Treace Medical Concepts Inc (TMCI) 2022 Q4 法說會逐字稿

Hello, and welcome to Treace Medical Concepts' Fourth Quarter 2022 Earnings Conference Call. (Operator Instructions)

您好，歡迎來到 Treace Medical Concepts 的 2022 年第四季度收益電話會議。 （操作員說明）

I would now like to hand the conference over to Vivian Cervantes of Investor Relations. You may begin.

我現在想把會議交給投資者關係部的 Vivian Cervantes。你可以開始了。

Good afternoon, everyone, and welcome to our fourth quarter 2022 earnings conference call. Participating from the company today will be John Treace, Chief Executive Officer; and Mark Hair, Chief Financial Officer. During the call, we will offer commentary on our commercial activity and review of fourth quarter financial results released after the close of market today, after which we will host a question-and-answer session. The press release can be found in the Investor Relations section of our website at investors.treace.com. This call is being recorded and will be archived in the Investors section of our website.

大家下午好，歡迎來到我們的 2022 年第四季度收益電話會議。今天參加公司會議的有首席執行官 John Treace；和 Mark Hair，首席財務官。在電話會議期間，我們將對我們的商業活動發表評論，並對今天收盤後發布的第四季度財務業績進行回顧，之後我們將舉行問答環節。新聞稿可在我們網站 investors.treace.com 的投資者關係部分找到。此通話正在錄音中，並將存檔在我們網站的“投資者”部分。

Before we begin, we would like to remind you that it is our intent that all forward-looking statements made during today's call will be protected under the Private Securities Litigation Reform Act of 1995, and these statements that relate to expectations or predictions of future events and market trends, as well as our estimated results or performance are forward-looking statements. All forward-looking statements are based upon our current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. All forward-looking statements are based upon current available information and Treace assumes no obligation to update these statements. Accordingly, you should not place undue reliance on these statements. Please refer to our SEC filings, including our Form 10-K for the full year 2022 to be filed on March 8, 2023, for a detailed presentation of risks.

在我們開始之前，我們想提醒您，我們打算在今天的電話會議中做出的所有前瞻性陳述將受到 1995 年私人證券訴訟改革法案的保護，以及這些與未來事件的預期或預測相關的陳述和市場趨勢，以及我們的估計結果或業績都是前瞻性陳述。所有前瞻性陳述均基於我們當前的估計和各種假設。這些陳述涉及重大風險和不確定性，可能導致實際結果或事件與這些前瞻性陳述預期或暗示的結果或事件存在重大差異。所有前瞻性陳述均基於當前可用信息，Treace 不承擔更新這些陳述的義務。因此，您不應過分依賴這些陳述。請參閱我們向美國證券交易委員會提交的文件，包括我們將於 2023 年 3 月 8 日提交的 2022 年全年的 10-K 表格，以詳細介紹風險。

With that, I'll now turn the call over to John.

有了這個，我現在將電話轉給約翰。

Thank you, Vivian. Good afternoon, everyone, and thank you for joining us on our fourth quarter 2022 earnings conference call. 2022 was another great year of growth and execution at Treace. At the beginning of the year, we strategically increased investments into our proven business strategies, namely, growing our direct bunion focused sales channel, increasing investments into our patient awareness DTC initiatives, and making targeted R&D investments in Lapiplasty innovations, as well as in our expanding suite of complementary products.

謝謝你，薇薇安。大家下午好，感謝您加入我們的 2022 年第四季度收益電話會議。 2022 年是 Treace 增長和執行的又一個偉大年份。今年年初，我們戰略性地增加了對我們行之有效的業務戰略的投資，即發展我們直接以拇囊炎為重點的銷售渠道，增加對我們患者意識 DTC 計劃的投資，以及對 Lapiplasty 創新以及我們的產品進行有針對性的研發投資擴展配套產品。

These investments resulted in strong revenue growth of 50% over 2021 and realized continued gains in our key operating metrics. Our operations continue to scale through 2022, ending our seasonally strong fourth quarter with positive adjusted EBITDA. We are proud of the progress we made and believe we built a strong foundation that will continue to fuel our growth over the coming years.

這些投資使收入在 2021 年實現了 50% 的強勁增長，並實現了我們關鍵運營指標的持續增長。到 2022 年，我們的業務將繼續擴大，以調整後的 EBITDA 為正，結束我們季節性強勁的第四季度。我們為我們取得的進步感到自豪，並相信我們建立了堅實的基礎，將在未來幾年繼續推動我們的增長。

Before I go into details about the quarter and year, let's start out with our market summary on where we stand today. Our disruptive Lapiplasty solution was specifically developed to correct the root cause of the bunion and address a large and underserved market. We've identified an addressable $5 billion-plus U.S. market of 1.1 million annual surgical candidates of which only 450,000 undergo bunion surgery each year, which we believe is mainly due to limitations associated with current standards of care.

在我詳細介紹季度和年度之前，讓我們先從我們今天所處的市場總結開始。我們的顛覆性 Lapiplasty 解決方案專門開髮用於糾正拇囊炎的根本原因並解決服務不足的大型市場。我們已經確定了一個可尋址的超過 50 億美元的美國市場，每年有 110 萬手術候選人，其中每年只有 450,000 人接受拇囊炎手術，我們認為這主要是由於與當前護理標準相關的限制。

As of the fourth quarter of 2022, we have penetrated approximately 5.5% of the estimated 450,000 annual bunion surgical procedures in the U.S., up from 3.8% in the fourth quarter of 2021, and reflecting approximately 2.2% market penetration of the 1.1 million annual U.S. surgical candidates that constitute our $5 billion-plus total addressable market.

截至 2022 年第四季度，我們已經滲透了美國估計每年 450,000 例拇囊炎手術的約 5.5%，高於 2021 年第四季度的 3.8%，反映了美國每年 110 萬例的市場滲透率約為 2.2%。構成我們超過 50 億美元總目標市場的外科候選人。

Turning to our Q4 and full year results. Revenue in the fourth quarter was $49.8 million, representing 49% growth over the fourth quarter of 2021, and was slightly above the previously announced revenue range expectation of $49.1 million to $49.6 million. During the fourth quarter, we continued to benefit from our commercial strategies and investments with strong demand trends from surgeons and patients and growing sales force productivity.

轉向我們的第四季度和全年業績。第四季度收入為 4980 萬美元，較 2021 年第四季度增長 49%，略高於此前公佈的 4910 萬美元至 4960 萬美元的收入區間預期。在第四季度，我們繼續受益於我們的商業戰略和投資，外科醫生和患者的需求趨勢強勁，銷售人員生產力不斷提高。

For the full year 2022, revenue was $141.8 million, a 50% increase over 2021 and also slightly above the top end of our pre-announced revenue expectation of $141.2 million to $141.7 million. Notably, our revenue growth in the second half of 2022 was above the growth rate we experienced in the same period for 2021. Therefore, we are extremely pleased not only with our top line growth but also sustained positive trends in our key operating metrics during the fourth quarter, including our expanding direct bunion focused sales team, which accounted for 77% of our Q4 revenue mix coming in well ahead of our 70% target for the year.

