Shoulder Innovations Q2 2026 Earnings Call

Please stand by. Welcome, ladies and gentlemen, to the first quarter of 2026 earnings conference call for Shoulder Innovations. At this time, all participants will be placed on 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. shortly. I would now like to turn the call over to Sam Betzinger, Investor Relations at Gilmartin 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. Earlier today, Shoulder Innovations issued a press release announcing financial results for the second quarter into June 30, 2026. 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 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. For our listing descriptions of the risks and uncertainties associated with our business, please refer to the risk factors section of our most recent in a 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 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, August 6, 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 now turn the call over to Rob.

Thanks, Sam. Good afternoon, everyone, and welcome to our second quarter earnings call. We have several noteworthy updates today across our future results and growth strategies, particularly with respect to our innovation pipeline, so we're excited to share those with you. At a high level, I'm pleased to report that our organization continued to demonstrate remarkable strength through the second quarter. Following a very strong first quarter start to 2026, we again delivered year-over-year and sequential revenue growth in Q2 as we rapidly onboarded new surgeons, deepening utilization within our existing customer base, and made steady progress in several key product initiatives. This performance enabled us to deliver second quarter net revenue of $17.2 million and increase at 56% year over year. Q2 gross margins was also strong at 78.3% up both year over year and sequentially. These improvements reflect ongoing operational efficiency and we expect further gross margin expansions from several additional cost reduction initiatives Jeff will cover shortly. Given these results, our growing scale, and the expanding efficiency of our commercial organization, we are raising our full year 2026 net revenue guidance today to a range of $67 to $69 million, representing growth of 42 to 46% over 2025. This compares to our prior range of $65 to $68 million, or 37 to 44% growth. Our guidance reflects our continued expectation for a normal degree of orthopedic seasonality that began, as expected, in June and will continue into the third quarter, consistent with patterns we've experienced in the past. customer activity, and our pipeline remain robust, giving us high conviction in this guidance. Our ability to deliver this growth in 2026 and beyond is grounded in the same three strategic priorities we've discussed during our last few calls, which include driving adoption among new surgeons, increasing penetration in our existing customer surgeon base to increase procedural volume, and adding products to our portfolio to address the unmet needs of patients and surgeons. Beginning with new surge in adoptions, we maintained our high pace of new customer additions through the second quarter, following our very strong start to the year. As a reminder, in the first quarter, we grew new customer additions at more than double the pace of the prior year. And in the second quarter, we added even more new customers than we did in Q1, an acceleration on top of an already strong start. Our W-2 commercial leadership organization is focused on targeting the roughly 1,800 high-volume insurance specialists in the U.S., and that approach is translating into rapid growth in our customer base. We are encouraged by these trends and expect that momentum to be durable for the balance of the year. To further capitalize on this sustained momentum, we again accelerated commercial expansion plans and added the top talent to our commercial leadership team in 2-2 following our investment in this area in Q1. Just as our first half performance has benefited from the accelerating productivity gains within the W-2 commercial leadership cohort hired in 2025, we expect these newly hired team members to be a growth driver in future quarters as they ramp and build deeper relationships within their territories. As always, the focused execution from our commercial leadership team is supported by our proprietary business intelligence platform, which has proven to be a true differentiator in our ability to execute on top of strong fundamentals. We also continue to invest in our surgeon-to-surgeon education programs, which we view as central to our commercial strategy. Our CEME team has carried out more than 90 surgeon engagement events so far this year, touching hundreds of surgeons, and the organic peer advocacy these events foster remains a key differentiator for our commercial model. In April, we hosted our national symposium in NAPA, the largest such event in SIS history by surgeon attendants. In the three months since, we've already seen a tangible increase in procedural volumes among attending surgeons as compared to before the event. further evidence of the power of our education program. Turning to our second strategic priority of increasing utilization and procedural growth within our customer base. In the second quarter, total implant volume across our core contender and prospect customers increased approximately 50% year-over-year to 2,238 units. This growth volume is strong on its own, but what stands out even more is the composition behind it. The vast majority of our implant volume growth this quarter was derived from our core surgeon category, with core surgeons also carrying out more procedures, meaning our growth is coming from core on both a physician and unit basis, exactly as our customer base