Zimmer Biomet Holdings Inc (ZBH) 2021 Q4 法說會逐字稿

Good morning, ladies and gentlemen, and welcome to the Zimmer Biomet Fourth Quarter 2021 Earnings Conference Call. (Operator Instructions) As a reminder, this conference is being recorded today, February 7, 2022. (Operator Instructions)

女士們，先生們，早上好，歡迎參加 Zimmer Biomet 2021 年第四季度收益電話會議。 （操作員說明）提醒一下，本次會議將於 2022 年 2 月 7 日今天錄製。（操作員說明）

I would now like to turn the conference over to Keri Mattox, Senior Vice President, Investor Relations and Chief Communications Officer. Please go ahead.

我現在想將會議轉交給投資者關係高級副總裁兼首席通訊官 Keri Mattox。請繼續。

Thank you, operator, and good morning, everyone. I hope you are all well and safe. Welcome to Zimmer Biomet's Fourth Quarter 2021 Earnings Conference Call. Joining me today are Bryan Hanson, our Chairman, President and CEO; and EVP and CFO, Suky Upadhyay.

謝謝接線員，大家早上好。我希望你們一切安好。歡迎參加 Zimmer Biomet 的 2021 年第四季度收益電話會議。今天加入我的是我們的董事長、總裁兼首席執行官 Bryan Hanson；執行副總裁兼首席財務官 Suky Upadhyay。

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. Please note, we assume no obligation to update these forward-looking statements even if actual results or future expectations change materially. Please refer to our SEC filings for a detailed discussion of these risks and uncertainties in addition to the inherent limitations of such forward-looking statements.

在我們開始之前，我想提醒您，我們在本次電話會議期間的評論將包括前瞻性陳述。由於各種風險和不確定性，實際結果可能與前瞻性陳述所表明的結果存在重大差異。請注意，即使實際結果或未來預期發生重大變化，我們也不承擔更新這些前瞻性陳述的義務。除此類前瞻性陳述的固有限制外，請參閱我們向美國證券交易委員會提交的文件，詳細討論這些風險和不確定性。

Additionally, the discussions on this call will include certain non-GAAP financial measures. Reconciliation of these measures to the most directly comparable GAAP financial measures is included within our Q4 earnings release, which can be found on our website, zimmerbiomet.com.

此外，本次電話會議的討論將包括某些非公認會計原則的財務措施。這些措施與最直接可比的 GAAP 財務措施的對賬包含在我們的第四季度收益發布中，可以在我們的網站 zimmerbiomet.com 上找到。

With that, I'll now turn the call over to Bryan. Bryan?

有了這個，我現在將把電話轉給布萊恩。布萊恩?

All right. Great. Thanks, Keri, and thanks, everyone, for joining us this morning. I'm going to just give you an outline of how we want the call to proceed this morning.

好的。偉大的。謝謝Keri，也謝謝大家今天早上加入我們。我將簡要介紹一下我們希望如何在今天早上進行電話會議。

I'm going to spend the first part of the discussion briefly talking about our fourth quarter results. And I'm also going to spend a little bit of time talking about what we're seeing so far in 2022. I know it's early, but I want to give you a sense of what we're seeing already and then just speak more broadly about our views of 2022 as a whole.

我將在討論的第一部分簡要討論我們的第四季度業績。我還將花一點時間談論我們在 2022 年到目前為止所看到的情況。我知道現在還為時過早，但我想讓你了解我們已經看到的情況，然後再說更多大致了解我們對 2022 年的整體看法。

And then I'm going to turn it over to Suky, who's going to provide more detail on fourth quarter and,, obviously, more detail on our guidance going forward. And then finally, it will come back to me before we move to Q&A. I just got a few things I want to close out the prepared remarks with, and then we'll, again, jump into Q&A.

然後我將把它交給 Suky，他將提供更多關於第四季度的細節，顯然，更多關於我們未來指導的細節。最後，在我們進行問答之前，它會回到我身邊。我剛剛得到了一些我想要結束準備好的評論的東西，然後我們將再次進入問答環節。

Okay. So first, let's start with Q4, and I'm going to break this into really 3 categories. The first will be around COVID impact in Q4 and how it compared to our expectations. The second will be around VBP impact and, again, how that compared to our expectations. And then finally, just performance outside of those environmental impacts and how we performed there.

好的。所以首先，讓我們從第四季度開始，我將把它分成三個類別。首先是關於第四季度的 COVID 影響，以及它與我們的預期相比如何。第二個將是關於 VBP 的影響，以及與我們的預期相比如何。最後，只是在這些環境影響之外的表現以及我們在那裡的表現。

Okay. So let's take a step back first, I think that will help. Just -- when we gave our updated Q4 guidance on our Q3 earnings call back in November, we actually outlined our expectations around how COVID and staffing pressure would likely impact our fourth quarter results. And unfortunately, our assumptions largely played out in the quarter.

好的。所以讓我們先退後一步，我認為這會有所幫助。只是——當我們在 11 月就第三季度收益電話會議提供更新的第四季度指導時，我們實際上概述了我們對 COVID 和人員壓力可能如何影響我們第四季度業績的預期。不幸的是，我們的假設在本季度基本上得到了體現。

As you probably remember, we felt that the pressure from the end of Q3 would continue into Q4, and thus, the overall pressure from COVID and staffing would actually accelerate from Q3 to Q4. And really, the big reason this played out, of course, we know now is because of the Omicron surge that occurred towards the end of the fourth quarter. And as many have already stated, a lot of that impact truly came in December itself.

您可能還記得，我們認為第三季度末的壓力將持續到第四季度，因此，來自 COVID 和人員配置的總體壓力實際上會從第三季度加速到第四季度。真的，這發生的主要原因，當然，我們現在知道是因為在第四季度末發生的 Omicron 激增。正如許多人已經說過的那樣，很多影響確實發生在 12 月本身。

So what's interesting about this surge, though, is that even though the overall impact of COVID was about what we expected, the way it manifested was different, right? So ICU capacity was definitely a factor, but we did not see it as the primary driver of cancellations of procedures during the quarter.

那麼，這次激增的有趣之處在於，儘管 COVID 的整體影響與我們預期的差不多，但它的表現方式卻有所不同，對吧？因此，ICU 容量絕對是一個因素，但我們並不認為它是本季度取消手術的主要驅動因素。

And so what we actually saw was more cancellations that occurred due to, really, either the patient or staffing member being diagnosed with COVID or actually having been around someone with COVID, and they were quarantining as a result and couldn't show up for the procedure. So that was really the shift that we saw in the quarter. So the overall impact was about what we expected, but the way, again, it manifested in the numbers was slightly different.

