Q3 2025 Shoulder Innovations Inc Earnings Call

November 11, 2025

Operator: Please stand by. Welcome, ladies and gentlemen, to the Q3 2025 Earnings Conference Call for Shoulder Innovations. At this time, all participants have been placed in a listen-only mode. At the end of the company's prepared remarks, we will conduct a question-and-answer session. Please note that this conference is being recorded and will be available on the company's website for replay shortly. I would like to turn the call over to Sam Bentzinger, Vice President, Investor Relations at Gilmartin Group, for a few introductory comments. Please go ahead.

Please stand by. Welcome, ladies and gentlemen, to the third quarter 2025 earnings conference call for Shoulder Innovations.

At this time, all participants have been placed in listen-only mode.

At the end of the company's prepared remarks, we will conduct a question-and-answer session.

Please note that this conference is being recorded and will be available on the company's website for replay shortly.

I would like to turn the call over to Sam Benzinger.

Sam Bentzinger: Good afternoon. Thank you for participating in today's call. Joining me from Shoulder Innovations are Rob Ball, Chief Executive Officer, and Jeff Points, Chief Financial Officer. Earlier today, Shoulder Innovations issued a press release announcing financial results for Q3 ended September 30, 2025.

Vice President of Investor Relations at Go Martin Group for a few introductory comments. Please go ahead.

Good afternoon, and thank you for participating in today's call. Joining me from Shoulder Innovations are Rob Ball, Chief Executive Officer, and Jeff Points, Chief Financial Officer.

Rob Ball: A copy of the press release is available on the Investor Relations section of the company's website. Before we begin, I'd like to remind you that this conference call is being recorded and that management will make remarks during this call that constitute forward-looking statements within the meaning of federal securities laws, and that these are being made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements contained in this call that relate to expectations or predictions of future events, results, or performance are forward-looking statements. 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. Accordingly, you should not place undue reliance on these statements.

Sam Bentzinger: A copy of the press release is available on the Investor Relations section of the company's website. Before we begin, I'd like to remind you that this conference call is being recorded and that management will make remarks during this call that constitute forward-looking statements within the meaning of federal securities laws, and that these are being made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements contained in this call that relate to expectations or predictions of future events, results, or performance are forward-looking statements. 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. Accordingly, you should not place undue reliance on these statements.

Earlier today, Shoulder Innovations issued a press release announcing financial results for the quarter ended September 30, 2023. A copy of the press release is available in the investor relations section of the company's website.

Before we begin, I'd like to remind you that this conference call is being recorded and that management will make remarks during this call that constitute forward-looking statements within the meaning of federal securities laws. These remarks are being made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.

Any statements contained in this call that relate to expectations or predictions of future events, results, or performance are forward-looking statements. These statements involve material risks and uncertainties that could cause actual results for events to materially differ from those anticipated or implied by these forward-looking statements.

Rob Ball: For a listen description of the risks and uncertainties associated with our business, please refer to the Risk Factors section of our most recent quarterly report on Form 10-Q and in our other filings with the Securities and Exchange Commission. Additionally, during this conference call, the company will discuss certain financial measures that have not been prepared in accordance with GAAP. This non-GAAP information should not be considered in isolation or as a substitute for or superior to results prepared in accordance with GAAP. Please refer to the tables in our earnings release for a reconciliation of these measures to the most directly comparable GAAP financial measure. This conference call contains time-sensitive information and is accurate only as of the live broadcast today, November 11, 2025.

Sam Bentzinger: For a listen description of the risks and uncertainties associated with our business, please refer to the Risk Factors section of our most recent quarterly report on Form 10-Q and in our other filings with the Securities and Exchange Commission. Additionally, during this conference call, the company will discuss certain financial measures that have not been prepared in accordance with GAAP. This non-GAAP information should not be considered in isolation or as a substitute for or superior to results prepared in accordance with GAAP. Please refer to the tables in our earnings release for a reconciliation of these measures to the most directly comparable GAAP financial measure. This conference call contains time-sensitive information and is accurate only as of the live broadcast today, November 11, 2025.

Accordingly, you should not place undue reliance on these statements.

For a listing of the risks and uncertainties associated with our business, please refer to the risk factor section of our most recent quarterly report on Form 10-Q and in our other filings with the Securities and Exchange Commission.

Additionally, during this conference call, the company will discuss certain financial measures that have not been prepared in accordance with GAAP. This non-GAAP information should not be considered in isolation or as a substitute for, or superior to, results prepared in accordance with GAAP. Please refer to the tables in our earnings release for a reconciliation of these measures to the most directly comparable GAAP financial measure.

Rob Ball: Shoulder Innovations disclaims any intention or obligation except as required by law to update or revise any financial projections or forward-looking statements, whether because of new information, future events, or otherwise. With that, I will now turn the call over to Rob. Thank you, Sam. Good afternoon, everyone, and thank you all for joining us for our first earnings call as a public company. We're very excited to share the results, the details of our exceptional Q3 performance today, and review our progress against key priorities driving continued commercial momentum. On the top line, revenue in the Q3 was $11.8 million, an increase of 58% year-over-year and over 7% sequentially. We're very pleased with this performance, which was driven by continued market adoption of our implant systems across a growing base of surging customers.

Sam Bentzinger: Shoulder Innovations disclaims any intention or obligation except as required by law to update or revise any financial projections or forward-looking statements, whether because of new information, future events, or otherwise. With that, I will now turn the call over to Rob.

This conference call contains time-sensitive information and is accurate only as of the live broadcast today, November 11, 2025. Shoulder Innovations disclaims any intention or obligation, except as required by law, to update or revise any financial projections or forward-looking statements, whether because of new information, future events, or otherwise.

Rob Ball: Thank you, Sam. Good afternoon, everyone, and thank you all for joining us for our first earnings call as a public company. We're very excited to share the results, the details of our exceptional Q3 performance today, and review our progress against key priorities driving continued commercial momentum. On the top line, revenue in the Q3 was $11.8 million, an increase of 58% year-over-year and over 7% sequentially. We're very pleased with this performance, which was driven by continued market adoption of our implant systems across a growing base of surging customers.

With that, I will now turn the call over to Rob.

Thank you, Sam. Good afternoon, everyone, and thank you all for joining us for our first earnings call as a public company.

We're very excited to share the details of our exceptional third quarter performance today, as well as our progress against key priorities driving continued commercial momentum.

Rob Ball: Q3 gross margin of 76.2% was also strong and reflects our commitment to enhancing profitability. We continue to take intentional actions to drive further improvement in gross margin and believe there is additional opportunity for expansion going forward. From a balance sheet perspective, we significantly strengthened our cash position, ending Q3 with over $137 million in cash and marketable securities, following our convertible notes financing and initial public offering in July, which raised a combined $115 million in gross proceeds. Our performance and accelerating business momentum exiting Q3 leaving us incrementally confident in our ability to sustain our commercial progress through 2025, 2026, and beyond. As a result, we are raising our revenue guidance for the forward year to a range of $45 to 46 million, representing growth of 42% to 45% year-over-year.

On the top line, revenue in the third quarter was $11.8 million, an increase of 58% year-over-year and over 7% sequentially. We're very pleased with this performance, which was driven by continued market adoption of our infant systems across the growing base of surgeon customers.

Q3 gross margin is 76.2%, which is also strong and reflects our commitment to enhancing Pro profitability.

We continue to take intentional actions to drive further improvement in gross margin, and I believe there is additional opportunity for expansion going forward.

From a balance sheet perspective, we significantly strengthened our cash positions, ending the third quarter with over $137 million in cash and marketable securities following our convertible notes financing and initial public offering in July, which raised a combined million dollars in gross proceeds.

Rob Ball: For the remainder of this call, I will provide a brief introduction to Shoulder Innovations for those who may be newer to our story and review our Q3 performance and key growth priorities in greater detail. Jeff will walk through our full Q3 financial results and discuss our outlook for the remainder of 2025. At the highest level, Shoulder Innovations is exclusively focused on transforming the shoulder surgical care market with an initial focus on shoulder replacement or arthroplasty. We find ourselves in the enviable position of being the only public, well-resourced company with this narrow focus in this highly attractive market. We estimate shoulder arthroplasty currently represents a $2.8 billion annual global market, with almost two-thirds of that opportunity in the United States. Within the US specifically, we estimate that approximately 250,000 shoulder arthroplasty procedures will be performed in 2025.

Performance and accelerated business momentum exiting the third quarter leave us incrementally confident in our ability to sustain our commercial progress through 2025 and beyond. As a result, we are raising our revenue guidance for the full year to a range of $45 million to $46 million, representing growth of 42% to 45% year-over-year.

