Medacta Group (SIX Swiss: MOVE) Q2 2026 Earnings Call

0:00 Good afternoon. This is the Coruscall Conference Operator. Welcome and thank you for joining the Medacta First Half 2026 Results Conference Call. As a reminder, all participants are in listen-only mode. After the presentation, there will be an opportunity to ask questions. At this time, I would like to turn the conference over to Mr. Francesco Siccardi, CEO of Medacta. Please, go ahead, sir.

0:31 Thank you very much and good afternoon or good morning. Welcome to Medacta H1 2026 results conference call. So the slides of today's presentation can be found on the Medacta Investor Relations website along with the media release. I would like to remind all participants that the presentation includes forward-looking statements which are subject to risk and uncertainties. Listeners and readers are therefore encouraged to refer to the disclaimer on slide two of today's presentation. And after those housekeeping remarks, I will now turn to slide number four and start with the highlights of today's publication.

1:25 As already reported, Medacta grew almost 10% in cost and currency in H1, reaching €368 million in terms of revenues. We managed to report an adjusted ABDA margin of 27.8% in constant currency or 26.5% reported equivalent to adjusted ABDA of 97 million euro. The net profit for the period reached 42 million or 11.4% and we are confirming both our 2026 outlook and our mid-term outlook.

2:17 If we turn to the same page, this is just to remind everybody how Medacta has been able to continue to deliver significantly above market growth. Our success relies on Differentiating innovation that are really improving patient outcome and at the same time they are sustainable under an health care system point of view. Those innovations are introduced in the market with a very strong focus on medical education. So training of surgeons all over the world that are able to acquire the knowledge necessary to use these new techniques, new technologies, new products through our medical education.

3:07 And then of course we needed to constantly expand our sales force globally across all our business lines in order to reach as many customers as possible on a global scale. If we go to the slide number six, we have already reported our geomix sales. We have been able to grow double digit across three out of four regions. In Maya at 10%, in Africa at 13.1%, in Latin America 16.4%. while North America differently from the other periods grew around 7%. This changed a bit our geomix and as you will see this will have an impact on some of our margins.

4:07 If we go to slide number seven, we can see a very solid growth across all the portfolio. Starting from our hip that grew around 8%, knees almost 11%, extremities almost 16%, and spine 4.5%. The product mix as well did change a little bit, and as we will hear later, this has an impact as well, mainly on the gross profits. If we go a little bit into the details, our performance in HIP continues to be significantly above market, probably around two times. We continue to focus on our minimally invasive solutions, and we have introduced in the first half of the year our enabling technology Nexstar HIP in the US and Australia, which is in limited market release. While we are in a full market release for our new Triple Taper Stem Infinity, which is starting to gain momentum in the U.S. and more recently in Japan.

5:30 On slide number nine, we can follow our Thank you very much. for Kinematic Alignment at the GMK Spherica, which is clearly driving our growth and becoming our most important e-product in a relatively short period of time. Here as well, we are more than two times faster than the market in this segment. In spine, we did growth single digit, 4.5%.

6:21 We have redesigned a bit our strategy, mainly in the US market, focusing much more on enabling technology, which is now representing around 50% of our spine revenues in the US, meaning 50% of our spine products are implanted with the support of Enabling Technology, and we are going more direct and more with exclusive agents in that segment. We continue to have a very strong performance in EMEA as well in Spain, followed by both Latin America and Asia Pacific, and this remains well above market growth in the first half of 2026.

7:10 We now move to the extremity segments, almost 16% year-over-year growth for H1. We have introduced here as well additional technology elements. Together with our NexStar shoulder application, we have introduced the revision shoulder arthroplasty, first in the US and now is going to expand. outside of the U.S. And this technology is supported by a new AI-based My Shoulder Planner, which helps surgeons to carefully plan their products, their procedures, and hopefully deliver a better care for their patients.