因此，我們實際看到的是更多的取消，實際上是由於患者或工作人員被診斷出患有 COVID，或者實際上與患有 COVID 的人在一起，因此他們被隔離，無法出現在程序。所以這確實是我們在本季度看到的轉變。所以總體影響與我們預期的差不多，但它在數字上的表現方式略有不同。

Okay. So transitioning from there to VBP. Remember, again, on our Q3 call, we discussed what we thought the impact of China Hip and Knee VBP would be in our fourth quarter results. And we actually -- we were largely right on how that played out. And so our expected headwind in large joints was in line with the expectations that we had and also what we communicated to you. So that was pretty much in check when we think about large joints.

好的。所以從那裡過渡到VBP。請再次記住，在我們的第三季度電話會議上，我們討論了我們認為中國髖關節和膝關節 VBP 對我們第四季度業績的影響。實際上，我們在很大程度上是正確的。因此，我們對大型關節的預期逆風符合我們的預期以及我們與您溝通的內容。所以當我們考慮大關節時，這幾乎是檢查的。

Now what changed during the quarter, actually, even post the quarter, was that on January 24, the Chinese government announced that it was formally nationalizing one of its Provincial Trauma VBP tenders, and that was kind of new to us. But based on that confirmation from the Chinese government and really just our knowledge of how the VBP process will work from here, we did take a sales reserve in the fourth quarter, which obviously results then in a negative Q4 impact to both our net sales and adjusted diluted EPS.

現在，在本季度，甚至在本季度之後發生的變化是，1 月 24 日，中國政府宣布正式將其省級創傷 VBP 招標之一國有化，這對我們來說有點新鮮。但根據中國政府的確認，以及我們對 VBP 流程如何從這裡開始運作的了解，我們確實在第四季度進行了銷售儲備，這顯然對我們的淨銷售額和第四季度產生了負面影響。調整後的稀釋每股收益。

And what I'll say is that even though this Trauma VBP adjustment came earlier than we anticipated, it is pretty consistent with the overall scale of the impact and consistent with our expectations and what we've been talking about more recently. Now I would say, looking forward, the good news is we have a lot more visibility now. We're a lot smarter on the topic, and we understand what the impact of VBP will now be on our 2022 business. And that has been included in our guidance, which Suky is going to talk about in just a minute.

我要說的是，儘管這次創傷 VBP 調整比我們預期的要早，但它與影響的整體規模非常一致，也與我們的預期和我們最近談論的內容一致。現在我想說，展望未來，好消息是我們現在有了更多的知名度。我們在這個話題上要聰明得多，我們了解 VBP 現在將對我們 2022 年的業務產生什麼影響。這已包含在我們的指導中，Suky 將在稍後談到。

Okay. So now looking past VBP and COVID in the fourth quarter, I'm very proud of the team when we focus on the things we can control. ZB's business execution against a challenging backdrop has been strong. Our strength of our team right now, that kind of one ZB culture, is as evident as it's ever been, and I think more important than ever. And the team has really been able to move our strategy forward even in these challenging times.

好的。所以現在回顧第四季度的 VBP 和 COVID，當我們專注於我們可以控制的事情時，我為團隊感到非常自豪。在充滿挑戰的背景下，中幣的業務執行力一直很強勁。我們現在團隊的力量，一種 ZB 文化，比以往任何時候都明顯，我認為比以往任何時候都更重要。即使在這些充滿挑戰的時期，團隊也確實能夠推動我們的戰略向前發展。

And a few proof points to be able to point at, the team was able to drive continued strong demand and momentum for ROSA. And that is globally, not just in the U.S., but globally. We actually more than doubled the number of installed ROSAs in 2021 versus our cumulative total at the end of 2020. That's a pretty significant jump up, and again, speaks to the momentum that we have in robotics and orthopedics.

還有一些可以指出的證據，團隊能夠推動 ROSA 持續強勁的需求和勢頭。這是全球性的，不僅在美國，而且在全球範圍內。實際上，與 2020 年底的累計總數相比，我們在 2021 年安裝的 ROSA 數量增加了一倍以上。這是一個非常顯著的增長，再次說明了我們在機器人和骨科領域的發展勢頭。

And those ROSAs are paying off. In the fourth quarter, those installed ROSAs allowed us to reach 10% in total knee procedure penetration in the U.S. for the first time as a company. That's a huge milestone for the organization, and it's just the beginning of this ROSA journey for us.

那些 ROSA 正在獲得回報。在第四季度，那些安裝了 ROSA 的公司使我們作為一家公司首次在美國的膝關節手術總滲透率達到 10%。這對組織來說是一個巨大的里程碑，對我們來說，這只是 ROSA 之旅的開始。

The team also delivered a successful limited launch of the world's first and really only smart knee, the Persona IQ. Now it's early, obviously, early days. We're in limited launch right now, as I said. But the launch trajectory feels great. The feedback is good, and we're looking forward to a full launch later this year. And then finally, and I think importantly, the team continues to execute in large joints across the board, driving again above-market performance in Q4 in the U.S. for both Knees and Hips versus 2019.

該團隊還成功推出了世界上第一個也是唯一一個智能膝關節 Persona IQ。現在很早，很明顯，很早。正如我所說，我們現在處於有限發布階段。但是發射軌跡感覺很棒。反饋很好，我們期待在今年晚些時候全面推出。最後，我認為重要的是，該團隊繼續全面執行大關節，與 2019 年相比，在美國第四季度的膝蓋和臀部表現再次高於市場。

Okay. So let's transition from Q4 and talk about what we're seeing so far in early 2022. And I'm going to speak specifically about COVID and staffing challenges. What I would tell you is that the challenges that we saw in Q4, in particular, in December, are unfortunately continuing into January.

好的。因此，讓我們從第四季度開始過渡，談談我們在 2022 年初到目前為止所看到的情況。我將具體談談 COVID 和人員配備方面的挑戰。我要告訴你的是，我們在第四季度，特別是在 12 月看到的挑戰不幸地持續到 1 月。

And as a practice, and I think prudently so, our team is continuing to build our financial models using what I'm going to call a recency bias in those models. And as a result of that, we're expecting that December, and really now January, pressure in COVID and staffing will continue through Q1. So what we're basically saying is that, overall, we anticipate that Q1 will likely be more pressured than Q4 was.