For the remainder of this call, I will provide a brief introduction to Shoulder Innovations for those who may be newer to our story and review our third core performance and key growth priorities in greater detail. Jeff will then walk through our full third quarter financial results and discuss our outlook for the remainder of 2025.

Initial focus on shoulder replacement or arthroplasty.

We find ourselves in the enviable position of being the only public, well-resourced company with this narrow focus in this highly attractive market.

We estimate shoulder osteoplasty currently represents a $2.8 billion annual global market, with almost two-thirds of that opportunity in the United States.

Rob Ball: Today, our product portfolio of advanced implant systems covers approximately 85% of those procedures, encompassing both anatomic and reverse shoulder arthroplasty. This comprehensive portfolio includes various specifically designed components capable of different modes of operation, optimized for patient-specific needs. More importantly, all our systems leverage consistent surgical techniques, our foundational InSet glenoid technology, and the same efficient two-tray instrumentation system. The remaining 50% of procedures represent adjacent indications in fracture and revision, which we intend to fully answer in the near future with several additional products currently in our pipeline. I'll share an exciting update on this front later in the call. Our product portfolio serves as the foundation for what we refer to as Shoulder Innovations' broader ecosystem. In addition to our implant products, this ecosystem also includes best-in-class enabling technology, differentiating efficient instrumentation systems, specialized support, and a surgeon-to-surgeon collaboration model.

Within the U.S. specifically, we estimate that approximately 250,000 shoulder arthroplasty procedures will be performed in 2025.

Today, our product portfolio of advanced implant systems covers approximately 85% of those procedures, encompassing both anatomic and reverse shoulder arthroplasty.

This comprehensive portfolio includes various specifically designed components capable of different modes of operation.

Optimized for patient specific meetings.

More importantly, all our systems leverage consistent, surgical techniques as our foundational insight. When I technology and the same efficient $2 trade instrumentation system.

The remaining 50% of procedures represent adjacent indications in fracturing revision, which we intend to fully enter in the near future with several additional products currently in our pipeline. I'll share an exciting update on this front later in the call.

Our product portfolio serves as the foundation for what we refer to as Shoulder Innovations: a broader ecosystem.

In addition to our implant products, this ecosystem also includes best-in-class enabling technology.

Rob Ball: Together, these elements are designed to address the longstanding clinical and operational challenges in the shoulder surgical market by improving outcomes, simplifying procedures, and increasing efficiency across all sites of care and our own operations. As mentioned, we are primarily known for our foundational technology, the InSet glenoid, a technology that addresses glenoid loosening, the primary complication with anatomic shoulder arthroplasty. With the InSet glenoid, published data shows an 87% reduction in the mechanism of action leading to failure, namely glenoid loosening. Long-term results published in multiple peer-reviewed publications demonstrate 0 surgical complications, 0 loose implants, and 100% implant survivorship at nearly 9 years of follow-up. These outcomes represent significant improvement over the standard of care designs. We are also focused on enabling technology as a key driver of our improved outcomes in the future.

Differentiating efficient instrumentation systems, specialized support, and assertion collaboration model.

Together, these elements are designed to address the long-standing clinical and operational challenges in the shoulder surgical markets by.

Improving outcomes, simplifying procedures, and increasing efficiency across all sites of care and our own operations.

As mentioned, we are primarily known for our foundational technology, the insect run on.

A technology that addresses ground and loosening the primary complication with anatomic shoulder arthroplasty.

With the insect going, published data shows an 87% reduction in the mechanism of action, leading to failure. Namely, down on the glucan.

Long-term results published in multiple peer-reviewed publications demonstrate zero surgical complications, zero loose implants, and 100% implant survivorship at nearly 9 years of follow-up. These outcomes represent a significant improvement over the standard of care designs.

Rob Ball: Preoperative planning plays a vital role in improving workflow and patient outcomes, thereby supporting market adoption. To that end, we view our ProVoyance platform, which is integrated with all of our products, as a key element of our success. ProVoyance, which we believe to be the first AI-enabled preoperative planning solution in the market, allows the surgeon to virtually perform procedures before operating using a CT-based 3D model of each patient's anatomy. I'll note specifically that within our ability to measure, virtually all our implants incorporate ProVoyance, making it a routine part of surgeon workflow. We continue to benefit from the shift of procedures from hospitals to ambulatory surgery centers, or ASCs, following CMS's decision to approve ASC reimbursement for shoulder arthroplasty in early 2024.

We are also focused on enabling technology as a key driver of our approved outcomes in the future. Pre-operative planning plays a vital role in improving workflow and patient outcomes, thereby supporting market adoptions.

To that end, we view Pro as a provided platform that is integrated with all of our products as a key element of our success. For Voyance, which we believe to be the first AI-enabled pre-operative planning solution in the market, it allows the surgeon to virtually perform procedures before operating, using a CT-based 3D model of each patient's anatomy.

I'll note specifically that within our ability to measure virtually all our implants, in quotes for a corporate Provo, making it a routine part of the surgeon workforce.

Rob Ball: Our early anticipation of this shift enabled us to offer a distinct advantage in the ASC setting with a two-tray instrumentation system compared to the 8 to 10 trays typically required by competitors. As a result, our ASC procedures grew from about 10% in December 2023, just prior to the reimbursement decision, to over 30%, positioning us well to benefit from the ongoing transition toward ASCs as a preferred site of care in the space. Holistically, we believe our unique ecosystem, combined with being the only company with a singular focus on the shoulder specialist, has supported our financial and operational performance today.

Finally, we continue to benefit from the shift and procedures from hospitals to Ambulatory Surgery centers or asc's following cms's decision to approve ASC, reimbursement for shoulder. Off the plasti. In early 2024, our early anticipation of this shift. Enable us enable us to offer a distinct advantage in the ESC. Setting with a 2 trade instrumentation system compared to the 8 to 10 traits typically, required by competitors. As a result. Our ASC procedures Grew From about 10% in December 2023. Just prior to the reimbursement decision to over 30% positioning as well to benefit from the ongoing transition toward afc's as a

Preferred site of care in the space.

Rob Ball: To sustain our above-market growth and drive continued commercial momentum, we are focusing on three key strategic priorities, which in the near term include driving adoption among new surgeons, increasing penetration in our existing surgeon customer base to increase procedural volume, and adding products to our portfolio to address the remaining unmet needs of patients and surgeons. This includes both expanding indications and continued enabling technology. We are executing well across each of these priorities with clear progress demonstrated in Q3, which I'll touch on now. I'll begin by reviewing our efforts to drive adoption among new surgeons. For context, our commercial model, we sell all our products through a network of independent distributors. To that network, we then overlay a dedicated W2 commercial leadership team with a primary focus of identifying high-volume surgeon targets.

Holistically, we believe our unique ecosystem, combined with being the only company with a singular focus on the shoulder specialist, has supported our financial and operational performance today.

To sustain our above-market growth and drive continued commercial momentum, we are focusing on three key strategic priorities, which in the near term include driving adoption among new surgeons.

Increasing penetration in our existing surgeon customer base to increase procedural volume and add products to our portfolio to address the remaining unmet needs of patients and surgeons. This includes both expanding indications and continued enabling technology.

I'll begin by reviewing our efforts to drive adoption among new surgeons.

For context, our commercial model.

Rob Ball: To enable this, we leverage a proprietary business intelligence platform, allowing us to precisely target our efforts to where we can make a difference and understand our effectiveness in making conversions. In total, there are about 15,000 surgeons in the US performing at least one shoulder arthroplasty each year, with roughly 1,800 high-volume shoulder specialists accounting for the majority of procedures. These shoulder specialists perform 35 or more procedures annually. Interestingly, while on average these surgeons perform around 80 arthroplasties annually, shoulder replacement typically represents less than half of the surgical volume for these surgeons. We segment this group of 1,800 high-volume surgeons into three categories by the way they interact with SHOULDER INNOVATIONS: prospects who perform one to two procedures per quarter, contenders who perform three to eight, and core surgeons who perform nine or more. Combined, our core and contender surges generate approximately 95% of our total revenue.

We sell all our products to a network of independent distributors. We then overlay a dedicated W2 commercial leadership team with a primary focus on identifying high-volume insurgent targets to enable this. We leverage a proprietary business intelligence platform, allowing us to precisely target our efforts to where we can make a difference and understand our effectiveness in making conversions.

In total, there are about 15,000 surgeons in the U.S. performing at least one shoulder arthroplasty each year, with roughly 1,800 high-volume shoulder specialists accounting for the majority of procedures.

These shoulder specialists performed 35 or more procedures annually.

Interestingly, while on average these surgeons perform around 80 arthroplasties annually, shoulder replacement typically represents less than half of the surgical volume for these surgeons.

