Alrighty. Thank you everyone for joining. Day two, Morgan Stanley's Global Healthcare Conference. Really appreciate you all being here. The most exciting bit, disclaimers: morganstanley.com/researchdisclosures. It's a great website, but what is exciting, obviously, is to have the Shoulder Innovations team here, so Rob and Jeff, thank you so much as CEO and CFO, respectively, for—
Thanks for having us.
Yeah, thank you.
Yeah, thank you very much.
Exciting time as a, you know, recent IPO, new to the market. It's. There's always a lot to talk about. I mean, on that, given, you know, the story is comparatively newer to the capital markets, it might be worth level-setting people who just want a high-level overview of, you know, the business and the product portfolio, just very high level.
Yeah, sure. So we are focused on what we call the shoulder surgical care market. So we think about the shoulder specialists and the surgery that they provide to patients for various ailments about the shoulder. So we have first landed in what we call arthroplasty or shoulder replacement, and that's where we are 100% focused in the moment. Our product line covers about 85% of that market, which is about a $2, $2.5-$3 billion market globally, growing about 10%, honestly. So about two-thirds of that market's in the U.S., and then that's. We sell exclusively in the U.S. today through an independent sales organization. We've been in operations about 10 years. That's, you know, enabled us to develop a pretty robust product line.
We don't cover certain indications, though, for example, Patrick, for example, fracture and revision indications, though we've got some products coming in the relatively near future. Recent sales performance has shown that we have very much engaged the market and caught their interest from a technology standpoint. What's really interesting is that the arthroplasty product lines are coupled with a number of other features of what we call an ecosystem, which has really rung true in the marketplace, so a couple other of those components is one is we couple it with a preoperative planning AI-enabled platform, which allows the surgeon to kind of virtually plan their surgery and perform the surgery prior to the actual patient. That's been very, very powerful for us. We have on the order of 98% engagement, meaning about 98% of the procedures go through the software first.
So that's been very powerful for us. The second is we have redesigned kind of the way you deliver these products to the marketplace, and we package all those products in a very efficient two-tray platform and instrumentation that just makes it obviously much more capital-efficient for us, but obviously much more effective for the healthcare system just in terms of managing cost and risk. Those have all been very helpful for us. That's kind of how the business functions.
Maybe for those who are less familiar with shoulder, it might be worth just giving the background to why historical revision rates have been quite high, the InSet Glenoid, how that fits into the ecosystem, and why it's differentiated.
Yeah, sure. So, there are two main types of shoulder replacement. There's what we call anatomic shoulder replacement and reverse shoulder replacement. Reverse actually represents about 70% of the market today that's been in market, a little over 20 years at this point, and it's really seen a rapid growth. It's been a great technology that's been important. And part of the reason it has been so prolific is because of the challenges with anatomic shoulder arthroplasty. So the main challenge with anatomic shoulder arthroplasty is loosening of what we call the glenoid component or the device that you attach to the scapular side of the shoulder blade side of the joint. And so, that has been a problem through a phenomenon we call rocking horse.
I won't get into the details of that today, but we have developed a device and a technique that effectively solve for that rocking horse problem. That we published that in the main journals in the shoulder arthroplasty space, both basic science and clinical research, that have evidenced dramatic improvements in that respect. That's very much actually what we're known for as a company. Our product line is indeed branded the InSet product line because it reflects the name of that main technology. But today we've grown. We you know match the market in terms of that distribution of anatomic to reverse, and the techniques that we've deployed in the anatomic for the InSet arthroplasty carry through into the reverse.
And so that's part of what enables us to bring to the market that two-tray platform that's been so effective for us.
Yeah, we'll definitely dig into that.
Yeah.
As an area. I mean, maybe just to touch on some of the financials, like Q2 you guys put out, today, I think it was like $11 million, 33% growth. Could you, could you give the audience a sort of view, Jeff, maybe around the strength that you guys are seeing there and, and how we ended up with those numbers?
