Shoulder Innovations Q1 2026 Earnings Report

Shoulder Innovations EPS Results

• Actual EPS: -$0.41
• Consensus EPS: -$0.44
• Beat/Miss: Beat by +$0.03
• One Year Ago EPS: N/A

Shoulder Innovations Revenue Results

• Actual Revenue: $16.71 million
• Expected Revenue: N/A
• Beat/Miss: N/A
• YoY Revenue Growth: N/A

Shoulder Innovations Announcement Details

• Quarter: Q1 2026
• Date: 5/13/2026
• Time: After Market Closes
• Conference Call Date: Wednesday, May 13, 2026
• Conference Call Time: 4:30PM ET

Shoulder Innovations (NYSE:SI) (NYSE:SI) is a medical device company focused on the design, development and commercialization of shoulder implant systems and related surgical instruments for orthopedic surgery. The company’s product portfolio includes modular shoulder prostheses, humeral and glenoid components, and instrumentation kits designed to facilitate both primary and revision shoulder arthroplasty procedures. Emphasizing a patient-centric approach, Shoulder Innovations works to offer implant solutions that aim to restore mobility and reduce post-operative complications.

In addition to its core implant offerings, Shoulder Innovations provides comprehensive clinical support and training programs for surgeons and operating room teams. The company collaborates with leading orthopedic specialists to refine surgical techniques, develop new implant geometries and conduct outcome studies. Its research and development efforts focus on advanced materials, biomechanical testing and minimally invasive procedures to improve implant longevity and patient recovery times.

Headquartered in the United States, Shoulder Innovations markets its products through a network of direct sales professionals and distribution partners to hospitals and surgical centers nationwide. The company is led by a management team with extensive experience in medical device development, regulatory affairs and orthopedic innovation. By investing in strategic partnerships and continuing education initiatives, Shoulder Innovations aims to drive growth and advance standards of care in shoulder reconstruction.

Shoulder Innovations Q1 2026 Earnings Call Transcript

Key Takeaways

• Positive Sentiment: First-quarter revenue beat expectations, with net revenue of $16.7 million up 65% year over year and 16% sequentially, while gross margin improved to 77.7%.
• Positive Sentiment: The company raised full-year 2026 revenue guidance to $65 million-$68 million, up from $62 million-$65 million, reflecting confidence in new surgeon adoption, higher utilization, and product launches.
• Positive Sentiment: Commercial momentum remained strong as total implant volume rose 51% year over year, with new customers entering the funnel faster and existing core surgeons increasing usage.
• Positive Sentiment: The company advanced its product pipeline, including full commercial launch of the i135RFX humeral stem, limited user release of the N22 Glenosphere, and progress on its robotic platform with a 510(k) submission targeted for 2027.
• Neutral Sentiment: Operating expenses increased, with SG&A and R&D both higher year over year, but management said cash burn should decline meaningfully from Q2 onward and reiterated confidence in reaching cash flow breakeven over time.

Presentation

[Sam Bentzinger, Investor Relations Representative at Shoulder Innovations]

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 the first quarter ended March 31st, 2026. A copy of the press release is available on the investor relations section of the company's website.

[Sam Bentzinger, Investor Relations Representative at Shoulder Innovations]

Before we begin, I'd like to remind you that management will make remarks during this call that constitute forward-looking statements within the meanings 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.

[Sam Bentzinger, Investor Relations Representative at Shoulder Innovations]

These statements involve material risks and uncertainties that could cause actual results of the risks and uncertainties associated with our business. Please refer to the Risk Factors section of our most recent annual report on Form 10-K 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.

[Sam Bentzinger, Investor Relations Representative at Shoulder Innovations]

This non-GAAP information should not be considered in isolation or as a substitute for or superior. This conference call contains time-sensitive information and is accurate only as of the live broadcast today, May 13th, 2026. 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'll turn the call over to Rob.