We segment this group of 18,800 high-volume services into three categories. By the way, they interact with children: Innovations prospects, who perform 1 to 2 procedures per quarter; contenders, who perform 3 to 8; and core surgeons, who perform 9 or more.

Rob Ball: This stickiness contributes to our revenue projectability and is validation that positive outcomes is fueling continued uptake among surgeons. We have consistently expanded our base of these core and contender surgeons each quarter through 2025 and have done so at a rapid pace. For instance, last quarter we announced a nearly 50% year-over-year increase in our core and contender surgeons. These increases have primarily been driven by enhanced awareness of the SI brand, supported by the targeted efforts of our commercial leadership team in identifying and converting high-volume surgeons. While we intend to provide our core and contender surgeon count on an annual basis moving forward, I'll share that we again increased the number of core and contender surgeons at the same pace during the Q3 and expect that trend to be durable moving forward.

Combined, our Core and Contender services generate approximately 95% of our total revenue.

This stickiness contributes to our revenue projections. That positive outcome is fueling continued uptake among surgeons.

We have consistently expanded our base of these core and Contender surgeons each quarter through 2025 and have done so at a rapid pace. For instance, last quarter, we announced a nearly 50% year-over-year increase in our core and Contender surgeons. These increases have primarily been driven by enhanced awareness of the site brand, supported by the targeted efforts of our commercial leadership team and identifying and converting the high-volume surgeons.

Rob Ball: Once we win new surgeons and they become integrated into our ecosystem, our second priority is to drive increased procedural volume. To achieve this, we seek to transition surgeons over time from prospect to contender and from contender to core by increasing penetration and utilization. In Q3, our core and contender customers skewed more towards core surgeons, highlighting our ability to increase utilization into this critical high-volume cohort. A key driver of this is our surgeon-to-surgeon education program facilitated by our customer experience and medical education team, the third component of our broader commercial organization. We are committed to fostering a collaborative community among shoulder surgeons where expertise is shared, new ideas are exchanged, and best practices are disseminated to enhance clinical outcomes. By facilitating these peer connections, we strengthen engagement within our ecosystem and reinforce its real-world success.

While we intend to provide our core and Contender surgeon count, on an annual basis moving forward, I'll share that we again increase the number of core and contenders surgeons at the same Pace during the third quarter and expect that Trend to be durable, moving forward.

Once we win new surgeons and they become integrated into our ecosystem, our second priority priority is to drive increased procedural volume.

To achieve this, we seek to transition surgeons over time from Prospect to Contender and from Contender to core by increasing penetration and utilization.

In Q3 our core and tender customer skewed more towards core surgeons highlighting our ability to increase utilization into this critical. High volume cohort.

A key driver of this is our surgeon detergent education program facilitated by our Customer Experience and Medical Education Team, the third component of our broader commercial organization.

Rob Ball: As surgeons share their positive experiences with our ecosystem and the impact on patient outcomes, we believe this organic advocacy further accelerates adoption, positioning us to benefit from the natural network effects within the shoulder surgical care community. As an example, just this past weekend, our team facilitated our second national shoulder symposium this year focused on learning and education around our ecosystem. This event was by far the largest in our history and included wet lab surgical training as well as robust didactic sessions, all designed, written, proctored, and driven by surgeons. Of note, and unsolicited from the podium, a number of surgeons highlighted the particular value SI provides in creating this community and the positive impact it's having on their practice. This has been a highly intentional effort by our team, and we took great pleasure in hearing the impact it's having.

We are committed to fostering a collaborative community among shoulder surgeons who are experts in sharing new ideas, exchanging knowledge, and disseminating best practices to enhance clinical outcomes. By facilitating these peer connections, we strengthen engagement within our ecosystem and reinforce this real world.

As Sergeant shared a positive experience with our ecosystem and the impact on patient outcomes. We believe this organic advocacy further accelerates adoption, positioning us to benefit from the natural network effects within the shoulder surgical care community.

Rob Ball: We continue to believe it's a clear differentiator that's helping to drive results. Results in Q3 demonstrate the benefit of our commercial model. Total implant volume increased 53% year-over-year to 1,584 units across our prospect, contender, and core surgeon customer base. This performance was driven by a couple of factors. Consistent with prior quarters, implant volume continued to rise as utilization ramped among existing surgeons, particularly those added late last year and early in 2025. Newly onboarded surgeons are ramping more quickly and becoming more productive sooner, which particularly supported the increase in implant volume on a sequential basis, which grew 5%. As an elected procedure, shoulder arthroplasty typically experiences a summer slowdown. Consistent with prior years, this trend was present in Q3 as average procedure volume among our early cohort core surgeons was down slightly on a sequential basis in Q3 versus Q2.

As an example, just this past weekend, our team facilitated our second National Shoulder Symposium this year, focused on learning and education around our ecosystem. This event was by far the largest in our history and included wet lab surgical training as well as robust diagnostic sessions, all designed, written, proctored, and driven by surgeons of note and unsolicited from the podium. A number of surgeons highlighted the particular value SI provides in creating this community and the positive impact it's having on their practice. This has been a highly intentional effort by our team, and we take great pleasure in hearing the impact it's having. We continue to believe there's a clear differentiator that's helping to drive results.

Results in Q3 demonstrate the benefit of our commercial model to total implant volume, which increased 53% year-over-year to 1,584 units across our Prospect, Contender, and course surgeon customer base.

Continue to rise as utilization wrapped around the ramp among existing surgeons, particularly those added late last year and early in 2025.

In addition, newly onboarded surgeons are ramping up more quickly and becoming more productive sooner, which particularly supported the increase in implant volume on a sequential basis, growing by 5%.

As an elective procedure, shoulder osteoplasty typically experiences a summer slowdown.

Rob Ball: We're particularly excited to know that we overcame this normal seasonal downtrend through deeper penetration in later surgery cohorts as well as new customer additions to drive meaningful sequential quarter-over-quarter growth. Looking ahead, we believe our commercial model is well optimized to ensure we can continue to add the appropriate resources to aggressively grow our customer base. Importantly, we expect to make further significant investments in our sales force as we scale from these early market share positions, driving greater predictability of our business. Leveraging our independent network will create a clear opportunity for operational leverage as we scale, a factor we consider critical to our success.

Consistent with prior years, this trend was present in Q3 as average procedure volume among our early cohort of core surgeons was down slightly on a sequential basis in Q3 versus Q2.

However, we are particularly excited to know that we overcame this normal seasonal downtrend through deeper penetration in later searching for cohorts, as well as new customer additions, to drive meaningful sequential quarter-to-quarter growth.

Looking ahead, we believe our commercial model is well-optimized to ensure we can continue to add the appropriate resources to aggressively grow our customer base.

Importantly, we expect to make further significant investments in our sales force as we scale from these early market share positions, driving greater predictability of our business.

Rob Ball: To ensure we continue to equip our growing surgeon customer base with a comprehensive best-in-class suite of shoulder surgical care solutions, our third strategic priority is focused on developing and launching new technologies to address the remaining unmet needs of patients and surgeons. As part of these efforts, in Q3, we launched our InSet 70 humeral stem, the latest expansion of our I-Series humeral stem product line. The InSet 70 is indicated for both anatomic and reverse shoulder arthroplasty, addressing a broad range of clinical needs. Featuring the same reliable fixation and streamlined workflow as the longer InSet 95, it also provides the added benefit of a bone-sparing nature, being the shortest possible stem indicated for reverse arthroplasty. It also maintains the special biomechanics we're known for, with customer feedback strongly suggesting differentiating improvements in the postoperative motion compared to other products and techniques.

Leveraging our independent network will create a clear opportunity for operational leverage. As we scale, a factor we consider critical to our success.

To ensure we continue to equip our growing customer base with a comprehensive, best-in-class suite of shoulder surgical care solutions, our third strategic priority is focused on developing and launching new technologies to address the remaining unmet needs of patients and surgeons.

In the third quarter, we launched our inset 70 humeral stem, the latest expansion of our IER humeral stem product line.

The Inset 70 is indicated for both anatomic and reverse shoulder arthroplasty, addressing a broad range of clinical needs.

Featuring the same reliable fixation and streamlined workflow as the longer inset 95, it also provides the added benefit of bone sparing. Nature, being the shortest possible stem, is indicated for reverse arthroplasty.

It also maintains the special biomechanics we are known for, with customer feedback strongly suggesting differentiating improvements in post-operative motion compared to other products and techniques.

