Treace Medical Concepts Q1 2024 Earnings Report $7.41 +0.31 (+4.37%) Closing price 04:00 PM EasternExtended Trading$7.38 -0.04 (-0.47%) As of 05:22 PM Eastern Extended trading is trading that happens on electronic markets outside of regular trading hours. This is a fair market value extended hours price provided by Polygon.io. Learn more. Earnings HistoryForecast Treace Medical Concepts EPS ResultsActual EPS-$0.30Consensus EPS -$0.30Beat/MissMet ExpectationsOne Year Ago EPS-$0.23Treace Medical Concepts Revenue ResultsActual Revenue$51.11 millionExpected Revenue$49.07 millionBeat/MissBeat by +$2.04 millionYoY Revenue Growth+21.10%Treace Medical Concepts Announcement DetailsQuarterQ1 2024Date5/7/2024TimeAfter Market ClosesConference Call DateTuesday, May 7, 2024Conference Call Time4:30PM ETUpcoming EarningsTreace Medical Concepts' Q1 2025 earnings is scheduled for Tuesday, May 6, 2025, with a conference call scheduled at 4:30 PM ET. Check back for transcripts, audio, and key financial metrics as they become available.Q1 2025 Earnings ReportConference Call ResourcesConference Call AudioConference Call TranscriptPress Release (8-K)Quarterly Report (10-Q)Earnings HistoryTMCI ProfilePowered by Treace Medical Concepts Q1 2024 Earnings Call TranscriptProvided by QuartrMay 7, 2024 ShareLink copied to clipboard.There are 9 speakers on the call. Operator00:00:00Good day, and thank you for standing by. Welcome to the Triste Medical Concepts First Quarter 2024 Earnings Conference Call. At this time, all participants are in a listen only mode. After the speakers' presentation, there will be a question and answer session. Please be advised that today's conference is being recorded. Operator00:00:33I would now like to hand the conference over to your first speaker today, Julie Dewey. Please go ahead. Speaker 100:00:42Good afternoon, everyone, and welcome to our Q1 2024 earnings conference call. We appreciate you joining us. I'm Julie Dewey, Treese's Chief Communications and IR Officer. With me today are John Treese, Chief Executive Officer and Mark Hair, Chief Financial Officer. During the call, John and Mark will offer commentary on our commercial activity and review our Q1 financial results released after the close of the market today, after which we will host a question and answer session. Speaker 100:01:11The press release and supplemental materials can be found in the Investor Relations section of our website at investors. Treese.com. This call is being recorded and will be archived in the Investors section of our website. Before we begin, we'd like to remind you that it is our intent that all forward looking statements made during today's call will be protected under the Private Securities Litigation Reform Act of 1995. Any statements that relate to expectations or predictions of future events and market trends as well as our estimated results, outlook or performance are forward looking statements. Speaker 100:01:46All forward looking statements are based upon our current estimates and various assumptions. 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. All forward looking statements are based upon current available information and Therese assumes no obligation to update these statements. Accordingly, you should not place undue reliance on these statements. Please refer to our SEC filings, including our Form 10 Q for the Q1 2024 filed today and our Form 10 ks for the full year 2023 filed on February 27, 2024 for a detailed presentation of risks. Speaker 100:02:33With that, I will now turn the call over to John. Speaker 200:02:37Thank you, Julie. Good afternoon, everyone, and thanks for joining us. I'm going to focus my comments today on our Q1 2024 highlights, the progress of our numerous product launches, including SpeedPlate, our other growth drivers, and then spend some time discussing developments in the market environment which is underpinning our decision to revise our full year guidance as well as tell you about our exciting opportunities and strategies going forward. Following my comments, Mark will cover specifics about our Q1 results and our 2024 guidance. We grew revenue 21% in the Q1 of 2024. Speaker 200:03:10Revenue performance was driven by increased procedure kit volume from our expanding base of surgeons and mix driven by increased adoption of our newer technologies in our core bunion and related midfoot cases, all supported by our dedicated direct sales team. We also benefited from strong patient demand trends that extended our seasonally strong Q4 into the Q1. Additionally, we made encouraging progress with respect to our adjusted EBITDA results. Our adjusted EBITDA loss improved 18% to a loss of $8,300,000 in the Q1 of 2024 compared to a loss of $10,000,000 for the same period in 2023. We've expanded our position in the foot and ankle market by adding complementary procedures and technologies to treat related deformities, namely our adductorplasty and hammertoe correction systems, both of which coexist frequently with bunions and are addressed at the same time and which together have expanded our TAM by an estimated $750,000,000 without diluting our focus on the $5,000,000,000 plus U. Speaker 200:04:08S. Bunion market opportunity. Additionally, exiting Q1, we now have full market availability a number of our newest technologies, including our Speed Plate fixation platform, hammertoe system, sterile instruments and our minimally invasive microlapoplasty procedure. We expect all of these new technologies to contribute to our growth going forward. And we recently announced that we've now treated more than 100,000 patients with our lapoplasty procedure, recognizing that our success is not only measured by numbers, but are the transformative change that our differentiated therapies provide the patients to overcome painful lifestyle limiting bunion and related midfoot deformities. Speaker 200:04:48Further highlighting our progress in the Q1, we delivered gains across our key operating metrics in Q1. We drove a year over year increase in volume of lapoplasty, adductoplasty and complementary procedures which were enabled by our versatile Speedplay platform. We also benefited from favorable mix as well with new products like Speedplay and our hammer toe systems as well as our expanded offering of procedure specific sterile instruments all being utilized more frequently in our core procedures. As we previously announced, we established the first ever National Bunion Day in the United States on significant increases significant increases in our website traffic and an amplified activity level on our find a doctor locator. Therese was also named the 1st medical device partner and official foot and ankle solution partner for the Professional Pickleball Association Tour. Speaker 200:05:44Pickleball is the fastest growing sport in the U. S. We believe we're uniquely positioned to drive greater awareness of the challenges posed by bunions and educate patients in this demographic on our pioneering lapoplasty procedure, the number one most commonly used 3 d bunion correction procedure by U. S. Surgeons. Speaker 200:06:03Now I'd like to turn to our product launches. Our Speed Plate launch continues to fuel our growth and we saw strong demand in the Q1. In fact, Speed Plate usage nearly doubled in Q1 versus Q4 of 2023. Exiting Q1, we've achieved full commercialization of SpeedPlate and expect adoption to continue steadily through the remainder of 2024. Additionally, we expect to launch a new Speedplay configuration in Q3, which is designed to address some incremental larger bone fusion procedures in the foot. Speaker 200:06:33Next, our microlappoplasty system. This exciting evolution of our instrumentation allows the patented lapoplasty procedure to be performed now through a 2 centimeter incision using our new Speed Plate Fixation technology. Our micro lapoplasty system is now fully available and throughout Q1 we witnessed a growing number of surgeons utilizing this minimally invasive lipoplasty approach. While we're excited about the growth opportunity that all these product launches represent, there's even more expected to come from our robust product development pipeline to deliver a steady cadence of new innovations in the second half of twenty twenty four, including mini adductoplasty and our Redpoint patient specific instrumentation. We believe both of these technologies will reinforce our market leadership position in the bunion and related midfoot correction space. Speaker 200:07:18We look forward to providing additional updates on these platforms as well as other new product innovations as we progress throughout the year. Turning to our guidance, despite our strong start to the year with expected growth opportunities stemming from product launches and new innovations I just mentioned, it's become clear that the market environment and competitive landscape is quickly