Zimmer Biomet Q2 2026 Earnings Call Transcript

Quartr
Provided by Quartr
August 5, 2026

Key Takeaways

  • Positive Sentiment: Zimmer Biomet reported Q2 net sales of $2.177 billion, up 4.0% organically at constant currency, exceeding expectations; U.S. organic growth was 4.6%, led by hips, technology, and higher-growth S.E.T. businesses.
  • Positive Sentiment: The company raised its 2026 organic revenue growth outlook to 2.25%-3.25% from 1%-3% and adjusted EPS guidance to $8.47-$8.59; reported sales growth guidance increased to 3.9%-4.9%.
  • Positive Sentiment: New products and technology are gaining traction, including the Z1 hip stem, HAMMR, OrthoGrid, iodine-coated hips in Japan, and ROSA Shoulder; technology sales grew 21.5% overall and more than 50% in the U.S.
  • Neutral Sentiment: The U.S. sales-force transformation is progressing ahead of expectations, but Zimmer Biomet plans to continue investing in specialized commercial capabilities through 2027, putting pressure on margins; Q2 adjusted operating margin declined 210 basis points to 25.7%.
  • Positive Sentiment: Operating cash flow rose 18% to $448 million and free cash flow increased 24% to $308 million; the company plans to repurchase up to $1 billion of shares in 2026, including $500 million already repurchased in the first half.
AI Generated. May Contain Errors.
Earnings Conference Call
Zimmer Biomet Q2 2026
00:00 / 00:00

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Operator

Good morning, ladies and gentlemen, and welcome to the Zimmer Biomet second quarter 2026 earnings conference call. If anyone needs assistance at any time during the conference, please press the star followed by the zero. As a reminder, this conference is being recorded today, August 5th, 2026. Following today's presentation, there will be a question and answer session. At this time, all participants are in listen only mode. If you have a question, please press the star followed by the one on your push-button phone. I would now like to turn the conference over to David DeMartino, Senior Vice President, Investor Relations. Please go ahead.

David DeMartino
David DeMartino
SVP of Investor Relations at Zimmer Biomet

Thank you, operator. 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.

David DeMartino
David DeMartino
SVP of Investor Relations at Zimmer Biomet

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 Ivan. Ivan?

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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. Then 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.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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 OptimiZe 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.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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. With that, let's turn to our three strategic priorities: people and culture, operational excellence, and innovation and diversification.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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 WAMGR, 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.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

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 $500 million Japanese hip market, this first-to-the-world technology is driving share of wallet and also competitive conversions.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Looking ahead, in the U.S., we continue to make excellent progress with Monogram and anticipate filing the 510(k) for Monogram in the very near future. Beyond these two transformational product launches, we expect to introduce over 50 new products in the next 36 months, with many of these launches being first-to-the-world introductions. While we could not be more enthusiastic about our current product cycle, we are deeply committed to being the boldest innovator in musculoskeletal health for years to come. Our role as the exclusive orthopedic investor in the Mobility Revolution Fund, a musculoskeletal venture capital fund launched through a collaboration between Deerfield Management and the Hospital for Special Surgery in New York City, is an example of this commitment.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Throughout the fund, we will have the opportunity to invest in disruptive technology, ranging from AI and data applications to cartilage repair, with the potential to redefine orthopedic care and further our mission to alleviate pain and improve the quality of life for people around the world. In addition to our organic innovation strategy, we are going to continue to look for responsible opportunities to diversify through M&A as we continue to aspire as a company to have a WAMGR, weighted average market growth rate, of 5%-6% by the end of this decade. All in, we delivered strong second quarter results, made strong progress on our key strategic priorities, and we increased our outlook for the year 2026. The work that we are doing to transform our company, starting with our critical commercial channel, is well underway.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

I am very proud of the team, I am very proud of our progress, and I am very excited with the momentum that we have as we advance our customer-centric strategy and address the most challenging problems in healthcare. I truly do mean it when I say that the boldest chapters for this company remain ahead. With that, I will turn the call over to Paul. Thank you.

Paul Stellato
Paul Stellato
Interim CFO, VP, Controller, and Chief Accounting Officer at Zimmer Biomet

Thanks, good morning, everyone. As Ivan reviewed, we grew sales 4% on an organic constant currency basis in the second quarter, driven by strength in hips, high growth segments of S.E.T., and robotics. We reported GAAP diluted earnings per share of $1.03 compared to GAAP diluted earnings per share of $0.77 in the second quarter of 2025. Higher revenue and lower acquisition-related costs, along with a lower share count, were the primary drivers of the increase. Our adjusted earnings per share were $2.07, in line with the prior year quarter, as higher revenue and lower share count were offset by the expected dilution from the Paragon 28 acquisition and investments in the U.S. commercial organization. Pricing was an 80-basis point headwind in the quarter, within our guidance range of up to 100 basis points of pricing pressure for the year.

