I didn't want to talk about infections all day. That sounds really boring. I want to talk about getting people back in the game, right? Having them rise. That's really been my approach, get people back on the field or the pitch. Let's just talk about what's the one-stop solution that Smith & Nephew are getting to. Let's first talk about cartilage. As Christie said, cartilage, actually, Dr. Robert Hunter, very famous U.K. physician. We're surgeons, so we're from the barber line. We're misters. I can explain that to you over a cup of coffee later. Dr. Hunter, who was a smart guy, recognized if you open cartilage up and you cut it doesn't heal. That was he quoted as 1720, still true to this day. There's been 1,000 different ways to heal cartilage. None of them really work. They're all really expensive. It's a huge clinical problem. There's not one person in this room, if I took an MRI of their knee, that doesn't have a cartilage defect. It's ubiquitous. Now, some people have worse, but it's a massive disease. The musculoskeletal burden in the U.S. is huge. Let's talk about how we fix early arthritis. I'm not talking about end-stage arthritis. That's what our colleagues will talk about, replacements. Early arthritis, which is an even bigger category, and it's actually more important because, yes, it's important to get grandma out to walk around, but I want to get her son 40 more years until he gets a knee replacement or maybe never give him a knee replacement. What do we have out there? We have autograft. You can take your own plug of your own body, put it into your thing. Well, that's kind of robbing Peter to pay Paul. Only an orthopedic surgeon would do something as silly as that. Let me take one part. Well, if God didn't want it there, he wouldn't have put it there. We get smart. Let's take a dead person and put it inside your knee. Well, usually, when you take a dead person, put it in his knee, he's like, "This is not my knee." When you do a liver transplant, you have to do cross-match. We don't cross-match musculoskeletal tissue, so there's a level of rejection. Allografts do great for five years, then there's a thing called microfracture, which is still the standard. Poke little holes and we're going back to Dr. Hunter's principles. It doesn't work. Cartilage doesn't heal by itself. Then there's fancy things where, out of Scandinavia, they create cell-based, where we took your cartilage, grow it up in the lab, then put it back in your knee. Well, that's two surgeries, a lot of money, it still doesn't work. It's actually illegal in Europe. If it was so good in Scandinavia, there's so much data about it, why can't you do it in Europe, but only in the U.S.? That's a little head-scratching. Because the data isn't there, that's what we care about. We care about data. What about ACL? What's the clinical problem with ACL? The clinical problem with ACL is what we call tunnel positions. What it is, with ACL, you have a femur, you have a tibia, you drill a tunnel in each. If you put the tunnel in the wrong spot, the graft will impinge. The graft impinges, it tears or it's too loose. It's as simple as that. We're bad at putting tunnels in the right spot because right now the human body is a 3D structure. When we look at a screen, it's a 2D structure. Whenever I take a resident, I can tell in 30 seconds. There was an old trick my father said. He said, "Take an unusual object, put it before you, close your eyes, lift it up, and spin it in the X-axis, then the Y-axis." If you can do that, maybe you can become a surgeon. Now spin it in the Z-axis. 80% of the people can't do that. Once you can do Z-axis, then your last name is Ranawat. No, I'm just joking. My daughter's here, so I said that to her. No pressure, Vivie. Tendon healing. Tendon healing is fascinating. The average person thinks tendon healing is just like bone healing. When you break a bone, it's very reproducible to heal a bone. It works. The nonunion rates of bone healing is under 1%. Actually, usually, the only times bone heals when we put too many plates on it, when you try to fix it too well. Bone can heal by doing nothing, maybe putting a little screw, a little plate on it. It heals very predictably. Tendon to bone doesn't heal predictably because it's not a traumatic event. It's 95% of the time, it's a degradative process. Now, you can go skiing in some beautiful place in France and tear a rotator cuff at 40, but that's a very rare event. More likely, you actually break your bone. You're very osty. What normally is, which I can see right now when I see people, like last time I gave a lecture, I'm like, "Okay, who can do this right now with their right arm, who played a little tennis yesterday and be like, 'God, my cuff's hurting a little bit.' Or out swimming." Again, if you're really honest, a lot of people will be like, "Yeah, it does." You are developing cuff disease. Cuff disease is a spectrum. If you use it, you will lose it, and you'll go from partial to full thickness. This process of degradation of tendon dying is really hard. Even when we fix it, and we bat 85% success rate, but what is that success rate? That means the patients say they're happy 85% of the times. If you look at the healing rates on ultrasound and MRI, it's like 50 or even lower. Look, I'm no shoulder surgeon, but I can tell you this. There's tendons all over the body, and those tendons are failing, whether it's a glute tendon, which I take care of, or an Achilles tendon. Every Achilles tendon tear in the NBA now, by a senior colleague of mine, gets a regenerative patch. Every single one. It's become now standard of care for the most high-profile players. If it's worth a $100 million contract ankle, then maybe it's worth 55-year-old shoulder for me, maybe. Have to fix my cuff. Let's get into the details of cartilage. Cartilage, CARTIHEAL has this massive group, and it's like the group before us. I'll have some people, some of the younger analysts will have an isolated defect, some of the middle age will have two or three holes, and some of the older guys like me will have pretty extensive disease. You had really what this implant showed, that it wasn't just for isolated disease. It carried a long spectrum of indications. From a selling purposes, that's a pretty simple thing. That means there are a lot of patients you can sell it to. That's good. It worked. How do I use CARTIHEAL today? Well, when I see a cartilage or really a cartilage with a bone lesion, I use it every time because CARTIHEAL turns into bone. Allograft does not always turn into bone, and even autograft doesn't heal always to bone. CARTIHEAL is very predictable to bone, and then the cartilage grows on top. I do it with either mild or moderate disease. If you truly have advanced OA, anything bone on bone, I refer to my colleagues, Dr. Haas and Dr. Ast. As I said, the healing rates, the scientific healing rates are very profound, 75%. Both the bone will heal, that's more like 95%. CARTIHEAL is a really osteoinductive agent and conductive agent, and then the cartilage heals around 75%. You get bang for your buck, and as we heard, you can do this with a lot of other complex procedures. I do this with an ACL, I do this with an osteotomy, with a scoliosis. We in sports have an armamentarium, which Smith & Nephew helps us a lot to fill out this armamentarium. Ultimately, it can either prevent or delay arthroplasty. That's really what we want. We want the people to get back in the game and play as much as you can. Here's a little quick little video. It's an isolated lesion. You do a mini arthrotomy. You drill. When I do an OATS plug or an allograft, it takes me 30 minutes to do. This takes me about six. It's another powerful thing. It's so easy, quick to do, and it's very reproducible. A lot of times we have things that are great biologically, but they're hard to put in. Sometimes we have things that are easy to put in and terrible biologically. This is a win-win. Great biologically, easy to put in. You line them up. Some of these things I don't do as much because I have a little ADD, as you can tell. I don't wash it out three times, probably only once. I do like to do this little step that makes it looks really clean. I don't see they wash that again. I don't do that. Come on. I don't change my gloves. Then it goes in. Here's the thing you want to do. You have to recess the plug a millimeter or two so cartilage regrows on top. It's not a flush implant. It's not an osteochondral allograft or an autograft, and you want to space them out. What we have now is that we have now developed a kit. It used to be you had trays, you had to sterilize trays. The future of orthopedic surgery, as we're hearing from the arthroplasty guys, outpatient, it's all outpatient. It's all surgery center basis. We don't want to do trays. Cooking trays cost a lot of time and energy. I think Mike will talk a lot about this. This is all just single disposable kit. It's another big advantage of this system. Here's when we talk about the data. RCT data in cartilage is obnoxious how little there is. We do these operations all the time. Yeah, I'm looking at like, Dr. Haas, he's like, "So true." We're such worse doctors than arthroplasty, but they can cure 1,000 patients in a week. That takes us 10 years to do that. What this RCT showed, and it got FDA approved, that compared to microfracture or debridement, their PROM scores were way ahead of them and MRI data. They repeated that at five years and it showed consistently. Let's delve a little deeper into that data. If you look here, the orange is CARTIHEAL. They had a 58% reduction in any failure, surgery or injection. A 76% reduction in injections. That's profound. Subsequent surgery, 20%. The risk of total joint replacement or osteotomy, the ultimate failure of your procedure, 80% at five years. There's a few things we can really say in orthopedics that are disease-modifying. Right? A total knee is not disease-modifying. One of my professors would used to call it internal amputation of the knee. That's an orthopedic joke. I never appreciated that because the total knee got me through college, so I was like, "It's a little harsh, Dr. Halford." Disease-modifying means that you can change the natural history. Right? TCO can be disease-modifying. It changes the natural history of arthritis. This is disease-modifying. It changes the natural history of the failing knee, and that's what's exciting. That's why joint preservation is exciting to me. The five-year results of the RCT shows lower incidence of treatment failure, lower risk of major surgery, equivalent outcomes, actually, depending on your OA, which is really fascinating. You would think the single minor disease guys would do better than the more massive disease guys. No. All comers are pretty close. The pain reduction was twice as better than standard of care. This is just a case where we did one. This is what a plug looks like. I did this one the other day. This is one I did on a fireman, where you can see much more extensive disease. This one I did with an osteotomy. This is what I said to you before. It's really filling out the whole armamentarium. Let's get to TESSA. As we heard a lot, traditional ACL surgery is hard. We're living in a 2D world for a 3D concept. We're using mechanical guides. It's amazing. When I do an ACL, now I look at my friends and colleagues, I look at Dr. Ast next door, we're in the same surgery center. He's got a robot for grandma, and I have an ACL for his son. That seems weird because he wants his operation to last for 50 years. We need to modernize sports medicine surgery because traditional marking using mechanical guides, whether inside out or outside in, are wrong. Video processing and augmented reality guidance can really make 2D 3D. Really what it is, you have your TV, and then you have an image base with an MRI or CAT scan overlapped the image, and you're holding your hand and seeing my tunnels in real-time. It is a game changer. It will blow you away as a surgeon. Because what those guys have, the robots are still pretty cool, but they're still looking at an image that's not real. I'm looking at a real-time 2D image, and then I have the actual imaging on top of it. It's a really powerful thing, and it's what's going to give me the ability to get my tunnels in the right spot. It's patient-specific because it's image-based, as we talked about first with the ACL, but now on the femur, we'll get tibia, and it's all segmentation. It is literally, it's funny that we're here, father of AI, I guess there's the plaque. It's using all AI technology. It's fascinating. It's all based on QR codes. The QR code has this, the big scanners that they use now, arthroscopically, we're using a small QR code. Fascinating. We did a paper showing that with 50 cadavers, it's 10 times more accurate than the free hand. That's the one thing I can tell you about all robotics navigation, all modern technology. When you compare that to the free hand, robots navigations, the robots are always better. It's a little depressing. Makes us feel like we're not so good. We still have to control the robot. We still have to control everything, the navigation. We still have to tell them where to go. That's always a debate. In terms of the science, they will always beat us if you're just asking them to make a straight cut. Let me quickly go to tendon healing. We heard about REGENETEN. We're going to hear a lot more, so I don't want to go too much about that. As I said, I am not a French shoulder doctor. I am an American hip doctor, but I use this for the glute. I use this for patellar tendon, quad tendon. These are all tendons in athletes that fail because the tendon is actually degenerous. That's the preexisting tradition. The way I think of REGENETEN, it's food for your tendon. All right? A tendon is slowly devascularizing. It's food for the tendon, and it feeds the tendon and thickens it. We've actually proven that in a paper. This is just an example of one doing the hip that where I do it for all my glute needs like this. We have an MRI paper to show that the thickness of the tendon after the REGENETEN patch is six millimeters thicker. This is consistent with RCT data in the rotator cuff. Now we're having multiple joints. Then it's just a matter of time until we show this in the Achilles, that the tendon is thicker and healthier. This is just a standard way to fix anything. This could be a rotator cuff. This is actually a glute medius or minimus, and you pass it, then you'll see how we normally do our construct. Right? Again, to go back to Christie's point, you first have to do biomechanics. Isaac Newton, I just saw his funeral in Westminster. Not his funeral, but his clinical because he was kind of my hero growing up. We're all biomechanists as orthopedic surgeons. Then you add biology. It's the one-two combo. This is the potential, all the other outcomes. This is that paper I wrote where we talked about increased healing. We can use it for the capsule as well, and a lot of other indications. This is just an example of the patient that I did it on, and this is how we do it. Just because of time, I want to just say, I really believe the big four, three of the big four that are mine, are really a vision to the future, how we think of improving biomechanics, biology, and enabling surgical technology. We're not doing this for the sake of here's a new anchor. That's how other companies do it. No. Here are clinical problems. Cartilage doesn't heal. Tendons are dying, and it's hard to do surgery sometimes. Go after clinical problems, find a company that's morally, ethically responsible to give you a clinical solution to that clinical problem, and you help patients. Thank you very much. Thank you so much, Dr. Ranawat. Very passionate presentation and very enjoyable. A couple of questions from me. One, can you maybe talk, clearly you find these products work very well, but why do you think other surgeons don't use them? Maybe talk about how this changes the duration of the surgery, the cost of surgery. What are kind of the barriers that prevent folks from using REGENETEN in every single procedure? I think REGENETEN has created a lot of adopters. REGENETEN was the first guy on the block. Right? Imitation is a great flattery. There are now three or four different patches out there. It's like when you come up with a good knee implant and all the other big five comes up with a knee implant that's pretty close, you know that you did something well. Like when you come up with first great wand with Arthrex or something like that. I've seen a lot of non-Smith & Nephew users use it. Then eventually they try other ones. It's still the best because it has the most science, and that's really the thing. When you have the science, you then eventually can go to your payer in saying, "So I would want a REGENETEN in my shoulder." That's usually the best way. You ask the surgeon if they believe in a product, would you take that product for yourself or put it into your own family members? That's what I would say. I'd say there is a cost. Obviously, it's added cost to an operation. Again, I'm saying, why did we pick REGENETEN rotator cuff? Because it's failing tremendously from really healing rates. There's room. I never wanted to be a hip replacement surgeon because the operation was 92%, 98%. Like, what room do you have to grow? The rotator cuff, you have 50% room to go. That's a good reason to study that. Go for the money. Thank you for that presentation. It was great. It's Graham from UBS. Can I just ask when you talked about your experience, learning abroad and spending time in Europe, in terms of sports medicine, we think of the market being so well progressed in the U.S. and maybe not as common or as growthy in Europe right now. What differences do you notice in terms of practice and the availability of some of these products? Yeah, obviously, every European country is vastly different. I have a cousin in the NHS. There's no meniscus repairs in the NHS. By the time the kid gets the ACL surgery, it's two years waiting. His meniscus is shredded. Versus you go to Harley Street, they fix meniscus like it's candy. There's that two-tiered system in certain countries. There are other countries like Italy, where they're very aggressive, and their NHS is a little bit more, I think, better access. It's very country specific. I will say this, they're all realizing now that sports medicine is a field. It used to be traditionally the European system was that you were a knee surgeon. You did everything soup to nuts other than knee. America had this false thing of joints and sports. In reality, the answer is that there's the pros and cons for both. I do see now the traditional knee German surgeon who used to just do arthroscopy on the knee and then do a scope. They're now people who really just focus on sports. The way you know that is look at ESSKA and look at ISAKOS. Those are the two biggest growing organizations in the world. I would say Europe is a huge market to grow for sports medicine. There are two webcast questions. The first is, how much cost and time do you think TESSA adds to a procedure? Do you anticipate difficulties getting reimbursement? I would say any new enabling technology, whether it was CORI or any robot, as we heard before, it takes time in the beginning. If it takes time to lower your failure rate, it's worth it. As you get better at it, that time goes away. That's just true for all of us. Yes, the first, it's usually a learning curve of 10 cases. Now, again, cost is always going to be the issue. If cost lowers the ACL failure rate in a 16-year-old young athlete is 30%. If you tell that to the young athlete every time they show up to you, the parents would walk right out of your door. You have to kind of tell them. It's insane. We have room to do better. We have to. If you take a 16-year-old and you do enough of