Xtant Medical Holdings, Inc.

Total revenue in Q2 2026 was $23 million versus $35.4 million in Q2 2025, or $24.8 million on a pro forma basis excluding divested noncore products/businesses and nonrecurring license revenue. Gross margin was 57.9% compared with 68.6% a year ago. Net loss was $9.4 million, or $0.07 per basic and diluted share, versus net income of $3.6 million, or $0.03 per basic share and $0.02 per diluted share, and adjusted EBITDA was a loss of $2.7 million versus positive adjusted EBITDA of approximately $6.9 million last year. For guidance, management lowered full-year revenue outlook to $99 million to $103 million from $101 million to $105 million, saying the second half still faces amnio-related headwinds but that biologics growth should accelerate sequentially as the sales force ramps.

Sean Browne said the quarter reflected meaningful operational progress despite soft reported results, especially the integration of the Dilon sales reps and the launch of Trivium Shaped. He emphasized that the larger commercial organization is still in transition, with much of Q2 spent training reps and integrating HEMOBLAST, but said that work is building a stronger foundation for future growth. He repeatedly framed the current period as a temporary step back to “sharpen the saw,” while saying the company’s broader portfolio and in-house manufacturing create a differentiated long-term position.

Scott Neils said the revenue shortfall was mainly driven by amnio weakness tied to the advanced wound care market, partially offset by about $1.5 million of HEMOBLAST sales and stronger hardware sales from Cortera Spinal Fixation. He noted that roughly $600,000 to $700,000 of revenue was not recognized because more HEMOBLAST transactions than expected were shipped under Dilon arrangements rather than Xtant’s own customer agreements, and said he expects substantially all HEMOBLAST sales to be processed through Xtant’s network going forward. On profitability, he pointed to the 57.9% gross margin decline, the $5 million exclusivity fee to Dilon flowing through operating expenses, and cash of $9.9 million with $23 million of debt and only $0.7 million available on the revolving facility at quarter-end.

Analysts focused on what specifically underperformed in orthobiologics, and management pointed to older workhorse lines like OsteoSelect, OsteoSponge, and 3Demin, plus weaker amnio sales than expected. On HEMOBLAST, management said the new reps create cross-selling opportunities into CollagenX and Amnio, and also broaden hospital access through materials management relationships and larger systems like Cleveland Clinic and Mass General. Scott said HEMOBLAST transactional volume is still expected to exceed $1 million per month on a gross basis, but revenue recognition depends on how much can be shifted onto Xtant purchase orders, with some Dilon-shipped product still expected in Q3.