[Rob Ball, CEO at Shoulder Innovations]

Thanks, Sam. Good afternoon, everyone, and welcome to our first quarter earnings call. I'm very pleased to report that 2026 is off to a strong start. Through the first few months of the year, we've rapidly onboarded new surgeons, deepened utilization within our existing customer base, and achieved several important product milestones. This performance reflects intensifying momentum across our entire organization, which enabled us to deliver first quarter net revenue of $16.7 million, an increase of 65% year-over-year and 16% sequentially. First quarter gross margin also came in strong at 77.7%. We see further opportunity for expansion as the organization continues to mature.

[Rob Ball, CEO at Shoulder Innovations]

Given the strength of these results, our growing scale, and the efficiency of our commercial organization more broadly, we have increased conviction in the trajectory of our business, and as a result, we are raising our full year 2026 net revenue guidance today to a range of $65 million-$68 million, representing growth of 37%-44% over 2025. This compares to our prior range of $62 million-$65 million or 31%-37% growth. Jeff will provide additional color on our outlook shortly.

[Rob Ball, CEO at Shoulder Innovations]

Our ability to deliver this growth in 2026 is grounded in the same three strategic priorities we discussed in our last two calls, which 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.

[Rob Ball, CEO at Shoulder Innovations]

This includes both expanding indications and enabling technology. We've made meaningful progress on all three priorities in the first quarter, which I'll walk through now. Let me start with new surgeon adoption. Our W-2 commercial leadership organization remains laser-focused on the roughly 1,800 high-volume shoulder specialists in the U.S., and that targeted approach continues to translate into rapid growth in our customer base of core and contender surgeon customers.

[Rob Ball, CEO at Shoulder Innovations]

We are very pleased with the new surgeon adoption trends we're seeing through the early part of 2026, and we expect that momentum to be durable throughout the year. As a reminder, we ended 2025 with 134 core and contender surgeons, up 61% year-over-year, and we'll update that figure on an annual cadence. Surgeon adoption continues to be driven by focused execution from our commercial leadership team, supported by our proprietary business intelligence platform. We are increasingly seeing the brand awareness we've built in the market over the past year compound that effort. Finally, we're benefiting from the accelerating productivity gains within the W-2 commercial leadership cohort hired in 2025.

[Rob Ball, CEO at Shoulder Innovations]

To capitalize on this growing momentum, we again added top talent to our commercial leadership team through Q1 to support further scaling of our business, particularly as we secure additional hospital approvals in key new territories. We are making progress with activating these markets and believe there is significant greenfield opportunity remaining across the U.S. for our team to target.

[Rob Ball, CEO at Shoulder Innovations]

We look forward to the contributions from these new commercial leaders as they ramp over the next couple of quarters and build deeper relationships within their territories. Meanwhile, we've continued to invest in our unique high touch surgeon-to-surgeon education programs facilitated by our Customer Experience and Medical Education team. We are seeing tangible results in terms of new surgeon adoption coming out of these sessions and increasingly view them as an integral part of our broader commercial strategy.

[Rob Ball, CEO at Shoulder Innovations]

Excluding industry meetings, our CEME team conducted 44 total SI-sponsored educational events in first quarter. In the peer-to-peer dynamic, these events generates organic advocacy that compounds across the shoulder surgical community. Most recently in April, we hosted our first national symposium of 2026 in Napa Valley. Surgeon attendance was up over 70% versus last year's event, making it the largest symposium in SI's history since we launched the program four years ago.

[Rob Ball, CEO at Shoulder Innovations]

These symposiums combine didactic content, case-based discussion, and hands-on experience with our InSet shoulder arthroplasty portfolio and ProVoyance preoperative planning platform, with curriculum designed, written, and proctored all by surgeons. The consistent positive feedback we received in terms of generating interest among new surgeons and helping to drive our second key strategic priority of increasing utilization and procedural growth within our customer base.

[Rob Ball, CEO at Shoulder Innovations]

For example, of the attending surgeons at our Napa course who are not already core or contender customers, more than 70% have already either performed their first case with our system, committed to their first case, or committed to increasing volume, and that progression has occurred in just a few weeks since the meeting. Looking at the first quarter specifically, total implant volume across our core contender and prospect customers increased 51% year-over-year to 2,184 units.