evolving and we've made the decision to revise guidance for fiscal 2024. We have decided to do this now because we're seeing increased use and surgeon adoption of MIS osteotomy solutions. At the same time, we're facing even more competition from knockoffs of our lapoplasty products. Both of these dynamics are creating incremental headwinds to our lapoplasty growth. Speaker 200:07:59Specific to these knockoffs, we fundamentally believe that none of these systems match lapoplasty's performance and reproducibility at the surgeon patient interface, nor are they supported by the strong differentiating clinical data sets that lapoplasty offers. We also believe some of these competing products are violating our IP. With this backdrop, I'd like to spend the next few minutes reviewing our strategy to expand our offerings and advance our business. While building our leading position in the Lapidus segment of the Bunyan market, we've simultaneously been pursuing a strategy to advance Treese from a company focused solely on Lapidus and related solutions to a comprehensive Bunyan Solutions company, Meaning to implement our strategy to expand our bunion solution portfolio, we plan to launch 2 innovative 3 d MIS osteotomy systems in late 2024 into the metatarsal osteotomy segment of the market which accounts for 70% of the overall procedure volume today and into our base of nearly 3,000 surgeon customers. Once launched, our customers who love lapoplasty but still perform on average over half their bunion cases using metatarsal osteotomies will then have a TRACE product to address all of their lapidus and osteotomy bunion cases. Speaker 200:09:14Additionally, we expect our MIS osteotomy solutions will afford us the opportunity to appeal to a new group of surgeons, those with a strong bias for using osteotomy approaches for the majority of their bunion patients. We expect to see the positive benefit of these new MIS innovations starting the Q4 of this year and ramping throughout 2025. I continue to believe we are uniquely positioned to build upon our market leading lapoplasty position while leveraging that position to make a significant impact in the large osteotomy segment of the bunion market. 1st, we are confident in our track record of developing, commercializing and rapidly innovating 3 d bunion technologies that achieve broad customer acceptance due to their elegant design, reproducibility and clinical effectiveness. We have proven this with lapiplasty and we've applied this expertise in our instrumented approach to our 3 d MIS osteotomy systems mentioned earlier. Speaker 200:10:09And we are confident in our ability to provide a strong educational resource for our surgeon customers as well as educate patients about our innovative therapies. Again, we have proven this with lapoplasty and we will apply this experience with our forthcoming 3 d MIS osteotomy platforms. Finally, we are confident in our Bunyan focused direct sales team's ability to deliver these 3 d MIS technologies to our base of nearly 3,000 laparoplasty surgeon users and continue to expand the size of our surgeon customer base over time. We recently trained an initial group of surgeons on one of our new 3 d MIS osteotomy platforms in anticipation of our upcoming limited market release and the surgeon feedback was overwhelmingly positive. I could not be more excited about the significant opportunity we expect from our new 3 d MIS osteotomy platforms. Speaker 200:10:59At the same time, we continue to focus on expanding our product offerings and the total market we serve to become a comprehensive bunion solutions company. We are taking decisive actions to mitigate the impact of the competitive challenges as well as our revised growth rates by rightsizing our P and L and reducing costs. In addition, we attend to assert and enforce our IP rights. I am confident in our ability to capture the opportunities ahead of us, innovate for our surgeon customer base and deliver value for our shareholders. I'll now turn the call over to Mark to review our Q1 financial performance and provide more details about guidance. Speaker 200:11:35Mark? Speaker 300:11:37Thank you, John. Good afternoon, everyone. Revenue for the Q1 of 2024 was 51,100,000 dollars a 21% increase with 1 less selling day than the prior year. Growth in the Q1 was driven by increased procedure kit volume from our expanding base of surgeons and increased adoption of our newer technologies, all supported by our dedicated direct sales team. As John mentioned, similar to what we saw last year, our seasonally strong Q4 extended into the Q1. Speaker 300:12:10This year, there was more carryover from the 4th quarter into the Q1 than originally anticipated, which was the main driver of upside in the quarter. Gross margin was 80.2% in the Q1 of 2024 compared to 80.9% in the Q1 of 2023. This decrease was primarily due to a shift in product mix to newer products partially offset by lower royalty rates. Total operating expenses were $59,900,000 in the Q1 of 2024 compared to total operating expenses of 47,900,000 dollars in the Q1 of 2023. The increase in operating expenses reflects strategic investments in our expanding direct sales channel, investments in product innovation and support for other corporate initiatives. Speaker 300:12:581st quarter net loss was $18,700,000 or $0.30 per share compared to a net loss of $13,500,000 or $0.23 per share for the same period in 2023. Adjusted EBITDA loss improved 18 percent to a loss of $8,300,000 in the Q1 of 2024 compared to a loss of $10,000,000 for the same period in 2023. Cash, cash equivalents, marketable securities and investment receivable totaled $112,100,000 as of March 31, 2024. We believe we have a lengthy runway in terms of our current cash level with sufficient balance sheet strength and flexibility to continue effectively executing on our strategic investments and growth initiatives for the foreseeable future. Let me now turn to our full year 2024 guidance. Speaker 300:13:49As John discussed earlier, we revised our revenue guidance for full year 2024 and now expect revenues of $201,000,000 to $211,000,000 down from $220,000,000 to 225,000,000 dollars representing growth of 7% to 13% compared to full year 2023. We continue to anticipate adjusted EBITDA for full year 2024 to improve approximately 50% compared to the full year 2023. Given our revised guidance, we now expect relatively flat year over year revenue growth in Q2 and high single digit revenue growth in Q3 and in Q4 versus the prior year. Now before we open up the call for questions, let me turn it back to John for some concluding comments. John? Speaker 200:14:37Thanks, Mark. As we wrap up, I want to take a minute to highlight what we believe to be the key takeaways from this call. Looking ahead, Teresa's evolution from a purely Lapidus focused company to a comprehensive bunion solution company is underway and on track. We continue to be relentlessly driven by our mission to advance the standard of care and are innovating to meet demand for certain customers and their patients. I'm confident we have the right team in place to navigate the current market challenges we face, achieve our ambitious goals and ultimately deliver long term value to our shareholders. Speaker 200:15:08With that, now let me turn the call over to the operator to open the line for your questions. Operator00:15:14Thank you. At this time, we will conduct the question and answer Our first question comes from the line of Robbie Marcus of JPMorgan. Your line is now open. Speaker 400:15:44Hi, this is actually Lily on for Robbie. Thanks for taking the question. Maybe just starting with the competitive dynamics, what changed? It sounds like for a really long time, you really weren't seeing any competitive impact at all. And now all of a sudden, it's created this pretty meaningful impact to your momentum. Speaker 400:16:07So what happened there? And can you give your or talk about your confidence in your ability to recapture some of that share loss that you're seeing, especially given you're going up against several larger ortho players? Speaker 200:16:20Yes. Hi, Lily. John Therese here. As we talked about competition in the past, what we stated is we know there are more competitors entering the market. We recognize there's competition, but that we had yet to see anything that was of a significant headwind that would thwart our ability to hit our communicated revenue targets. Speaker 200:16:45What we're communicating here and with this revised guide is that we now are feeling that type of competitive pressure that is creating a headwind. So that's why we had to make the guide change. We've discussed the increased use of MIS osteotomies in the marketplace, which we believe we have a great solution for later in this year. And specific to lapoplasty, we've seen competitors become a little more aggressive