SiBone NASDAQ: SIBN raised its full-year 2026 outlook after reporting double-digit revenue growth in the first quarter, with management pointing to new product launches, expanding physician adoption, international momentum and a proposed Medicare reimbursement change as key drivers for the year ahead.
The medical device company reported worldwide revenue of $52.6 million for the quarter ended March 31, 2026, up 11.2% from the prior-year period. U.S. revenue rose 10% to $49.3 million, while international revenue increased 33.9% to $3.3 million.
Chief Executive Officer Laura Francis said the quarter reflected progress across SiBone’s platform strategy, including its focus on technologies for patients with compromised bone. “We have never been better positioned as we accelerate growth through 2026 and into 2027,” Francis said.
Revenue Growth and Profitability Improve
SiBone said gross profit increased 11.3% to $41.9 million, while gross margin was flat year over year at 79.8%. Management said the margin performance reflected better-than-anticipated average selling prices from favorable procedure mix and benefits from operational efficiency initiatives.
Operating expenses rose 4.1% to $47 million, a pace below revenue growth. Francis said the company’s operating expense growth represented “nearly 2.5x operating leverage.” The company’s net loss narrowed to $4.3 million, or $0.10 per diluted share, compared with a net loss of $6.5 million, or $0.15 per diluted share, in the prior-year quarter.
Adjusted EBITDA was $2.5 million, compared with $0.5 million in the first quarter of 2025. Free cash flow was negative $3.4 million, improving 50.7% from the prior year. The company ended the quarter with $144.7 million in cash and marketable securities.
Management noted that first-quarter results were modestly affected by weather disruptions early in the period and by the company’s decision to pace trauma distributor onboarding while finalizing its partnership with Smith+Nephew. In response to an analyst question, management estimated the weather-related impact at about $500,000 and said much of that volume is typically recaptured within roughly 60 days.
Guidance Raised for 2026
SiBone increased its full-year revenue guidance to a range of $230 million to $233 million, implying year-over-year growth of about 14% to 16%. The company also raised its full-year gross margin expectation to approximately 79%, up 100 basis points from prior guidance.
Management said revenue growth is expected to accelerate as the year progresses, with a more pronounced impact in the second half from product launches, commercial expansion and geographic initiatives. Full-year operating expenses are expected to grow approximately 12.5% at the midpoint of revenue guidance.
In the question-and-answer session, management said the guidance increase was consistent with the company’s “disciplined approach” early in the year, while noting potential upside from INTRA Ti, the Smith+Nephew partnership, proposed reimbursement changes and a planned fourth-quarter launch of a third Breakthrough Device Designation product.
Product Launches and Pipeline Remain Central
Francis highlighted several recent product and market developments, including the launch of INTRA Ti, a 3D titanium solution within SiBone’s sacroiliac joint portfolio. She said INTRA Ti is intended to align with interventional physician workflows and outpatient sites of care, while also serving surgeons.
The company also introduced TNT TORQ in Europe and launched TORQ in Australia. Francis said TNT TORQ expands the company’s pelvic trauma portfolio in Europe, while TORQ gives SiBone a “beachhead” in pelvic fixation in Australia.
SiBone said its third Breakthrough Device Designation product is progressing on schedule, with verification and validation nearing completion and a 510(k) submission targeted for the early third quarter. Francis said the company expects a commercial launch in the fourth quarter, depending on timing, and described the technology as addressing a significant unmet need in spine surgery.
Francis said the new product could be used by spine surgeons in procedures they already perform and may be used in the same cases as Granite, the company’s spinopelvic fixation product. She said that could increase surgeon engagement and procedure density among existing customers.
CMS Proposal Could Support Granite Adoption
A major focus of the call was a proposed reimbursement change from the Centers for Medicare & Medicaid Services. Francis said CMS has proposed creating new diagnosis-related group families for extensive or complex spinal fusion procedures, including procedures that incorporate Granite.
SiBone had previously requested that CMS assign pelvic fixation procedures using Granite to higher severity levels within existing DRGs. Francis said CMS instead proposed new DRG families after analyzing the complexity and cost profile of the procedures.
“We appreciate the acknowledgment by CMS of the higher procedure complexity in cases where Granite is used,” Francis said. She added that the proposed change could increase average hospital payment by as much as $50,000 per procedure, depending on patient diagnosis and severity, and would take effect Oct. 1 if finalized.
Francis said the proposed reimbursement would help remove cost as a potential objection for hospitals and support long-term access to Granite. In the Q&A session, she said the proposed new DRGs are “significantly better” than what the company requested and described the change as a “very significant and underappreciated tailwind.”
Physician Engagement and Commercial Expansion
SiBone reported more than 1,650 active physicians in the quarter, up more than 17% year over year. Francis said the company has now posted 20 consecutive quarters of double-digit physician growth.
The company ended the quarter with 89 quota-carrying territory managers. Annual revenue per territory was $2.2 million, up 11% from the prior year, marking the 14th consecutive quarter of double-digit territory productivity growth. Francis said the company remains on track to expand to approximately 100 territories over the next 12 months.
SiBone’s hybrid commercial model includes territory managers, territory representatives and more than 300 third-party agents. Francis said the model allows territory managers to focus on high-impact engagement while expanding reach, particularly in spinopelvic and pelvic trauma markets.
The company also discussed its partnership with Smith+Nephew, which is focused on trauma. Francis said the first phase of field rollout was completed in April, with training and surgical capacity rollout expected to be substantially complete by the end of the second quarter. Revenue contribution is expected to build in the third quarter and accelerate in the fourth quarter.
Francis said Smith+Nephew’s trauma team is focused on level 1 and level 2 trauma centers and that SiBone’s TNT product is synergistic with its partner’s portfolio. Management said it would provide more detail as the relationship matures.
Francis closed the call by emphasizing the company’s physician growth, territory productivity gains, improving profitability and product pipeline. “We’ve built something durable and scalable here, and we’re excited about what comes next,” she said.
About SiBone NASDAQ: SIBN
Si-BONE, Inc is a commercial‐stage medical device company focused on the design, development and commercialization of implant systems to treat degenerative conditions of the sacroiliac (SI) joint. Its flagship product, the iFuse Implant System, consists of triangular titanium implants that are inserted via a minimally invasive surgical procedure to stabilize the SI joint and alleviate chronic lower back and buttock pain.
FDA‐cleared in 2012, the iFuse portfolio has expanded to include the iFuse-3D and iFuse-3Di devices, which feature a porous, 3D-printed surface to promote bone ongrowth and biological fixation.
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