Zimmer Biomet Holdings, Inc. 2026 Q2 Earnings Call

Good morning, everyone. Welcome to Zimmer Biomet's second quarter 2026 earnings conference call. Joining me on today's call are Ivan Tornos, our Chairman, President, and CEO, and Paul Stellato, our Interim CFO and VP Controller and Chief Accounting Officer. Before we get started, I'd like to remind you that our comments during this call will include forward-looking statements. Actual results may differ materially from those indicated by the forward-looking statements due to a variety of risks and uncertainties. For a detailed discussion of all these risks and uncertainties, in addition to the inherent limitations of such forward-looking statements, please refer to our SEC filings. Please note we assume no obligation to update these forward-looking statements, even if actual results or future expectations change materially. Additionally, the discussions on this call will include certain non-GAAP financial measures, some of which are forward-looking non-GAAP financial measures.

Reconciliation on these measures to the most directly comparable GAAP financial measures and an explanation of our basis for calculating these measures is included within our second quarter earnings release, which can be found on our website, zimmerbiomet.com. With that, I'll turn the call over to Iván.

Iván? Thank you, David. Good morning, everyone, and thank you for joining today's call.

I would like to start the way that I always do, with gratitude, thanking our Zimmer Biomet team members around the world. Thank you for your commitment, your resilience, and most importantly, your dedication to serving our customers and their patients each and every day. I'm truly grateful to have the opportunity to serve alongside you on this journey. Equally important, I'm beyond proud of the work that you do daily. Through my prepared remarks this morning, I'm going to cover three things. First, I'll summarize all the strong second quarter results. Second, I'll review our upgraded outlook for the year 2026. Thirdly, I'll provide an update on our three strategic priorities, which remain unchanged. First, people and culture, second, operational excellence, and third, innovation and diversification.

To begin, we delivered second quarter net sales of $2.177 billion, which came in above our expectations, representing 4.8% growth on a reported basis and 4% growth on an organic constant currency basis. On an organic constant currency basis, we grew 4.6% in the U.S., while our international business grew 3.1%. The growth in the U.S. demonstrates the strong progress we are making across a variety of fronts, including our U.S. Salesforce transformation. Starting with hips, we delivered 5.1% constant currency growth, including 5.9% growth in the critical U.S. market and 4.2% growth internationally. In the U.S., our hip triple play continues to gain momentum, driven by the continued penetration of Z1, our triple taper hip stem, which now represents over 40% of our U.S. hip systems and will soon surpass 100,000 implants worldwide.

Secondly, we've seen greater utilization of HAMMR, our surgical impactor, which is now used in over 25% of our U.S. primary hip cases. Thirdly, we have seen increased adoption of OrthoGrid, our AI-based navigation solution for direct anterior hip procedures. OrthoGrid had its strongest quarter to date and the first half of 2026, saw as many cases as the entire full year 2025. We expect growth to accelerate in this platform in quarters to come. Outside the U.S., our iodine-coated hip launch in Japan is exceeding expectations as we are seeing robust demand from both existing surgeons and competitive accounts. We expect this first-to-the-world technology to be a meaningful growth driver in the second half of the year 2026 and well beyond 2026. We're actively pursuing pathways to bring this game-changing technology to additional markets outside of Japan.

Knees increased 0.1% in the quarter, with U.S. knee growth of 1.4%, offset by a 1.5% decline internationally, which was heavily impacted by China and core emerging markets. We continue to see traction with new product launches and are very confident that the specialization work being done in the U.S. and go-to-market changes in key OUS markets will lead to improved performance. S.E.T. grew 3.4% on an organic constant currency basis in the quarter, which was a 180 basis points acceleration from the first quarter of the year. In the U.S., we delivered mid-single-digit growth, and Paragon 28 sales increased mid-teens. This was driven by a differentiated and innovative product portfolio, strong execution, healthy market dynamics, and the successful integration of the acquisition. CMFT, Craniomaxillofacial and Thoracic, once again grew double digits, led by our thoracic franchise, while upper extremities reported another quarter of upper single-digit growth.