Rob Ball: This bone-sparing approach is gaining traction in the marketplace. The launch of I-70 further strengthens our commitment to innovation, improved patient outcomes, and meaningful value for surgeons. We executed a robust limited user release in Q2 and Q3 with 100% successful customer response. We are pleased with the commercial uptake we have seen so far in the marketplace with this new product. We're also focused on expanding our product portfolio and capabilities with the goal of providing a comprehensive suite of solutions that cover 100% of shoulder procedures performed. We have several new applications planned in the near term, including fracture, revision, and metal hypersensitivity. These new applications will enable us to capture the remaining 15% of shoulder procedures that our product portfolio currently does not cover. The first of these efforts focuses on an indication expansion.

This bone-sparing approach is gaining traction in the marketplace, and the launch of I70 further strengthens our commitment to innovation, improved patient outcomes, and meaningful value for surgeons.

We executed a robust limited user release in Q2 and Q3 with a 100% successful customer response. We are pleased with the commercial update we have seen so far in the marketplace with this new product.

We're also focused on expanding our product portfolio and capabilities with the goal of providing a comprehensive suite of solutions that cover 100% of shoulder procedures performed. We have several new applications planned in the near term, including fracture revision and metal sensitivity. These new applications will enable us to capture the remaining 15% of shoulder procedures that our product portfolio currently does not cover.

Rob Ball: We are pleased to share that we recently received FDA 510(k) clearance that expands our I-Series humeral implant product line to include certain fracture indications. We plan to initiate a limited market release in the coming weeks while we simultaneously seek to advance the full breadth of indications with FDA through the remainder of 2025 and into early 2026. Separately, we also remain on track to launch a new line of humeral and glenoid technologies for the portion of the population who have metal hypersensitivity and may experience adversity associated with allergic reactions from metal implants. We expect to receive FDA clearance and subsequently launch these technologies in the coming weeks, and we look forward to sharing additional updates as we're able to. Importantly, these new products and applications are associated with higher ASPs, making them constructive to gross margin and providing a double benefit to our near-term market growth.

The first of these efforts focuses on an indication expansion. We are pleased to share this recently received FDA clearance that expands our I-Series Humo Implant product line to include certain fracture indications.

We plan to initiate a limited market release in the coming weeks while we simultaneously seek to advance the full breadth of indications with the FDA through the remainder of 2025 and into early 2026.

Separately, we also remain on track to launch a new line of humeral and glenoid technologies for the portion of the population who have metal hypersensitivity and may experience adversity associated with allergic reactions to metal implants. We expect to receive FDA clearance and subsequently launch these technologies in the coming weeks, and we look forward to sharing additional updates as we're able to.

Rob Ball: Finally, in parallel to new implant development and indication expansion, we believe we can further extend our competitive position by introducing complementary enabling technologies to support the full continuum of care in shoulder surgery. As I've shared recently, we've made significant progress in this area and couldn't be more excited about the opportunity. We're looking forward to sharing more on this front in the coming weeks. Looking beyond the near term, we see significant opportunities to further broaden our impact and extend our leadership position. From a longer-term perspective, we plan to evaluate entry into attractive international markets over time, which we currently do not have a presence in, and expand into adjacent markets beyond shoulder arthroplasty. With adjacent markets, particularly among the 1,800 high-volume surgeons that we're targeting, shoulder arthroplasty typically represents less than half of their case volume.

Importantly, these new products and applications are associated with higher ASPs, making them constructive to gross margin and providing a double benefit to our near-term market growth.

Finally, in parallel to the new implant development and indication expansion, we believe we can further extend our competitive position by introducing complementary enabling technologies to support the full continuum of care in shoulder surgery.

Front in the coming weeks.

Looking beyond the near term, we see significant opportunities to further broaden our impact and extend our leadership position from a longer-term perspective. We plan to evaluate entry into attractive international markets over time, which we currently do not have a presence in, and expand into adjacent markets beyond shoulder oopsie.

Rob Ball: The rest of their surgical volume is commonly comprised of sports medicine and shoulder trauma procedures, both of which are highly relevant markets for us to target moving forward. Sports medicine, driven largely by rotator cuff procedures, is a market with a similar size and growth rate to shoulder arthroplasty. This creates a meaningful opportunity to expand our TAN within our existing customer base. I'll continue to update you on our progress on these initiatives as we move forward. With that, I'll now turn the call over to Jeff Points, our CFO, to review our Q3 results in more detail and provide our outlook for the remainder of 2025.

With adjacent markets, particularly among the 1,800 high-volume surgeons that were targeting shoulder up to plastic, typically represents less than half of their case volumes. The rest of the surgical volume is commonly comprised of sports medicine and shoulder trauma procedures, both of which are highly relevant markets for us to target. Moving forward, sports medicine, driven largely by the rotator cuff procedure, is a market with a similar size and growth rate as shoulder arthroplasty. This creates a meaningful opportunity to expand our reach within our existing customer base.

I'll continue to update you on our progress on these initiatives as we move forward.

Operator: Thanks, Rob, and good afternoon, everyone. As Rob mentioned, total revenue for Q3 2025 was $11.8 million, a 58% increase from $7.5 million in the prior year. Our unique commercial model and proprietary business intelligence capabilities drove continued commercial expansion in Q3, resulting in increased adoption of our implant systems across new and existing surgeons. Gross margin for Q3 2025 was 76.2% compared to 76.5% in the prior year. Selling, general, and administrative expenses in Q3 2025 were $15.1 million compared to $8.5 million in the prior year. The increase was primarily driven by increased headcount in the commercial organization, higher legal costs related to litigation, higher variable selling expenses, and increased professional service fees related to our transition to a public company.

Jeff Points: Thanks, Rob, and good afternoon, everyone. As Rob mentioned, total revenue for Q3 2025 was $11.8 million, a 58% increase from $7.5 million in the prior year. Our unique commercial model and proprietary business intelligence capabilities drove continued commercial expansion in Q3, resulting in increased adoption of our implant systems across new and existing surgeons. Gross margin for Q3 2025 was 76.2% compared to 76.5% in the prior year. Selling, general, and administrative expenses in Q3 2025 were $15.1 million compared to $8.5 million in the prior year. The increase was primarily driven by increased headcount in the commercial organization, higher legal costs related to litigation, higher variable selling expenses, and increased professional service fees related to our transition to a public company.

With that, I'll now turn the call over to Jeff Points, our CFO, to review our third quarter results in more detail and provide our outlook for the remainder of 2025.

Thanks, Rob, and good afternoon, everyone.

As Rob mentioned, total revenue for the third quarter of 2025 was $11.8 million, a 58% increase from $7.5 million in the prior year.

Our unique commercial model and proprietary business intelligence capabilities drove continued commercial expansion in the third quarter, resulting in increased adoption of our implant systems across new and existing surgeons.

Growth margin for the third quarter of 2025 was 76.2%.

Compared to 76.5% in the prior year.

Selling, general, and administrative expenses in the third quarter of 2025 were $15.1 million, compared to $8.5 million in the prior year.

Operator: We expect an increasing amount of investment in Q4, reflecting our accelerating commercial momentum, the continued impact of ongoing litigation, which is nearing resolution, and our first full quarter of public company expenses. Research and development expenses in Q3 2025 were $1.5 million compared to $1.1 million in the prior year. The increase was primarily driven by investment in new product development efforts. Net loss in Q3 2025 was $8.7 million compared to a loss of $4.1 million in the prior year. The adjusted EBITDA loss in Q3 2025 was $7.5 million compared to a loss of $2.9 million in the prior year. The increase in net loss and the adjusted EBITDA loss was primarily related to increasing operating expenses and changes in the fair value of the company's preferred stock warrant liability and convertible notes.

Jeff Points: We expect an increasing amount of investment in Q4, reflecting our accelerating commercial momentum, the continued impact of ongoing litigation, which is nearing resolution, and our first full quarter of public company expenses. Research and development expenses in Q3 2025 were $1.5 million compared to $1.1 million in the prior year. The increase was primarily driven by investment in new product development efforts. Net loss in Q3 2025 was $8.7 million compared to a loss of $4.1 million in the prior year. The adjusted EBITDA loss in Q3 2025 was $7.5 million compared to a loss of $2.9 million in the prior year. The increase in net loss and the adjusted EBITDA loss was primarily related to increasing operating expenses and changes in the fair value of the company's preferred stock warrant liability and convertible notes.

The increase was primarily driven by increased headcount and the Commercial organization. Higher legal costs related to litigation, higher variable selling expenses, and increased professional service fees related to our transition to a public company.

We expect an increase in the amount of investment in the fourth quarter, reflecting our accelerating commercial momentum, the ongoing impact of litigation, which is nearing resolution, and our first full quarter of public company expenses.

Research and development expenses in the third quarter of 2025 were $1.5 million, compared to $1.1 million in the prior year.

The increase was primarily driven by investment in new product development efforts.

Net loss for the third quarter of 2025 was $8.7 million, compared to a loss of $4.1 million in the prior year.