作為一種實踐，我謹慎地認為，我們的團隊將繼續使用這些模型中的新近度偏差來構建我們的財務模型。因此，我們預計 12 月以及現在的 1 月，COVID 和人員配備的壓力將持續到第一季度。所以我們基本上要說的是，總的來說，我們預計第一季度可能會比第四季度面臨更大的壓力。

And so what does that mean for our outlook for the full year? Again, we're going to follow that same approach. We're going to look at 2022 in a similar way, actually, in a very similar way in the way we gave guidance for Q4 of 2021. Until we see a fundamental shift in the current state and what's happening today in the environment, we are projecting that the COVID pressure will continue throughout the year and will be -- actually follow a similar peak and valley trend that we saw in 2021.

那麼這對我們全年的展望意味著什麼呢？同樣，我們將遵循相同的方法。我們將以類似的方式看待 2022 年，實際上，以與我們為 2021 年第四季度提供指導的方式非常相似的方式。直到我們看到當前狀態的根本轉變以及今天環境中正在發生的事情，我們預計 COVID 壓力將在全年持續，並且實際上將遵循我們在 2021 年看到的類似高峰和低谷趨勢。

As I'm sure you can appreciate, given that about 80% of our revenues come from elective procedures, ZB must be highly attuned to this topic. And trust me, we are. We're highly focused in this area, and that has been captured in our assumptions for guidance.

我相信你會明白，鑑於我們大約 80% 的收入來自選舉程序，ZB 必須高度關注這個話題。相信我，我們是。我們高度關注這一領域，這已在我們的指導假設中得到體現。

And with that, I'm going to transition to Suky to give you, again, more detail on Q4 and also our 2022 guidance. Okay, Suky?

有了這個，我將過渡到 Suky，再次為您提供有關第四季度的更多詳細信息以及我們的 2022 年指導。好吧，蘇基？

Thanks, and good morning, everyone. For this morning's call, I'm going to focus on 3 topics: first, our Q4 results, including commentary on the impact of COVID; second, how that translates into full year '22 financial guidance that we provided this morning; and third, I'll provide a brief update on our longer-term outlook.

謝謝，大家早上好。對於今天上午的電話會議，我將重點關注 3 個主題：首先，我們的第四季度業績，包括對 COVID 影響的評論；其次，這如何轉化為我們今天早上提供的 22 年全年財務指導；第三，我將簡要介紹我們的長期前景。

Moving forward, unless otherwise noted, my statements will be about the fourth quarter 2021 and how it compares to the same period in 2020. And my revenue and P&L commentary will be on a constant currency or adjusted basis. We've also provided changes versus the fourth quarter of 2019 or pre-pandemic results as we feel it is an important comparison.

展望未來，除非另有說明，否則我的報表將是關於 2021 年第四季度以及與 2020 年同期相比的情況。我的收入和損益表評論將基於不變貨幣或調整後的基礎。我們還提供了與 2019 年第四季度或大流行前結果相比的變化，因為我們認為這是一個重要的比較。

Net sales in the fourth quarter were $2.04 billion, a reported decline of 2.3% and a constant currency decline of 0.8% or down 4.4% versus '19. On a consolidated basis, we were about flat through November versus 2019 and declined in December due to the Omicron variant surge.

與 19 年相比，第四季度的淨銷售額為 20.4 億美元，報告下降 2.3%，固定匯率下降 0.8% 或下降 4.4%。綜合來看，與 2019 年相比，我們在 11 月基本持平，但由於 Omicron 變體激增，我們在 12 月有所下降。

Expectations for the fourth quarter had contemplated the impact of China VBP in Hip and Knee, and that was largely in line with expectations. Separately, we booked the sales adjustment related to channel inventory for China VBP in Trauma of approximately $30 million, triggered in part by the Chinese government's announcement relating to a National Trauma VBP, which was made on January 24.

對第四季度的預期已經考慮了中國 VBP 對髖膝關節的影響，這與預期基本一致。另外，我們在創傷中為中國 VBP 記錄了與渠道庫存相關的銷售調整約 3000 萬美元，部分原因是中國政府於 1 月 24 日發布了與國家創傷 VBP 相關的公告。

This adjustment was about a 650 basis point headwind to S.E.T. category growth and about a 150 basis point drag on consolidated Q4 growth. In short, excluding the impact of the China VBP on our S.E.T. results, the quarter was generally in line with the assumptions that we provided on our third quarter call and broadly consistent with the midpoint of our implied fourth quarter guidance range.

這一調整對 S.E.T. 造成了大約 650 個基點的阻力。類別增長和對第四季度綜合增長的約 150 個基點拖累。簡而言之，不包括中國 VBP 對我們 S.E.T. 的影響。結果，該季度總體上符合我們在第三季度電話會議上提供的假設，並且與我們隱含的第四季度指導範圍的中點大體一致。

The Americas declined 1.5% in the fourth quarter, down 1.9% versus 2019, with the U.S. declining 2.3% or down 2.4% versus 2019. The impact of Omicron late in the quarter, in tandem with lingering hospital staffing challenges, drove lower regional results.

美洲第四季度下降 1.5%，與 2019 年相比下降 1.9%，美國與 2019 年相比下降 2.3% 或下降 2.4%。本季度末 Omicron 的影響以及揮之不去的醫院人員配備挑戰，導致區域業績下降.

EMEA grew 17.3% or down 3% versus '19. The region experienced positive growth versus '19 earlier in the quarter, but quickly decelerated with the emergence of Omicron.

與 19 年相比，歐洲、中東和非洲地區增長了 17.3% 或下降了 3%。該地區在本季度早些時候與 19 年相比經歷了正增長，但隨著 Omicron 的出現迅速減速。

Lastly, Asia Pacific declined 17.5% or down 15.1% versus '19, driven primarily by price adjustments on channel inventory ahead of Hip, Knee and Trauma VBP as well as some negative impact from a spike in COVID cases starting in December in markets like Japan and Australia.

最後，與 19 年相比，亞太地區下降了 17.5% 或 15.1%，這主要是由於在 Hip、Knee 和 Trauma VBP 之前渠道庫存的價格調整以及從 12 月開始在日本等市場出現的 COVID 病例激增的一些負面影響和澳大利亞。

Now turning to our business category performance in the fourth quarter. The Global Knee business increased 0.4% or down 3.9% versus 2019, with U.S. Knees declining 5.2% or 3.9% versus '19. In the quarter, China VBP had a negative impact on Knee growth of about 250 basis points.

現在轉向我們在第四季度的業務類別表現。全球膝關節業務與 2019 年相比增長 0.4% 或下降 3.9%，美國膝關節業務與 19 年相比下降 5.2% 或 3.9%。本季度，中國 VBP 對 Knee 增長的負面影響約為 250 個基點。

Our Global Hip business declined 2.8% or down 6% versus '19, with U.S. Hips declining 4.4% or 3% versus '19. VBP impact on Hip was about 700 basis points in the quarter.