[Rob Ball, CEO at Shoulder Innovations]

Has been the case in recent quarters, this volume growth reflected a combination of several additional compelling dynamics. First, surgeons are entering our new customer funnel faster. In fact, in the first quarter, we more than doubled the number of new customers entering our funnel as compared to the first quarter of 2025.

[Rob Ball, CEO at Shoulder Innovations]

Surgeons are scaling through the funnel from prospect to contender to core at a faster pace. Third, we're seeing increased volume from existing surgeons within their current prospect, contender, and core categories. Within these dynamics, the standout signal is that our highest growth surgeon category in first quarter was core, both year-over-year and sequentially, which is the strongest core status.

[Rob Ball, CEO at Shoulder Innovations]

Importantly, even as we rapidly added core surgeons, we've continued to see increases in units per surgeon both year-over-year and sequentially in that category. This is particularly meaningful proof point. New entrants to the core category typically join at the lower end of the volume range, which would normally compress the average. Our highest volume core surgeons more than offset that dynamic, demonstrating that our existing core surgeons are continuing to grow their utilization even as the segment expands.

[Rob Ball, CEO at Shoulder Innovations]

To ensure we continually equip these surgeons in best-in-class product portfolio, we've also remained focused on our third strategic priority of developing and launching new technologies to address the remaining unmet needs of patients and surgeons, both through new indications and enabling technology. We've had an active few months on this front to start the year, and I want to highlight a couple specific areas of progress.

[Rob Ball, CEO at Shoulder Innovations]

Starting with new indications, consistent with our prior communicated timing, we initiated a limited user release of our i135RFX products in early Q1. We recently expanded the indication to include more complex fractures, and two weeks ago, we announced the transition of our InSet 135 RFX humeral stem from limited user release to full commercial launch following receipt of that expanded clearance from FDA.

[Rob Ball, CEO at Shoulder Innovations]

With this broader label, the i135 now addresses primary revision and fracture total shoulder arthroplasty cases, and equally important, its addition to our portfolio means that Shoulder Innovations can now nearly support the full spectrum of shoulder arthroplasty procedures our surgeon customers perform in both the operating room and ambulatory surgery settings. The i135 joins the smaller form factor i195 and i70, launched in 2024 and 2025 respectively, as the third addition to the I-Series humeral stem product line.

[Rob Ball, CEO at Shoulder Innovations]

Consistent with those earlier launches, the i135 is built on our exclusive InSet lateral-lateral implant philosophy, which independent peer-reviewed research has shown reduces complications and maximizes postoperative range of motion. To date, surgeons have used the i135 in both anatomic and reverse shoulder arthroplasty configurations, and consistent feedback has highlighted its ease of use, straightforward surgical technique, and seamless integration with our two-tray surgical instrumentation system.

[Rob Ball, CEO at Shoulder Innovations]

Underpinning the clinical confidence behind the 135 and our entire implant portfolio is the real-world evidence we're building through our clinical data registry. We've now enrolled over 500 patients across both anatomic and reverse shoulder arthroplasty configurations. We continue to believe this registry will generate a robust body of evidence that strengthens our position with surgeons, health systems, and patients over time.

[Rob Ball, CEO at Shoulder Innovations]

Separately, on the new product front, we initiated a limited user release of our N22 Glenosphere in first quarter and have been pleased with its reception so far. As a reminder, the N22 is the first introduction in our new line of technologies designed for patients with metal hypersensitivity who may experience adversity associated with allergic reactions from metal implants.

[Rob Ball, CEO at Shoulder Innovations]

We view this as an exciting incremental addressable market and look forward to providing further updates on our full launch plans in the months ahead. Turning now to enabling technology. Since announcing in December our strategic partnership with Interventional Systems to introduce the mid- and longer-term economic and competitive opportunities associated with this technology.

[Rob Ball, CEO at Shoulder Innovations]

As a reminder, the solution is designed to integrate directly with our ProVoyance platform to deliver a seamless enabling technology experience from preoperative planning through intraoperative execution, allowing surgeons to plan in ProVoyance and deploy that plan in the operating room as a single connected workflow. In March, we performed yet another cadaver lab which further reinforced our conviction that Interventional Systems technology is indeed the right product for this robotic application in shoulder arthroplasty.