7:58 On the sportsman side, which is the other element together with shoulder arthroplasty, part of the extremity, In this segment of Medacta, we launched SecureFix, which is an all-inside meniscal repair system for knee sports medicine, which is very well appreciated by our customers and is a clear driver for our knee sports med portfolio. Here as well, we have a growth rate which is more than two times the market year over year. I would now like to ask our CFO, Corrado Farsetta, to go over line by line of our P&L and comments on the marginalities.

8:48 Thank you, Francesco, and good afternoon, everyone. Let me now walk you through our financial performance in the first semester, and let's start with the gross profit slide. In H1, the gross profit was 240 million, increasing from 233 of the previous year. On sales, the GP margin in the first semester was 65.2% compared to 68.3% of the previous year, representing a reduction of about 3%. This reduction is attributable to three main factors. The first one is an adverse effects impact of 1.3%. The second one is a price erosion of about 0.5%.

9:36 Those two, let's say, coming from the market, totaling 1.8% of this 3% reduction are, as I said, taken from that. There is a third element which is strictly related to the top line performance in terms of geographic mix and product mix, as just discussed by Francesco, which is affecting our GDP of another 1.3%. And this is primarily attributable, as we have seen, to lower sales in the US market, to a higher top line coming from our new business, sports medicine, and also given a lower than expected top line also to a higher DNA ratio of coming primarily from our instruments that are in the market.

10:31 This is important because those two, the two elements coming from the market are taken, the second one are strictly related to our, say, top line and performance. Moving to the ABDA margin slide, what you see here is, as always, there are two lines. The yellow line is representing the evolution of our ABDA margin in reported currency. And the red line is showing the ABDA margin at cost and currency. So you see that net from the 1.3% FX effect, there is a 0.9% reduction from the previous semester, which is primarily coming from the AGP erosion that we have just discussed, only partially offset by a limited operating leverage due to volumes and also the ability of the company to keep our costs under control.

11:31 Moving to the net profit slide. The net profit in the first semester amounted to about 42 million compared to 60 million of the previous year. In order to comment comparable numbers, we should read last year net profit as 46 million, net from the one-off positive purchase gain coming from the acquisition of the company last year, so 46. Comparing to 49, which is coming from 42, reported plus about 7 million of negative effects effect. So the net adjusted and comparable is 49 versus 46.

12:18 Moving to the slide of the operating cash flow. The number, the operating cash flow in the semester was about 56 million, down from 73 of the previous year, and this is representing, of course, the performance, just discussed, of our ABDA. but also a higher networking capital needs that were basically needed to replenish the implant safety inventory after the super strong performance of last year and the preparation of the necessary inventory level to enter the Indian market in the second half of the year. We will discuss very soon in the next slide the investing activities, 74 million, and this is resulted into a negative frequency law of 18.6 million.

13:12 Moving to the slide 21, sorry, CAPEX 2017, yes. This is the usual pie of our CAPEX, as always, instruments for 2 million represented the biggest chunk of our investment, but it's important to notice that our tangibles now are 22 million, and this is a number reflecting the big amount of investments that we have to do in order to expand our production capacity, to produce our offices and facilities to accommodate and say the future production machines and employees that we have in our pipeline.

14:02 The rest are more or less in line with the previous year research and development 8 million and other 2 million for a total of 74 million. Moving to the CAPEX for growth instruments plus other intangibles, This chart summarizes the evolution of CAPEX on sales over the last three semesters. Three lines. The yellow line is representing CAPEX for other tangibles that are primarily land, buildings, and production capacity. The light yellow line is representing instruments on sales, and the blue line on top is the total of the two.

14:47 As you see, the percentage on sales of our instruments is pretty stable, around 10.5% to 11.9%. This fluctuation is basically driven by two main factors. The first one is the acceleration of top line. And the second one is also the planning and delivery phase in our business, which basically means to place orders ahead of time in the order of 9 to 12 months. So it is feasible to adjust, but it's not necessarily possible to do it in the first semester or in the same year. So this explains these situations. The other one is, as we said, representing the expansion of our land and buildings and the expansion of our production capacity. So 17.5% is without, just to be clear, without the R&D investments that we've seen in the previous slide.