Yeah, thanks for the question, Patrick. We, we're pleased with second quarter performance, 33% growth. That, obviously, capped a strong first half of the year for us. A couple of major reasons for that growth was really just the increased adoption and utilization of our implant systems, and that's amongst both existing and new surgeons. Then, of course, we're adding to our base customers pretty drastically. We've seen kind of, you know, those metrics sequentially have really improved and increased over the last few quarters, and I think that's really contributing towards really strong growth. In fact, we talked about in a press release, new customers went up about our total customers went up about 50% from last year. So obviously that will bode well for the second half and gives us some real momentum as we enter the second half of the year.
Thinking about the second half of the year, you guys obviously have a public guidance out now that kind of brackets the street estimates. Can you walk us through that and how to think about the back half of the year and the quarterly cadence Q3, Q4?
Yeah, sure. Obviously we've been public for about five weeks now, so we went through a process of just, you know, really understanding our business and putting together guidance and how we feel about that. We've got a disciplined, thoughtful approach in doing that. And, of course, that guidance reflects a similar growth rate in third and fourth quarter that we experienced in kind of first and second quarter. It also reflects a second half growth rate similar to what we experienced last year. So again, we feel good about that and really feel good about the momentum coming out of second quarter as we enter the second half of the year.
Yeah, just to emphasize the point, I mean, what we feel excited about is we're seeing quite consistent and perhaps even a slightly growing growth rates in the second half of this year, even on a meaningfully larger base. So, we're continuing to capture share in the market at a relatively stable pace, so it's great.
Maybe if I wind it back to the base product on this side of things, I mean, you mentioned obviously the two sets, and I guess the more efficient tooling. Maybe again for the audience, give people an idea, you know, traditional shoulder arthroplasty, you know, how many sets are typically competitors using, and why it matters so much to drift down to a smaller amount of instrumentation.
Yeah, so one fundamental change that's happening in the marketplace is CMS in January of 2024 allowed for payment of reimbursement for shoulder arthroplasty in the standalone surgery center. So suddenly you have many standalone surgery centers that are at least partially owned by physicians that operate there that, you know, that have a lot of motivation to take those procedures from the hospital to the ambulatory surgery center, except that in that ambulatory surgery center environment, the challenge is that they really just don't have the real estate or the equipment to process a lot of hardware. I'll put it that way, right? So traditionally, you may have eight to 10 trays of instruments for a shoulder replacement that need to be decontaminated and sterilized. That happens before and after the procedure.
For that to happen in a surgery center that was constructed some years ago for carpal tunnel and cataracts, I mean, it's just that the space just does not exist to handle that type of material. So we become an obvious choice for new surgeons to get started, particularly in their ambulatory surgery center, because of that solution alone. Even take away the advantages we provide from an implant standpoint or clinical benefit standpoint, that alone has been very helpful for us. In fact, we ran some numbers not so long ago to understand where do surgeons operate first with our products, and it approaches 50% of the time their first case is in a standalone surgery center for all the obvious reasons I just characterized, so.
I had dinner with STERIS last night, and they echoed the ASC sterilization challenge.
Yeah.
They were just like, It's like four or five docs running a facility.
Right.
They're just not equipped to manage it. Maybe, like, if you could explain to people, like, how you ended up, from an engineering standpoint, getting down to such a smaller amount of instrumentation relative to peers.
Yeah, so as a team, we've been involved in this space literally for decades. If you read our backgrounds, you know, kind of the registration statement's a good, you know, characterization. We as a team worked at DePuy many years ago, developed a product line there. We worked around R&D and Tornier for many years. We developed a very broad product line there, which is obviously now Stryker's, at least a part of Stryker's product line. I think that experience was very educational for us to understand that, you know, kind of, you know, obviously we all know Wayne Gretzky recommended to skate where the puck is going.
We did foresee, probably maybe a little bit too early, but did foresee, "Hey, these, this, these procedures are going to transition at some point to the ambulatory surgery center, so let's be ready for that." What we were able to do, Patrick, is really start with a blank sheet of paper. In order to accomplish that instrumentation, I'll call it minimization, you have to start with the design of the implants. That's where we focused with the, with the requirement we will only have two trays of instruments.