these, and they come back and it's a failure, and you thought you did a really good job, that athlete's devastated. I don't want that because I had two ACLs, and my knees are not so good now. That was 40 years ago. We have to do better with this. There is a clinical need here. Then the second question was just how does what you've talked about today translate into procedure volumes for the hip and knee replacements down the line? As much as I would say I want to eliminate hip and knee replacement, hip and knee replacement is not going anywhere. Okay. It's such a good operation. We're not talking about attacking hip and knee replacements. We're talking about the middle, the injection middle, where you just say, "Oh, no, my cortisone is going to work. No, my PRP is going to work. No, this PT will work." No. It's really about going after that middle-aged population where we could say we could do better. Because when arthroplasty surgeons tried to address them 20 years ago, they realized that they did not have good results. That's the irony. The irony is that if you take care of just Medicare patients over 65 in the United States, you will have much happier patients than if you Once I go after the 54-year-old, that's more higher stakes. Great. Thank you very much. We're now just going to a break so everybody can go and get some tea and coffee and see the product fair. We'll be back here at 10:05, so 20 minutes. Thank you. Welcome back, everyone. I hope you enjoyed that quick break, and hopefully you also got to see some of our innovative portfolio in the adjacent room. My name is Mayank Shandil, and I lead our global portfolios across orthopedics and robotics. Over the next 10 minutes, I will take you through how we are going to build our competitive advantage across knees and robotics. We have a strong track record of innovation across both robotics and enabling technology, along with implant design. With the acquisition of Blue Belt Technologies in 2016, we have pioneered the use of handheld robotics for total knee arthroplasty. In fact, Smith & Nephew remains the only company with FDA-approved robotic indications for partial, total, and revision knees. The digital tensioner, launched in 2023, was yet another unique solution that helps make the procedure more precise and reproducible. I will speak more to this in subsequent sections. On the implant side, we were the first to bring to market the asymmetric joint line with Journey, which has matched the average patient's anatomy more accurately. Across our LEGION and Journey platforms, we offer surgeons distinct choices on both implant geometry and materials to help personalize the procedure for every patient. I want to reiterate that when we speak of innovation with knees, we always mean procedural innovation. That spans the robotic and technology part, as well as the implant design. While the robot is critical in the OR, it is the implant that the patient goes back home with, and its design must accommodate varying needs in the future. Let's talk about those needs. The expectations from all of our stakeholders, starting with the patient but across surgeons, OR staff, administrators, even payers, are evolving rapidly. Our key objectives will always remain the same: make patients happier and improve their satisfaction from knee replacement surgery. What we're seeing is personalization of the implant position makes patients more satisfied with their outcome, future implant designs must accommodate this. While implant geometry plays an important role, it's really the technology, the robot, that helps position the implants accurately, precisely, and reproducibly every single time. The purpose of this technology fundamentally has to be to make more complex surgery easy and to make less complex surgery more reproducible. Finally, the shift from hospitals to ambulatory surgery centers, or ASCs as they are known, is driving a distinct need for streamlined workflows and efficiency. I realize that ASC is a very U.S.-centric acronym, but think of these as smaller outpatient or day surgery centers, and we'll discuss these in greater detail in our subsequent sections. For now, I will concisely state that at these outpatient centers, cost of technology, its footprint and procedural breadth, even the number of instrument trays can all contribute to significant inefficiencies. Any solution we build for the future must address all these needs. Always starting with the patient, making sure technology is doing what it's supposed to do, that's more complex surgery, easy, less complex surgery, reusable, doing that while driving leaner and more efficient workflows. Now while we clearly understand these needs, at Smith & Nephew, we are also aware that our current knee portfolio is complex, with as many as four knee brands. Any solution we create for the future must ensure that we are not only evolving our knee procedural offering, that's across the implant design and surgical workflows, like I said, but also actively streamlining our portfolio. We manage significantly fewer SKUs across our value chain. Since we announced this objective last year, I'm happy to report that we are well on our way, with production stopped on 10% of primary knee SKUs already. By making these strategic portfolio choices, we will reduce our overall SKU burden while at the same time adding an innovative new knee system. I will share more on that soon. Before I do, though, let's dive a little bit deeper into how we look at the future of knee surgery. We really have three key design priorities. First and foremost is the ability to personalize the position of the implant for each patient's anatomy. Like I said, the implant design must accommodate for this personalization. Second, the implant and the robotic solution needs to work together to unlock better outcomes for our patients. Lastly, going back to that really important point around efficiency, the solution must offer all these benefits without adding significant cost or complexity in the OR, especially in the ASC. Starting with personalization and without getting into too much technical detail, we know that satisfaction in a knee replacement procedure is driven significantly by the balance of the soft tissue around it. These are typically the ligaments that support the knee, especially on the inner and outer sides. Till the invention of this device on your screens, most surgeons were using some subjective ways to assess tension in ligaments. We have learnt that the subjectivity can create variation in assessment, not just across different surgeons, but also for the same surgeon between their first and last cases on the same day. Our unique digital tensioner is the first step towards an objective assessment of each individual patient's soft tissue that will eventually help us personalize soft tissue tension for every type of patient. The clinical impact is actually already showing up in level 1 evidence. Smith & Nephew handheld robotics significantly reduced soft tissue releases while improving patient-reported outcomes and natural joint feeling at one year. Here's another great example of how our robotics and implant systems can help personalize the surgical process, even in complex surgical settings. In a revision situation where there is bone loss and limited reliance on anatomical landmarks, our unique CORI revision workflow simplifies the procedure significantly through accurate implant placement and the ability to plan for bone defects. We can even use the digital tensioner, typically used for more straightforward primary cases, to dial in the right soft tissue tension for each patient, eventually improving function and outcomes even in these complex revision scenarios. With this simplified workflow, multi-center data across 100 revision knee cases shows CORI reduces mental and physical demand on OR staff by 54% versus conventional instrument, without compromising on surgical performance. I'm going to now switch from personalization to performance. Before I do, this is Landmark. There are three things I want you to remember about our new knee system. One, Landmark will incorporate the differentiated kinematics of our JOURNEY platform while retaining the simplicity of use of our LEGION platform. What that also means is it's compatible with existing instruments and it'll allow us to retain our customers while being offensive with conversions across full-cemented and cementless offerings. Second, Landmark will be our most robotically enabled knee ever, period. Think simplified workflows, advanced patellofemoral planning, and industry-leading soft tissue optimization, much more. Lastly, and perhaps most importantly, Landmark will have industry-leading lean astray configurations, including for robotic cases, without compromising on intraoperative options for the surgeon. The ability to dial in patient-specific alignment with pre-op planning, without compromising on function or survivorship, is one of the holy grails of knee replacement today. Typically, ± 3 degrees on alignment is considered safe, although some surgeons can go beyond that. But within those three degrees, the Landmark design actually covers 90% of the patient population out there. Think of it as for 90% of patients that are out there, Landmark does not require additional cuts to accommodate for patient variation. This equates to easier workflows and less compromise in the position of the patellofemoral joint. This is the Landmark advantage with alignment. Another area where Landmark has differentiation is the design of the patellofemoral joint. Landmark is designed to allow for the patella to find its natural position by changes made to the patella groove, along with the ability to prevent rotational compromise of the femoral component. I've mentioned Landmark will be our most robotically enabled knee ever. This is another area where you will see that come to life. I can't disclose too much here today, but please know that CORI's unique capabilities lend themselves really well to planning and executing the patellofemoral joint in a total knee. Besides improving function, this can also help reduce the incidence of anterior knee pain, which remains a common problem with knees even today. All of our new platforms across hips, knees, and shoulders will have best-in-class tray configurations that drive efficiency. For LANDMARK, we will be able to support a robotic total knee replacement with up to 50% fewer trays than some of our competitors while offering multiple implant options, as well as cemented and cementless fixation. This is significant since it not only reduces sterilization costs, but also the burden on OR staff. Remember, ASCs are typically leaner on staff compared to hospital ORs. The commercialization of LANDMARK will focus on our full procedural offering for knee arthroplasty, pairing together a distinct implant design that replicates the normal position and movement of the knee with the amplifying power of handheld robotics. Whether surgeons use LANDMARK with manual instruments or with the CORI robotic system, LANDMARK will bring amplified efficiency, personalization, and performance to every procedure. Finally, most importantly, while we continue to innovate with the robotic platforms and implant systems, we continue to generate valuable data across the episode of care. Starting with our image-agnostic CORIOGRAPH pre-op planning, all the way into intra-op and post-op data around outcomes and function, we have the ability to create this connected ecosystem that will eventually help build algorithms. Algorithms that can one day drive clinical decision-making for patients with different anatomies, disease progression, or even functional expectations. Our exclusive partnerships, and I'll speak more to this when I talk about ASCs, enable us not only to capture the clinical data across the episode of care, but also critical health economic data that can unlock value for hospitals and ASCs, and even payers and policymakers in the future. I'm very confident about our direction on robotics and knee surgery, and I'm convinced that this will create competitive advantage for Smith & Nephew in the coming years. With that, it is now my pleasure to introduce Dr. Steve Haas from the Hospital for Special Surgery in New York. Dr. Haas, besides being an accomplished surgeon and a global thought leader, is also the immediate past president of the American Knee Society and has been the chief of knee service at HSS for the last 18 years. He will talk to us about the evolution of implant design and enabling technology from his unique vantage point. Dr. Haas, please. Before I begin, I want to thank Mayank and Deepak for inviting me to come. I have a special warm spot in England. I studied here when I was in school and spent a year in London and another four months up at Oxford, and I love London and I love England, and it's a real pleasure and an honor to be here. I'm going to speak, as you heard, about LANDMARK and CORI, and I think I'm going to try to share with you why I think this is really the next evolution of knee replacement. I think something that probably most people don't know is some of the great limitations that we've had in knee replacement up to this point. It's a great operation. I love it. I do it all the time. We have had problems. sort of a bit of what Anil talked about before, it is true that hips are about 95% perfect. Knees are not 95% perfect. They're 80% perfect, maybe 85% perfect. It gives us, as an academic, you say, "I have things I can do to make it better," and in partnership with you guys, I think that we may have done that. Okay. With that, we have to look at the reality of the world today. Our patients today are not what they were 20 years ago. Our expectations of what our patients want to do, they're not all 65-year-olds or 80-year-olds who just want to walk down the street. They want to ski, they want to mountain climb. Some of the more professional athletes that I have want to do that, which I wouldn't suggest the bungee jumping for most people. Some people want to do, frankly, whatever this patient was doing, she wanted to do that. I don't even know what she's doing, the demand of the patient is to restore them to the activities that they want to do, and many of the patients are in fact younger, or if they're older, even much more active than they used to do. The demands on us is to make patients happy, we have to meet their expectations. I'd like to share a little history of knee arthroplasty to understand how we got to where we are and what the limitations have been up to this point in time. Knee replacement started in the 60s really as hinges. That's where the term. If I could outlaw the term knee replacement, I would. I can't. Knee replacement is a terrible term. We don't do an internal amputation of the knee. It was, in fact, an internal amputation when you put a Bita hinge in. In the 70s and 80s, the first successful resurfacing replacements were developed, actually at HSS by Anil's dad and my mentor, who was British, John Insall, who trained at Cambridge. That was a revolution because knee replacement turned into like a dentist capping a tooth, just capping the end of the thighbone and the shinbone, the femur and the tibia, and the kneecap with implants that were about a third of an inch thick, about 7 to 10 mm thick. That was a great innovation. Now, that worked amazingly well, but there were no lefts and rights at that time. Okay? If you can understand how we got to where we are, there were no lefts and rights. There were one or two sizes. Those things worked, and they last a long time, but they were really crude. You matched essentially the patient to the implant rather than the implant to the patient. The concept of resurfacing was started. In the 90s, that was improved upon. You focused on refinement of this basic design, improved instrumentation, so it could be put in. That brings us to about 2006 to 2013. I don't think probably people think about this, but the knee replacements by the three major companies beyond Smith & Nephew, Stryker, Zimmer, and DePuy, all those systems were developed, literally, they were released in 2006 to 2013. Knees that are going in today, they were designed then, and the philosophy and science of the time is what's used today. Okay? Now, what happened since that time? There were improvements. In fact, the main improvements were, well, there were new polyethylene inserts that had some asymmetry in them, were introduced, and there was the introduction of 3D-printed technology, which was applied to only the tibia and the patella. Those were improvements, and I think really great improvements, but limited. The big limitation is, well, if your designs, your femur in particular, was designed in 2006, it's stuck with that. It's symmetric. It's mostly symmetric. They're left and rights, but only a little bit left and right, and they're based on science of the time of 2005 to 2013. It's really not what we think today. Those are limited by those concepts. Why do we care? Well, if you look in knee arthroplasty, again, very happy, makes lots of patients happy, lasts a long time. The reality is that lots of patients aren't satisfied with the result. A lot of them are, but a lot aren't. 10%-20% of patients are not satisfied with the result, and especially if you look at the younger patient, I mean, younger is the people in their 50s and 40s. Especially in their 50s, we do a lot of patients, and about 15% of those patients aren't satisfied with the result. This happens to be a publication we did, but it's been reproduced elsewhere. You had about 20%-25% were only moderately satisfied. They're happy. They'd have the operation again, but they aren't thrilled, and they don't always return to the activities they wanted to do. With this, if you look at the world of orthopedic arthroplasty, new concepts have been developed to improve these outcomes, which is what makes it fun. We have these new concepts. It's a really exciting time in orthopedics because we have technology and science that have introduced these new concepts. What are these new concepts? Well, the first one, it seems so simple to me, but restore native anatomy. We want to restore the anatomy, and that means restoring the anatomy of the femur, the thigh bone, the tibia, the shin bone, and the overall alignment of the leg. Years ago, what we did is we thought everybody, in part because the best we could do, we said everybody ought to have a straight leg. It didn't make a difference how you started. Like all things in life, not everybody's the same. People aren't vastly different, but people are a few degrees one way or the other, and if you start off with a bowed leg, a little bit bowed, maybe that's the way we ought to put you back in the first place. Not say you were straight, and the person got a little knock-knee should be straight, and everybody got the same. The restoration of that concept, and that concept applies to both the thigh bone and the shin bone. Reproducing anatomy, a personalized alignment strategy. The next is restoring the natural motion pattern. The knee is not a hinge. It doesn't just bend. It actually rotates. It bends. It slides. It has a multitude of motion activities. Trying to reproduce that natural stability and motion is actually a goal of this new concept. The third one I already talked a bit about is 3D-printed technology. 