Tenon Medical, Inc. Q1 FY2026 Earnings Call

Greetings and welcome to the Tenon Medical First Quarter 2026 Financial Results and Corporate Update Conference Call. As a reminder, this conference call is being recorded. Your hosts today are Steve Foster, President and Chief Executive Officer, and Kevin Williamson, Chief Financial Officer. Mr. Foster and Mr. Williamson will present results of operations for the first quarter ended March 31, 2026 and provide a corporate update. A press release detailing these results was released today and is available on the Investor Relations section of our company's website, www.tenonmed.com. Before we begin the formal presentation, I would like to remind everyone that statements made on the call and webcast may include predictions, estimates, and other information that might be considered forward-looking. While these forward-looking statements represent our current judgment on what the future holds, they are subject to risks and uncertainties that could cause actual results to differ materially. You are cautioned not to place undue reliance on these forward-looking statements, which reflect our opinions only as of the date of this presentation. Please keep in mind that we are not obligating ourselves to revise or publicly release the results of any revision to these forward-looking statements in light of new information or future events. For a more complete discussion of these factors and other risks, you should review our quarterly and annual reports on file with the Securities and Exchange Commission at www.sec.gov. At this time, I'll turn the call over to Tenon Medical's Chief Executive Officer, Steve Foster. Please go ahead, sir.

Thank you, Saatchi, and good afternoon to everyone. I'm pleased to welcome you to today's first quarter 2026 financial results and corporate update conference call for Tenon Medical. We are off to a solid start in 2026. We delivered strong first quarter revenue and gross profit, which were the highest for any first quarter in the company's history. First quarter revenue came in at $1.4 million, nearly double the prior year period, and gross margin reached 68.5%, up from 44.5% a year ago. Two dynamics drove the quarter. More procedures across both of our platforms, and a meaningful, more efficient cost base behind those revenues. On the top line, growth came from two places. A higher number of catamaran cases, and the first full quarter of meaningful Symmetry Plus contribution since we acquired the side vantage assets late last August. Physician engagement is a leading indicator for us as well, and on that front, we trained 21 physicians across both systems this past year. The most notable development this quarter is the expansion in gross margin. At 68.5%, we are approximately like 24 percentage points higher than a year ago. While increased revenue has contributed to improved absorption of fixed production overhead, we're also benefiting from a more streamlined commercial footprint and stronger field productivity. We expect these structural gains to persist. Beyond the financials, a few items from the quarter that are worth noting. First, our two-platform offering is increasingly working the way we had hoped. Physicians are evaluating KEDWIN and Symmetry Plus as complementary tools in both primary and revision procedures. These systems provide optionality in both inferior and posterior and lateral approaches to the same anatomy, and we are seeing this translate into adoption at several leading centers. Capital, in March, we closed a $4.3 million dollar senior convertible note placement with a group of institutional and high-net-worth investors. That financing extends our runway and gives us the flexibility to keep investing behind commercial expansion, product launches, and our clinical programs without further distraction. Taken together, the quarter gives us a healthier balance sheet, a broader product set actually in the market, and clearer evidence that continues to straighten them. The U.S. Patent and Trademark office issued multiple notices of allowance during the quarter on applications expected to grant later in 2026, on top of the 10 patents that issued in 2025. Our portfolio today stands at 29 U.S. patents and nine international patents granted, with another 31 applications pending. That depth matters for a small cap medical device company. It protects what we have built around Catamaran and Symmetry Plus. In addition, we have dramatically accelerated our R&D project work. This includes significant incremental additions to the Symmetry Plus lateral and oblique platform that will be launched in the back half of 2026. Additionally, in the spirit of providing comprehensive optionality to our physician customers, we are moving towards regulatory submission and subsequent alpha activity of safer pelvic anatomy. Lastly, our aggressive commercial activity is highlighted by the addition of an experienced senior sales professional to manage the eastern part of the lower 48. We will join other members of our commercial team at a newly established training and education center in the Tampa, Florida area designed intentionally to accelerate our physician and distributor education activity. Looking out over the rest of the year, our focus is very narrow. Keep growing procedure volumes on both platforms, aggressively educate our physician and distribution partners, and protect the gross margin gains we've made this quarter as we scale. We have multiple ways to win in this market, lateral and inferior poster now, and additional innovations. I'll turn the call over to Kevin to discuss our financials in some detail.

