OrthoPediatrics Corp (KIDS) 2022 Q4 法說會逐字稿

Good morning, and welcome to OrthoPediatrics Corporation Fourth Quarter and Full Year 2022 Earnings Conference Call. (Operator Instructions) As a reminder, this call is being recorded for replay purposes.

早上好，歡迎來到 OrthoPediatrics Corporation 第四季度和 2022 年全年收益電話會議。 （操作員說明）作為提醒，正在錄製此通話以供重播。

I would now like to turn the call over to Trip Taylor from the Gilmartin Group for a few introductory comments.

我現在想把電話轉給 Gilmartin Group 的 Trip Taylor，聽取一些介紹性的評論。

Thank you for joining today's call. With me from the company are David Bailey, President and Chief Executive Officer; and Fred Hite, Chief Operating and Financial Officer.

感謝您參加今天的電話會議。和我一起來自公司的還有總裁兼首席執行官 David Bailey；首席運營和財務官 Fred Hite。

Before we begin today, let me remind you that the company's remarks include forward-looking statements within the meaning of federal securities laws, including the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.

在今天開始之前，讓我提醒您，公司的言論包括聯邦證券法含義內的前瞻性陳述，包括 1995 年《私人證券訴訟改革法案》的安全港條款。

These forward-looking statements are subject to numerous risks and uncertainties, and the company's actual results may differ materially. For a discussion of risk factors, I encourage you to review the company's most recent annual report on Form 10-K as updated and supplemented by our other SEC reports filed from time to time.

這些前瞻性陳述受眾多風險和不確定因素的影響，公司的實際結果可能存在重大差異。關於風險因素的討論，我鼓勵您查看公司最新的 10-K 表格年度報告，該報告由我們不時提交的其他 SEC 報告更新和補充。

During the call today, management will also discuss certain non-GAAP financial measures, which are supplemental measures of performance. The company believes these measures provide useful information for investors in evaluating its operations period-over-period.

在今天的電話會議中，管理層還將討論某些非 GAAP 財務指標，這些指標是業績的補充指標。該公司認為，這些措施為投資者評估其同期運營提供了有用的信息。

For each non-GAAP financial measure referenced on this call, the company has included a reconciliation of the non-GAAP financial measures to the most directly comparable GAAP financial measures in its earnings release. Please note that the non-GAAP financial measures have limitations as analytical tools and should not be considered in isolation or as a substitute for OrthoPediatrics' financial results prepared in accordance with GAAP.

對於本次電話會議中提到的每項非 GAAP 財務指標，公司在其收益發布中都包含了非 GAAP 財務指標與最直接可比的 GAAP 財務指標的對賬。請注意，非 GAAP 財務指標作為分析工具具有局限性，不應孤立地考慮或替代 OrthoPediatrics 根據 GAAP 編制的財務結果。

In addition, the content of this conference call contains time-sensitive information that is accurate only as of the date of this live broadcast today, March 1, 2023. Except as required by law, the company undertakes no obligation to revise or update any statements to reflect events or circumstances taking place after the date of this call.

此外，本次電話會議的內容包含時效性信息，僅截至本次直播之日 2023 年 3 月 1 日為止準確。除法律要求外，公司不承擔修改或更新任何聲明的義務反映本次電話會議日期之後發生的事件或情況。

With that, I would like to turn the call over to David Bailey, President and Chief Executive Officer.

有了這個，我想把電話轉給總裁兼首席執行官大衛貝利。

Thanks, Trip. Good morning, everyone, and thank you for joining us on our fourth quarter and full year 2022 conference call. As we start all earnings calls, I'd like to begin by highlighting that we helped nearly 17,000 children in the fourth quarter and approximately 70,000 for the full year 2022.

謝謝，旅行。大家早上好，感謝您加入我們的第四季度和 2022 年全年電話會議。在我們開始所有財報電話會議時，我想首先強調，我們在第四季度幫助了近 17,000 名兒童，在 2022 年全年幫助了大約 70,000 名兒童。

Since inception and with the additions of MD Orthopedics and Pega Medical, we have now helped over 630,000 children. Doing the right thing for children remains our top priority. Consistent with our preannouncement on January 9, we generated quarterly revenue of $31 million, representing growth of 25% compared to the fourth quarter of 2021.

自成立以來，隨著 MD Orthopedics 和 Pega Medical 的加入，我們現在已經幫助了超過 630,000 名兒童。為兒童做正確的事仍然是我們的首要任務。與我們在 1 月 9 日發布的預告一致，我們的季度收入為 3100 萬美元，與 2021 年第四季度相比增長了 25%。

For the full year of 2022, we generated $122.3 million, representing growth of 25% compared to 2021. Despite the negative impacts from COVID in Q1 2022, record high rates of RSV and flu in the back half of the year and ongoing hospital staff shortages, we once again produced record revenue and growth in excess of 20%, a trend that has been ongoing since our founding, excluding the pandemic-ridden year of 2020.

2022 年全年，我們產生了 1.223 億美元，與 2021 年相比增長了 25%。儘管 2022 年第一季度受到 COVID 的負面影響，但下半年 RSV 和流感的發病率創歷史新高，醫院工作人員持續短缺，我們再次創造了創紀錄的收入和超過 20% 的增長，這一趨勢自我們成立以來一直在持續，不包括大流行肆虐的 2020 年。

In addition to growing the top line in excess of 20%, we continue to grow revenue faster than expenses, which resulted in our first year of profitability. The headwinds we experienced in Q4 reduced our potential adjusted EBITDA. However, we are pleased to have generated our first full year of positive adjusted EBITDA in 2022.

除了收入增長超過 20% 之外，我們的收入增長速度繼續快於支出增長，這導致我們第一年實現盈利。我們在第四季度經歷的不利因素降低了我們潛在的調整後 EBITDA。然而，我們很高興在 2022 年實現了第一個全年正調整 EBITDA。

Our successful top and bottom line growth was driven by continued strong share gains resulting from increasing surgeon product adoption as a result of executing our account conversion strategies, increasing set deployments, launching new products, sales synergies from our 2 acquisitions and our ongoing commitment to train the next generation of pediatric orthopedic surgeons.

我們成功的收入和利潤增長是由於執行我們的客戶轉換策略、增加設備部署、推出新產品、我們 2 次收購的銷售協同效應以及我們對培訓的持續承諾而導致外科醫生產品採用率增加所導致的持續強勁的份額增長所推動的下一代小兒整形外科醫生。

Overall, we are extremely proud of our performance and believe OrthoPediatrics is in its strongest strategic position of all time. With continued momentum from those growth drivers, we expect to deliver total revenue just over $146 million to $149 million for the full year 2023, while also continuing to improve our profitability. Additionally, with the strengthened balance sheet following our capital raise in August 2022, we believe that we have a solid line of sight to cash flow breakeven in the next 5 years.

總的來說，我們對我們的表現感到非常自豪，並相信 OrthoPediatrics 處於有史以來最強大的戰略地位。在這些增長動力的持續推動下，我們預計 2023 年全年的總收入將超過 1.46 億美元至 1.49 億美元，同時還將繼續提高我們的盈利能力。此外，隨著我們在 2022 年 8 月籌集資金後資產負債表得到加強，我們相信我們對未來 5 年的現金流盈虧平衡有明確的預期。

Moving to our revenue categories. In the fourth quarter of 2022, we generated total Trauma and Deformity revenue of $22.1 million, representing growth of 34% compared to the prior year period. This included combined global revenue of approximately $4.1 million for MD Orthopedics and Pega Medical.

轉到我們的收入類別。 2022 年第四季度，我們的創傷和畸形總收入為 2210 萬美元，比去年同期增長 34%。這包括 MD Orthopedics 和 Pega Medical 的全球總收入約為 410 萬美元。

Organic Trauma and Deformity revenue was $17.9 million, representing growth of 9% compared to the same period prior year. Organic revenue growth in the quarter was driven by market share gains with PNP Femur, Cannulated Screws and our Orthex External Fixation Systems, in addition to growth of legacy implant systems. We were also benefited from the sales synergies achieved with both of our 2022 acquisitions, MD Orthopedics and Pega Medical, which has meaningfully expanded our Trauma and Deformity portfolio.

有機創傷和畸形收入為 1790 萬美元，與去年同期相比增長 9%。本季度的有機收入增長受到 PNP 股骨、空心螺釘和我們的 Orthex 外固定係統市場份額增長的推動，此外還有傳統植入系統的增長。我們還受益於我們 2022 年收購 MD Orthopedics 和 Pega Medical 所實現的銷售協同效應，這顯著擴展了我們的創傷和畸形產品組合。

As a reminder, in April of 2022, we acquired Iowa-based MD Orthopedics, a leader in the nonsurgical treatment of clubfoot. And in July, we acquired Pega Medical and their gold standard Fassier-Duval telescopic IM nailing system used to treat rare bone diseases. I am pleased to report that OP continues to positively impact their growth trajectories of both new franchises. And as we continue to execute, our strategic rationale is further validated.

提醒一下，2022 年 4 月，我們收購了位於愛荷華州的 MD Orthopedics，這是馬蹄內翻足非手術治療領域的領導者。 7 月，我們收購了 Pega Medical 及其用於治療罕見骨病的黃金標準 Fassier-Duval 伸縮式 IM 釘系統。我很高興地報告，OP 繼續對這兩個新特許經營權的增長軌跡產生積極影響。隨著我們繼續執行，我們的戰略依據得到進一步驗證。

Turning to MDO. In 2022, we achieved strong initial sales with the existing portfolio of specialty clubfoot bracing products from strong European distributor reorders, new market expansion and improved brand visibility in the U.S., as a result of its association with OrthoPediatrics. Going forward, we believe the momentum we are generating in our nonsurgical franchise ensures it will be a material contributor to our growth rate going forward.