我們的全球臀部業務與 19 年相比下降了 2.8% 或 6%，美國臀部與 19 年相比下降了 4.4% 或 3%。本季度 VBP 對 Hip 的影響約為 700 個基點。

Our Sports, Extremity and Trauma category decreased 4.3% or down 6.2 versus '19. The sequential deceleration was due to a softer market due to COVID and the impact of China National VBP in Trauma, as discussed earlier. Excluding the impact of Trauma VBP in the quarter, S.E.T. was growing low single digits versus 2020 and about flat versus '19 on an underlying basis.

我們的運動、四肢和創傷類別與 19 年相比下降了 4.3% 或 6.2。如前所述，連續減速是由於 COVID 和中國國家 VBP 在創傷中的影響導致市場疲軟。排除本季度創傷 VBP 的影響，S.E.T.與 2020 年相比，增長較低個位數，與 19 年基本持平。

The Dental and Spine category declined 3% or down 3.8% versus '19, with Dental posting growth and Spine declining, primarily due to continued pressure from COVID.

與 19 年相比，牙科和脊柱類別下降了 3% 或 3.8%，牙科增長和脊柱下降，主要是由於 COVID 的持續壓力。

Finally, our Other category grew 14.1% or up 1.9% versus '19. Inside this category, we saw ongoing demand for ROSA Knee as well as increased revenues from the launch of our ROSA Partial Knee and Hip applications.

最後，我們的其他類別與 19 年相比增長了 14.1% 或 1.9%。在這一類別中，我們看到了對 ROSA 膝關節的持續需求，以及我們推出 ROSA 局部膝關節和髖關節應用程序帶來的收入增加。

Moving on to our P&L. For the fourth quarter, we reported GAAP diluted loss per share of $0.40 compared to our GAAP diluted earnings per share of $1.59 in the fourth quarter of 2020. This decrease was driven primarily by lower revenue, a debt extinguishment loss recognized on our bond tender offer, litigation-related charges and restructuring charges that we incurred in Q4 to continue to address pressures on revenue from COVID and the stranded costs associated with the spin.

繼續我們的損益表。對於第四季度，我們報告的 GAAP 攤薄每股虧損為 0.40 美元，而我們在 2020 年第四季度的 GAAP 攤薄每股收益為 1.59 美元。這一下降主要是由於收入下降，即在我們的債券要約收購中確認的債務清償損失，我們在第四季度產生的訴訟相關費用和重組費用，以繼續解決來自 COVID 的收入壓力以及與分拆相關的擱淺成本。

On an adjusted basis, diluted earnings per share of $1.95 represented a decline from $2.11 in the fourth quarter of 2020. The decrease was primarily from lower revenues in tandem with lower gross margins due to COVID-19 and the impact of China VBP in both recon and trauma, which were partially offset by targeted reductions in SG&A and a slightly lower tax rate. In addition, FX was a modest headwind to earnings per share in the quarter.

經調整後，每股攤薄收益為 1.95 美元，較 2020 年第四季度的 2.11 美元有所下降。下降主要是由於 COVID-19 導致收入下降以及毛利率下降以及中國 VBP 在這兩個領域的影響和創傷，這部分被有針對性地減少 SG&A 和略低的稅率所抵消。此外，外匯對本季度的每股收益構成了適度的不利影響。

Adjusted gross margin was 69.1%. Fourth quarter gross margin was pressured due to lower manufacturing volumes and the impact of China VBP. For the full year, adjusted gross margin was 70.7% and in line with prior commentary.

調整後的毛利率為69.1%。由於製造量下降和中國 VBP 的影響，第四季度毛利率受到壓力。全年調整後的毛利率為 70.7%，與之前的評論一致。

Our adjusted operating expenses of $882 million declined year-over-year. In spite of that, we continue to invest in R&D and commercial infrastructure across priority areas like S.E.T., robotics and data and informatics, which are being funded by accelerated improvements in efficiency across other areas of SG&A.

我們調整後的運營費用為 8.82 億美元，同比下降。儘管如此，我們仍繼續投資於 S.E.T.、機器人、數據和信息學等優先領域的研發和商業基礎設施，這些資金來自 SG&A 其他領域的效率加速提高。

Our adjusted operating margin for the quarter was 25.9%, down versus the prior year, but in line with the prior quarter. The adjusted tax rate was 14.4% in the quarter. The Q4 and full year tax rates were favorable to our expectations due to some discrete onetime items in the quarter.

我們本季度調整後的營業利潤率為 25.9%，與去年同期相比有所下降，但與上一季度持平。本季度調整後的稅率為 14.4%。由於本季度一些離散的一次性項目，第四季度和全年的稅率有利於我們的預期。

Turning to cash and liquidity. Operating cash flows were $366 million, and free cash flows totaled $224 million, with an ending cash and cash equivalents balance of just $480 million. We continue to make good progress on delevering the balance sheet. In the fourth quarter, we reduced debt by approximately $400 million, bringing the total debt reduction in '21 to approximately $900 million, excluding the effects of foreign currency on non-U.S. denominated debt.

轉向現金和流動性。經營現金流為 3.66 億美元，自由現金流總計 2.24 億美元，期末現金和現金等價物餘額僅為 4.8 億美元。我們在去槓桿方面繼續取得良好進展。在第四季度，我們減少了大約 4 億美元的債務，使 21 年的債務總額減少到大約 9 億美元，不包括外幣對非美元計價債務的影響。

Moving to our financial outlook for 2022. We are issuing '22 financial guidance based on the following key assumptions. COVID and customer staffing pressures are expected to continue throughout 2022. We expect the COVID and staffing pressures that we saw in December to accelerate into the first quarter of this year with the first half of 2022 being more pressured than the second half.

轉向我們對 2022 年的財務展望。我們根據以下關鍵假設發布 '22 財務指導。 COVID 和客戶人員配備壓力預計將持續到 2022 年。我們預計，我們在 12 月看到的 COVID 和人員配備壓力將加速到今年第一季度，2022 年上半年的壓力將大於下半年。

We do not see China VBP as a material impact to growth in '22 versus '21, but we expect variability by quarter, with more pressure in the first half. Furthermore, we anticipate completing the spin of our Dental and Spine businesses in the near term. And as such, the guidance we are providing is only for RemainCo Zimmer Biomet.