is designed to progress. Surgeons frequently enter the funnel as prospect, move to contender, and then grow to become core. Those first two categories remain consistent across quarters, while our core category only continues to grow. This trend, combined with sequential increase of new surge in ads to the funnel this quarter, gives us a highly encouraging outlook on the current trajectory of our customer base. Importantly, we're seeing these utilization increases broadly across all our territories. In the second quarter, each of our territories grew year-over-year, and the majority demonstrating more than 80% growth year-over-year. We also continue to enter new markets and deepen our presence in the current ones. For instance, we recently expanded our commercial presence within two highly prominent hospital systems and now have full access at both centers. Even as we continue to make progress activating new markets across the U.S., we believe there is a significant greenfield opportunity remaining for our expanded commercial leadership team to target. To ensure we continually equip surgeons with the best-in-class product portfolio, we also remain focused on our third strategic priority of developing and launching new technologies to address the unmet needs of patients and surgeons. 2026 has been an active year on this front, and I want to start with three recent product introductions and then walk through updates on our enabling technology platform, our robotic program, and four additional pipeline projects. First, on recent progress, we transitioned our I-135 RFX humoral stem to full commercial launch last quarter following receipt of expanded clearance from FDA to include more complex fractures. Full launch progressed through the second quarter in line with our expectations, and we're pleased with the consistent surgeon feedback across both anatomic and reverse shoulder arthroplasty configurations. Second, we recently moved our N22 Glenosphere into full launch since debuting it earlier this year. This product is the first introduction of our new line of technologies designed for patients with metal hypersensitivity and represents an incremental address of the marker for us. And third, we fully rolled out our new titanium plasma spray, or TPS, reverse base plate, as a product line extension, which provides an additional option for surgeons to match implant selection to patient need. We're seeing early success across each of these products. In fact, a growing portion of our total procedures year-to-date have involved the use of one of these new products, and all three have contributed to our recent uplift and average selling price. Beyond these recent introductions, we are also committed to further extending our technology advantage and have significantly advanced several programs across enabling technology and new product development. As I've shared on recent calls, the integration of robotic surgery into our ecosystem has unlocked a renewed innovation cycle within our technical and clinical teams, and I want to outline a few initiatives that have taken clear shape over the past several quarters and represent meaningful opportunities in the near future. At the center of this innovation cycle and overarching across each of our pipeline project is a technological revamp of our ProVeance Enabling Technology platform. We're building upon the platform's strong existing foundation to better align with each surgeon's unique needs while delivering a substantial step up from a software perspective in terms of available information and functionality. Based on surgeon feedback to date, we believe strongly that this platform is the main engagement center for our customers and that when paired with the innovation programs I'll describe next, will drive an important shift in how shoulder surgery is planned and executed. We believe this advancement will further expand our competitive advantage, creating an environment where innovation for improved care happens through a software advancement, and that is a shift that will benefit all stakeholders through improved care, lower costs, and lower capital requirements. We're also developing this next-generation software platform to be fully compatible with our upcoming shoulder-specific micro-robotic solution for shoulder arthroplasty, which will enable us to offer a comprehensive, integrated enabling technology suite. The purpose of enabling technology is to support more accurate, effective surgery. However, rapid and sustainable uptake requires the simplest possible adjustment to existing surgical technique, delivering predictable, consistent procedure times in the OR, and an economic proposition that is value accretive for all clinical partners. We believe this approach will deliver better outcomes at a lower economic burden across all sites of care, particularly the ambulatory surgery center. Since announcing our strategic partnership with INS in December, we've made tangible progress each quarter with product development running almost a full year ahead of our initial internal forecast, and we remain incredibly excited with the mid- and longer-term economic and competitive opportunities associated with this technology. Officially, the robotic technology will be known as INSET NEO, and we are planning FDA submission in the first half of 2027. We'll provide additional details on product features and filing timelines over the coming quarters. Alongside the filing, we also anticipate kicking off a robotic training program in early Q1 of next year, which will enlist the expertise of our current surgeons. Consistent with our broader philosophy surrounding peer-to-peer medical education, we believe this train-the-trainer approach will be effective in creating a scalable way to share knowledge and drive surgeon engagement at a rapid