3D-printed technology has proven to be very successful in the tibia and in the patella, for reasons I'll talk about a little bit later. That's one of the third concept. The last one is what makes a lot of this possible is robotics. Because of the accuracy we get with the robotics and the reproducibility we get with the robotics, we can do some of the other things that are the earlier concepts. If you look at this, in fact, Landmark is the first knee to incorporate its design, to incorporate all these concepts into the design. The others can't because they were designed long before these concepts were actually thought about. I'm going to try to explain, this is actually a pretty simple concept. You say, "Why didn't the knees do this all along?" They didn't. They didn't because they started at HSS and other places as symmetric designs and then just grew out of that. This is looking at the knee. If you were looking at the knee as it was bent, just looking straight at the end of the thigh bone, this is the femur. What you want to do is essentially match the back, which would be touching the tibia or shin bone, and the front, which is where the kneecap sits. It's pretty simple. If I'm doing a resurfacing operation, I want to match that anatomy. Simple concept. In fact, traditionally, knees don't do that. If you match the back, the kneecap is in the wrong place. The groove for the kneecap is not in the right place because they weren't designed to match the front and back at the same time. They simply weren't designed anatomically. They weren't asymmetric. They were designed in a way that didn't match anatomy. In fact, to show you this is actually a real case. This happened to be a Mako case. That's the Stryker knee, and that's a Trabecular knee placed on. As you see, the back lines up in the back, but the groove is there, and that's where the groove of the patella is. You can do, you say, "Well, I'll match the front," but then you're not going to match the back. At the end of the day, you're making a compromise. With Landmark, since it was designed anatomically, it's a simple concept. It's designed like the natural anatomy. We simply took what the average anatomy is, and we put it back together and said, "It's asymmetric, but that's what it looks like. That's the natural anatomy." It matches the back and the front because the kneecap groove is in the correct place. It's a simple concept, knee replacements, because of their vintage, did not do that because it wasn't thought of. There's another aspect to it, too, because what this is a diagram of essentially looking at the alignment. It has the overall leg alignment. It's called CPAK, it's the overall alignment. It's a classification system. You look at, you have bowed legs on the left, knock knees on the right, and the individual categories of how the bowed leg and knock knee are made up, either of the femur and tibia. Ideally, you'd want to match it all. The green dots are the distribution of normal patients. Simple. Those are the distribution. Those are their alignments. Well, if you take a knee and you say, "Well, I'm going to put it in the way we know is safely to put it in the way that we've gotten accustomed to and say, "This we know is safe. We have lots of data saying ± 3 degrees is okay to do it." Well, you can only match the anatomy with the conventional knees that are out there, those other designs, in about 40% of patients. You may want to, but you can't. If you want to match them to a larger proportion, you have to make cuts of the bone that were not known to be safe. We don't know. I think probably some of them are okay, but some of them probably aren't, and some of them aren't okay in patients, because historically, we know that if you deviate from those guidelines, especially in heavier patients, which a lot of patients are, you get failure. We don't know that deviating is safe, and the only way to match anatomy with this traditional design is to deviate from that conventional way we do it. If you look at LANDMARK, simply with doing it the conventional way that we know is safe to do, it's just easy. It matches anatomy. Again, if you take it and design it like the average person, to get to the bell-shaped curve doesn't take very far. If you're designed like an outlier where people aren't symmetric, then it takes a big deviation to match all the anatomy. I think that the first goal, matching anatomy. The second is restoration of that normal rotational motion. We think that that will also make the knees feel more natural and function better. In fact, we build on the proven technology of JOURNEY. JOURNEY to publications. This happened to be a publication by me, but there are publications, literally 20 or more publications on JOURNEY, showing it has the most natural motion pattern of any knee. What we did is combined that with the ease of use and the versatility of LEGION, built on that to make this a simple thing to restore that native rotational motion and natural motion pattern. Additionally, by doing that, we could optimize the patella groove. By optimizing the patella groove, we said, "Well, we want that groove to be good even if we modify those cuts a little bit." That groove is very forgiving, and not only is it in the right anatomic position to start with, it's forgiving for variations in alignment. I think it has by far the most advanced patella groove, certainly in the industry. If you look at this, what the other designs did, basically, because they were designed before they wanted this rotational motion, they introduced the asymmetric plastic. They didn't necessarily mate that femur with the tibia. They took an existing femur and said, "Well, let's make a plastic to mate it." Whereas LANDMARK was designed in conjunction. The whole system was designed together with mating those two together to optimize that stability and rotational motion that we need to get. 3D-printed technology. I've already alluded to this. 3D-printed technology, it's actually interesting because there's a picture of bone, and there's a picture of the 3D-printed titanium. They look pretty much the same. That's part of what induces the bone to grow into it. It's really been shown that there are fewer failures with 3D-printed technology. Really, all contemporary tibias and patellas that are porous-coated or non-cemented are 3D-printed. Because the femurs were designed in 2006 to 2013, they weren't. They didn't change that. Other than sort of smaller niche products, they did not change the main temporal components. They still rely on using older porous technology. Landmark, again, is the only knee that has incorporated into the whole system, 3D-printed technology for the entire system, the femur, the tibia, the patella. The entire system, which I think will eliminate some of these outlier failures that you do get in non-cemented knee arthroplasty. All right. Now we'll move on to robotics and talk a little bit about the history of robotics and how we got to where we are in robotics. Robotics first started in the 2000s, really as navigation. It was just to guide you on how to do it. In 2008, the RIO Robot, which ultimately became Mako, was introduced, and it was a big advance. It was the first robotic platform that was really successful. It relied on a CT scanner, so you had to have a CT scan. It did have a haptic saw or burr that you could use. Though some of the limitations, it still, and to this day, it still requires manual assessment of ligaments. In other words, you have a device that's accurate to within a degree or so to make the bone cuts, but when I assess the ligaments, the soft tissues, I literally tug on them. I say I hold it, and I pull on it one way or the other, or I stick a spoon. It's literally a little spoon underneath to say, is the ligament loose or tight? Which we've shown and is, as you can imagine, less than accurate because I might pull a little harder if I drank some more coffee or if I'm the big guy or what the day is like, how hard I'm going to tug on the leg. That's a limitation of it. Then I would argue the biggest limitation is, I can't argue because in 2008, that was probably not a bad idea. It's a big truck in the OR. The big truck in the OR is a more and more problem as we go into ambulatory surgery and efficiency of surgery, which I'll go into. 2012, 2020, well, you had NAVIO. NAVIO was a great innovation because it was handheld robotics. You actually had a robot that you held in your hand that could execute the plan that you designed on the computer. That was a great innovation. The other thing that it had is it had the ability to map the bone and do it image-free. Now you didn't have to get a CT scan ahead of time. You could map the bone accurately and do it without the added ability or requirement of getting a CT scan. As you know, it was acquired by Smith&Nephew. Then CORI came along in 2020. It has been improved on and now CORI XT. Those improvements included, you've heard some of them, the ability to add a tensioner, now to robotically and accurately measure the soft tissues and personalize the soft tissues. Additionally, the additions of, if you want CT-guided, you can do CT pre-planning. You can do and develop the image from a CT or an MRI. The versatility of having image-agnostic doesn't require you to have a CT. It could be image-free, which is actually very useful in, I suspect, in Europe, where you're much more cost-constrained. In the U.S., I happen to like the pre-op planning, with the MRI or CT, but actually, once you do the image free, you say, "Well, gosh, it saves my office a bunch of time." You find that you may even prefer that, and certainly having the versatility of all three, CT, MRI, and image-free, is the best of all. Other robots came along, too. In fairness, we did have ROSA, and you have VELYS. ROSA, same truck, but didn't even do much of what. It doesn't even have a cutting device. It just puts a guide in front of the bone. I would argue that that's a much more limited kind of platform. In fact, they do share with Mako in having the large robot. To give you this sort of visual, I thought this is a good way to describe the two. The robot is in the orange of holding my hand. That's the CORI robot. That is a robotic device that automatically will remove the bone. I'm going to show how it does that. Okay? It's doing the same thing as the Mako robot on the right, as it has an arm with a saw on it or a burr on it. I have the burr in my hand, but it's robotically controlled, meaning turn on, off, go in, out, and I'll show you. The ROSA robot, which is equally actually as big as the Mako, and it doesn't even have anything to remove bone. It just puts a cutting guide, which I have to then take a saw and manually cut it. The idea of having this small mobile device, it creates huge efficiency ergonomics. It seems like that's the difference between a big brick phone or having your iPhone in your hand today. Okay? How this works, essentially, what you have is you have this robot in my hand, and the burr will come in and out, on and off, and it comes out to the depth it needs to come out to. If I'm doing this, that's me removing the bone, looking at the screen. I'm just waving my hand in front of the bone. In fact, it will come out to the depth, and if I push it in farther, it's going to pull back. It's going to move exactly the bone, and it has a boundary control, which is, I would argue, an improvement on haptics because it just shuts off. It doesn't stop me from doing it. It just turns off. It pulls the burr back. If I go off the field where bone is supposed to move, it just pulls back. It's gone. I can't remove bone from bone I'm not supposed to remove. It won't injure soft tissues because it's going to disappear and shut off. It allows me to remove exactly the amount of bone I'm going to remove in a very expeditious fashion. As I said, there are a multitude of things that I think are improvements. Having the versatility of CT, MRI scans. Having the robotic tensioner. As Mayank said, there's an indication for primary total knee, uni, revision total knee, total hip replacement with CT guidance, and total shoulder replacement. It's the only revision FDA-approved in the U.S. This, I think, gives a good visual also about telling how the efficiency. If I'm going to do a case, and I'm doing it either in an ambulatory surgery, or if I'm at a hospital where I've got one room and I'm going into the other room, which is frequent. For efficiency, surgeons will get the one room prepped and ready. When they finish the other room, they can go right into another room. That's really the way that many efficient hospitals or most in the U.S. are going to do it. I suspect a lot in Europe as well. What has to happen if you're using a Mako robot is that robot has to get rolled into the room. It has to get that drape put on, all those arrays have to be put on, and then it has to be registered. There's just no way about it. It takes time to do. You talked about does it affect infection rates. Well, I'm not sure it does. We haven't shown robots has increased, although I would more worry about when I have a truck running in the room from one room to the other, and I have to get it ready right away. When you are doing CORI, each CORI, the cart is where the brains are. The robot's in the handpiece, and each cart comes with multiple handpieces. When I go to the room, that's AMG rolling the cart into the room from one to the other. That's a pretty simple thing to do. It doesn't have to be prepped because it's not in the surgical field. The robot is. My circle's not exactly right, but my robot's already there on the table. Okay? That's already in there. I just walk in the room, and I use it. They plug it in. That, to me, is obviously a much more efficient setup and doesn't require the draping, prepping that is necessary with the larger robotic trucks. You already saw this. Much more efficient as far as with LANDMARK and CORI. You have many fewer trays, you just don't need to. That is crucial for the ambulatory surgery. Mike's going to talk about that. They can't cook 10 baskets over and over during the day. Fewer instruments create the efficiency, and not only efficiency, the cost of sterilizing instruments, and frankly, the cost of banging around this for a long period of time, the cost of manufacturing all those instruments. I, as developer scientists, I would always be frustrated because what limits you in innovating in the design of an implant is often you build all these instruments. You can't change anything because the instruments are already built, and the instruments are so expensive. The more extra instruments you need, the more limits you are in future progress. There are lots of reasons why having fewer instruments is far better for the system, the company, and for the surgeon. In summary, Landmark, as I hope I shared with you why I think it's the next evolution of knee arthroplasty. It's the easiest knee to restore natural anatomy. It optimizes this for activities that our patients want to do. We've already shown we can reproduce natural motion patterns in the knee. It's the only knee incorporating all the 3D-printed technology, and I think that's really where the arthroplasty world's going. CORI obviously optimized for mobility, efficiency. It's shocking to me that no one has been using robotic tensioners. There's one other that has come along, but none of the major companies have it, and I think that's essential. We want to get all this accuracy in our bone cuts, but soft tissues are vitally important. Getting accuracy in them with the robotic tensioner is so important, and as I mentioned, has the broad indications. I think that's the next evolution. Thank you, Dr. Haas. We can do a couple of questions. Yeah. Yeah. Thanks for the presentation. This was excellent. Could I just ask one on robots? If you think about over the last, say, 15, 20 years, I get the sense, ex the Mako, people would buy the robots from the company from which they were already buying most of their implants because you could use a robot for a portion, but not that many necessarily of your procedures. Do you think we've tipped that over to the point where people will buy the best robot and adjust their implant behavior as a result? Do you think that makes a difference for CORI because it is genuinely differentiated when you look at what you described there? Yeah. The answer is, I think that in fact people will. I will say, actually, it's an interesting thing because I think for a bunch of years, people didn't love Triathlon knee even. It wasn't Triathlon knee that people liked. They liked the Mako, they used Triathlon knee. I would actually argue that a lot of the growth came about, in fairness, they were the first to do it. They got the credit for doing it first. I would be critical of them because they've sort of sat on that laurel for a bit. I hate to say it, but they milked it. They milked that for a while, and they haven't improved it. Why don't they have a tension-- Don't tell them. I don't want them doing this. It's crazy. Literally, if you do a Mako case, you're tugging on the knee to assess the ligaments. It's crazy. It's crazy when you have this sophisticated instrument to do the bone custom planning. That to me is nuts. The other thing is, I think they relied on the laurels. Triathlon was an okay knee, but it's from 2006. Now, they did improve with the non-cemented. That was an improvement. That femur literally is from 2006, and it was okay back then, but it's old. It does not incorporate the new technology, and that picture I showed you is real. That is just reality. It does not match natural anatomy. If our current thinking, which is the current trend that's been on for over five years now, is that matching it in anatomy is good, and it makes sense. We're doing a resurfacing operation. We want to resurface them, and we realize that 20% or 15% of our patients are not happy. Well, some of them are probably not happy because we didn't restore their anatomy properly, so that requires us to alter things, to compromise in all sorts of ways. Like I said, if you were selling all these robots and you sold your mediocre knee, then they got by. I think the answer is having a robotic platform that is more forward-thinking, that is more modern, I think will in fact get people to convert. If you add that to a knee that is state-of-the-art, to me, that's a combo that really hasn't existed. I think the synergy of the two is really what makes it, and that's why I think this is really exciting. Dr. Haas, thank you so much. Veronika from Citi. Two questions from me. The first one's on LANDMARK, and obviously, the anatomical approach is unique. How receptive do you think your peers will be to that? Does it require a different surgical approach, retraining? Is this something that folks are going to be super excited and want to use? They're going to say, "You know what? I've never done it this way. Maybe I'm just going to wait for a while." My second question, I think I asked you this in New York, but I'm going to ask again, bur versus blade, and how you think about CORI and how important the blade attachment is going forward in terms of driving better adoption. Thank you. Great questions. Anatomical. First of all, you don't have to modify the technique at all. Actually, interestingly enough, in many ways, it's actually easier. If you did your knee the way you did it before you worried about anatomic alignment, you'd match the anatomy perfectly in 40% of people. Because again, it's based off average anatomy. If you did nothing, you didn't even know it existed, and just said, "I'm going to do the knee the old mechanically neutral way," you'll match anatomy in 40% of people, which gets you halfway there, right? The way, actually, if you reincorporate this, actually, in CORI, you don't even know it exists. It's actually invisible. You just know that you're going to match. We have the CPAKs on there. In other words, the alignment. You have on the screen the alignment. You'll see, you match that alignment 90% of the time. You don't even have to know why you're doing it. You just say, "I want to match the anatomy," and it dials it all in. It's really seamless to do it. You don't even know what's happening. You just know. If you plugged in asymmetrically, like if you happen to put in. You went in, and you said, "Well, I'm