The adjusted even loss in the third quarter of 2025 was $7.5 million compared to a loss of $2.9 million in the prior year.

The increase in that loss and the adjusted loss was primarily related to the increase in operating expenses and changes in the fair value of the company's preferred stock warrant liability and convertible notes.

Operator: Our cash and cash equivalents as of 30 September 2025, were $137 million. This includes gross proceeds of approximately $115 million from our July convertible notes financing an IPO. We continue to believe these funds put us in a strong financial position to continue investing in growth while enabling us to achieve cash flow break-even with cash on hand. Turning now to our outlook for the remainder of 2025, reflecting the strong momentum year to date, we now expect full-year 2025 total revenue to range from $45 to $46 million, up from our prior guidance of $42 to $44 million, which represents annual growth of 42% to 45% over 2024. With that, I'll turn the call back to Rob for a few closing remarks.

Jeff Points: Our cash and cash equivalents as of 30 September 2025, were $137 million. This includes gross proceeds of approximately $115 million from our July convertible notes financing an IPO. We continue to believe these funds put us in a strong financial position to continue investing in growth while enabling us to achieve cash flow break-even with cash on hand. Turning now to our outlook for the remainder of 2025, reflecting the strong momentum year to date, we now expect full-year 2025 total revenue to range from $45 to $46 million, up from our prior guidance of $42 to $44 million, which represents annual growth of 42% to 45% over 2024. With that, I'll turn the call back to Rob for a few closing remarks.

Our cash and cash equivalents as of September 30, 2025, were $137 million.

This includes growth proceeds of approximately $115 million from our July convertible note financing and IPO.

We continue to believe these funds put us in a strong financial position to continue investing and growing.

While enabling us to achieve cash flow break-even with cash on hand.

Turning now to our outlook for the remainder of 2025.

Reflecting the strong momentum here today, we now expect full-year 2025 total revenue to range from $45 million to $46 million.

From our prior guidance of 42 to 44 million, which represents annual growth of 42% to 45% over 2024.

Rob Ball: Thanks, Jeff. We are very pleased with our performance in the Q3 and see substantial runway for growth within our $2.8 billion shoulder arthroplasty market. Our disruptive ecosystem, backed by strong clinical results and improved outcomes for patients and surgeons, is addressing the existing limitations within this market and driving accelerating business momentum. Further, our unique commercial organization and proprietary business intelligence capabilities, AI-enabled preoperative software offering, and novel product suite position us well to capture share in this market, particularly as shoulder surgical care continues to grow in the outpatient settings. We appreciate your support and continued interest in Shoulder Innovations as we work towards our mission to redefine shoulder surgical care and enable best-in-class outcomes for shoulder specialists and their patients. We look forward to sharing updates with you on our progress in the quarters and years to come.

With that, I'll turn the call back to Rob for a few closing remarks.

Thanks, Jeff. We are very pleased with our performance in the third quarter and see substantial runway for growth within our $2.8 billion Plasti markets, our disruptive ecosystem backed by strong clinical results and improved outcomes for patients. Insurgents is addressing the existing limitations within this market and driving accelerating business momentum.

To further our unique commercial organization and proprietary business intelligence capabilities, AI-enabled pre-operative software, offering, and novel product suite position as well to capture share in this market, particularly as shoulder surgical care continues to grow in the outpatient settings.

Rob Ball: With that, I'll now turn the call over to the operator for Q&A. Operator?

Progress and the quarters and years to come.

With that, I'll now turn the call over to the operator for Q&A.

Operator.

Operator: Thank you. Ladies and gentlemen, if you would like to ask a question, please press star one on your telephone keypad, and a confirmation tone will indicate your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. Our first question comes from the line of Patrick Wood with Morgan Stanley. Please proceed.

Thank you.

Ladies and gentlemen, if you would like to ask a question, please press star 1 on your telephone keypad. A confirmation tone will indicate your line is in the question queue.

You may press *2 if you would like to remove your question from the queue.

For participants using speaker equipment, it may be necessary to pick up your handset before pressing the start keys.

Patrick Wood: Hey, guys. Thanks so much, and congrats on the first set of results. I love it. I'd love just to start with basically the strength of the business that we saw this quarter and how things landed versus at least your internal expectations. Would it be fair to say the volumes came in considerably ahead of where you were hoping, but the surge in engagement? I'm curious. We can all see versus what our external expectations were, but how did it land relative to how you thought things were going to pan out?

And our first question comes from the line of Patrick Wood with Morgan Stanley. Please proceed.

Hey guys, thanks so much and um, congrats on the, on the first set of results. Um, I, you know, I'd love just to start, I love it. I I'd love just to start with, basically, the strength of the business. Um, you know, that we saw this quarter and, you know, how things landed versus at least your internal expectations, would it be fair to say, you know, the volumes came in a little, you know, considerably ahead of where you were hoping but you know the surgeon engagement I'm I'm curious we can all see versus you know what RX external expectations were but how did it land relative to, you know, how you thought things were going to pan out?

Rob Ball: We obviously came away very excited, Patrick, with the way we performed. We saw performance as a function of both kind of existing customers continuing to lean in further, kind of driving those customers from that contender spot to core spot. Obviously, we share already that as we progressed through the quarter, we were able to move a number of those customers towards core and then just continue to add kind of customers before the quarter and through the quarter. Obviously, that business momentum has accelerated relative to where we were early in the year, and kind of we're obviously excited about that and are kind of planning on driving that on a go-forward basis.

You know, we obviously came away very excited, Patrick, with the way we performed. Um, you know, we saw...

The function of both, you know, kind of existing customers continuing to lean in further, kind of driving those customers from that Contender spot to Core spot. So, obviously, we share already that, as we progress through the quarter, we were able to move a number of those customers towards Core. Uh, and then just continue to have continued to add, you know, kind of customers before the quarter and through the quarter. So, um, so obviously that business momentum.

Um has accelerated relative to where we were early in the year.

You know, kind of work. Obviously excited about that.

Rob Ball: For sure, we came in strong relative to our guidance, I think that's just a function of obviously, we remain a relatively immature business as we grow, and we are continuing to reduce, I'll characterize it, standard deviation of volatility, if you will, in kind of surgeon-by-surgeon volume. Obviously, that growth helps us to kind of continue to prove the predictability of the business, so.

And our, um, you know, kind of planning on driving that on a go-forward basis. Um,

You know, for sure. Um, you know, we came in strong relative to our guidance, and I think that's just a function of, you know, obviously we remain a relatively immature business, you know, as we grow and and um, you know, we are continuing to reduce our characterize and standard deviation of of volatility if you will in in kind of surgeon, by serving surgeon volumes. And so, obviously that growth, then helps us to kind of continue to prove the predictability of the business. So,

Patrick Wood: That's awesome. Just as a quick follow-up, you obviously mentioned that the newer surgeons are ramping faster with each cohort that's coming on board. How are you guys managing that? Is that a function of getting better at onboarding people, at getting them into the ecosystem faster? What's kind of driving that?

That's awesome. Um, and that's just a quick follow-up. You know, you obviously mentioned that the newer surgeons are ramping faster with each cohort that's coming on board. You know, how are you guys managing that? Is that a function of getting better at onboarding people and getting them into the ecosystem faster? What's kind of driving that?

Rob Ball: Yeah. Thanks, Patrick. Great question. We do manage those groups, indeed, by cohorts, that's how we're able to analyze and understand that as we've produced those cohorts quarter by quarter, we are indeed driving faster ramp through the funnel, so to speak. I'd say it's a function of a number of things. One, as we mature as a business, kind of our brand equity has increased, there's a more implied trust related with that brand. I think that's one element that has been helpful. Obviously, as we have scaled our commercial organization and we've grown in our talent in that commercial organization, that group has become much, much more skilled at leveraging our business intelligence platform for a couple of things.

Yeah, thanks. Thanks, Patrick. Um, great question. So we do manage those groups indeed by cohorts, and so that's how we're able to analyze and understand that, you know, as we've produced those cohorts quarter by quarter, we are indeed driving faster ramp through the funnel, so to speak.

Rob Ball: One is to indeed identify who are the right targets to invest our time and energy in, but then also those that we have begun to make progress with, how do we cultivate the progress through the funnel for those individuals? The way those teams work together and leverage the business intelligence functions has certainly matured very nicely over the past, I'll call it, year to 18 months and has indeed caused an acceleration of our ability to grow those surgeons towards that core status, which we're after.