We announced, this morning, that we've now commercially released, what is now the, the 70 ml length version of our InSet series stem. A logical question is, so as we introduce those more products, does that mean, is that now a third tray? I said, "No, we continue to reconfigure the trays to maintain that same footprint." We expose ourselves to the operating room with two trays, you know, yet still, so.
One of the questions we get sometimes is, how hard would it be for the existing players to reverse engineer their current product line down to fewer trays? Maybe not two, but how hard would that be for them, do you think?
So, I mean, I think my guess is challenging, you know. I just know the way we've accomplished it has been through the design of the implants, and for us to reconfigure instrument techniques to go even further reducing instrumentation, I think, starts with implant design, so I can say tongue in cheek, all they'd have to do is redesign their implants, which is obviously somewhat facetious, but I think that's, you know, at its core, that's where it starts.
We often talk about the space requirements or the sterilization requirements, but how does it compare from a workflow perspective and practice for the surgeon with fewer trays versus more?
So I think at its core, Patrick, it's not just for the surgeon, it's for the entire staff, you know, so you frequently can deal with staff in these types of environments that, you know, outside of the surgeon, that are maybe somewhat less experienced. There's not as many procedures as hip or knee, for example, and so just the intimidation factor of seeing a back table with two trays versus eight trays or 10 trays. I mean, we've actually been pleasantly surprised about how encouraging the staff has been to the surgeon. "Hey, can we use this product more? This is a lot easier for us." It also is simpler for our staff to understand and instruct on, right?
I mean, when you've got eight trays of instrumentation laying there and they're, you know, focusing with a low-weight laser point or not pick up that one, not pick up that one. It's just, it's a communications challenge for everyone. It's not intuitive, and so we're glad that we've been able to resolve some of that.
Jeff, is it easier as well from a capital intensity level, like where you have the sets, how many you have, keeping track of them? Is that an easier challenge?
Yeah, absolutely lower capital requirements, and obviously tracking those and replacing, you know, at some point they're replacing instruments and stuff. It's just much less of that. So it's definitely a competitive advantage.
I know again.
If I could, we also are still constantly reassessing how do we improve. If I have $150,000 of instrumentation sitting in an operating room to make a change across the entire geography of the U.S. or the world, that's a big decision. If you can minimize that decision, it allows you to be more rapidly responsive to the thirst for your customers, and that's played out for us for sure.
That's interesting. You mean basically to open new accounts and to get involved with them, you can take more risks because the sunk cost is lower kind of thing from the capital requirement perspective?
You know, I mean more if I have a customer that says, "I love your product, except I'd rather this be blue instead of pink." For me to change something from pink to blue is a relatively inexpensive proposition. If I have to change eight times as many things from pink to blue, that's a much bigger decision.
One of the other things, like certainly from the KOL calls that we had done, that comes up a lot was range of motion. Maybe again, people seem to be able to understand what the trade-offs historically were for a lot of shoulder patients, relative to, with your solution.
Yeah. So with respect to range of motion, particularly with reverse shoulder arthroplasty, there has always been an exchange between stability of the joint. And what I mean by that is the fact that the joint does not dislocate postoperatively and the range of motion. So there's always been this counterplay of how well tensed or how tense do I implant the device, versus the risk of dislocation. And so, we've been able to find a lot of success, a bit of a sweet spot with respect to seeming to minimize that dislocation probability but maximize range of motion. In fact, there's a surgeon that, you know, you can go to all those and see we interview many surgeons, but one particularly, I think the interview was entitled, I came for the InSet.
I stayed true to reverse, and that's really what has encouraged that individual in that way, which is, you know, he just found near-term postoperatively patients were just moving better. And that was incentivized by design from a biomechanical standpoint, but you obviously you don't really know until you get in the hands of many surgeons that that's indeed the case. So our customer discovery data internally tells us that many of our customers, more than half at least those surveyed, characterized that they get better results than they did prior, particularly with respect to range of motion.