These compelling results were partially offset by continued pressure in both trauma and restorative therapies. Technology and data, bone cement, and surgical grew 21.5%, demonstrating that our strategy of offering a comprehensive suite of customer-centric solutions is resonating with customers. We delivered record capital sales this quarter, driven by both ROSA with OptiPlan and TMINI, and saw early contribution from the much-anticipated next generation ROSA Shoulder launch. ROSA Shoulder is the only robotic shoulder system in the world that can perform both anatomic and reverse procedures and reset both the glenoid and humeral sides of the joint. Surgeon feedback from the first round of cases is very strong, and we look forward to doing many more cases in quarters to come.

U.S. technology sales grew over 50%, and we continue to have a very robust capital equipment pipeline, demonstrating surgeon enthusiasm for our differentiated product offerings and a healthy CapEx environment. Turning now to our outlook. With a strong first half, the transition to a dedicated and specialized U.S. sales channel progressing as planned, continued new product momentum, and healthy underlying markets, we are raising our full-year organic constant currency revenue guidance to 2.25%-3.25% from the previous range of 1%-3%. We are also increasing our adjusted earnings per share guidance to $8.47-$8.59, from the previous guidance of $8.40-$8.55. Paul will provide more detail in his prepared remarks. Let's turn to our three strategic priorities: people and culture, operational excellence, and innovation and diversification.

First, in the area of people and culture, which is a key pillar of our strategy, we are doing great things. This is our top priority as a company, underpinning all that we do. I love the fact that this is truly, and I mean truly, becoming a competitive advantage for Zimmer Biomet. Over the last year, we were recognized by leading global publications such as TIME Magazine and Forbes as one of America's best companies. We are also highlighted by Fortune Magazine as one of America's most innovative companies. We earn multiple Great Place to Work certifications and Best Workplaces awards all around the world. These recognitions not only cement our status as a best and preferred place to work, they also help us recruit top performers in key roles while maintaining high engagement and low people turnover.

Our people and culture-first imperative extends to the acquisitions that we do. When we acquired Paragon 28 just over 12 months ago, our goal was to strike the right balance between integration and preserving the fast, agile, and entrepreneurial culture that had been central to the success of Paragon 28. More than a year after the close, Paragon 28 is growing mid-teens, with commercial integration largely completed and negligible turnover among key team members. Paragon 28 now represents the template for future acquisitions as we identify a target that makes sense strategically and financially, accelerates our wing guard, and creates a growth platform, just like Paragon 28 has done for Zimmer Biomet. We have successfully brought Paragon 28 into the company, combining the best of both organizations. We are now very confident of the capabilities in place to do future deals with similar dynamics to this one.

Finally, our people and culture-first imperative is central to how we are approaching our global commercial transformation. In the U.S., our transition to a dedicated and focused sales organization, one specialized around key call points and growth areas, is progressing as planned. Six months in, with less customer disruption and sales force turnover than initially expected, we have confidence to accelerate our transformational efforts in certain territories. We firmly believe that once these efforts are completed at the end of next year, Zimmer Biomet will be a stronger company with a far more productive commercial channel and a more durable, diversified, and scalable growth engine. Our second priority is operational excellence. We continue to take actions to drive efficiencies. This includes shifting certain R&D spend to our newly opened global capability center in India, where we can access strong talent while improving our cost structure.

Additionally, we are excited to open a new manufacturing plant in Costa Rica, which furthers our strategy of increasing supply chain resilience while gaining access to lower-cost geographies. Construction in Costa Rica is well underway, and we are scheduled to establish the initial manufacturing lines next year. Lastly, to drive long-term margin improvement, we are aggressively implementing AI, artificial intelligence initiatives to address our operating expenses cost base. Our third strategic priority is innovation and diversification. We remain very excited about our pipeline and the differentiated technologies we are bringing to market. As previously mentioned, we are encouraged by the early launch of our iodine coated hip platform in Japan, which is designed to help address the risk of periprosthetic joint infection after total joint replacement. Within the overall half a billion JPY Japanese hip market, this first-to-the-world technology is driving share of wallet and also competitive conversions.