15:46 Moving to the last slide of my presentation. The leverage net debt on adjusted EBITDA was 1.2 times, very low, compared to 0.9 times of the full year last year. I think that that concludes my part of the presentation and I'll now hand over to Francesco who will take you through the outlook session and some final remarks. Thank you.

16:18 Thank you, Corrado. Yes, so we mentioned at the beginning Medacta is confirming its outlook for 2026 with revenue growth in the range of 10% to 14% and an expansion of the adjusted EBITDA margin of around 50 base points versus prior year in cost and currency. At the same time, we confirm our mid-term outlook, which brings our revenue compound annual growth rate in constant currency between 12% and 15%. with a gradual improvement of the adjusted EBITDA compared versus 2025, again in constant currency and subject to unforeseen events.

17:09 And Medacta remains not impacted by the U.S. status and will continue to monitor the development. Which are the key messages? The key message is that Medacta is able to continue to develop and to grow an above market rate for H1 2026. This is the result of our differentiating innovation, medical education, and constant expansion of our sales reps and teams. We have been able to continue to deliver a high adjusted ABDA margin of approximately 28% in cost and currency. An accelerating U.S. development and expansion as we have announced the acquisition of a first large piece of land in Tennessee where we are going to develop our new U.S. headquarters and manufacturing activity for the U.S. market.

18:17 and our aim continues to be to outgrow the market in a significant way for the years to come. Thank you very much for your attention and once again thanks to all our employees, clients, suppliers and partners worldwide for the excellent period. Thank you very much. This is the Coruscant Conference Operator We will now begin the question and answer session. Anyone who wishes to ask a question may press star and 1 on their touch-tone telephone. To remove yourself from the question queue, please press star and 2. Please pick up the receiver when asking questions.

19:05 Anyone who has a question may press star and 1 at this time. The first question is from Sam England with Berenberg. Please go ahead.

19:17 Hi guys, thanks for taking the questions. Can you just give us a bit of a sense of what you've seen in the US joint market so far in Q3? I think one of your competitors commented at a conference yesterday that the markets remain quite soft this quarter, so I wondered if that's what you're seeing as well, and to what extent you think you can offset any market weakness with innovation and share gains in the second half? And then, Secondly, your EBITDA margin now implies a bit of a step up in margins in the second half of this year. So can you just walk through the drivers that you see to get you to hit that level in the second half? And do you expect any of the gross margin pressures that you called out to ease as we move into the second half so you can hit that guidance? Thanks.

20:01 Yeah, thank you, Sam. So in the U.S., we have seen, of course, H1 market. Now everybody reported the numbers, which is quite a bit lower than the previous years in terms of market growth. We have seen probably 3% U.S. market growth versus an expected 5, 5.5%. Q3, we have started to see, at least on our end, some of the medacta-specific factors to be reduced, especially the spine dilution in the U.S., Spine segment, which is heading in the right direction.

20:52 We have seen a good reacceleration on the hip side, but this was very much linked to our introduction of this triple taper stem. So we remain very confident on our ability to accelerate quite a bit in the U.S. specifically as well, which was the biggest gap we had and the biggest surprise we had in H1. It's fair to remind maybe everybody that last year Medacta USA did an exceptionally strong H1. So we have a different comparable in H2, both in the U.S. and at company level. So definitely we see a better chance to accelerate in the second half, including in the U.S., and that's true outside of the U.S. as well.

21:51 On the ABDA margin, I think it's pretty much linked as well to what we just discussed. So we were aiming in terms of growth a bit higher. We did generate cost in the first half of the year in order to achieve a higher growth rate. In terms of people, structure, etc., this did not fully materialize in certain regions in particular. We mentioned the U.S. growing in a single digit, which is a very big surprise for us. And, of course, we have quite a bit of leverage to adjust our cost increase So we did reduce our cost increase to the level of revenues we are seeing at the moment.

