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Text: For today's call, I'll provide opening comments followed by Preston, with an update on the current environment and our most recent acquisitions.
Glenn will then provide additional details regarding our quarterly results before opening the call to Q&A.
I would like to start my comments by expressing my appreciation for the perseverance shown by our employees as they work through the many challenges that we've faced during 2020.
Throughout the year, we maintained high employee engagement while continuing to support surgeons and caregivers around the world.
Our fourth quarter organic sales declined to roughly 1%, reflecting the impact of a resurgence of COVID-19 infections offset by a continuation of emergent procedures and strong performance by our large capital products.
We are also excited about closing the Wright Medical deal during the quarter and the category leadership technique that we gain in the fastest-growing segment within the orthopaedics market.
Preston will provide some additional updates on the integration shortly.
Throughout the quarter, we maintained the financial discipline instituted at the beginning of a pandemic which combined with a favorable tax rate, led to an adjusted earnings per share of $2.81 in the quarter, up approximately 13% versus 2019.
And we delivered impressive cash flow from operations which exceeded $3 billion for the full year.
In addition to closing the Wright Medical acquisition, we also made progress in many areas that will provide future growth opportunities.
We have established a structure focused on digital, robotics, and enabling technology where we see a significant opportunity to create a companywide unified digital ecosystem, including Mako.
We maintained our commitment to drive innovation across our various business units, including neurovascular where we gained new product approvals across aspiration, stent retrievers, and flow-diverting stents, and in our MedSurg segment, where we continued product introductions with a focus on safety and prevention.
Finally, we successfully launched our ASC sales model, which leverages the Stryker portfolio to provide end-to-end solutions to meet the growing demand and shifts to the outpatient setting.
Our continued support for our customers and our commitment to innovation will position us well for growth as the pandemic eventually subsides.
Turning to 2021, our people and culture of execution remain strong which will allow us to deliver on our commitment to make healthcare better and to resume our customary strong organic sales growth and leverage earnings.
My comments today will provide an update on the current environment, trends related to the latest COVID-19 impacts, and updates on our most recent acquisitions of Wright Medical and OrthoSensor.
During the fourth quarter, elective procedures were negatively pressured in those regions globally as localized infection and hospitalization rates surged through the month of December.
As a result, growth was uneven and correlated for the state of the pandemic in each region.
The areas impacted the most include the U.S. and many of the countries in Western Europe, most notably, the United Kingdom, driven by a countrywide lockdown.
Even with the procedural variability, we saw growth in emerging markets, including China which grew double-digit over prior-year quarter.
Looking forward, hospitals are better equipped to handle this resurgence and they are working to bring back the procedures, but have been delayed.
But we expect that the variability of elective procedures will continue during the first quarter until infection rates begin to decline and the distribution of the vaccines become more prevalent.
This slowdown in elective procedures had a negative impact on our more deferrable businesses, which make up approximately 40% to 50% of our total sales.
However, the slowdown this quarter was not as impactful as the decline in the second quarter as hospitals were better equipped to manage COVID patients while maintaining some level of elective surgeries.
In addition, the early trends on the launch of our new ProCuity bed are positive and expected to continue into 2021.
During the year, our Mako install base grew by 33% and exceeded another milestone with over 100 robots sold and installed in the fourth quarter.
This growth continues to highlight the demand for our differentiated Mako robotic technology, as well as our ongoing success selling and installing robots in major teaching institutions, ASCs, and competitive accounts.
We are also excited about our recent approvals for Mako TKA in China, Russia, and Brazil which all provide opportunities for growth as these markets continue to embrace robotic, digital and enabling technologies.
Turning to U.S. knee procedures.
In the fourth quarter, approximately 44% of our total knees will make their knee procedures, a trend that continues to increase.
The shift toward cementless knees also continued and in the fourth quarter, cementless knees made up 42% of our U.S. knee procedures.
During the pandemic, feedback from surgeons has pointed to limited trialing of competitive products in businesses like joint replacement as surgeons worked to performing procedures restricted by cancellations and deferrals.
However, as the pandemic subsides and we return to a more normal environment, we expect to continue to outpace the market driven by our Mako installations throughout the year and our strong order book heading into 2021.
We are also enthusiastic about the Wright Medical acquisition and the category leadership we gain in both upper extremities and foot and ankle through Wright's diverse portfolio of implants, biologics, and enabling technology.
The combination of Stryker and Wright will continue to drive innovation that enhances our customers' ability to address patient needs across to more than $3 billion extremities market.
The integration has been progressing well over the last few months.
The long period from sign to close was used to ensure that the appropriate integration plans were in place, leveraging our years of deal experience.
To date, the teams have been focused on moving quickly to align the new combined organization.
Considerable progress has been made, including the creation of specialized business units and sales forces for trauma, upper extremities, and foot and ankle, which is a key part of our overall decentralized strategy that allows us to remain close to the customer.
The U.S. sales leadership organizational structure for these three specialized business units has been announced and the rollout and full alignment of territories will be finalized during the first quarter as planned.