2022 年全年收入為 1.418 億美元，比 2021 年增長 50%，也略高於我們預先宣布的 1.412 億美元至 1.417 億美元收入預期的上限。值得注意的是，我們在 2022 年下半年的收入增長高於我們 2021 年同期的增長率。因此，我們不僅對我們的收入增長感到非常滿意，而且我們的關鍵運營指標在 2022 年的持續積極趨勢中也非常高興第四季度，包括我們不斷擴大的以拇囊炎為重點的直接銷售團隊，該團隊占我們第四季度收入組合的 77%，遠遠超過了我們今年 70% 的目標。

Strong steady increases in the number of new surgeon users ending in Q4 with 2,387 active surgeons, which is an increase of 604 during the year, up 34% year-over-year. A year-over-year increase in trailing 12 months surgeon utilization with an average of 10.3 kits per active surgeon in Q4, up from 9.8 kits a year ago, and strong blended average selling prices of $5,907 per Lapiplasty kits sold in the quarter, representing 10% growth over the prior year due to steadily increasing contribution from our Adductoplasty Midfoot Correction System, as well as our more recently commercialized S4A Anatomic Plates, our SpeedRelease, and our TriTome tissue instruments.

截至第 4 季度末，新外科醫生用戶數量穩步增長，有 2,387 名活躍外科醫生，年內增加 604 名，同比增長 34%。過去 12 個月的外科醫生使用率同比增長，第四季度每位在職外科醫生平均使用 10.3 個工具包，高於一年前的 9.8 個工具包，並且本季度售出的每個 Lapiplasty 工具包的混合平均售價為 5,907 美元，代表由於我們的內收成形術中足矯正系統以及我們最近商業化的 S4A 解剖板、我們的 SpeedRelease 和我們的 TriTome 組織器械的貢獻穩步增加，因此比上一年增長 10%。

Our strategic investments and commercial focus have allowed us to successfully grow our business, giving us confidence, we have a well-defined, proven, and scalable commercial strategy. Therefore, as we turn to 2023, we are providing full year revenue guidance of $187 million to $193 million, which reflects an increase of 32% to 36% over 2022 revenue. We look forward to balancing aggressive execution on our proven strategic initiatives to maximize our growth and market penetration with modestly improving expense leverage. Given our market differentiation and large $5 billion-plus U.S. opportunity, we remain committed to our growth agenda.

我們的戰略投資和商業重點使我們能夠成功發展我們的業務，給我們信心，我們有一個定義明確、經過驗證和可擴展的商業戰略。因此，當我們轉向 2023 年時，我們將提供 1.87 億美元至 1.93 億美元的全年收入指導，這反映出比 2022 年收入增長 32% 至 36%。我們期待著在我們經過驗證的戰略計劃上積極執行，以最大限度地提高我們的增長和市場滲透率，同時適度提高費用槓桿。鑑於我們的市場差異化和超過 50 億美元的巨大美國機會，我們仍然致力於我們的增長議程。

Shifting now to our commercial and market development activities. As discussed, we made targeted investments in 2022 with the goal of increasing our market penetration by, expanding the footprint and coverage of our bunion focused direct sales channel, advancing our patient awareness DTC initiatives, and driving more targeted R&D investments into the market.

現在轉向我們的商業和市場開發活動。正如所討論的，我們在 2022 年進行了有針對性的投資，目標是通過擴大以拇囊炎為重點的直銷渠道的足跡和覆蓋範圍，提高我們的患者意識 DTC 計劃，並推動更有針對性的研發投資進入市場，從而提高我們的市場滲透率。

We have a highly specialized team at Treace, including a rapidly growing direct sales force, one that's 100% focused on bunion and related midfoot surgery and represents the only such organization we're aware of in the MedTech industry. We believe this has contributed meaningfully to our revenue and market penetration. In the fourth quarter, 77% of our revenue was generated by our direct sales force, up sequentially from 74% in the third quarter and up from 58% just a year ago.

我們在 Treace 擁有一支高度專業化的團隊，包括一支快速增長的直銷隊伍，該隊伍 100% 專注於拇囊炎和相關的中足手術，並且代表了我們在 MedTech 行業中唯一知道的此類組織。我們相信這對我們的收入和市場滲透率做出了有意義的貢獻。第四季度，我們 77% 的收入來自我們的直銷團隊，高於第三季度的 74% 和一年前的 58%。

We were happy to announce last quarter that we surpassed our previously communicated 70% year end target earlier than anticipated and we expect to grow to a higher mix of direct revenue over time. We ended the fourth quarter with 168 quota-carrying direct sales reps, an increase of 107% from the 81 direct reps that we had at the end of the year 2021.

我們很高興在上個季度宣布，我們比預期提前超過了之前傳達的 70% 的年底目標，並且我們預計隨著時間的推移，直接收入將增長到更高的組合。截至第四季度末，我們有 168 名配額直接銷售代表，比 2021 年底的 81 名直接銷售代表增加了 107%。

Given the strong interest from great candidates to join our employee sales team, we're also happy to announce that we exceeded our year end target of 150 quota-carrying sales reps set forth at the beginning of the year. We believe these new reps are joining our team because of our unique growth profile and culture, driven by disruptive technologies that are backed by strong clinical datasets and supported by our market-leading patient and surgeon education programs. Including associate sales reps, clinical specialists, and sales management, our employee fleet in the field, increased 85% to 267 sales employees in the fourth quarter compared to 144 employees at the end of last year.

鑑於優秀候選人對加入我們的員工銷售團隊的強烈興趣，我們也很高興地宣布，我們超過了年初設定的 150 名配額銷售代表的年終目標。我們相信，這些新代表之所以加入我們的團隊，是因為我們獨特的增長概況和文化，受到強大臨床數據集支持的顛覆性技術的推動，並得到我們市場領先的患者和外科醫生教育計劃的支持。包括助理銷售代表、臨床專家和銷售管理在內，我們在該領域的員工隊伍在第四季度增加了 85%，達到 267 名銷售員工，而去年年底為 144 名員工。

We continue to experience strong benefits from our expanded direct sales team. Our direct reps typically scale with significant revenue and cost leverage achieved within 24 months, primarily because they're exclusively focused on our products and fully utilize our suite of corporate resources and programs. In 2023, we plan to continue to invest in our direct sales channel to drive increased market penetration with a target of having over 200 quota-carrying direct reps by the end of the year 2023.

我們繼續從擴大的直銷團隊中受益匪淺。我們的直接代表通常會在 24 個月內實現顯著的收入和成本槓桿擴展，這主要是因為他們專注於我們的產品並充分利用我們的公司資源和計劃套件。到 2023 年，我們計劃繼續投資我們的直銷渠道，以推動市場滲透率的提高，目標是到 2023 年底擁有超過 200 名直接銷售代表。

Our patient awareness DTC initiatives are a key component of our commercial strategy. We remain focused on our patient awareness DTC initiatives that are designed to educate and steadily increase the number of potential patients visiting our website, become educated on the benefits of Lapiplasty, locate experienced Lapiplasty surgeons in their area, and ultimately for these patients to schedule a consultation.

我們的患者意識 DTC 計劃是我們商業戰略的關鍵組成部分。我們仍然專注於我們的患者意識 DTC 計劃，這些計劃旨在教育和穩步增加訪問我們網站的潛在患者數量，了解 Lapiplasty 的好處，在他們的地區找到經驗豐富的 Lapiplasty 外科醫生，並最終為這些患者安排一個諮詢。

Our investment in DTC is resulting in 100s of 1,000s of patients visiting our website every month and 10s of 1,000s of patients searching for a Lapiplasty surgeon in their area. Now with one out of four surgeons in the U.S. using Lapiplasty, we have a larger than expanding national surgeon base that can field inquiries from a higher volume of patients. Given this, we believe the time is right to step up our DTC investments in 2023, which we've initiated earlier this year than last.