我們認為中國 VBP 不會對 22 年和 21 年的增長產生重大影響，但我們預計各季度會出現變化，上半年壓力更大。此外，我們預計在短期內完成對牙科和脊柱業務的拆分。因此，我們提供的指導僅適用於 RemainCo Zimmer Biomet。

For the first quarter, ZimVie will be reported as discontinued operations, and we expect to provide pro forma 2021 information for RemainCo on or around our first quarter earnings call. While we do not have full P&L restatements available at this time, for comparison, we have provided our unaudited net sales estimate of $6.827 billion for RemainCo Zimmer Biomet.

對於第一季度，ZimVie 將被報告為停止運營，我們預計將在第一季度財報電話會議上或前後提供 RemainCo 的 2021 年備考信息。雖然我們目前沒有完整的損益表重述，但作為比較，我們提供了 RemainCo Zimmer Biomet 的未經審計的 68.27 億美元淨銷售額估計。

Against this backdrop, our current expectations for the full year 2022 financial outlook are: reported revenue growth in the range of negative 4% to 0 versus 2021, with an expected foreign currency exchange headwind of approximately 200 basis points, this translates to negative 2% to positive 2% on a constant currency basis; adjusted operating profit margin of 26.5% to 27.5%; adjusted tax rate of 16% to 16.5%; adjusted diluted earnings per share in the range of $6.40 to $6.80; and free cash flow of $700 million to $800 million.

在此背景下，我們目前對 2022 年全年財務前景的預期是：與 2021 年相比，報告的收入增長在負 4% 至 0 的範圍內，預計外匯逆風約為 200 個基點，這意味著負 2%在固定貨幣基礎上為正 2%；調整後的營業利潤率為 26.5% 至 27.5%；調整後的稅率為 16% 至 16.5%；調整後的每股攤薄收益在 6.40 美元至 6.80 美元之間；以及 7 億至 8 億美元的自由現金流。

In spite of that guidance, we expect Q1 revenue to be flat to up slightly versus the first quarter 2021 due to headwinds from COVID and the impact of VBP being somewhat offset by the easier comp relative to the first quarter of last year and a roughly 130 basis point selling day tailwind that will largely be reversed in the fourth quarter. We expect approximately $160 million of net interest expense and approximately 212 million average shares outstanding for the year. We remain committed to our investment-grade rating and expect to pay down $750 million of debt maturing in the second quarter of this year.

儘管有這一指導，我們預計第一季度的收入將與 2021 年第一季度持平或略有上升，原因是 COVID 帶來的不利因素以及 VBP 的影響在一定程度上被相對於去年第一季度的更容易補償和大約 130基點賣出日的順風將在第四季度基本扭轉。我們預計今年的淨利息支出約為 1.6 億美元，平均流通股約為 2.12 億股。我們仍然致力於我們的投資級評級，並預計將償還今年第二季度到期的 7.5 億美元債務。

Now turning to our longer-term outlook. With the ZimVie spin transaction nearing completion, we are also taking this opportunity to update our long-term margin expectations. Given the prolonged impact COVID-19 is having on our business, we are removing our target of at least 30% adjusted operating profit margin exiting 2023. However, we do expect to improve margins over the long term as we will continue to make targeted investments in our business to enhance top line growth while also accelerating cost savings to fund those investments.

現在轉向我們的長期展望。隨著 ZimVie 旋轉交易接近完成，我們也藉此機會更新我們的長期保證金預期。鑑於 COVID-19 對我們業務的長期影響，我們將取消 2023 年調整後營業利潤率至少 30% 的目標。但是，我們確實希望長期提高利潤率，因為我們將繼續進行有針對性的投資在我們的業務中，以提高收入增長，同時加快成本節約，為這些投資提供資金。

In summary, the macro environment presents challenges, but our underlying business fundamentals remain strong as we continue to execute successfully against what we can control. With that, I'll turn the call back over to Bryan.

總之，宏觀環境帶來了挑戰，但我們的基本業務基礎仍然強勁，因為我們繼續成功地執行我們可以控制的事情。有了這個，我會把電話轉回給布萊恩。

All right. Thanks, Suky. And before we move into the Q&A session, I just want to spend a few minutes to talk about our broader corporate strategy and, really, importantly, our execution against that strategy.

好的。謝謝，蘇基。在我們進入問答環節之前，我只想花幾分鐘來談談我們更廣泛的公司戰略，以及，真正重要的是，我們對該戰略的執行。

When I joined ZB, we looked very closely at, number one, reimagining our corporate mission and culture; but also, number two, making sure that we transform the long-term strategy of the company and change the way we think about innovation. And that was really where that ZBEdge ecosystem has come from.

當我加入 ZB 時，我們非常關注，第一，重新構想我們的企業使命和文化；其次，確保我們轉變公司的長期戰略並改變我們對創新的看法。這就是 ZBEdge 生態系統的真正來源。

So through that, we prioritized R&D spend in robotics and data. And we also tripled the number of ZB team members with robotics and data background so that we had that competency to truly move the needle in this area. And where we didn't want to build a competency, we forged strategic partnerships with the likes of Canary to be able to drive traction in smart implants, but also with larger players like Microsoft and Apple to further enhance our data and robotics ecosystem.

因此，通過這種方式，我們優先考慮了機器人和數據方面的研發支出。我們還將具有機器人技術和數據背景的 ZB 團隊成員數量增加了兩倍，這樣我們就有能力真正推動這一領域的發展。在我們不想建立能力的地方，我們與 Canary 等公司建立了戰略合作夥伴關係，以推動智能植入物的發展，同時還與微軟和蘋果等大型企業建立了戰略合作夥伴關係，以進一步增強我們的數據和機器人生態系統。

And hey, we're seeing results. Our Vitality index has nearly doubled from 2018 to 2021. And I'm proud to say that our new product pipeline is stronger than ever. And as a result of that, we expect to increase our Vitality Index an additional 50%, 5-0 percent, over the strat plan period.

嘿，我們看到了結果。從 2018 年到 2021 年，我們的活力指數幾乎翻了一番。我很自豪地說，我們的新產品線比以往任何時候都更強大。因此，我們預計在戰略計劃期間將我們的活力指數再增加 50%，即 5-0%。

But beyond innovation in our strategy, we're also transforming the company by modernizing and streamlining its operating model, right? We're focused on accelerating and expanding programs to drive efficiencies in the company, simplifying the company and using that cost savings to enable investment in the business for growth, but also positioning us to expand margins. And that will absolutely continue.