22:42 So we are confident that if revenues develop in the way we now see and expect to continue, we are going to be able to basically hit the targets we have in mind. We had a little bit, again, of external factors headwinds, in particular some fuel surcharge, so hitting our variable transportation cost, that this is something we cannot control. And I think the fuel this morning is, again, at some record highs, so this will not help. But let's say outside of external factors, Basically, the contribution coming from a strong top line acceleration, which is what we expect, should help us to increase leverage on our cost and therefore expand our marginality.

23:42 Great. Thanks. Thank you. The next question comes from Michelle Bushler with ZKB. Please go ahead.

23:53 Hello and thank you for taking my question. You noted the notable softening within Medacta existing customers in the U.S. and the general market slowdown. Could you maybe comment on that a bit more, like how much was coming from existing customers and how much was coming from new customers?

24:12 Yeah, so this was quite an interesting dynamic because we have seen a very successful and continued pickup of new customers. In terms of number of customers, we are almost as strong as the previous year, whereas we discussed before we had a record year, which means our offering, our products, Our ability to attract new customers and to hire new salespeople remains pretty much intact, while we have seen for different reasons mainly base attrition, so existing customers either doing Last than the previous year, moving more business from hospital to ambulatory surgery centers, and this is a more profitable business for them, and so therefore they are happy with potentially a lower volume, and maybe we are present working with them in an ASC and not in the hospital.

25:18 What else we've seen? We've seen some, of course, reduction on the spine side, which was, again, more Medacta-specific thing linked to our decision to refocus on more profitable spine business and not growing at any cost. and refocusing mainly on our specialty products, as we said, technologies and sales through technology that is specific for the SPI.

25:58 Okay, thank you. And if I may, follow-up questions. You mentioned in the first half strikes in Europe. Do you still see that for the second half or is that over?

26:11 Yeah, so unfortunately it's not over. We're talking now specifically about Spain, which is one of our fastest growing markets in Europe. which is still growing despite the fact that the Spanish market in the first half is almost down 20% due to those strikes in the public market. So they have announced that those strikes will potentially continue but it's really unknown and there are some regions which are Not taking part of those strikes anymore. And as you know, Spain is a federal state, so the regions are very, very autonomous.

26:58 And we will have to see. It is very challenging for us to forecast Spain. I just actually had a meeting this morning with our Spain general manager. and that's a little bit an unknown situation. Medacta is doing very, very well despite this very strong headwind and would have been a record year in Spain for us without. But still Spain is affected by those strikes, while we did not see any other strike outside of Spain, which was the case in H1 with France, for example. So outside of Spain is more normal.

27:40 Perfect, thank you. And maybe last question from my side. Do you have the approval for the first product in India already?

27:48 We did, actually. A few weeks ago, we just got approval for our NEES, which is the most strategic product. Thank you, Francesco. Thank you. The next question comes from Graham Doyle with UBS. Please go ahead.

28:35 Good afternoon, guys. Thanks for taking the questions. Just two, please. One for Francesco, one for Corrado. Francesco, on the top line, so when I look at the midpoint of the guidance, I think it's something like 14% growth in the second half, which is about four percentage points more than H1, which is when I look at my math. So In H2, you've got an extra trading day. It seems like U.S. demand probably gets a little bit better as sort of insurance normalizes and you get through deductibles. Presumably, there's some pent-up European demand from strikes. And then you've got the improving spine piece as well. So is it still reasonable to think of like the midpoint or better is actually still possible for the full year, i.e. because of these tailwinds, you could do something like a 14% in the second half? and then Corrado, just a quick one on depreciation.

29:28 There's nothing happening. You're not accelerating depreciation on instruments or anything. It's just a case of there's a greater share of instruments out there. Just double check how that calculation is. Thank you.