Thank you, Steve. I will now provide a summarized review of our financial results. A full breakdown is available in our press release that crossed the wire this afternoon. Starting with the top line, first quarter revenue was $1.4 million, an increase of approximately 90% from $0.7 million a year ago. Two factors are at work here. First, catamaran surgical procedure volumes saw strong year-over-year growth, driven primarily by new physician adoption. And second, Q1 was the first quarter to fully reflect Symmetry Plus revenue since we closed that acquisition in August of last year and Alpha launched the system in Q4 2025. Further product enhancements and a full commercial launch of Symmetry Plus are planned for in the back half of 2026, which we expect to support continued growth this year and into 2027 and beyond. gross profit was 0.9 million or 68.5 percent of revenue versus 0.3 million or 44.5 percent of revenue in the first quarter of last year that is an approximately 193 percent increase in dollar terms and the highest for any first quarter in the company's history on a margin basis we picked up about 24 percentage points year over year driver is straightforward higher revenue is spreading our fixed production costs over a larger base, and we expect to see continued margin expansion as revenue scales. Operating expenses came in at $4.2 million, modestly above the $4.0 million we ran in the first quarter of 2025. The step-up is primarily driven by higher sales and marketing expenses, reflecting increased commercial activity related to higher revenue, as well as supporting the Symmetry Plus rollout, while partially offset by lower stock-based comp versus a year ago. When normalizing stock-based comp expense year-over-year with an R&D, development-related expenses increased in the first quarter versus Q1 2025, driven by project-related activities tied to future product launches, primarily related to assets that were acquired in the acquisition we closed in August last year. Net loss for the quarter narrowed to $3.5 million, worth $0.31 per share from $3.6 million or $1.01 per share a year ago. The per share figure benefits from a larger share count, but on a dollar basis, the improvement is real. Stronger revenue and gross profit, more than offset higher OPEX and the interest expense from the March convertible note issuance. We ended the quarter with $4.6 million in cash and cash equivalents compared to $3.8 million as of December 31, 2025. In March 2026, the company closed a private placement of senior convertible notes for gross proceeds of $4.3 million, which provides additional runway to fund our commercial and clinical priorities deep into the year. Overall, we believe the financial and strategic actions achieved this quarter have positioned Tenom with initiatives to drive faster growth while sustaining a streamlined and disciplined cost base. I'll now hand the call

back to Steve for closing comments. In summary, the first quarter of 2026 reflects early returns on the strategy we have been executing against, including approximately 90 percent year-over-year revenue growth, a 24 percentage point expansion and gross margin to 68.5 percent, a strengthened balance sheet, and a meaningfully expanded intellectual property portfolio. These results provide a strong platform for continued execution. Building on that foundation, our priorities are clear, drive continued procedure growth across both Catamaran and Symmetry Plus, expand our base of trained physicians, and maintain the disciplined cost structure now showing true in our gross margin and field productivity. With the differentiated multi-approach portfolio, a strengthened balance sheet, and a deepening intellectual property portfolio, we believe Tenon is well positioned to build on this quarter's momentum and deliver increasing value to patients, providers, and shareholders. I thank you all for attending, and now I'd like to hand the call over to our operator to begin our question and answer session with covering the analysts.

Thank you. We will now be conducting a question and answer session. If you would like to ask a question, please press star 1 on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star 2 if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we pull for questions. The first question is from Scott Henry from AGP. Please go ahead.

Thank you and good afternoon. One of the first questions or the first question I'm going to ask is with regards to seasonality. Typically, I think of surgical procedures being down in the first quarter. You've got copay resets and all of that. So, you know, based on, you know, typical tough first quarter, it seems like we should be very encouraged by the strong numbers relative to Q4. Steve, is that a fair assessment? Thanks for the question, Scott. Absolutely fair.

Look, the dynamics of primarily deductible resets are very real. Our physicians have wild and crazy Decembers in particular, which I feel bad for them sometimes the way it piles up, but there's no doubt that's a real factor in all of this, and things tend to settle in Q1. I think that's true 2410 on just like any other medical device company, especially elective-type procedures such as ours. So I think that's a fair statement. I think it's very real, and we're encouraged as well by a solid, strong Q1 that gets us off and running here in 2026.

Okay, thank you. And then building off that, how should we think about at least directionally 2Q relative to first quarter, and are there any launch metrics that you can give us that we can follow to try to gauge the progress of the launch?

