Shoulder Innovations (NYSE:SI) executives told investors the company exited 2025 with accelerating commercial momentum, highlighted by rapid revenue growth, expanding surgeon adoption, and continued investment in new products and enabling technologies.
Fourth-quarter and full-year financial results
Revenue in the fourth quarter of 2025 was $14.4 million, up 65% year-over-year and 23% sequentially. For the full year, revenue was $47.3 million, an increase of 50% versus 2024. CEO Rob Ball said results were driven by “continued market adoption” of the company’s implant systems across a growing base of surgeon customers.
Operating expenses rose as the company scaled its commercial organization and navigated public company and legal costs. Selling, general and administrative (SG&A) expenses were $16.3 million in Q4 2025, up from $9.1 million a year earlier, driven by increased headcount, higher legal costs related to litigation, higher variable selling expenses, and increased professional service fees related to becoming a public company. For the full year, SG&A was $54.8 million, up from $34.5 million in 2024, with the company attributing the majority of the increase to IPO, public company, and legal costs.
Research and development expense was $3.2 million in Q4 2025, compared to $1.2 million in the prior-year quarter, reflecting investment in new product development and an initial milestone payment and development tied to the company’s robotic platform partnership. Full-year R&D expense was $7.7 million, up from $4.5 million in 2024.
Net loss for Q4 2025 was $7.8 million, compared with a loss of $3.8 million in Q4 2024. Adjusted EBITDA loss was $7.0 million in Q4 2025, compared with a loss of $2.6 million a year earlier. For the full year, net loss was $40.4 million versus $15.6 million in 2024, while adjusted EBITDA loss was $36.1 million versus $11.4 million in 2024. CFO Jeff Points said the wider losses reflected higher operating expenses and changes in the fair value of preferred stock warrant liability and convertible notes.
Cash and cash equivalents were $124.3 million as of Dec. 31, 2025. Points said the company believes its cash position supports continued investment in growth while enabling it to reach cash flow breakeven with cash on hand.
Commercial momentum: surgeon adoption and volume growth
Management emphasized continued progress in expanding its surgeon base and deepening utilization among existing customers. Ball described a commercial model that combines a nationwide independent distributor network with a W-2 commercial leadership team using a proprietary business intelligence platform to identify and convert high-volume shoulder specialists.
The company said it ended 2025 with 134 core and contender surgeons, a 61% year-over-year increase. Ball said core and contender surgeons represented about 95% of revenue, supporting “visibility and durability” in growth models. Shoulder Innovations plans to disclose core and contender surgeon counts annually going forward.
Implant volume also expanded. Total implant volume increased 62% year-over-year in Q4 to 1,976 units. Full-year 2025 implant volume was 6,506 units, up 50% versus 2024.
Ball said growth has been supported by both newly added surgeons ramping faster and existing surgeons increasing utilization. The company also said it shortened conversion times through its prospect-to-contender-to-core pipeline. From Q1 to Q3, it reduced the time to convert a surgeon from prospect to contender by 41% and from contender to core by 43%. Ball said surgeons who entered the pipeline in Q3 reached core status roughly 40% faster than those who entered in Q1.
Management pointed to education programs as a driver of adoption. The company held 48 company-sponsored education events during Q3 and Q4, including cadaveric and skills labs, regional events, and a national shoulder arthroplasty symposium in November. Ball said surgeons who attended that symposium subsequently increased their monthly utilization of Shoulder Innovations products by about 40% compared with their average monthly volume over the prior 12 months. The next national symposium is scheduled for May, and management said enrollment is already at capacity.
Product portfolio expansion and robotics partnership
Shoulder Innovations discussed several initiatives to broaden its product portfolio and enabling technologies. In December, the company announced a strategic partnership with Interventional Systems to introduce a shoulder-specific microrobotic solution designed to integrate with its ProVoyance platform for preoperative planning and intraoperative execution. Ball said ProVoyance is already used in “virtually all” implant procedures, making it a routine part of workflow.
Ball highlighted two differentiators for the planned robotic system:
- Portable “robotics as a service” model: designed to be transported into the operating room case-by-case, avoiding a traditional capital purchase model and aimed at supporting the shift of procedures to ambulatory surgery centers (ASCs).
- Minimal workflow disruption: designed to look identical to a non-robotic plan while improving execution accuracy, with management saying setup time and time saved from reduced ambiguity may “cancel each other out.”
The company said it has completed initial cadaveric sessions and received positive feedback from surgeon partners.
Ball also provided an update on site of care trends, noting that by the end of 2025, more than 30% of Shoulder Innovations procedures were performed in ASCs. He said this outpaced the broader market, which the company believes is in the “mid- to high teens%.” During Q&A, Ball said ASC penetration continued to increase through 2025 and into early 2026, and he cited the company’s instrumentation platform and changes in CMS payment policies as factors supporting adoption in standalone surgery centers.
On the implant portfolio side, the company said it began a limited market release of the InSet I-135RFX Humeral Stem, described as the third addition to its InSet Series humeral stem line in as many years, with indications including primary, revision, and certain fracture procedures. Management also said it commenced a limited market release of the N-22 Humeral Head, positioned as the first in a new line of glenoid technologies for patients with metal hypersensitivity. Ball and Points said these products carry higher average selling prices (ASPs) and could be constructive to gross margin as volumes build.
During Q&A, management said the company’s products commercially launched and in limited market release bring it closer to covering the full spectrum of shoulder arthroplasty cases, with full market release of the broader set of products expected by the end of 2026. Points also noted ASPs declined slightly in Q4 due to payer mix and a lower reverse procedure percentage, but said ASPs were already improving in Q1 and that most growth is expected to be unit-driven.
Clinical registry update
Ball said the company’s clinical data registry—initiated in late 2024 to evaluate real-world clinical and radiographic outcomes and implant survival—has enrolled more than 300 patients. Management reiterated a target enrollment of 2,500 patients with follow-up extending to 10 years post-operatively, and said enrollment is progressing in line with expectations.
2026 outlook and operating expense commentary
Shoulder Innovations initiated full-year 2026 revenue guidance of $62 million to $65 million, representing 31% to 37% growth year-over-year. Points said the outlook reflects confidence in continued growth from new surgeon adoption, deeper penetration among existing surgeons, and commercial launches of new products, while also accounting for typical seasonal dynamics, including lower sequential industry volumes in Q3 followed by a step-up in Q4.
On profitability, Points said the company expects to maintain strong gross margins with potential incremental improvements later in the year depending on the timing of cost reduction initiatives and new product adoption. At the guided revenue range, the company expects operating expenses—and SG&A in particular—as a percentage of revenue to be relatively stable compared with Q4 2025, with more substantial leverage beginning in Q4 2026. Points also said the company expects to continue investing in R&D throughout 2026, noting in Q&A that Q4 R&D ran at about 22% of revenue and that a similar level is expected for the next several quarters.
The company said it is proactively increasing inventory and asset purchases in the first half of 2026 but still expects quarterly cash burn in 2026 to remain relatively flat to Q4 2025, with more noticeable improvement later in the year.
In closing remarks, Ball said momentum from 2025 continued to accelerate into the first quarter of 2026. He also announced that Drew Hykes, former CEO of Inari Medical, joined the company’s board earlier in March.
About Shoulder Innovations (NYSE:SI)
Shoulder Innovations (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.