轉向多域作戰。 2022 年，由於與 OrthoPediatrics 的合作，我們現有的專業馬蹄內翻足支撐產品組合實現了強勁的初始銷售，這得益於強勁的歐洲經銷商再訂單、新市場擴張以及在美國提高的品牌知名度。展望未來，我們相信我們在非手術特許經營中產生的勢頭確保它將成為我們未來增長率的重要貢獻者。

The acquisition of Pega Medical positions us at the forefront of the pediatric rare bone disease market by means of the Fassier-Duval telescopic IM nailing system. In 2 quarters, we have fully integrated the Pega Medical product portfolio into our U.S. sales channel. This integration has produced an immediate positive revenue uplift.

通過 Fassier-Duval 伸縮式 IM 釘系統，對 Pega Medical 的收購使我們處於兒科罕見骨病市場的前沿。在兩個季度內，我們已將 Pega Medical 產品組合完全整合到我們的美國銷售渠道中。這種整合立即產生了積極的收入增長。

Our customer surgeons' feedback is extremely positive. The product synergies are obvious and the cultural integration of the business is exactly what we had hoped for. Both acquisitions bolster our market-leading positions in their respective categories while expanding our total addressable market, and we are very pleased with the performance of each thus far.

我們的客戶外科醫生的反饋非常積極。產品協同效應明顯，業務文化融合正是我們所希望的。這兩項收購都鞏固了我們在各自類別中的市場領先地位，同時擴大了我們的總潛在市場，我們對迄今為止每項收購的表現都非常滿意。

Looking ahead, we are excited by the multiple opportunities to further expand our leadership position within pediatric Trauma and Deformity. Further deployments of new PNP Femur, Orthex, Cannulated Screw and legacy implant sets are a core component of our growth.

展望未來，我們很高興有多種機會進一步擴大我們在兒科創傷和畸形領域的領導地位。進一步部署新的 PNP 股骨、Orthex、空心螺釘和傳統植入物組是我們增長的核心組成部分。

Additionally, we expect both Pega Medical and MDO to outpace our organic corporate growth rate in 2023. With Pega, there are multiple levers for growth, including plans to dramatically improve surgeon access to key Pega Medical products, deploying more instrument sets to meet the increasing demand, fully training our global sales representatives and launching of new products. These opportunities position this business to be a key contributor to our growth for several years. With MDO, we expect to accelerate growth as we train new customers in the Ponseti technique, open new international markets and introduce several new nonsurgical specialty bracing products throughout 2023.

此外，我們預計 Pega Medical 和 MDO 都將在 2023 年超過我們的有機企業增長率。有了 Pega，有多種增長槓桿，包括計劃大幅改善外科醫生對 Pega Medical 關鍵產品的訪問，部署更多儀器套件以滿足日益增長的需求需求，全面培訓我們的全球銷售代表和推出新產品。這些機會使該業務成為我們多年來增長的關鍵貢獻者。借助 MDO，我們希望在整個 2023 年通過 Ponseti 技術培訓新客戶、開拓新的國際市場並推出幾種新的非手術專業支撐產品來加速增長。

Now I'll move to the scoliosis business. In the fourth quarter, we generated scoliosis revenue of $8 million, representing organic growth of 12% compared to the prior year period. Similar to T&D, our revenue growth was primarily a factor of taking market share with key products such as RESPONSE and ApiFix, which is accelerating with additional 7D placements.

現在我將轉向脊柱側凸業務。第四季度，我們產生了 800 萬美元的脊柱側凸收入，與去年同期相比有機增長 12%。與 T&D 類似，我們的收入增長主要是通過 RESPONSE 和 ApiFix 等關鍵產品佔據市場份額的一個因素，這些產品隨著額外的 7D 佈局而加速。

During the quarter, we gained market share and added new surgeon customers in prominent accounts that will lead to material growth in 2023. We also onboarded several new ApiFix users and added additional commercial sites. We continue to see response pull-through in accounts where ApiFix and/or 7D is being adopted. We expect our scoliosis business to be a significant growth driver for OP for many years to come as more surgeons adopt our response fusion system. We completed the placement of additional 7D units and expand the user base for ApiFix, as we report 2-year clinical outcomes data to our customers.

在本季度，我們獲得了市場份額並在重要客戶中增加了新的外科醫生客戶，這將導致 2023 年實現實質性增長。我們還吸引了幾個新的 ApiFix 用戶並增加了其他商業網站。我們繼續在採用 ApiFix 和/或 7D 的賬戶中看到響應拉動。隨著越來越多的外科醫生採用我們的反應融合系統，我們預計我們的脊柱側凸業務將在未來許多年成為 OP 的重要增長動力。我們完成了額外 7D 單元的放置，並擴大了 ApiFix 的用戶群，因為我們向客戶報告了 2 年的臨床結果數據。

Moving on to international. In the fourth quarter of 2022, we generated quarterly international revenue of $8.3 million compared to $5 million the prior year period, primarily driven by new set sales to our stocking distributors as well as the addition of MDO and Pega international revenue.

走向國際化。在 2022 年第四季度，我們產生了 830 萬美元的季度國際收入，而去年同期為 500 萬美元，這主要是由於向我們的庫存分銷商銷售新套裝以及增加 MDO 和 Pega 國際收入所推動的。

In January, we announced the formation of our direct sales organization in Germany, which is one of the largest orthopedic markets in Europe. OrthoPediatrics GmbH marks our first direct international organization and reflects our expanding commitment to helping children across the globe. With this new direct sales organization, we will be able to establish deeper connections with the German pediatric orthopedic community and provide a deeper level of service that we believe will ultimately lead to better patient outcomes.

1 月，我們宣佈在德國成立直銷機構，德國是歐洲最大的骨科市場之一。 OrthoPediatrics GmbH 標誌著我們的第一個直接國際組織，反映了我們不斷擴大對幫助全球兒童的承諾。通過這個新的直銷組織，我們將能夠與德國兒科骨科社區建立更深層次的聯繫，並提供更深層次的服務，我們相信這最終會帶來更好的患者治療效果。

This, along with the integration of Pega products in our European sales agencies, additional international product launches in key markets, new market expansion within the MDO franchise and increasing willingness for set purchases from our international stocking distributors gives us confidence that our international business is well positioned to generate strong growth in 2023.

這一點，連同 Pega 產品在我們歐洲銷售機構的整合、在主要市場推出的更多國際產品、MDO 特許經營權內的新市場擴張以及從我們的國際庫存分銷商處購買套裝的意願增加，使我們相信我們的國際業務狀況良好有望在 2023 年實現強勁增長。

Turning to new product development. In 2022, we launched several new products, including drive rail, bone support and 3D side, along with the MDO and Pega product portfolio. Altogether, this brings our total product offering to 46 systems. We are pleased with the initial contributions and expect our recent product launches to be a source of growth in 2023. We have also advanced R&D projects across our entire business. This includes progressing the late-stage development projects from Pega and MDO that made these business incrementally more attractive to us.

轉向新產品開發。 2022 年，我們推出了幾款新產品，包括驅動導軌、骨骼支撐和 3D 側面，以及 MDO 和 Pega 產品組合。總而言之，這使我們的產品總數達到 46 個系統。我們對最初的貢獻感到滿意，並預計我們最近推出的產品將成為 2023 年的增長源泉。我們還在整個業務中推進了研發項目。這包括推進 Pega 和 MDO 的後期開發項目，這些項目使這些業務逐漸對我們更具吸引力。

In scoliosis, we remain on track to launch our new RESPONSE derotation instrumentation, RESPONSE Cannulated Screws and a number of RESPONSE instrument set upgrades. Additionally, we finalized the development of our RESPONSE power system that will assist surgeons when placing both pedicle and set screws, and we look forward to launching this system in the second quarter of 2023.

在脊柱側凸方面，我們繼續按計劃推出新的 RESPONSE 去旋轉器械、RESPONSE 空心螺釘和一系列 RESPONSE 器械套件升級。此外，我們完成了 RESPONSE 動力系統的開發，該系統將在放置椎弓根和固定螺釘時協助外科醫生，我們期待在 2023 年第二季度推出該系統。

In Trauma and Deformity, we continue to advance several organic development initiatives such as PNP Tibia, DF2 and the Orthex preplanning software, which just received FDA 510(k) approval, and we expect an initial launch of each in 2023. Within the Pega Medical product family, we continue to invest in the development of several limb deformity correction products with at least 2 slated for launch in 2023.

在創傷和畸形領域，我們繼續推進多項有機開發計劃，例如 PNP Tibia、DF2 和剛剛獲得 FDA 510(k) 批准的 Orthex 預規劃軟件，我們預計每項計劃都將在 2023 年首次推出。在 Pega Medical 內部產品系列，我們繼續投資開發多款肢體畸形矯正產品，其中至少 2 款計劃於 2023 年推出。

Lastly, we continue working on introducing several new nonsurgical products through MDO, where we're building a robust cadence of new product introductions starting in 2023. In all, we are pleased with our ability to advance the development of the next generation of pediatric orthopedic solutions while remaining on path towards improved profitability, and we believe the constant introduction of new products in 2023 and beyond is another source of revenue growth and competitive advantage.