with getting doctors to trial these alternative products and that's another headwind. Surgeons like to often evaluate new things and there's just a lot of them out there to try right now. Speaker 200:17:22So it's hard to say how many of these surgeons will try it for a competitive product for a while and then ultimately come back to lapoplasty and then how many might fully convert and stick with a competitive offering. We've seen a lot of these scenarios where surgeons evaluate other systems and they do come back to lapoplasty, but it definitely creates some headwinds. But fundamentally, we believe that as we get more of our osteotomy MIS sets into the market over time late this year along with our other planned launches, this should put us in a much stronger position as we'll have a comprehensive suite of bunion offerings to bring to our base of nearly 3,000, lapoplasty users who on average are using osteotomies for half or more of their cases. So I think we've got a great plan in place. We've got a little bit of a headwind here for the next couple of quarters and we'll look forward to those launches at the end of the year. Speaker 400:18:18Got it. That's helpful. And then maybe just to follow-up on that. I appreciate that you're not breaking out kits and physician count and ASP anymore. But can you talk through which of those pieces is really the driver of the step down? Speaker 400:18:34Are you not able to train as many physicians? Is utilization declining? Is it the ancillary products that you're not able to tack on as much? So how should we qualitatively, I guess, be thinking about all those pieces moving forward? Thank you. Speaker 300:18:48Hey, Lily, this is Mark. Maybe I'll take a first shot and then John can add any incremental thoughts. You talked about the growth and what is really driving that growth. It came from 2 things as we talked about. It's coming from incremental kit volume as well as mix and that mix is involving these new products that John talked about. Speaker 300:19:07We have Speedplay, which is a premium price product. We have hammertoe. We have these incremental complementary products, sterile use instruments that are used in the procedures. So it's really coming the 21% growth in Q1 really came from both volume as well as mix. Speaker 400:19:42$1,000,000 Sorry, it might have been on you. I was more of asking for the full year. So how should we be thinking about how those pieces play into the lower appreciating that you're not breaking them out specifically, but qualitatively, what's moving lower in those buckets? Thanks. Speaker 300:20:04Yes. So that's a great question. So what we will continue to see is increases in both volume as well as our blended ASP. We've been talking last year, we saw a lot of uplift in what we refer to as blended ASP, meaning that's really the mix and our new product launches that are used at the same time as our core lapoplasty procedures. So we will continue to benefit that from that product mix and new product offerings this year, but we will continue to see volume increases as well. Speaker 300:20:38So it's going to come from both the volume increases and then the incremental products. So what we saw in Q1, maybe not at the same growth rate, but we're going to see similar growth from both. Speaker 400:20:54Got it. Thank you. Operator00:20:58One moment for our next question. Thank you. Our next question comes from the line of Richard Newitter of Truist Securities. Your line is now open. Speaker 500:21:12Hi, thanks for taking the questions. Just the first one, it sounds like you're experiencing stepped up competition from the knock off bucket on your core laparoplasty offering. So what just do we think in the updated outlook, are we just supposed to view it as you continue to see that trialing and that competition getting worse and then you offset that with some of the continued mix items to some extent from the growing portfolio. And then we buy time until the MIS offerings in osteotomy come and that's kind of the call down on the outlook? Or I'm just trying to understand what the trend is on the core lapoplasty competitive situation over the next 2 to 3 quarters before you even have an offering to start to make inroads on the MIS osteotomy piece? Speaker 300:22:15Yes, Rich, this is Mark. I think the way you articulated it to begin with is right that we see continued competition from competitors in the Lapidus space that are competing directly with lapoplasty. We have a tougher comp in Q2 and we have easier comps in Q3 and Q4 and we expect to see some benefit from these new product launches in the back half of this year. So that's going to help us with the growth in the back half. Speaker 500:22:44Okay. And then just as we think of the obviously, it's a slower top line growth trajectory, but it sounds like you're going to accommodate the P and L accordingly. Can you talk a little bit just about how you plan to manage the P and L? I see that you your updated EBITDA guidance is relatively unchanged on Speaker 600:23:07a it's going to increase 50% Speaker 500:23:09year over year. How much control do you have over the levers there? And it sounds like you need to step up spending as you're exiting the year. So just help me reconcile that. Thanks. Speaker 300:23:23Yes. So Rich, we're evaluating all these opportunities to reduce costs and we're confident that we can definitely manage them. Based on our lower revenue guide, if you take the midpoint or based on the lower guide, there's a healthy component of the cost reductions that come very naturally from reduced variable expenses related to COGS, commissions, corporate incentives. And then the remaining expenses are discretionary in nature that we know that we can manage and will impact our business longer term. So we're a nimble company. Speaker 300:23:55We're nimble enough that we can operate the P and L effectively without losing sight on our core opportunities. So we feel comfortable with that P and L guidance. Speaker 600:24:08Okay. Thanks. Operator00:24:11One moment for our next question. Thank you. Our next question comes from the line of Drew Ranieri of Morgan Stanley. Your line is now open. Speaker 700:24:24Hi, John and Mark. Thanks for taking the questions. Maybe just to again, hey, revisit the competition again. You mentioned you're at about 3,000 surgeons now. So maybe just hone in on this a little bit more and kind of like what you're seeing in your surgeon base. Speaker 700:24:45And I think we're also all kind of struggling to see or really understand that the 7% to 13% growth guidance that you're giving now is really de risked for the competition at this point. Like why should we be confident that this is the right range? What are you seeing that maybe help instill that? Speaker 200:25:13Yes. Hi, Drew. It's John. I think we feel pretty good about the guide. We've definitely got some headwinds, but we also have tailwinds. Speaker 200:25:23We're still adding new surgeons, but some of the volume that our surgeons were doing are being taken by some of the competitive trials, some to MIS osteotomy. So we're just seeing a we plan to continue to add new surgeons. It's just that the efficiency we're getting per surgeon is a little reduced. And then there's some churn there as some may decide to go with a competitive product mid or longer term. So is that I think that anything else I missed there or Mark or? Speaker 300:26:05Yes. And we feel really good. I mentioned it a little bit earlier that the comps are much lighter in Q2 excuse me in Q3 and Q4. So that's going to that gives us additional confidence. And then having these new product lines that have been we've been working on for a long time here. Speaker 300:26:27We've developed some great products, not by ourselves. We've used a great surgeon advisory group to help us build these new MIS products. We've got John also mentioned we have other things that we've been talking about for a while. I mean we've got a Redpoint products. We have a new speed plate design that's coming. Speaker 300:26:52And we have other things as well that we're always coming in the back half of the year with easier comps. So we feel good about the guide and that it's been properly Speaker 700:27:04derisked. Okay. Got it. And again, just with the surgeons, can you talk about maybe like what attrition rate you're maybe seeing in the surgeon base at this point, compare that maybe to historical levels? And when we do think about the surgeon base, I mean, where in the curve or the adoption curve are you kind of seeing the most impact within the kind of competition dynamic? Speaker 700:27:35I mean, is this happening more to like your year 1, year 2, year 3 surgeons? Or is this getting into even some more of your tenured base? Speaker 300:27:44Yes. Great question, Drew. So we've talked about that, we said last year that we plan to grow 250 