going to look at LEGION," which is more traditional, right? If you put a LEGION in, you'd see you weren't matching the anatomy, right? If you wanted to compare and someone wanted to see it. If you ask it, there's screens that can tell you how you got there, but it's invisible. It's designed to be totally, you don't know why it's happening, you just know you got there. The burr versus saw. Oh, the burr and saw. Yeah. The burr, actually, that's another good question. I think the burring, in fact, you are correct. I think that sawing is the traditional way that people did it. I think burring, for a limited amount of. When you do CORI, you have different options. The way I do CORI, because I like to saw the bone, and when I do certain cuts. I burr the distal femur. That, frankly, the adoption of that would be pretty easy because that's really simple to do, and it's super fast. I use a cutting block to cut the rest of the cuts because those cuts are really easy through a cutting block. The tibia, you have the option of cutting and burring. I happen to like to cut. We recognize that there are people who like to cut, so you actually have a cut option for the tibia. Essentially, you use CORI to essentially guide you in how you make the cut. I think we've resolved that objection to it for those who like to cut. We built a cutting option into it. In fact, that's the way I do it. Actually, the beauty is if you are not perfect. Actually, we check the cuts, you don't have to, but I do. You check the cuts, and sometimes our manual cuts can be a degree off. For that matter, if you look at it, well, obviously, you'd have that with ROSA because you're just cutting through a slot. In Mako, if you look at the accuracy, you can be a degree or two off. In fact, I check the cut, and if it's a degree or two off, which sometimes it is, I can take the burr. When you use the burr, and this is kind of a neat thing, I call it the eraser because if you're just rubbing the wand on the tibia, it literally takes 30 seconds. You rub the burr because it's going to come out and do it on its own. I literally take it like an eraser and erase any little bits of bone away. It literally is within a half-degree accuracy. It's incredibly accurate to do that. I do that if my cuts are not perfect. I sort of like that to be perfect. Perfect as I can be, I'll take the burr and do that. It's actually kind of neat to watch it. Okay. I think we're running out of time. Maybe we can have another opportunity to get Dr. Haas back on stage and ask the rest of the questions. Okay. Thank you. Sure. Appreciate it. Great session. Great questions as well. Thank you very much. Let's switch gears a little bit here now. We heard from Dr. Haas, his perspective on the evolution of both implant design and technology in knee surgery. I trust it is clear to you how Smith & Nephew is working to build its differentiated value proposition for the future of knee surgery. The other significant trend we talked about was the shift in care from hospitals to ASCs. We talked about some of this, but understanding and serving the unique needs of this segment are paramount to future success. This is also an area where we have competitive advantage. Before we get to that, let's review what makes this segment unique and so important. There are about over 4,000 ASCs in the U.S. performing some type of orthopedic or sports medicine procedures. Let's call them musculoskeletal procedures. These centers already have and will continue to see strong double-digit procedural growth as more surgeries move from multi-specialty hospitals into dedicated outpatient settings. However, this ASC care setting is very different. The ORs are smaller with limited capacity for sterile reprocessing and storage. They usually operate with much leaner staffing models while opting for higher efficiency and throughput. Ongoing reimbursement changes we know will continue to drive an even higher procedural uptake. With growing volumes and a focus on throughput, recent mandates also require these centers to maintain and report on their patient outcomes, a task that can be burdensome with these leaner operating models. As you can see, whether you're a surgeon or an ASC stakeholder, there is a fine balance across throughput, efficiency, and outcomes that needs to be maintained constantly. At Smith & Nephew, we understand the business pressures and ASC stakeholders face, and have enhanced our commercial model to fully align with our customers' priorities. Smith & Nephew is partnering with ASCs to deliver value across the episode of care, becoming far more than just an implant provider. Through procedural solutions across the full Smith & Nephew enterprise, robotic technology that's optimized for ASCs, expanded strategic partnerships, and access to unique insights and analytics, Smith & Nephew is positioned to be the partner of choice to help ASCs deliver their priorities of clinical, economic, and patient outcomes. We maintain a higher procedural penetration across both hips and knees versus market and ASCs anyway. Furthermore, in 2025, 40% of our CORI robotic units were deployed in ASCs in the U.S. This strong segment performance is really a function of our robotic form factor, which is aligned with ASC needs, our best-in-class tray configuration for efficiency, and our unique ability to leverage in our sports medicine business, where we enjoy market-leading positions. Recently, we have revised our commercial model to serve our ASC customers even better and have forged some strategic partnerships that help ASCs unlock more value. I'll dive into each of these in a little more detail. Let's start with CORI. I said this earlier, and you heard this from Dr. Haas as well, CORI is the only robotic system, handheld or otherwise, that covers the knee procedural breadth all the way from partial, total, and revision knees. With the introduction of CORI Shoulder earlier this year, we'll hear from Dr. Klifto about that, we expanded procedure coverage to include both reverse and anatomic shoulder arthroplasty. With CORI Hip launching soon, CORI will become uniquely positioned to offer musculoskeletal-focused ASCs the flexibility to use the same robotic platform for multiple procedures. Also remember that CORI is small footprint. It can be wheeled between ORs like Dr. Haas showed, with quick setup and turnaround time, something that ASCs really value. CORI's overall cost of ownership is also significantly lower than larger arm-based robotics. All these factors combined, it's really no surprise that we deploy 40% of our CORIs in ASCs in the U.S. Given the recent CMS mandate, CMS is the Centers for Medicare & Medicaid Services in the U.S. They've had a recent mandate for ASCs to report on patient outcomes for every case, we have forged some unique partnerships to help enable this. Not only do our strategic partners facilitate patient outcome reporting, but they also drive improved patient engagement and compliance across the episode of care. We also offer ASCs actionable analytics and optimized performance with real-time metrics and connectivity across multiple reporting systems. Lastly, most importantly, these partnerships help generate clinical and health economic data across the patient journey, which will ultimately help us personalize these pathways for patients and ASC stakeholders. Beyond the attractive form factor and procedural breadth of CORI, I mentioned this earlier as well, we will have the best-in-class tray configuration for all our flagship brands across knees, hips, and shoulders, so Landmark, Catalystem, and Aetos. This really matters in ASCs, where OR space, sterile reprocessing space, and staffing are all constrained and designed to maximize throughput and efficiency. Compared to the competition, our knee and hip platforms will offer up to a 50% reduction in OR trays, while our AETOS platform, you'll hear more about this, will offer up to a 70% reduction. This is a result of deliberate design choices we have made to ensure we offer the leanest configurations without compromising on intra-op surgical options. As I mentioned earlier, there are close to 4,000 ASCs in the U.S. that perform some sort of musculoskeletal procedures. Out of these 4,000, over 60% perform both sports medicine and orthopedic procedures. This is where our combined portfolio really shines. Whether it's knee, hip, or shoulder arthroplasty or knee, hip, or shoulder soft tissue repair, we have unique and clinically differentiated offerings across both, as you heard from Christie, Dr. Ranawat on the sports side earlier. Our sports medicine business also carries capital with unique technologies like TESSA, which we will be able to offer to over 60% of these ASCs. All the portfolio technology and partnership capabilities are underpinned by one thing, and that is our commercial model that drives relentless focus towards our ASC stakeholders. Over the last few months, we have reshaped our model with new leadership and a dedicated ASC team. We are continuing to build flexible deployment models and other partnerships that will help us deliver enhanced turnkey solutions for musculoskeletal-focused ASCs. In summary, Smith&Nephew is uniquely positioned to meet the needs of this ASC segment through its enterprise portfolio strength, differentiated technology, strategic partnerships, and a dedicated ASC organizational structure. I'm also really excited about our future in this space. With that, I would now like to introduce Dr. Mike Ast, who is also from HSS. Besides being the Chief of the Knee Service at HSS, Dr. Ast is also the Director of ASC Strategy at the Hospital for Special Surgery and their Chief Medical Innovation Officer. Dr. Ast will share with us his perspective on the ASC segment and how he sees it evolving in the future. Dr. Ast, please. Thanks, Mike. Thank you to everybody for joining us today. It's really cool to see a room full of people interested in what we do, right? So it's hard to know exactly how interesting the rest of the world finds what we do, but it's nice to see at least a few of you think it's as cool as we do. As Mike said, my name is Mike Ast. I'm a hip and knee replacement surgeon from HSS. I'm not gonna talk to you at all about hip and knee replacements. Instead, what we're gonna talk about is sort of the way that healthcare systems are changing across the world. I know that ASCs are an extremely United States-focused concept, but I would argue that our existence and the world of ASCs in the United States translates a lot to the global healthcare economy, and there are actually a lot of synergies and parallels between more nationalized healthcare systems and what we have seen successful in the U.S. and why there's a lot of lessons learned in the ASC that will translate to the global market. I mean, we're already seeing some of that as you move around. This is a picture of one of our ASCs. Just that's the fun one 'cause it says sports medicine, and that's where all the famous athletes get their treatment. I'm lucky enough that I work in actually one of our other ASCs, and what makes me so lucky is that I get to partner with Dr. Ranawat, which is why they are so mad at us today 'cause both of us are supposed to be there operating today. Instead, we're here with you great folks. The world of outpatient arthroplasty, the concept of having a hip or knee replacement and going home on the same day, has rapidly accelerated over the last couple of years. I started my personal journey on this in 2013, so I am one of the sort of people who've been in this the longest. I've been doing same-day discharge from ambulatory surgery centers and hip and knee replacement for about 13 years now. In the United States, a variety of factors have caused us to move a lot of our hip and knee replacements from the inpatient space to what we call the outpatient space. That's either a same-day discharge from a hospital or from an ambulatory surgery center. For knee replacements, you can see based on this graph, that happened just around 2021. For hip replacements, it happened about a year later. More than half of the hip and knee replacements done in the United States are done in an outpatient setting, meaning in a setting where patients are staying for shorter amounts of times and oftentimes not even going to a hospital. We saw a little bit of this, but this is the classic, I don't need to explain a consultant McKinsey slide to a group of investors, but this is that understanding of how that market affects the healthcare system in the United States, where ambulatory surgery centers are one of the fastest-growing markets in healthcare, with double-digit continued growth over the last couple of years and an over $12 billion market value. This is an interesting map because, as we heard from Mayank, about 4,000 ASCs in the United States do things like musculoskeletal care. This is a map of the ASCs doing hip and knee replacements. This isn't just general musculoskeletal care. This isn't sports medicine. This is specifically those doing multiple types of joint replacement procedures in there. It goes directly to the question that was asked earlier, is there ever a point at which the technology becomes so differentiated it helps make the sale? The answer is absolutely, because when you are doing both hips and knees and potentially shoulders, you don't want to buy seven different robots to accomplish that, and it becomes a very different conversation. The really interesting part about this is, number 1, it shows you the disparity of healthcare in the United States, where the middle of our country has dramatically less access than other parts of the country, and an access issue extends beyond the United States to many global healthcare systems, where access is more important than necessarily cost or outcomes, just trying to get more access with less resources. I can also tell you that if I showed you this map five years ago, there would be maybe 11 dots, and if I show you 10 years ago, there'd be three dots. There'd be one in Chicago, there'd be mine in New Jersey, and there would be another one in New York. That'd be it. There'd be three dots 10 years ago. There's now 574 as of last May. I just looked it up just to try to be as up-to-date as I can. There's 603 ambulatory surgery centers in the United States doing multiple types of joint replacement procedures as of earlier this year. This is the fastest-growing segment in the U.S. healthcare market. The lessons learned translate across the global markets. If you look in the global markets, we may not be using the term ambulatory surgery center or day surgery center, but we are still focusing on the same important topics. How do we do more with less? How do we become more efficient? How do we utilize our healthcare resources in a way to get more patients care sooner? We heard it from Dr. Ranawat this morning, that the challenge of meniscal repairs in some of the healthcare systems around the country is that the patient doesn't get surgery for 2 years, and 2 years is too late. We know that healthcare systems around the world are working to decrease wait times, increase capacity, yet not spend more money. If you look at the penetration of ASCs, it remains low to moderate in most of the healthcare systems around the world. If you look at outpatient growth, the concept of simply trying to utilize fewer resources for the same thing, we're actually seeing moderate to even high growth in a lot of markets around the world. That's because what keeps global healthcare leaders up at night is no different than the things that drove us to ambulatory surgery centers in the United States. It's long waiting lists, it's workforce shortages, you need to do more with less. It's bed shortages, it's an aging population utilizing more healthcare resources in a very different way than they did 20 or 30 years ago when we started doing joint replacements. This is not, as I said, a uniquely American problem. This is right out of the NHS, where reforming elective care for patients is an absolute priority of the U.K. system, where their goal is to get 92% of patients to the operating room within 18 weeks, a goal that we are not yet achieving in the United Kingdom. The National Audit Office put out, this came out earlier last year, that their surgical transformation goals are to create surgical centers that are more efficient and more focused so that they can provide more efficient care and more efficient utilization of resources. What does that sound to you like? Sounds like an ambulatory surgery center. This sounds like the United States concept of an ambulatory surgery center. While we talk about ASCs as a uniquely American thing and some of the drivers of ASCs, like the financial incentives we see surgeons partner with their ASCs to achieve, the goals are a great lesson for the rest of the world and for the global market that Smith & Nephew addresses. We know that the wins we see in the ASC market in the United States will translate to larger global wins in the future. When you're the NHS and you've got a fixed amount of money to spend and you do a traditional joint replacement, with 100 arthroplasty beds, you can do 1,000 cases a year. If you can take that length of stay and transition to outpatient arthroplasty, those same beds, those same resources, can now do almost 3,600 arthroplasties. You can over triple your ability to care for patients and your access to care simply by modernizing the way we deliver care and learning the lessons of the ASCs. Again, those long wait lists can be addressed by more procedures per operating room, those capacity constraints, because we have less dependence on inpatient beds. Workforce shortages are addressed with a significantly more efficient utilization of nursing resources, and you get a scalable care delivery model that allows you to bring more care to more patients as they age. This is why the ASC market may feel unique in the U.S., but it's actually a global consideration. In the U.S., the ASC has a variety of challenges. A variety of both headwinds and tailwinds. The tailwinds we've heard. More surgeries are being paid in an outpatient way, it's helping us shift more to the ASC. There's this concept being discussed, in Congress in the United States called site neutrality, where every single site's going to get paid exactly the same, doesn't matter if you're in a hospital or an ASC. Therefore, a significantly more cost-efficient and cost-effective site of service like an ASC becomes a huge win. There was this introduction of something called the NO PAIN Act, which helped us pay for some of the resources we need to be able to get patients out a bit more quickly, and I think that was very helpful. A variety of other considerations you see here on the screen that help us understand why ASCs have become so popular. They've got headwinds too. PROMS reporting, as Mayank alluded to earlier, is a challenge in a resource-constrained situation like an ASC. We don't have a lot of extra people to do a lot of this extra work. At HSS, we have entire departments of people just calling patients to get these patient-reported outcomes to achieve the mandatory reporting from the government. The ASC doesn't have any of that stuff. They don't have people to do that, partnerships with our vendor partners really make that possible. Push to value-based care in the United States has been talked about for a long time, the mandates are now coming. A full country mandated bundle for hip and knee replacements is on its way called CJR-X. It'll be next year. This will be a huge push to the surgery centers to try to control costs. Issues we have with our insurance companies always are a problem for anybody, the more we restrain resources, the harder it is for us. Platform consolidation, like the large consolidation of major healthcare systems in the United States, has driven