但除了我們的戰略創新之外，我們還通過現代化和精簡其運營模式來改變公司，對吧？我們專注於加速和擴展計劃以提高公司效率，簡化公司並利用節省的成本來實現對業務的投資以實現增長，同時也使我們能夠擴大利潤。這絕對會繼續下去。

And that reinvestment is working. That reinvestment in our business for growth is working. It is driving growth, and I know that COVID is hiding that growth. But if you go back in time before the disruption of COVID, we went from 0% growth in 2017. And believe me, I acutely remember this because I joined the company in December 2017. But we went from 0% growth in 2017 to a 3.2% growth rate in Q4 of 2019, and that was the last full kind of pre-COVID quarter that we had. And that was really just on the beginning end of that Vitality Index moving north, just -- we're just getting traction in Vitality Index.

這種再投資正在發揮作用。對我們的業務進行再投資以促進增長正在發揮作用。它正在推動增長，我知道 COVID 隱藏了這種增長。但如果你回到 COVID 中斷之前的時間，我們從 2017 年的 0% 增長。相信我，我清楚地記得這一點，因為我於 2017 年 12 月加入公司。但我們從 2017 年的 0% 增長到2019 年第四季度的增長率為 3.2%，這是我們在 COVID 之前的最後一個完整的季度。這實際上只是活力指數向北移動的開始，只是 - 我們剛剛在活力指數中獲得牽引力。

So I would say that, even though COVID disruption is definitely muting our growth, there's no question that, that's happening, we're confident that we have the right strategy, and we're executing against that strategy. That we have a differentiated portfolio, and that's even getting stronger because of our Vitality Index movement. And our execution capability will allow us to pull that all together so that we can get back on that growth trajectory as we see recovery from COVID, okay?

所以我想說，儘管 COVID 的中斷肯定會抑制我們的增長，但毫無疑問，這種情況正在發生，我們相信我們擁有正確的戰略，並且我們正在執行該戰略。我們擁有差異化的投資組合，並且由於我們的活力指數運動而變得更加強大。我們的執行能力將使我們能夠將所有這些整合在一起，以便在我們看到從 COVID 中復蘇時，我們可以回到增長軌跡，好嗎？

And so one last point that I want to make in our transformation, I want to talk about active portfolio management. Today, we gave an update on our ZimVie spin progress, and we're expecting to finalize the spin ahead of schedule on March 1.

所以我想在我們的轉型中提出最後一點，我想談談積極的投資組合管理。今天，我們提供了有關 ZimVie 旋轉進度的最新信息，我們預計將在 3 月 1 日提前完成旋轉。

And I'm very excited about the ZimVie Investor Day today. You're going to hear from its CEO, Vafa Jamali, and the team that he's put together. I think you're going to be excited about what you hear. And I can tell you that both Vafa and I know that we are creating more shareholder value as 2 independent companies.

我對今天的 Zimvie 投資者日感到非常興奮。你會聽到它的首席執行官 Vafa Jamali 和他組建的團隊的消息。我想你會對你聽到的內容感到興奮。我可以告訴你，我和 Vafa 都知道，作為兩家獨立的公司，我們正在創造更多的股東價值。

For ZB, for RemainCo, we get increased focus, we get enhanced revenue growth, and we get margin accretion. For ZimVie, they get to prioritize the investment in their Dental and Spine businesses in a way that we would not have. And that really enables them to build a stronger stand-alone business in those attractive markets.

對於 ZB，對於 RemainCo，我們獲得了更多的關注，我們獲得了更高的收入增長，我們獲得了利潤增長。對於 ZimVie，他們可以以我們沒有的方式優先考慮對牙科和脊柱業務的投資。這確實使他們能夠在這些有吸引力的市場中建立更強大的獨立業務。

Of course, you're going to hear a lot more about ZimVie over the coming weeks, starting with the Investor Day today. But outside of ZimVie, we've also continued to move our M&A strategy and our partnership strategy forward. We've done almost 20 different transactions between M&A and partnerships to be able to enhance our position in faster-growth categories.

當然，從今天的投資者日開始，您將在接下來的幾週內聽到更多有關 Zimvie 的消息。但在 Zimvie 之外，我們還繼續推進我們的併購戰略和合作夥伴戰略。我們在併購和合作夥伴之間進行了近 20 項不同的交易，以增強我們在快速增長類別中的地位。

And we have, I know, much more to accomplish here. But even with the limited available capital that we've had given the COVID pressure, we're absolutely off to the right start. So as you can tell, there's a lot happening at ZB. There's a lot that we're proud of. And there's a lot that will absolutely continue to fuel our transformation and, ultimately, help drive our mission and, very importantly, drive value for you.

我知道，我們還有很多事情要做。但是，即使我們給 COVID 壓力的可用資金有限，我們也絕對是正確的開始。如您所知，ZB 發生了很多事情。我們有很多值得驕傲的地方。有很多東西絕對會繼續推動我們的轉型，並最終幫助推動我們的使命，非常重要的是，為您創造價值。

So with that, I'm going to turn the call back to Keri, and we'll move to our Q&A session.

因此，我將把電話轉回給 Keri，我們將進入問答環節。

Thanks, Bryan. (Operator Instructions) With that, operator, may we have the first question, please?

謝謝，布萊恩。 （操作員說明）這樣，操作員，我們可以問第一個問題嗎？

(Operator Instructions) We'll take our first question from Josh Jennings with Cowen.

（操作員說明）我們將回答 Josh Jennings 和 Cowen 的第一個問題。

Just wanted to start off on 2022 revenue guidance and just make sure I understand the impact of VBP that you're baking into the range. I know you don't usually break out guidance for specific regions, but anything you can do to just help us think about what's baked in for Americas and EMEA versus Asia Pac into that down 4% to flat on a constant currency basis for 2022?

只是想從 2022 年的收入指導開始，並確保我了解 VBP 的影響，你正在進入該範圍。我知道您通常不會針對特定地區提供指導，但您可以做些什麼來幫助我們思考美洲和歐洲、中東和非洲與亞太地區相比，2022 年按固定匯率計算下降 4% 至持平？

And then just a follow-up on the operating margin guidance, just the trajectory. I know as these pressures are in play, you've taken another look at that in that 30% target. But just as you're moving through these transformation programs and looking at regional profitability, infrastructure in smaller markets and other areas of cost reductions, I mean, how do you balance that with the top line growth projections? Is there any risk that you're going to be impacting revenue growth over the next couple of years by pursuing these transformation programs?

然後只是對營業利潤率指導的跟進，只是軌跡。我知道這些壓力正在發揮作用，您已經在 30% 的目標中重新審視了這一點。但是，正如您正在通過這些轉型計劃並著眼於區域盈利能力、較小市場的基礎設施和其他成本降低領域，我的意思是，您如何平衡這些與頂線增長預測？通過實施這些轉型計劃，您是否會影響未來幾年的收入增長？

Yes. Maybe I'll just start real quick on that last portion of it, and then I'll pass it over to you, Suky. We actually feel more confident in our ability to invest for growth in the business because of the transformation programs. The transformation programs are not specifically associated with R&D and investment in those key growth drivers for us, they're more focused on finding efficiencies that do not impact our ability to spend in those growth areas.

