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Text: For today's call, I will provide opening comments followed by Preston with an update on the Wright Medical Integration.
Glenn will then provide additional details regarding our quarterly results, before opening the call to Q&A.
Despite the ongoing presence of the pandemic, we posted a strong quarter of organic sales growth of 4.7% versus Q1 2019.
This was driven by outstanding international results, particularly in Asia Pacific and the benefits of our diversified business model.
Across our franchises, Mako, Neurotech and Medical had excellent performances, each posting strong double-digit growth versus 2019, a trend that we expect to continue for the remainder of the year in these businesses.
Mako followed up a very strong Q4 with a banner Q1 performance, including an uptake in international installations.
As expected, elective procedures were negatively impacted to start the year which had the largest impact on our hip and knee businesses.
However, the trends improved progressively throughout the quarter, with US hip and knee accelerating in March and into April, where we are seeing mid single-digit growth as compared to April 2019.
We also saw improved growth in small capital within parts of Neurotech and instruments during the quarter.
In addition, our order book has picked up across our capital businesses, which is a good sign of pending growth as procedure volumes return to more normal levels.
These trends give us confidence in achieving our guidance of 8% to 10% full year organic sales growth compared to 2019, which is equivalent to 12% to 14% organic versus 2020, despite one less selling day.
Our momentum has continued regarding cost management and cash flow.
And while spending will increase to support future growth, it will be done in a disciplined manner.
Glenn will elaborate on our raised earnings per share guidance shortly.
We also published our first annual comprehensive report during the quarter, which captures our environmental, social and governance strategy as well as commitments regarding our carbon footprint, diversity and equity inclusion and supply chain transparency.
We are encouraged by the progress we are making in these areas.
Overall, I am pleased with the strong start to the year and the momentum that is continuing to build.
And while pandemic flash points are still occurring, we are well positioned to deliver growth at the high end of med tech, with leveraged adjusted earnings.
My comments today will focus on first quarter performance in our combined trauma and extremities business, an update on the ongoing integration of Wright Medical and on our most recent acquisition activity.
During the quarter, our combined trauma and extremities business showed good resiliency, growing 2.6%, including Wright Medical compared to 2019 despite the ongoing impacts of COVID restrictions during the quarter.
Our trauma business, which is less selective in nature, benefited from inclement weather in the US and Europe in February.
Performance in upper extremities and foot and ankle was driven by the recovery of elective procedures throughout the quarter, along with lower-than-expected sales dis-synergies through the initial stages of the integration.
As a result of the strong performance of our trauma and extremities business in the first quarter, we now expect the combined business to deliver mid single-digit growth for the full year when compared to 2019.
We remain encouraged with the progress and pace that the team has delivered with bringing the businesses together throughout the Wright Medical Integration.
As we have mentioned previously, we utilized the lengthy period from announce to close to build and resource the robust integration plan that we are now executing.
As we move through the quarter, our teams made progress against many key integration milestones.
To-date, the team has established three distinct business units with specialized commercial, R&D and selling organizations.
We believe this dedication and focus will be a core driver of future growth across trauma, upper extremities and foot and ankle.
In addition to establishing dedicated business units, the team made considerable progress with our US sales integration, including the establishment of sales leadership, sales channel and territory alignment and identification of cross-selling priorities.
Considerable progress has also been made on aligning the long-term portfolio and pipeline strategies.
Our focus on the integration will remain a key priority for the remainder of 2021 as we balance the complexity of the integration, while minimizing sales disruption.
Over the next few quarters, we will conclude the US commercial integration, including the initiation of cross-selling, and we will kick off sales integrations across our international markets over the next several months.
Finally, our dedicated business development teams continue to identify and execute on tuck-in acquisitions.
During the quarter, we completed the acquisition of TMJ Concepts, a medical device company that manufactures a patient-specific temporomandibular joint reconstruction prosthesis system.
In our craniomaxillofacial business, personalized medicine plays a critical role and the acquisition of TMJ Concepts supports their business strategy of driving category leadership through innovation and purpose of restoring form, function and hope to patients.
These acquisitions continue to demonstrate our focus on our strategy of driving category leadership and market-leading growth.
As a reminder, we are providing our comments in comparison to 2019 as it is more normal baseline given the variability throughout 2020.
Our organic sales growth was 4.7% in the quarter.
As a reminder, this quarter included the same number of selling days as Q1 2019 and one less day than 2020.
Compared to 2019, pricing in the quarter was unfavorable 1.4%.
Versus Q1 2020, pricing was 0.9%, unfavorable.
Foreign currency had a favorable 1.3% impact on sales.
During the quarter, the continued impact of the COVID-19 pandemic and related surgical procedure cancellations, primarily in the US and Europe, negatively impacted our sales.
However, toward the end of the quarter, we did see improvements in sales momentum, primarily in the US and our Asia-Pacific businesses.
Also, as noted in the fourth quarter, demand for certain capital products continued as we saw strong results in our Mako and emergency care products.
For the quarter, US organic sales increased by 1%, reflecting the continuing 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 showed strong growth of 15% and impacted by positive sales momentum in China, Japan, Australia, and Canada.
Our adjusted quarterly earnings per share of $1.93 increased 2.7% from 2019, reflecting sales growth partially offset by higher interest charges resulting from the Wright acquisition as well as an overall disciplined ramp-up in operating costs.