some pros and cons in the world of ASCs. I think the most important thing to understand, whether you're talking about a United States ASC or the increased utilization of resources and trying to improve access to care around the world, is to understand what makes that ASC different. Nothing will ever explain the difference between an ASC and a hospital like this picture right here. You never think of a picture is worth 1,000 words. This picture is worth 10 million. This is my first ASC where I worked. This is a real photo. This is a real surgical photo. I'm going to explain a few things about it. Number one, this is a wall-to-wall picture. The average operating room in a hospital that does joint replacements is about 600 sq ft. This room, 358 sq ft, just barely half of it. This is the entire room. Also, you're looking at the entire staff. The nurse is taking the picture. You see Ben in the back, his back is to us. He's our anesthesiologist. On the right side, that's Dan, that's my PA. On the left, that's Elise, my surgical tech. On the table, the reason I'm allowed to show all of these, is that's my other PA's dad. The patient is my other PA's father, he's the one who let me use this picture all around the world, and I use it all the time. Let's look at a couple unique things. Number one, as I said, really, really tiny. Number two, not a lot of extra people. The most important part of the picture, I want you to look at the lights on the surgical field. If you look, there are, like in every operating room, lights attached to the ceiling that we move around. Does anyone notice where those lights are pointing? The back corner of the room, right? They're not even on the surgical field. Why is that? Well, because they were broken. In a surgery center, we just did the math. It was cheaper to rent this portable light sticking over the side of Dan's head than it was to fix the lights in the ceiling. In the hospital, if a single light bulb goes out between cases, I walk to the administrators and I tell them, "I'm canceling the rest of my day if that light bulb isn't changed by the time my next surgery starts. By the way, it's still better not to slow down my turnover. I don't want to wait for it. I just want to make sure it's done before I start." In my surgery center, I say, "Light's too many lights. Fine. We'll rent another one. It'll stick over the side. I won't be able to see. I don't really care." It's a completely different way you think about utilizing resources when you start to constrain the resources and have a good reason to do so. In the surgery centers, because I owned it, fixing those lights came out of my pocket, as I still do today. In the NHS, it's because we're out of money, we need to spend less and do more and make decisions that way. I think that's why you understand the unique patient population, room size, sterilization, cash flow. It is a different world when you transition to the world of an ASC. What do ASCs need? They don't need a supplier. You can buy supplies from anywhere. What ASCs need, ASCs need an enabler. They need someone who can help us achieve what we need to achieve using the right amount of resources at the right time for the right patient. An enabler, that's the key. We need to limit variability because we don't have enough staff, that staff needs to be very good because they need to move very efficiently. Our goal at our hospital is, let's try to get two or maybe three surgeries done in this room this day. In my surgery center, I want 10. I want three times as much production from one-third as much staff. Guess what? We are very good at achieving it. We achieve it almost every time. There are examples of ambulatory surgery centers in the U.S. that are as efficient in a day as our hospitals are in a month, using less resources and less time. We also need more unique things from our partners, as Mayank alluded to, we need help in getting these problems, in being more efficient. These are just two examples of technology. Interestingly, these technologies aren't about patient-reported outcomes. The one on the bottom left, this is a technology for operating room operational management. How are we managing our block time? How many cases are we doing? How is our turnover going? Tracking patients throughout the day, because we don't have someone to sit with them the whole time, so we can tag them electronically, and we can use technology to focus on that episode of care. On the top right, the one you never talk about when you're a surgeon at a hospital, but you really talk about when you're a surgeon at a surgery center, that's the financial performance of my surgery center yesterday. On a day-to-day basis, on a beat-by-beat basis, understanding your financial operational metrics are critical when you're trying to drive super high levels of efficiency. This is actually where Smith & Nephew leads. This is where Smith & Nephew has the absolute advantage. This is CORI, as we've seen over and over again. What is this? This is CORI in my operating room, so same operating room. This one's our bigger one. This one's 410 sq ft. This is our massive operating room, still two-thirds the size of the one at the hospital. This is the same surgery. I took the entire robot, and I moved it around the surgical field from one side to the other. You can see the back of my PA closing, sort of the same position you saw him in the other case. I can move it within the room while the surgery's going on without breaking sterile technique, without worrying about the constraints of the size of the room. Absolutely ideal for the ASC because of size, but mostly because of procedural breadth. By the time that hip is launched, we will be able to use this exact same appropriately sized robot for partial knees, total knees, revision knees, total hips, and total shoulders, all of which we do at my ASC, all of which we do not have the space or capital capacity to buy a different robot for each one. Significant decisions are guided by that procedural breadth. What's next? Obviously, we've heard about LANDMARK implants and implant systems optimized for the fact that we just don't have as many sterilizers in the ASC as we do in the hospital. As you start to specialize your care delivery centers, whether they're ASCs or specialized hospitals, you need to improve efficiency by improving consistency and minimizing waste and trays. Like I said, the future of CORI with the introduction of hip and shoulder, which you can see in the product hall next door. It's actually the first time I've seen them show the hip in a product theater. Congratulations. I think you are group number one to see that outside of the lab. Very exciting technology and something I can't wait to use next year. The right to win is very simple for Smith & Nephew, actually, right to arguably the largest ASC footprint of any of the major orthopedic companies that are competing in this space because of their leading market position in sports, because Anil is doing sports cases in the room right next door to where I am doing joint cases. It's the same team, the same people, the best-in-class robotics for the ASC, as we talked about, the minimal trays associated with both CATALYSTEM and LANDMARK, all of the newest systems being tailored to higher efficiency with less resource utilization, then data management partnerships that can help me solve the problems I actually have, especially associated with new government mandates for our ASC. That's why I say put all those things together, you look at Smith & Nephew, and we look at Smith & Nephew, certainly Dr. Ranawat and I, owners of our ASC who are making these decisions, look to Smith & Nephew as our partner of choice. Thank you. Thank you, Dr. Ast. Maybe we can have, again, a shortened Q&A session. We will have another opportunity to get Dr. Ast and Dr. Haas back on the stage. Yeah, please. Thanks. Maybe just on the shift from hospitals to ASCs. Ultimately, does it actually create any more hips or knees that need to be done? Because it just looks to me like unless there is some untapped supply, and there is a massive backlog, you are just moving one site to another, which is great for the system. I am just thinking in terms of total volumes, because presumably over time with price, the ASCs are particularly chosen because Medicare pays a lower price. I can imagine you over time, as we go up the patient curve in terms of severity, you might also, in turn, have additional costs and therefore try and find a way to relieve those costs elsewhere. I am just trying to understand from a market perspective, does it actually untap a pool of patients that weren't already there? Yeah. I think it's really interesting. We always think about it as a somewhat finite supply, like eventually you're just going to run out of patients. When you think about sort of at the surface level, I agree with you. It's sort of we're just taking the patients that we would've done somewhere, doing them somewhere else, maybe getting them in sooner, but eventually you're going to run out. The one interesting thing we learned about the ASC market, which I don't know how all that translates outside of the U.S., but there are a significant number of patients, especially since COVID, who are actually very afraid of the hospital. Especially in some markets, like some of our smaller markets, the local hospital is where mom and dad went to die. Nobody wants to go there for elective care. We saw an enormous influx of patients who said, "I was never going to get a hip or knee replacement because I will never go to the hospital unless I'm having a heart attack. I'm not going to that place. That's a bad place." The sick model of care. Now you tell me I can come to this day center where I had my carpal tunnel done a few years ago, and it was no big deal, and I loved it. I can get a hip or knee replacement. I actually think there is now, I'm not saying this is a massive market, but there is an additional market opened up by moving out of the hospital. I certainly never planned it that way. I didn't recognize it early, but I have seen it pretty consistently over the last 10 years and much more consistently in the last five, where these patients who simply did not want such a big surgery that it needed a hospital are very, very comfortable now that it's not such a big surgery, even though, okay, it's exactly the same surgery. More questions? Okay. If not, thank you very much, Dr. Ast. Thank you. We'll just go to a break now and be back here in 15 minutes at 11:35, please. Thank you. All right. Good morning, everyone. Thank you for having me here in London. I'm Scott Gunn, Vice President of U.S. Commercial Marketing for Trauma, Extremities, and Shoulder at Smith & Nephew. Today, I'm going to spend some time, about 10 minutes, on one simple idea. Shoulder arthroplasty is transforming fast, Smith & Nephew is building a platform designed to lead in the next phase of this growth. Over the past decade, shoulder arthroplasty has undergone a profound transformation. Today, it's a $2 billion segment, and it's growing roughly 9% with strong momentum in the U.S. That growth is being driven by a few big forces. First, expanded clinical indications in aging populations. Second, the continued rise of reverse shoulder arthroplasty. Reverse has grown from roughly 29% to over 70% in cases in recent years. Third, technology innovation. 3D imaging, pre-op planning, software, and robotics are shaping how shoulder procedures are performed. What's important to understand is it's not just that the market is growing, but how value is being created. We're seeing an ecosystem shift towards software integration, workflow efficiencies, and outpatient care models that enhance overall treatment value. Let's anchor on that clinical landscape for a moment. Shoulder arthroplasty spans a broad range of pathology, so versatility matters. On the anatomic side, procedures commonly address glenohumeral arthritis, inflammatory arthritis, avascular necrosis, and post-traumatic arthritis, where the rotator cuff is healthy. On the reverse side, we're reversing the ball and socket mechanism in the absence of a healthy rotator cuff and treating more complex cases. Rotator cuff arthropathy, massive irreparable tears, complex proximal humeral fractures, and severe bone loss. The takeaway is straightforward. This is a market that increasingly demands precision options and the ability to perform across a wide range of anatomies and indications. Here's how Smith & Nephew has approached this. Our shoulder journey has been deliberate, building step by step from acquisition of the Integra LifeSciences Orthopedic business, to implant designs, to 3D planning, to integrated enabling technology. You see that evolution from TITAN, supported by total shoulder, reverse shoulder, and fracture, to planning tools like ATLASplan, and then to AETOS, including stemless and expanded sizing. Now that innovation arc culminates in a modern platform centered on two key pillars, the AETOS shoulder system and CORI Shoulder. This is the foundation for how we compete, not only implants, but with integrated solutions that fit where the market is going. What's changing in the OR and the site of care? We see three major trends. First, surgeons are increasingly focused on bone preservation, revision options, and reducing risks like stress shielding, driving a shift towards short stem and stemless approaches. Second, there's rising demand for efficiency in the OR, higher throughput, less storage and sterilization, and a continued shift to ambulatory surgery centers. Third, we're seeing rapid adoption of technology and advanced materials, more pre-op planning, more personalized execution through robotics and mixed reality. The common thread across all three is this: the market is moving towards a more personalized surgical approach with more intra-op data and a clearer link between execution and functional outcomes. Let me bring that to life with AETOS. AETOS is designed around what we describe as elegant design and elevated experience. At the core is a design-driven bone engagement to load and preserve bone. The system uses a cruciform design intended to provide rotational stability advantages, particularly in osteoporotic bone, linking stability to engagement of higher density bone. Performance is essential, but in today's environment, system efficiency is also a competitive weapon. AETOS is a single-shoulder platform supporting meta stem, stemless, anatomic, total shoulder, and reverse total shoulder with a design that supports workflow consistency and practical intraoperative flexibility. The operational benefits are meaningful. Compared to other systems, AETOS delivers a reported 67% reduction in implant inventory, 70% reduction in trays, along with a significant reduction in weight. That matters because it directly impacts reprocessing, storage, staffing burden, and the ability to scale in outpatient settings. The second pillar is CORI Shoulder, our handheld robotic approach to shoulder arthroplasty. The concept is simple: data-driven decision-making through pre-op planning and precise intraoperative execution. On the front end, we support CT-based 3D shoulder planning. In the OR, CORI Shoulder is intended to enable execution for both anatomic and reverse across humeral and glenoid preparation. Importantly, this is not just about a single case. It's about building a learning system where surgeons can analyze insights and apply learnings from past cases to perform and refine over time. The value proposition is simple: precision, reproducibility, and personalization at scale. When we talk about robotics, access and practicality are important. One point of differentiation here is form factor. CORI Shoulder is positioned as handheld and portable in contrast to larger biop systems, supporting an ASC fit profile and a simpler footprint. Another differentiator is procedural coverage. This is positioned to support humerus plus the glenoid execution in both anatomic plus reverse shoulder workflows. Finally, adoption matters. A robotics approach that keeps the workflow close to manual instrumentation can support a more manageable learning curve. Let me close by stepping back to the full portfolio. What we're building is a simple and powerful shoulder portfolio, where advanced biomechanics with Tendon Seam, proven biologics with REGENETEN, and innovative technologies combine to improve outcomes. With arthroplasty and the launch of AETOS in 2024, with anatomic and reverse and stemless options, this positions us for high-growth shoulder replacement segment, CORI Shoulder extends our hand-held robotics opportunity into shoulder replacement. The headline is Smith & Nephew is pursuing growth by offering a broad, clinically relevant shoulder portfolio, spanning repair and replacement, supported by enabling technology that aligns with where the market is going. To bring this to life through a clinical lens, it's my pleasure to introduce Dr. Christopher Klifto from Duke University. Dr. Klifto is an associate professor of orthopedic surgery at Duke University School of Medicine, he specializes in shoulder joint replacement surgeries, including reverse total shoulder, anatomic shoulder arthroplasty, and hemi shoulder arthroplasty. Today, he'll speak about recent trends and advances in shoulder surgery, including the development of Smith & Nephew's AETOS shoulder system and CORI Shoulder. His perspective will connect innovation to what matters most and how these advances support surgeons and improve outcomes for our patients. Please join me in welcoming Dr. Christopher Klifto. All right. Awesome. First of all, thank you for having me. This is actually the first time I've been to London, really. Mike and Scott, were also first time we've been to London, so we had a proper day together. Yesterday, we went to Buckingham Palace, which was great. We did all the stuff that we thought we should do. We went to Chinatown, of course. Why not? Mike apparently doesn't own a tie, so we had to go shopping for him. This is his first tie he's ever owned, which is great. We went to a pub, which was awesome. We wanted to have a really great local dinner, so we went to Smith & Wollensky. Yeah. I think we crushed it. Yeah. All right. I'm going to be talking about Smith & Nephew Shoulder: Landscape and Changing Innovation. Truthfully, this has totally changed my practice, partnering with Smith & Nephew, because the investments that we've made, I feel like, have really changed my patients' lives. I want to go over that. Quickly about me. I'm an orthopedic surgeon. I grew up outside of Philly, I don't know if any of you know what Philadelphia's like, but it's a blue collar, gritty town, this is actually our mascot, Gritty, this is how our fans get ready for games, every single game, he essentially commits a felony. He beats up the opposing mascot and then throws him off the balcony, so. It's fine. Yeah. I've been at Duke for the last nine years, we're a rabid fan base there, too, but we have a little bit different way to psych out our opponents. This is a guy named Speedo Guy, and this is how he tries to get players on the opposite team to miss foul shots. A little bit of a different way to do it, but yeah. Dr. Weinrod knows what I'm talking about. Most importantly, yeah. End of presentation. I should stop there, right? Most importantly, I'm a shoulder geek, and the reason why I love shoulders so much is I have the opportunity to care for a patient from their entire continuum of shoulder health. I see them from healthy shoulders, maybe throwing athletes, all the way to rotator cuff repairs, all the way to reverse shoulder arthroplasties. That is extremely rewarding. What keeps me up at night, I have a five-year-old, and I'm trying to figure out ways how to keep her out of jail. She just walks around and shoots things all day, and she