是的。也許我會很快開始最後一部分，然後我會把它交給你，Suky。實際上，由於轉型計劃，我們對投資業務增長的能力更有信心。轉型計劃與我們對那些關鍵增長動力的研發和投資沒有特別關聯，它們更專注於尋找不影響我們在這些增長領域支出能力的效率。

So they really actually bring more confidence that we'll be able to spend on the things that are actually going to drive growth in the future. But outside of that, I'm going to push it over to you for the other questions.

所以他們真的帶來了更多的信心，我們將能夠把錢花在真正能推動未來增長的事情上。但除此之外，我將把它推給你其他問題。

Yes. So Josh, thanks for the question. Regarding revenue guidance, so we talked some of the overarching assumptions in that guide on negative 2% to 2% on an ex FX basis for the full year revenue is really around the concept of we expect COVID to continue for the full year, and the impact of COVID on elective procedures and staffing shortages, again, to really be with us for the entirety of 2022.

是的。所以喬希，謝謝你的問題。關於收入指導，因此我們討論了該指南中的一些總體假設，即全年收入在外匯基礎上為負 2% 至 2%，實際上是圍繞著我們預計 COVID 將持續全年的概念，以及再次，COVID 對選修程序和人員短缺的影響，在整個 2022 年都與我們同在。

Now what we're saying is, broadly, we would expect to see procedural volumes consistent with 2021. And that's in the backdrop of COVID actually accelerating in the first quarter, right, where we expect the first quarter on an underlying basis to be down. So we do expect to see some recovery in the later quarters within the year.

現在我們要說的是，從廣義上講，我們預計會看到與 2021 年一致的程序量。這是在 COVID 實際上在第一季度加速的背景下，對，我們預計第一季度在基礎上會下降.因此，我們確實預計在今年晚些時候的幾個季度會出現一些復甦。

Specifically inside of that, your question to VBP, we don't see VBP as a material headwind or tailwind at this time relative to large joints or trauma given the charges that we've taken in the fourth quarter of 2021. Now I would say that the cadence of that by quarter is going to be definitely different. Even though it's not a full year headwind or tailwind, it will definitely be more pressured in the first half of the year than in the second half of the year. So that's how we think about VBP.

特別是在這裡面，你對 VBP 的問題，鑑於我們在 2021 年第四季度收取的費用，我們目前不認為 VBP 相對於大關節或創傷而言是一個重大的逆風或順風。現在我想說那個季度的節奏肯定會有所不同。雖然不是全年逆風順風，但上半年的壓力肯定會比下半年更大。這就是我們對 VBP 的看法。

Now I think your other question was regarding how do we see regional performance in that flattish -- but we're not going to comment on regional color at this time. There's a lot more that's got to play out relative to COVID and the recovery by region before we're going to talk about that. So we'll give you more color as we get into the -- further into the first quarter on our first quarter call. But right now, consolidated level, we expect it at our midpoint to be about flat.

現在我認為您的另一個問題是關於我們如何看待這種平淡的區域表現 - 但我們目前不打算評論區域顏色。在我們討論這個問題之前，與 COVID 和各地區的複蘇有關，還有很多事情要做。因此，當我們進入第一季度電話會議的第一季度時，我們將為您提供更多色彩。但現在，綜合水平，我們預計它在我們的中點將基本持平。

Our next question comes from Vijay Kumar with Evercore ISI.

我們的下一個問題來自 Evercore ISI 的 Vijay Kumar。

My first one, Suky, is on the EPS guidance here. The base of Zimmer, right, ex the spin, I just want to make sure I have the right numbers. I'm getting to maybe something like [$7.15] of earnings in 2019, [$6.65] earnings on a comparable basis for last year, fiscal '21.

我的第一個，Suky，在這裡的 EPS 指導。 Zimmer 的基礎，對，前旋轉，我只是想確保我有正確的數字。我可能會在 2019 年獲得類似 [7.15 美元] 的收益，在 21 財年的可比基礎上獲得 [6.65 美元] 的收益。

One, can you just walk us through the bridge [right] the fiscal '22 guidance of [$6.60] at the midpoint? What is the [cause of decline] from '19? Perhaps volumes may be (inaudible)...

一，你能帶我們走過橋[對]中點[6.60美元]的22財年指導嗎？從 19 年開始 [下降的原因] 是什麼？也許卷可能是（聽不清）......

Vijay, I'm sorry to interrupt, but you're a little staccato. You're not coming in really well so we can't capture your question. I don't know if -- maybe if you can go on, if you're on a speaker, something, maybe you can change it. We can't hear you really well.

維杰，我很抱歉打斷你，但你有點斷斷續續。你進來的不是很好，所以我們無法捕捉到你的問題。我不知道——如果你可以繼續，如果你在揚聲器上，也許你可以改變它。我們聽不見你的聲音。

Yes, Vijay, it sounds like your line is just not a good connection. Maybe you can get back in the queue. Sorry about that.

是的，維杰，聽起來你的線路連接不好。也許你可以回到隊列中。對於那個很抱歉。

Are you still there?

你還在嗎？

Yes. Sorry, guys. Can you hear me now?

是的。對不起大家。你能聽到我嗎？

Much better. Much better. Go ahead.

好多了。好多了。前進。

Yes. Apologies for the bad connection. But Suky, maybe on just EPS guidance, right? What is the comparable earnings in fiscal '19 and '21? I'm getting to $7.14 of earnings or $7.15, downwards $6.60 in '21. Maybe walk us through the bridge from '19, what caused the declines? And year-on-year versus '21, the guide implies flattish earnings, that bridge would be helpful.

是的。為糟糕的連接道歉。但是 Suky，也許只是 EPS 指導，對吧？ 19 財年和 21 財年的可比收益是多少？我的收入將達到 7.14 美元或 7.15 美元，在 21 年下降了 6.60 美元。也許從 19 年開始帶我們穿過這座橋，是什麼導致了下降？與 21 年相比，該指南暗示收益持平，該橋樑將有所幫助。

Yes, sure. So thanks for the question, Vijay. So first of all, I'm not really going to bridge back to 2019. By the time we get through 2022, we'll effectively be in -- 3 years removed from that -- in a COVID environment. So it's really difficult to draw a lot of comparisons.