Paul Stellato
Paul Stellato
Interim CFO, VP, Controller, and Chief Accounting Officer at Zimmer Biomet

Adjusted gross margin was 71.1%, down 120 basis points year-over-year and in line with our expectations. This decrease was driven by increased manufacturing costs, partially offset by geographic and product mix. Adjusted operating margin was 25.7%, down 210 basis points year-over-year and in line with our expectations as we continue to invest in our U.S. channel. Adjusted net interest and non-operating expenses were $71 million, modestly below the prior year. Our adjusted effective tax rate was 18%, and fully diluted shares outstanding were 192.8 million, down year-over-year due to $500 million in share repurchases during the first half of 2026, including $250 million repurchased during the second quarter. Now turning to cash and liquidity. We had another strong quarter of cash generation with operating cash flow of $448 million and free cash flow of $308 million, up 18% and 24% respectively.

Paul Stellato
Paul Stellato
Interim CFO, VP, Controller, and Chief Accounting Officer at Zimmer Biomet

We ended the quarter with approximately $410 million in cash and cash equivalents. Regarding our updated outlook for the full year 2026. As Ivan mentioned, we now expect organic constant currency revenue growth of 2.25%-3.25%, up from 1%-3% previously. We continue to anticipate foreign exchange to be an approximate 50 basis point tailwind to the full year revenue growth. In addition, given Paragon 28's strong performance, it will contribute 110 basis points to full year reported sales growth, above our initial expectation of around 100 basis points. As a reminder, the Paragon 28 transaction closed on April 21st, 2025, and is now included within organic growth. We now expect 2026 reported sales growth to be 3.9%-4.9%, up from 2.5%-4.5%.

Paul Stellato
Paul Stellato
Interim CFO, VP, Controller, and Chief Accounting Officer at Zimmer Biomet

The updated revenue guidance contemplates a healthy orthopedic procedural market and new product momentum balanced with the continued risk of disruption from our U.S. and international go-to-market changes and up to 100 basis points of pricing erosion. From a phasing perspective, we continue to anticipate third and fourth quarter constant currency growth rates to be consistent, while foreign exchange is expected to be a 50 basis point headwind in the third quarter. Shifting to the P&L. For the full year, we continue to expect gross margin to be around 71%, and we now forecast operating margins to decline a little more than 50 basis points, reflecting the aforementioned investments in our U.S. commercial organization. Within that, we anticipate third quarter operating margins to be down slightly on a sequential basis from the second quarter.

Paul Stellato
Paul Stellato
Interim CFO, VP, Controller, and Chief Accounting Officer at Zimmer Biomet

Our assumptions for full year net interest and other non-operating expense and tax rate remain unchanged at $295 million and 18%, respectively. As previously announced, we now plan to repurchase up to $1 billion of shares this year, an increase of $250 million from our initial expectation. As a result, we now anticipate having about 193 million fully diluted weighted average shares outstanding for 2026. Taking all of this into account, we are increasing our adjusted earnings per share expectations for the year to a range of $8.47-$8.59, versus our prior guidance of $8.40-$8.55. We continue to expect to grow free cash flow 9%-11%. We remain focused on delivering solid results this year while continuing to position the company for long-term success. With that, I'll turn the call back over to David.

David DeMartino
David DeMartino
SVP of Investor Relations at Zimmer Biomet

Thank you, Paul. Operator, let's open up for questions. In order for us to take as many questions as possible, please limit yourself to one question. Operator, please go ahead.

Operator

Thank you. If you are dialed in via the telephone and would like to ask a question, please signal by pressing star one on your telephone keypad. If you're using a speakerphone, please make sure your mute function is turned off to allow your signal to reach our equipment. Again, please press star one to ask a question. We'll pause for just a moment to allow everyone an opportunity to signal for questions. We'll go first to Rick Wise with Stifel.

Rick Wise
Rick Wise
Managing Director at Stifel

Thank you. Good morning, Ivan. It's terrific to see all the positive progress and see the quarter's healthy beat and raise performance. Of course, I'm inclined to credit your Tornado Tour efforts as helping, in particular, the U.S. sales team get all jazzed up. Share with us, if you would, Ivan, some more of your updated latest thoughts about the Salesforce transition. It seems to be going well, maybe help us better understand what's left to do, the growth implications, since it seems to be going better than expected. Also maybe help us understand, it seems like you're making a deliberate choice to reinvest some of the sales outperformance, margin outperformance in higher SG&A spend. Is that a conscious decision? Is there something we need to understand better? Maybe just about the implications going forward in the second half and 2027. Thank you.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Thank you, Rick, and good morning. First and most important, I'm going to invite you to the next Tornado Tour. You're going to love it. Five states in five days, seeing countless reps, managers, and distributors. Giddy up, because it's an intense week. I'll tell you, the Salesforce transition, the go-to-market changes are going better, if not much better than expected, and I think that's evidenced in the numbers that we posted for the quarter. We delivered almost 6% growth in hips, 5.9%. Our technology business, we invested a lot, added a ton of reps in the channel, grew 53% in the quarter. When you look at S.E.T., there is a lot to unpack in S.E.T., as you know. Our Shoulders business, our Upper Extremities business, delivered upper single digit growth. Again, that's the outcome of the specialization changes that we're making.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