最後，我們繼續致力於通過 MDO 推出幾種新的非手術產品，我們正在建立從 2023 年開始推出新產品的強勁節奏。總而言之，我們很高興能夠推動下一代兒科骨科產品的發展解決方案，同時繼續提高盈利能力，我們相信在 2023 年及以後不斷推出新產品是收入增長和競爭優勢的另一個來源。

Moving on to surgeon training and education. As a leader in pediatric orthopedics, we believe it is our responsibility to help advance the entire field of pediatric orthopedics, and we see no greater contribution than our commitment to help train the next generation of pediatric orthopedic surgeons.

繼續進行外科醫生培訓和教育。作為小兒骨科領域的領導者，我們相信幫助推動整個小兒骨科領域的發展是我們的責任，我們認為沒有比我們致力於幫助培訓下一代小兒骨科醫師做出更大貢獻的了。

Clinical education and training is at the core of everything we do. With that said, we are pleased with another year of extremely prolific clinical education and training. Again, in 2022, we were proud to continue our leadership in sponsoring the major pediatric orthopedic surgical societies, such as POSNA, EPOS, SLAOTI and IPOS. In 2022, we conducted more than 280 training events for health care professionals covering more than 700 product sessions. Additionally, we held 7 ApiFix user group meetings and ran 15 Orthex training courses throughout the year. In the fourth quarter, we intended and we're the lead supporter of the IPOS meeting in Orlando and saw strong attendance at the Specialty Day in several of our hands-on workshops.

臨床教育和培訓是我們所做一切的核心。話雖如此，我們對又一年的極其多產的臨床教育和培訓感到滿意。再次，在 2022 年，我們很自豪能夠繼續領導贊助主要的兒科整形外科學會，例如 POSNA、EPOS、SLAOTI 和 IPOS。 2022 年，我們為醫療保健專業人員舉辦了 280 多場培訓活動，涵蓋 700 多場產品會議。此外，我們全年舉行了 7 次 ApiFix 用戶組會議並舉辦了 15 次 Orthex 培訓課程。在第四季度，我們打算並且我們是奧蘭多 IPOS 會議的主要支持者，並且在我們的幾個實踐研討會中看到了專業日的大量出席。

Finally, I want to call out our efforts and substantial progress on our ESG initiatives. As a company that lives our cause every day, we are committed to effecting lasting and meaningful change in the organizations with whom we engage. In early February 2023, we released our ESG report, highlighting several key accomplishments in 2022, including our diverse employee representation and strong environmental and business ethics. We are proud to stand behind on our dedication to fostering an environment that is respectful, compassionate and inclusive of everyone in our community.

最後，我想強調一下我們在 ESG 舉措方面所做的努力和取得的實質性進展。作為一家每天都在為我們的事業而奮鬥的公司，我們致力於在與我們打交道的組織中實現持久而有意義的變革。 2023 年 2 月初，我們發布了 ESG 報告，強調了 2022 年的幾項主要成就，包括我們多元化的員工代表以及強大的環境和商業道德。我們很自豪能夠支持我們致力於營造一個尊重、富有同情心和包容我們社區中每個人的環境。

With that, I'll turn the call over to Fred to provide more detail on our financial results. Fred?

有了這個，我會把電話轉給弗雷德，以提供有關我們財務業績的更多細節。弗雷德？

Thanks, Dave. Our fourth quarter 2022 worldwide revenue of $31.0 million increased 25% compared to the fourth quarter of 2021. Growth in the quarter was driven primarily by continued surgeon adoption. MDO and Pega Medical contributed $4.1 million of combined revenue. For the full year of 2022, our worldwide revenue of $122.3 million increased 25% when compared to 2021.

謝謝，戴夫。與 2021 年第四季度相比，我們 2022 年第四季度的全球收入為 3100 萬美元，增長了 25%。本季度的增長主要是由持續採用外科醫生推動的。 MDO 和 Pega Medical 貢獻了 410 萬美元的合併收入。 2022 年全年，我們的全球收入為 1.223 億美元，與 2021 年相比增長了 25%。

Growth in the year was primarily driven by set deployments, increasing surgeon adoption of key new products and sales synergies from our 2 new acquisitions. In the fourth quarter of 2022, U.S. revenue was $22.7 million, a 15% increase from the fourth quarter of 2021. For the full year of 2022, our U.S. revenue of $92.4 million increased 19% compared to 2021.

這一年的增長主要是由固定部署、增加外科醫生對關鍵新產品的採用以及我們 2 項新收購的銷售協同效應推動的。 2022 年第四季度，我們在美國的收入為 2270 萬美元，比 2021 年第四季度增長 15%。2022 年全年，我們在美國的收入為 9240 萬美元，比 2021 年增長 19%。

Growth in the quarter and the year was primarily driven by organic growth in Trauma and Deformity and scoliosis products as we continue to deploy more sets and increased surgeon adoption as well as the addition of MDO and Pega Medical.

本季度和本年度的增長主要是由創傷和畸形以及脊柱側彎產品的有機增長推動的，因為我們繼續部署更多設備和增加外科醫生的採用率以及 MDO 和 Pega Medical 的加入。

In the fourth quarter of 2022, we generated total international revenue of $8.3 million, representing growth of 67% compared to the prior year period. For the full year 2022, our international revenue of $29.9 million increased 47% compared to 2021. Growth in the quarter and the year was driven primarily by increased procedure volumes, increased set sales to our international stocking distributors as well as the addition of MDO and Pega Medical.

2022 年第四季度，我們的國際總收入為 830 萬美元，比去年同期增長 67%。到 2022 年全年，我們的國際收入為 2990 萬美元，比 2021 年增長了 47%。本季度和本年度的增長主要是由於手術量增加、對我們的國際庫存分銷商的成套銷售增加以及 MDO 和佩加醫療。

In the fourth quarter, Trauma and Deformity revenue of $22.1 million increased 34% compared to the prior year period. For the full year of 2022, Trauma and Deformity revenue of $85.1 million increased 29% compared to 2021. Growth in the quarter and the year was driven primarily by the organic growth from Cannulated Screws, PNP Femur, Orthex Systems as well as the nonorganic growth from MDO and Pega Medical.

第四季度，創傷和畸形收入為 2210 萬美元，比去年同期增長 34%。 2022 年全年，創傷和畸形收入為 8510 萬美元，比 2021 年增長 29%。本季度和全年的增長主要是由空心螺釘、PNP 股骨、Orthex 系統的有機增長以及非有機增長推動的來自 MDO 和 Pega Medical。

In the fourth quarter of 2022, Scoliosis organic revenue of $8.0 million increased 12% compared to the prior year period. For the full year of 2022, Scoliosis organic revenue of $33.4 million increased 19% compared to 2021. Growth was primarily driven by increased sales of our RESPONSE fusion system, ApiFix nonfusion system and 7D sales as well as pull-through and increased set sales to our international stocking distributors as they look to respond to increased backlog.

2022年第四季度，脊柱側彎有機收入為800萬美元，比去年同期增長12%。 2022 年全年，脊柱側凸有機收入為 3340 萬美元，與 2021 年相比增長 19%。增長的主要推動因素是我們的 RESPONSE 融合系統、ApiFix 非融合系統和 7D 銷售的增長以及 pull-through 和成套銷售的增長我們的國際庫存分銷商希望應對增加的積壓訂單。

Finally, Sports Medicine/Other revenue in the fourth quarter of 2022 was $0.9 million, which decreased 22% compared to the prior year period. For the full year of 2022, Sports Medicine and Other revenue of $3.8 million decreased 9% compared to 2021.

最後，2022 年第四季度運動醫學/其他收入為 90 萬美元，較上年同期下降 22%。 2022 年全年，運動醫學和其他收入為 380 萬美元，比 2021 年下降 9%。

Turning to set deployment, $6.3 million of sets were consigned in the fourth quarter of 2022 compared to $2.4 million in the fourth quarter of 2021. For the full year of 2022, we deployed $20.1 million, up 48% compared to 2021. We continue to experience strong demand for more and more sets and would expect to see increased deployments in 2023.

談到佈景部署，2022 年第四季度共交付了 630 萬美元的佈景，而 2021 年第四季度為 240 萬美元。2022 年全年，我們部署了 2010 萬美元，比 2021 年增長 48%。我們繼續對越來越多的設備有強烈的需求，預計 2023 年部署會增加。

Touching briefly on a few key metrics. For the fourth quarter of 2022, gross profit margin was 68.5% compared to 72.9% in the fourth quarter of 2021. The decrease in gross margin was driven primarily by higher set sales sold at cost to our international stocking distributors as well as a minimum purchase obligation fee on the FIREFLY licensing agreement, which resulted from unfavorable impacts of respiratory illnesses in the quarter.

簡要介紹幾個關鍵指標。 2022 年第四季度的毛利率為 68.5%，而 2021 年第四季度為 72.9%。毛利率下降的主要原因是按成本向我們的國際庫存分銷商銷售的套裝銷售額增加以及最低採購量FIREFLY 許可協議的義務費用，這是由於本季度呼吸道疾病的不利影響所致。

For the full year of 2022, gross profit margin was 74.1% compared to 74.9% in 2021. The slight decrease was primarily driven by the fourth quarter performance. Total operating expenses increased $5.9 million or 25% from $23.6 million in the fourth quarter of 2021 to $29.5 million in the fourth quarter of 2022.

