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DATE
Thursday, Nov. 5, 2026
CALL PARTICIPANTS
- Chief Executive Officer - Rob Ball
- Chief Financial Officer - Jeff Points
- Investor Relations - Sam Bentzinger
TAKEAWAYS
- Net Revenue -- $16.2 million, representing 38% growth driven by new surgeon additions and higher utilization among existing customers.
- Full-Year Revenue Guidance -- $68 million to $70 million, representing a raised outlook from the previous range of $67 million to $69 million.
- Gross Margin -- 78.5%, compared to 76.2% due to increased average selling prices and the flow-through of cost reduction programs.
- Implant Systems Sold -- 2,126 units, representing 34% growth attributed to increased productivity in the core surgeon category.
- Average Selling Price -- $7,616 per implant system, representing a 2% increase versus last year.
- Year-to-Date Revenue -- $50.1 million, representing 52% growth compared to the same period in 2025.
- SG&A Expenses -- $17.1 million, representing a 14% increase due to investments in the commercial organization and higher variable selling expenses.
- R&D Expenses -- $3.2 million, representing a 107% increase driven by development work on the InSet Neo robotics platform.
- Adjusted EBITDA Loss -- $5.5 million, improved from a loss of $7.5 million due to higher gross profit.
- Cash Position -- $92.3 million in cash, cash equivalents, and marketable securities as of Sept. 30, 2026.
- Operating Loss -- $7.6 million, remaining unchanged as higher gross profit was offset by increased operating expenses.
- Inventory -- $24.4 million, compared to $21.6 million at the end of 2025, reflecting scaling requirements.
- Clinical Registry Enrollment -- 900 patients, with IRB approval secured to incorporate approximately 250 retrospective patients to expand two-year data.
- Target Market Reach -- 1,800 high-volume shoulder specialists in the U.S. targeted by the W2 commercial organization.
- Recruiting Costs -- Zero dollars spent on commercial team recruiting as growth has been driven by organic interest.
- Long-term Debt -- $14.8 million as of Sept. 30, 2026.
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RISKS
- Points stated, "guidance accounts for seasonal dynamics that are typical in our industry, specifically... a shift in procedure mix during the second half of the year, which typically lowers our percentage of reverse procedures and correspondingly impacts ASPs," indicating a potential headwind to average selling prices.
- Points warned that "SG&A expenses as a percentage of revenue to increase in Q4 compared to Q3," as the company invests in greenfield opportunities and commercial footprint expansion.
- Points indicated that "cash burn to moderately increase in Q4" due to planned investments in the commercial team and research and development initiatives.
SUMMARY
Shoulder Innovations, Inc. (NYSE:SI) reported third quarter results featuring increased revenue and gross margins while raising its full-year financial guidance. Management reported progress on the product roadmap, including the clinical launch of a next-generation glenoid implant and the advancement of its robotics platform. The company expanded its commercial leadership and resolved outstanding patent litigation through a settlement agreement. Strategic focus remains on surgeon adoption and increasing penetration within the existing customer base to drive procedural volume.
- Management reported that development of the InSet Neo robotics platform is progressing ahead of internal timelines, with an FDA submission planned for the first half of 2027.
- The company entered a settlement agreement with Catalyst OrthoScience Inc. to resolve all outstanding patent litigation during the quarter.
- Ball noted that the InSet Go anatomic glenoid moved from the pipeline into the operating room with the first surgical cases completed in early Oct. 2026.
- The company announced an exclusive partnership with ALM Ortho to provide bespoke additively manufactured solutions for severe deformity and complex revision cases.
- Management indicated that a limited user release of the InSet Clutch guide system is expected to commence in the first quarter of 2027.
- Ball reported that surgeon-to-surgeon education programs have included more than 150 engagement events so far this year, including a record turnout at the second national symposium.
- Management stated that a partnership with a soft tissue device manufacturer is expected to result in the first surgical procedures around year-end.
INDUSTRY GLOSSARY
- Arthroplasty: The surgical reconstruction or replacement of a joint.
- Glenoid: The shallow cavity of the shoulder blade that receives the head of the humerus.
- Humeral head: The upper portion of the humerus bone that fits into the shoulder socket.
- InSet Go: The company's next-generation anatomic glenoid implant designed to reduce surgical steps.
- InSet Neo: The company's proprietary portable robotic technology platform.
- 510(k): A premarket submission made to the FDA to demonstrate that a device is safe and effective.
- CMS: Centers for Medicare and Medicaid Services.