Sure. So we'll have a busy 2026. So Symmetry Plus, which is our lateral platform that came over with the side vantage acquisition, has been in alpha since late fall and is now coming out of alpha into full launch. That's the show of that technology. We have two additional incremental pieces to that platform that we'll launch through. One is involved in the preparation of the joint to create a proper defect, to prepare the joint to be grafted, fixated, and eventually fused. And then the second component will come out a bit later in the year. We will make the construct more effective. And so you'll see both of those things happen throughout the course of the year. The additional and incremental implant will be second. On top of that, I mentioned a new technology that we're working on that will be...

Great. And final question, I'll give Kevin a chance to chime in. OPEX in first quarter, is that a good baseline going forward? Perhaps it grows a little bit as sales increase. So is that how we should think about that, OPEX, in first quarter, or is there any noise in that?

Yeah, good afternoon, Scott. Thanks for the questions. Absolutely. I think it is a good baseline here for the year. And we expect to continue to leverage the P&L and improve profitability throughout the year, growing revenue, expanding margin faster than we're growing OPEX, specifically around the fixed costs. So as far as looking at the fixed costs, absolutely a good baseline there. There will be some investments we make throughout the year, so you will see some increase in OPEX, but it will be at a lower clip in revenue, and I think we have been pretty efficient to this point to mix in some strong investments here into one to lay the foundation here for the rest of the year without expanding our fixed costs. So you will continue to see that throughout the year.

Okay, great. Thank you for taking the questions.

Thanks, Scott. The next question is from Anthony Vendetti from Maxim Group. Please go ahead.

yes thanks um on the um on the new system the new indication that you um expect to have the alpha release in in the fourth quarter 26 can you talk about a little bit about from a scientific standpoint how that is going to be complementary or differs from from the two products that you have now and then if you alpha release it in fourth quarter 26 are you looking to commercialize Is it first quarter 27, second quarter 27? Do you have that sort of timeline framed out?

Yes, thanks, Anthony. So two things. One is we are committed to certain principles when we address various components of the sacral pelvic anatomy. And the core principle is we are a fusion-focused, arthrodesis-focused organization. So while we'll explore and introduce new approaches, new instrumentation, new technology to the sort of proper joint preparation, grafting, and fixing.

In terms of training physicians, sort of how has that evolved for Tenon this year? And can you talk about the plans to accelerate that training or the training programs that you have in place to get more of these physicians up to speed and aware of your technology?

Well, for us, it's evolved dramatically because we're not a single approach, single technology company any longer, right? And so we're using a variety of different training tools, whether a physician wants to focus on an inferior posterior approach to the anatomy, a lateral or oblique approach to the anatomy or other. So that's perhaps number one on the evolve.

Okay, great. And then, is there anything that you're doing specifically to try to increase conversion rates where you're like, okay, you know, they've been trained or they know the product? You know, how do you go about making sure that, or not that you can insure it, but that you can convert physicians from trying the product or demoing it to, you know, making it part of their ongoing practice?

Sure. Yeah, it's relatively simple. It's done in a complex environment, right? So the first thing we have to do is be compelling with them and convince them, hey, this is worth your time to take a look at, to spend some time with, et cetera. And that's usually a combination of, you know, everything that you've done.

Okay, and then lastly for Kevin, you know, gross margin was very strong at 68 and a half. But, you know, high 60s, is that a good gross margin to look at for the rest of 26? And I believe, and certainly Kevin, chime in and tell me if I'm wrong here, but I believe, you know, at a larger revenue base in 27 and beyond, the expectation is for that gross margin to be 70% plus, correct?

Correct. And, yeah, thanks, Anthony. And we spoke to that before. As we continue to scale revenue, we will continue to absorb some of those SIPs costs. They're not very large SIPs costs, but as we get our revenue base up, we'll absorb them and margin will continue to expand. You know, really up towards and up to the ceiling of what our true product margin is as you absorb those kind of, you know, logistics-based costs in there. So, yes, we expect, you know, high 60s is a good place to be. We expect to increase from here, and I think we're going to be very happy with where our margin gets to here over the coming quarters and into 27. Excellent.

Thanks so much. Appreciate all the caller. I'll hop back in the queue.

This concludes the question and answer session. I'd like to turn the floor back over to Steve Foster for closing comments.

Thank you, Saatchi. I'd like to thank each of you for joining our earnings conference call today. Look forward to continuing to update you on our ongoing progress and growth. If we were unable to answer any of your questions, please reach out to our IR firm, MZ Group, who would be more than happy to assist. And with that, I wish everyone a good day.

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