to 300 surgeons this year. We're well on track with that. We continue to add surgeons that fuel current and future growth. Speaker 300:28:03And so we continue to do that. What we're seeing is that it's not so much an attrition rate. It's more of how often are they going to use our lapoplasty, this lapidus solution in the OR. And to the extent there are competing products both from an MIS perspective that's the osteotomy. It's a different approach altogether to the bunion correction. Speaker 300:28:33Or if there's other Lapidus type solutions, there's just a lot more of them. And so we're seeing that. We continue to add new surgeons. They continue to do what we're expecting them to do in that 1st year, but we're seeing some of our more tenured surgeons who have been using other options rather than laparoplasty exclusively. Speaker 700:29:01Got it. I'll hop back in queue. Thanks. Thanks. Speaker 800:29:33This is Harrison on for George. Good afternoon and thanks for taking the questions. I wanted to start on rightsizing the P and L. I was wondering if you could just expand a little bit on costs or areas that you could see costs take out. Is this primarily in the sales and marketing line? Speaker 800:29:55Or are there other areas we could see some leverage in 2024? Speaker 300:30:01Hey Harrison, this is Mark. Great question. As I did mention before that when there is lower revenue, there's a fair and healthy portion of costs that come out because they're purely variable in nature. And so there will be reductions in that sales and marketing line item just because that's where a lot of the variable expenses come from. But there will also be some overall reductions in throughout the P and L. Speaker 300:30:28But again, we believe that those are going to be discretionary spending items and that we're definitely nimble enough that we can operate Speaker 800:30:38the P and L effectively Speaker 300:30:38and without losing sight on all these commercial initiatives and programs and launches that we're talking about. So it's yes, there will be some that are variable in the sales and marketing line, but it will impact some of the G and A and R and D Speaker 700:30:52as well. Speaker 800:30:55Okay. Yes. Sounds good. And then in terms of protecting your IP, I was wondering if because I mean, I guess I know there's been competition, for a while. Has there been a new product or is there something specific to go after there? Speaker 800:31:16And kind of what's the game plan in terms of protecting that IP? Speaker 200:31:23Yes. Harrison, John here. We're really not going to comment much on our IP strategy, timing, but as and when things may happen, we will communicate to you as we progress. Speaker 800:31:42Understood. Thanks for taking the questions. Thank you. Operator00:31:48One moment for our next question. Our next question comes from the line of Danielle Antalffy of UBS. Your line is now open. Speaker 600:32:01Hey, John and Mark. This is Simon Nagan on for Danielle. Thanks for taking the question. When you think about the competition that you're when you think about the competition that you're currently facing, is this coming in the form of larger competitive headwinds from surgeons not converting over from osteotomies? Or is this purely from the competitive lapoplasty products? Speaker 600:32:21Just wondering how should we think about that? Speaker 200:32:25Yes, Simon, John here. It's really not one competitor per se, but it's an amalgamation of a number of competitors, big companies, small companies, public and private that are now selling products intended to directly compete with lapoplasty. Several of those companies also offer MIS osteotomy products, which as of this time, we do not have, but that's a temporary situation for us. And there are more competitors today than there were last year, But we're focused on effectively navigating this market environment and continue to work to capture opportunities ahead and innovate for our surgeon base. And we've got a great MIS osteotomy platform coming in Q4. Speaker 200:33:13And we're very excited about the capabilities that we'll have in transforming Treice Medical into a full line bunion product company and feeling the next leg of the growth of this business. Speaker 600:33:28That's really helpful. And just a quick follow-up for you. There were a couple of comments on how efficiency per surgeon has come in maybe a bit less than expectations. Do we think that this is impacting, I guess, maybe your future targets for total lapoplasty penetration growth? And how should we think about this impacting utilization over the next, I guess over the near term? Speaker 300:33:54That's a great question. One thing that we continue to see is a nice steady uptick of surgeon net surgeon adds. So we continue we had 475 ads last year. We've had a lot of surgeon ads. We've had healthy surgeon additions this year as well. Speaker 300:34:17So we continue to see that. It's been more of surgeons have always had the option of how to approach bunions. And so we believe that lapoplasty provides a great solution. We have a lot of clinical data, we believe more than any other Lapidus type solution. And so we have a lot of confidence that our lapoplasty solution gives great results and it's elegantly designed for surgeons. Speaker 300:34:44We constantly and regularly hear how much they appreciate the design in the OR. We've made it faster and more effective and more efficient. However, surgeons have always had the option of whether or not they're going to approach a patient surgery with a lapidus procedure or an osteotomy. And there have been some differences between the two approaches. And so we continue to see that in some surgeons or continue to use lapoplasty, but may have may decide that maybe the percentage of the lapis or the lapoplasty procedures in their overall patient base is shifting a little bit. Speaker 300:35:24So it's more of that. I don't want to say that's the answer for every surgeon because every surgeon is different, but we've definitely seen a trend that MIS osteotomies are more and more of the overall procedure base. Speaker 200:35:41And Mark, I think that's why we're pretty excited about this upcoming MIS osteotomy program that we're going to be launching because now we can be the solution provider for those cases that they're opting to do MIS osteotomies on today instead of a lapoplasty potentially. Speaker 100:36:10Julia, operator, are you there? Operator00:36:13Yes, I am. I'm showing no further questions at this time. I would now like to turn it back to Julie Dewey for closing remarks. Speaker 100:36:21Thank you, and thanks everybody for joining us today. We appreciate your time and interest. If you have more questions, please reach out, and we look forward to talking to you next quarter. This concludes our call. Operator00:36:34Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.Read moreRemove AdsPowered by Conference Call Audio Live Call not available Earnings Conference CallTreace Medical Concepts Q1 202400:00 / 00:00Speed:1x1.25x1.5x2xRemove Ads Earnings DocumentsPress Release(8-K)Quarterly report(10-Q) Treace Medical Concepts Earnings HeadlinesTreace Medical appoints John Treace as chairman of the boardApril 7 at 9:20 PM | markets.businessinsider.comTreace Medical Concepts: No Solid FootingApril 7 at 9:20 PM | seekingalpha.comTrump’s Secret WeaponHave you looked at the stock market recently? Millions of investors are scrambling trying to figure out what's coming next. But here's the truth… This is just the beginning. Trump has made it clear his tariffs are coming, and that the market will get worse before it gets better. Luckily, our FREE Presidential Transition Guide details exactly what will happen in the next 100 days, and how to protect your hard-earned savings during these times. Don't wait for the next crash to wipe you out. Act now.April 9, 2025 | American Alternative (Ad)Treace Medical Concepts, Inc. (NASDAQ:TMCI) Receives $10.14 Consensus Price Target from BrokeragesApril 3, 2025 | americanbankingnews.comTreace Announces Clinical Study Data Demonstrating Positive Lapiplasty® and Adductoplasty® Outcomes at the 2025 ACFAS Annual Scientific ConferenceMarch 28, 2025 | globenewswire.comTreace Highlights New Innovations at the 2025 ACFAS Annual Scientific ConferenceMarch 25, 2025 | globenewswire.comSee More Treace Medical Concepts Headlines Get Earnings Announcements in your inboxWant to stay updated on the latest earnings announcements and upcoming reports for companies like Treace Medical Concepts? Sign up for Earnings360's daily newsletter to receive timely earnings updates on Treace Medical Concepts and other key companies, straight to your email. Email Address About Treace Medical ConceptsTreace Medical Concepts (NASDAQ:TMCI), a medical technology company, designs, manufactures, and markets medical devices in the United