[Rob Ball, CEO at Shoulder Innovations]

This particular cadaveric session encompassed the entire procedure, beginning with a CT scan through ProVoyance, through operating the robot, placing the device in a cadaveric specimen as intended. Product development for the robotic solution is progressively slightly ahead of schedule. We are targeting 510(k) submission in 2027. We look forward to sharing additional updates regarding timing and product features on our future earnings call this year.

[Rob Ball, CEO at Shoulder Innovations]

As a final note, and stepping back across everything we've discussed today, we are increasingly finding that focused shoulder-specific nature of our ecosystem is attracting interest from partners who see the value in reaching this market through us, and that excitement is only growing as we scale, whether through programs like our robotic development initiative or best-in-class implant portfolio or the strong clinical outcome surgeons are achieving with our products.

[Rob Ball, CEO at Shoulder Innovations]

As we look ahead, we are excited about a number of near-term opportunities we see to further expand the breadth of our shoulder solutions we offer surgeons and patients, both through our own innovative vision through the relationships that market leadership attracts. We look forward to sharing more updates on these opportunities in coming quarters. With that, I'll now turn the call over to Jeff to review our first quarter results in more detail and provide an update on our outlook for 2026.

[Jeff Points, CFO at Shoulder Innovations]

Thanks, Rob. Good afternoon, everyone. As Rob mentioned, net revenue for the first quarter of 2026 was $16.7 million, a 65% increase from $10.1 million in the prior year. Our unique commercial model and proprietary business intelligence capabilities drove continued commercial expansion in the first quarter, resulting in increased adoption of our implant systems across new and existing surgeons.

[Jeff Points, CFO at Shoulder Innovations]

Gross margin for the first quarter of 2026 was 77.7% compared to 76.9% in the prior year. The improvement was driven by improved ASPs along with benefits from cost reduction programs. Selling general and administrative expenses in the first quarter of 2026 were $18.2 million, compared to $10.5 million in the prior year.

[Jeff Points, CFO at Shoulder Innovations]

The increase in SG&A expenses was primarily driven by increased headcount in the commercial organization, higher variable selling expenses, and increased professional service fees related to our transition to a public company. SG&A expenses have continued to decline as a percentage of revenue over the last few quarters, declining from 128% of revenue in Q3 of 2025 to 109% in Q1 of 2026, demonstrating our ability to drive operating leverage alongside our accelerated revenue growth.

[Jeff Points, CFO at Shoulder Innovations]

While this trend may not continue in every sequential quarter going forward, we're focused on balancing ongoing investments in our commercial organization with improving operating leverage and increasing productivity. Research and development expenses in the first quarter of 2026 were $3.8 million, compared to $1.6 million in the prior year.

[Jeff Points, CFO at Shoulder Innovations]

The increase was primarily driven by investment in new product development efforts, including a second milestone payment and development costs related to the robotic platform strategic partnership. Net loss in the first quarter of 2026 was $8.4 million, compared to a loss of $4.7 million in the prior year.

[Jeff Points, CFO at Shoulder Innovations]

The adjusted EBITDA loss in the first quarter of 2026 was $7.0 million, compared to a loss of $3.5 million in the prior year. The increase in both net loss and the adjusted EBITDA loss were primarily related to the increase in the aforementioned operating expenses. Our cash and cash equivalents as of March 31st, 2026, were $108.5 million.

[Jeff Points, CFO at Shoulder Innovations]

As mentioned in March, we are proactively increasing our inventory and asset purchases in the first half of the year to ensure preparedness for accelerated growth. This, combined with working capital changes, contributed to our cash burn in the first quarter. Looking ahead, we expect to see significantly lower cash burn starting in Q2 and continuing through the balance of 2026.