- ASC: Ambulatory Surgery Center.
Full Conference Call Transcript
Operator: Welcome, ladies and gentlemen, to the third quarter 2026 earnings conference call for Shoulder Innovations. At this time, all participants have been placed in 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. I will now turn the call over to Sam Bentzinger, Investor Relations at Gilmartin Group, for a few introductory comments. Please go ahead.
Sam Bentzinger: 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 third quarter ended September 30, 2026. A copy of the press release is available on the Investor Relations section of the company's website. Before we begin, I would 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 a list and description 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.
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 table 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, November five, 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 will now turn the call over to Rob.
Rob Ball: Thanks, Sam. Good afternoon, everyone, and welcome to our third quarter earnings call. Q3 marked another quarter of strong growth and execution for Shoulder Innovations, and I am looking forward to walking through both our commercial performance and several product and pipeline updates. Our third quarter results reflect the consistency of our commercial model, especially through what is typically the slowest stretch of the orthopedic calendar. We added new surgeons ahead of plan, grew volume within our existing customer base, and kept product roadmap moving, including launching the InSet Go, our next generation glenoid implant. Third quarter net revenue was $16.2 million, an increase of 38% year-over-year. Q3 gross margin was also strong at 78.5%, up year-over-year and sequentially.
Sustained pricing discipline and our cost-down programs continue to strengthen our margin profile, and Jeff will cover the additional cost initiatives that we expect to contribute beginning in 2027. We were also pleased to see the favorable CMS final rulings related to shoulder arthroplasty published yesterday evening. We are proud to have delivered these results through the normal summer seasonality as we saw across the orthopedic market, which we anticipated on our last call and incorporated into our guidance at that time. Notwithstanding, the impact of seasonality amongst our more tenured core surgeons was more pronounced this quarter as compared to the third quarter of 2025.
However, as was the case in 2025, new customer additions in Q3 drove significantly above market growth despite these dynamics. With three strong quarters behind us, we are again raising our full year 2026 net revenue guidance to the range of $68 million-$70 million, representing growth of 44%-48% over 2025. This compares to our prior range of $67 million-$69 million, or 42%-46% growth. As is typical, procedure volumes began to improve in September, and we have been encouraged by the start to the fourth quarter. The pace of new surgeon activity and the depth of our funnel underpin the confidence behind our updated outlook.
Our progress this quarter maps directly to the three strategic priorities that guide how we invest our time and resources. These 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 unmet needs of patients and surgeons. Beginning with new surgeon adoption, we again added new customers into our core contender and prospect funnel at a pace ahead of our expectations in the third quarter, as we have done every quarter this year. Our W2 commercial organization remains focused on the roughly 1,800 high-volume shoulder specialists in the U.S., and that targeted approach continues to translate into steady growth in our customer base.
We expect that momentum to be durable as we close out the year. To support this momentum, we have accelerated our hiring plans, again adding top talent to our commercial leadership team through the third quarter, and further additions continuing in the early weeks of Q4 as well. The 2025 cohort of commercial leaders has been a meaningful contributor to our growth this year, and we expect this year's hires to follow a similar path as they ramp, with our business intelligence platform helping each of them prioritize the right surgeon targets from day one. Additionally, surgeon-to-surgeon education remains one of the most effective tools we have for converting new customers.
Our CEME team has now carried out more than 150 surgeon engagement events so far this year. In August, we hosted our InSet Society meeting alongside our national sales meeting, which together drew approximately 250 attendees. The energy and optimism across both simultaneous events were outstanding, and the R&D initiatives we outlined on our last call were exceptionally well received by our surgeon partners. Even further, just after quarter end, we hosted our second national symposium of 2026. After a record turnout at our spring symposium earlier in the year, this event drew even more healthcare providers, making it our largest and most successful symposium to date.
The event generated numerous new surgeon conversions, and we believe these programs strengthen our brand and lay the foundation for future growth. Regarding our second priority, increasing utilization and procedural growth within our customer base, third quarter implant volume across our core contender and prospect customers grew approximately 34% year over year to 2,126 units. When we look at our customer base by annual cohort, we continue to see each group of surgeons grow its volume over time, with average volume per cohort increasing from 24 to 25, and again so far in 26. Within that, the majority of our implant volume growth this quarter was again derived from our core surgeon category.