does it always in cheetah print, which I can't figure out, but I got to keep her out of jail somehow. Also how to improve the outcomes of my patients with shoulder pathology. There are two main problems, at least when I think about it, as far as how we're going to solve the shoulder world. One is to improve rotator cuff healing. Chris, you talked about a lot, their outcomes are just not good. There's not another procedure that we do in orthopedics that we're okay with a 30% failure rate. It's like, "Okay, we're just going to keep going." Also, patients hate extended immobilization, so we have to solve that problem. The other thing is how are we going to perfect shoulder arthroplasty? I'm going to give some data here. We're just not that good at it. Low volume surgeons do a lot of these, so we have to figure out ways to improve our outcomes. As Chris talked about, we have a 30% failure rate with re-tears. This is after large systematic reviews, and we know that if their patients have a re-tear, they have worse patient-reported outcomes, higher pain scores, and a reduced range of motion. These are things that we have to figure out how to solve on the front end. There are two main types of re-tears that we're trying to prevent, and this is going to make sense kind of at the end when we go over the products, there's this Type 1, which is a tear at the footprint, and this is when essentially the tendon tears off the bone that we've repaired. There's the Type 2 tear, which is more medial. This is where the sutures kind of come through, and it tears at the muscle tendon interface, and we have to have different solutions for both of these. This is a typical patient. I just did this guy four weeks ago. He's a tennis player. He has pain at night. The X-rays show minimal arthritis here, but you can see on the bottom right side, for those of you who are non-clinical, that is a massive rotator cuff tear. I think a lot of people would say, "In a 77-year-old, maybe we should do a shoulder replacement on this person." He comes in and says, "I don't want a shoulder replacement. I want to have my full range of motion for tennis. I don't want to have to deal with the complications of arthroplasties, please try a rotator cuff repair." Probably why Dr. Weinrod has stopped doing shoulder. Very smart, by the way. These used to be extremely hard repairs. We would do convergent stitches, which means we bring the tendon kind of put together more. We do two double row repairs, tie anterior, posterior, eight sutures. You can see there's sutures everywhere. It's extremely challenging. This would take over an hour to do, this is why a lot of people stop doing shoulder and why a lot of failures occur because it's just so challenging. That was the currency. You have these multiple anchors, suture passers, as Chris talked about, now we have Tendon Seam. The beautiful thing about Tendon Seam is that this is a repair that is potentially 2x stronger. Why is that important? If it's 2x stronger, then there's a chance that patients don't have to have sling use because the repair is stronger than the active contraction of a rotator cuff. That is a paradigm-shifting technology, if that's true, and there's less procedural steps. I did this case four weeks ago. I was lucky enough to get Tendon Seam on the earlier side. This is, again, we just do a small reduction with one anchor, you can see that brings this massive cuff over. The beautiful thing about Tendon Seam is you have one portal, the apparatus comes in through the superior aspect of the cuff, it's this linked construct, it's amazingly fast and easy to use. You see these multiple punches, instead of having suture everywhere, it's a very streamlined, easy procedure to do. This procedure, which would normally take me over an hour to do, took me 20 minutes. This is using REGENETEN. The beautiful thing about Tendon Seam and REGENETEN is that the Tendon Seam is able to hopefully prevent these Type 1 tears, then you could use REGENETEN, which is a biologic that could actually prevent these Type 2 tears. There's a theory that we have all the things that we need in our toolbox now to prevent re-tears as they continue. This is just my early experience of Tendon Seam. It's unbelievable. These are my first 11 cases. My average time to fix a rotator cuff has been 14 minutes, which is just so fast compared to I'm a pretty fast surgeon, admittedly. My best time has been seven minutes. That's essentially how long it takes to do a carpal tunnel now. This is changing how we do rotator cuff repairs, which has been truly remarkable for my practice. We also have REGENETEN, which is a bioinductive implant which can actually improve the tendon quality after we fix these with Tendon Seam. You can see at five weeks, three months, six months, you have a torn tendon that's pathologic, and with the augment here, it becomes almost a normal tendon that's even thicker, which is awesome. There's been plenty of studies showing that this decreases re-tear rates. With these massive cuff tears like this patient, it essentially has a 96% healing rate, which is just remarkable for patients that have over a 30% failure rate with standard cuff repairs. The next critical question is some of these patients do develop arthritis, some of these patients do need arthroplasty. How do we address this problem? The things that I try and think about are scapulothoracic motion, so I'll talk about in a second, surgical execution, and how do we make this applicable to low-volume surgeons? If people are doing less than 20 per year on average, we have to make this so they're able to be the person who does 400 per year. We have to have innovative techniques with improved efficiency and new approaches that I'll talk about in a second. Mike beautifully talked about the ASC transition, so I won't talk about that as much, but having tray reductions and smaller footprints are going to be a big deal for us. What I use for this is the AETOS system with CORI and CORIOGRAPH, and it's been a game changer for my practice. The AETOS system is a nice streamlined system. You have CORIOGRAPH, which, in my opinion, is one of the best planners out there. CORI, like we talked about for hip and knee, this is made for shoulder. I'm going to show you why. One of the issues that we have when we're counseling our patients is we don't know what to tell them what their postoperative range of motion is going to be. The reason for this is most of the planners out there right now only map glenohumeral motion, and that's only two-thirds of the motion of the shoulder. Patients who come in with a reverse shoulder arthroplasty, they want to know, "Can I do things like comb my hair? Can I put luggage up in a plane?" We don't know what the right answer is. With this technology, which is unique to Smith & Nephew, is that we now have the ability to map what scapulothoracic does. This has been a game changer for me because now I'm able to see where the impingement points are when not only the glenohumeral joint moves, but when the scapula moves. I could change intraoperatively my execution to give them what they care about most. We know from looking at all arthroplasties that one of the most, if not the most common reasons for revisions is malposition of components. If you look at this study right here, glenoid malposition, humeral malposition is a huge reason why patients need revisions. We had to come up with a solution that is not only good for reverses, for anatomics, but had to be for the glenoid and the humerus. This is unique to Smith & Nephew, along with the burr technology. This is how it works if you haven't seen it. You asked a great question, like, is the burr good for hips and knees? Maybe I can't speak on that, I'll tell you what it is, what has to happen for shoulders. You can see the shoulder is a very small space. You have only a little area, and you can't get a saw in there for the glenoid and the humerus. I use this technique that Mike taught me, where essentially we do it with the tibia. We burr, we then use a saw for intraoperative speed, then we use, again, the burr to kind of refine and make it accurate. Then you can see how small that space is for the shoulder, for the glenoid. If you had a big saw, you physically can't do it. This is why it's such a great application for shoulders. Then we also have this postoperative assessment tool. Like Steve was talking about, there's a tensioner of the knee, now we have a tensioner of the shoulder. It's an awesome application that has totally changed my practice. This is my second patient I ever did. I can't make an X-ray look better than that. Manually, that is just as good as I'm going to show it. The glamour shot is what it is. This is her at six weeks. These are outcomes that I haven't been able to get manually. She's so happy. This was due to the technology that Smith & Nephew has given me. We're truly changing our patients' lives with this technology. We talked about anatomics. For those of you who aren't familiar with the shoulder world, we're trending away from anatomics because frankly, we're just not very good at them. It has soft tissue balancing. If you overstuff the components, they fail quickly. There's something called a perfect circle method. If you draw a circle around the medial aspect of your implant. It should hit the edge of the humerus on the lateral medial side, you can see that's spot on. This was just done with the robotic application. I think that we actually may change the landscape with this technology back to anatomics, maybe the tennis player who wants more range of motion, who won't get an arthroplasty because he doesn't want to give that up, anatomics may be able to give him that. He may get the arthroplasty quicker. This was just another case. On the bottom left side, that's a glenoid that if I have my pin placement at all inaccurate, this is going to fail, the base plate won't be stable. Using robotics, as you'll get an X-ray that looks like this, which again, is awesome, that I probably would have messed up if I didn't have a robotic application. This is my learning curve, this is data that we already submitted for publication. I had no CORI experience whatsoever. I'm not a CORI user. I'm not a hip and knee user. I started doing this. Mike taught me what to do in the lab. We're working on it. It took me 12 cases to almost get to where I was with manual, I'm still downtrending. For someone who doesn't use CORI at all, the application, the usability is just so easy. One of the other cool things that we did, this was the first in the world the other day. We're trying to move to more MIS type approaches, and in the shoulder world, that's subscapularis-sparing. What that means is we go in between the supraspinatus and the subscapularis, and we work in a very small space. It's extremely hard to do, but we have a robot that allows you to do this. We did the entire case working through that small interval just because CORI is made for shoulder arthroplasty. You can see we're working through that small interval of burring, and it's actually able to do the case with a robot subscapularis-sparing, which has been just unbelievable. No sling needed for these patients, which is great. The question is, Mike talked about intraoperative execution accuracy, how that decreases turnover time, how that increases efficiency. This is my data showing that we've been 12% more accurate predicting every single part of the arthroplasty, the stem, the glenoid, the screws. My team essentially lays the implants out on the back table, and I use them the majority of the time, which has been unbelievable. How does this apply to the ASC? Well, if we're able to increase efficiency, we decrease costs. If we have, like Scott talked about, less trays and we have increased intraoperative efficiency, then we have more value to ASCs, which is why we're going to succeed there. Also, our footprint is so small. Like Mike was showing, the CORI robot is, like I said, made for shoulders. You can move it around the shoulder, you can go from left to right, which is a little bit unique to shoulders, and the footprint's so small. It's a small burr. Not only that, I run two rooms as well. We're able to move the robot back and forth, which the other robots can't do, which has been awesome. My residents call me coach. I don't know why, because I guess Coach K. This is Coach K, who's the old coach for Duke, and I do yell at them like he is here, so maybe that's where it comes from. These are my first 50 cases with CORI robotics. Objectively, the X-rays almost match the plan every single time. Each case is getting faster. I've done 12. It worked 12 cases to get proficient, and I have downtrending times. Most importantly, there's been no major complications for someone who didn't know how to use CORI before. Lastly, bringing this all together, this is a case I did a couple weeks ago. CORI plus AETOS plus Tendon Seam. The theory is that if you potentially don't want to use a subscapularis-sparing approach, but you don't want any sling use, you could use this accurate execution with CORI. You could use AETOS, which is efficient and a great implant, but then you use Tendon Seam, which has the ability to overcome active contraction of rotator cuff muscles. Potentially, you don't need any slings if you want to go that way. We have the technology to go through the entire continuum of shoulders, and treat patients well. In conclusion, I truly believe with the technology that Smith & Nephew has, we're going to become the leader in the shoulder space from rotator cuff all the way to shoulder arthroplasty. Most importantly, I truly believe we're improving patients' lives and outcomes, which allows surgeons to sleep at night. I think we are solving shoulders, but most importantly, I'm still trying to keep my five-year-old out of jail, who is still dressed in cheetah. Thank you. Okay, any questions for Dr. Klifto? I'd love to get your perspective, I guess, before CORI and getting robotics, just how much that's changed your practice in terms of speed. You talked about, obviously, the outcomes, but just in terms of speed and procedure time. Then there was a bunch of new shoulder systems on the market. Just curious if you could compare and contrast and why AETOS is the one that you settled on. Is that more because of CORI or because of everything else? Thank you. Yeah. To answer the second part is because of CORI. Dr. Haas talked about this. If you have a technology that makes you better, I'm going to do that every time because I would want my family to have that. I'd want me to have that if I was on the operating table. We started this process four or five years ago, and that's when I got involved with the AETOS system. The AETOS system has been great. It's streamlined. It's fast. My surgical techs like it because there's two trays. It's very streamlined. I think the market is going to go to robotics because I don't think it's that much slower, to be honest with you. I wouldn't have the patience, I think, to do a slower system, and I'm almost time neutral already with very little experience. It's been great. Yeah. I've got one question at the moment on the webcast, which is, can you talk about the potential cannibalization of REGENETEN with Tendon Seam? It's a really good question, and I'm still working through that for some different indications, like partial thickness rotator cuff tears. One of the things that I think Smith & Nephew does so well is they do clinical data to support it. I think as we learn more about Tendon Seam, we're going to have a very good guidance for that. Like I said, they treat two different things, which is great. We have two ways to solve Type 1s and Type 2s. And I think they serve different purposes. There is some overlap, but they're also divergent enough that I don't feel like there's going to be a ton of cannibalization. Okay. Awesome. Thank you, Dr. Klifto. Lastly, I just want to welcome up our executive leadership team and the surgeons that are still here for some final questions. Take a chair. You want a chair? Get the surgeons in there. Should this be in the middle? Yeah. Fire mine. That's right. Okay. Yeah. Sebastian. Hi, Sebastian Jantet with Panmure Liberum. Question for Dr. Haas. You made a very compelling case for the LANDMARK knee. I guess a couple of questions from that. Why are the competitors not doing the same thing? What are the resistance points from other kind of consultants who aren't convinced about that approach? I think it's easy to answer to why they haven't, because they have to design a new system to do it. There's cost involved in doing it. As I sort of talked about with Stryker, I think they just simply relied on the fact that they had growth from the robot, and that worked pretty well. They're doing it. They don't feel that they have to at this point, but at some point, when something new becomes better, then they're forced to do it. I think that at the end of the day, they haven't wanted to make the cost of investment so much into what they have, and it's good enough that it gets by. It gets a little bit even more complicated because, as a good example, Persona, which tried to be personalized, but they were personalized for 2013, right? They said, "Well, I'm going to make a new titanium knee," but they made that for a niche product, but they added it onto their portfolio already, so they really can't change it without a major investment. I think that they just don't want to make the major investment to update it, so they'll live with the adequate but not best technology. Yeah. The other consideration is we've actually seen this happen, right? This is triple taper stems all over again. We saw this in the hip market seven years ago with ACTIS. You have to have someone do it first, and then when it was really successful, obviously then we saw the market follow. I would not be surprised if we don't see some development in this direction five years from now. It's just nice to know that we're probably just on the forefront of the right answer. I think there's no doubt that if you follow this forward, following the anatomy is going to be the way we go. Might there be other approaches to do it? The answer is, well, you could, there's two different approaches to it, but you're not going to take the same symmetric implants that we did that are only minor modification from the '70s going forward. That will ultimately change. It just requires an impetus to make the change. Just to build on this just from a business perspective, right? The path that we took to get to LANDMARK runs through a gap that we had to fill, right? In contrast to our three competitors, we run our business on two different platforms in the U.S. It's more than that when you go outside the U.S., you've got ANTHEM and GENESIS II and everything else. That which our competitors do once, we have a choice to do, whether we repeat that innovation across two platforms. Actually, we've got two material systems, which has got OXINIUM and cobalt chrome. It's actually a more complex portfolio thing for us. Right now, we're challenged because as the market has shifted towards cementless, we've got it on LEGION, we don't have it on JOURNEY. Our choice we face was to just bring cementless onto JOURNEY. Literally take JOURNEY as it is today and bring a cementless analog on it. Rather than just take that approach, it took an opportunity to take a step back and say, "What are the clinical problems that yet need to be addressed?" This is where we had an opportunity to bring forward the type of innovations that Dr. Haas and Dr. Haas just alluded to. It was fundamentally born out of necessity, but we're using this opportunity to actually try and, if not leap forward, to at least make a significant dent into key unmet clinical needs. Just one more question, this is for any of the surgeons. Just basically looking