States. The company offers Lapiplasty 3D bunion correction system that combines instruments, implants, and surgical methods designed to surgically correct three planes of the bunion deformity. It also provides Lapiplasty mini-incision system designed to allow the Lapiplasty procedure to be performed through a 3.5cm incision. In addition, the company offers Adductoplasty system designed for reproducible realignment, stabilization, and fusion of the midfoot. Treace Medical Concepts, Inc. was founded in 2013 and is headquartered in Ponte Vedra, Florida.View Treace Medical Concepts ProfileRead more More Earnings Resources from MarketBeat Earnings Tools Today's Earnings Tomorrow's Earnings Next Week's Earnings Upcoming Earnings Calls Earnings Newsletter Earnings Call Transcripts Earnings Beats & Misses Corporate Guidance Earnings Screener Earnings By Country U.S. Earnings Reports Canadian Earnings Reports U.K. Earnings Reports Latest Articles Lamb Weston Stock Rises, Earnings Provide Calm Amidst ChaosIntuitive Machines Gains After Earnings Beat, NASA Missions AheadCintas Delivers Earnings Beat, Signals More Growth AheadNike Stock Dips on Earnings: Analysts Weigh in on What’s NextAfter Massive Post Earnings Fall, Does Hope Remain for MongoDB?Semtech Rallies on Earnings Beat—Is There More Upside?These 3 Q1 Earnings Winners Will Go Higher Upcoming Earnings Bank of New York Mellon (4/11/2025)BlackRock (4/11/2025)JPMorgan Chase & Co. (4/11/2025)Progressive (4/11/2025)Wells Fargo & Company (4/11/2025)The Goldman Sachs Group (4/14/2025)Interactive Brokers Group (4/15/2025)Bank of America (4/15/2025)Citigroup (4/15/2025)Johnson & Johnson (4/15/2025) Get 30 Days of MarketBeat All Access for Free Sign up for MarketBeat All Access to gain access to MarketBeat's full suite of research tools. Start Your 30-Day Trial MarketBeat All Access Features Best-in-Class Portfolio Monitoring Get personalized stock ideas. Compare portfolio to indices. Check stock news, ratings, SEC filings, and more. Stock Ideas and Recommendations See daily stock ideas from top analysts. Receive short-term trading ideas from MarketBeat. Identify trending stocks on social media. Advanced Stock Screeners and Research Tools Use our seven stock screeners to find suitable stocks. Stay informed with MarketBeat's real-time news. Export data to Excel for personal analysis. Sign in to your free account to enjoy these benefits In-depth profiles and analysis for 20,000 public companies. Real-time analyst ratings, insider transactions, earnings data, and more. Our daily ratings and market update email newsletter. Sign in to your free account to enjoy all that MarketBeat has to offer. Sign In Create Account Your Email Address: Email Address Required Your Password: Password Required Log In or Sign in with Facebook Sign in with Google Forgot your password? Your Email Address: Please enter your email address. Please enter a valid email address Choose a Password: Please enter your password. Your password must be at least 8 characters long and contain at least 1 number, 1 letter, and 1 special character. Create My Account (Free) or Sign in with Facebook Sign in with Google By creating a free account, you agree to our terms of service. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
There are 9 speakers on the call. Operator00:00:00Good day, and thank you for standing by. Welcome to the Triste Medical Concepts First Quarter 2024 Earnings Conference Call. At this time, all participants are in a listen only mode. After the speakers' presentation, there will be a question and answer session. Please be advised that today's conference is being recorded. Operator00:00:33I would now like to hand the conference over to your first speaker today, Julie Dewey. Please go ahead. Speaker 100:00:42Good afternoon, everyone, and welcome to our Q1 2024 earnings conference call. We appreciate you joining us. I'm Julie Dewey, Treese's Chief Communications and IR Officer. With me today are John Treese, Chief Executive Officer and Mark Hair, Chief Financial Officer. During the call, John and Mark will offer commentary on our commercial activity and review our Q1 financial results released after the close of the market today, after which we will host a question and answer session. Speaker 100:01:11The press release and supplemental materials can be found in the Investor Relations section of our website at investors. Treese.com. This call is being recorded and will be archived in the Investors section of our website. Before we begin, we'd like to remind you that it is our intent that all forward looking statements made during today's call will be protected under the Private Securities Litigation Reform Act of 1995. Any statements that relate to expectations or predictions of future events and market trends as well as our estimated results, outlook or performance are forward looking statements. Speaker 100:01:46All forward looking statements are based upon our current estimates and various assumptions. 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. All forward looking statements are based upon current available information and Therese assumes no obligation to update these statements. Accordingly, you should not place undue reliance on these statements. Please refer to our SEC filings, including our Form 10 Q for the Q1 2024 filed today and our Form 10 ks for the full year 2023 filed on February 27, 2024 for a detailed presentation of risks. Speaker 100:02:33With that, I will now turn the call over to John. Speaker 200:02:37Thank you, Julie. Good afternoon, everyone, and thanks for joining us. I'm going to focus my comments today on our Q1 2024 highlights, the progress of our numerous product launches, including SpeedPlate, our other growth drivers, and then spend some time discussing developments in the market environment which is underpinning our decision to revise our full year guidance as well as tell you about our exciting opportunities and strategies going forward. Following my comments, Mark will cover specifics about our Q1 results and our 2024 guidance. We grew revenue 21% in the Q1 of 2024. Speaker 200:03:10Revenue performance was driven by increased procedure kit volume from our expanding base of surgeons and mix driven by increased adoption of our newer technologies in our core bunion and related midfoot cases, all supported by our dedicated direct sales team. We also benefited from strong patient demand trends that extended our seasonally strong Q4 into the Q1. Additionally, we made encouraging progress with respect to our adjusted EBITDA results. Our adjusted EBITDA loss improved 18% to a loss of $8,300,000 in the Q1 of 2024 compared to a loss of $10,000,000 for the same period in 2023. We've expanded our position in the foot and ankle market by adding complementary procedures and technologies to treat related deformities, namely our adductorplasty and hammertoe correction systems, both of which coexist frequently with bunions and are addressed at the same time and which together have expanded our TAM by an estimated $750,000,000 without diluting our focus on the $5,000,000,000 plus U. Speaker 200:04:08S. Bunion market opportunity. Additionally, exiting Q1, we now have full market availability a number of our newest technologies, including our Speed Plate fixation platform, hammertoe system, sterile instruments and our minimally invasive microlapoplasty procedure. We expect all of these new technologies to contribute to our growth going forward. And we recently announced that we've now treated more than 100,000 patients with our lapoplasty procedure, recognizing that our success is not only measured by numbers, but are the transformative change that our differentiated therapies provide the patients to overcome painful lifestyle limiting bunion and related midfoot deformities. Speaker 200:04:48Further highlighting our progress in the Q1, we delivered gains across our key operating metrics in Q1. We drove a year over year increase in volume of lapoplasty, adductoplasty and complementary procedures which were enabled by our versatile Speedplay platform. We also benefited from favorable mix as well with new products like Speedplay and our hammer toe systems as well as our expanded offering of procedure specific sterile instruments all being utilized more frequently in our core procedures. As we previously announced, we established the first ever National Bunion Day in the United States on significant increases significant increases in our website traffic and an amplified activity level on our find a doctor locator. Therese was also named the 1st medical device partner and official foot and ankle solution partner for the Professional Pickleball Association Tour. Speaker 200:05:44Pickleball is the fastest growing sport in the U. S. We believe we're uniquely positioned to drive greater awareness of the challenges posed by bunions and