[Jeff Points, CFO at Shoulder Innovations]

We continue to believe we are in a strong financial position to continue investing in growth while maintaining our ability to achieve cash flow breakeven with cash in hand. Turning now to our guidance and outlook for 2026. On the top line, we expect full year 2026 net revenue to range from $65 million-$68 million, representing growth of 37%-44% year-over-year.

[Jeff Points, CFO at Shoulder Innovations]

This guidance reflects our continued high degree of conviction in our ability to deliver industry-leading growth by driving adoption among new surgeons, increasing penetration in our existing surgeon customer base, and through commercial launches of new products. In addition, guidance accounts for seasonal dynamics that are typical in our industry, specifically lower sequential volumes in Q3 2026, noting there could be some quarter-to-quarter fluctuations based on product mix and ASP.

[Jeff Points, CFO at Shoulder Innovations]

Cost down initiatives remain a significant focus and area of progress, and we're confident they will continue to drive further gross margin improvement as we further scale our business. At our current full-year revenue guidance, we expect SG&A expenses as a percentage of revenue to increase slightly from Q1. As our conviction around business growth increases, we will continue to identify and invest in greenfield opportunities across new geographic areas for commercial team footprint expansion.

[Jeff Points, CFO at Shoulder Innovations]

Specifically, we expect this increase in SG&A expenses as a percentage of revenue will be more significant in Q2 and Q3 before declining in Q4. Finally, with currently contemplated innovation programs, we expect R&D expenses as a percentage of revenue to moderate late in 2026. With that, I'll turn the call back to Rob for a few closing remarks.

[Rob Ball, CEO at Shoulder Innovations]

Thanks, Jeff. In sum, the first quarter was a strong start to 2026 across every dimension of the business. We grew net revenue 65% year-over-year, expanded gross margin, rapidly onboarded new surgeons, deepened utilization within our existing base, and advanced several meaningful product milestones, all while continuing to build the clinical, commercial, and product foundation that we believe will be drive durable above market growth for years to come.

[Rob Ball, CEO at Shoulder Innovations]

The commercial organization we build is performing. The market opportunity in front of us remains large and under-penetrated. The confidence we have in our team that through our continued performance throughout 2026 and beyond. With that, I'll now turn the call over to the operator for Q&A. Operator?

[Operator]

Thank you. At this time, we'll conduct the Q&A session. If you would like to ask a question, please press star one on your telephone keypad. 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. One moment please while we pull for questions. Your first question comes from David Roman with Goldman Sachs. Please state your question.

[David Roman, Analyst at Goldman Sachs]

Thank you. Good afternoon, everyone. Maybe we could just dive into the results here for Q1 in a little bit more detail. As you kind of reflect on the sequential and year-over-year improvement here in growth, can you just maybe detail from your perspective what you saw transpire throughout the quarter and to what extent that is the result of product launches, commercial execution? I'm sure it's some combination of all of the above, but maybe you just break down what you think helped support such a significant inflection here on a sequential basis. I had one follow-up on the outlook.

[Rob Ball, CEO at Shoulder Innovations]

Sure. Thanks, David. Appreciate the question. We certainly saw contributions in our growth in Q1 from all segments that you described. Obviously, the key priorities that I described in the call, you know, kind of are the key ones that are driving the growth. You know, kind of we're executing as expected. New customer growth is obviously a meaningful contributor to what's driving growth and what drove growth in Q1. That was also supported by, you know, kind of very nice volume increases from our existing customer base, and some additional increase we associated with, you know, average selling prices as well. So all of those were key components of growth.

[Rob Ball, CEO at Shoulder Innovations]

You know, I'd characterize that that's all a function of just downright excellent execution across the entire organization, particularly in the commercial organization and the way that they work together with the CEME team, you know, kind of leveraging our business intelligence platform or identifying the right targets to invest and spend time on. That's just producing results, quite frankly.

[David Roman, Analyst at Goldman Sachs]

That's helpful perspective. Maybe if I kind of translate that into the outlook here, appreciating Jeff's comments on seasonality for Q3. as I look at the number here in Q1 and try to kind of square that with the guidance you're given, even when considering the seasonality dynamic, it does look like a relatively conservative representation of the outlook. maybe you could help us understand, of the things that you saw go well in Q1, what have you translated to the balance of the year? What have you sort of risk-adjusted in your outlook, and how are you thinking about them?