我們對 DTC 的投資導致每月有 1,000 名患者中有數百名訪問我們的網站，並且有 1,000 名患者中有數十名在他們的地區尋找乳頭整形外科醫生。現在，美國有四分之一的外科醫生使用 Lapiplasty，我們擁有一個比不斷擴大的全國外科醫生基地更大的基地，可以接受更多患者的諮詢。鑑於此，我們認為是時候在 2023 年加強我們的 DTC 投資了，我們今年比去年更早啟動了這項投資。

Our surgeon education and training programs also continue to be well received. Interest and attendance by new surgeons at our training events was strong and oversubscribed very often in 2022. Likewise, our advanced training events both online and in-person, where our more tenured surgeons can acquire advanced skills and learn new approaches such as our Mini-Incision and Adductoplasty procedures, continued to show a strong surgeon demand.

我們的外科醫生教育和培訓計劃也繼續受到好評。 2022 年，新外科醫生對我們的培訓活動表現出濃厚的興趣和出席率，而且經常出現超額訂閱。同樣，我們的高級培訓活動包括在線和麵對面，我們的資深外科醫生可以在這些活動中獲得高級技能並學習新方法，例如我們的 Mini-切口和內收成形術手術繼續顯示出強勁的外科醫生需求。

Our education programs play a key role in the effective onboarding of new surgeon users and increasing the skills of our existing users broadening their patient indications. During 2022, we added a record 604 new surgeons compared to 508 in the same period last year, representing a 34% increase. We are encouraged to see this continued strong growth in our surgeon user base. As of the fourth quarter, our active surgeon base which includes surgeons who performed at least one case in the trailing 12 months has achieved approximately 25% penetration of the estimated 10,000 foot and ankle surgeons who perform bunion surgery in the U.S.

我們的教育計劃在新外科醫生用戶的有效入職和提高我們現有用戶的技能以擴大他們的患者適應症方面發揮著關鍵作用。 2022 年，我們新增了 604 名新外科醫生，而去年同期為 508 名，增幅為 34%。我們很高興看到我們的外科醫生用戶群持續強勁增長。截至第四季度，我們活躍的外科醫生基礎（包括在過去 12 個月內至少執行過一次手術的外科醫生）在美國進行拇囊炎手術的估計 10,000 名足踝外科醫生中實現了約 25% 的滲透率。

As our surgeon base continues to mature, we look forward to utilization gains with increased use of our Lapiplasty and Adductoplasty systems, as well as further adoption of our growing portfolio of complementary products, all supported by our expanding direct sales channel and patient awareness DTC initiatives. We were pleased to see the high level of interest and attendance of new surgeons that are training events in 2022. It is evident that we offer a great education platform for a growing network of Lapiplasty surgeons and we look forward to hosting additional surgeon training events in 2023 across the country and at our new state-of-the-art training facility here at our headquarters in Ponte Vedra.

隨著我們的外科醫生基礎不斷成熟，我們期待通過增加使用我們的 Lapiplasty 和 Adductoplasty 系統以及進一步採用我們不斷增長的補充產品組合來提高利用率，所有這些都得到我們不斷擴大的直銷渠道和患者意識 DTC 計劃的支持.我們很高興看到新外科醫生對 2022 年培訓活動的高度興趣和出席。很明顯，我們為不斷增長的隆鼻外科醫生網絡提供了一個很好的教育平台，我們期待在2023 年在全國各地以及我們位於 Ponte Vedra 總部的最先進的新培訓設施中。

Speaking now to our product development strategy. We have an R&D team committed to driving innovation to maintain our industry leadership with, programs for both in next-generation bunion correction systems, as well as the development of new complementary technologies addressing other bunion-related pathologies, and IP defense of our technology and innovations. At the end of Q4, we had 40 granted U.S. patents and over 46 U.S. patent applications pending.

現在談談我們的產品開發戰略。我們的研發團隊致力於推動創新以保持我們的行業領先地位，包括下一代拇囊炎矯正系統的計劃，以及開發解決其他拇囊炎相關病症的新補充技術，以及我們技術和知識產權的防禦。創新。截至第四季度末，我們擁有 40 項美國專利授權和超過 46 項美國專利申請待審。

2022 was a terrific year of innovation for us. Following full commercialization of our Adductoplasty System in Q2, in August, we announced the full commercial release of our Lapiplasty 3-n-1 Cut Guide, our Lapiplasty S4A Anatomic Plating Kit, and the SpeedRelease and TriTome tissue release instruments. While still early adoption of these products has progressed nicely, and we are encouraged by the favorable response received from the surgeon community for our growing portfolio of bunion-focused technologies.

2022 年對我們來說是創新的一年。在我們的 Adductoplasty System 在第二季度全面商業化之後，8 月，我們宣布了我們的 Lapiplasty 3-n-1 Cut Guide、我們的 Lapiplasty S4A Anatomic Plating Kit 以及 SpeedRelease 和 TriTome 組織釋放儀器的全面商業發布。雖然這些產品的早期採用進展順利，但外科醫生社區對我們不斷增長的以拇囊炎為重點的技術組合的積極回應令我們感到鼓舞。

In February, at the American College of foot and ankle surgeons, we highlighted two new exciting product innovations. Namely, our micro Lapiplasty System, this is an advanced instrumentation option designed to further reduce both the incision size and related tissue dissection with the Lapiplasty procedure. This evolution of our instrumentation allows the bunion correction and joint preparation steps of the patented Lapiplasty procedure to be performed through a 2 centimeter incision.

2 月，在美國足踝外科醫生學院，我們重點介紹了兩項激動人心的新產品創新。即，我們的微型 Lapiplasty 系統，這是一種先進的儀器選項，旨在通過 Lapiplasty 程序進一步減少切口尺寸和相關組織解剖。我們儀器的這種演變允許通過 2 厘米的切口執行獲得專利的 Lapiplasty 程序的拇囊炎矯正和關節準備步驟。

And our speed plate implant fixation platform. This is a new fixation technology platform designed for rapid insertion through a small 2 centimeter incisions, serving as both an enabling technology for the micro Lapiplasty procedure, but also with broader applicability to our standard and Mini-Incision Lapiplasty systems, as well as Adductoplasty Midfoot procedures.

還有我們的speed plate種植體固定平台。這是一種新的固定技術平台，旨在通過 2 厘米的小切口快速插入，既可作為顯微乳頭成形術手術的支持技術，也可更廣泛地適用於我們的標準和小切口乳頭成形術系統，以及內收成形術中足程序。

We continue to anticipate the commercial release of these technologies during the second half of 2023. We're excited about the potential benefits this micro Lapiplasty speed play combination could bring to patients. As with any procedure that involves smaller incisions and less tissue dissection, we believe this can translate to even faster patient recovery with less pain and swelling.We look forward to providing additional updates on our new product innovations, as we continue to develop our pipeline centered on our core technologies and IP aimed at improving surgeon user experience, patient outcomes, and supporting continued market penetration.