educate patients in this demographic on our pioneering lapoplasty procedure, the number one most commonly used 3 d bunion correction procedure by U. S. Surgeons. Speaker 200:06:03Now I'd like to turn to our product launches. Our Speed Plate launch continues to fuel our growth and we saw strong demand in the Q1. In fact, Speed Plate usage nearly doubled in Q1 versus Q4 of 2023. Exiting Q1, we've achieved full commercialization of SpeedPlate and expect adoption to continue steadily through the remainder of 2024. Additionally, we expect to launch a new Speedplay configuration in Q3, which is designed to address some incremental larger bone fusion procedures in the foot. Speaker 200:06:33Next, our microlappoplasty system. This exciting evolution of our instrumentation allows the patented lapoplasty procedure to be performed now through a 2 centimeter incision using our new Speed Plate Fixation technology. Our micro lapoplasty system is now fully available and throughout Q1 we witnessed a growing number of surgeons utilizing this minimally invasive lipoplasty approach. While we're excited about the growth opportunity that all these product launches represent, there's even more expected to come from our robust product development pipeline to deliver a steady cadence of new innovations in the second half of twenty twenty four, including mini adductoplasty and our Redpoint patient specific instrumentation. We believe both of these technologies will reinforce our market leadership position in the bunion and related midfoot correction space. Speaker 200:07:18We look forward to providing additional updates on these platforms as well as other new product innovations as we progress throughout the year. Turning to our guidance, despite our strong start to the year with expected growth opportunities stemming from product launches and new innovations I just mentioned, it's become clear that the market environment and competitive landscape is quickly evolving and we've made the decision to revise guidance for fiscal 2024. We have decided to do this now because we're seeing increased use and surgeon adoption of MIS osteotomy solutions. At the same time, we're facing even more competition from knockoffs of our lapoplasty products. Both of these dynamics are creating incremental headwinds to our lapoplasty growth. Speaker 200:07:59Specific to these knockoffs, we fundamentally believe that none of these systems match lapoplasty's performance and reproducibility at the surgeon patient interface, nor are they supported by the strong differentiating clinical data sets that lapoplasty offers. We also believe some of these competing products are violating our IP. With this backdrop, I'd like to spend the next few minutes reviewing our strategy to expand our offerings and advance our business. While building our leading position in the Lapidus segment of the Bunyan market, we've simultaneously been pursuing a strategy to advance Treese from a company focused solely on Lapidus and related solutions to a comprehensive Bunyan Solutions company, Meaning to implement our strategy to expand our bunion solution portfolio, we plan to launch 2 innovative 3 d MIS osteotomy systems in late 2024 into the metatarsal osteotomy segment of the market which accounts for 70% of the overall procedure volume today and into our base of nearly 3,000 surgeon customers. Once launched, our customers who love lapoplasty but still perform on average over half their bunion cases using metatarsal osteotomies will then have a TRACE product to address all of their lapidus and osteotomy bunion cases. Speaker 200:09:14Additionally, we expect our MIS osteotomy solutions will afford us the opportunity to appeal to a new group of surgeons, those with a strong bias for using osteotomy approaches for the majority of their bunion patients. We expect to see the positive benefit of these new MIS innovations starting the Q4 of this year and ramping throughout 2025. I continue to believe we are uniquely positioned to build upon our market leading lapoplasty position while leveraging that position to make a significant impact in the large osteotomy segment of the bunion market. 1st, we are confident in our track record of developing, commercializing and rapidly innovating 3 d bunion technologies that achieve broad customer acceptance due to their elegant design, reproducibility and clinical effectiveness. We have proven this with lapiplasty and we've applied this expertise in our instrumented approach to our 3 d MIS osteotomy systems mentioned earlier. Speaker 200:10:09And we are confident in our ability to provide a strong educational resource for our surgeon customers as well as educate patients about our innovative therapies. Again, we have proven this with lapoplasty and we will apply this experience with our forthcoming 3 d MIS osteotomy platforms. Finally, we are confident in our Bunyan focused direct sales team's ability to deliver these 3 d MIS technologies to our base of nearly 3,000 laparoplasty surgeon users and continue to expand the size of our surgeon customer base over time. We recently trained an initial group of surgeons on one of our new 3 d MIS osteotomy platforms in anticipation of our upcoming limited market release and the surgeon feedback was overwhelmingly positive. I could not be more excited about the significant opportunity we expect from our new 3 d MIS osteotomy platforms. Speaker 200:10:59At the same time, we continue to focus on expanding our product offerings and the total market we serve to become a comprehensive bunion solutions company. We are taking decisive actions to mitigate the impact of the competitive challenges as well as our revised growth rates by rightsizing our P and L and reducing costs. In addition, we attend to assert and enforce our IP rights. I am confident in our ability to capture the opportunities ahead of us, innovate for our surgeon customer base and deliver value for our shareholders. I'll now turn the call over to Mark to review our Q1 financial performance and provide more details about guidance. Speaker 200:11:35Mark? Speaker 300:11:37Thank you, John. Good afternoon, everyone. Revenue for the Q1 of 2024 was 51,100,000 dollars a 21% increase with 1 less selling day than the prior year. Growth in the Q1 was driven by increased procedure kit volume from our expanding base of surgeons and increased adoption of our newer technologies, all supported by our dedicated direct sales team. As John mentioned, similar to what we saw last year, our seasonally strong Q4 extended into the Q1. Speaker 300:12:10This year, there was more carryover from the 4th quarter into the Q1 than originally anticipated, which was the main driver of upside in the quarter. Gross margin was 80.2% in the Q1 of 2024 compared to 80.9% in the Q1 of 2023. This decrease was primarily due to a shift in product mix to newer products partially offset by lower royalty rates. Total operating expenses were $59,900,000 in the Q1 of 2024 compared to total operating expenses of 47,900,000 dollars in the Q1 of 2023. The increase in operating expenses reflects strategic investments in our expanding direct sales channel, investments in product innovation and support for other corporate initiatives. Speaker 300:12:581st quarter net loss was $18,700,000 or $0.30 per share compared to a net loss of $13,500,000 or $0.23 per share for the same period in 2023. Adjusted EBITDA loss improved 18 percent to a loss of $8,300,000 in the Q1 of 2024 compared to a loss of $10,000,000 for the same period in 2023. Cash, cash equivalents, marketable securities and investment receivable totaled $112,100,000 as of March 31, 2024. We believe we have a lengthy runway in terms of our current cash level with sufficient balance sheet strength and flexibility to continue effectively executing on our strategic investments and growth initiatives for the foreseeable future. Let me now turn to our full year 2024 guidance. Speaker 300:13:49As John discussed earlier, we revised our revenue guidance for full year 2024 and now expect revenues of $201,000,000 to $211,000,000 down from $220,000,000 to 225,000,000 dollars representing growth of 7% to 13% compared to full year 2023. We continue to anticipate adjusted EBITDA for full year 2024 to improve approximately 50% compared to the full year 2023. Given our revised guidance, we now expect relatively flat year over year revenue growth in Q2 and high single digit revenue growth in Q3 and in Q4 versus the prior year. Now before we open up the call for questions, let me turn it back to John for some concluding comments. John? Speaker 200:14:37Thanks, Mark. As we wrap up, I want to take a minute to highlight what we believe to be the key takeaways from this call. Looking ahead, Teresa's evolution from a purely Lapidus focused company to a comprehensive bunion solution company is underway and on track. We continue to be