We're growing across the board. Surgical had a great quarter. Again, across the board, the dedicated specialist structure is yielding results, 4.6% growth in the U.S. You see that the changes that we're making are increasing productivity, the number of cases per week are increasing, and again, we're seeing the return on these investments. Beyond the financials, we look at all kinds of people metrics. Our attrition rates or people turnover rates are the lowest that we have seen in a while. Engagement is very high. We are on track to complete all of these by the end of 2027. We're going at the right pace. We always say we're going to have three stages. The first one is done, which was the lower or lowest risk. We are now in the second stage.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

We're taking our time to understand what is the pace, what is the level of investment that we need to secure, then quickly we're going to move into the third stage. Again, repeating myself, we'll be done with this project, we'll have a fully dedicated and specialized structure by the end of 2027. Everything is on track, and that's why you see us today raising our guidance. In terms of your second question, the SG&A question, look, we said from day one that we're not going to be penny-wise and pound-foolish. This is not a cost-savings strategy, the go-to-market changes in the U.S. This is a growth strategy. We want to have the best sales force in orthopedics, and we're building just that. To not be penny-wise, pound-foolish, we got retention agreements across the board. We locked in the top six independent distributors.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

We have added 200 tech reps, or we're adding 200 tech reps, probably mid-point into recruiting those 200 reps. We've invested heavily in sales excellence programs across the board. We got what we deem the best comp plan in orthopedics today, which is enabling us to recruit med tech top reps from across the board. Really excited about the people that we're bringing here. That's why the SG&A is modestly up. We like these investments. We know they are going to help us go at pace derisking the go-to-market changes. Most importantly, we know that these investments in 2026 are going to yield better results in 2027. I love what we see, everything on track, and thank you for your question.

Rick Wise
Rick Wise
Managing Director at Stifel

Thank you.

Operator

We'll go next to Larry Biegelsen with Wells Fargo.

Larry Biegelsen
Larry Biegelsen
Senior Medical Device Equity Research Analyst at Wells Fargo

Good morning. Thanks for taking the question. Congrats on the nice quarter here. Ivan, you know the recon market question is coming, and you talked about healthy underlying trends. When we aggregate the data, it looks like the recon market did slow in the first half of 2026. Looks like it slowed in the U.S. and outside the U.S. My question is, what do you attribute that to? You know there have been concerns about the ACA subsidies expiring and the Medicaid cuts. What are you assuming in the guidance? I know you framed it as kind of low single-digit percent of your U.S. procedures for both the ACA exchanges and Medicaid. That's still, call it in the aggregate, maybe 5%. If those decline, say, 20%, it could still be a 1% headwind for you. How are you thinking about this? Thank you.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Larry, good morning. Thanks for the question. Look, this is my second stint in orthopedics, eight years now at Zimmer Biomet, previously with DePuy for a few years. The one thing I've learned is that markets don't change one quarter to the other. We don't look at one quarter dynamics. The second half of 2025 was stronger than the first half of 2026. Hips was very strong in the second quarter. We continue to see knees, the knee market in the U.S., around 3% or 4%. Again, we don't look at one quarter dynamics. We know that in Q1 there were some acute events. Some of that got resolved in the second quarter. I'm talking about some of the strikes. I'm talking about some of the external changes. We are not concerned about market health. We continue to peg the overall market at 4%-5%.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Otherwise, we'll not be growing 4.6% in the quarter in the U.S. Relative to the ACA, we keep monitoring this. I'll tell you, for us, the exposure to ACA and exchanges is low single digit. Our single largest payer, or our largest payer for Zimmer Biomet, is Medicare. As you know, the population age matters. The average hip patient in the U.S. is 65 years old. For knees, it's around 67 years old. These are Medicare patients. When you throw on top of that commercial, that's virtually the entire payer ecosystem. Low single exposure to ACAs. We track all kinds of data. As the largest orthopedic company in the world, we look at the waiting list, which remain unchanged. Average in the top 10 hospitals in the U.S. is three to six months. That is waiting times. We look at cancellation rates.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

This is a metric that we started to monitor during COVID. What percentage of times do patients cancel their procedure? At one point, this was 40%, 50%. For the last five years, it's been in the teens. That tells us that when a patient commits to a procedure, 85%, 90% of the time, they will go through the procedure. That's no change. We look at referral cycles. From the time you go to see a primary care doctor to the time you schedule the surgery, what is the waiting cycle? Again, remains pretty much the same. You may have some mixed elements. Hips are stronger one quarter, knees softer one quarter. Again, overall, we are not concerned. We like what we see as we look into the second half of the year 2026.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Internationally, there's all kinds of events, whether it's tenders, whether it is geopolitical dynamics in the Middle East. We're not concerned about market health, and that's why we're raising guidance for the second half of 2026. Thanks for the question.