我們繼續期待這些技術在 2023 年下半年的商業發布。我們對這種微型 Lapiplasty speed play 組合可能給患者帶來的潛在好處感到興奮。與任何涉及更小切口和更少組織剝離的手術一樣，我們相信這可以轉化為更快的患者康復，更少的疼痛和腫脹。我們期待在我們繼續開發以管道為中心的過程中提供有關我們新產品創新的更多更新我們的核心技術和 IP 旨在改善外科醫生的用戶體驗、患者結果並支持持續的市場滲透。

Turning to Clinical Data. A key differentiating driver for our business is our commitment to clinical evidence, which we believe resonates with both surgeons and their patients. From what we can see in the marketplace, we believe we're the only industry participant with a growing body of clinical data demonstrating rapid return to weight bearing in a walking boot with low recurrence rates at 12 and 24 months, and interim data demonstrating positive patient-reported outcome scores following our bunion correction procedure.

轉向臨床數據。我們業務的一個關鍵差異化驅動因素是我們對臨床證據的承諾，我們相信這會引起外科醫生及其患者的共鳴。從我們在市場上看到的情況來看，我們相信我們是唯一擁有越來越多的臨床數據的行業參與者，這些數據表明在 12 個月和 24 個月時復發率低且可以快速恢復步行靴的負重，並且中期數據顯示積極我們的拇囊炎矯正程序後患者報告的結果評分。

During the fourth quarter, we announced the treatment of the first patient in our MTA3D Adductoplasty clinical study. As a reminder, the MTA3D study is a prospective multi-center clinical study that will evaluate outcomes of Adductoplasty combined with the Lapiplasty procedure for patients in need of bunion and midfoot deformity correction. We look forward to providing interim updates on our MTA3D study in the future.

在第四季度，我們宣布了 MTA3D 內收成形術臨床研究中第一位患者的治療。提醒一下，MTA3D 研究是一項前瞻性多中心臨床研究，將評估內收成形術結合 Lapiplasty 手術對需要拇囊炎和中足畸形矯正的患者的結果。我們期待在未來提供有關 MTA3D 研究的臨時更新。

At 2023, American College of foot and ankle surgeons Annual Scientific Conference in February, we announced an interim data analysis from our flagship aligned 3D prospective Lapiplasty study on 128 patients with at least 24 month follow-up, which demonstrated early return to weight bearing in a walking boot at an average of 8.1 days, a low recurrence rate of 0.9%, 80.8% reduction in pain measured using the visual analog scale or VAS at 24 months, 92% and 90% improvement in walking, standing, and social interaction patient reported quality of life measures respectively using the Manchester-Oxford Foot Questionnaire or MOxFQ through 36 months, and notably 97.3% of patients reporting they were satisfied or very satisfied with the overall results of their Lapiplasty procedure at 36 months.

在 2023 年 2 月舉行的美國足踝外科醫生年度科學會議上，我們宣布了對 128 名至少隨訪 24 個月的患者進行的旗艦對齊 3D 前瞻性乳頭成形術研究的中期數據分析，這表明早期恢復負重步行靴平均 8.1 天，低復發率 0.9%，24 個月時使用視覺模擬量表或 VAS 測量的疼痛減少 80.8%，步行、站立和社交互動患者的改善分別為 92% 和 90%分別使用曼徹斯特-牛津足部問卷或 MOxFQ 報告了 36 個月的生活質量測量，特別是 97.3% 的患者報告他們在 36 個月時對他們的 Lapiplasty 手術的總體結果感到滿意或非常滿意。

We believe we're the only company to offer this level of clinical evidence on a commercial, surgical bunion product and it's rewarding to see the meaningful impact the Lapiplasty procedure is making on patients' lives, not only physically, but socially as well as demonstrated by the high 97% patient satisfaction rating at three years post Lapiplasty surgery.

我們相信我們是唯一一家提供這種商業、手術拇囊炎產品臨床證據的公司，看到 Lapiplasty 手術對患者的生活產生有意義的影響是值得的，不僅是身體上的，而且是社會上的以及所證明的Lapiplasty 手術後三年的患者滿意度高達 97%。

As a reminder, later this year, we expect to submit our primary endpoint ALIGN3D manuscript for publication in a peer-reviewed journal. This is a milestone culmination of activities that began five years ago with the first patient enrolled in 2018. Again, we believe the positive interim patient data coming from our differentiated ALIGN3D study resonates strongly with the surgeon and patient communities and is further reinforcing market adoption of Lapiplasty.

提醒一下，今年晚些時候，我們希望提交我們的主要終點 ALIGN3D 手稿，以便在同行評審的期刊上發表。這是五年前開始的活動的一個里程碑高潮，第一位患者於 2018 年入組。我們再次相信，來自我們差異化的 ALIGN3D 研究的積極中期患者數據引起了外科醫生和患者社區的強烈共鳴，並進一步加強了市場對乳頭整形術。

In closing, 2022 was another strong year performance and growth for our company. We are experiencing significant momentum in all aspects of our business and have developed a specialized and scalable business model that we believe will allow us to continue to advance our growth strategy. I'm proud of the great execution delivered by our team here in Ponte Vedra, Florida and throughout the country, and we remain highly and extremely excited about our future prospects, as we continue to execute on our strategic plans.

最後，2022 年是我們公司又一個強勁的業績和增長年。我們在業務的各個方面都經歷了巨大的發展勢頭，並開發了一種專業且可擴展的業務模式，我們相信這將使我們能夠繼續推進我們的增長戰略。我為我們在佛羅里達州蓬特韋德拉和全國各地的團隊所提供的出色執行感到自豪，並且隨著我們繼續執行我們的戰略計劃，我們對未來的前景仍然非常興奮。

With that, I'll now turn the call over to Mark to review our financial performance. Mark?

有了這個，我現在將電話轉給馬克來審查我們的財務業績。標記？

Thank you, John. Good afternoon, everyone. Revenue in the fourth quarter was $49.8 million up $16.3 million and 49% over the prior year. Growth was driven by increases in procedure volumes and an increase in blended average selling price due to adoption of our newer complementary technologies. Our seasonally strong fourth quarter revenue increased 51% sequentially over Q3.

謝謝你，約翰。大家下午好。第四季度收入為 4980 萬美元，比去年同期增長 1630 萬美元和 49%。由於採用我們更新的互補技術，手術量的增加和混合平均售價的增加推動了增長。我們季節性強勁的第四季度收入比第三季度環比增長 51%。

In the fourth quarter 2022, the number of active surgeons performing at least one case in the trailing 12 months increased 34% year-over-year to 2,387 surgeons, which translates to approximately 24% penetration of the estimated 10,000 surgeons in the U.S., who performed bunion procedures. Surgeon utilization increased to an average of 10.3 Lapiplasty kits purchased in the trailing 12 months, up from an average of 9.8 a year ago.

在 2022 年第四季度，在過去 12 個月中至少執行過一次手術的在職外科醫生人數同比增長 34% 至 2,387 名外科醫生，這相當於美國約 10,000 名外科醫生的滲透率約為 24%，他們進行了拇囊炎手術。在過去的 12 個月裡，外科醫生的使用率從一年前的平均 9.8 個增加到平均 10.3 個 Lapiplasty 套件。

We are pleased with this notable increase. As a reminder, we commercialized Lapiplasty seven years ago, and in the past two years alone, we've added 1,112 active surgeons, nearly half of our total active surgeon base. On the average, this growing number of active surgeons steadily increase utilization each year they use Lapiplasty due to positive patient outcomes and expanding indications in their practices.

