You are given a text that consists of multiple sentences. Your task is to perform abstractive summarization on this text. Use your understanding of the content to express the main ideas and crucial details in a shorter, coherent, and natural sounding text. 
Text: I hope you are all well and safe.
Joining me virtually today are Bryan Hanson, our Chairman, President and CEO; and EVP and CFO, Suky Upadhyay.
As we're all aware, obviously, given the news recently, COVID is still very much with us, and we're watching it very closely, as you can imagine.
But given that even, we've seen some real progress since our last call, and I think that's obvious to everybody.
The world has not returned to normalcy yet, but travel is returning.
We have more team members in our offices, and I am personally looking forward to attending the AAOS meeting in about a month in San Diego.
So really looking forward to that meeting.
We have a lot of great technology that we're going to be able to showcase there and just really happy it's going to be in person again, finally.
You, our team members are the driving force for this progress that we've seen in our own facilities and certainly in our communities as well.
Also, I want to say that I hope in our investor community that you're continuing to stay safe and have been hopefully able to travel over the last few months to see family and friends.
This is an opportunity for us to take advantage of some travel as we begin to turn to more of a normal environment, of course, not there yet, and we know this isn't happening consistently anyway in all regions.
But overall, we are encouraged and we're doing our part to keep this moving forward.
And every single day, we are supporting our customers and patients that they serve.
We're doing this safely, obviously, but this is a big focus for us as a mission-driven organization to be there for our customers so they can complete the procedures that they have and we can make sure that the patients receive the care that they deserve.
And with that, I think it's a good lead into our Q2 call.
And I think most importantly, our 2021 guidance view on a go-forward basis.
And then I'll come back to close out the call with some updates on our active portfolio management and product in pipeline highlights.
I'll wait to do that after he provides the guidance information.
So just to set him up a little bit, overall, let me just say that our performance in the quarter improved meaningfully from the first quarter of this year, and that was pretty much across all regions and product categories.
And as recovery from the global pandemic continued to take hold, we saw that recovery in our procedures also move in the right direction.
While we certainly anticipate some ongoing COVID pressure, we currently think it's going to be manageable by hospitals, and we expect that the recovery will continue to build sequentially throughout the second half of 2021.
Again, moving in the right direction.
And my revenue and P&L commentary will be on a constant currency or adjusted basis.
Also, I'll provide constant currency revenue growth versus 2019 as we think that is a more relevant comparison for this quarter.
Net sales in the second quarter were $2.027 billion, a reported increase of 65.3% and an increase of 60.7% on a constant currency basis versus the same period in 2020.
When compared to the second quarter of 2019, net sales were flat on a constant currency basis, and we did not have a material impact from selling days.
Overall, consolidated and regional results were slightly better than the expectations we provided on our last quarterly call, with growth versus 2019 in the Americas and Asia Pacific and sequential improvement in EMEA.
For the quarter, the Americas increased 68.3% or up 1.9% versus 2019.
We continue to see variability by country within the region with the U.S. growing 66.2% or 3.3% versus 2019.
EMEA grew 80.5% or down 7.3% versus 2019 with continued COVID pressure being a factor.
We did see improvement in EMEA as we moved through the quarter, and we expect that trend to continue through the back half of this year.
Lastly, Asia Pacific grew 24.4% or 2.8% versus 2019 in spite of some unexpected headwinds.
While the region has been largely stable in recent quarters, it was impacted late in the second quarter by channel inventory contraction in our knee and hip categories within China, and advance of the rollout of volume-based procurement or VBP.
In addition, we saw a resurgence and increase of COVID19 in a number of markets, including Japan.
Despite these headwinds, the region continued to pose growth.
Turning to our business categories.
The global knee business increased 72.2% or down 6.3% versus 2019.
In the U.S., knees increased 77% or was flat versus 2019.
While we are seeing sequential improvement in the recovery of procedural volumes in large joints, the path back to normalized market growth is taking a bit longer than most expected.
Still, we continue to be encouraged by the team's execution and ongoing strong momentum for Persona and ROSA Knee.
Our global hip business increased 39.9% or down 2.8% versus 2019.
In the U.S., hip grew 46.6% or up 3.1% versus 2019.
Strong demand and favorable feedback continues for the Avenir Complete hip, which continued adoption for both gold and platinum accounts.
The sports, extremities and trauma category increased 53% or up 10.8% versus 2019 driven by solid growth in sports medicine, CMFT and upper extremities.
We continue to see strong surgeon registrations of the Signature ONE surgical planning system for shoulder procedures.
Our dental and spine category grew 69.4% or up 0.8% versus '19, fueled by recovery in dental.
New products and better commercial execution drove growth in the quarter with strong contributions from implants and digital solutions in our dental business.
Finally, our other category grew 105.9% or up 7.5% versus '19.
This reflects the ongoing demand for ROSA Robotics and strong capital purchases in the quarter.