We've seen marked increases in productivity among both the core and contender groups. Put simply, the prospect to contender to core progression we've described since our first earnings call continues to play out as designed, and with new surgeons entering the funnel at a steady pace, our base of future core surgeons keeps growing. We believe this predictability is one of the most important value drivers of our business. We also continue to expand our geographic coverage in U.S. markets and deepen our presence in the existing ones. Over the past 12 months, we have established encouraging talent presence within several new major metropolitan markets and anticipate these investments will drive meaningful impact in each region.
More recently, we have continued to bolster these efforts with additional investments expected to contribute more substantially in 2027. With the vast majority of roughly 1,800 high-volume shoulder specialists in the U.S. not yet using our platform, our expanded commercial leadership team has a long runway of greenfield opportunity ahead of it. Turning to innovation and our third strategic priority of developing and launching new technologies, most recently, we have moved our next-generation anatomic glenoid from the pipeline into the operating room, while during the third quarter, we expanded our N-22 line and continued to advance our development programs.
I'll start with these two recent product introductions and then walk through updates on our enabling technology platform, our robotics program, and the pipeline projects we outlined last year. First, in early October, surgeons completed the first cases with InSet Go, our next-generation InSet anatomic glenoid, consistent with the timing we outlined on our last call. InSet Go preserves the key design elements of our InSet glenoid, including our InSet Plus augmented options, while reducing the surgical steps involved. The surgeon response to InSet Go has been unanimously positive since launch.
Second, we received FDA clearance for and launched our N-22 humeral head, extending our N-22 line for patients with metal hypersensitivity into anatomic procedures and building the uptake we've seen with the N-22's glenosphere on the reverse side. Combined with the other products we've launched over the past year, including our I-135RFX humeral stem and titanium plasma spray, or TPS, reverse base plate, the share of our procedures using at least one new product continued to tick up in the quarter. These launches also continue to support our average selling price.
Turning to enabling technology, during the quarter, we released a new version of ProVoyance, which we consider to be the main engagement center for our surgeons, that includes new features and security upgrades. These updates also build the planning foundation for our robotic technology known as InSet Neo. We connect to keeping the workflow simple and procedure times predictable for surgeons and enabling them to deliver the most accurate and effective surgery possible. As it relates to InSet Neo, development is progressing ahead of our initial internal timelines, and we remain on track for a planned FDA submission in the first half of 2027.
Surgeon feedback on the portable case-by-case model continues to be very encouraging, and we look forward to sharing more on product features and our commercial approach as we near submission. Now for a few updates across the rest of our development pipeline. Beginning with our InSet Clutch guide system for anatomic and reverse glenoid procedures, Clutch is designed to allow surgeons to more effectively transfer and execute their preoperative plan from ProVoyance into the operating room through a simple, reusable solution, and we expect it to provide a modest uplift to average selling price.
With the new version of our ProVoyance software now in place, we expect to commence a limited user release of Clutch in the first quarter of 2027. Second, we commenced the limited user release of our subscapularis sparing technique and instrumentation during the quarter. Failure of the subscapularis tendon remains a persistent postoperative complication in anatomic shoulder arthroplasty, and the low profile of our InSet implant designs makes our platform particularly well-suited to a technique that avoids takedown of the tendon. We are seeing growing surgeon interest and have modestly expanded availability as the limited release continues through year-end, and we expect the technique to continue evolving with input from our surgeon partners over time.
Third, our spectrum of solutions continues to broaden beyond standard products via InSet One, our patient-matched, additively manufactured iteration of our InSet Reverse solution, purpose-built for our risk-based approach to preoperative planning. We believe InSet One can improve upon existing market designs for challenging and complex patient indications, and over the midterm, can represent a lower-cost, higher-margin procedure for the majority of patients. Our target timing for FDA submission remains on track for 2027. Augmenting our support for complex surgery even further is our exclusive collaboration with ALM Ortho, a leader in additively manufactured devices for the treatment of severe deformity and complex revision cases.
This relationship allows us to offer bespoke solutions for highly complex cases where surgeons may not view our current portfolio as optimal. We have been very encouraged by the positive response from our customers since announcing this partnership in September, and had previously underestimated the negative impact of not having great solutions in this particular area. The first patients were treated in the third quarter successfully through this partnership, and we expect more meaningful revenue contribution beginning in 2027. Taken together, we believe that InSet One and our partnership with ALM Ortho substantially improves our ability to drive impact in complex surgery. We are also making progress with the soft tissue device manufacturer we partnered with last quarter.