我們對這一顯著增長感到高興。提醒一下，我們在七年前將 Lapiplasty 商業化，僅在過去兩年中，我們就增加了 1,112 名活躍的外科醫生，幾乎占我們活躍外科醫生總數的一半。平均而言，越來越多的活躍外科醫生每年使用 Lapiplasty 穩步提高利用率，這是由於積極的患者結果和擴大他們的實踐適應症。

We sold 8,426 Lapiplasty procedure kits in the fourth quarter, a 35% increase versus the prior year's fourth quarter, blended average selling price in the fourth quarter was $5,907, a 10% increase over the fourth quarter in 2021 driven by the adoption of our Lapiplasty and Adductoplasty Systems, as well as early impact from our newer technologies, our S4A Plating Kit, SpeedRelease and TriTome instruments.

我們在第四季度售出了 8,426 個 Lapiplasty 手術套件，比去年第四季度增長了 35%，第四季度的混合平均售價為 5,907 美元，比 2021 年第四季度增長了 10%，這得益於我們的 Lapiplasty 的採用和內收成形術系統，以及我們的新技術 S4A 電鍍套件、SpeedRelease 和 TriTome 儀器的早期影響。

We continue to see greater uptake of our other complementary forefoot products, as we add direct sales reps who tend to focus more on selling these complementary products within Lapiplasty cases, displacing other competitive bunion-related forefoot products. For the full year 2022, revenue was $141.8 million, a 50% increase over 2021, slightly above the top end of our pre-announced revenue expectation of $141.2 million to $141.7 million and above our prior 2022 revenue guidance range of $135 million to $138 million. We sold 24,656 Lapiplasty procedure kits for the full year 2022, a 41% increase versus the prior year, with a blended average selling price of $5,753, a 7% increase over the prior year.

隨著我們增加了直銷代表，他們更傾向於在 Lapiplasty 案例中銷售這些補充產品，取代其他與拇囊炎相關的競爭性前腳產品，我們繼續看到更多人採用我們的其他補充性前腳產品。 2022 年全年收入為 1.418 億美元，比 2021 年增長 50%，略高於我們預先宣布的 1.412 億美元至 1.417 億美元收入預期的上限，高於我們之前 2022 年 1.35 億美元至 1.38 億美元的收入指導範圍.我們在 2022 年全年售出了 24,656 個 Lapiplasty 手術套件，比上一年增長了 41%，混合平均售價為 5,753 美元，比上一年增長了 7%。

Gross margin was 80.4% in the fourth quarter of 2022 compared to 81.1% in the fourth quarter of 2021. The 70 basis point decrease was due in part to an increase in capitalized surgical instruments and related depreciation, necessary to support our expanding direct sales force, as well as increases in payroll and related costs. For the full year 2022, gross margin was 80.6% down from 81.1% in the year ago period primarily due to increases in capitalized surgical instruments and related depreciation, necessary to support our increased direct sales force, as well as increases in payroll and related costs.

2022 年第四季度的毛利率為 80.4%，而 2021 年第四季度為 81.1%。下降 70 個基點的部分原因是資本化手術器械和相關折舊的增加，這是支持我們不斷擴大的直銷隊伍所必需的，以及工資和相關成本的增加。 2022 年全年，毛利率為 80.6%，低於去年同期的 81.1%，這主要是由於資本化手術器械和相關折舊的增加，這是支持我們增加直銷隊伍所必需的，以及工資和相關成本的增加.

Total operating expenses were $43.5 million in the fourth quarter of 2022, which includes sales and marketing expenses of $29.4 million, research and development expenses of $3.7 million, and general and administrative expenses of $10.4 million. This compares to total operating expenses of $32.7 million in the fourth quarter of 2021, which included sales and marketing expenses of $22.3 million, research and development expenses of $3.4 million, and general and administrative expenses of $7.0 million.

2022 年第四季度的總運營費用為 4350 萬美元，其中包括銷售和營銷費用 2940 萬美元、研發費用 370 萬美元以及一般和管理費用 1040 萬美元。相比之下，2021 年第四季度的總運營費用為 3270 萬美元，其中包括銷售和營銷費用 2230 萬美元、研發費用 340 萬美元以及一般和管理費用 700 萬美元。

For the full year 2022, operating expenses were $149.2 million compared to $93.1 million in the prior year period. The increase in operating expenses reflects strategic investments in our expanding direct sales channel, investments in product innovation, increased capacity requirements as well as support for other commercial initiatives.

2022 年全年運營費用為 1.492 億美元，上年同期為 9310 萬美元。運營費用的增加反映了我們對擴大直銷渠道的戰略投資、對產品創新的投資、增加的產能需求以及對其他商業計劃的支持。

Fourth quarter net loss attributable to common stockholders was $4.4 million or $0.08 per share compared to a net loss of $6.6 million or $0.12 per share for the same period of 2021. Full year 2022 net loss attributable to common stockholders was $42.8 million or $0.77 per share compared to a net loss of $20.7 million or $0.43 per share in 2021. As noted, we ended the fourth quarter, our seasonally strongest with approximately $300,000 in adjusted EBITDA.

第四季度歸屬於普通股股東的淨虧損為 440 萬美元或每股 0.08 美元，而 2021 年同期為淨虧損 660 萬美元或每股 0.12 美元。2022 年全年歸屬於普通股股東的淨虧損為 4280 萬美元或每股 0.77 美元相比之下，2021 年的淨虧損為 2070 萬美元或每股 0.43 美元。如前所述，我們結束了第四季度，這是我們季節性最強的季度，調整後的 EBITDA 約為 300,000 美元。

Cash, cash equivalents, and marketable securities were $81.3 million as of December 31, 2022. On February 8, we completed a follow-on offering of 5,476,190 shares of common stock, which raised net proceeds of $107.5 million. This is the first time we raised capital since our IPO. And we believe this provides us with additional balance sheet strength and flexibility to continue aggressively executing on our strategic investments and growth initiatives.

截至 2022 年 12 月 31 日，現金、現金等價物和有價證券為 8130 萬美元。2 月 8 日，我們完成了 5,476,190 股普通股的後續發行，募集資金淨額為 1.075 億美元。這是我們自 IPO 以來首次籌集資金。我們相信這為我們提供了額外的資產負債表實力和靈活性，以繼續積極執行我們的戰略投資和增長計劃。

Before concluding, let me turn to our outlook for full year 2023. As John mentioned, we are providing full year 2023 revenue guidance of $187 million to $193 million, an increase of 32% to 36% over 2022 revenue. We remain encouraged by the underlying strength and momentum in our business with our strategic investments clearly delivering on growth. For the first quarter 2023, consistent with prior years, we expect a sequential revenue decrease from the fourth quarter due to normal seasonality coming off our usual strong year end performance, unlike Q1 2022, we do not expect incremental revenue from rescheduled fourth quarter procedures to benefit the first quarter of 2023.