29:41 Thank you, Graeme. So, concerning the top line, there are all the elements you mentioned, plus, of course, India, Q4 is only Q4, that's 100% growth. There are a few other elements you mentioned, spine, there are some price cuts that came into force, for example in France, which is our most important market in September last year, so by September this Price deduction would be not there anymore. It was around 3% in certain products, so it's quite significant. There are still, of course, some variables, like we mentioned Spain and the strike, the spine re-accelerating in the U.S.

30:38 So is it easy to achieve the mid-portion of the guidance? I would say it's not, but is it possible? I would say it is possible. but probably is more likely to be slightly below the midline given the fact that we have four months to go. But we remain positive. I mean, we're always very ambitious at Medacta. I think to grow even 10% to 12% in the current environment is phenomenal and would probably be close to 3% above three times the market. which is remarkable. But we always target very, very high numbers and I always prefer to be slightly disappointed on a very good performance than being happy because we did 6%.

31:38 That is a little bit on the sales. I hope I addressed your question. Otherwise, just let me know. Then I'll ask Corrado to address the other one.

31:47 Yes. Hi, Graham. So, yes, I confirm we didn't change any accounting treatment of our CapEx. What we have seen in the first semester is a pure arithmetical result coming from lower expected top line and the same amount of instruments and DNA that are still in the market regardless of the level of top line reached in a certain semester. Just a pure arithmetical calculation, nothing else.

32:18 But if I can comment on that, Graham, Of course, very often in business, revenues fix a lot of problems. So as we can control our new instrument sets that we put in the market, we did put in the market a higher number of instruments based on higher expectation. We can Thank you very much. All the facts are linked to an unexpected softening.

33:07 So you put resources, networking capital, instruments, people. Then you're slightly behind. You see this phenomenon in H1. You try to adjust it immediately. In H2, most of it you can manage it. Some of it you can't. And then you have a little deterioration. But H1 was probably our worst semester in the last four years. Five years after COVID. And we were compared with the best semester of Medacta history, which was probably H1 2025.

33:45 Thanks a lot, guys. Maybe a cheeky follow-up, which is if you look at some of your big peers like J&J, whether it's their spin or Smith & Nephew kind of re-evaluation board, though, there's clearly a lot of disruption, which you'd have thought would be quite good for you guys in terms of market share gains and being able to invest and kind of work closer with surgeons. But is there any logic in, you know, if an interesting product or The return on invested capital when we do it internally

34:44 is incredibly better. I mean, you have seen probably a novice just announced the acquisition of Essential Spine for 150 plus million. We developed in-house our own technology. We are going to introduce our own robotic pretty soon. and we spent a fraction of that. I mean, you see it in our R&D, it didn't explode. So that is, I think, always better. Then if there are opportunities, as you have seen with the sports medicine, with the smaller lines, we always look at it. And there are, as you said, from time to time, Thank you very much.

35:55 The next question comes from Ed Hall with TFL. Please go ahead.

36:01 Good afternoon. Yeah, thanks for taking my questions. The first one would be back on the US and the acceleration you guys have talked about. So we've seen the last three semesters of sort of relatively flat reported numbers. I appreciate that you've outlined the headwinds over the last 12 months. So if we think about sort of We're looking at H2, and you talked about spine getting better and the hip reacceleration from the tapered stem. What else should we expect from the US market? Is it too far to say that we would see a lower attrition rate on the base surgeons in H2? Am I jumping to conclusions there? I mean, that would be my first question.

36:46 And then the second question for Corrado, I guess, on the inventory in the rebuild that we've seen there. How much of this would be fought for India versus repairing safety stocks from the exceptional growth you guys saw in 2025? Thanks.

37:04 So let me try to address the U.S. So we mentioned a good reacceleration on the hip side. The knee was already growing pretty well, I would say. We have introduced a new shoulder as well, which we see a good acceleration. It's called the monobloc medactive stem, which addresses an important segment of the of the market, which is mainly represented by the market leader, which is Striker Shoulder, or the former Tournier. That is going to help us a lot. And then you mentioned correctly the spine, which should reduce the dilution on the overall growth rate of Medacta USAID. Is the base attrition going to reduce in a significant way? We believe so.