[Jeff Points, CFO at Shoulder Innovations]

As we set that annual guidance number, it's a number that we have high conviction around when we set that. Again, there's lots of variables and inputs that will go as we've kind of set the annual guidance number.

[David Roman, Analyst at Goldman Sachs]

Okay. Maybe just if I could just push there just a little bit more. Is there anything here that you're It doesn't sound like you're seeing anything in the business that would contemplate a worsening of those metrics. This just happens to be in early in the year, so you're taking a balanced approach. Is that a fair way to summarize the outlook?

[Rob Ball, CEO at Shoulder Innovations]

I think that's very fair. I mean, I think we're providing guidance that we have a very, very high degree of conviction in. We obviously are, you know, kind of excited about the performance we were able to deliver in Q1, and we don't see, we don't have any view of any perspectives in the marketplace today that, you know, kind of fundamentally change, you know, our view on the trajectory of the business.

[David Roman, Analyst at Goldman Sachs]

Great. Very helpful. Nice to see the momentum here.

[Rob Ball, CEO at Shoulder Innovations]

Great. Thank you.

[Jeff Points, CFO at Shoulder Innovations]

Thank you.

[Operator]

Your next question comes from Ryan Zimmerman with BTIG. Please state your question.

[Ryan Zimmerman, Analyst at BTIG]

Thank you for taking the questions, and congrats on the quarter here. You know, kind of lifting off where David finished on the quarter. I'm just wondering, you know, Rob, you're getting really good growth, and you're getting really good conversion in your core contender segment of the business. As you scale, I have to imagine, and I, you know, appreciate your thoughts on this, that there is a bit of a broadening of the customer base. You know, as I think about, you know, this kind of contribution from, you know, the prospects or the non-core contenders, how do you see that, you know, changing over time?

[Rob Ball, CEO at Shoulder Innovations]

I think, Ryan, appreciate the question first. It may be well-received if we were a lot further ahead of where we are right now. I mean, we've characterized the market as we're focused on high-volume surgeons. There's 1,800 of those. Obviously, we reported at the end of last year 134 core and contender. We just perceive ourselves as having a long, long way to go. I'd also like just to characterize that we are focused on building a platform here. This isn't a product. We see that platform as a substantial foundation through which to continue to deliver both arthroplasty and other products.

[Rob Ball, CEO at Shoulder Innovations]

Not only do we see, you know, that opportunity for growth in continuing into that core and contender network in a, in a meaningful way, you know, we believe we'll be able to continue to drive additional revenues through that channel as time goes on. Hopefully that's helpful.

[Ryan Zimmerman, Analyst at BTIG]

That is. You know, the ASPs were ahead of where we thought they would be. Is that a reflection of new indications and higher ASPs per case? Is that a reflection of a higher mix of reverse shoulders? What do you think about the durability of the ASP this quarter relative to the balance of the year?

[Rob Ball, CEO at Shoulder Innovations]

Yeah. I'll make a couple comments here on, you know, from a, from a product perspective and let Jeff follow up on his thoughts on durability based on the metrics. You know, I've shared in the last couple calls that we have been focused on delivering improvement in the Average Selling Prices. We've indeed focused there and have executed there. That's through a function of identifying the right centers to spend time on where we can derive higher prices. I'd also say it's a function of our commercial organization becoming more skilled at navigating the negotiation with those centers and selling into the SKUs, if you will, that augment price. I'll put it that way.

[Rob Ball, CEO at Shoulder Innovations]

That's been a really helpful dynamic as we've learned as an organization collectively on how to do that well. That's obviously resulted in a great outcome here. I think we are, I'd characterize, as just ever so slightly ahead of schedule as it relates to new products in Q1. I'd characterize, as I have before, that those products do have higher ASPs, and that contributed in a very small way in Q1 to the average selling prices. We're hopeful that can have a more meaningful contribution in outyears. I'll put it that way. More so in 2027, if you will. It did play a very small role here in the quarter. Jeff, I'll let you.