I was speaking to a wound care company yesterday who had two different sets of docs who were treating patients, one with their product, one without, and then the patients met, and the word of mouth became an important component here. For patients, it's such a practical consideration how their range of motion. Is there a way here where, whether it's the surgeons or the patients, you can end up with a word of mouth that sort of spreads and helps, helps you guys grow over time?
You know, I think it for sure it's word of mouth. We have surgeons that have used our product, have been so surprised by the outcomes that they're receiving that for sure they write emails to their friends and say, "You gotta give this a hard look." And it's quite frankly been some of the drive behind why we've added so many customers recently, right? I mean, that's as Jeff mentioned in Q2, actually in the first half, about 50% over prior year, which is, you know, been delightful for us obviously and bodes well for the momentum that we're hoping to be able to describe in the second half here, so.
On the commercialization strategy, you guys have a, like a hybrid model essentially with an introduction and then a distributed model, which is quite capital efficient. I mean, splitting into two, maybe one for you, Rob, and one for you, Jeff, like the first step for you, Rob, how do you, how are you finding that that's working for you guys? How do you ensure that when the distributor takes over, you keep those customers locked in? And then.
Yeah.
Jeff, you can think about the financial impact of that flexibility of scale versus a full, like, W-2 force. You see what I mean?
Yeah. So I'll just push back a little bit on the idea of hybrid. So we are not a hybrid model. We are an independent distribution model. The reason we've chosen the independent distribution model is we are seeking to provide maximum service in every single surgery where our products are used. And so that means we're in every single surgery across the U.S. And so in order to do that, obviously you need to scale that organization quickly. And from a cash flow standpoint, we wanted to do that on a commission-only basis. And the independent organization is a way to do that. But we also wanted simultaneously a little more control over our growth rate. And so what we've done is we've overlaid a pretty meaningful size W-2 organization on top of that independent organization.
And we've built, which I think is likely second to none, business intelligence platform for that W-2 organization, which allows them to very carefully curate where should we be spending our time as a commercial organization. And so, that has led to a meaningful increase in what we call core and contender customers, as we characterized 50% increase over prior year. But another interesting fact about that performance is that when you look back, I think it's six or eight quarters, the ratio of our core contender surgeons to our W-2 has been very flat, kind of in the three and a half to four range. And we see that continuing as we layer.
And so, that our view is that gives us quite a bit of predictability with respect to our ability to invest in that organization and what we would expect to happen with respect to that organization. So that's one of the things that's been so powerful about us, you know, kind of getting public here over the past five weeks or so. It does put us in a position to be able to scale that organization at the right pace that matches our objectives from a commercial and financial standpoint.
I think, Patrick, on the financial side, obviously this is a major benefit for us, because the variable selling expenses will kind of scale with revenue, right? Up and down with revenue. So, you know, we only pay commissions then as we have revenue. If revenue's lower, we pay less commission. So obviously we manage that. We don't have the overhead of, you know, a couple hundred salespeople. They're all W-2. So major advantage for us and will help us as we kind of scale the business.
We all love flexibility.
Yeah.
I mean, maybe, maybe just to touch on the ASPs as well. It's always tricky because the mixed dynamic between anatomic and reverse kind of shifting is quite a bit. But if we, if in your mind, if you were to sort of normalize that, how should we think about ASPs, going forward, just ex the kind of mixed bit of it?
Yeah. So ASPs were really strong in Q2. And obviously we benefited from both some surgeon dynamics and mixed dynamics. But we're kind of feeling good about where that landed today. We've obviously targeted centers where we can gain kind of higher ASPs. We've done a good job executing on that. And I think we're kind of feeling good about where ASPs are and kind of where they'll continue.
The IPO, you know, you guys raised a good chunk of money and very successfully. You know, maybe walk the audience a little bit through how you're planning to use the $75 million and how you're thinking about it?
