SI-BONE, Inc. Q3 FY2025 earnings call

Innovation

• Built industry-leading platform for sacropelvic anatomy, pioneered SI joint fusion, and launched iFuse Torque in Europe. Progressed on products launching in 2026, filed 510(k) for next-gen tech. Granite successful in adult deformity with 40% growth in multi-implant cases. TNT contributed to trauma surgeon growth, with a new device in development.

Physician Engagement

• Approximately 1,530 physicians performed procedures, a 27% year-over-year increase. Added 330 physicians in the quarter, the largest quarterly increase. 25% of SI joint fusion physicians performed other procedures, and longer-active physicians did more cases.

Commercial Execution

• Trailing twelve-month average revenue per territory was $2.1 million, up 16%. Ended the quarter with 88 quota-carrying territory managers, plan to increase territories. Completed 135,000 procedures.

Operational Excellence

• Worldwide revenue $48.7M (+20.6%), U.S. revenue $46.4M (+21.2%), international revenue $2.3M (+10.2%). Gross profit $38.8M (+21.8%), gross margin 79.8%. Operating expenses $44.2M (+11.9%). Net loss narrowed, positive adjusted EBITDA $2.3M. Net cash flow breakeven, ended quarter with $145.7 million in cash and marketable securities.

Worldwide revenue in the third quarter was $48.7 million, representing approximately 21% growth. U.S. revenue grew over 21% to $46.4 million. International revenue saw growth fueled by the launch of iFuse Torque. Gross profit was $38.8 million, an increase of $6.9 million or 21.8%, with a gross margin of 79.8%. Adjusted EBITDA was $2.3 million for the quarter, translating to an adjusted EBITDA margin of approximately 5%. The company achieved positive operating cash flow, with net cash flow breakeven for the second consecutive quarter and first quarter of meaningful positive cash flow from operating activities.

Updated full-year 2025 revenue guidance to $198 million to $200 million, implying year-over-year growth of approximately 18% to 20%. Full-year gross margin expected at 79.5%, operating expense growth guidance maintained at 10% at the midpoint of the revenue range.

Q: On physician density and halo effect between product categories, operating leverage A: Laura A. Francis and Anshul Maheshwari discussed physician density as a key focus, broad platform expansion, opportunity for cross-product halo effect, and operating leverage with revenue growth outpacing OpEx growth.

Q: On guidance update, Q4 momentum A: Laura A. Francis and Anshul Maheshwari talked about strong Q3 performance, continued outperformance, Q4 momentum with 27% growth in active physician base, strong October and November trends.

Q: On 2026 growth expectations, gross margin durability A: Laura A. Francis and Anshul Maheshwari mentioned confidence in 2026 growth, favorable reimbursement, international growth from Torque, and gross margin durability stabilizing around 78%-78.5%.

Q: On territories, seasonality A: Laura A. Francis and Anshul Maheshwari discussed territory productivity, target to reach 100 territories, and managing seasonality through surgical capacity and physician engagement.

Q: On physician drivers, product pipeline impact on TAM A: Laura A. Francis discussed broad physician growth drivers, including spine surgeons, interventionalists, and trauma surgeons, and product pipeline impact on TAM expansion.

Q: On TORQ European launch, ASP trend A: Laura A. Francis and Anshul Maheshwari talked about TORQ European launch momentum, ASP trends driven by procedure mix and implant cases.

Q: On TNT, NTAP, long-term profitability A: Laura A. Francis and Anshul Maheshwari discussed NTAP impact on TNT adoption, capital-light model, and long-term profitability through revenue growth and operating leverage.

Q: On EBITDA inflection, interventional market expansion, product reimbursement A: Anshul Maheshwari and Laura A. Francis discussed EBITDA leverage, interventional market expansion as additive, and product reimbursement tailwinds.