pace. Our revamped enabling technology suite is also fundamental to several initiatives across new product development. First, we've spent the last several quarters working to improve the transferability of preoperative planning information into the operating room through a simple, reusable solution. With limited available starting in Q3, our new Inset Clutch Guide System for anatomic and reverse blenary procedures will allow surgeons to more effectively transfer and execute the intended surgical plan in the OR. We also expect this solution to provide a modest uplift to average selling price. Second, we've developed a new concept for reverse procedures branded INSET1, offering a highly unique solution purpose-built for our risk-based approach in off-preoperative planning. Born out of our next-generation enabling technology platform, INSET1 will enable surgeons to formulate a patient-matched, additively manufactured iteration of our INSET reverse solution, leveraging expansive data set and highly optimized decision algorithms to treat challenging and complex patient indications, improving upon existing market designs. We also believe that over the midterm, paired with our robotic solution, INSET1 can represent a lower cost, higher margin procedure for the majority of patients, enabling even lower capital costs in our current small trade platform. We're targeting FDA submission for this product in 2027. We expect to commence a limited user release in Q3 of this year for our new subscapularis variant technique initiatives. Failure of the subscapularis tendon remains a persistent postoperative complication, particularly across anatomic shoulder arthroplasty, where Shoulder Innovation's inset platform has a marked advantage due to the structure of our unique implant designs. Together with a group of innovative surgeons, our engineering and clinical teams have developed instrumentation to more effectively enable surgery where takedown of the subscap tendon can be avoided, which may materially reduce the risk of this complication. This technique can also have a significant impact on postoperative protocols, pain, and simplicity of patient recovery. And last, certainly not least, we're looking forward to the first surgical cases for our next generation inset anatomic glenoid implant in early q4 of this year branded inset go we expect this solution to further streamline streamline the or experience by further reducing the surgical steps we expect this innovation will save up to 10 minutes per procedure the inset and inset plus glenoid implants are a foundational technology for shoulder innovations and this next generation product builds on our heritage of published and recognized clinical success and deploying experience and know-how inaccessible to any other competitor. External to our own pipeline, we also continue to generate incremental interest from additional strategic partners who see the value in accessing the shoulder surgical care market through our platform. Our enhanced brand awareness has been a meaningful positive development for SI since our IPO last year. And to that end, we are pleased to announce a new exclusive collaboration with a leader in additive manufacturing devices for the treatment of severe deformity where no other solution currently exists and cases frequently involve challenging revisions or other complicated circumstances. We expect this partnership will enable us to offer improved bespoke solution for highly complex revision cases, bolstering our broader way of offerings to the shoulder surgical care market. To be clear, these are cases where surgeons may not perceive our current solutions to be optimal for the patient condition, and this relationship will enable further expansion into these complex cases. We've also spoken before about the broader opportunity in adjacent indications, particularly soft tissue procedures. While we're bringing the same rigor to this market as we did with arthroplasty, an opportunity has emerged for faster, more immediate impact. We're pleased to announce a new relationship with a soft tissue device manufacturer that we expect will enable us to begin commercializing several of these devices before year-end. We don't expect material 2026 revenue from this partnership, but it marks an important starting point that should yield strategic advantages as our commercial organization continues to grow. Before turning the call over to Jeff, I have one final update on the clinical evidence front. As we've shared previously, we are actively building a database of real-world evidence for our clinical data registry. Clinical data collection efforts within the registry are ahead of our expectations. While still preliminary, our initial review suggests improvements in postoperative acromial fractures, reduced complications related to instability, advances in patient range of motion, and materially favored aesthetic outcomes. Furthermore, we've recently identified the opportunity to accelerate our ability to publish a more thorough report of these results through partnerships with centers that hold large bodies of retrospective data. While a modest investment will be required to enable the advancement, we're encouraged by these early signals and are confident this improved approach can accelerate our pathway to publication of these results by several quarters. I'm excited that each of these innovation and clinical opportunities remain central to our existing clinical focus within shoulder surgical care, and we expect them to accelerate the efficiency of our commercial engine as we continue to scale. We look forward to providing additional updates on each of these as we progress. With that, I'll now turn the call over to Jeff to review our full second quarter results and discuss our updated full-year 2026 outlook in more detail.