So clearly, as I just described, our number one priority is to scale the commercial organization. That's gonna be the largest driver of growth for us. And our view is we find ourselves in that linear relationship between our commercial organization and number of customers. And so we want to step that up, you know, kind of at the appropriate pace. I'll put it that way. We also, as a team, have a long history of innovation in this space. We've been behind some of the more relevant, you know, technology changes in arthroplasty. And so obviously we will continue that legacy and lean in further even into implant development and new products. Obviously, one subject that obviously is a hot topic in the space is enabling technology. We remain very excited about that area.
We think it does indeed have relevance in the shoulder arthroplasty space. We're spending a fair amount of time, discovering exactly what we're gonna do there and are hopeful to be able to present some real solutions to the market relatively soon.
IPOs are pretty time-consuming. I can imagine other than the joy of working with me, probably one of the best bits was like the time that you've now got back. What are you doing with the time that you know, that you've kind of now got back and you've got more time to focus? What's the main focus right now?
Yeah. We chatted in the hallway earlier. I mentioned, you know, you kind of go into the IPO of all of the what-ifs in terms of like the long list of if we could only, you know, do these things. And now you find yourself with actually the capital to do with excellence many of the things that you'd look forward to doing.
And so, you know, I think a lot of the time, at least I've spent or we spent as a team over the past four, five weeks have obviously been continuing to execute on the business, which is performing very well, but also reconsidering in the light of a new balance sheet, what are some things that we might, you know, kind of do differently or more aggressively. I'll put it that way. And so, working through those and working very quickly on bringing on additional resources to be able to execute on a lot of those initiatives.
Was there anything that came out of the process that surprised you? Because it's obviously very different suddenly when you're talking to like the focus of people externally versus what you had expected it.
Yeah.
To be.
Not so much. I think the one thing that, that popped up for me, we were obviously expressing a model where what we really need to do is get the capital on the balance sheet so that we can scale the commercial organization. We demonstrated some great history on our ability to scale, at least in a small way. So the question is how fast and where is that commercial organization gonna come through? And I guess we received fewer questions I would've expected, like how are you gonna find all these people that you need to be successful commercially? You know, one of the things I've shared with most is that we've not yet spent a dollar on recruiting our commercial organization.
And the reason for that is I think we've built such a great reputation in the marketplace so far as the innovator, the, you know, kind of the next generation in shoulder arthroplasty that the individuals are actually come to us, right? And so, that's where they're coming from. That's been a great story for us. We see that as accelerating at this point. And, one investor somewhere in the process mentioned, you know, there's a lot of ways you can assess opportunities. One of them is go where the talent's going. And, you know, that it feels like that for sure right now and, and we're having fun with that.
So it sounds like the rep side has been a pleasant surprise. And I guess more than the reps, like the entire talent set has been not easier, but
For sure, it's been way easier than we thought it would be. I mean, you go out into the market as a small company. You're asking, you know, kind of individuals to take personal financial risk to engage your vision, and we found a lot of really talented networked folks that have been excited to join us in that respect, and it's been easier than I thought. I don't know if it's surprising or not, but certainly easier, and less expensive, you know, so.
I feel the opposite for my business, so that's quite nice to know. You mentioned enabling tech. I'd love to, I'd love to dig into that, how you're viewing that ecosystem and how it could fit in, for SI.
Yeah. So, obviously an important component of enabling technology is that pre-operative planning step. And we are really a best-in-class solution there. And, we've been involved in that part of the process for literally more than a decade now and are a leader in that space. And so that's obviously the 98% of all engagement we have with that is important. And you can kind of think about enabling tech as several steps in the journey of the patient. So first, the patient needs help and gets the pre-operative planning. Then you need to execute in the operating room. And then once you've executed in the operating room, you actually can think about confirming, did I actually perform what I did in the plan? And then how, what is the impact that's having on clinical outcomes?
That's kind of how we're breaking it down into those four pieces. Obviously most of what the market talks about today is that middle part about executing in the operating room, which our view is just one step. It's obviously a very important step. But I don't know that there's a one-size-fits-all for that step for every patient and every care setting, right? And so, the way we think about that is certainly there are benefits that we can provide to surgeons and their patients by improving the reliability with which you can execute that plan. But that has to come with the ability to both A, confirm you executed well to the plan. Otherwise, it's just imaginary. And it has to come with the idea that you're actually producing better outcomes. That's how we're thinking about it.