at the ASC model, you paint a picture of an environment where you have to be extremely efficient, right? In order to make a decent economic return out of an ASC. Also at the same time, you've got a lot of volume going into the ASCs, and you've got a lot of pressure on reimbursement, and they're putting more pressure on you in terms of outcome reporting. I guess trying to look at it perhaps from the other perspective, if I'm Smith & Nephew and I've got a strong position in that market, am I going to be seeing a lot of price pressure from you guys, a lot of pressure to get cheaper and cheaper because your margins are getting squeezed? I think that the answer to that is of course, but not just in the ASC. The markets are getting squeezed actually much harder in the hospitals. I think actually the ASCs, the implant pricing is critical to a certain level. The beauty of ASCs, and I don't want to get overly technical in the way that we think about it, and I also don't want to try to teach business to a bunch of really smart business people, but in ASCs, the biggest shift is the change from cost accounting to throughput accounting. What that means is when we look at a hospital and you look at the finances of a hospital, every single question is, how do we make the care cheaper? Because we're looking simply at costs. We have a cost center, this is our cost center, we anticipate next year the revenue will go down, we need to decrease costs. Which is why you see the continuous RFPs and downward price pressure on the simplest thing we can. When you go back to the first joint replacement bundle called CJR accomplished absolutely nothing clinically, the only thing it did was make us send less people to post-acute care, to rehab centers and nursing homes, and made implants cheaper. That was it. The entire successful program, considered today the most successful bundled care program in the history of medicine. It did nothing but decrease cost. Surgery centers are much smarter than that and recognize spend money where it matters to do one more surgery. I don't need a better margin on each surgery. I need more surgeries for a better margin overall. When you transition to throughput accounting, you actually see a decrease in downward price pressure because what I'm actually going to go to the companies and ask is not, "Deepak, can you sell me an implant cheaper?" It's, "Can we work together to create a model where my entire episode of care is more efficient?" Because I don't care about a cheaper implant, I want to do one more surgery because I have a very fixed overhead cost. I'm going to spend this much every day no matter what. That last margin is 100% profit. Hospitals don't have that because they've got very, very high overhead costs. They have very high fixed costs, they always say, "Well, we're going to do one more case, or we're going to spend a little less money." They're not firing anybody. They're not saving anything. At the surgery center, because the lights go off at 6:00, it actually really makes a difference. That's why the entire way we count over it looks so different, which I think actually improves the ability to resist downward price pressure on implants. Great. Thank you. One more thing I would add, which we have not talked about, is this concept of a single vendor ASC, which is really how the market's going. All the big dogs are trying to now. Arthrex bought an arthroplasty company. Everyone's trying to be enabled to be a single vendor. There's no single vendor that has a tower, that has a robot, that has a sports platform, has an arthroplasty platform, has a trauma platform, and now a pretty fricking ridiculous shoulder platform. There's nobody else. Everyone's trying to get that, but nobody has Oh, and a shaver platform and a camera platform. That's really, I would say, the positional power of Smith & Nephew to really take over soup to nuts. Graham. Thank you. Maybe a question for the surgeons, particularly on the ortho side in terms of just the stickiness of surgeons with implants. Obviously the launch of LANDMARK should be a driver of share gains, and I know, Deepak, we could get an update on what you were saying before around you stopped losing accounts and started winning accounts back. How willing are, in your experience, your peers to switch if they are using a Triathlon? How easy is it to get people to switch? It's a great question. I think historically it was a bit different than it is today. I think historically, people were less likely to switch. They got pretty fixed in. Interesting enough, even though arthroplasty is a relatively mature science in many ways, a lot of these new concepts are very hot. We're recognizing, especially on the knee side, that there is a need to make it better. There's a general recognition, these new approaches that we talk about are sort of really hot topics. I think there is much more interest in pursuing these new concepts. That was, I think, started with the robot, but really with the alignment strategies, really changed it because a lot of people were saying, "Well, I'm doing it the way I did it along, and I know that that's an issue, so how do I change to make it better?" I personally think this is going to make it easy for them to change because it's built to do exactly what we want to do, as opposed to trying to overlay something that wasn't designed that way. I think this will make it easier, but I think that the ability to get people to change is easier now because of the new concepts that are really hot. I'll just add, I'll go right back to the hip market. If you're changing same for same, it's really hard. If you bring out another symmetric implant that looks like all the other implants, no one's going to change. Just like we saw with the triple taper stem, when it is differentiated, when it solves a clinical need, and when it addresses a problem we actually know exists. Then the change was actually pretty easy, and you saw that in the way that the entire hip market shifted with access. Just on the specificity of the sports med side in an ASC, do surgeons behave differently? I spoke to a few ASCs who try and streamline things. They think about, do we need to use those extra screws? Are there things that we can do that maybe slightly reduce cost and speed up procedures? Is there a different behavior and experience? 100%. If you do an ACL, sometimes you put a screw and you could do a backup fixation. Maybe if you really don't think you need it, some people just say, "I do it all the time." Why? "Just because I do it all the time." No. Well, you should only do it when it's needed, right? I think also efficiency of how fast you can operate out. There are a lot of factors and then ultimately you get a report card of how expensive is your operation versus if Klifto and I both did a rotator cuff and we're like, "Well, you're consistently more expensive." All these conversations happen in ASC, but you ultimately work together. Then the last thing that there's always a game of like, "Oh, I have a really expensive case. I'm doing it in the main hospital. There's a lot of dirty laundry in the ASCs, that's why we have Dr. Ast to make sure we're all clean. Thanks. It's Charles Weston from RBC. I was actually just following up really from Graham's point and just, I guess, pushing back. You guys are key opinion leaders, implant designers, whereas a lot of surgeons in the U.S. and elsewhere would just be more standard surgeons, if that's not insulting to them. Historically, there's always been considered to be that kind of loyalty to an implant or loyalty to a relationship that you have with a salesperson. I guess distinguishing between some of the hip, knee sports med devices, because I suspect they're all quite different in terms of the attraction of innovation. Are there any things in this kind of new and reinvigorated portfolio that you think would make somebody with that tight relationship really reconsider what they're choosing? It is a absolute truth that the surgeons develop a relationship with their reps and that the sales force uniquely, as opposed to pharma, which is not a tied to reps. We do rely on having great sales forces. I actually, having been around this industry for a long time, I think a vital role, which we have two of them I know that I'm involved with in August, is educating the sales force on what are the benefits. Personally, if I'm going to talk to a surgeon and I'm going to tell him why I think he ought to use LANDMARK. Okay? It a bit depends on what his interest is. If he's interested in moving from a traditional alignment to a modern alignment strategy, well, that one's easy because it's just going to be easier to do that, right? If he's just a regular surgeon, I would go after him and say, "Listen, do you have a lot of patellofemoral pain? Is that a big problem in your issue?" Because I think that if I was looking at this, what I'm sort of excited in my life is to have I really believe we have, I won't say solved the problem because I won't be that arrogant and to think that we solved a problem that was probably going on for centuries, even in non-total knees. Knee campaign going up and down stairs after knee replacement, it's the bane of our existence. If you're a knee replacement surgeon, the patients come back and they say, "I love my knee. I'm glad you had it done. But boy, I go up and down stairs and it hurts. I get out of the seat, I go to the movie, it hurts." I think we know why that has been happening. It was a forgotten part of the joint. We cared about all the other stuff, but we forgot about the patella, and we just gave some cursory attention to it, where we really focus on that. I think by all the metrics and all the testing we have, this is going to be better. That's how I would go after it. You look at where the issue is with the surgeon, and that's how I think you can get traction. I'll try not to make this take too long, actually, I think what we have learned is that relationship that has always been critical gets very different as you shift from hospital to surgery centers. I think the ASC and the strength of the ASC portfolio and the ASC play is a big thing. I'll tell the story of John and Walt. John was one of my first partners. Walt was his rep from company A, we'll call it. John and Walt were best friends. Walt was the best man at his wedding and the godfather of his oldest son. Talk about the relationship between a surgeon and their rep. For 30 years, John used nothing but company A with Walt, period. The hospital could have said, "We're switching to one." Wouldn't have made any difference. John used company A 100% his entire career. We opened our surgery center, in 2013 started going out to all the companies and said, "Hey, this is the structure we need. We need less trays. We need all the things that I talked about today." Company B, C, and D, no problem. In. Great. Company A had a hard time getting there. Their structure couldn't do it. They couldn't figure it out. The next day, John switched from company A to company B. The next day. When John owned the center- It mattered which company he used. I love you, Walt, but I'm going to company B. It's 30 years of loyalty gone in one day of a bad contract. I think that as we see this side of serviceship, this is a very uniquely American thing. Because of the financial state that surgeons have in surgery centers and the completely different way we look at the way accounting is done, those loyalties are great. They're not worth cash in my pocket. I think that is the biggest driver of the change we've seen in regards to brand loyalty at the implant level. Did Walt change companies shortly thereafter? Actually, Walt retired. The gentleman in the fourth row at the end, and then I'll get to you, Veronika. Fourth row. Kane. Thank you. Kane again, Deutsche. Dr. Haas, you mentioned, I think you used the term truck, referring to Mako and, I think, ROSA. Just wondering, are there any thoughts on some of the sort of smaller handheld options in the market? We obviously get Mako with their small handheld with a T10, which obviously is quite small and implant-agnostic. Yeah, any thoughts on how those two might relate- Yeah. -to CORI? I'm flattered. I shouldn't be flattered. Smith & Nephew should be flattered because at least they're driving the handheld market. I think that the T10 is a nice concept. I actually think Zimmer probably made some sense to do it because the T10. First of all, the software is very rudimentary. I actually served for T10 because I was the only person who knew enough about T10 to be its sort of rep for one of the courses. I'm not a rep, but I had to be the surgeon to show it. I think it's intriguing in some ways, but it's very limited. Literally, the software is sort of sad in a way. Probably reflects their lack of resources. But their software, even though it gave a CAT scan, doesn't show the patellar groove. It's sort of crazy. It wasn't done that way, but it didn't. That can be improved because they can update it, but they haven't at this point. All that it does is it puts a pin, and then you have to cut, and it has rudimentary soft tissue balancing. It's a very limited platform of what it is. I think it frankly does everything ROSA does pretty much in a more compact. If you were comparing to ROSA, I think it's a lot better, but it does what ROSA does. It just puts pins in to put a guide in. I think that the Stryker, it hasn't been out to be used, and I think some of the limitations of that, the two biggest ones, first of all, it doesn't tie into Mako. The software, it doesn't tie into what is actually reasonably good software. What people like about Mako is in part the software, and it doesn't tie into Mako software. The second thing is that people, surgeons are just, while they like saws, nobody really is going to like to just freehand a saw, even if it's robotic. It's just awkward. I've used it is awkward to put a saw up and try to hold the saw and think you're going to get the plans right and get it right. I think having some assistance with the saw is good. Our concept is that you robotically do place a guide with the saw because at least you have a platform to rest the saw on. You're holding it with your hand, but you have a platform to hold it on. I'm flattered. Thank you. Just maybe one quick one for Deepak and John. Out of all the sort of innovation platforms today, which would you say might surprise you the most, maybe over a sort of three- to five-year view? Or do you love them sort of all equally? Look, I think I'll go first, John. You can pick favorites among your children. I'd say, look, each part of our portfolio has a role to play in our success. Each business has a role to play. I think we've called that out in the capital market day in terms of the role that Orthopaedics does in terms of improving returns, the role that Sports plays in terms of driving and accelerating our growth, and likewise, with Wound. So each portfolio. Within that, the role of innovation, which over the last four some odd years, has played a vital role in driving growth. More than half of our growth has come from products we've introduced in the previous five years. That won't stay like that forever, but we're in a phase where we've invested in a stepped-up way in R&D. We're continuing that within the R&D chapter, it'll account for similar proportions of our growth. Within that framing, each one has a role to play. I talked about parts of our pipeline being front-end loaded, and it's like that in Orthopaedics. LANDMARK is one vivid example that's come to light today. All the functionality in CORI is another example of that. We just recently released shoulder capability on CORI. Dr. Klifto wasn't here, wasn't at the New York event because it was still too early. We've brought him here now because fast-forward now six months, it is a reality. Fast-forward six more months, it will have hip capability, maybe seven months. Every time I talk to my team, I shave a month off, and it drives my team nuts. Six, seven months, we'll have hip functionality on CORI. Those things are front-end loaded. On the Sports side, the big four that the team talked about, Christie talked about, each has a role to play. REGENETEN is now quite a mature story, right? We're in early innings with CARTIHEAL, with AGILI-C, but January of 2027 should be a pivotal point because we'll have CPT 1 code, right? Tendon Seam, literally early innings. You heard Dr. Klifto talking about how he's already started to talk about that in his practice. We haven't talked a whole lot about Wound, but we've made references to EXOGEN, PICO. We talked about LEAF, but that itself is an innovation story from 2025, where we brought forward LEAF 3.0 and all the connectivity that went with it. What I'm trying to give you a sense for is there's quite a good balance in terms of level of innovation, in terms of our R&D programs, and how they map out in terms of timeline when they start to really drive top line. Also risk. There's some incremental things we're doing in our portfolio. There's some things that are really new to the world. TESSA, there is no other spatial surgery visualization platform on the market today. I think hopefully you get a sense now of the level of innovation that's in our portfolio and how each one plays a role. In all of this, I don't think I've picked a favorite. Absolutely, there's a role to play. Perhaps, John, maybe you'll take sides. I think you've covered the broad ground there across the portfolio. For me, the personal favorite is TESSA, actually, because I think that the potential breadth of application of that navigational surgery. Obviously, initially we're looking at it from an ACL perspective, but what really excites me is this could become big. It could be a game changer in terms of the way that surgery gets conducted, and I think the op GIs, it's a long game. This is a five, 10-year game, but I think there's huge opportunity in TESSA. I don't know, Scott, whether you talk about it much more knowledgeably than me, but to me, that's the most exciting development in our portfolio. Yeah. I'd love to get Dr. Ranawat's perspective on it as well. We do see it as it's an opportunity to change the way arthroscopic surgery is practiced. The vision is to have TESSA be a platform 10 years from now that surgeons can't imagine doing cases without. It is going to be a journey. We're starting with a single application on the platform, and we'll build from there. We believe it's the right place to start. We've led and created categories across sports medicine, and we've led in the innovation of the arthroscopic tower, and this is an opportunity for us to do that again. Dr. Ranawat, you've probably, as much as any surgeon that we work with, had exposure to TESSA and seen the potential of it. How would you regard it? Yeah. 10 years ago, I was very much involved, actually 15, with Mako when it was in Florida. I remember going to India, going to other countries, and talking about a robotic partial knee, and people thought I was all crazy. Then you went 10 years later, 15 years ago I was in India, and the number of robots in India now, there's about 100 of them in every company. That's India. Then if you look at the fourth floor of HSS, there were zero robots when I was a resident, zero anterior hip when I was a resident, and now it's all anterior hip and all robots. So the way that navigator robotic technology changed arthroplasty is going to be the way that we still do 2D arthroscopy. That's very rudimentary. It's going to change the way in 10 years how all arthroscopy's done. Because the world doesn't live in 2D. Your body's a 3D thing, that's the best way to improve surgical accuracy. Veronika. This is probably an unfair question, but I'm going to ask it anyhow, and it's for all the docs in the room. Obviously, you speak very passionately about Smith & Nephew