We saw improvements both sequentially versus Q2 2020 in units sold as well as increased revenues from software due to the launch of our Partial Knee application.
Moving on to the P&L.
For the quarter, we reported GAAP diluted earnings per share of $0.67.
Our reported GAAP diluted earnings per share were up significantly when compared to a reported GAAP diluted loss per share of $1 in the second quarter of 2020.
The increase in year-over-year GAAP earnings was driven by higher revenue, offset by normalized spending levels and IPRD investments within the quarter.
In addition, the second quarter of 2020 had some onetime GAAP charges that did not repeat.
On an adjusted basis, diluted earnings per share of $1.90 was significantly higher than the prior year, driven as expected by the recovery of elective procedures since the pandemic drop in the second quarter of 2020.
Adjusted gross margin was 71.7% and in line with expectations.
Our adjusted operating expenses of $923 million stepped up sequentially versus the first quarter due to higher variable selling expenses related to higher sales and increased discretionary spending to support investments in commercial infrastructure and innovation through R&D.
Improved revenue performance and stable gross margins more than offset higher spending to drive 26.2% operating margins, a slight improvement over the first quarter of this year.
The adjusted tax rate of 16.5% in the quarter was in line with our expectations.
Turning to cash and liquidity.
For the quarter, operating cash flows were $453.9 million, and free cash flow was robust at $358.7 million, and we ended the second quarter with cash and cash equivalents of just over $1 billion.
We continue to make good progress on deleveraging the balance sheet and expect to make another $300 million in debt repayments in the third quarter.
Moving to our financial guidance.
We are tightening our guidance range to better reflect our year-to-date performance and a more informed view of the potential impact of COVID.
There are some key assumptions that underpin our 2021 financial guidance.
We assume no worsening of elective procedure trends due to COVID and that procedure volume recovery continues in the second half of the year.
But recovery may not be linear by region and/or by product category.
e also expect to see seasonality impact in the third and fourth quarter as we have observed in prior years.
With the narrowing of our guidance range, we are now expecting reported revenue growth to be 14.5% to 16.5% versus 2020, with the impact of foreign currency unchanged at about 150 basis points of a tailwind for the full year.
On a constant currency basis, compared to 2019, we expect Q3 to grow sequentially over Q2 and for that improvement to continue in the fourth quarter.
Turning to the P&L.
Our adjusted diluted earnings per share is now in the range of $7.65 to $7.95, and we have narrowed our adjusted operating margin projection to be 26.5% to 27% for the full year.
Our updated earnings per share guidance reflects our performance to date, our expectation of improved growth in the second half and that discretionary operating expenses remained consistent with Q2 through the balance of the year.
While operating margins are expected to decline sequentially in the third quarter, in line with lower sales revenue and steady investment levels versus the second quarter, we expect overall second half operating margins to be stronger than first half operating margins.
Our adjusted tax rate projection is unchanged at 16% to 16.5% for the full year.
And finally, our free cash flow estimates remain in the range of $900 million to $1.1 billion.
We will continue to update you on market dynamics and financial expectations as we move through the remainder of the year.
To summarize, our performance in Q2 was slightly better than our expectations that we have communicated to you through the second quarter.
While we anticipate some ongoing COVID pressure, we have more confidence in the momentum of the recovery and our ability to execute against that backdrop.
And I'm going to now just hit three topics before we move to Q&A.
First, I want to talk about execution in some of the product and pipeline highlights that we have under that category; second, I'm going to talk about our progress against active portfolio management, which is a big effort for us, obviously; and then third is innovation.
And inside of that innovation, how we believe we're going to be able to drive attractive long-term growth that ultimately will deliver value to you, our shareholders.
So let's start with our team's execution.
And I've said this before, and I'll continue to say it, that the things that ZB was able to directly control over the past year, 1.5 years, the team -- they've executed against it, they delivered against it.
And I'm very proud of the team for doing that during a time of significant turbulence around them.
And in Q2, in the recent weeks, we've hit key milestones with our ZB products and our solutions.
ROSA for Partial Knee was approved back in April, as we've talked about before.
And our first patient surgery was actually performed early in the quarter, and we've continued to see good traction with that technology so far and great feedback so far.
And it's important for us because partial knees, I think most of you know, is a market where ZB has a sizable market share position.
So we're very excited about the possibilities here, not just from a revenue standpoint, but also the potential impact for patients in the surgery area.
And then if I just look at ROSA overall, we did see another strong quarter in Q2 of market demand and traction with ROSA total knee as well with placement momentum broadly continuing across the world, not just in the U.S. but internationally as well.
We want to see strength in the U.S., but we want to see that OUS, and we did get to see that kind of mix again in Q2.
We also saw capital expenses for our customers being much stronger in Q2 and -- And as a result of that, we saw a shift back to upfront sales of ROSA.
So more of those happened in Q2 than what we would typically see.
And again, that just speaks to the strength of capital budgets and people's desire to acquire in that way.