Larry Biegelsen
Larry Biegelsen
Senior Medical Device Equity Research Analyst at Wells Fargo

Thank you.

Operator

We'll go next to Mathew Blackman with TD Cowen.

Mathew Blackman
Mathew Blackman
Managing Director at TD Cowen

Good morning, everybody. Can you hear me okay?

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Yes, we can, Matt.

Mathew Blackman
Mathew Blackman
Managing Director at TD Cowen

Great. Appreciate you taking the question. Ivan, I just wanted to drill down a little bit on some of your latter comments, in response to Larry's question, and specifically on the hip market. It was a noisy quarter in the hip market globally. Everyone's growth decelerated, with the exception of Zimmer Biomet. Just sort of hoping to get your perspectives, first on the U.S. market, anything notable in terms of volumes or share or mix? Then OUS, obviously, you've got new products, particularly in Japan. I appreciate that OUS has a lot of different geographies, but just help us understand the opportunity OUS for the Zimmer hip franchise and the health of key underlying markets there. Thanks so much.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Thanks, Matt, for taking the time this morning. Let me just piggyback to that first comment, that Zimmer Biomet did grow in the quarter. Again, I'll tell you, that tells you that it's all about execution. The markets are not a problem. The innovation story is compelling here. As long as we continue to execute, our expectation is that we'll continue to deliver the performance that we can deliver. Relative to new products, hips, and the opportunity outside of the U.S. and here in the U.S., let's start with iodine. It's one of the most transformational products that this company has launched. Periprosthetic joint infections are the number one cause for readmissions. Infection is a multibillion-dollar cost to all healthcare systems. Japan is the second-largest market outside of the U.S., roughly $500 million in value. The launch has gone much better than expected.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Candidly, we're struggling to supply at the pace that we need to supply. The demand is very high. We expect to convert the lion's share of the entire market over to iodine-coated devices. We get a 40% premium every time that we move from a non-iodine-coated hip to a coated hip. We are converting not just Zimmer Biomet customers, also competitive accounts. The launch is going really, really well. We are in active conversation with the FDA to understand the pathway to bring this to the U.S., we got a pipeline of countries all over the world where we're going to be bringing this disruptive technology. Here in the U.S., look, we don't have iodine today, we do have the hip triple play, what we call the hip triple play platform, Z1, HAMMR or surgical impactor, and also OrthoGrid.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

All three of them are taking market share. All three of them are going better than expected, that's why we delivered 5.9% growth in hips in the U.S. this quarter. That's on hips. I'm not going to ramble through the rest of the portfolio, we like the innovation story. Again, I'll leave you with that one word, execution. We got to execute better. That's why we're making the go-to-market changes, then we'll be able to deliver quarters like this, if not much better than this.

Mathew Blackman
Mathew Blackman
Managing Director at TD Cowen

Thanks.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Thanks, Matt. Yeah.

Operator

We'll go next to Patrick Wood with UBS.

Patrick Wood
Patrick Wood
Head of US MedTech Research at UBS

Beautiful. Thanks, guys. Appreciate the question. Ivan, you obviously said there's a lot to unpack in S.E.T. I'd love to just drill into that a little bit better. Obviously, a bit of a sequential acceleration on that side. I know there's a lot going on between shoulder and sternal closure. Anything you can give us a sense for what drove that acceleration, how you're thinking about that for the balance of the year and moving into 2027? Thanks.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Hey, thanks, Patrick. We love this business. We delivered a 4%+ in the U.S. We're slightly behind meeting the growth globally in S.E.T. Some timing with Sports Medicine, that is going to move on to the second half. As you heard in my prepared remarks, Paragon 28 is growing close to 15%, or the upper extremities business growing strongly, close to upper, actually upper single digit. The CMFT business growing in the tens, I don't know how many quarters in a row. This is driven by our thoracic business. You know the opportunity here is $2+ billion, when you move from wires to rigid fixation for the sternal closure. It's a standard of care change. Again, CMFT growing in the teens, Shoulder is going upper single digit. Paragon 28, stellar growth at almost 15%. We expect bigger growth in the second half.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

We like where we are with S.E.T. We do have two headwinds. We've been very candid about those two headwinds, those being trauma and restorative therapies. Actually, if you take those out, the U.S. growth would be solidly in the upper single digit year-to-date. We're addressing the changes that we need to make in those two businesses, trauma and restorative therapies. Net-net, the second half of 2026, we expect to have a much better S.E.T. growth profile, but again, very pleased with the progress and congratulations to the team, especially Paragon 28, for a stellar performance in the second quarter.