2022 年全年毛利率為 74.1%，而 2021 年為 74.9%。略有下降主要受第四季度業績推動。總運營費用從 2021 年第四季度的 2360 萬美元增加到 2022 年第四季度的 2950 萬美元，增幅為 590 萬美元或 25%。

Total operating expenses increased $24.6 million or 27% from $91.4 million in 2021 to $116.1 million in 2022. The increase was driven by the addition of MDO and Pega Medical as well as incremental personnel required to support the ongoing growth of the company.

總運營費用從 2021 年的 9140 萬美元增加到 2022 年的 1.161 億美元，增幅為 2460 萬美元或 27%。增加的原因是 MDO 和 Pega Medical 的增加以及支持公司持續發展所需的人員增加。

Sales and marketing expenses increased $1.0 million or 10% to $10.9 million in the fourth quarter of 2022. For the full year of 2022, sales and marketing expenses increased $5.4 million or 14% to $45.1 million. The increase was primarily driven by increased sales commission expense coupled with the addition of our recent acquisitions.

2022 年第四季度，銷售和營銷費用增加 100 萬美元或 10% 至 1,090 萬美元。2022 年全年，銷售和營銷費用增加 540 萬美元或 14% 至 4,510 萬美元。增加的主要原因是銷售佣金費用增加以及我們最近的收購。

General and administrative expenses increased $4.5 million or 37% to $16.6 million in the fourth quarter of 2022. For the full year of 2022, general and administrative expenses increased $13.3 million or 29% to $59.4 million. The increase was driven primarily by the addition of MDO and Pega Medical as well as the personnel and resources to support the ongoing expansion of business and an increase in legal expenses associated with our recent acquisitions.

2022 年第四季度，一般和行政費用增加 450 萬美元或 37% 至 1,660 萬美元。2022 年全年，一般和行政費用增加 1,330 萬美元或 29% 至 5,940 萬美元。增長的主要原因是 MDO 和 Pega Medical 的加入，以及支持業務持續擴張的人員和資源，以及與我們最近的收購相關的法律費用的增加。

Research and development expenses increased $0.4 million or 26% to $2.0 million in the fourth quarter of 2022. For the full year of 2022, research and development expenses increased $2.5 million or 45% to $8.0 million. The increase was driven primarily by incremental product development, including research and development associated with our recent acquisitions.

2022 年第四季度研發費用增加 40 萬美元或 26% 至 200 萬美元。2022 年全年研發費用增加 250 萬美元或 45% 至 800 萬美元。這一增長主要是由增量產品開發推動的，包括與我們最近收購相關的研發。

Total other income was $0.4 million for the fourth quarter of 2022 compared to $5.4 million for the same period last year and was $21.7 million for 2022 compared to $0.6 million for 2021. In the fourth quarter of 2022, we realized a $0.5 million fair value adjustment benefit compared to a $5.5 million benefit for the fourth quarter of 2021. For 2022, fair value adjustment of contingent consideration was a benefit of $25.9 million compared to a $1.8 million benefit in 2021. We reported an adjusted EBITDA loss of $2.2 million in the fourth quarter of 2022 compared to a loss of $0.6 million for the fourth quarter of 2021.

2022 年第四季度其他收入總額為 40 萬美元，去年同期為 540 萬美元，2022 年為 2170 萬美元，而 2021 年為 60 萬美元。2022 年第四季度，我們實現了 50 萬美元的公允價值調整與 2021 年第四季度 550 萬美元的收益相比。2022 年，或有對價的公允價值調整為 2590 萬美元，而 2021 年為 180 萬美元。我們報告第四季度調整後的 EBITDA 損失為 220 萬美元2022 年第四季度虧損 60 萬美元，而 2021 年第四季度虧損 60 萬美元。

For the full year 2022, we generated a positive $0.2 million of adjusted EBITDA compared to a negative $0.2 million in 2021. We ended the fourth quarter with $120 million in cash, short-term investments and restricted cash. We maintained a strong cash position and $50 million available on our line of credit.

2022 年全年，我們的調整後 EBITDA 為正 20 萬美元，而 2021 年為負 20 萬美元。第四季度結束時，我們擁有 1.2 億美元的現金、短期投資和受限現金。我們保持著強勁的現金狀況和 5000 萬美元的可用信貸額度。

In the current economic environment, our strong balance sheet, positive adjusted EBITDA and line of sight to cash flow breakeven positions us favorably to execute on our current business strategy. For 2023, we expect an operating environment similar to 2022 with hospital staffing and capacity constraints along with the outsized respiratory illness rates.

在當前的經濟環境下，我們強勁的資產負債表、積極的調整後 EBITDA 和現金流量盈虧平衡的視線使我們有利於執行我們當前的業務戰略。對於 2023 年，我們預計運營環境將與 2022 年類似，醫院人員配備和能力受到限制，呼吸道疾病發病率過高。

In 2023, revenue is expected to be in the range between just over $146 million to $149 million, representing year-over-year annual growth between 20% and 22%. The guidance assumes roughly $5 million of revenue contribution from MDO and Pega Medical before the acquisitions become organic on their anniversaries. We expect organic growth of 15% to 18%.

到 2023 年，收入預計將在 1.46 億美元至 1.49 億美元之間，同比增長 20% 至 22%。該指南假設 MDO 和 Pega Medical 在收購週年紀念日成為有機收入之前貢獻了大約 500 萬美元的收入。我們預計有機增長率為 15% 至 18%。

Lastly, we plan to deploy around $25 million of new sets in 2023, representing a year-over-year annual growth of 24%. Additionally, moving down the P&L, we now expect to generate between $3 million to $4 million of adjusted EBITDA in 2023.

最後，我們計劃在 2023 年部署約 2500 萬美元的新設備，同比增長 24%。此外，降低損益表，我們現在預計 2023 年調整後的 EBITDA 將產生 300 萬至 400 萬美元。

At this point, I'll turn the call back to Dave for closing comments.

在這一點上，我會將電話轉回 Dave 以徵求結束意見。

Thanks, Fred. Unlike many businesses our size, our growth doesn't rely on 1 or 2 major products for a few key initiatives. We are a company with an amazing cause, supported by an amazing culture, dedicated to changing the world by meeting unmet needs in pediatric health care.

謝謝，弗雷德。與我們規模的許多企業不同，我們的增長並不依賴於 1 或 2 個主要產品來實施一些關鍵舉措。我們是一家擁有令人驚嘆的事業的公司，以令人驚嘆的文化為後盾，致力於通過滿足未滿足的兒科保健需求來改變世界。

Our ability to surround surgeons with the most comprehensive portfolio of pediatric orthopedic solutions has truly differentiated us. The focus and specialization of our products expand surgeons opportunities to help kids and enables improved clinical outcomes.

我們能夠為外科醫生提供最全面的兒科骨科解決方案組合，這讓我們真正脫穎而出。我們產品的重點和專業化擴大了外科醫生幫助孩子並改善臨床結果的機會。

As we think about 2023 and beyond, we believe our capacity to help even more kids has never been greater. We have several growth drivers in place across the business such as set deployments and key account conversions, continued share gains in T&D with the leading products such as PNP Femur, outsized growth in our new nonsurgical specialty bracing business, accelerating growth of the Pega Medical franchise, continued share gains in our Scoliosis fusion and ApiFix nonfusion segment and the opportunity for further international sales growth as markets stabilize.

展望 2023 年及以後，我們相信我們幫助更多孩子的能力從未如此強大。我們在整個業務中有幾個增長動力，例如固定部署和關鍵客戶轉換、PNP 股骨等領先產品在 T&D 中的持續份額增長、我們新的非手術專業支撐業務的超額增長、加速 Pega Medical 特許經營權的增長，我們的脊柱側彎融合和 ApiFix 非融合部分的份額持續增長，隨著市場穩定，國際銷售進一步增長的機會。

These opportunities give us every reason to be confident that our growth story will continue. Clearly, I believe OrthoPediatrics is in a position of tremendous strength, and we are confident we can continue to make share gains, grow revenue and improve profitability and most importantly, positively impact the lives of children and their families.

這些機會讓我們有充分的理由相信我們的增長故事將繼續下去。顯然，我相信 OrthoPediatrics 處於巨大的優勢地位，我們有信心我們可以繼續獲得份額收益、增加收入和提高盈利能力，最重要的是，積極影響兒童及其家庭的生活。

With that said, I'd like to turn the call back over to the operator and open the line for questions. Thank you.

話雖如此，我想將電話轉回給接線員並打開問題熱線。謝謝。

(Operator Instructions) Our first question comes from Rick Wise with Stifel.

（操作員說明）我們的第一個問題來自 Stifel 的 Rick Wise。

Thank you for all the excellent perspective on the year ahead. It sounds like another terrific year on [tap]. I think it's best if I start with the guidance. You basically reiterated your range, the $146 million to $149 million and the 20%, 22%. And thank you for calling out the $5 million related to MDO and Pega.

感謝您對未來一年的所有精彩展望。 [點擊] 這聽起來又是一個了不起的一年。我認為最好從指導開始。你基本上重申了你的範圍，1.46 億美元到 1.49 億美元和 20%、22%。並感謝您撥出與 MDO 和 Pega 相關的 500 萬美元。

But -- and help me think through -- maybe break it down a little further, if the organic is 15% to 18%, and I'm a simple guy, I say myself, they've grown 20% or much better for the last -- since inception, I think the CEO just said. Help me better understand why we can't expect even stronger performance from the organic portfolio, particularly when I think about more docs trained, more products launched, going direct in Germany, getting the sales synergies, it just seems like this is an incredibly conservative setup, but maybe I'm not appreciating your perspectives on RSV or some other factors. Hello?