Product is on order, and we expect to perform our first surgeries with these devices around year-end. This represents an important first step in adjacent soft tissue procedures performed by the same high-volume shoulder specialists we serve today. Finally, I want to provide a brief update on the clinical evidence front. Enrollment in our clinical data registry continues to exceed our expectations, now approaching around 900 patients enrolled across anatomic and reverse configurations. As we shared last quarter, we are partnering with centers that hold large bodies of retrospective data to accelerate our pathway to publication.
The first of these sites has now received IRB approval, which will allow us to incorporate approximately 250 retrospective patients and meaningfully expand our base of two-year data. We remain encouraged by the early signals we have seen and look forward to sharing more as work progresses. To help illustrate the sort of confidence in our products we believe our registry will ultimately validate, I would like to share recent feedback from one of our leading surgeon partners in New York on his experience with our reverse system. In his words, "I did roughly 50 reverses from a single competitor and had five stress fractures right before switching to SI.
In two years, I have done over 250 SI reverses, and I have yet to see one." While anecdotal, this reflects the type of feedback we consistently hear from surgeons and the differentiation we have designed into our reverse platform. With that, I will now turn the call over to Jeff to review our full third quarter results and discuss our updated full year 2026 outlook in more detail.
Jeff Points: Thanks, Rob, and good afternoon, everyone. As Rob mentioned, net revenue for the third quarter of 2026 was $16.2 million, a 38% increase from $11.8 million in the prior year. Growth was driven primarily by a 34% increase in implant systems sold, aided by our powerful business development system, and reflecting new surgeon additions and higher utilization among existing customers, along with a year-over-year increase in average selling price. Gross margin for the third quarter of 2026 was 78.5%, compared to 76.2% in the prior year. The year-over-year increase reflects higher ASPs and the cost reduction programs now flowing through our product costs.
Selling, general, and administrative expenses in the third quarter of 2026 were $17.1 million, compared to $15.1 million in the prior year. The increase in SG&A expenses was primarily driven by increased headcount in our commercial organization and higher variable selling expenses, partially offset by lower legal-related expenses. As announced in early September, we entered into a settlement agreement to resolve all outstanding patent litigation. Research and development expenses in the third quarter of 2026 were $3.2 million, compared to $1.5 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 third quarter of 2026 was $7.0 million, compared to a loss of $8.7 million in the prior year. The Adjusted EBITDA loss in the third quarter of 2026 was $5.5 million, compared to a loss of $7.5 million in the prior year. The change in both net loss and Adjusted EBITDA loss primarily reflects higher gross profit, partially offset by higher operating expenses. In addition, the prior year period included charges or changes in the fair value of the company's preferred stock warrant liability and convertible notes. Our cash equivalents, and marketable securities as of September 30, 2026 were $92.3 million.
As expected, our cash burn improved again in Q3 compared to Q2, as we balance investing behind our growth drivers and leveraging our operating model. We continue to believe we are in a strong financial position to continue investing in growth while maintaining our ability to achieve cash flow break-even with cash on hand. Turning now to our guidance and outlook for 2026. On the top line, we now expect full-year 2026 net revenue to range from $68 million to $70 million, representing growth of 44%-48%.
This guidance reflects our continued high degree of conviction in our ability to deliver industry-leading growth by providing 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 a sequential step-up in volumes in Q4 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 continue to expect similar margins for the fourth quarter.
Longer term, we expect our pending 510(k) related to additive manufacturing of certain products to add capability to our supply chain, providing incremental cost reductions on certain products beginning in 2027. In tandem with volume-driven savings, we see continued room for margin expansion as we scale. On operating expenses, the discipline we've demonstrated this year has created flexibility to continue investing in our commercial organization. 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, and we've already begun deploying additional investments in the fourth quarter.
At our current full-year revenue guidance, we expect SG&A expenses as a percentage of revenue to increase in Q4 compared to Q3. Finally, with currently contemplated innovation programs, we continue to expect R&D expenses as a percentage of revenue to remain relatively consistent through fourth quarter and begin to moderate in 2027. From a cash standpoint, we expect cash burn to moderately increase in Q4, considering the additional investments in both the commercial team and research and development. With that, I will turn the call back to Rob for a few closing remarks.
Rob Ball: Thanks, Jeff. In sum, the third quarter demonstrated the durability of our growth and execution capabilities as an organization. We delivered 38% revenue growth, continued to add new surgeons ahead of plan, deepened utilization within our existing surgeon base, and advanced a broad and increasingly differentiated product pipeline. Beyond our own pipeline, our partners are extending what our platform can offer with ALM Ortho, bringing bespoke solutions for the most complex revision cases, and our soft tissue partnership positioning us to serve more of each shoulder specialist practice. Together with our organic development, we believe each of these relationships will meaningfully expand what we are able to offer surgeons and their patients over time.