Patrick Wood
Patrick Wood
Head of US MedTech Research at UBS

Thanks, guys.

Operator

We'll go next to Vijay Kumar with Evercore ISI.

Vijay Kumar
Vijay Kumar
Senior Managing Director at Evercore ISI

Hi, Ivan. Good morning, thank you for taking my question. I guess I'll focus on bone tech and cement, north of 20%, really strong. How much of this is being driven by Zimmer's tech strategy resonating in the marketplace versus any one-time effect? Did you benefit from any bone cement competitors being off the market? If so, could that be a comp headwind when you think about 2027? Thank you.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Hey, thanks, Vijay. Look, there's a lot in this other category. I particularly don't love the name other for everything. The lion's share of the growth is technology. Technology in the U.S. grew 30% in Q1. In the second quarter, it grew 53%. As we look at the second half of 2026, the pipeline technology, both in the U.S. and outside the U.S., is very strong. I'll tell you, the lion's share of the growth is technology. Our bone cement business is a tiny fraction of that category. There were some one-time events in some international markets. No, the growth here comes from technology, number one, and surgical. I referenced the surgical, the first quarter 2026, and the second quarter has been much, much stronger than the past. That is part of our ASC strategy. No, it's certainly not bone cement, it's technology.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

I'll tell you, there's two different dynamics here, one internal and one external. On the external front with technology, the CapEx environment is very healthy. As you probably heard now from all competitors, we all have a strong pipeline of robots that we're selling. The CapEx, again, is very, very healthy, mostly in the U.S., but in some countries outside of the U.S. The second dynamic is here internally, we have the most comprehensive suite of solutions, whether it's handhelds that are cordless, whether it's CT scan devices, non-CT scan devices, mixed reality, large footprint robotics, if I can speak. Whether it's the launch of ROSA OptimiZe, whether it's ROSA Shoulder, it'll take me an hour to go through it. We got a best-in-class portfolio in technology, and we're in the early stages of gaining the market share that we can gain with our technology. Thanks.

Vijay Kumar
Vijay Kumar
Senior Managing Director at Evercore ISI

Brilliant. Thank you.

Operator

We'll go next to Travis Steed with Bank of America.

Travis Steed
Travis Steed
Managing Director at Bank of America

Hey, congrats on the good quarter. I guess I'm looking at kind of comp adjusted growth. Q2 was a nice acceleration. If you end up beating the guide in the back half, you'll have another acceleration in the back half of the year on the total company growth. Is that the Salesforce transition getting better? Is the execution getting better? Is it new products? Just curious what's driving that kind of acceleration over the course of the year. When you look at 2027, what gets better? What gets worse? Is the Salesforce acceleration or is the Salesforce less of a headwind in 2027 or new products more of a tailwind? Is pricing better or worse in 2027? Just trying to think about the factors of 2027.

Travis Steed
Travis Steed
Managing Director at Bank of America

We can make our own call on kind of market growth rates, kind of the Zimmer specific factors on 2027 that you could kind of call out what gets better or worse.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Travis, thanks for joining. Look, the numbers, when you see the numbers without understanding the details can mislead you. If you look at 2025, if you look at last year, the first half of 2025, when you adjust for the selling day impact dynamics of the first half, the growth in the first half of 2025 is 3.6%. When you look at the second half of 2025, when you adjust for the ERP comparable versus 2024, and I'm going back in history, now the growth rate in the second half of 2025 is around 4%, 4.2%. That's 3.6% growth, real growth in the first half of 2025 and 4.2% growth in the second half of 2025. That's a 60 basis points acceleration from the first half to the second half. What gives us confidence that we're going to deliver that, if not more?

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

We've seen great momentum with our go-to-market changes, again, as evidenced by the results. We continue to see an uptick in new product acceleration or said business, as I referenced earlier during my answer to Patrick, it is going to accelerate. We don't have the supply challenges we had with the Sports Medicine. We continue to see Paragon 28 delivering strongly early in Q3. They continue to do really well. A combination of commercial execution, innovation, and the fact that the growth is not as acute as it may look at face value give us confidence on delivering on the second half of 2026. Relative to 2027, we're not going to get into commentary around what 2027 looks like. I will tell you, if you ask me today, we are confident that the performance should improve in the year 2027.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

To begin with, by then, we'll be mostly done with all the go-to-market changes. We will not have the struggles that we have in China today. China is only 2% of the revenue of Zimmer Biomet, 1% of the EBITDA. It's a country that has been declining 20% this year. We're going to have favorable comps as we get into 2027. We also have some noise in emerging markets. Those disappear as we get into 2027. The U.S. should perform better given the go-to-market changes. We're not going to have some of the headwinds that we got today in a variety of international regions. We do believe 2027 is going to be better, but we'll talk about 2027 when it's time to talk about 2027. Thank you.