但是 - 幫我想清楚 - 也許進一步分解，如果有機是 15% 到 18%，我是一個簡單的人，我自己說，他們已經增長了 20% 或更好最後 - 自成立以來，我認為首席執行官剛剛說過。幫助我更好地理解為什麼我們不能期望從有機產品組合中獲得更強大的性能，特別是當我想到更多的文檔培訓、更多的產品推出、直接進入德國、獲得銷售協同效應時，這似乎是一個非常保守的設置，但也許我不欣賞你對 RSV 或其他一些因素的看法。你好？

Speakers, you may be muted. One moment, please. Mr. Wise, you may want to repeat your question.

揚聲器，你可能被靜音了。稍等一會兒。 Wise 先生，您可能想重複您的問題。

Yes. Okay. Sorry about that, guys. We did hear the question. We were not muted, but for some reason, we lost the sound coming through. So Dave will answer the question at this time. Sorry about that.

是的。好的。對不起，伙計們。我們確實聽到了這個問題。我們沒有靜音，但由於某種原因，我們失去了通過的聲音。所以戴夫會在這個時候回答這個問題。對於那個很抱歉。

No problem.

沒問題。

Well, Rick, I think it's a good question. We have obviously historically been a grow organically at greater than 20%. And you can imagine that internally, we're not planning to move off that aspiration. And I think we have the opportunity here to do that. But I think Fred and I have seen enough disruption over the course of the last 12 to 18 months, certainly since the pandemic, but maybe even more recently that our thought here was to guide based on the fact that we don't know what the future holds necessarily in terms of respiratory illness, COVID, staffing.

嗯，瑞克，我認為這是個好問題。從歷史上看，我們的有機增長顯然超過 20%。你可以想像，在內部，我們不打算放棄這個願望。我認為我們有機會做到這一點。但我認為弗雷德和我在過去 12 到 18 個月的過程中看到了足夠多的破壞，當然是自大流行以來，但也許最近我們的想法是基於我們不知道是什麼的事實來指導就呼吸系統疾病、COVID、人員配置而言，未來必然存在。

And so we basically have guided with the expectation that those things that we saw in 2022 occur again in 2023, that may be very conservative, but that's the way we've guided. And so we hope that, that isn't the case, but I think that is the basis of a guide that would be slightly lower than 20% organic, but again, I think internally, we certainly have the aspiration to continue our long string of growth in excess of 20%.

因此，我們的指導基本上是期望我們在 2022 年看到的那些事情會在 2023 年再次發生，這可能非常保守，但這就是我們的指導方式。所以我們希望，情況並非如此，但我認為這是有機含量略低於 20% 的指南的基礎，但我再次認為，在內部，我們當然有繼續我們長期努力的願望增速超過20%。

And just we're 2/3 of the way through the first quarter. Obviously, it's hard not to ask is RSV lessening, getting worse, exactly the same? Just maybe help us some of the headwind assumptions. Is it just like the fourth quarter? What's going on, on that side?

我們只是第一季度的 2/3。顯然，很難不問 RSV 減少、惡化是否完全一樣？也許可以幫助我們做出一些逆風假設。跟第四季一樣嗎？那邊是怎麼回事？

Yes. I think we're seeing -- and you've probably seen this just the new cycle has certainly slowed down with respect to RSV, flu, some of the things that impacted us in the fourth quarter like we had never seen. And so I think that was still impacted, obviously, early in January, numbers were still very high. But I think what we're seeing here is that a general trend in the right direction. And hopefully, we continue to see that through the summer. And hopefully, we can continue to see this through the balance of the year.

是的。我認為我們正在看到——你可能已經看到了這一點，新周期在 RSV、流感方面肯定有所放緩，一些在第四季度影響我們的事情是我們從未見過的。所以我認為這仍然受到影響，顯然，在 1 月初，數字仍然很高。但我認為我們在這裡看到的是朝著正確方向發展的總體趨勢。希望我們能在整個夏天繼續看到這一點。希望我們可以在今年餘下的時間裡繼續看到這一點。

Okay. I'm going to sneak in one more, apologies. On gross margin, Fred, you highlighted higher set sales, the FIREFLY licensing and RSV. Can you help us understand the relative impact of each on the fourth quarter? Would your gross margins if you would -- I don't know how you would exclude it, especially the RSV side, but if we exclude that, would we imagine gross margins would have been 74%? And help us think about the first quarter relative to all that?

好的。對不起，我要偷偷地再說一遍。關於毛利率，弗雷德，你強調了更高的銷售額、FIREFLY 許可和 RSV。您能否幫助我們了解每一項對第四季度的相對影響？如果你願意，你的毛利率會——我不知道你會如何排除它，尤其是 RSV 方面，但如果我們排除它，我們會想像毛利率會是 74% 嗎？並幫助我們考慮相對於所有這些的第一季度？

Yes. Thanks, Rick. So our gross margin does fluctuate between the quarters depending on volume. So highest in the third quarter, a little lower in the second quarter and then down in the fourth quarter, and typically, the first quarter is our softest because of RSV volume was much less than we expected in the fourth quarter, and so volume was lower. So that did bring our margin down in the fourth quarter. But even if you compare to last year in the fourth quarter, which had that lower volume as well, the decline versus last year was probably split pretty evenly between higher set sales at cost as well as this FIREFLY license agreement minimum commitment. So it's pretty even. We would expect, I think, going forward, that 2023 margin is probably similar to 2022 across the quarters, excluding probably the softness we saw in the fourth quarter of 2022.

是的。謝謝，瑞克。因此，我們的毛利率確實會根據銷量在季度之間波動。第三季度最高，第二季度略低，然後第四季度下降，通常，第一季度是我們最疲軟的，因為 RSV 數量遠低於我們在第四季度的預期，因此數量是降低。所以這確實使我們在第四季度的利潤率下降了。但即使你與去年第四季度相比，去年第四季度的銷量也較低，與去年相比的下降可能在按成本計算的較高設定銷售額和 FIREFLY 許可協議的最低承諾之間平均分配。所以它很均勻。我認為，展望未來，我們預計 2023 年各季度的利潤率可能與 2022 年相似，可能不包括我們在 2022 年第四季度看到的疲軟。

Our next question comes from Ryan Zimmerman with BTIG.

我們的下一個問題來自 BTIG 的 Ryan Zimmerman。

Hopefully, we won't lose the feed again. Rick's question was so good, I think the call might had to end there. I want to just squeeze in a few questions for me. Number one, there's been some disruption in the spine market. As you guys know, NuVasive and Globus and Orthofix and SeaSpine, each of those have subsequent growing rod franchises. I'm wondering kind of what your expectations are as a result of those changes in the market? And what -- any disruption to those franchises could do for OrthoPediatrics whether it's new business or distributors or whatnot? Just appreciate your thoughts there.

希望我們不會再次丟失 Feed。 Rick 的問題非常好，我認為電話可能不得不到此為止。我只想為我提幾個問題。第一，脊柱市場出現了一些混亂。正如你們所知，NuVasive 和 Globus 以及 Orthofix 和 SeaSpine，它們中的每一個都有隨後不斷增長的釣竿特許經營權。我想知道您對市場的這些變化有何期望？還有什麼——對這些特許經營權的任何破壞都會對 OrthoPediatrics 產生影響，無論是新業務還是分銷商還是諸如此類的東西？只是欣賞你的想法。

Yes. Good question. So I think particularly on the NuVasive side, obviously, you have the MAGEC rod there, and we see that product obviously being used for early onset scoliosis. We don't see a lot of the other companies growing at least spinal growing technology, I'm not sure that's available in the market just yet.

是的。好問題。所以我認為特別是在 NuVasive 方面，顯然，那裡有 MAGEC 桿，我們看到該產品顯然用於治療早發性脊柱側凸。我們沒有看到很多其他公司至少在發展脊柱生長技術，我不確定市場上是否有這種技術。

But I think the disruption generally benefits us, probably benefits several companies. It's not something that we've necessarily factored into our growth for next year. But I think that there's probably some disruption, particularly on the -- potentially on the NuVa side that would drive us to be able to attract some different salespeople, add to our selling organization in areas where they're strong. But again, I don't think it's something that we've contemplated as one of our major growth drivers for next year.

但我認為這種破壞通常有利於我們，可能有幾家公司受益。這不是我們必須考慮到明年增長的因素。但我認為可能存在一些中斷，特別是在 NuVa 方面，這可能會促使我們能夠吸引一些不同的銷售人員，在他們強大的領域增加我們的銷售組織。但同樣，我認為這不是我們考慮作為明年主要增長動力之一的事情。

Yes. I would just add that we don't highlight it a lot, but we are working on our own growing rod technology. It is not going to be launched in '23, as it's still being developed, but we're pretty excited about what that could be in the future as well.

是的。我只想補充一點，我們並沒有過多強調它，但我們正在研究我們自己的種植桿技術。它不會在 23 年推出，因為它仍在開發中，但我們也對未來的發展感到非常興奮。

I appreciate that, Fred. And then for MD Ortho and Pega, you made the comment that they will grow above, I guess, the corporate average. But help us understand kind of the growth before OrthoPediatrics acquisitions and then after and kind of the lift that you expect as a result of integrating those into your sales force?