[Jeff Points, CFO at Shoulder Innovations]

Yeah. I'll just say, Ryan, that I would expect there'll be some variation as we go forward in ASPs. Obviously, we saw a really nice increase here in Q1, which contributed to just gross margins as well. I mean, the higher ASPs along with the cost down programs kind of starting to kick in, improved gross margins. I would expect these ASPs to kind of stay in this neighborhood as we go throughout the rest of the year.

[Ryan Zimmerman, Analyst at BTIG]

Very helpful. Thank you. Nice quarter.

[Rob Ball, CEO at Shoulder Innovations]

Thank you.

[Jeff Points, CFO at Shoulder Innovations]

Thank you.

[Operator]

Your next question comes from Matt Taylor with Jefferies. Please state your question.

[Matt Taylor, Analyst at Jefferies]

Hi, thanks for taking the question. Can you hear me okay?

[Rob Ball, CEO at Shoulder Innovations]

I hear you great.

[Jeff Points, CFO at Shoulder Innovations]

Hey, Matt.

[Rob Ball, CEO at Shoulder Innovations]

Thanks, Matt.

[Matt Taylor, Analyst at Jefferies]

Great. Thank you, guys. Yeah, I just wanted to double-click on, you made a lot of comments about the robotic system and the progress you're making there. Maybe you could just talk about how you're expecting that to start to contribute either to the stickiness of your business or your ability to drive even more share and give some thoughts on how it's really differentiated from some of the other solutions in the market.

[Rob Ball, CEO at Shoulder Innovations]

Sure. Appreciate the question, Matt. I think, you know, kind of I'll start with the end of your question first. You know, from a differentiation standpoint, we were focused on a number of things to deliver to the market with respect to robotic-enabled surgery. Indeed, I think we're accomplishing that. One is we wanted to develop a platform that was completely time-transparent, leveraged the exact same surgical techniques that surgeons use today, so there was no ambiguity about the fact that we could indeed drive optimized outcomes. That is a key differentiator for us. It's a very simple platform that indeed will be time-transparent.

[Rob Ball, CEO at Shoulder Innovations]

The second differentiator we wanted to make sure that we delivered was the fact that the system was kind of able to provide a fundamentally different economic model to the marketplace, more thought of as Robotics as a Service instead of a capital acquisition. That requires that it be a portable platform, and indeed, that is indeed what we're delivering. We will provide the robotic on an event-by-event basis in a case about the size of a carry-on suitcase, you know? I think those are two components of differentiation that are particularly special as it relates specifically to the shoulder arthroplasty market that's gonna, you know, kind of provide a lot of traction.

[Rob Ball, CEO at Shoulder Innovations]

I'd characterize that as we have continued to do customer discovery with those differentiators in the marketplace, we have received a resounding yes as it relates to, You know, one of which has been, engaging with our current surgeon customers about the excitement of that future and them being excited about what that means for their own practice and, indeed, them kind of imagining what that means for their practice.

[Rob Ball, CEO at Shoulder Innovations]

From a, from a brand, equity and a stickiness standpoint, it's been powerful. I'd say another impact of that, platform has been, really, quite frankly, an entirely new innovation cycle that we consider, built around robotics, which I think is gonna be quite exciting. I've shared a little bit about that recently, and I'm planning here to share more in the next couple quarters in more detail.

[Matt Taylor, Analyst at Jefferies]

Great. Thanks, Rob.

[Operator]

Your next question comes from Matthew O'Brien with Piper Sandler. Please state your question.

[Matthew O'Brien, Analyst at Piper Sandler]

Good afternoon. Thanks for taking the questions. I mean, just to follow up a little bit on both David and Ryan's questions on the, on the outlook for the year increase and Jeff, based on what you're saying on the, on the pricing side, it seems like most of the bump is just due to price over the next several quarters. It seems like the volumes are, again, much better than we were modeling in Q1. Is there something else you're factoring into the guide?