relentlessly driven by our mission to advance the standard of care and are innovating to meet demand for certain customers and their patients. I'm confident we have the right team in place to navigate the current market challenges we face, achieve our ambitious goals and ultimately deliver long term value to our shareholders. Speaker 200:15:08With that, now let me turn the call over to the operator to open the line for your questions. Operator00:15:14Thank you. At this time, we will conduct the question and answer Our first question comes from the line of Robbie Marcus of JPMorgan. Your line is now open. Speaker 400:15:44Hi, this is actually Lily on for Robbie. Thanks for taking the question. Maybe just starting with the competitive dynamics, what changed? It sounds like for a really long time, you really weren't seeing any competitive impact at all. And now all of a sudden, it's created this pretty meaningful impact to your momentum. Speaker 400:16:07So what happened there? And can you give your or talk about your confidence in your ability to recapture some of that share loss that you're seeing, especially given you're going up against several larger ortho players? Speaker 200:16:20Yes. Hi, Lily. John Therese here. As we talked about competition in the past, what we stated is we know there are more competitors entering the market. We recognize there's competition, but that we had yet to see anything that was of a significant headwind that would thwart our ability to hit our communicated revenue targets. Speaker 200:16:45What we're communicating here and with this revised guide is that we now are feeling that type of competitive pressure that is creating a headwind. So that's why we had to make the guide change. We've discussed the increased use of MIS osteotomies in the marketplace, which we believe we have a great solution for later in this year. And specific to lapoplasty, we've seen competitors become a little more aggressive with getting doctors to trial these alternative products and that's another headwind. Surgeons like to often evaluate new things and there's just a lot of them out there to try right now. Speaker 200:17:22So it's hard to say how many of these surgeons will try it for a competitive product for a while and then ultimately come back to lapoplasty and then how many might fully convert and stick with a competitive offering. We've seen a lot of these scenarios where surgeons evaluate other systems and they do come back to lapoplasty, but it definitely creates some headwinds. But fundamentally, we believe that as we get more of our osteotomy MIS sets into the market over time late this year along with our other planned launches, this should put us in a much stronger position as we'll have a comprehensive suite of bunion offerings to bring to our base of nearly 3,000, lapoplasty users who on average are using osteotomies for half or more of their cases. So I think we've got a great plan in place. We've got a little bit of a headwind here for the next couple of quarters and we'll look forward to those launches at the end of the year. Speaker 400:18:18Got it. That's helpful. And then maybe just to follow-up on that. I appreciate that you're not breaking out kits and physician count and ASP anymore. But can you talk through which of those pieces is really the driver of the step down? Speaker 400:18:34Are you not able to train as many physicians? Is utilization declining? Is it the ancillary products that you're not able to tack on as much? So how should we qualitatively, I guess, be thinking about all those pieces moving forward? Thank you. Speaker 300:18:48Hey, Lily, this is Mark. Maybe I'll take a first shot and then John can add any incremental thoughts. You talked about the growth and what is really driving that growth. It came from 2 things as we talked about. It's coming from incremental kit volume as well as mix and that mix is involving these new products that John talked about. Speaker 300:19:07We have Speedplay, which is a premium price product. We have hammertoe. We have these incremental complementary products, sterile use instruments that are used in the procedures. So it's really coming the 21% growth in Q1 really came from both volume as well as mix. Speaker 400:19:42$1,000,000 Sorry, it might have been on you. I was more of asking for the full year. So how should we be thinking about how those pieces play into the lower appreciating that you're not breaking them out specifically, but qualitatively, what's moving lower in those buckets? Thanks. Speaker 300:20:04Yes. So that's a great question. So what we will continue to see is increases in both volume as well as our blended ASP. We've been talking last year, we saw a lot of uplift in what we refer to as blended ASP, meaning that's really the mix and our new product launches that are used at the same time as our core lapoplasty procedures. So we will continue to benefit that from that product mix and new product offerings this year, but we will continue to see volume increases as well. Speaker 300:20:38So it's going to come from both the volume increases and then the incremental products. So what we saw in Q1, maybe not at the same growth rate, but we're going to see similar growth from both. Speaker 400:20:54Got it. Thank you. Operator00:20:58One moment for our next question. Thank you. Our next question comes from the line of Richard Newitter of Truist Securities. Your line is now open. Speaker 500:21:12Hi, thanks for taking the questions. Just the first one, it sounds like you're experiencing stepped up competition from the knock off bucket on your core laparoplasty offering. So what just do we think in the updated outlook, are we just supposed to view it as you continue to see that trialing and that competition getting worse and then you offset that with some of the continued mix items to some extent from the growing portfolio. And then we buy time until the MIS offerings in osteotomy come and that's kind of the call down on the outlook? Or I'm just trying to understand what the trend is on the core lapoplasty competitive situation over the next 2 to 3 quarters before you even have an offering to start to make inroads on the MIS osteotomy piece? Speaker 300:22:15Yes, Rich, this is Mark. I think the way you articulated it to begin with is right that we see continued competition from competitors in the Lapidus space that are competing directly with lapoplasty. We have a tougher comp in Q2 and we have easier comps in Q3 and Q4 and we expect to see some benefit from these new product launches in the back half of this year. So that's going to help us with the growth in the back half. Speaker 500:22:44Okay. And then just as we think of the obviously, it's a slower top line growth trajectory, but it sounds like you're going to accommodate the P and L accordingly. Can you talk a little bit just about how you plan to manage the P and L? I see that you your updated EBITDA guidance is relatively unchanged on Speaker 600:23:07a it's going to increase 50% Speaker 500:23:09year over year. How much control do you have over the levers there? And it sounds like you need to step up spending as you're exiting the year. So just help me reconcile that. Thanks. Speaker 300:23:23Yes. So Rich, we're evaluating all these opportunities to reduce costs and we're confident that we can definitely manage them. Based on our lower revenue guide, if you take the midpoint or based on the lower guide, there's a healthy component of the cost reductions that come very naturally from reduced variable expenses related to COGS, commissions, corporate incentives. And then the remaining expenses are discretionary in nature that we know that we can manage and will impact our business longer term. So we're a nimble company. Speaker 300:23:55We're nimble enough that we can operate the P and L effectively without losing sight on our core opportunities. So we feel comfortable with that P and L guidance. Speaker 600:24:08Okay. Thanks. Operator00:24:11One moment for our next question. Thank you. Our next question comes from the line of Drew Ranieri of Morgan Stanley. Your line is now open. Speaker 700:24:24Hi, John and Mark. Thanks for taking the questions. Maybe just to again, hey, revisit the competition again. You mentioned you're at about 3,000 surgeons now. So maybe just hone in on this a little bit more and kind of like what you're seeing in your surgeon base. Speaker 700:24:45And I think we're also all kind of struggling to see or really understand that the 7% to 13% growth guidance that you're giving now is really de risked for the competition at this point. Like why should we be confident that this is the right range? What are you seeing that maybe help instill that? Speaker 200:25:13Yes. Hi, Drew. It's John. I think we feel pretty good about the guide. We've definitely got some headwinds, but we also have tailwinds. Speaker 