I'd say it's a a function of a number of things 1. As we mature as a business, kind of our brand Equity has increased, and so there's a, a more implied trust related with that brand. So I think that's 1 element that has been helpful. Um, obviously, as we have scaled, our commercial organization and we've grown in our talent and that commercial organization. Um, that group has become much, much more skilled at leveraging, our business intelligence platform for a couple of things. 1 is indeed identify who are the right targets to invest our time and energy in. But then also, um, those that we have begun to make progress with, how do we cultivate uh, that the progress through the funnel for those individuals. And so the way those teams work together and leverage the business intelligence functions has certainly matured

Very nicely over the past year to 18 months, we have indeed caused an acceleration of our ability to grow those surgeons towards that core status, which we're after.

Patrick Wood: Love it. Thanks, Jeff. Thanks, guys.

Rob Ball: Yep. Thank you.

Love it. Thanks, thanks, Jeff. Thanks, guys.

Yep, thank you.

Operator: The next question comes from the line of David Roman with Goldman Sachs. Please proceed.

The next question comes from the line of David Roman with Goldman Sachs. Please proceed.

David Roman: Thank you. Good afternoon, everyone. I appreciate all the detail and background as you kick off your first earnings call here as a public company. Maybe just to pick up a little bit here on the outlook, as I think about the comments you made about Q3 and seasonal dynamics and contrast that with how you're presenting the outlook here for Q4, it does contemplate fairly marginal sequential growth. Maybe you could just unpack some of the assumptions in the Q4 guidance, and perhaps this is also a good opportunity just to talk to us a little bit about your philosophy in setting guidance as you progress post-IPO.

to, to talk to us a little bit about your philosophy in, in, in setting guidance, as you progress, uh, post IPO

Rob Ball: Yeah. David, I'll start with that. Maybe I'll start with your last question just on kind of our philosophy. Obviously, we're going to be kind of use a disciplined, thoughtful approach to setting guidance. We're always going to incorporate the latest and best information we have available to us at the time. Keep in mind, we mentioned 2 times now our state-of-the-art business intelligence platform. We've got a significant amount of data that we utilize to help us predict and provide outlooks and forecasts. That's kind of how we build it. Obviously, we look at it a lot of different ways. I think as we look at Q4, we're using all that information to kind of build that up. Really pleased with the momentum that we have kind of coming out of Q3 into Q4.

Jeff Points: Yeah. David, I'll start with that. Maybe I'll start with your last question just on kind of our philosophy. Obviously, we're going to be kind of use a disciplined, thoughtful approach to setting guidance. We're always going to incorporate the latest and best information we have available to us at the time. Keep in mind, we mentioned 2 times now our state-of-the-art business intelligence platform. We've got a significant amount of data that we utilize to help us predict and provide outlooks and forecasts. That's kind of how we build it. Obviously, we look at it a lot of different ways. I think as we look at Q4, we're using all that information to kind of build that up. Really pleased with the momentum that we have kind of coming out of Q3 into Q4.

Yeah, so David, I'll I'll start with that. Maybe I'll start with your last question, um, just on kind of our philosophy. But obviously, we're going to be kind of use a discipline thoughtful approach to setting guidance. We're always going to incorporate the latest and best information. We have available to us at the time. Um, keep in mind, we mentioned a couple times now, our state of the art business intelligence platform. So we've got

Rob Ball: Really, our confidence in that Q4 guidance is grounded in the same drivers that have propelled us kind of through Q3 so far. We're just really executing well across the entire business, both adding new surgeons to our customer base and then seeing increased procedure volume by existing surgeons as well. We think that will obviously bode well for the rest of the year and was really how we determined the appropriate guidance for the balance of 2025.

Jeff Points: Really, our confidence in that Q4 guidance is grounded in the same drivers that have propelled us kind of through Q3 so far. We're just really executing well across the entire business, both adding new surgeons to our customer base and then seeing increased procedure volume by existing surgeons as well. We think that will obviously bode well for the rest of the year and was really how we determined the appropriate guidance for the balance of 2025.

Uh, you know, a significant amount of data that we utilize to help us, you know, predict and provide outlooks and forecasts. And so, um, that that's kind of how we build it, obviously. Look at it, a lot of different ways. And, um, you know, I think as we look at, at at Q4, we're using all that information to kind of kind of build that up, will we pleased with the momentum that we have kind of coming out of Q3 in the Q4 and and really our confidence in that Q4 guidance is grounded in the same drivers that have propelled us kind of through Q3 so far. We're just

Really executing well across the entire business, both adding new surges to our customer base and then seeing an increase procedure volume uh by existing surges as well. So we, we think that will um, probably see both well for the rest of uh, the rest of the year. And was really how we how we determine the appropriate guidance for uh the balance of 2025.

David Roman: Very helpful. Maybe, Rob, you could talk to us a little bit about you laid out some of the timelines for new product launches and allowing you to access a broader set of the market here. Maybe you could help us further think through just the ramp timelines and any framework you can help us put around the impact of new product launches. You have the shorter stem approved now. You're obviously continuing to see ProVoyance roll out, have a number of new products coming in, exiting this year, and into 2026. How should we contextualize just product launch timing and when that ultimately translates into an impact to the business?

Uh, very helpful. And maybe, uh, Rob, you could talk to us a little about you. You laid out some of the timelines for new product launches and allowing us to access a broader set of the market here, but maybe you can help us further think through just the ramp timelines and any framework you can help us, uh,

Put around the impact of new product launches, like you have the shorter stem approved. Now, your, your, your obviously, uh, continuing to see proy roll out and then have a number of new products coming in, you know, exiting this year and, and, and into 26. So, how

How should we contextualize this product launch timing, and when that ultimately translates into an impact to the business?

Rob Ball: Yeah, sure. Thanks, David. Think about three new products. You have i70. You have the i135, which is for fracture indications, and then what we call N-22 or those devices that are for the hypersensitivity to metallic alloys. I70, as I mentioned, is now in market, fully commercial launched, and we're seeing that ramp really nicely. Obviously, it's very early in that launch kind of process, and so we're not necessarily forecasting a massive bolus of growth associated with that in 2025 and think that will be more impactful in 2026. We really expect to be able to kind of begin with the i135 in what we'll characterize as a limited user release phase really early in 2026, very early in 2026. That's our intention at this point.

Yeah, sure, thanks David. Um, appreciate the opportunity to hear. Uh, so think about 3, new products, you have I70. You have the i135 is, which is for fracture indications, and then what we call in 22, or that, that those devices that are for the, um, the hyper sensitivity, uh, to metallic Alloys. Um, so I 70, as I mentioned is now in market fully commercial launched, um, and we're seeing that ramp really nicely.

Um obviously it's very early in that um, that launched, you know, kind of process. And so we're not necessarily forecasting, a massive bolus of growth associated with that in in 25 and think that will be more impactful impactful in in 2026.

Rob Ball: We would go through a limited early release phase and then transition into a full launch probably later in the first half of 2026. With the N-22, we actually have product in the warehouse today. We are completing the regulatory process so as to be able to release that product. That is something I'm hopeful very early in 2026 that we will be able to release into the marketplace. That does not warrant so much of a limited user release. It's quite a bit simpler product, I'll put it that way. We're hopeful that that can expand a little more aggressively in 2026. That gives you a good feeling.

We really expect to be able, you know, kind of begin with the i135. And what we'll characterize is a limited user release phase really early in, uh, 2026 very early in 2026. That's our intention at this point. So so we would go through a limited early release phase, uh, and then transition into a full launch, uh, probably later in the first half.

Of 26.

And then with the n22, we actually, um, have product in the warehouse today. Um, we are completing the regulatory process. So as to be able to release that product, that is something I'm hopeful very early in in 2026 that we will be able to release into the marketplace. That does not warrant so much of a, um, of a limited user release. It's a quite a bit simpler product, I'll put it that way. Um, and so we're, we're hopeful that that can can expand a little more aggressively in 2026, um, but that gives you a good feeling

David Roman: Maybe I can sneak one more in here. You talked about the summit you hosted over the weekend, which was very prominently featured by a number of your surgeon partners on social media. Can you just maybe give us your takeaways in a little bit more detail from that meeting? What were some of the highlights, especially as it relates to surgeons who are first-time being exposed to Shoulder Innovations?

And maybe I can speak one, one and one more in here. You talked about the summit you hosted over the weekend, which was very prominently featured by a number of your surgeon partners on social media. Can you just...

Yeah. Maybe give us your takeaways a little in a little bit more detail from that that that meeting and what were some of the the

Rob Ball: Yeah. I mean, as you can imagine, we came away extremely excited about the feedback we received from the meeting. We have done at least 6 of these meetings, probably more. I apologize. I don't remember the number off the top of my head. We have definitely grown with each meeting. I will characterize this was our largest by far meeting, which included a very full cadaveric laboratory session and a very, as I mentioned, robust didactic session. I'd characterize feedback from the meeting was extremely positive, with many elements of direct feedback with surgeons kind of committing like they understand and want to convert. It's been a really fun kind of couple of days coming off that time in Nashville with that group of surgeons.