Thanks, Rob, and good afternoon, everyone. As Rob mentioned, net revenue for the second quarter of 2026 was $17.2 million, a 56% increase from $11 million in the prior year. Our unique commercial model and proprietary business intelligence capabilities drove continued commercial expansion in the second quarter, resulting in increased adoption of our implant systems across new and existing surgeons. Gross margin for the second quarter of 2026 was 78.3%, compared to 76.2% in the prior year. The improvement was driven by continued strong ASPs, along with benefits from negotiated cost reduction programs across our product lines. Selling general and administrative expenses in the second quarter of 2026 were $20.1 million, compared to $12.8 million in the prior year. The increase in SG&A expenses was primarily driven by increased headcount in the commercial organization, higher variable selling expenses, and increased costs associated with becoming a public company. Excluding public company costs, we delivered operating leverage across SG&A during the quarter as compared to the prior year. Research and development expenses in the second quarter of 2026 were $3.4 million compared to $1.4 million in the prior year. The increase was primarily driven by investment in new product development efforts, including substantial work related to the robotics platform. Net loss in the second quarter of 2026 was $10.2 million, compared to a loss of $19.2 million in the prior year. The adjusted EBITDA loss in the second quarter of 2026 was $8 million, compared to a loss of $18.1 million in the prior year. The decrease in both net loss and the adjusted EBITDA loss were primarily related to a significant prior year charge related to changes in the fair value the company's preferred stock, warrant liability, and Series E purchase option. Our cash and cash equivalents and marketable securities as of June 30, 2026 were $99 million. As expected, our cash burn improved in Q2 compared to Q1, primarily due to a lower level of asset and instrument purchases along with other working capital improvements. Looking ahead, we expect improvements in cash burn during the second half of the year as compared to the first half as we proactively increased our inventory and asset purchases in q1 and q2 we remain confident in our balance sheet and our ability to fund our growth plans with cash on hand during the quarter we also announced the closing of two new debt facilities for an aggregate amount of up to 50 million with steeple venture banking consisting of a fully funded term loan to refinance our existing credit facility and a separate undrawn online of credit. This refinancing represents an important step in strengthening our financial foundation as we continue to rapidly scale, providing material future cost savings on our existing debt structure while enabling financial flexibility. In the near future, we expect to file a shelf registration statement on Form S3 as we recently became eligible following the one-year anniversary of our IPO. This is standard corporate housekeeping, and we have no imminent plan to raise capital through a primary offering. The filing will also register shares held by certain pre-IPO investors and insiders satisfying registration rights granted in our March 2025 financing. This is a procedural step to meet those contractual obligations. It's not a sale of stock and we have no visibility into if or when any holder might choose to sell. turning now to our guidance and outlook for 2026 on the top line we now expect full year 2026 net revenue to range from 67 to 69 million representing growth of 42 to 46 percent 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 insurgent 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, and a shift in procedure mix during the second half of the year, which typically lowers our percentage of reverse procedures and correspondingly impacts ASPs. Regarding gross margins, we are very pleased with our progress on margin improvement and expect similar margins for the balance of 2026, noting there could be some quarter-to-quarter fluctuations based on product mix and ASP. Looking ahead, we recently filed a 510-K with FDA related to additive manufacturing of certain products. This 510-K is separate from the additive manufactured products that Rob discussed earlier and will add additional capability to our supply chain, providing incremental cost reductions of up to 30 percent on certain products beginning sometime in 2027. Cost-down initiatives remain a key focus and we're confident they'll continue driving gross margin improvement as we scale. At our current full-year revenue guidance, we expect SG&A expenses in Q3 as a percentage of revenue to increase from Q2 before declining in Q4. 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. Finally, with currently contemplated innovation programs, we expect R&D expenses as a percentage of revenue to moderate late in 2026. With that, turn the call back to Rob for a few closing remarks.