38:08 We have analyzed really customer by customer what's going on and we believe that this phenomenon should significantly reduce and at the same time We have seen, as we said, a good pipeline of new customers picking up, and that's where the confidence in the second half acceleration of the U.S. market is coming from. And the first two months, smaller months, because those are the summer months, are confirming those trends. So we are positive. We remain cautious because those are things out of our hands, but we are quite confident on a good recovery in the second half of the U.S.

38:55 Corrado, I'll let you comment on the networking capital.

38:58 Sure. Let me say, networking capital, I would say that the biggest chunk of our change in inventory is driven by the growth of the top line. Today we have to serve new customers and the biggest chunk of this change in inventory per semester is for those new customers in the market. Then there is a portion of this change in inventory which is, as we say, needed to cover some tensions of our inventory that are observed after the super strong growth of the last year and then the smallest portion of this changing inventory, 25 million, The smallest portion of it is related to the new market of India. Of course, we will keep this new inventory proportionate to the top line in this semester, so I would say that this is the very small part of this changing inventory.

39:58 And just an additional comment on that. You are comparing, if you want, a rebuilding of networking capital with a stock level of last year, which was really aggressively deployed. Because of the very high demand, I think the first semester last year, if I remember well, Anja, was above 20%, around 20% in growth. And this was quite above our plans, so the stock level you see at the end of H1 2025 was not a physiological level, was already impacted by an above, higher than expected growth. And this was the case as well at the end of the year, which is where we were starting to rebuild our stock levels in 2026.

40:58 Very clear, thanks. And maybe just to follow up on India, I appreciate this, I think, at the four-year call at the start of the year, you mentioned pricing was comparable to Europe with roughly 100 million patients. Is this the sort of market size we should think of and how should we get to sort of a realistic number for a midterm?

41:25 So what is very interesting about India is not only the current market of 100 million, but its growth rate. And I believe reports talk about 15 plus percent growth rate of the Indian market able to absorb those kind of procedures. So every year we should talk about this 100 million because when you have those growth rates in three, four years, you are close to 200 million and so on and so forth. and that is what is appealing about India. They are absorbing quite a lot of innovative products. They are very keen in technologies as well. So the pricing, as you said, it's in a range that we feel comfortable to play with.

42:15 It's a European price, it's a low European price, but it's a European price.

42:22 Very clear. Thank you very much and congrats again.

42:26 Thank you and thanks a lot. The next question comes from Sandra Dici with Octavian. Please go ahead.

42:37 Yes, good afternoon. Thank you for taking my question. That one on the spine margin, the growth in that segment has, as you mentioned, been somewhat soft due to the transition to direct sales force, but you also indicated that profitability has been protected. Now, did also the dilution to the group margin continue to decrease, or where is the spine profitability today relative to the rest of your business? Maybe also more importantly, what do you need to achieve in spine so that spine is no longer diluted to the group margin? Is that anytime soon or what should we expect there?

43:22 Yeah, so high standard, first of all. It's too long we didn't see each other. So spine is a... It's quite an interesting beast. First of all, on the GP point of view, it is actually higher than joint. So if we talk about the margins starting from the top, the gross profit margin of spine is better than most of our product lines. Then you go down at ABDA level, and today it is improving. is not yet at the level of the core business of Medacta, hip and knee.

44:08 And this was mainly driven by very, very high commission paid in the U.S., which was driving our profitability of that line in the U.S. to negative numbers. Overall, spine is already Thank you very much. What needs to happen? We need to change our business model in the U.S. in order for scale to bring marginality, and this is what we've been doing. And then, in general, overall, continue to scale it up in order for this business to leverage some of the fixed costs and increased marginality.