Highlights, especially as it relates to surgeons, who are first time being exposed to shoulder Innovations.

Yeah, I mean as you can imagine, we came away extremely excited about the feedback we received from the meeting.

Rob Ball: Obviously, we couldn't be much more excited than the impact we expect that can have here on the next couple of Qs.

I characterize feedback from the meeting was extremely positive with many, uh, elements of direct feedback with surgeons kind of committing like, they understand and and want to convert. And so it's been a, a really fun kind of couple days coming off that that time in Nashville uh with that group of surgeons.

David Roman: Excellent. Thanks so much.

excellent. Thanks so much.

Operator: The next question comes from the line of Matthew O'Brien with Piper Sandler. Please proceed.

The next question comes from the line of Matthew O'Brien with Piper Sandler. Please proceed.

Matthew O'Brien: Good afternoon. Thanks for taking that question. I know that the unit number came in nicely above expectations, which was great to see, especially in a seasonally softer quarter. The other area that generated meaningful upside in our model was the ASP side of things. Rob, maybe talk a little bit about the mixed dynamics that you saw here in Q3 and then how do we think about that metric going forward? I'm not saying that it's going to stay at this level forever, but is this something that's somewhat sustainable in this ballpark for the next several quarters? I have a follow-up. Thanks.

Rob Ball: Yeah. Thanks, Matt. Yeah. We agree. That was a notable metric for Q3. I would characterize maybe not without intention, Matt. As I mentioned, we do leverage our business intelligence platform to target. Obviously, kind of that can mean targeting accounts where we expect to be able to garner a more profitable transaction. Clearly, some focus by our team in driving that metric was impactful and had a nicely positive result in the quarter. I mentioned already those new products. Most of them that are coming in the relative near term, all are constructed from a gross margin, really from a price standpoint. We remain quite optimistic around where ASPs can lead for us. One additional detail is that from a mixed perspective, that price was not driven by adjustments in mix from quarter to quarter.

Dude afternoon, thanks for taking the questions. Um, you know, I know that the the unit number came in nicely above expectations, which was great to see, especially seasonally uh and a seasonally software quarter. Um, the other area that was meaningfully or generated meaningful upside in our model, was the ASP side of things. So Rob, maybe talk a little bit about, um, the mixed dynamics that you saw here in Q3. Um, and then how to think about that metric going forward. I'm not saying that, you know, it's going to stay at this level forever. But is this something that somewhat sustainable in this ballpark, for the next several quarters and then I have a follow-up. Thanks.

Yeah, I think that, um, yeah, we agreed. That was a, a notable, uh, metric for, uh, Q3. And I would characterize, maybe, uh, not. Not without intention Matt. Um, so as I mentioned, we do leverage, uh, our business intelligence platform to Target and obviously, you know, kind of that can mean a targeting to council. We expect to, to be able to Garner a more profitable transaction. So um, clearly some focus by our team in driving that metric was impactful and had a, a nicely positive result in the quarter.

I mentioned already those new products, uh most of them that are coming in the relative near-term. All are constructed from a gross margin, really from a price standpoint. So we're we remain.

Rob Ball: We continue to believe that we perform very close to overall market with respect to our mix between anatomic and reverse procedures. Obviously, just as a recollection, reverse comes in a little bit higher ASP typically than anatomic does, kind of that's been constructive. I will also say that we have continued to see positive momentum as it relates to transition to ambulatory surgery centers. As most understand, we do have ever so slightly lower pricing at those ASCs. Those ASPs were improving kind of in spite of that ASC transition as well. Obviously, we're excited about that performance.

Quite optimistic around where asps uh, can lead for us. Um, 1 additional detail is that um, from a mixed perspective that price was not driven by adjustments, in mix from quarter to quarter. Uh, so we believe continued to believe that we performed very close to Market overall Market with respect to our mix between anatomic and reverse procedures, obviously, just as a recollection. Um, you know, reverse comes in a little bit higher ASP typically than an atomic does and so, um, you know, kind of, that's been that's been constructed. I will also say that we have continued to see. Um,

Positive momentum, as it relates to transition to Emily Choice, surgery centers. And as most understand we, we do have ever so slightly lower pricing at those asc's. And so those asps were improving, um,

You know, kind of in spite of that ASC transition as well. So obviously, we're we're excited about that performance.

Matthew O'Brien: Got it. Very helpful there. Then follow-up's actually for Jeff. Jeff, the EBITDA in the quarter was a little bit lower than we were looking for despite the revenue upside and the gross margin upside. Maybe just tease out some of these legal costs if you can just tell us incrementally how much higher was it. Then when might we start to see a little bit more of the leverage come through? Because again, you're making some investments at headcount, etc. When might we see some revenue upside in the quarter really translate into EBITDA upside? Thanks.

Got it. Very helpful there. And then a follow-up is actually for Jeff. Jeff, you know, um,

Rob Ball: Yeah. Matt, thank you for the question. As I mentioned, legal costs obviously kind of really accelerated here in Q3 as we get closer to that, especially the IP case going to trial here in the first half of 2026. That ramped up. That will continue into Q4 and likely into Q1. I think that obviously will persist for the next couple of quarters. I think obviously, we've got a couple of items that were fair value adjustments, both related to the convertible notes and the preferred stock warrants that also impacted EBITDA. Obviously, we will not see those again. Those are gone now between Q2 and Q3. Those also impacted adjusted EBITDA. I think as we think about it, I think on a go-forward basis, over time, we're going to see leverage in both R&D and SG&A.

Jeff Points: Yeah. Matt, thank you for the question. As I mentioned, legal costs obviously kind of really accelerated here in Q3 as we get closer to that, especially the IP case going to trial here in the first half of 2026. That ramped up. That will continue into Q4 and likely into Q1. I think that obviously will persist for the next couple of quarters. I think obviously, we've got a couple of items that were fair value adjustments, both related to the convertible notes and the preferred stock warrants that also impacted EBITDA. Obviously, we will not see those again. Those are gone now between Q2 and Q3. Those also impacted adjusted EBITDA. I think as we think about it, I think on a go-forward basis, over time, we're going to see leverage in both R&D and SG&A.

The even the quarter was a little bit lower than we were looking for, despite the revenue upside and the gross margin upside. So maybe just tease out some of these, um, legal costs. If you can just just tell us, you know, like incrementally how much higher was it. And then when might we start to see a little bit more of the Leverage, come through? Because again you're making some Investments at headcount Etc. So when might we see you know some Revenue upside in the quarter really translate into eat it upside. Thanks.

Yeah, so Matt, thank you for the question. And and um, as I mentioned legal costs, obviously kind of really accelerated here in Q3 as we get closer to that. Um, especially the IP case, uh, going to trial here in the first half of 26, that ramped up, that will continue, uh, in the Q4 and likely into q1. Um, so I I think, um, that obviously will be that will persist for the next couple of quarters. Um, and then, I think, obviously, we've got a couple of, um, items that work fair value adjustments, but

Rob Ball: I think there's going to be some quarterly fluctuations there, Matt, but I think over time, we're going to focus on driving both of those categories down as a percentage of revenue. Again, there's going to be some quarterly fluctuations here and there, but I think over time, we're going to drive that down, and that'll be a focus for us.

Jeff Points: I think there's going to be some quarterly fluctuations there, Matt, but I think over time, we're going to focus on driving both of those categories down as a percentage of revenue. Again, there's going to be some quarterly fluctuations here and there, but I think over time, we're going to drive that down, and that'll be a focus for us.

Focus for us.

Operator: The next question comes from the line of Matthew Taylor with Jefferies. Please proceed.

The next question comes from the line of Matthew Taylor with Jeffrey's please proceed.

Matthew Taylor: Hi. Good afternoon. Thanks for sending the question. This is Matt on the line for Matt Taylor. Maybe just a quick follow-up on the ASPs, which you had this quarter. Like you just mentioned, it seems to be a little bit more durable. On your 2025 guidance, when you look to increase that, could you help us maybe break down the contribution from higher ASPs versus volume growth?

Hi, good afternoon. Thanks for taking the question. This is uh, Matt on the line for uh, Matt Taylor. Maybe just a quick follow-up on the, uh, on the asps which you had this quarter and like you just mentioned, it seems to be a little bit more durable. So on your 2025 guidance, when you look to increase, that could you help us maybe break down the contribution from higher asps versus volume growth?

Rob Ball: Yeah. I think the way to think about it, our ASPs were $74.65 in Q3. That's a good proxy for how we expect that to finish in Q4. I think we've seen a nice ASP increase from Q1 to Q2 to Q3, so we've increased that throughout the calendar year. I do expect that to stay pretty similar as we go throughout Q4. Obviously, the balance of the increase would be unit increases then in Q4.