在結束之前，讓我談談我們對 2023 年全年的展望。正如約翰所說，我們提供的 2023 年全年收入指引為 1.87 億美元至 1.93 億美元，比 2022 年收入增長 32% 至 36%。我們的戰略投資明顯帶來增長，我們的業務的潛在實力和勢頭仍然令我們感到鼓舞。對於 2023 年第一季度，與往年一樣，我們預計由於正常的季節性影響我們通常強勁的年底表現，因此第四季度的收入將連續下降，與 2022 年第一季度不同，我們預計重新安排的第四季度程序不會增加收入受益於 2023 年第一季度。

Turning to the middle of the P&L, we expect that our operations and expenses will continue to grow throughout 2023, as we increase our DTC investments and further expand our direct sales force while increasing leverage of our fixed costs and overhead expenses. Therefore, we expect to show modest improvements to adjusted EBITDA for the full year compared to 2022.

談到損益表的中期，我們預計我們的運營和費用將在整個 2023 年繼續增長，因為我們增加了 DTC 投資並進一步擴大了我們的直銷隊伍，同時增加了我們固定成本和管理費用的槓桿作用。因此，我們預計與 2022 年相比，全年調整後的 EBITDA 將略有改善。

Before turning the call over to the operator, I'd like to provide an update on our IP litigation. As you recall, we filed a lawsuit in March 2022 to enforce our IP. Although the terms are confidential, we reached a mutually agreeable resolution to settle the matter and are pleased with the outcome. Since inception, we've made important investments in our proprietary technologies and remain committed to protecting and growing our IP portfolio.

在將電話轉給接線員之前，我想提供有關我們知識產權訴訟的最新信息。您還記得，我們於 2022 年 3 月提起訴訟以強制執行我們的知識產權。儘管條款是保密的，但我們達成了雙方都同意的解決方案來解決此事，並對結果感到滿意。自成立以來，我們對我們的專有技術進行了重要投資，並繼續致力於保護和發展我們的知識產權組合。

With that, let me turn the call over to the operator to open the line for your questions.

有了這個，讓我把電話轉給接線員打開你的問題。

(Operator Instructions) Our first question comes from the line of Robbie Marcus with JPMorgan.

（操作員說明）我們的第一個問題來自摩根大通的 Robbie Marcus。

Start with congratulations again on a great quarter and good guide. Maybe we could talk about the trends that are informing the guide here. You're clearly adding a lot of reps, your revenue per procedure continued to grow up. Maybe speak to just how you think about the key drivers of the guide and any color you want to give us on how to think about the growth between the volumes versus the revenue per procedure?

再次祝賀一個偉大的季度和良好的指導。也許我們可以在這裡討論為指南提供信息的趨勢。您顯然增加了很多代表，每個程序的收入繼續增長。也許談談你如何看待指南的主要驅動因素，以及你想給我們的任何顏色，說明如何考慮每個程序的數量與收入之間的增長？

Great question. As John mentioned in the prepared remarks, we feel really encouraged by the strength and the momentum that we experienced in the back half of last year, we had really strong growth in both the third quarter and then again in the fourth quarter. And we believe a lot of this has been driven by the investments that we've been making throughout the full year last year, namely, it's really that growing and building direct sales channel, which we believe is already beginning to have some dividends that we've experienced and they've been able to push through some of the headwinds that we've had historically.

很好的問題。正如約翰在準備好的發言中提到的那樣，我們對去年下半年的實力和勢頭感到非常鼓舞，我們在第三季度和第四季度都有非常強勁的增長。我們相信這在很大程度上是由我們去年全年所做的投資推動的，也就是說，它確實是在發展和建立直銷渠道，我們相信這已經開始產生一些紅利，我們經歷過，他們已經能夠克服我們歷史上遇到的一些不利因素。

So, that's one of our primary drivers. The other thing that we're looking for, and then as we talked about, there'll be, excuse me, enhanced DTC and patient awareness efforts. We think that now that we've got a larger surgeon base that it's the right time to continue to invest in patient awareness. Now that we've got more surgeons and a sales force to support those additional inquiries.

所以，這是我們的主要驅動力之一。我們正在尋找的另一件事，然後在我們談論的時候，對不起，加強 DTC 和患者意識的努力。我們認為，既然我們擁有更大的外科醫生基礎，那麼現在是繼續投資提高患者意識的合適時機。現在我們有更多的外科醫生和銷售人員來支持這些額外的查詢。

And I feel like I know the answer here, but I'll still ask it anyways, given the growth you're seeing, the growth you're expecting. But it's a large -- a very large under-penetrated market for instrumented procedures. There are a lot of companies going after it. Maybe just give us a sense of what you're seeing out in the field. Are there any products that -- or companies you're losing accounts to? And what's the competitive message that your reps are putting out there to keep the growth engine going?

我覺得我知道這裡的答案，但無論如何我還是會問這個問題，考慮到你所看到的增長，以及你所期望的增長。但它是一個很大——一個非常大的儀器化程序滲透不足的市場。有很多公司在追趕它。也許只是讓我們了解一下您在該領域看到的情況。是否有任何產品 - 或者您正在失去客戶的公司？您的代表為保持增長引擎運轉而發出的競爭性信息是什麼？

Yes, Robbie. John. And yes, we kind of go back to the fundamentals here that our #1 competitor as we see it is the osteotomy procedure, it's 70% of the procedure base, and changing the mindsets of these surgeons to using Lapiplasty for the majority of their bunion cases versus the minority. That's where we really focus our efforts with our surgeon education programs, our direct sales force, and even the patient awareness side comes into play there. So, it's converting that procedure, not a company's product specifically that we're after, and that's what's been the underlying growth driver of this business for the past seven years and we're going to continue to focus.

是的，羅比。約翰。是的，我們有點回到這裡的基本原理，我們看到的第一競爭對手是截骨手術，它佔手術基礎的 70%，並且改變了這些外科醫生的心態，將 Lapiplasty 用於他們的大部分拇囊炎案例與少數。這就是我們真正專注於我們的外科醫生教育計劃、我們的直銷團隊，甚至患者意識方面發揮作用的地方。因此，它正在轉換該程序，而不是我們所追求的公司產品，這是過去七年來該業務的潛在增長動力，我們將繼續關注。

That said, there are a few companies on the market and more are entering with products, claiming to be like Lapiplasty. We haven't really seen a notable increase in the pressure or impact on us from those companies or products, as we know the market is really large over $5 billion and we're just way out ahead of everybody. We've always expected that these companies would try to come along and opportunistically get a piece of the market that we pioneered and developed here.

也就是說，市場上有幾家公司，更多的公司帶著產品進入，聲稱類似於 Lapiplasty。我們還沒有真正看到這些公司或產品給我們帶來的壓力或影響顯著增加，因為我們知道這個市場確實很大，超過 50 億美元，而我們只是領先於所有人。我們一直期望這些公司會嘗試加入並抓住機會從我們在這裡開拓和開發的市場中分得一杯羹。

And in some ways, these companies coming to market or sort of validating us, but keep in mind that these products are coming from companies that have multiple product lines, highly distracted salesforces, large bags of products to sell, of which this Lapiplasty like product is just yet another. And with over seven years of use and refinement, Lapiplasty is just so elegant and reproducible at the doctor-patient interface how it works and it's protected by a lot of patents.