Outside the U.S., the leadership team is working to align the sales forces throughout the year.
Our teams are executing the sales integration while continuing to drive day-to-day business, and during the quarter, there was minimal disruption caused by the closing in integration activities.
Finally, I want to restate our ongoing commitment to M&A, which was most recently demonstrated by our acquisition of OrthoSensor, a leader in the digital evolution of musculoskeletal care and sensor technology for joint replacement.
Smart devices and implants will play an important role in the future of orthopaedics and the addition of OrthoSensor will allow us to continue to innovate and advance smart sensor technology, including intraoperative sensors, wearables, and ultimately, smart implant.
As a release to 2021 guidance, Glenn will provide an update on our full-year guidance for sale, operating margin, and EPS.
Updates to this annual guidance will be made each quarter as necessary throughout the year.
Today, I will focus my comments on our fourth quarter financial results and the related drivers.
Our organic sales decline was 1.1% in the quarter.
As a reminder, this quarter included the same number of selling days as Q4 2019.
Pricing in the quarter was unfavorable 0.8% from the prior year, while foreign currency had a favorable 1.2% impact on sales.
Early in the quarter, there was continued momentum from Q3.
However, during November, the impact of the resurgence of COVID-19 and the related cancellations of procedures, primarily in the U.S. and Europe, significantly impacted our sales momentum.
However, we did see demand for certain capital products continue as we have strong results in our Mako, medical beds, and emergency care products.
For the quarter, U.S. organic sales declined 1.5%, reflecting the slowdown in elective procedures as a result of the pandemic, somewhat offset by strong demand for Mako, medical products, and neurovascular products.
International organic sales were flat, impacted by the resurgence of the COVID-19 pandemic, primarily in Europe, which was mostly offset by growth in Canada, China, and Brazil.
Organic sales decline for the year was 4.8%, with a U.S. decline of 5.8%, and an international decline of 2.1%.
2020 had one additional selling day compared to 2019 and for the year, price had an unfavorable 0.7% impact on sales.
Our adjusted quarterly earnings per share of $2.81 increased 12.9% from the prior year, reflecting strong financial discipline, good operating expense control, and a favorable operational tax rate.
Our fourth quarter earnings per share was positively impacted by $0.03 from foreign currency.
Our full-year earnings per share was $7.43, which is a decline of 10%, reflecting the impact of lower sales, especially in Q2, as well as the impact of idling certain manufacturing facilities during the year, offset by strong expense discipline throughout the year.
Now, I will provide some highlights around our segment performance.
Orthopaedics had constant currency sales growth of 2.8% and an organic sales decline of 5.8%, including an organic decline of 5.7% in the U.S.
This reflects a slowdown in elective procedures related to COVID-19 and a very strong prior-year comparable as Q4 2019 U.S. organic growth was 7.2%.
Other ortho grew 12.3% in the U.S., primarily reflecting strong demand for our Mako robotic platform, partially offset by declines in bone cement.
The Trauma and Extremities business also delivered positive growth led by our core trauma and shoulder products.
Internationally, orthopaedics declined 6% organically, which also reflects the COVID-19 related to procedural slowdown, especially in Europe.
This was somewhat offset by stronger performances in Australia and Canada.
During the quarter, the Wright Medical acquisition was successfully closed.
For the quarter, Wright delivered flat growth on a comparable basis.
This included a positive performances other than U.S. shoulder, double-digit growth in U.S. ankle, as well as strong international growth led by Australia.
On a comparable basis for the full year, Wright had a 10.3% decline, mainly driven by the COVID-19 related slowdown in the second quarter.
In the quarter, MedSurg had constant currency growth of 1.5% and organic growth of 1.3%, which included 2.2% growth in the U.S. Instruments had U.S. organic sales growth of 4.5%.
In the quarter, sales growth was driven by gains in its power tool, waste management, and smoke evacuation products and its service business.
Endoscopy had a U.S. organic sales decline of 7% primarily impacted by the slowdown in the capital businesses offset by gains in the sports medicine business, which grew over 9% in the quarter.
The medical division had U.S. organic growth of 9.7% reflecting solid performances in patient care, emergency care, and its Sage businesses.
Internationally, MedSurg had an organic sales decline of 2.4%, reflecting a general slowdown in instruments and endoscopy businesses and strong comparables across most geographies.
Neurotechnology and Spine had constant currency and organic growth of 2.1%.
This growth reflects many strong performances within our neurotech product line including neuro-powered drills, SONOPET, and Neurovascular offset by the impact of procedural deferrals, especially in the U.S.
Our U.S. neurotech business posted an organic decline of 1.2% as procedural deferrals impacted sales in the quarter.
Internationally, Neurotechnology and Spine had organic growth of 13.5%.
This performance was driven by strong demand in Australia, Japan, and China.
Now, I will focus on operating highlights in the fourth quarter.
Our adjusted gross margin of 65.1% was unfavorable approximately 120 basis points from the prior-year quarter.