We're not sure a highly capital-intensive model is indeed the way to go, and we're also not sure we've been excited about what we've seen in the space so far in the marketplace. We've worked very hard to devise a strategy here that we're hopeful to share more about soon.
How do you think sometimes we've got questions around robotics in relation to how it's developed in knee and hip, but those are very different joints, to shoulder. How do you think about the role that it plays and the relative difference versus the presence that we've got?
Yeah. So I think I'll characterize it in two ways. One, so if you look at the clinical literature, knee arthroplasty would definitely demonstrate that surgeons that leverage or enabling tech or just call it a robot in surgery have seen higher volumes, right? And so that's statistically significant. And so that's helped them grow their practice. So that's important. But at the same time, there's not strong literature that success that patients are actually having better outcomes. So it puts us in a position that seems somewhat of a commercially or marketing-driven part of the market. In shoulder arthroplasty, there are still some fundamental problems that need to be solved. For example, what is the best position to place the glenoid component on the scapula?
If you ask 50 surgeons, you know, kind of that question, I don't know if you'll get 50 answers, but you're probably gonna get 10 answers. So there's some ambiguity about those types of questions. And what you have to do is understand that we're operating in a more challenging environment in the shoulder. There's less access. It's an oblique approach, so it's more complicated. And assistance in knowing that you've placed it where you thought you would can be relevant in adjusting those outcomes. We also have a particular structure we deal with in shoulder arthroplasty, which is the subscapularis muscle and tendon. The ability to manage that differently, these are the, for example, a subscap sparing approach, which many have talked about. That would be interesting and powerful in the space. And robotics perhaps can play a role in enabling that.
Our surgeon customers perform many procedures already in a subscap sparing approach, but that may get more accessible to more surgeons.
Taking a step back, one of the things that differentiates Shoulder from a lot of the other markets in ortho that we look at is just the sheer growth rate. I know you guys said more than 10%, but probably if you look at the players, it's probably well north of 10% at the moment. It's doing really well as a market. Why do you think that is? Is it historic revision rates that were tough that scared patients away? Because the proportion of patients that actually get a surgery is still pretty low versus those with shoulder pain.
100%. Yeah. So if you look at the number of patients that see a physician for shoulder pain is relatively similar to knee arthroplasty that you do. We see, you know, excuse me, you see three to four times as many knee surgeries as you do shoulder surgeries. So for sure, there's some tentativeness there. I think one of the things you have to remember is reverse shoulder arthroplasty entering the market in the early 2000s was transformational in access of care, surgical care to patients in that time period. And of course, it takes time for the reputation of that type of procedure to grow in what I'll call the, you know, kind of provider marketplace. And so I think we're in a position where you see many, many more patients open to shoulder surgical procedures because of the improved technology.
But then simultaneously, over that same time period, there's been a meaningful shift towards specialization in shoulder. It's an exciting space for new surgeons. And so that skill increase has also been an important factor. So I think those will continue to be key drivers in growth in the space outside of the demographics you'll hear every other CEO talk about.
The shoulder surgeons we speak to definitely seem less miserable than the hip and knee ones. To be fair, it's not a high bar to clear, but nonetheless.
Yeah. Yeah. Yeah.
Yeah. I mean, do you think that there, like, there's a real patient understanding at this stage that the clinical outcomes are generally getting a lot better, you know, than just dealing with injections or whatever? And do you think that's really gone down to that patient base? Are we still building that confidence in the procedure?
I think it's improved, but we're still building that confidence. You know, I think that patients that get a shoulder replacement feel better after surgery. And the more of that dynamic is communicated into the marketplace, the more demand there will be from patients.
How important is that ASC transition also to getting patients through the door, knowing that it's a faster turnaround? It's not as intimidating as like just a large inpatient.