But what is clear is that there's a real focus for hospitals to be bringing in robotic systems for their ORs whether they buy them outright or they get them through other arrangements.
Either way, that momentum, that demand is very real.
And ROSA continues to be a cornerstone, one of the key ones, of our ZBEdge suite of connected solutions.
So again, a lot of enthusiasm on what that will mean in coming years in terms of expansion of indications, and overall robotics penetration for ZB.
Also in the quarter, we saw Revision continue its very strong momentum.
Again, this is a great tip of the spear product for us, where we can go in and get competitive conversions and revision but also use those competitive conversions for access to the typical total knee as well for that surgeon.
So very exciting, not just on the revision side but also opening the door to a much larger opportunity to get their typical knee conversion as well.
We're also excited about adding another key variable to our ZBEdge portfolio of connected technologies, and that is our Persona iQ, which will be the first and only smart implant on the market.
And we certainly still have to get FDA approval on that.
We're working diligently with them to help with any information they need to move that forward, and we're certainly hoping to receive approval in the relatively short term.
But ultimately, again, that time line is up to the FDA.
And it's important for us because it takes the Persona implant, which is that known and trusted design in an implant and it combines it with Canary Medical's tibial extension, which has the sensor technology in it.
And the combination of those two things will now inside the body, give us an opportunity to measure the range of motion of that patient, step count, walking speed and other mobility metrics that we believe are going to be indicators of post-surgery progress.
So again, helping us close the loop in those connected technologies that we have in ZBEdge.
So more to come when we hear back from the FDA.
But once we do get that approval, we would look to limited launch the technology for a quarter or two and then post that time frame, move into full launch.
So let's move to my second topic that is on active portfolio management, and our efforts around active portfolio management.
We have the ZB portfolio management strategy in place.
We have the right process in place, and we have definitely built our capabilities to move this forward over the last 1.5 years to two years.
So we're excited about this phase of the organization.
And we're focused, as we said before, on mission-centric M&A that is WAMGR-accretive.
So in other words, weighted average market growth accretive to the organization.
And you've seen us move this forward already with the selective tuck-in acquisitions that we did late last year that really illustrate our strategy at work.
These are smaller deals, again, tuck-in size deals that were designed to fill portfolio gaps and better position us as an organization in high-growth, high-priority markets like sports medicine, ASC and sternal closure where we truly do believe we have a right to win in attractive markets with strong profitability.
And of course, there's the planned spin-off transaction of our spine and dental businesses that is fully underway and on track.
We continue to be encouraged by the energy and the momentum around NewCo.
As CEO Vafa Jamali, builds out his team and refines his corporate strategy, and we believe creates two independent and even stronger companies that is going to maximize value for not just our customers, but also for you, our shareholders.
And that brings me to the last topic that we have before we move to the Q&A, and that's going to be around innovation.
And really inside of innovation, how we see our ability to drive attractive long-term growth that will ultimately deliver value to all of our stakeholders, including you, obviously, our shareholders.
We are focused on evolving ZB from what I would define as a metal and plastic provider of implants into a leading med tech innovator.
And we have a lot of shots on goal across a number of programs to do this, including a number of robotics launches over the near term, smart implants that we have today, but also the technology road map that we have in smart implants.
New functionality with mymobility and really just the broader ZBEdge ecosystem of those connected technologies that are going to help us drive mix benefit and share of wallet benefit, but also competitive conversions.
And I've mentioned before, more than 70% of our new product development investment is directed toward ZBEdge and those connected technologies inside of ZBEdge.
And our exclusive partnership with Apple continues to be productive and collaborative.
And we forged several other tech alliances that we know are going to drive future innovation that will benefit patients.
And I believe this fundamental shift is coming for ZB and for our core markets with technology advancements, potentially changing the care paradigm for patients in the future, and that's really what our focus is.
So the momentum is real on the innovation front.
And we think it will ultimately allow us to drive long-term growth that is very attractive to us and to you.
And most importantly, it also gives ZB the chance to really change the lives of patients around the world.
And let me close by saying that I continue to be highly confident in the ZB team and our business momentum.
While there continues to be uncertainty due to the global pandemic that we cannot control, I truly believe that we are ready and well positioned for success.
And our strategy is absolutely working.
The transformation of our business is well underway, and I'm excited about the value we can drive for our shareholders on a go-forward basis.
Your dedication to safety is critical and your focus on delivering on our mission is unmatched and you do it daily.
I remain incredibly proud of what we're accomplishing and what we're accomplishing together.
With that, operator, may we have the first question, please?

user
q2 adjusted earnings per share $1.90.
q2 earnings per share $0.67.
q2 sales $2.027 billion versus refinitiv ibes estimate of $1.98 billion.
updates 2021 financial guidance, narrowing range for full year outlook.
sees 2021 reported revenue growth of 14.5% - 16.5%.
sees 2021 adjusted earnings per share of $7.65 - $7.95.

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