在某些方面，這些公司進入市場或某種程度上驗證了我們，但請記住，這些產品來自擁有多個產品線、高度分心的銷售人員、大量產品要出售的公司，其中這種 Lapiplasty 產品只是另一個。經過七年多的使用和改進，Lapiplasty 在醫患界面上是如此優雅和可重現它是如何工作的，並且受到許多專利的保護。

We have a tremendous patent portfolio 40 issued patents, and then we're constantly iterating the technology, making it faster, easier for the surgeon and ways to make it a quicker recovery for the patients. So, nobody is out there with that level of commitment to iterating, improving, and modifying rapidly, but the other barriers we have are just the -- beyond that and the IP and the product innovation, our beachhead of clinical data, that keeps getting stronger and stronger. The bunion focused direct sales channel, our powerful surgeon and patient training programs. While these service really great offensive driver of our business, they offer the service a great defensive barrier as well.

我們擁有龐大的專利組合 40 項已發布專利，然後我們不斷迭代技術，使外科醫生更快、更容易，並為患者提供更快康復的方法。因此，沒有人對快速迭代、改進和修改做出如此程度的承諾，但我們面臨的其他障礙只是——除此之外，IP 和產品創新，我們的臨床數據灘頭陣地，不斷獲得越來越強。以拇囊炎為主的直銷渠道、我們強大的外科醫生和患者培訓計劃。雖然這些服務確實是我們業務的強大進攻驅動力，但它們也為該服務提供了強大的防禦屏障。

So kind of a long answer to your question, but I think for these multi-line distracted companies, it's really hard to compete with a rapidly innovating highly focused company with a first mover advantage, that's so far out ahead like we are.

對你的問題的回答有點長，但我認為對於這些多線分心的公司來說，真的很難與一家像我們這樣遙遙領先、具有先發優勢、快速創新、高度專注的公司競爭。

(Operator Instructions) Our next question comes from the line of Drew Ranieri with Morgan Stanley.

（操作員說明）我們的下一個問題來自 Drew Ranieri 與摩根士丹利的合作。

Congrats on the great quarter and guide. Maybe just another guidance question to start. But as you are thinking about the guidance build for this year. Can you maybe just help us kind of parse out how you're thinking about the maturing surgeon base versus utilization improvements? I mean you're already at around 10% penetrated for surgeons, but just maybe how are you kind of thinking about those factors in the guide? And if this is really going to be a year where all those mature active surgeons that you've added over the past two years really kind of move up the utilization curve.

祝賀偉大的季度和指南。也許只是另一個開始的指導問題。但是當你考慮今年的指導構建時。你能不能幫我們分析一下你是如何看待成熟的外科醫生基礎與利用率提高的？我的意思是，外科醫生的滲透率已經達到 10% 左右，但也許您是如何考慮指南中的這些因素的？如果這真的是一年，你在過去兩年中添加的所有那些成熟的活躍外科醫生真的會提高利用率曲線。

Andrew, this is Mark. Great question and thanks for joining us. Yes. We've previously commented that a lot of our revenue growth year-over-year is not purely from new surgeons, but from the increased utilization of our existing surgeon base. And so, we've been really pleased with, and in my prepared remarks, I commented on nearly half of our active surgeons have come over the last two years. What we do believe though is that there is an incremental build of utilization year-after-year, it doesn't come exclusively in year two or exclusively in year three.

安德魯，這是馬克。很好的問題，感謝您加入我們。是的。我們之前曾評論說，我們的收入同比增長中有很大一部分並非純粹來自新的外科醫生，而是來自我們現有外科醫生基地的利用率提高。因此，我們真的很高興，在我準備好的發言中，我評論了過去兩年來我們近一半的活躍外科醫生。不過，我們確實相信，利用率逐年遞增，並不只出現在第二年或第三年。

So, we believe that a lot of the patterns that we've seen year-after-year will continue to hold true as we continue and plan to add new surgeons this year in 2023 as well, and our existing surgeon base will continue to move up that chain and have increased utilization on average. We have commented that in the most recent 12 month period that new surgeons have been adopting Lapiplasty at a faster rate than they ever have before. So, we believe that the surgeons who are coming to our labs, getting trained, they're very interested in adopting Lapiplasty and the data is proving out that when they do come become a customer, they're actually doing more cases than the average shows, and what -- more than what we've had historically.

因此，我們相信，隨著我們繼續併計劃在 2023 年今年增加新的外科醫生，我們年復一年看到的許多模式將繼續適用，我們現有的外科醫生基地將繼續移動在這條鏈上，平均利用率提高了。我們評論說，在最近 12 個月的時間裡，新外科醫生以比以往任何時候都快的速度採用唇部成形術。因此，我們相信來到我們實驗室接受培訓的外科醫生，他們對採用隆鼻手術非常感興趣，而且數據證明，當他們成為我們的客戶時，他們實際上做的病例比平均水平多顯示，以及什麼 - 比我們歷史上所擁有的更多。

So, all of this builds into to our revenue build for the guidance number that we gave. So we feel really good about the strong surgeon base, we plan on adding more and now we've got that direct sales channel to support all of these surgeons in their journey.

因此，所有這些都建立在我們給出的指導數字的收入基礎上。因此，我們對強大的外科醫生基礎感到非常滿意，我們計劃增加更多，現在我們有了直銷渠道來支持所有這些外科醫生的旅程。

Got it. And maybe just a couple of other financial questions too. Just as we do think about the seasonality from 4Q to 1Q. Mark, I got your comment that this past first quarter was -- had the benefit from recapturing some of the COVID procedures, but should we be -- just maybe help us put a finer bow on maybe the sequential step-down? And then second, can you help us a little bit more with OpEx for the year just in terms of your revenue growth rate?

知道了。也許還有其他幾個財務問題。就像我們確實考慮從 4Q 到 1Q 的季節性一樣。馬克，我收到你的評論說，過去的第一季度是——從重新獲得一些 COVID 程序中獲益，但我們應該——只是幫助我們更好地鞠躬，也許是連續的降壓？其次，就您的收入增長率而言，您能否在今年的運營支出方面為我們提供更多幫助？

So, I wanted to comment in the remarks that there was a little bit of an anomaly, we're glad that we're not talking about or making references to COVID anymore, but wanted to just bring to everyone's memory that Q1 of 2022 did have some benefit from some rescheduled cases. So, historically and if you adjust for some of those -- some of the benefit in Q1, the last couple of years, we've had a step-down, and so Q1 has been roughly about 80% of the revenue plus or minus, but around 80% of the revenue in Q4.

所以，我想在評論中評論說有一點異常，我們很高興我們不再談論或提及 COVID，但只想讓每個人都記住 2022 年第一季度所做的事情從一些重新安排的案件中獲益。所以，從歷史上看，如果你調整其中的一些 - 第一季度的一些好處，在過去的幾年裡，我們已經降級了，所以第一季度大約是收入的 80% 正負，但佔第四季度收入的 80% 左右。

So that's a very normal step down, that's what we experienced last year if you adjust the revenue out of Q1 and kind of push it back into Q4, that would have been the same. So we would expect something very similar to that as we come into 2023. Overall, you asked a question about the OpEx and we're going to continue to invest in the company. John outlines several things that we will continue to do, we'll continue to build a sales channel, we'll continue to invest in R&D, and we will have some incremental investments in our DTC program. So there will be some build. But overall, there'll be some improved leverage in 2023 versus 2022.