Thanks, Jeff. In sum, the second quarter reflected strength across every dimension of our business. We continue to rapidly onboard new services against a large underpenetrated market opportunity, deepening utilization within our existing customer base and advancing a broad and increasingly differentiated product pipeline from the continued ramp of our I-135 RFX and N22 launches to the next generation of our enabling technology suite to the accelerating progress we're making on our robotic platform. At the same time, the growing external interest we're seeing from external partners is a testament to the position we've built in the shoulder surgical market, and we believe these relationships will meaningfully expand what we're able to offer surgeons and patients over time. This quarter also marks just a year since our IPO, and reflecting on everything our team has accomplished in that time, the growth we've delivered and the products we've brought to the market and relationships we've built across the surgeon and partner community, our confidence in what lies ahead is very strong. The commercial organization we've built continues to perform. Our pipeline has never been deeper, and our conviction in the team's ability to execute has never been higher. We believe shoulder innovations remain in the very early stages of what we can accomplish in transforming shoulder surgical care, and we look forward to demonstrating that in the back half of 2026 and beyond. With that, I'll now turn the call over to the operator for Q&A. Operator?

Thank you. At this time, we'll be conducting a question and answer session. If you'd like to ask a question, please press star 1 on your telephone keypad. The confirmation tone will indicate your line is in the question queue. Star 2, if you'd like to remove your 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. Our first question comes from Matthew O'Brien with Piper Sandler. Please proceed with your question.

Great. Thanks for taking the question. Maybe, for starters, on the guidance side of things, if you look at the – it's good to see a bump up in the back half of the year, and I understand seasonality and mixed changes, but this time last year you saw a pretty meaningful bump up second half of the year versus the first half, this year it's essentially flat, first half versus second half, and I know you want to be conservative, but I'm just curious about any other dynamics we should be aware of, especially competitively.

I know one of your competitors has a new robotic system in shoulder, and they seem to be chatting that up a little bit, so just anything like that that you can point to as far as the back half guy goes, and then I do have a follow-up. yeah um matt appreciate the question very much um and and thanks for pointing that out you know i characterize a couple things remain factually true that i i shared in the prepared remarks one our pace of new customer ads has done nothing but accelerate relative to last year we feel uh really confident and excited about the progress that we've developed here in uh in q1 and q2 You know, there's nothing that we're remarking about or considering as it relates to any changes in the market dynamics in the second half of the year. And I'd characterize that, like all quarters that we've reported on so far, we've presented numbers that we consider to be very high-conviction numbers. And, you know, it's no more complicated than that, Matt.

Got it. And then on the robotics side, you know, great news to hear that things have accelerated and the submission in the first half of next year. Can you talk about, you know, I know it's a little earlier, but just plans for that system, selling it, ASPs, and then, you know, I'm sure you're going to get some kind of ASP bump on the implant side of things from it. Is there anything you can frame up for us as we think about the impact of that system next year?