200:25:23We're still adding new surgeons, but some of the volume that our surgeons were doing are being taken by some of the competitive trials, some to MIS osteotomy. So we're just seeing a we plan to continue to add new surgeons. It's just that the efficiency we're getting per surgeon is a little reduced. And then there's some churn there as some may decide to go with a competitive product mid or longer term. So is that I think that anything else I missed there or Mark or? Speaker 300:26:05Yes. And we feel really good. I mentioned it a little bit earlier that the comps are much lighter in Q2 excuse me in Q3 and Q4. So that's going to that gives us additional confidence. And then having these new product lines that have been we've been working on for a long time here. Speaker 300:26:27We've developed some great products, not by ourselves. We've used a great surgeon advisory group to help us build these new MIS products. We've got John also mentioned we have other things that we've been talking about for a while. I mean we've got a Redpoint products. We have a new speed plate design that's coming. Speaker 300:26:52And we have other things as well that we're always coming in the back half of the year with easier comps. So we feel good about the guide and that it's been properly Speaker 700:27:04derisked. Okay. Got it. And again, just with the surgeons, can you talk about maybe like what attrition rate you're maybe seeing in the surgeon base at this point, compare that maybe to historical levels? And when we do think about the surgeon base, I mean, where in the curve or the adoption curve are you kind of seeing the most impact within the kind of competition dynamic? Speaker 700:27:35I mean, is this happening more to like your year 1, year 2, year 3 surgeons? Or is this getting into even some more of your tenured base? Speaker 300:27:44Yes. Great question, Drew. So we've talked about that, we said last year that we plan to grow 250 to 300 surgeons this year. We're well on track with that. We continue to add surgeons that fuel current and future growth. Speaker 300:28:03And so we continue to do that. What we're seeing is that it's not so much an attrition rate. It's more of how often are they going to use our lapoplasty, this lapidus solution in the OR. And to the extent there are competing products both from an MIS perspective that's the osteotomy. It's a different approach altogether to the bunion correction. Speaker 300:28:33Or if there's other Lapidus type solutions, there's just a lot more of them. And so we're seeing that. We continue to add new surgeons. They continue to do what we're expecting them to do in that 1st year, but we're seeing some of our more tenured surgeons who have been using other options rather than laparoplasty exclusively. Speaker 700:29:01Got it. I'll hop back in queue. Thanks. Thanks. Speaker 800:29:33This is Harrison on for George. Good afternoon and thanks for taking the questions. I wanted to start on rightsizing the P and L. I was wondering if you could just expand a little bit on costs or areas that you could see costs take out. Is this primarily in the sales and marketing line? Speaker 800:29:55Or are there other areas we could see some leverage in 2024? Speaker 300:30:01Hey Harrison, this is Mark. Great question. As I did mention before that when there is lower revenue, there's a fair and healthy portion of costs that come out because they're purely variable in nature. And so there will be reductions in that sales and marketing line item just because that's where a lot of the variable expenses come from. But there will also be some overall reductions in throughout the P and L. Speaker 300:30:28But again, we believe that those are going to be discretionary spending items and that we're definitely nimble enough that we can operate Speaker 800:30:38the P and L effectively Speaker 300:30:38and without losing sight on all these commercial initiatives and programs and launches that we're talking about. So it's yes, there will be some that are variable in the sales and marketing line, but it will impact some of the G and A and R and D Speaker 700:30:52as well. Speaker 800:30:55Okay. Yes. Sounds good. And then in terms of protecting your IP, I was wondering if because I mean, I guess I know there's been competition, for a while. Has there been a new product or is there something specific to go after there? Speaker 800:31:16And kind of what's the game plan in terms of protecting that IP? Speaker 200:31:23Yes. Harrison, John here. We're really not going to comment much on our IP strategy, timing, but as and when things may happen, we will communicate to you as we progress. Speaker 800:31:42Understood. Thanks for taking the questions. Thank you. Operator00:31:48One moment for our next question. Our next question comes from the line of Danielle Antalffy of UBS. Your line is now open. Speaker 600:32:01Hey, John and Mark. This is Simon Nagan on for Danielle. Thanks for taking the question. When you think about the competition that you're when you think about the competition that you're currently facing, is this coming in the form of larger competitive headwinds from surgeons not converting over from osteotomies? Or is this purely from the competitive lapoplasty products? Speaker 600:32:21Just wondering how should we think about that? Speaker 200:32:25Yes, Simon, John here. It's really not one competitor per se, but it's an amalgamation of a number of competitors, big companies, small companies, public and private that are now selling products intended to directly compete with lapoplasty. Several of those companies also offer MIS osteotomy products, which as of this time, we do not have, but that's a temporary situation for us. And there are more competitors today than there were last year, But we're focused on effectively navigating this market environment and continue to work to capture opportunities ahead and innovate for our surgeon base. And we've got a great MIS osteotomy platform coming in Q4. Speaker 200:33:13And we're very excited about the capabilities that we'll have in transforming Treice Medical into a full line bunion product company and feeling the next leg of the growth of this business. Speaker 600:33:28That's really helpful. And just a quick follow-up for you. There were a couple of comments on how efficiency per surgeon has come in maybe a bit less than expectations. Do we think that this is impacting, I guess, maybe your future targets for total lapoplasty penetration growth? And how should we think about this impacting utilization over the next, I guess over the near term? Speaker 300:33:54That's a great question. One thing that we continue to see is a nice steady uptick of surgeon net surgeon adds. So we continue we had 475 ads last year. We've had a lot of surgeon ads. We've had healthy surgeon additions this year as well. Speaker 300:34:17So we continue to see that. It's been more of surgeons have always had the option of how to approach bunions. And so we believe that lapoplasty provides a great solution. We have a lot of clinical data, we believe more than any other Lapidus type solution. And so we have a lot of confidence that our lapoplasty solution gives great results and it's elegantly designed for surgeons. Speaker 300:34:44We constantly and regularly hear how much they appreciate the design in the OR. We've made it faster and more effective and more efficient. However, surgeons have always had the option of whether or not they're going to approach a patient surgery with a lapidus procedure or an osteotomy. And there have been some differences between the two approaches. And so we continue to see that in some surgeons or continue to use lapoplasty, but may have may decide that maybe the percentage of the lapis or the lapoplasty procedures in their overall patient base is shifting a little bit. Speaker 300:35:24So it's more of that. I don't want to say that's the answer for every surgeon because every surgeon is different, but we've definitely seen a trend that MIS osteotomies are more and more of the overall procedure base. Speaker 200:35:41And Mark, I think that's why we're pretty excited about this upcoming MIS osteotomy program that we're going to be launching because now we can be the solution provider for those cases that they're opting to do MIS osteotomies on today instead of a lapoplasty potentially. Speaker 100:36:10Julia, operator, are you there? Operator00:36:13Yes, I am. I'm showing no further questions at this time. I would now like to turn it back to Julie Dewey for closing remarks. Speaker 100:36:21Thank you, and thanks everybody for joining us today. We appreciate your time and interest. If you have more questions, please reach out, and we look forward to talking to you next quarter. This concludes our call. Operator00:36:34Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.Read moreRemove AdsPowered by