所以這是一個非常正常的下降，這就是我們去年所經歷的，如果你調整第一季度的收入並將其推回到第四季度，那就是一樣的。因此，我們預計到 2023 年會出現與此非常相似的情況。總的來說，你問了一個關於 OpEx 的問題，我們將繼續對公司進行投資。約翰概述了我們將繼續做的幾件事，我們將繼續建立銷售渠道，我們將繼續投資於研發，我們將對我們的 DTC 計劃進行一些增量投資。所以會有一些構建。但總體而言，與 2022 年相比，2023 年的槓桿率會有所提高。

(Operator Instructions) Our next question comes from the line of Ryan Zimmerman with BTIG.

（操作員說明）我們的下一個問題來自 BTIG 的 Ryan Zimmerman。

Congrats on all the growth and everything you said before. I'm sitting here at the American Academy of Orthopaedic Surgeons. I'm thinking about kind of who your marginal customer is. Now, I know it's not the general orthopath that's going to necessarily pick-up a Lapiplasty kit. But as we think about the 1.1 million potential bunion surgeries out there versus those that are having the 450,000. How do you think about that 450,000 growing over the next few years, what's it going to take? Is it more DTC? It's just -- John your thoughts on general market growth, and what moves the needle from actual surgery to penetrate more of those candidates?

祝賀所有的成長和你之前所說的一切。我坐在美國骨科醫師學會這裡。我在想你的邊際客戶是誰。現在，我知道一般的正畸醫生不一定會選擇 Lapiplasty 套件。但是當我們考慮 110 萬潛在的拇囊炎手術與 450,000 的手術時。您如何看待未來幾年增長的 450,000 人，這需要什麼？是否更多 DTC？只是——約翰，你對總體市場增長的看法，是什麼讓針頭從實際手術中滲透到更多的候選人中？

Ryan. Good to hear from you and thanks for the question. Yes. So, I think if you look at all the kind of standard market reports that companies can acquire out there, they would typically show the bunion procedure base growing at 3%, 4% maybe for the next five years, that's my recollection. How we try to expand that is obviously through our DTC and patient awareness efforts and investments.

賴安。很高興收到你的來信，感謝你的提問。是的。所以，我認為，如果你看看公司可以獲得的所有標準市場報告，它們通常會顯示拇囊炎手術基礎增長 3%，未來五年可能增長 4%，這就是我的回憶。我們如何嘗試擴大這一點顯然是通過我們的 DTC 和患者意識的努力和投資。

If we can get to those fence sitting patients with our DTC messages, with our stronger clinical evidence, and communicate that there is a better procedure now, a better offering than there was in the past that recurrence rates can be much lower than they were in the past, that you can get back to bearing weight and back to your activities at a predictable time, then we think that can resonate, and we think that can bring some of these fence sitting patients over the fence and connecting with our doctors maybe for consultation through our website about Lapiplasty. So I think in the coming years, that's our project, we're going to try to work to expand our relative portion into the 1.1 million, as best we can. And yes, that's where we put our efforts.

如果我們能夠通過我們的 DTC 信息和更有力的臨床證據與那些圍觀的患者溝通，並傳達出現在有更好的程序，比過去更好的產品，復發率可能比過去低得多過去，你可以在可預測的時間恢復負重並恢復你的活動，然後我們認為這會產生共鳴，我們認為這可以讓一些圍欄坐著的病人越過圍欄並與我們的醫生聯繫，也許是為了通過我們的網站諮詢有關 Lapiplasty 的信息。所以我認為在未來幾年，這是我們的項目，我們將盡最大努力努力將我們的相對份額擴大到 110 萬。是的，這就是我們努力的地方。

Fair enough, John. I know it's not an easy question. And there's no magic silver bullet I guess, but I appreciate the commentary. And then the second question is just around complementary products. I mean, they're so important for you guys, as we think about the model and the move higher in ASPs. I'm wondering if you can kind of help us understand what the attachment rates are as you think about them today for your key kind of complementary products and where you think you can take that over time or where we should think about that going over time?

很公平，約翰。我知道這不是一個簡單的問題。我想沒有靈丹妙藥，但我很欣賞評論。然後第二個問題是關於互補產品。我的意思是，它們對你們來說非常重要，因為我們考慮模型和 ASP 的提升。我想知道你是否可以幫助我們了解你今天對你的主要補充產品的依戀率是多少，以及你認為隨著時間的推移你可以接受它或者我們應該考慮隨著時間的推移？

Sure. So the complementary product is definitely a great part of our strategy. And most of our complementary products are all aimed at improving the outcomes for these bunion patients. We got to Adductoplasty because we've recognized people with that midfoot deformity, didn't get as good an enduring correction or lasting correction with their bunion procedure, if you didn't fix the midfoot. So these are all really tied together. So the attachment rate I think kind of goes hand-in-hand. If a surgeon is doing an Adductoplasty procedure 99% of the time they're going to be doing a Lapiplasty as well.

當然。因此，互補產品絕對是我們戰略的重要組成部分。我們的大部分配套產品都旨在改善這些拇囊炎患者的預後。我們進行了內收成形術，因為我們已經認識到患有中足畸形的人，如果你不修復中足，他們的拇囊炎手術就無法獲得持久矯正或持久矯正。所以這些都是緊密聯繫在一起的。所以我認為依戀率是齊頭並進的。如果外科醫生在 99% 的時間裡都在做內收成形術，那麼他們也會進行乳頭成形術。

Our speed release instrument is another excellent example of an instrument that can make the great toe tissue release, (inaudible) release much easier, more predictable for the surgeon, and this occurs in over 95% of our Lapiplasty cases. So, attachment rate can be very, very high there, once we get a doctor trained on it and they implement it in their practice.

我們的快速釋放儀器是另一個很好的儀器示例，它可以使大腳趾組織釋放，（聽不清）釋放更容易，外科醫生更可預測，這發生在我們超過 95% 的唇成形術病例中。因此，一旦我們對醫生進行培訓並在他們的實踐中實施，依戀率就會非常非常高。

Other things like the S4A plates, not really complementary, but heavy conversion going on right now out in the field to doctors wanting to use that next generation more advanced plating geometry on their patients and supplanting earlier versions of our plating with that. And then, of course, in the back half later this year, we'll be releasing the micro Lapiplasty and the speed plate technologies. And I think speed plate is going to be a really neat technology platform for us, it's going to be used in a variety of Lapiplasty and other midfoot cases as well.

其他的東西，比如 S4A 板，不是真正的互補，但現在正在現場進行大量轉換，醫生希望在他們的病人身上使用下一代更先進的電鍍幾何形狀，並用它取代我們早期版本的電鍍。然後，當然，在今年下半年，我們將發布微型 Lapiplasty 和速度板技術。而且我認為速度闆對我們來說將是一個非常巧妙的技術平台，它也將用於各種 Lapiplasty 和其他中足案例。

Thank you. I'm showing no further questions in the queue. I would now like to turn the call back to Vivian for closing remarks.

謝謝。我不會在隊列中顯示更多問題。我現在想把電話轉回 Vivian 以作結束語。

Thank you, Tawanda. Thanks, everyone, for joining us today on behalf of Treace Medical, this concludes our call and we look forward to our next update following the close of the first quarter of 2023.

謝謝你，塔旺達。感謝大家今天代表 Treace Medical 加入我們，我們的電話會議到此結束，我們期待著 2023 年第一季度結束後的下一次更新。

Thank you. You may now disconnect.

謝謝。您現在可以斷開連接。