Yeah, I appreciate that. It's a great question, Matt. You know, kind of we're not in a position yet to share with the market our strategy as it relates to economic relationships we might build with operating centers. But I think what I've shared in the last couple calls is what we believe is very differentiated about our platform is the structure and the portability of our platform puts us in a very, very unique position as it relates to the types of economic relationships we can build with centers, both in ambulatory surgery centers and inpatient hospitals. And I think that puts us in a position where we can build pricing into the implant. We can build pricing into actual capital purchase of the robot itself and, frankly, everything in between, Matt. We know we will start with a careful and pensive limited user release to ensure we get just everything right the first time and we're extremely excited about what we're achieving from an outcome standpoint in 2027. But, you know, I think we're in a very advantaged position relative to, I'll say, competitors as it relates to the relationships that we can build. Now, having said all of that, we do believe there will clearly be economic benefit to the company for deployment of that technology commensurate with the clinical benefit that we're providing for both hospitals and patients. So, you know, we're excited about, you know, kind of what that can be, and we believe it will be quite meaningful for shoulder renovations on a go-forward basis.

Understood. Thank you.

Yep.

Our next question comes from Patrick Wood with UBS. Please proceed with your question.

Amazing. Thanks, guys. I've got two. Maybe the first one on Insect Go, you know, 10 minutes is a pretty material saving in terms of surgery time. I mean, you know, our time, 40, 50 bucks a minute, it's pretty meaningful. Do you think the bigger opportunity here is to use that as a way to break into new accounts, to get utilization per, you know, surgeon up? Or is this also something where you can say, hey, look, I'm probably saving you minimum 500 bucks of absorbed overhead per case and include a little bit of pricing? or is it a bit of both? How are you to keep on angling it?

I think interactions with surgeon customers in that context is commonly less about the minute-by-minute cost. It's more about can I fit an additional surgery into my surgery day? That's where the economic benefit can really be gained. And I think when you reach times like 10 minutes, that can be possible. I'll put it that way. It won't always be common just based on the surgery schedule, but it is, as you mentioned, Patrick, a material amount of time and can enable that. I'll just highlight a recent anecdote. Because of the efficiency we've enabled in our system, we recently had a major hospital center did eight surgeries in one day in a major, you know, kind of inpatient hospital setting. So a remarkable achievement that we were, you know, kind of really delighted with. And it is a function of the inefficiency that we present. And I'll just characterize that it's not just a surgeon that responds positively, it's the entire staff. And so we have found over time that everything we can do to simplify the procedure is constructive for both the surgeon and their team broadly and is, frankly, a positive advantage for us.

Makes sense. No, I completely get it. I guess the other one is obviously the core surgeon utilization is in a good spot. You know, maybe this is a strange question, but what do you find typically per surgeon triggers, you know, them to really drive utilization up? Is it, you know, a few months in, they've, you know, done a few insect glenoids and then, you know, they suddenly begin to transition more of their book over? and is there like a triggering point of comfort with the system that you found recently that's getting them to adopt it much faster? Like what's that moment that kind of gets them to buy in, if that makes sense?

Well, I wish that every surgeon was the same and we just had a recipe we could deploy. And on some level, you know, kind of we have to manage, you know, each interaction according to the particular surgeon's needs. And that's, you know, kind of that's what's very helpful about the level of experience we have in our W-2 commercial leadership team. They can navigate that. I'll just call it complexity, if you will. You know, I'd say having said that, one thing that has been remarkable in the perceived change of how our customers view us as we have materially moved from the Inset Glenoid Company to the Inset Platform Company, What I mean by that is surgeons recognize the significant technological benefits of our lateral lateral kinematics in our reverse platform. And so as we've grown and matured as a company, we've seen surgeons become starters with our reverse platform more commonly than was the case historically as compared to our anatomic platform. And I think the immediate outcome results are more evident in reverse for our company, for our technology as it relates to anatomic. And so that's been quite remarkable. So what we find, Patrick, is when surgeons leverage our reverse, we tend to build quite a bit of loyalty pretty quickly.