Travis Steed
Travis Steed
Managing Director at Bank of America

That's helpful. Thank you.

Operator

We'll go next to Robbie Marcus with JPMorgan.

Robbie Marcus
Robbie Marcus
Senior Analyst at JPMorgan

Oh, good morning and congrats on a good quarter. Ivan, I wanted to ask, following up on, you were talking about all the different tech and robotic platforms you have. How do you think about coalescing that as a strategy to drive revenue growth and balance that? I have to imagine there's a decent amount of support dollars that go into having so many robotic platforms. How do you think about all of those? Do you focus on a few? Do you keep the broadest offering? How do you think about returns and support for those platforms? Thanks a lot.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Hey, thanks, Robbie. Look, we've taken a very data-centric approach to what is the best pathway when it comes to technology. We don't call ourselves a robotic company. We call ourselves a technology company. We segmented all kinds of technology within orthopedics. Percentage of surgeons that use robotics in the U.S. Remains 20%. 80% of surgeons don't use a robot in the U.S. When you look at all U.S. dynamics, 10% of surgeons will use a robot, 90% do not. We don't want to be a robotic company. We want to be a navigation company, that's why here in the U.S., we offer surgical guidance for non-robotic users. We have FDA-approved mixed reality. We recently acquired, three quarters now, four quarters ago, OrthoGrid for direct anterior and similar technologies outside of the U.S.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

When you look at the percentage of surgeons that use robots, again, they're 20% in the U.S., 29,000 orthopedic surgeons, 20% use robots here in the U.S. One robot does not fit all. We do extensive market research. You got some surgeons that prefer CT scan, you got some that prefer imageless, you got some that like small, portable to move the robot from one operating room to the other one. We have that optionality. Again, we got large footprint, small footprint, portable, which by the way is cordless, CT scan, non-CT scan. We got all kinds of robots. Similar dynamics outside of the U.S. Outside the U.S., the preference is for CT scan-less robotics, and we have that. That's why you see such a comprehensive suite of solutions. In terms of the cost, look, we're evaluating that.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

As we launch Monogram, as we continue to track which products are doing better than others, as we see where the standard of care is going to evolve towards, we may start to prune the portfolio, have a more simplified portfolio. Right now, we like the optionality of having such a comprehensive suite of solutions, and look, 53% growth in the second quarter tells us that we're doing something right. Thanks, Robbie.

Operator

We'll go next to Matt Taylor with Jefferies.

Matt Taylor
Matt Taylor
Managing Director at Jefferies

Great. Good morning. Thanks for taking the question. Ivan, I won't ask you about Other since you don't like that, but let me ask another technology-based question. I'd love an update on ROSA Shoulder, how that is going. Maybe you could talk about the rollout, the uptake that you expect and how that's differentiated from other technology-driven shoulder solutions.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Hey, Matt. Good to hear from you. First of all, I do like the category Other, I just don't like the name, because we do a lot of bold stuff within what we call Other. To be continued on that. ROSA Shoulder is going better than expected. Early in the launch, but what a great opportunity. Shoulder arthroplasty, as you know, is one of the fastest-growing areas within orthopedics. Today, only about 20% of doctors perform shoulder arthroplasties because it is a very difficult procedure. The real estate in the shoulder is minimal. The accuracy needs to be very high. It's very complex. Reimbursement is very high. It's actually the highest of all core orthopedic procedures. You bring in a solution to a complex problem that you can monetize, you're going to get rewarded. That's what robotics are bringing to the space.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

As you know, earlier this year, we received the clearance for next generation ROSA Shoulder. We launched the original version, I want to say 1.5 year ago. We did a very extensive LMR, limited market release. We learned a ton, and with the learnings, we reconfigured parts of ROSA, and now we launched ROSA Shoulder next generation, what we call version 1.1. It is the only system that can do both reverse and anatomic procedures. Reverse is roughly 70% of all shoulder arthroplasties around the world, especially here in the U.S. You got a third of surgeons that prefer an anatomic approach, and again, we are the only company that offers both. It is also the only system that can do both the humeral and the glenoid resection. What that gives you is more accuracy in the cuts that yields to a better outcome and faster recovery.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Generation Two versus Generation One is a much simpler and improved interface. Again, we took our time. I know we've been talking about the LMR for, I don't know, a 1.5 year. Now we're moving into a full market release, as we speak, in the next couple of weeks. Again, only a month into the launch, but we have seen great adoption. We're getting outstanding feedback, and early to make commitments, but if we do the work that I believe we're going to do, we expect the penetration of robotics to go faster than it did when robots were launching knees back 10, 12 years ago. A great overall opportunity and a great platform, and we look forward to updating you every other quarter.