我很感激，弗雷德。然後對於 MD Ortho 和 Pega，你發表評論說他們的增長將超過公司平均水平。但是，請幫助我們了解 OrthoPediatrics 收購之前和之後的增長情況，以及您期望將這些業務整合到您的銷售團隊中後的增長情況？

I mean they're small, so they should be already growing, I think, at a relatively good rate. And so I just appreciate kind of your compare and contrast maybe what kind of impact you're having from those 2 businesses and as a result of those acquisitions?

我的意思是它們很小，所以我認為它們應該已經在以相對較好的速度增長。因此，我很欣賞您的比較和對比，也許您對這兩家企業以及這些收購產生了什麼樣的影響？

Yes. So good question. Neither of those businesses were effectively growing when we acquired them. So they're pretty static. I think it was primarily lack of sales force focus, lack of inventory. Just generally speaking, those businesses hadn't had a lot of capital investments made behind them despite the fact that there was a lot of demand for both of those products.

是的。好問題。當我們收購這些業務時，它們都沒有有效增長。所以它們非常靜態。我認為這主要是缺乏對銷售人員的關注，缺乏庫存。一般來說，儘管對這兩種產品的需求很大，但這些企業並沒有進行大量的資本投資。

So I think, particularly on the Pega side, when we have our selling organization adopt those products, which we have now for the first 2 quarters, I mean, surgeons were very keen to be able to call somebody that they already knew, they spent time in the operating with to help them work through some very difficult products.

所以我認為，特別是在 Pega 方面，當我們讓我們的銷售組織採用這些產品時，我們現在已經在前兩個季度使用了這些產品，我的意思是，外科醫生非常渴望能夠打電話給他們已經認識的人，他們花了在運營中幫助他們完成一些非常困難的產品。

So we've seen growth almost -- well, we saw growth accelerate from the minute we adopted -- the U.S. sales force adopted that particular product line. And so I think as we get inventory for this product as well as new products out for both MDO and Pega, and we can get those in the hands of both our U.S. and international selling organizations, we expect those product lines, those 2 businesses to grow in excess of 20% for the next several years.

所以我們幾乎看到了增長——好吧，我們看到增長從我們採用的那一刻起就加速了——美國銷售人員採用了那個特定的產品線。因此，我認為當我們獲得該產品的庫存以及 MDO 和 Pega 的新產品時，我們可以將這些產品交到我們的美國和國際銷售組織手中，我們希望這些產品線，這 2 個業務未來幾年增長超過20%。

Yes, I would just add, particularly on the Pega side, I think we've gotten a question from an investor in the past, can this grow 40% or 50%? And it's not going to grow that fast because we have to get inventory. We have to get set and we have to deploy those sets. So obviously, we ordered a lot of sets when we first bought it. We've now put our second round of sets orders on place. Those will start showing up in the second half of '23. And so as we continue to roll out more and more sets on the Pega side, we'll have growth well in advance of the overall business growth for the next 5 years.

是的，我只想補充一點，特別是在 Pega 方面，我想我們過去從投資者那裡得到了一個問題，它能增長 40% 還是 50%？而且它不會增長那麼快，因為我們必須獲得庫存。我們必須做好準備，我們必須部署這些設備。所以很明顯，我們剛買的時候訂了很多套。我們現在已經下了第二輪套裝訂單。這些將在 23 年下半年開始出現。因此，隨著我們繼續在 Pega 方面推出越來越多的設備，我們將在未來 5 年的整體業務增長之前實現增長。

Yes. Last point I'd make on that, Ryan, is that on the Pega side, the only product that had been aggressively commercialized of their 7 products was the FD rod. And so we're already seeing an uptick in the use of FD rod in indications that are more related to trauma. And so we see a build of -- and share gains of the FD rod, but also you have 6 additional products that, for the most part, are new to our customers.

是的。 Ryan，我要說的最後一點是，在 Pega 方面，他們的 7 種產品中唯一被積極商業化的產品是 FD 魚竿。因此，我們已經看到在與創傷更相關的適應症中使用 FD 棒的情況有所增加。因此，我們看到了 FD 桿的構建和共享收益，但您還有 6 種額外的產品，這些產品在大多數情況下對我們的客戶來說是新的。

They may have a few KOLs that have used them that help maybe design those products, but for the most part, they're entirely new to our customers, both in the U.S. and around the world. And so we are thinking about how we pace out new product development and new product launch, kind of feel like we've got in the bag here about 6 different products that we'll be launching over the course of the next 12 months or so that I think our customers are really going to like.

他們可能有一些 KOL 使用過它們來幫助設計這些產品，但在大多數情況下，它們對我們的客戶來說是全新的，無論是在美國還是在世界各地。因此，我們正在考慮如何加快新產品開發和新產品發布的步伐，感覺我們已經掌握了 6 種不同的產品，我們將在未來 12 個月左右推出這些產品我認為我們的客戶真的會喜歡。

And so far, we've gotten positive feedback on. They just haven't had access to them or a sales force to really credibly deliver those products and educate on those products. So pretty bullish about what that could look like as we start to roll out products beyond the FD rod.

到目前為止，我們已經得到了積極的反饋。他們只是無法接觸到他們或銷售人員來真正可靠地交付這些產品並就這些產品進行教育。當我們開始推出 FD 棒以外的產品時，我們非常看好它的樣子。

Our next question comes from Matthew O'Brien with Piper Sandler.

我們的下一個問題來自 Matthew O'Brien 和 Piper Sandler。

Dave, on RSV, it sounds like things are tapering off. And I know the guide for the year is somewhat conservative, which is great. But what -- you trained a lot of folks last year, but what did it do to you as far as the momentum goes, especially in Trauma and Deformity as far as taking market share? Because I'm sure you had to slow down as far as your interactions with clinicians, et cetera. So what kind of headwind are you facing this year to getting that momentum back going in T&D as we think about '23?

戴夫，在 RSV 上，聽起來事情正在逐漸減少。我知道今年的指南有些保守，這很好。但是，你去年培訓了很多人，但就勢頭而言，這對你有什麼影響，特別是在創傷和畸形領域，就佔據市場份額而言？因為我敢肯定，就您與臨床醫生等的互動而言，您必須放慢速度。那麼，在我們考慮 23 年時，您今年面臨什麼樣的逆風才能讓 T&D 恢復這種勢頭？

Yes. I don't know that a blunted momentum. I think we were definitely having a lot of conversations with customers. And you've seen from the deployment in Q4 that we were pretty aggressive, obviously, for year and for Q4 and getting new sets to the field.

是的。我不知道那是一種遲鈍的勢頭。我認為我們肯定與客戶進行了很多對話。你已經從第四季度的部署中看到，我們在今年和第四季度都非常積極，顯然，我們正在為該領域提供新的設備。

So it's possible, Matt, that some of those sets that deploy and then ultimately take a little bit of time to get inside the children's hospitals and get on consignment, it's possible that some of that momentum would have slowed down a little bit just from a pure administrative standpoint.

所以有可能，馬特，其中一些設備部署後最終需要一點時間才能進入兒童醫院並開始寄售，這種勢頭中的一些可能會因為純粹的行政立場。

We've seen that right on the 7D side where surgeons get very excited, but then just some of the administrative challenges of moving this through the process have been slowed just by some of the disruption in the marketplace. But we just came out of our sales meeting in Miami. I don't know that I've seen our U.S. sales force more excited or motivated about what we've got in front of us in the future.

我們已經在外科醫生非常興奮的 7D 方面看到了這一點，但是僅僅通過市場的一些中斷就減緩了通過該過程移動這一過程的一些管理挑戰。但我們剛剛結束在邁阿密舉行的銷售會議。我不知道我是否見過我們的美國銷售團隊對未來擺在我們面前的東西更加興奮或更有動力。

And I think when we look at key account conversions, when we look at places where we are starting to win either not normally single vendor contracts, but let's say, 2 vendor contracts, that trended pretty positively in the back half of this year. And so I just don't think what we've seen so far is kind of the harvest of all of the leg work we've done with deployed inventory, new product launch, new products, getting in new customers using more products. And hopefully, if the market kind of stabilizes here we'll start to reap some of the benefits of the hard work that we put in here throughout 2022 and into 2023. Does that make sense, Matt?

而且我認為，當我們查看關鍵客戶轉換時，當我們查看我們開始贏得通常不是單一供應商合同的地方時，而是說，2 個供應商合同，在今年下半年趨勢非常積極。所以我認為到目前為止我們所看到的並不是我們在部署庫存、新產品發布、新產品、使用更多產品吸引新客戶方面所做的所有腿部工作的收穫。希望，如果這裡的市場穩定下來，我們將開始收穫我們在整個 2022 年和 2023 年所做的辛勤工作帶來的一些好處。馬特，這有意義嗎？

Totally. I really appreciate that. And then on the ApiFix side, Dave, I think it's important to address for investors. I think you've said a doubling of revenues that you're expecting this year from that product. I know a lot of people have been very bullish about it. I certainly am.

完全。我真的很感激。然後在 ApiFix 方面，戴夫，我認為為投資者解決問題很重要。我想你已經說過你預計今年該產品的收入會翻一番。我知道很多人都非常看好它。我當然是。

I want to make sure that the expectation for the company on the opportunity for ApiFix hasn't changed anyway? Or when we should think about maybe a little bit more of an inflection in that product? I know doubling sales is not easy, but a bigger inflection from a contribution perspective, when we should think about that?