As we head into the final quarter of 2026, we are carrying strong momentum in the new surgeon adoption and a portfolio that is broadening with each launch and a team that has consistently delivered on its commitments. We believe Shoulder Innovations remains in the early stages of what we can accomplish in transforming shoulder surgical care, and we look forward to finishing 2026 strong and building on that momentum into 2027. With that, I will now turn the call over to the operator for Q&A. Operator?
Operator: Thank you. We will now be conducting a question-and-answer 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 poll for questions. Our first question is from Matthew O'Brien with Piper Sandler. Please proceed with your question.
Matthew O'Brien: Hi, good afternoon. This is Ana on for Matt. Thanks for taking our questions here. Maybe to start, just would love to hear more on the top-line guide for the fourth quarter. It essentially implies like a similar level of sequential dollar revenue growth versus Q4 last year. Just wondering, what exactly is baked into the top-line growth assumptions for the fourth quarter, and what could be some areas of potential upside? Sorry for the long-winded question there, but any color there would be helpful. Then I have one follow-up.
Rob Ball: Yeah, sure. For sure. We're obviously excited about the momentum that we've seen build coming out of Q3 into early Q4. As is our typical mode of operation, we provide guidance that carries a very high degree of conviction. Our revenue performance, like all quarters, will be measured as a function of number of surgeons we can add and the volume we can drive to those surgeons. Quarter by quarter, we've been able to meaningfully increase both of those, and we expect to continue to do so.
Matthew O'Brien: Awesome. Great. That's super helpful. Then, I guess just on that surgeon acquisition comment, you mentioned accelerated conversion of the core contender surgeons in the quarter. Maybe if you could also provide some additional detail on what exactly is driving this, if it's the broader portfolio, more reps in the field, improving productivity, the surgeon-to-surgeon training. Just any additional commentary you can provide there. And thanks for taking the question.
Rob Ball: Yeah, sure. Yeah, no, my pleasure. Thanks for the question, Ana. I think on the softer side, of course, as we've grown as a company, brand recognition, brand equity has played an important role in our potential customer base being already familiar with the name and that being constructive in the conversations we've had. On the harder side, for sure, the metrics that we track and manage against are the raw performance of our commercial organization and the relative relationship between the number of feet on the street or units of selling capacity we have available to us as compared to the number of customers operating.
We obviously watch those figures carefully and pace our investments against those very carefully as we have built a great dataset through our business development platform to help us to understand those relationships and be able to provide some predictability around the model. I think that is in part why you do see quite significant operating leverage this quarter as we have gotten better and better at understanding those relationships and tuning in our investments.
Operator: Next question. Our next question is from Ryan Zimmerman with US Bancorp, BTIG. Please proceed with your question.
Ryan Zimmerman: Hey, Rob. Hey, Jeff. Thanks for taking our questions. Congrats on a nice quarter.
Rob Ball: Thank you.
Ryan Zimmerman: We've had a lot of companies report so far this earnings season. There's been some debate about the health of the recon market. You guys are clearly doing well. You're taking share. I guess I would love, Rob, for your perspective on kind of whether you think there's been any change in procedure dynamics broadly, regardless of your ability to take share. Your perspective on the shoulder market, I think, would be appreciated. Then I have a follow-up.
Rob Ball: Sure. Thanks, Ryan. I appreciate the question. I think it's fair to say that our dataset is far inferior to other larger companies, so it's difficult for us, just in terms of scale, obviously, and it's very difficult for us to make any sort of data-based conclusions around kind of overall health of the marketplace. I can characterize in the shoulder arthroplasty market, we clearly remain passionate about the supply-demand imbalance that exists in the shoulder surgical care market broadly, and specifically in shoulder arthroplasty, so continue to kind of drive that forward.
While for sure, as we got through kind of summer months, we found seasonality to be exactly as expected in terms of timing, and we kind of signaled that in our last call and obviously baked that into our expectations for the quarter. In terms of overall health of the market, I don't think I have any data that says that we're seeing a downturn or seeing an upturn. What we've seen is kind of normal seasonality dynamics.
Ryan Zimmerman: Fair enough. You are introducing a number of products next year. I am curious how to think about both utilization of the product set. I would think that you are going to have higher attachment rates on certain things that would help some of the mix, particularly with your core contender population, but also on pricing. I mean, if you can, again, have higher attachment rates on some of these incremental products, I would think that there could be some price lift next year just in the composition of those implant systems that are used. I would be curious if you have any directional thoughts at this point.