Matt Taylor
Matt Taylor
Managing Director at Jefferies

Great. Thanks so much for the thoughts.

Operator

We'll go next to Ryan Zimmerman with U.S. Bancorp BTIG.

Ryan Zimmerman
Analyst at U.S. Bancorp BTIG

Thank you. First, Ivan, I have to say congrats on the World Cup. I think we all have known you're a big fan there, and it's nice to see. I want to ask about pricing in the quarter. If you look at pricing over the last three quarters, the headwinds have increased a little bit. It's still within the range of what you expect. When you think about Medicare as your largest payer, the CJR-X program, the PFS rates that are proposed for 2027, which are down potentially up to 20% right now. Is it your assumption that pricing headwinds will increase in orthopedics because of these dynamics? It just seems like that it will increase the shift to the ASC and potentially put some pressure on implant pricing. Would appreciate your thoughts there. Thank you.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Hey, thanks for joining. Yes, Spain did send Lionel Messi into retirement, and before that, we sent my friend Cristiano Ronaldo into retirement. If you ask me, that game should have been 3-0, not 1-0. Relative to pricing, look, the ongoing question for five years now, 20 quarters, I've been asked whether I thought that pricing was going to get worse, and it hasn't. It is very much within the guidance that we provided of flat to 100 basis points. Pricing dynamics are not changing all that much in the ASC environment. As you know, most of these ASCs are owned by surgeons or private equity companies or astute operators that understand that the implant is only around 14%-15% of the overall cost.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

The conversation is not about the implant, the conversation is around reduction of surgical time, ensuring that you're not sending the patient to an inpatient unit, lowering readmissions, et cetera, et cetera. We continue to track pricing dynamics, inpatient, HOPD, hospital outpatient departments, and standalone ASCs, and they're very comparable. If you look at the data going back 20 years, the implant right now, as a percentage of DRG, remains at the lowest point. I'm not sure that you got much more to squeeze in those implants. With the conversation we're having now around CJR expansion, comprehensive joint registry expansion, with the focus right now not on the surgery alone, but the entire recovery, the entire episode of treatment, I don't envision that anyone who understands data is going to choose lower price implants or is going to try to negotiate lower pricing.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

It's going to be around the comprehensive bundle of care and companies that drive efficiency, companies that enable best-in-class clinical outcomes are going to win. With all that rambling, I'll tell you, we don't expect the second half to be an uptick when it comes to price erosion. 85% of our book of business is contracted. We got visibility into the second half of 2026 as well as 2027, and we're very confident on our guidance of flat to 100 basis points at worst of price erosion. Thanks for joining the call.

Ryan Zimmerman
Analyst at U.S. Bancorp BTIG

Thank you.

Operator

We'll go next to Steve Lichtman with William Blair.

Steve Lichtman
Steve Lichtman
Research Analyst at William Blair

Thank you. Morning. Ivan, you touched on M&A in your prepared remarks. With Paragon 28 now fully in the fold, could you give us your latest thoughts on the type of deal that makes sense for Zimmer Biomet right now? Are you thinking about going further outside of your verticals? Any comments on size preference in terms of tuck-in or could we see something larger? Thanks.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Hey, thanks, Steve. Look, it hasn't changed. It's the same story I believe that we've been telling for now two to three years. Our M&A strategy remains consistent across three vectors. First, we're going to focus on the higher growth segments of recon. Not all recon is created equal. You got segments within recon that are higher growth, data, technology, infection, and that's why we have acquired companies like OrthoGrid, obviously Monogram, surgical impactors, and other data technology plays. That's vector number one. We will continue to invest in higher growth segments of recon where we own the control point and where we are the leading company globally. The second vector is going to be higher growth areas within S.E.T. Again, foot and ankle, Sports Medicine, upper extremities, CMFT. There's a lot of optionality there. We've done some deals there. You referenced Paragon 28, which is going great.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Also, Embody in Sports Medicine is going great. Our acquisitions in CMFT are going much better than expected. That's why for, again, five years, CMFT has been growing strongly in the teens. Again, our second vector is going to be S.E.T. Then thirdly, at some point, we look at more adjacent areas to S.E.T. Are there businesses peripheral to neuro that we want to look into? S.E.T. happens, most of these procedures happen in an ASC. What are some other opportunities? Those are the three vectors we're going to go at pace. We're going to be bold, as I tell my team, but not reckless. In terms of criteria, you called it. It's similar to Paragon 28. Up to $2 billion acquisition price, ideally. That's our zip code.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Needless to say, whatever we acquire needs to be immediately accretive to revenue and WAMGR, or weighted average market growth rate. Similar to Paragon, it has to be EPS accretive by the second year. We're looking for a double-digit return on investment capital, or invested capital ROIC, by the year five. We're going to take our time. We have an ambition to have a WAMGR of 5%-6% by the end of the decade. That doesn't mean we need to buy our delta from four and a quarter to eight to six. It's a lot of organic work that we're doing to move into higher growth WAMGR environments from an R&D perspective.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Yes, now that we know that we can do effective R&D or M&A, now that we've learned that we can integrate, given what we've done with Paragon 28, we're going to continue to look at this. Thanks for the question.