Excellent. Great to see you. Thanks, guys. Yeah, thank you. Thank you.

As a reminder, if you'd like to ask a question, please press star 1 on your telephone keypad. One moment, please, while we poll for questions. Our next question comes from Ryan Zimmerman with U.S. Bank. Please proceed with your question.

Thank you, and congrats on a nice quarter here. I want to ask, I mean, you know, I've listened to some of your peers talk over the last week during their earnings calls, and one of the things that struck me is, you know, their U.S. extremities numbers were maybe a little lower than I thought they would be. And so, you know, in that vein, Rob, I'm wondering if you could talk about, I mean, your core contender growth is impressive. And so in that context, do you see yourself taking share from existing players in the market? Do you see these core contender surgeons as they, you know, move up that curve in terms of utilization, growing the market? And, you know, what are your thoughts about kind of that tradeoff between market growth accelerating versus, you know, share gain potentially?

Yeah, thank you, Ryan. Appreciate the question. You know, kind of, I would say, I can't quantify the ratio, but a vast majority of the growth that we're driving is indeed taking share from larger market incumbents. As time has gone by and we've penetrated further into the market and particularly into centers with fellowship programs, you can consider a growth of the market can be in part developed by graduating fellows with shoulder specialty training. And as we've grown, we've been able to capture more of those, but we're in the very early innings. So what that means is, for sure, there is a portion of market that we're capturing, you know, call it 90-10, if you understand, Ryan, you know, kind of very small portion related to expanding the market. A vast majority of that is just capture of existing market share from competitors.

Understood. And, you know, I was struck by, you know, you have a lot going on in the pipeline, Rob. You laid a lot out on the table this afternoon. When I think about, you know, provoyance today versus where you want to take it, I mean, how do you make that transition, you know, smooth? And how are you thinking about, you know, the impact of that, you know, playing through the business as you integrate these new programs, as you advance software, as you add, you know, potentially robotics, you know, in 27 at some point? You know, help us think through what that means for the existing ProVoyance user base.

Yeah, it's another great question, Ryan. You know, so as you know, ProVoyance has been very much an enabler for the relationships we've built with our core surgeons today. And the way those surgeons typically become familiar and excited about ProVoyance is frankly training from other surgeons. We have a number of surgeons that we've enlisted that are just experts on how to apply it into their clinical practice and have a quite very loud and effective voice in helping other surgeons to leverage it in the same way. And as we expand the utility of provoyance, we would expect to use that same surgeon-to-surgeon communication basis as the primary driver. Now, as it relates to what do we think the impact is on the business on a go-forward basis, you know, I would think about it, you know, in these terms. As we move into a more enabled technology environment in shoulder surgical care, the goal or the vision is that what happens in the operating room is more and more a preconceived resolution of what you have already planned in preoperative planning. So as time goes by, we will care for more and more of the risks and take more and more of the decision-making at the software level and less of that decision-making happening in the operating room. So what happens in the operating room is just a function of what you've already conceived in the software. We think that will provide for a more rapid pace of innovation in that we can provide better and better decision-making tools more quickly at the software level. And number two, we think that enables us to put ourselves in a position where we have a very rich and sticky, for lack of a better term, environment that it's very hard for surgeons to leave. So we think it can be quite effective for driving loyalty on a go-forward basis.

Very helpful. Look forward to it.

We have reached the end of the question and answer session. I would now like to turn the call over to management for closing remarks.

Appreciate everybody's engagement today. Obviously, we're excited about the results that we have produced and excited about the future for the company. We have a ton of new innovation that we think is going to have a meaningful impact on a go-forward basis. So very much appreciate everyone's engagement today, and have a great afternoon.

This concludes today's conference. You may disconnect your lines at this time, and we thank you for your participation.