SI‑BONE, Inc. (NASDAQ: SIBN) reported record fourth‑quarter revenue of $56.3 million, a 15.0% increase from the prior year, and a full‑year revenue of $200.9 million, up 20.2% YoY. The company posted a gross margin of 79.0% in Q4 and 79.6% for the year, exceeding the 200‑basis‑point guidance range. Adjusted EBITDA turned positive at $5.1 million in Q4 and $8.9 million for the year, while operating loss narrowed to $2.5 million. Cash and cash equivalents stood at $147.8 million, providing a strong balance‑sheet foundation for continued growth.
The earnings per share of –$0.04 beat the consensus estimate of –$0.13 by $0.09, a significant surprise that reflects disciplined cost control and a favorable product mix. The company’s operating leverage and pricing power in its sacropelvic platform helped offset the impact of higher sales‑and‑marketing and R&D spend, allowing it to deliver a better-than‑expected EPS despite a net loss on a GAAP basis.
Revenue growth was driven by robust demand across the sacropelvic platform, with the SI‑joint fusion and pelvic fixation segments contributing the largest share of the lift. U.S. revenue grew 13.9% to $53.5 million, and the company noted that 35% of SI‑joint fusion sales now occur in ambulatory surgery centers, a high‑margin channel that has expanded its commercial footprint.
Gross margin expansion to 79.6% for the full year, 200 basis points above guidance, was driven by a stable average selling price and a favorable procedure mix that reduced the cost of goods sold. Improved supply‑chain efficiency and scale also helped maintain margin strength even as the company invested in new product launches and expanded its sales force.
For 2026, SI‑BONE guided for worldwide revenue of $228.5 million to $232.5 million, representing 14%–16% year‑over‑year growth. The company expects gross margin to remain around 78% and operating expenses to rise 12.5% at the midpoint of the guidance range, reflecting planned investments in product launches, sales expansion, and pipeline development. Management highlighted high‑teen growth in U.S. procedure volume, favorable reimbursement dynamics, and a partnership with Smith+Naphew that expands the company’s reach into the trauma market as key catalysts for the outlook.
"In 2025, we demonstrated the strength and scalability of our business model, delivering another year of worldwide revenue growth that exceeded 20% while expanding margins and exiting the year with positive free cash flow. These results reflect disciplined execution, a differentiated platform, and durability of demand across our portfolio," said CEO Laura Francis. CFO Anshul Maheshwari added, "Our fourth quarter worldwide revenue grew 15% to a record $56.3 million. U.S. revenue was $53.5 million, representing 13.9% growth. Gross margin was 79% for the quarter and 79.6% for the full year. The gross margin for the full year came in approximately 200 basis points above our original 2025 guidance. In 2026, we expect worldwide revenue of $228.5 million to $232.5 million, implying year‑over‑year growth of 14% to 16% driven by high‑teens growth in U.S. procedure volume. We expect annual operating expenses to grow 12.5% at the midpoint of the revenue range, allowing us to fund key growth initiatives, including new product launch activity, planned sales force expansion and pipeline development."
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