我想確保公司對 ApiFix 機會的期望無論如何都沒有改變？或者我們什麼時候應該考慮該產品的更多變化？我知道銷售額翻倍並不容易，但從貢獻的角度來看，這是一個更大的變化，我們應該什麼時候考慮？

Yes. Good question. So we -- obviously, we're pleased with the doubling of this product line in the U.S. And I think as we -- again, I know we've said this a number of times, but as our surgeons get more and more comfortable with the data, that's when we expect more rapid adoption.

是的。好問題。所以我們 - 顯然，我們對美國的這條產品線翻了一番感到高興而且我認為我們 - 再一次，我知道我們已經說過很多次了，但是隨著我們的外科醫生變得越來越舒服有了數據，那是我們期望更快採用的時候。

And what we are seeing right now is more willingness from a commercial account standpoint to start with ApiFix, do a few cases. And I think there is a bit of a wait-and-see approach that most of our customers are having. And you can understand that given some of the challenges with other new technologies that have entered the pediatric space on the spine side that have had -- kind of had a start-stop phenomenon in some of those product lines.

我們現在看到的是，從商業賬戶的角度來看，更願意從 ApiFix 開始，做一些案例。我認為我們的大多數客戶都持觀望態度。你可以理解，鑑於其他新技術已經進入脊柱側兒科領域的一些挑戰，其中一些產品線出現了啟停現象。

And so I think our customers are being cautious. Obviously, doubling is really -- we're really pleased with that. But I think when we start to get 2-year data and then ultimately 3-year data, that's when we start to see inflection point. And just so you know, we should have about 90 patients at 2 years by the end of 2023. We have 30 patients right now at the end of -- well, 30 patients by the end of Q1, and we expect to get on the podium at POSNA for the first time with 2-year data with our 30 patients. So still small numbers, but I think we would look at a bigger inflection point maybe out in 2024-2025 when the data is a little richer, data is a little more aged.

所以我認為我們的客戶很謹慎。顯然，翻倍確實是——我們對此非常滿意。但我認為，當我們開始獲得 2 年數據，然後最終獲得 3 年數據時，我們就會開始看到拐點。就像你知道的那樣，到 2023 年底，我們應該在 2 年內有大約 90 名患者。我們現在有 30 名患者 - 好吧，到第一季度末有 30 名患者，我們希望能夠首次在 POSNA 的講台上展示我們 30 名患者的 2 年數據。所以仍然是小數字，但我認為我們會看到一個更大的拐點可能會在 2024-2025 年出現，那時數據會更豐富一些，數據會更老一些。

Our next question comes from Mike Matson with Needham & Company.

我們的下一個問題來自 Needham & Company 的 Mike Matson。

So I wanted to ask one just about kind of the market opportunity. So I'm wondering if you look at all the pediatric surgeons out there, I guess I'm focused more on the U.S. here, but what -- I don't know if you're going to give me numbers on this, but maybe we could just discuss it.

所以我想問一個關於市場機會的問題。所以我想知道你是否看過那裡所有的兒科外科醫生，我想我在這裡更關注美國，但是 - 我不知道你是否會給我這方面的數字，但是也許我們可以討論一下。

What portion of those pediatric surgeons are now your -- customer of OrthoPediatrics in some way. So how much of your growth is coming from just actually taking a surgeon that's not using any of your products and getting them to use some of your products versus having a bunch and the majority already using your products and just trying to get them to deeper penetration in those existing accounts?

這些兒科外科醫生中有哪一部分現在是您的——在某種程度上是 OrthoPediatrics 的客戶。因此，您的增長有多少來自於實際聘請一位不使用您的任何產品的外科醫生並讓他們使用您的一些產品，而不是讓一群人和大多數人已經在使用您的產品並試圖讓他們更深入地滲透在那些現有帳戶中？

Yes. Good question, Mike. So we have -- I think every major children's hospital in the United States is a customer of ours. And then there are some additional places that aren't freestanding children but have pediatric orthopedic surgeon more in a community setting. So about 1,400-or-so surgeons. I can't substantiate this exactly, but I would argue that there's very, very few of those products -- surgeons that don't have some type of association with one of our products, where they're using at least 1 of our 46 implant system.

是的。好問題，邁克。所以我們有——我認為美國每一家主要的兒童醫院都是我們的客戶。還有一些地方不是獨立兒童，而是在社區環境中有更多的兒科整形外科醫生。所以大約有 1,400 名左右的外科醫生。我無法準確證實這一點，但我認為這些產品中非常非常少——外科醫生與我們的一種產品沒有某種關聯，他們至少使用我們 46 種產品中的一種植入系統。

I think the challenge for us, and I think it's been the secret to our growth here in this consistent kind of drumbeat of 20% has been that we are deep -- getting deeper penetration with existing people who have a solid relationship with OrthoPediatrics.

我認為我們面臨的挑戰，我認為這是我們在這種持續的 20% 的鼓聲中增長的秘訣在於我們很深 - 與與骨科有牢固關係的現有人員進行更深入的滲透。

And so moving a customer who may use 1 or 2 of our systems to 4 or 5 of our systems or 10 or 12 of our systems or somebody who's using 25 of them to 35 of our systems, so that's generally the strategy here. And I think that applies also outside of the United States, particularly in developed markets in Europe, where customers are generally accessing or using at least one of our products. We have that relationship, and we're just expanding that relationship.

因此，將可能使用我們的 1 或 2 個系統的客戶轉移到我們的 4 或 5 個系統或 10 或 12 個系統，或者將使用其中 25 個系統的客戶轉移到我們的 35 個系統，所以這通常是這裡的策略。我認為這也適用於美國以外的地區，尤其是在歐洲的發達市場，那裡的客戶通常至少訪問或使用我們的一種產品。我們有這種關係，我們只是在擴大這種關係。

But again, Mike, we have still fairly low share total. I mean we think we're in the very early innings of this. T&D and Scoliosis probably in the mid-teens kind of share. And so we got a long way to go to be able to get more and more of these customers using more of our products, and we think we've got a long growth runway there for the next several years.

但是，邁克，我們的總份額仍然很低。我的意思是我們認為我們還處於早期階段。 T&D 和脊柱側凸可能在十幾歲左右。因此，要讓越來越多的客戶使用我們的產品，我們還有很長的路要走，我們認為在接下來的幾年裡我們有很長的增長跑道。

Okay. That's helpful. And then just you mentioned your international markets, emerging markets. So I wanted to ask, can you just remind us what you're doing in some of the emerging markets like China, Brazil, et cetera? I mean are you in any of those markets right now? Is there an opportunity, if you're not to enter them?

好的。這很有幫助。然後你剛才提到了你的國際市場，新興市場。所以我想問，你能不能提醒我們你在中國、巴西等一些新興市場做了什麼？我的意思是你現在在這些市場中的任何一個嗎？有沒有機會，如果你不進入他們？

Yes. We have a strong business in Brazil, certainly was -- as almost all of our markets internationally but maybe more so than others. Brazil impacted by COVID and a really nice recovery opportunity for us there.

是的。我們在巴西擁有強大的業務，當然是 - 幾乎與我們所有的國際市場一樣，但可能比其他市場更多。巴西受到 COVID 的影響，對我們來說是一個非常好的複蘇機會。

So we do well there. We have a lot more products that we can get in and then get approved in Brazil, and so that's a growth opportunity. But at this stage, frankly, with the volume of growth opportunities that we have right in front of us right now, it's been difficult for us to contemplate an aggressive push into markets like China and India.

所以我們在那裡做得很好。我們有更多的產品可以進入，然後在巴西獲得批准，因此這是一個增長機會。但在現階段，坦率地說，鑑於我們眼前的大量增長機會，我們很難考慮積極進軍中國和印度等市場。

There is opportunities there. We do have a lot of inbound requests, both from surgeons as well as from distributors who would like to carry products. But I think we've got our hands full with enough things that we know a lot about that are right in front of us that is a matter of execution for us to continue our growth. But in the out years, those markets will really remain potential long-term sources of growth for us.

那裡有機會。我們確實有很多入境請求，既有來自外科醫生的，也有來自想要運送產品的經銷商的。但我認為我們已經掌握了足夠多的事情，我們知道很多事情就在我們面前，這是我們繼續發展的執行問題。但在未來幾年，這些市場仍將是我們潛在的長期增長來源。

Yes. With that said, I think MDO is starting setup into India. And I do think that that's an easier entry point in some of these countries. So just starting to dabble in India on the specialty bracing side of things, but we have nothing in China right now.

是的。話雖如此，我認為 MDO 正在開始進入印度。我確實認為在其中一些國家/地區，這是一個更容易的切入點。所以剛開始涉足印度的專業支撐方面，但我們現在在中國什麼都沒有。

Our next question comes from Dave Turkaly with JMP Securities.

我們的下一個問題來自 JMP Securities 的 Dave Turkaly。

I was wondering, Fred, if you might quantify the dollar amount of the gross margin impact? Because I think you said that you would still expect '23 to wind up where '22 is, which I think is like down around 74%. So I want to make sure that that's true. And then if you could give that dollar amount, that would be helpful.

我想知道，弗雷德，你是否可以量化毛利率影響的美元金額？因為我認為你說過你仍然希望 23 年結束於 22 年的水平，我認為 22 年下降了 74% 左右。所以我想確保這是真的。然後，如果你能給出那筆金額，那將會很有幫助。

So I think the comment was in the fourth quarter, gross margin was 68.5%, which was lower than last year, and that reduction between the 2 years in the fourth quarter versus the 72.9% we saw in the fourth quarter of 2021. So that reduced gross margin rate is -- probably half of that reduction is from the higher set sales at 0 cost and the other half of it is from the FIREFLY.