[Matthew O'Brien, Analyst at Piper Sandler]

I don't know if it's the robotic, you know, competition or any sales churn or something else that we're just not thinking about that would, you know, potentially impact the outlook for the year. You know, to David's point is that, hey, we're still early in the year, and we're just trying to be as conservative as possible.

[Jeff Points, CFO at Shoulder Innovations]

Thanks, Matt, for the question. In my prepared remarks, I talked about seasonality in Q3. That's obviously very common for our industry. We would expect Q3 to be lighter and then have a step up in Q4. I will say as well that our ASP is somewhat dependent on the reverse percentage, so that obviously is a little bit lower as you get later in the year due to payer mix. We saw that in Q4 of 2025. We'd expect to see the same in 2026. We should kind of remain durable for the ongoing foreseeable future, and we're feeling really good about the business.

[Rob Ball, CEO at Shoulder Innovations]

For sure. We are feeling good about the business. I'll just double-click on something that Jeff said in the prepared remarks that we have deployed a fair amount of cash here in Q1 related to both, you know, kind of inventory and assets and leaning into the commercial organization. I'd characterize that the purpose for that is being very prepared for above expectations growth and to find ourselves not in a circumstance where we can't support a business that continues to accelerate. You know, I'll just, you know, kind of emphasize that indeed we prepared ourselves for the opportunity that things go a lot faster and to make sure that we aren't constrained in our ability to support, you know, even higher levels of growth.

[Matthew O'Brien, Analyst at Piper Sandler]

Got it. Very clear. Thanks, Rob. Then, Jeff, on the gross margin side and the update tonight, you know, well above what we were modeling for gross margin here in Q1 and, you know, a stable outlook there. I don't wanna go out too far, but just looking at that metric, looking at some of the leverage we saw in SG&A specifically in Q1, then, you know, your commentary about R&D ramping down later this year. Are we getting to the point where we can start talking about Shoulder reaching, you know, EBITDA profitability maybe earlier than other orthopedic companies historically have? You know, kind of TBD there? Thanks.

[Jeff Points, CFO at Shoulder Innovations]

Yeah. Obviously, Matt, we're not providing any sort of threshold on that, but you know, we're not providing a revenue threshold or a timeline. Obviously, with the profile that we have, you've got a really strong margin profile. Obviously, we're starting to see leverage in kind of the SG&A line. We're demonstrating that. You know, we believe we're on track for that, and we're balancing our investments that we're making with long-term profitability. So you'll likely over time see continued progress in that, in that area.

[Rob Ball, CEO at Shoulder Innovations]

Yeah. I'll lean into that a little bit harder. I'd say that, you know, I don't know, Matt, what compared to others means, but I will say we have passion around the fact that we've constructed a highly capital-efficient business that drives above-market gross margins, and the natural consequence of building a business like that is above-market performance as it relates to EBITDA. I mean, that's by design. That's our intent here.

[Matthew O'Brien, Analyst at Piper Sandler]

Okay. I mean, I can be more specific, Rob. I mean, it's like $200 million-$250 million historically most of these companies turn profitable. I don't wanna put a number out there for you, but it would seem like you're likely earlier than that.

[Rob Ball, CEO at Shoulder Innovations]

I We're not gonna put a number on it either, Matt. I'd say most particularly because to the extent that we are effectively deploying capital, we're gonna continue to effectively deploy.

[Operator]

Here and there are no further questions at this time. I'll hand the floor back to Rob Ball for some concluding remarks. Thank you.

[Rob Ball, CEO at Shoulder Innovations]

Thank you very much, operator. Just appreciate everyone engaging today. Appreciate the questions from the analysts. I'm hopeful that we've provided you some encouraging news around our trajectory, and we're excited to share again with you here in a couple months. Everyone have a great afternoon.

[Operator]

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

Participants

Executives

• Jeff Points, CFO
• Rob Ball, CEO
• Sam Bentzinger, Investor Relations Representative

Analysts

• David Roman, Analyst at Goldman Sachs
• Matt Taylor, Analyst at Jefferies
• Matthew O'Brien, Analyst at Piper Sandler
• Ryan Zimmerman, Analyst at BTIG