Rob Ball: So, it is a great question, Ryan. I think, as always, there are kind of vectors of growth for price, and there are vectors of diminution for price. So, kind of obviously, we are seeking to consistently optimize price, and I think you are correct. A number of these new products in and of themselves are opportunity for improving price. Those additional products, I think the point you are making, Ryan, is that those additional products give you better call it stickiness with customers and thus a little more influence on price. I think indeed that is possible.
At the same time, as you know, we continue to grow further and further into the ambulatory surgery setting, and we do see modestly lower prices in the ambulatory surgery setting, and I do not expect that to slow down. Either a greater sophistication of purchasing power by ASCs or the volume of ASCs performing shoulder replacements. So we see that mix going up towards ASCs, and we see more pressure in ASCs as time goes by. I think those are both likely the case.
Having said that, with CMS payment and outpatient centers finalized last night, as you know better than I do, we do see a really constructive economic setup, we think particularly for shoulder replacement in the outpatient setting, which we think overall is kind of just helpful for our potential growth going forward.
Ryan Zimmerman: Understood. Thanks, Rob.
Rob Ball: Yep.
Operator: Once again, if you would like to ask a question, please press star one on your telephone keypad. Our next question is from Matthew Taylor with Jefferies. Please proceed with your question.
Matthew O'Brien: Hey, good afternoon. This is Matthew on for Matt. I have a quick question and a follow-up right after that. I would say it's really great to see the momentum in the rep hiring and the adoption that follows it. I wanted to ask if you would attribute some of the strength in the rep recruiting to the disruption you see at some of the other ortho companies and their commercial efforts. Also if you think your rep hiring to continue into Q4, but even into next year.
Rob Ball: Hi, Matt. Thanks a lot for the question. A good question. I would attribute our success at hiring to a number of factors. Probably first and foremost is the culture in the organization that we've worked very, very hard to create. We've invested a lot of time and effort into creating an environment where people can really enjoy and perform, I'll put it that way. I'd say that's been a very attractive cultural environment that indeed, I think if you ask many of our employees as they talk with their friends at other organizations, they communicate that quite robustly, and I think that's been a real opportunity for us.
In contrast, I think on some level, some of those elements don't exist in some other organizations, and so the contrast kind of can be exaggerated. I'd say a couple other factors that are important for our hiring is, one, indeed commercial team members love to sell products that they love to sell. We have a product that is kind of clinically and technically differentiated. You hear yes a lot when you're selling our product. That's certainly a lot more fun to develop a commercial business around than kind of hearing yes less often, I'll put it that way.
Also, as you're executing that commercial plan, what makes it also fun is knowing that you have a group of people around you with high levels of competence. The level of talent that we've been able to kind of bring alongside Shoulder Innovations is really quite remarkable. I'll yet brag again, I've shared this with many people, we have yet to spend $1 in recruiting of a commercial team member. It definitely has happened very organically.
Speaker 6: Okay. Wow, that's very helpful. Thanks. I'll just ask a quick follow-up and maybe ask a little bit differently on the debate on deferrable procedures or deferrable elective procedures. Maybe you can kind of shed some light or some anecdotal information on the deferrability of shoulder replacements. Would you say like these patients are typically those who have delayed treatment or at the point where they have no ability to defer and they need a procedure? Sorry for the long-winded question, but any color would be helpful.
Rob Ball: Yeah, I think the dynamic is similar as you find in other, call it lower extremity, knee or hip markets in the sense that there is a range of deferrability. It's just a matter of how long that time is. Obviously, you get to a point with a pain in your knee that you just can't walk, and that makes it somewhat less deferrable. The challenge with shoulders is you just can't sleep. Obviously, many people are side sleepers, and you get to the point where you can't sleep at night, and it becomes really effectively non-deferrable or a non-elective procedure. That time period may be different in upper extremity versus lower extremity.
I'm not an expert in exactly what those time periods are, but I'd say you have a very similar dynamic there as you do in other cases.
Speaker 6: Great. Thank you very much.
Rob Ball: Thanks for the question.
Operator: Thank you. There are no further questions at this time. I would like to turn the call back over to Mr. Ball for closing remarks.
Rob Ball: Thanks, everybody. I appreciate your participation, engagement, and support. Have a great afternoon. Look forward to talking again in a couple months.
Operator: This concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation.
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