Steve Lichtman
Steve Lichtman
Research Analyst at William Blair

Thanks, Ivan.

Operator

We'll go next to Joanne Wuensch with Citi.

Joanne Wuensch
Joanne Wuensch
Managing Director at Citi

Good morning. Thank you so much for taking the question, and nice quarter. I'm a little curious how you're thinking about guidance philosophy and how you're thinking about the raise for the second half of the year and as you think about setting 2027. The company in a very short period of time has gone through a number of changes, a Salesforce change, a new product pipeline, a couple of stumbles, not worth mentioning. How do you think about pulling all of this together when you do give the guidance? Should we think about your commentary in the phrase of conservative, realistic, or hopeful? Thank you.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Hey, thanks, Joanne. Look, I say that my guidance or guidance philosophy is going to be to say less and do more.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

We're going to take a measured approach given all the variables that we continue to analyze. That's what we're doing. We're confident on the guidance for the second half of 2026. Lots of puts and takes. We see certainly more upside than downside, when we look at where we finish the first half. We're going to go one quarter at a time. We'll take the same philosophy for 2027. At the right time, we'll talk about 2027. The philosophy is going to be to say less and to do more as we did in the second quarter of 2026. Thank you.

Operator

We'll go next to Vik Chopra from BMO.

Vik Chopra
Vik Chopra
Managing Director at BMO

Oh, hey, good morning, and thanks for taking the question. Congrats on a nice quarter. Ivan, I wanted to ask where you are with your CFO search and what specific attributes you're looking for in a permanent CFO. Thank you.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Thank you. We have a great interim CFO who's sitting here to my right. Paul Stellato has been a great business partner for four years. A lot of the transformational work that this company has gone through over the last four years has been led by Paul. I am in no hurry here because I got a stellar interim CFO. Obviously, we're looking also at external candidates. We're looking for someone who wants to be part of this transformation, somebody who's going to be in the trenches, somebody who I think like an operator, somebody with experience in value creation, someone who brings credibility from a street perspective, a true business partner. That's what we're looking for. Again, we're going to take our time.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

We've got a great interim CFO here at Zimmer Biomet, and everything is very much on track as we think about the search and the process. Thanks for the question.

Operator

This concludes the question and answer portion of today's call. I would like to turn the call over to Ivan Tornos for any closing remarks.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Thanks, operator. Look, we started today with gratitude, and I'm going to close with gratitude. I want to thank again all the employees, 17,000 of you at Zimmer Biomet who do so much every day. I'm grateful for your hard work, your dedication, the results, the progress, and most importantly, for what you do for patients and customers every day. In closing, we're very pleased with the results in the second quarter. The transformation of the company is going as expected, if not better than expected. We are extremely confident on the guidance rates that we provided this morning. Most importantly, we're really excited about the changes that we're making in 2026. We always say it was going to be a transitional year. It will be a transitional year, and as we enter in 2027, 2028, we're going to have a totally different company.

Ivan Tornos
Ivan Tornos
Chairman, President, and CEO at Zimmer Biomet

Very excited, very proud of the team, and I thank everybody for joining the call this morning.

Operator

This concludes today's call. Thank you for your participation. You may now disconnect.

Executives
    • David DeMartino
      David DeMartino
      SVP of Investor Relations
    • Ivan Tornos
      Ivan Tornos
      Chairman, President, and CEO
    • Paul Stellato
      Paul Stellato
      Interim CFO, VP, Controller, and Chief Accounting Officer
Analysts
    • Rick Wise
      Managing Director at Stifel
    • Larry Biegelsen
      Senior Medical Device Equity Research Analyst at Wells Fargo
    • Mathew Blackman
      Managing Director at TD Cowen
    • Patrick Wood
      Head of US MedTech Research at UBS
    • Vijay Kumar
      Senior Managing Director at Evercore ISI
    • Travis Steed
      Managing Director at Bank of America
    • Robbie Marcus
      Senior Analyst at JPMorgan
    • Matt Taylor
      Managing Director at Jefferies
    • Ryan Zimmerman
      Analyst at U.S. Bancorp BTIG
    • Steve Lichtman
      Research Analyst at William Blair
    • Joanne Wuensch
      Managing Director at Citi
    • Vik Chopra
      Managing Director at BMO
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