所以我認為評論是在第四季度，毛利率為 68.5%，低於去年，第四季度兩年間的下降與我們在 2021 年第四季度看到的 72.9% 相比。所以降低的毛利率是 - 可能一半的減少來自零成本的更高套裝銷售，另一半來自 FIREFLY。

Okay. And the fair value adjustment, the $26 million, what was that for?

好的。公允價值調整，即 2600 萬美元，是為了什麼？

That was in the third quarter related to the ApiFix. So we updated the model and our third-party valuation firm sent us a new accretion model, which changed the accretion on ApiFix. As you may recall, we have a system sales payment out, an earn-out payment based on sales in year 4, which is April of 2024. So that adjustment was a favorable adjustment in the third quarter of 2022.

那是在與 ApiFix 相關的第三季度。所以我們更新了模型，我們的第三方估值公司給我們發送了一個新的增生模型，它改變了 ApiFix 上的增生。您可能還記得，我們有一個系統銷售付款，一個基於第 4 年銷售額的盈利付款，即 2024 年 4 月。因此，該調整是 2022 年第三季度的有利調整。

Okay. And then lastly, the $25 million in sets, I think in the past, you'd said some of the new acquisitions, maybe before MD Ortho, maybe ApiFix and Orthex had sort of a different investment needed. So the $25 million that you're forecasting this year, I guess, any comments or color on how maybe the newer products are a component of that or what's core versus what's new or how maybe MDO and Pega compared to the other acquisitions you've done from a set standpoint?

好的。最後，2500 萬美元的套裝，我想在過去，你說過一些新的收購，也許在 MD Ortho 之前，也許 ApiFix 和 Orthex 需要某種不同的投資。所以你今年預測的 2500 萬美元，我猜，關於新產品如何可能是其中的一個組成部分或什麼是核心與新產品或 MDO 和 Pega 與你的其他收購相比如何的任何評論或顏色從既定的角度來做？

Absolutely. The benefit of MDO is that (technical difficulty) so that specialty bracing business can grow very aggressively without us deploy more and more capital as we are on some of the legacy businesses. The Pega side, I would say, is more similar, although they have a high return on their sets being deployed. It's similar to the legacy business.

絕對地。 MDO 的好處是（技術難度），這樣專業支撐業務就可以非常積極地增長，而無需像我們在一些傳統業務上那樣部署越來越多的資本。 Pega 方面，我想說，更相似，儘管他們在部署的設備上有很高的回報。它類似於傳統業務。

So we are deploying capital on the Pega side of the business in '23. I would expect to do that for years to come. But in that $25 million is definitely some efficiencies from no capital for MDO growth, ApiFix growing at tremendously efficient capital and as well, you mentioned Orthex, which is probably our second highest product from an efficiency standpoint. So there is the efficiencies built into that $25 million number for 2023, and we would expect that to probably increase, particularly as ApiFix continues to become a bigger part of the business.

因此，我們在 23 年將資金部署在業務的 Pega 方面。我希望在未來幾年內這樣做。但是，在這 2500 萬美元中，MDO 增長的無資本絕對是一些效率，ApiFix 以極其高效的資本增長，而且，你提到了 Orthex，從效率的角度來看，它可能是我們第二高的產品。因此，2023 年這個 2500 萬美元的數字中包含了效率，我們預計效率可能會增加，特別是隨著 ApiFix 繼續成為業務的重要組成部分。

Our next question comes from Sam Brodovsky with Truist.

我們的下一個問題來自 Truist 的 Sam Brodovsky。

Just 2 quick ones to start on MDO and Pega. In terms of the cadence of growth, I mean, should we expect those businesses to follow the broader company seasonality in '23? Or can growth start to pick up a little more and maybe look a little off from that?

MDO 和 Pega 只需 2 個快速入門。就增長節奏而言，我的意思是，我們是否應該期望這些企業在 23 年遵循更廣泛的公司季節性？還是增長會開始回升一點，也許看起來有點偏離？

And then between the 2 businesses, should we expect fairly similar growth rates for both or maybe MDO grows a little faster given it's got about 1/4 head start on Pega?

然後在這兩項業務之間，我們是否應該期望兩者的增長率相當相似，或者 MDO 的增長速度可能會更快一些，因為它在 Pega 上有大約 1/4 的領先優勢？

Yes. I would say that the MDO business, the seasonality of the MDO business is a little different than our traditional implant business. I believe there is some seasonality there, but it's not a lot. So that should, hopefully, as that business grow start to flatten our seasonality a bit. Certainly, it's not big enough at this stage to have that big of an impact overall. But over the course of the next several years, as it grows, it will flatten that seasonality some.

是的。我會說 MDO 業務，MDO 業務的季節性與我們傳統的植入業務略有不同。我相信那裡有一些季節性，但不是很多。因此，希望隨著業務的增長開始稍微平息我們的季節性。當然，在現階段它還不足以產生如此大的整體影響。但在接下來的幾年裡，隨著它的發展，它會在一定程度上消除這種季節性。

Pega is very similar in terms of its seasonality, although it may be a little bit flatter because it's a trauma and lung deformity product, it's not as impacted, obviously, what we see in the big summer scoliosis selling season. I think we expect both of those businesses to grow at similar rates, again, north of 20%, but kind of similar rate.

Pega 在季節性方面非常相似，雖然它可能有點扁平，因為它是一種創傷和肺畸形產品，但它顯然沒有我們在夏季脊柱側凸銷售旺季看到的那樣受到影響。我認為我們預計這兩項業務將以相似的速度增長，再次超過 20%，但速度有點相似。

And some of this because there has not been any growth in these businesses for the last [days] will be predicated on, as Fred said, when some of this Pega medical inventory hits the shelf as well as these businesses haven't really been prolific in terms of their new product launches. And we do expect, for the first time, both of these businesses to launch new products in 2023 expected those moments to potentially drive increasing revenue as well. So I hope that answers your question. I think both growing at similar types of rates throughout the year, and some of that is indexed by when we get new products and inventory to the field.

正如 Fred 所說，其中一些原因是這些業務在過去 [幾天] 沒有任何增長，這取決於當一些 Pega 醫療庫存上架時以及這些業務並沒有真正多產在他們的新產品發布方面。我們確實首次預計，這兩家企業都將在 2023 年推出新產品，預計這些時刻也可能推動收入增長。所以我希望這能回答你的問題。我認為兩者在全年都以類似的速度增長，其中一些是根據我們何時向該領域獲得新產品和庫存進行索引的。

Got it. That's helpful. And on 7D, you had mentioned that contributed well in 4Q. Can you just maybe quantify that a little bit at all? And how much that plays into expectations for the Scoliosis business in '23?

知道了。這很有幫助。在 7D 上，您曾提到在 4Q 中做出了很好的貢獻。你能稍微量化一下嗎？這對 23 年脊柱側彎業務的預期有多大影響？

Yes. So we've had a couple of additional deployments over the course of Q3 and early Q4. We are -- we look at those deployments and ultimately the contracted revenue that comes with those deployments as a source of growth for our Scoliosis franchise. Scoliosis franchise historically grows faster, at least organically, it grows faster than the Trauma and Deformity business.

是的。因此，我們在第三季度和第四季度初進行了一些額外的部署。我們是——我們將這些部署以及這些部署帶來的最終合同收入視為我們脊柱側彎特許經營權的增長來源。脊柱側彎特許經營歷史上增長更快，至少在有機方面，它比創傷和畸形業務增長更快。

We are going to -- we expect that again. Obviously, with more and more deployments of 7D that are leading to more market share gains with our RESPONSE Fusion System as well as the interaction that we see between the technologies of 7D, ApiFix kind of making the entire Scoliosis portfolio more credible to top KOL.

我們將 - 我們再次期待。顯然，隨著越來越多的 7D 部署導致我們的 RESPONSE Fusion System 獲得更多的市場份額，以及我們看到的 7D 技術之間的相互作用，ApiFix 使整個脊柱側彎產品組合對頂級 KOL 來說更加可信。

So 7D has performed really well. Surgeons, one of the -- we've seen such positive response from surgeons, and we have several of these units right now that we think are at the 3, 2, 1 yard line in terms of being able to get them across the goal line and start to enjoy revenue increases with response as a result of their placement.

所以7D的表現非常好。外科醫生，其中之一 - 我們已經看到外科醫生的積極反應，我們現在有幾個這樣的單位，我們認為在能夠讓他們越過球門方面處於 3、2、1 碼線線並開始享受由於安置而引起的收入增長。

There are no further questions at this time. I'd like to turn the call back over to David Bailey for closing remarks.

目前沒有其他問題。我想將電話轉回給 David Bailey 以作結束語。

Great. Thank you all for joining us on the call. Sorry for the technical difficulties here. Hopefully, it wasn't too disruptive and you could hear the answers to our questions. But we appreciate your ongoing interest in OrthoPediatrics and look forward to reporting out on a successful 2023. Thank you.

偉大的。感謝大家加入我們的電話會議。很抱歉這裡的技術困難。希望它不會造成太大干擾，您可以聽到我們問題的答案。但我們感謝您對 OrthoPediatrics 的持續關注，並期待在 2023 年取得成功。謝謝。

Thank you. This does conclude the program. You may now disconnect. Everyone, have a great day.

謝謝。這確實結束了程序。您現在可以斷開連接。大家，祝你有美好的一天。