45:16 So I would say is around a third of the marginality we have on the core joint business at the moment. We are already quite happy because only a few years ago it was barely a break even. And if you go two years back, it was we were losing money. And this is trending in the right direction. The next business line we needed to Turnaround in terms of profitability is sports medicine, which is starting, of course, from negative. We are investing highly, Salesforce expansion, et cetera. And those are the two areas we needed to grow.

46:02 in order to reduce the dilution at ABDA level. But that's as well why we believe in our mid-term guidance of potentially further expanding our ABDA over time.

46:21 Great, thank you. That was super helpful. And maybe if I may, a quick follow-up on the profitability. The US impact, as you mentioned, that the lower contribution has kind of a negative impact on the gross margin. Can you confirm that on EBTA level there is no meaningful difference between the US and and the rest of your portfolio. And did I understand it correctly? You would expect that the regional mix will come more supportive in the second half.

46:54 Yes, that's correct. So the U.S. pricing is higher than the European pricing, so a geomix change will impact the GP. It has a much lower impact at ABDA level because the U.S. market carries quite a lot of additional costs from distribution costs, marketing costs, insurance costs, and so on and so forth. EBDA wise, the profitability of the US market and some of the European markets are similar, very comparable.

47:33 Thank you.

47:36 Thank you very much, Sandra. For any further questions, please press star and 1 on your telephone. Gentlemen, there are no more questions registered at this time. Excuse me, there's one quick last question from Graham Doyle with UBS. Please go ahead.

48:04 Hi, sorry, thanks for taking the follow-up, but I figured we had a bit more time. One of the comments you made, Francesco, is just that the H1 was obviously a bit more challenging on the top line than you'd anticipated, and obviously you've talked about the U.S. Do you have any idea what's actually happening in the U.S. as to why that market is a little bit slower?

48:25 I would say there are two factors. Number one is it's simply happening what I was expecting since a few years, that the market is going back to a normal growth rate, a pre-COVID growth rate. And if you look at the MedTech reports pre-COVID, I think the joint replacement market was in the range of 2.5%, 3%, while we were used now after COVID-21, 22, 23 at rates of around 5%, 5.5%, which were quite a bit higher. And that was abnormal. And if you want still a recovery of the big gap generated by COVID, and then you remember the shortages of nurses, et cetera. So it took quite a bit longer than expected.

49:21 to recover all the patients missing during 2020-2021. But then, of course, it would normalize. There's no reason why it shouldn't go back to pre-COVID level, and that is one factor. This is general, I would say. The second one is more Medacta specific. We have, as you know, quite a lot of customers in the ASC segment. and I always mention that the surgeons that are working in an ASC are working as well in a hospital. Very often we work with them first of all in an ASC and then we have to fight with them to go through the hospital purchasing department and it takes quite a bit of time.

50:14 It did happen in the first half of the year that Quite a significant number of surgeons that were working in an ASC and in a hospital, and we were only serving them in an ASC and only partially in a hospital. They basically dropped their hospital volume. The surgeons picking up those hospital volumes were not Medacta customers, so we have seen some attrition. This is one of the phenomenon we studied in order to understand why our customer base volume was was going down. But this has nothing to do with the general market slowdown.

51:00 And once this phenomenon is finished, that's a temporary situation. But we were helping the transition of many customers from hospital to ASC. And when they drop their hospital volume, we lose volume. and that is something we have seen unexpectedly in H1. And they can drop their hospital volume because they make significantly more money in an ASC setting, so even by doing 80% of the volume they were doing before, they probably make more than what they were doing before in working in the hospital significantly more.

51:45 So that was an interesting phenomenon we focused on and we did understand.

51:53 Thank you so much. It's really, really helpful.

51:56 Thank you very much. Thank you for the last minute question. This was the last question. Back to you for any closing remarks you may have.

52:08 No, I would like to thank as well, as always, everybody for participating into this call. And once again, thanks to all our employees, clients, suppliers and partners worldwide that help us to deliver those performances. So thank you very much and speak to you all soon. Ladies and gentlemen, thank you for joining. The conference is now over. You may disconnect your telephone.