Compared to the prior-year quarter, gross margin dilution was impacted by price, business mix, and unabsorbed fixed cost, as production was brought in line with reduced demand during the quarter.
This was primarily offset by acquisitions and foreign exchange.
Adjusted R&D spending was 5.5% of sales.
Our adjusted SG&A was 30.3% of sales, which was favorable to the prior-year quarter by 200 basis points.
This reflects the continued focus on disciplined operating expense controls, which have been in place since the second quarter.
These cover most of our discretionary spending including curtailments in hiring, travel, meetings, and consultants.
In summary for the quarter, our adjusted operating margin was 29.2% of sales, which is a 90 basis points improvement over the prior-year quarter and reflects the impact of the spending discipline previously discussed.
Related to other income and expense as compared to the prior-year quarter, we saw a decline in investment income earned on deposits and interest expense increases, related to increases in our debt outstanding, related to the funding of the Wright Medical acquisition.
Our fourth quarter had an adjusted effective tax rate of 8%.
Our full-year effective tax rate was 12.6%.
These rates reflect one-time operational fluctuations that arose due to the pandemic with a mix of foreign losses related to lower foreign manufacturing activity, combined with reduced U.S.-sourced income that resulted from the sharp drop in sales at the end of the year.
For 2021, we do not anticipate these circumstances arising as we expect to return to normalized operations during the year.
And we expect our full-year effective tax rate to be in the range of 15.5% to 16.5%.
Focusing on the balance sheet, we ended the year with $3 billion of cash and marketable securities, and total debt of $14 billion.
During the quarter, we executed the Wright Medical acquisition, which resulted in the disbursement of $5.6 billion, inclusive of the retirement of Wright's convertible debt.
Turning to cash flow, our year-to-date cash from operations was approximately $3.3 billion.
This historically strong performance resulted from the disciplined working capital management, somewhat offset by lower earnings.
Turning to cash flow for 2021.
We will not be repurchasing any shares and we anticipate that capital expenditures will be approximately $650 million.
Anticipating a more normalized year in 2021 and a ramping of investment in our businesses, we expect the free cash flow conversion rate as a percent of adjusted net earnings, including the one -- excluding the one-time impacts from the Wright Medical integration, about 70% to 80%.
And now, I will provide 2021 guidance on a stand-alone legacy basis and further guidance including Wright Medical.
We are providing our guidance in comparison to 2019 as it is a more normal baseline given the variability throughout 2020.
As Preston indicated, we will be providing annual guidance on our organic sales growth and earnings and we'll update this throughout the year as part of our regular earnings calls.
As we assess the current operating environment, we believe that the recovery ramp of elective procedures will continue to be variable based on region and geography, and will continue into the second quarter of 2021.
Given this variability, we expect organic sales growth to be in the range of 8% to 10% for the full year 2021 when compared to 2019.
As a reference, our organic sales growth excludes Wright Medical, there are the same number of selling days in 2021 compared to 2019 and one less when comparing to 2020.
Consistent with the pricing environment experienced in both 2019 and 2020, we would expect continued unfavorable price reductions of approximately 1%.
Additionally, as we are comparing growth to 2019, our 2021 organic sales growth guidance includes two years of price reductions.
The foreign exchange rates hold near current levels, we anticipate sales and earnings per share will be modestly favorably impacted as compared to 2020 and 2019.
For the full year 2021, we do not expect to deliver operating margin expansion as a result of the op margin dilution of the Wright Medical acquisition.
However, excluding the dilutive impact from Wright, we do anticipate expansion of 30 to 50 basis points of operating margin in 2021 for our legacy Stryker business compared to 2019.
This includes anticipated increases in hiring, discretionary expenses, and other costs that support future growth and business expansion as our businesses continue to ramp back to more normalized levels.
Finally, for 2021, we expect adjusted net earnings per diluted share to be in the range of $8.80 to $9.20 for the full year.
This includes the previously announced $0.10 dilution, driven by the addition of the Wright Medical business for the full year.
While Wright Medical is dilutive in 2021, we expect it to be accretive starting in 2022.
As it relates to other aspects of Wright Medical, we expect comparable growth for Trauma and Extremities, to be in the low to mid-single digits in 2021 when compared to 2019.
This includes the integration of Stryker's legacy extremity business with Wright Medical, which will all be part of our Trauma and Extremities division.
This growth is impacted by the recovery from COVID-19, partially offset by the synergies from the integration activities in 2021.
We also reiterate our previous guidance on cost-saving synergies from the deal of approximately $100 million to $125 million over the next three years.
And now, I will open up the call for Q&A.

user
q4 adjusted earnings per share $2.81.
quarterly organic net sales decreased 1.1%.
compname says expect 2021 organic net sales growth to be in range of 8% to 10% from 2019.
sees q1 2021 adjusted earnings per share $8.80 to $9.20.
sees 2021 adjusted earnings per share $8.80 to $9.20.

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