Yeah. Yeah. I mean, I'll share my hypothesis, which is that the ASC reimbursement dynamic enables surgeons to more rapidly facilitate their practice transition from the hospital setting to the ASC setting. So that's that plus COVID has kind of lowered some barriers. I'll put it that way, right? And so, to me, what that represents is a dramatic increase in potential capacity of operating, just frankly operating room capacity, and it's a lot easier to build an ambulatory surgery center into the hospital. So, I think we're gonna find surgeons. They enjoy shoulder arthroplasty. And I think we're gonna find surgeons that now that they can increase their own capacity, indeed exercising their or operating their practice in a way that actually can attract and execute on more shoulder procedures than they did before. I think that ASC setting is gonna be a pretty massive driver of growth.
You've been involved in the shoulder market for a long time. Do you think, people's expectations have changed around, as they get older, their range of motion, their ability to be active? We hear it a lot, but like, is that actually a thing or is that like a bullet on the McKenzie slide?
No, I think it's 100%. Expectations are much more dramatic. I mean, I'm 53. I lift more weights now than I did when I was 50 or 23. And I think that that's not uncommon for this age group, I'll put it that way. And so I think most patients have a higher demand expectation out of their, they're going to get a shoulder replacement or a shoulder procedure because they wanna continue the activities that they were doing before that they can't anymore, so.
On the surgeons themselves, how, like, how are you seeing, you know, the utilization and the engagement of the, let's say, the older, not by age, but the original cohort versus some of the newer adds? How has that trended over time for you guys?
So I think for sure we see the pace at which new surgeons engage with us increasing. Said another way, more recently, surgeons that we have added to our core and contender group, I'll put it that way, they've reached that core contender status faster than, you know, previous cohorts. So I think that's a number of things. Our brand equity obviously has increased. We've become better at communicating and educating those surgeons. And, you know, kind of one simple thing is being a public company, which we now kind of can share, like we're really the only publicly traded pure play company focused on their practice. That means something to them. That's important to them.
I was gonna ask, like, how has the internal reception to them being public and that whole process been, like, for the people reporting into both of you, how has that been sort of received, I guess?
I mean, I'll just comment that I've not yet spoken to a shoulder surgeon that didn't know we were public, right? I mean, so that was, you know, kind of they were aware of that fact and with a lot of excitement. I think we're, it's, it's encouraging for the space, but.
Yeah. I just think the brand recognition and everything has been completely positive. So we're excited about that. And Jeff, for the incremental money you guys now have, like, how's it working when you're deciding how and where to allocate it? Are like some of the teams coming through with like business plans or are they just sort of saying, "I found these three great guys in this territory"? Like, how are you kind of managing allocation, if you know what I mean?
Yeah. We've got a plan. We go through as a management team, talk about priorities, and, you know, we're gonna invest pretty heavily but responsibly at the same time, right? So we're just focused on prioritizing, you know, how to build a great business and do that as quickly as possible.
Yeah. Of course, you don't arrive at the IPO not knowing that you were doing an IPO before, right? So we obviously had a lot of those discussions prior to kind of completing that process, and we're beginning to lean into those even before, so.
Yeah.
And then, I guess, from the internal sales force perspective, are there particular geographies or areas within the U.S. that, you know, you're looking to especially target at the moment?
I don't know if I wanna get into where we're strong and where we're not so strong from a competitive dynamic, but I'd say there is no shortage of opportunities throughout the U.S. for us to improve our commercial footprint, and we're excited and delivering in all those areas.
We'll put it another way. For the total shoulder market, is it like Sunbelt distribution or is it like, is there a skew outside of the usual, like, demographic? 'Cause I guess average age is what, 65?
For sure. Yeah. There's obviously a bias towards California, Texas, Florida, Arizona. You know, those are very high volume on average per capita, I guess, let's put it that way, areas for shoulder arthroplasty. Obviously that's where we, we seek to, you know, kind of penetrate the quickest and.
Nice. Well, Rob, Jeff, thank you so much. Thank you. Awesome. Thanks, guys.
Thank you, Patrick.
Thanks.