technology and all the innovations, and you're clearly big product users. If we look at the performance, especially of the orthopedics business at Smith & Nephew, it's been fairly poor. We've seen a fair amount of share losses, and particularly in the U.S. I'm just curious about your perspective of how to reconcile your bullishness, enthusiasm with the sort of financial results that we see, because that's what we on this side of the room care about. Maybe you can talk through when you talk to your peers who maybe are not Smith & Nephew users, what are the frustrations that you hear from them? That's a question which I think needs to be addressed. To me, having, again, sort of seen the spectrum and seen the effect of There was, I think, holes that needed to get filled. Okay. There were decisions that were made long before the folks in this room were here. Those decisions left, I think the holes that are being filled. The problem dates farther, dates 5 to 10 years back, okay. The way it could've been addressed in a couple ways. You could've just tried to patch a hole. The patch and hole is just continuing a problem that existed for a long time, that you said, "Well, we're just going to add another part onto a complicated portfolio that had good parts, but some of them are dated and didn't modernize the technology." You say, "Listen, we're going to take the innovation we have, and we're going to look towards consolidating the portfolio into the newest technology that's forward-thinking." I think that the issue was appropriately-- and I would argue probably hard decisions to make because they financially required big commitments that I said some of these other companies are going to face. Matter of fact, they are facing. It's not just Smith & Nephew. There are other companies that I think didn't face those issues and will have to do. I think management came out and said, "We have the problem." They've recognized it and then made the investment, and I think we're almost there. I think time is going to tell, but I think the issues were recognized and addressed in a really forward-thinking way. Not an unfair question at all. There's three here. I'll get you, David, and Julien. Hi, Beatrice [inaudible]. Thank you for taking our questions. I had a couple. Firstly, on LANDMARK, how does it stack up relative to competitor needs suited for kinematic alignment? Secondly, on ASCs, you've noticed an above-market penetration in ASCs in both hips and knees. How much further do you expect this to be able to penetrate this market? Kind of directionally, how do you think about this gap versus the market changing going forward? You've gotten the clinical parts of that now during the course of the day. Just let me address the business part of it. As I said, what LANDMARK seeks to do is address the gap that we currently have on our JOURNEY platform, which doesn't have a porous component. Over the last couple of years, we've seen an acceleration in the proportion of knees in the market that are porous. A lot of that is time-driven, and I'll have our surgeons comment on that. From where I sit, a lot of the acceleration is being driven to that. Roughly half of our customer base in the U.S. is on JOURNEY, right? We have a need to address that because taking a JOURNEY surgeon today and having them go and adopt LEGION, which is not kinematic alignment, right, it may be a short-term proposition, but it's not a longer-term proposition. As I said, the business decision we faced was either to plug a hole, as you just said, Dr. Haas, or take a step back and try to address some of the shortcomings. What we've tried to do is blend the best of LEGION and JOURNEY. LEGION is a relatively easy knee to put in. Maybe not the easiest knee, and our surgeons can comment on it, but it is easier than JOURNEY to put in. JOURNEY, as you alluded to, has the alignment, the kinematic alignment, and the natural feel of a knee. What we've tried to do is get the best of both worlds. We've tried to do this now with the imperatives of the market that we see today and where it's going to, which is all about the ASC, the efficiency to fit in a 300-square-foot OR, right, where you can't have 10 trays, right? What we've sought to do, as we did with AETOS and as we did with CATALYSTEM, is to make the implant tray efficient, right? The third thing we did is design the system to be put in with CORI, right? That offers the level of personalization, as Dr. Haas kind of went through in his presentation, that we think addresses an unmet need. No one thing is kind of a slam dunk, to use an American expression, right? What we're betting on is that combination of the implant characteristics, the efficiency around capital. We obviously benefit when we put less capital in the account, surgeons and institutions benefit when you have tray efficiency built in, plus the robotic aspect of it. All of that as a proposition we hope will carry the day. Plus, you've got our presence in sports, that commercially you've got to do things to make all of that count. That's the bet that we're making around this. Can I also just- Yeah. Briefly. You notice that Dr. Haas didn't use the term kinematic alignment specifically because it has no definition. Right. The idea of kinematic alignment is really best articulated saying, we used to say make the cuts straight. Kinematic alignment says make the cuts crooked, right? Because kinematic alignment's attempt was to take a symmetric implant and recreate an asymmetric anatomy, right? The joint of a knee is not flat, so to make a flat implant not flat, you have to cut it crooked. The beauty of LANDMARK is biomechanically, cutting it flat is better. Having a flat cut but a kinematic implant essentially takes kinematic alignment or that term and makes it way safer and way easier to do. You no longer have to figure out how crooked is crooked enough. Instead, you can simply cut straight and put in an appropriately designed implant. It will eliminate the surgical kinematic alignment and simply create an anatomic alignment with the right implant. The best way to say that, it's designed for kinematic alignment. It's designed anatomically to match the kinematic. That chart I showed was the 90-40. If you're a kinematic aligner, okay? In CORI, by the way, as I said, this is buried, you are recreating the kinematic alignment. That's what it'll show, the CPAK restores the kinematic alignment, and you will be able to be perfectly aligned kinematically in 90% of people without modifying the technique more than three degrees, which we all think is safe. Which is really kind of pretty remarkable. You can be a kinematic surgeon without the compromise of saying, "I have to make a really crooked cut. This is where the role of robotics comes in, right? You've got CORI, because we've designed it in a way that makes it easy for a surgeon to do. Again, Dr. Haas brought it to life, right? You essentially go in and use it as an eraser, use it in that context. Having a plan that allows a surgeon to execute to what effectively is kinematic alignment without having to explicitly think about it, that's the design principle that we used to make this come to life. Again, it's not any one thing that's necessarily going to carry the day. It's the package of all of these things that we expect to make a difference. Just one further comment. We actually, in addition to CORI, which I think is the best way to do it, obviously, we have manual instruments that are kinematic alignment instruments. That is simple. They just cut the thickness of the implant, which is the philosophy of the original kinematic before robotics. We have those instruments, which we'll be doing really quite simply, just like any kinematic surgeon would do. We have manual kinematic instruments for LANDMARK as well. To bring it home, too, is look, shared moves in orthopaedics, they don't happen overnight. We don't expect that you launch LANDMARK and tomorrow the whole world starts to embrace LANDMARK. I hope that's the case. There is a pace at which we need to introduce this into the market. There are real costs in orthopaedics for putting capital out there, so we are being much more thoughtful in how we place capital. Right? In other words, we want surgeons who want to give us their primary business, right? Because that's what makes the economics work for us. The consequence of that is we're not going to put a whole bunch of capital out there for surgeons to go try this for a small proportion of their cases. Right? Those are things that pace the launch. David, I think you were next, and then Julien, I'll come to you. Sorry, Charles, I need to point because you don't see. Hi. David Adlington, JPMorgan again. Bigger picture question for the panel, really. I just wondered if you were seeing any impact from the usage of GLP-1s in terms of either the type or pace of patients coming in, how it's affecting surgery. I think I've talked about this before, maybe even with this group. I think GLP-1s are a fascinating medication in the way that they impact us, I also think everyone's misreading some of the data. Right? Now they say, "Oh, you take a GLP-1, no one's ever getting a knee replacement. Oh." There's actually absolutely no data that supports that. Even the papers put out saying that's not what they're saying. What we've seen from GLP-1s is patients come in lighter. Great. Right? That means we had that initial bump where we all of a sudden had a whole new crop of patients who qualified for surgery in places that had BMI cutoffs or something else. There's the anti-inflammatory effect, I think right now we're actually seeing across the board a little bit of that lull as patients are a little happier, getting a little more active. What I anticipate is we're actually going to see a big rise, right? Because we're sort of saturated. Basically, everyone takes a GLP-1. It's no less than 100% of my patients. That doesn't mean they tell us they do, that doesn't mean they get it from a doctor, right? When push comes to shove and we tell them, "By the way, you might die from anesthesia if you don't tell me you take it," all of a sudden, everyone takes it, at least in our case. Right? I think we've hit sort of a market saturation where we're going to see the weight loss people who lose enough weight and get enough anti-inflammatory effect that they're great and they're happy and they're going to avoid surgery in the short term. They'll get more active, they'll use it. GLP-1s don't fix bone-on-bone arthritis. They may make a patient take a little longer to get to the level of symptoms in which they decide that surgery is the right answer. As we heard from Anil's talk, nothing grows back cartilage and bone-on-bone arthritis hurts. As the GLP-1 patients get more active, I actually think we're going to see it go in the other direction, and we're going to see them increase the number of joint replacements we do because patients are going to be happy they're so active. They're no longer willing to be obese and sedentary. They're no longer obese. They're no longer willing to be sedentary. I think that'll drive an increase in utilization in these surgeries. Not like this week. I think it's going to be a year or two. We'll watch this kind of funny lull, and then I actually think we'll see a pretty big rise. Okay. I think the last question from Julien, unless David you had a follow-up. Thank you. Julien from Bank of America. Thanks for the presentation. Something that stood out to me is how much you use REGENETEN, not only for rotator cuff, but for a lot of different applications. I know, Deepak, when you spend of time and money on having some clinical studies. My understanding is that the penetration for all rotator cuff is still in the single digits right now. My question is more, how do you see the penetration for REGENETEN over time among all the applications, and do you think it's going to take many years again for all the applications to match the rotator cuff? Thank you. Yeah. The thing about the. I'll quickly talk about too. Right now, the American Academy of Orthopaedic Surgeons, which is really against anything that helps science, sorry, are saying that patch augmentation is indicated. That was a big, big deal when the academy said that. There's a lot of politics that went into that. That's going to trickle down everywhere, and as I say, right now, every NBA athlete who tears Achilles gets a REGENETEN. I can't tell you who the surgeon is, but it's. If you're putting it on our most elite athletes, who probably have the best biology, God knows I need it when I tear my Achilles. It's impossible to say, but every day, there's another patch. It's just like how the robots came. It's going to go. There's completely a patch war right now. Is your patch better healing? Is your patch more bioreactive? Is your patch a little stronger? It's all different, but we're first to market. It was kind of how Arthrex was with the wand business. It was by far the best wand business. How DYONICS was with the shaver. It was the best shaver business. Now that's all standard tier, and then everyone copied it. I really think it will be. Yeah. From what we see across the board, we see about roughly 10% as Dr. Ranawat, something like maybe a little under 10% of all shoulders have REGENETEN in the market. For us, as Dr. Ranawat said, there's quite a bit of innovation, quite a bit of activity in the field, which is good in the sense that all of that attention encourages trial, encourages use, encourages hopefully over time, appropriate adoption. It's that appropriate thing that we're indexing on. REGENETEN is not just REGENETEN, and of course, it's a great product, but it's the clinical evidence that supports the use of it, the statistically significant reduction in re-tear rates. First, we demonstrated the one-year time point, now the two-year time point. That just didn't happen. We funded the trials to do that. We're doing that for the Achilles, we're doing that in the hip. That's a very significant part of how we bring therapies to market. The engineering of it, the product development of it are important. For example, NextGeneten, I think that's a code name. Maybe it is a trade name. The next version of REGENETEN, it's an improved delivery system. Actually, it's so much more than that because we're going to invest actively behind how to use it for all the different applications. That's equally as important as coming up with the next generation patch. Right. If I could just come in on the REGENETEN journey, we've learned a lot along the way, but I would say that rotator cuff was the natural first place to go. We identified it years ago as one of the largest unmet needs in all of sports medicine. Dr. Ranawat and Dr. Klifto talked about that. It was the largest procedural area as well. That was the first place that we wanted to go. We wanted to focus on that, build the body of evidence around that, put all of the market development effort behind that in terms of medical education, having the right channel that was scientifically well-versed that could tell the story and launch that in the right way. We know that there are other applications for other tendons that are also in need of help when it comes to healing. Those are logical next places to go, Achilles, hip as well. Then Deepak talked a bit too about the importance of the delivery system. I'd say if you think about what differentiates REGENETEN today from the other entrants into that category that we've effectively created, it is about the evidence. It is about being the first in that space to create it. That's a huge advantage that REGENETEN will have, but it's also about the arthroscopic delivery of REGENETEN, which is really, really slick. It'll get even better with the next generation of delivery systems that we'll introduce. That makes a big difference, especially when you're talking to surgeons about the importance of efficiency in the operating room. It's a good story, and it also gives us some lessons in how do we begin to do it again with CARTIHEAL and other category-shaping types of technology. There's the innovation itself, the technology, there are all the things that go on around that in order to shape the category and deliver on it commercially. What I like about Smith & Nephew Sports, it isn't that we're just building another anchor always. There are a lot of other companies that want to build another anchor. You have to still do that in sports. You have to. Another Rotator anchor, another Nautilus anchor. All the things that we talked about today is truly looking at the next five, 10, 15, 20 years. REGENETEN was the one where, like, yeah, we called it five years ago. Boom. Done. Next five years will be CARTIHEAL, and 10 years will be TESSA. That to me as a surgeon, I'm not selling anything. I'm letting science sell itself, and I'm saying, "This is the future. This is an innovative concept." It's not looking at old school. Same thing with what Dr. Haas was saying. We're not looking at the old way of doing knee replacements. Let's look at the new way. That's what's intriguing, and that's what makes people become adopters. Okay. I think we'll leave it at that. As we close the session today, I hope what you've seen clearly is how the strength of our company, Smith & Nephew, lies in the combination of a differentiated innovation program and real-world clinical validation. You've heard directly from our leading surgeons on how our technologies are improving outcomes in practice and why they choose to use our products every day. That external perspective is critical, and we believe it's one of the most powerful indicators, really, of the value of our portfolio. Stepping back, a few points to take away. First, innovation is a core driver of our growth, with a strong and a sustained cadence of launches across all of our business units, Orthopaedics, Sports, and Wound Management. I hope you also saw the portfolio depth and breadth clearly displayed with differentiated solutions across all of our business units, addressing really significant needs and meaningful unmet needs. I think that combination gives us the multiple growth drivers that we've talked about in various forms. Surgeon advocacy is important. It reinforces our competitive positioning and supporting adoption and market share. Each of our surgeons here could work with any company, could use any company's products. You've hopefully chosen to work with us because you see the value of innovation, you see the value of the approaches and the philosophy that we have here, and that's important to us. All of this underpins our right strategy. It gives us confidence in delivering our medium-term growth targets, and returns ambitions. Ultimately, everything that we do comes back to the patient and improving patient outcomes. That's why those of us who run the company show up to work every day. That's what drives our innovation, what drives our philosophy, and that's ultimately why we're confident on the opportunities ahead. I'll take a moment now to thank our surgeon panelists and those who have to leave to catch their flights. It's not a small thing for you to take a day, two days out of your practice. These are your busy operative days, and it means a lot to us that you've done that. To speak about your experience, speak about why you've chosen to work with us and the products that you use. Thank you very much on behalf of all of our colleagues for being here today. To my colleagues, it's not a small thing, to put together something like this. To our IR team, to our business unit teams, and to my colleagues around ExCo, really appreciate you bringing our innovation to life in the way that you have in creating this opportunity. We look forward to continuing this dialogue with you. We've got some refreshments and light lunch outside and look forward to continue this conversation there. Thank you very much.