Jeff Points: Yeah. I think the way to think about it, our ASPs were $74.65 in Q3. That's a good proxy for how we expect that to finish in Q4. I think we've seen a nice ASP increase from Q1 to Q2 to Q3, so we've increased that throughout the calendar year. I do expect that to stay pretty similar as we go throughout Q4. Obviously, the balance of the increase would be unit increases then in Q4.

Yeah, I think.

These were 7,465 in Q3; that's a good proxy for how we expect that to finish in Q4. I think we've seen a nice ASP increase from Q1 to Q2 and Q2 to Q3. So we've increased that throughout the calendar year. I do expect that to stay pretty similar as we go throughout Q4, and then obviously the balance of the increase would be unit increases in Q4.

Matthew Taylor: Great. Thank you very much.

Great, thank you very much.

Rob Ball: Thank you.

Jeff Points: Thank you.

Operator: As a reminder, if you would like to ask a question, please press star 1 on your telephone keypad. The next question comes from the line of Ryan Zimmerman with BTIG. Please proceed.

As a reminder, if you would like to ask a question, please press *1 on your telephone keypad.

And the next question comes from the line of Ryan Zimmerman with btig, please proceed.

Ryan Zimmerman: Good evening and congrats on the Q1 here. Can you hear me okay, Rob and Jeff?

Rob Ball: Yeah. Thanks, Ryan.

Jeff Points: Yeah. Thanks, Ryan.

Ryan Zimmerman: Great. A couple of questions for me, and then I'll hop back in queue. One, for you, Rob, I mean, as you think about the user base, particularly those that have or use ProVoyance, I'm just curious if you could kind of talk about kind of the stickiness with which users are using your product with ProVoyance and kind of what you see in utilization with those ProVoyance users, maybe relative to the broader market. I think that would be helpful for us. The second question, Jeff, you alluded to some gross margin gains. I know those are kind of a ways away. Just curious kind of how to think about gross margin opportunities. I know ASPs are going to obviously help, but maybe more on the cost side, if there's anything to call out there or changes in timing, that would be appreciated.

Uh, good evening, and congratulations on the first quarter here. Can you hear me okay? Robin? Jeff? Yeah, thanks, Ryan. Great.

Um, so so a couple questions for me. Um, and then, you know, I'll I'll hop back in queue but, you know, 1, uh, for you Rob. I mean, as you think about the user base, you know, particularly those that have or use Provo. I'm just curious. If you could kind of talk about kind of the stickiness with which users are, um, using your, you know, product with Provo and kind of what you see in utilization. Um, you know, with those Pro voyance users, maybe relative to the broader Market, uh, I think that would, you know, be helpful for us. And then the second question, you know, Jeff, you alluded to some gross margin, gains. I know those are kind of ways away. Um, just curious kind of, you know, how to think about, uh, gross margin opportunities. I know asps are going to obviously help, but maybe on more on the cost side. Um, if there's anything to call out there changes in time in uh, that would be appreciated.

Rob Ball: Yeah. Thanks for the question, Ryan Zimmerman. Specifically, as it relates to leverage of ProVoyance, we have seen continued penetration of the use of ProVoyance as a percentage of the number of cases. How we measure that, Ryan Zimmerman, is just looking at the number of cases that are created in a quarter versus the number of units that we sell in a quarter. Transparently, we've gotten to the point where we can't really discern when cases are not planned, if that makes sense. We're actually effectively planning the same number of cases that we perform, I'll put it that way. Our belief is, by and large, to the extent that we can measure, 100% of our cases are indeed planned. I'm sure there's some puts and takes there, but it's done close.

Yeah, thanks for the question Ryan. Um,

You know, specifically as it relates to leverage of Providence, we have seen a continued penetration of the use of performance as a percentage of the number of cases. How we measure that, Ryan, is by looking at the number of cases that are created in the quarter versus the number of units that we sell in a quarter.

Rob Ball: That's been a very, very important component of our selling process, both how our sales team communicates with surgeons about use of our products, but then also as part of really the core workflow of using our products. One of the reasons for that is our implant products provide for some really special flexibility as it relates to treating complex glenoids. Use of that planning product in the context of those special treatment options is really, really helpful in a unique way. I think that's been quite important in the way that surgeon workflow operates and so has been very effective from a stickiness standpoint. Also, I want to emphasize that we don't present a typical preoperative plan platform.

And and transparently, we've gotten to the point where we can't really discern when cases are not planned at that, make sense. So we're actually effectively planning the same number of cases that we that we perform. I'll put it that way. So so our belief is by and large to the extent that we can measure. 100% of our cases are indeed planned. Um, I'm sure there's a, there's some puts and takes there, but it's, it's done close.

That's been a very, very, uh, important component of our selling process, both how our, how our sales team communicates with surgeons about use of our products. But then also uh, as part of the really, the core workflow of using our products, 1 of the reasons for that is our implant products provide for some really special flexibility as it relates to treating complex glenoid and use of that planning product in the context of those uh special. Uh, treatment options is really, really helpful in a unique way. And I think that's been very quite important in the way.

Rob Ball: We present a platform that's somewhat automated in the sense that the surgeon can operate very autonomously, and they can do that on their own without help of us as a company. That's been an important component that gives the surgeon the independence to do that planning when and where and why they want to, if you will. It has been important for us. Thanks, Ryan. Yeah. Ryan, it's just a follow-up on the gross margin question. Obviously, we're very pleased with 76.2%, very attractive gross margins. I would say longer term, we're excited about a couple of different opportunities. One is we talked about new products. They'll have a higher ASP, a higher margin profile. Those products gain traction will benefit from that. There's also cost reductions. As we kind of scale our volume, there's cost reduction opportunities with that volume.

Surgeon workflow operates. And so as has been very effective from a sticky standpoint. So, um, also I, I want to emphasize that, you know, we don't, we don't present a typical preoperative plan platform. We prevent we present an

I just wanted someone automated in the sense.

Jeff Points: Yeah. Ryan, it's just a follow-up on the gross margin question. Obviously, we're very pleased with 76.2%, very attractive gross margins. I would say longer term, we're excited about a couple of different opportunities. One is we talked about new products. They'll have a higher ASP, a higher margin profile. Those products gain traction will benefit from that. There's also cost reductions. As we kind of scale our volume, there's cost reduction opportunities with that volume.

A surgeon can operate, very autonomously. Uh, and they can do that on their own without help of us as a company. And so that's been, uh, an important component that gives the surgeon, the independence to do that planning. When and where, and why they they want to if you will. So um, it has been important for us. So thanks Ryan.

Yeah, Ryan. I just want to follow up on the grow.

Rob Ball: We've got specific cost-down projects underway that we think will start to benefit us perhaps as early as late 2026. I think all three of those, we're excited about kind of what kind of opportunity that provides for gross margin going forward.

Jeff Points: We've got specific cost-down projects underway that we think will start to benefit us perhaps as early as late 2026. I think all three of those, we're excited about kind of what kind of opportunity that provides for gross margin going forward.

Um, obviously, we were very pleased with 76.2%, very attractive gross margins. I would say, longer term, I'm more excited about a couple of different opportunities. One is, we talked about new products; they'll have a higher AFP and a higher margin profile, so the product's interaction will benefit from that. There's also cost reductions, as we kind of scale our volume; there are cost reduction opportunities with that volume. And then we've got specific cost-down projects on their way that we think will start to benefit us perhaps as early as late 2026. I think all three of those we're excited about, you know, kind of where that, um, what kind of opportunity that provides for gross margin going forward.

Matthew Taylor: Thanks, Jeff.

Thanks Jeff.

Rob Ball: Thank you.

Jeff Points: Thank you.

Thank you.

Operator: Thank you. This concludes the question-and-answer session. I'd like to turn the call back to Rob Ball for closing remarks.

Thank you. This concludes the question and answer session. I'd like to turn the call back to Rob Ball for closing remarks.

Rob Ball: Yeah. Okay. Yeah. Thanks, everybody. I appreciate the engagement. I'm hopeful we were able to answer some of your questions. Obviously, looking forward to talking again next quarter and going through our results again. Thanks much for your time. Have a great evening.

Yeah, okay, yeah, thanks, thanks. Um, thanks everybody. I appreciate the engagement. Um, I'm I'm hopeful we were able to answer some of your questions and obviously um, looking forward to

To talk again next quarter. Um again, so thanks thanks much for your time. Have a great evening.

Operator: Thank you. This concludes today's conference. You may disconnect your lines at this time. Thank you for your participation.

Thank you, this concludes today's conference. You may disconnect your lines at this time.

And thank you for your participation.

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