Our first quarter earnings per share was positively impacted from foreign currency by $0.03.
Now, I will provide some highlights around our segment performance.
Orthopaedics had constant currency sales growth of 17.2%, an organic sales decline of 0.7%, including an organic decline of 1.7% in the US.
This reflects a slowdown in elective procedures related to COVID-19.
Other Ortho grew 49% in the US, primarily reflecting strong demand for our Mako robotic platform, partially offset by declines in bone cement.
As noted previously, in March, we began to see good sales momentum in our US orthopedic businesses, with all segments delivering positive organic growth as compared to March 2019.
Internationally, Orthopaedics grew 1.5% organically, which reflects the COVID-19 related procedural slowdown in hips and knees, especially in Europe, offset by strong performances in Australia and Japan.
For the quarter, our trauma and extremities business, which includes Wright Medical, delivered 2.6% growth on a comparable basis.
This includes strong performances in US shoulder and US trauma.
In the US, comparable growth was 4.4%.
In the quarter, MedSurg had constant currency and organic sales growth of 5.3%, which included 1.6% growth in the US.
Instruments had a US organic sales decline of 3%, primarily impacted by continued procedural slowdown that impacted its power tool business, partially offset by gains in its waste management, smoke evacuation products, and services business.
As a reminder, during the first quarter of 2019, Instruments had a very strong growth of approximately 18%.
Endoscopy had a US organic sales decline of 5.7%, reflecting a slowdown in some of the capital businesses, which was partially offset by gains in our General Surgery, Video & Sports Medicine businesses, the latter of which grew over 11% in the quarter.
The medical division had US organic sales growth of 13.6%, reflecting double-digit performance in its emergency care and Sage businesses.
Internationally, MedSurg had an organic sales growth of 19.9%, reflecting strong growth across Europe, Canada, Australia and Japan in Medical, Endoscopy and Instruments.
Neurotechnology and spine had constant currency and organic growth of 12.8%.
This growth reflects double-digit performances in our Interventional spine, neurosurgical and ENT businesses and 27% growth in our neurovascular business.
Our US Neurotech business posted an organic growth of 12%, reflecting strong product growth in our neuro powered drills, SonoPet IQ, bipolar forceps, Bio reabsorbs and nasal implants.
Additionally, within our US neurovascular business, we had significant growth in all product categories, including hemorrhagic, flow diversion and ischemic.
Internationally, Neurotechnology and spine had organic growth of 31.7%.
This performance was driven by strong demand in China and other emerging markets.
Now, I will focus on operating highlights for the first quarter.
Our adjusted gross margin of 65.4% was unfavorable approximately 40 basis points from our first quarter 2019.
Compared to the first quarter in 2019, gross margin was primarily impacted by price, acquisitions and business mix.
Adjusted R&D spending was 6.8% of sales, reflecting our continued focus on innovation.
Our adjusted SG&A was 35.2% of sales, which was unfavorable to the first quarter of 2019 by 70 basis points.
In summary, for the quarter, our adjusted operating margin was 23.5% of sales, which is 160 basis points decline over the first quarter of 2019.
This reflects the dilutive impact of the Wright Medical acquisition, combined with the disciplined ramp-up in cost to fuel future growth, as well as the two-year compounding of certain costs given the comparison to 2019.
We also reiterate our operating margin expansion guidance of 30 to 50 basis points improvement over 2019 operating margin, excluding the impact of Wright Medical.
Related to other income and expense as compared to the first quarter in 2019, we saw a decline in investment income earned on deposits and interest expense increases related to increases in our debt outstanding for the funding of the Wright Medical acquisition.
Our first quarter had an adjusted effective tax rate of 13%, given our mix of income.
Given our current circumstances and the outlook for the full year, we would expect to be at the lower end of our range for the full year guided effective tax rate of 15.5% to 16.5%.
Focusing on the balance sheet, we ended the first quarter with $2.3 billion of cash and marketable securities and total debt of $13.1 billion.
During the quarter, we repaid $750 million of maturing debt.
Turning to cash flow.
Our year-to-date cash from operations was approximately $450 million.
This performance reflects the results of earnings, continued good management of working capital and approximately $170 million of one number expenditures related to the Wright Medical Integration.
Based on our first quarter performance and the current operating environment, we continue to expect 2021 organic net sales growth to be in the range of 8% to 10%.
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.
As it relates to the sales expectations for Wright Medical, we now expect comparable growth for trauma and extremities to be in the mid-single digits for the full year when compared to the combined results for 2019.
If foreign currency exchange rates hold near current levels, we expect net sales in the full year will be positively impacted by approximately 1%.
Net earnings per diluted share will be positively impacted by $0.05 to $0.10 in the full year, and this is included in our revised guidance range.
Based on our first quarter performance and including consideration of our improved full year Wright Medical sales impact, disciplined cost management, and continued positive recovery outlook, we now expect adjusted net earnings per diluted share to be in the range of $9.05 to $9.30.
And now I will open up the call for Q&A.

user
q1 adjusted earnings per share $1.93.
qtrly organic net sales increased 1.8% from 2020 and 4.7% from 2019.
continue to expect 2021 organic net sales growth to be in range of 8% to 10% from 2019.
sees 2021 adjusted net earnings per diluted share to be in the range of $9.05 to $9.30.
expect continued unfavorable price reductions of approximately 1% in 2021.

assistant