是的，當然。所以謝謝你的問題，維杰。所以首先，我不會真的回到 2019 年。當我們度過 2022 年時，我們將有效地處於 - 3 年後 - 在 COVID 環境中。所以很難進行很多比較。

But here's how I would think about how we arrived at our operating margin and our guide, ultimately, for EPS. And so if you use 2021 as a starting point, we ended the year at 26% on adjusted operating margins. From there, we've got some tailwinds and some headwinds.

但是，這就是我如何看待我們如何最終達到我們的營業利潤率和我們的指導方針。因此，如果你以 2021 年為起點，我們調整後的營業利潤率為 26%。從那裡開始，我們遇到了一些順風和一些逆風。

Starting with the headwinds. We have been talking about incremental pressure coming in to 2022, really, from 2 dynamics. One was the China VBP. And while the overall revenue impact will be roughly the same as what we saw in 2021, there is a greater margin impact in 2022 because the composition of that revenue downside between the years is a little bit different.

從逆風開始。我們一直在談論到 2022 年的增量壓力，實際上，來自 2 個動態。一個是中國VBP。雖然整體收入影響將與我們在 2021 年看到的大致相同，但 2022 年的利潤率影響更大，因為這些年之間收入下降的構成略有不同。

The second headwind that we're seeing is really around inflationary input costs. Things like energy costs, metals, labor, freight, these are definitely being impacted and felt within our company. So if you put those 2 things together, that's roughly about 100 basis points, maybe slightly more.

我們看到的第二個逆風實際上是通脹投入成本。能源成本、金屬、勞動力、貨運等因素肯定會在我們公司內部受到影響和感受到。所以如果你把這兩件事放在一起，大約是 100 個基點，可能會多一點。

So using our '21 exit of 26% and those headwinds, you would normally arrive at about a 25% adjusted operating margin for 2022. However, we do have some tailwinds. We have the spin. And as we've talked about, prior to the spin, we said that, that would be about 125 basis points accretive to operating margins. It's actually a little bit higher, more like 150 basis points even after netting out stranded costs.

因此，使用我們 21 年 26% 的退出和這些逆風，您通常會在 2022 年獲得約 25% 的調整後營業利潤率。但是，我們確實有一些順風。我們有自旋。正如我們所說，在旋轉之前，我們說過，這將使營業利潤率增加約 125 個基點。它實際上要高一點，即使在扣除擱淺成本後也差不多是 150 個基點。

And then we have another element. We've been deploying some additional restructuring activities within the company because of the continued pressure of COVID. That's going to be a tailwind of about 50 basis points. So when you add that spin accretion plus the other efficiency programs of 50 basis points, that's what gets you from an underlying 25% operating margin in 2022, up to a 27% at our midpoint.

然後我們有另一個元素。由於 COVID 的持續壓力，我們一直在公司內部部署一些額外的重組活動。這將是大約 50 個基點的順風。因此，當您將自旋增長加上其他 50 個基點的效率計劃時，這就是您從 2022 年基本 25% 的營業利潤率到我們的中點的 27% 的原因。

So hopefully, that gives you the big building blocks. Again, headwinds being VBP and input costs, tailwinds being spin and other efficiency.

因此，希望這可以為您提供重要的構建模塊。同樣，逆風是 VBP 和投入成本，順風是旋轉和其他效率。

That's helpful, Suky. Just one last one. What are you assuming for TSA revenues? I understand the stranded cost, I think, $70 million, $75 million-ish. Are there any offset from TSA that's being assumed in the guide?

這很有幫助，蘇基。就最後一張。您對 TSA 的收入有何假設？我理解擱淺的成本，我認為，7000 萬美元，7500 萬美元左右。指南中假設的 TSA 是否有任何偏移？

Yes. We will get some TSA income. We're structuring those pretty much on a cost -- with a slight cost plus. But because we do not see them as core to our business or recurring, we're actually going to be non-GAAP-ing that benefit. So we do not have any benefit in our earnings per share related to TSA income.

是的。我們將獲得一些 TSA 收入。我們幾乎是在成本上構建這些結構——稍微增加一點成本。但是因為我們不將它們視為我們業務的核心或經常性，我們實際上將獲得非公認會計原則的好處。因此，我們在與 TSA 收入相關的每股收益中沒有任何好處。

So just -- I mean, TSA should be equal to the stranded cost, right, 75-ish, Suky?

所以只是 - 我的意思是，TSA 應該等於擱淺成本，對，75 左右，Suky？

I wouldn't say it's a complete 1 for 1 there, Vijay. It will be substantially lower than those stranded costs.

Vijay，我不會說這是一個完整的 1 對 1。這將大大低於那些擱淺的成本。

Our next question comes from Robbie Marcus with JPMorgan.

我們的下一個問題來自摩根大通的 Robbie Marcus。

Great. Two for me. Maybe I'll just ask them both upfront. One, as it relates to the guide, you sort of touched on this, it's flat at the midpoint in a COVID environment. Bryan, should we be thinking that closer to that mid-single-digit growth is off the table as long as a COVID environment still exists?

偉大的。兩個給我。也許我會提前問他們兩個。一，因為它與指南有關，你有點觸及到這一點，它在 COVID 環境的中點是平坦的。布萊恩，我們是否應該認為只要 COVID 環境仍然存在，接近中個位數的增長就不可能了嗎？

And then second question, as I think about RemainCo, how do we think about it if there's any way to give us before the full pro formas are out? Gross margin was a bit disappointing in the quarter. How do we think about the components of operating margin in 2022? Is it much more SG&A-driven? Or are there gross margin improvements as well?

然後是第二個問題，當我想到 RemainCo 時，如果有任何方法可以在完整的備考結束之前給我們，我們如何考慮它？本季度的毛利率有點令人失望。我們如何看待 2022 年營業利潤率的組成部分？是否更多地由 SG&A 驅動？還是毛利率也有提高？

Great. Okay. So I'll start with the question around COVID and our growth rate. And I think it would probably be pretty obvious to most. If we continue to see COVID pressure and staffing pressure kind of at the rate that we're seeing today, yes, it would be very challenging, obviously, for the company to get to mid-single digits. That wouldn't be something that we think is possible in an intense COVID environment.

偉大的。好的。因此，我將從有關 COVID 和我們的增長率的問題開始。我認為這對大多數人來說可能很明顯。如果我們繼續以我們今天看到的速度看到 COVID 壓力和人員配備壓力，是的，顯然，公司要達到中個位數將是非常具有挑戰性的。這不是我們認為在激烈的 COVID 環境中可能發生的事情。

What we do believe is when COVID gets behind us that we absolutely have the building blocks to get there. But in a COVID environment, just given the pressure on elective procedures and given the fact that we have 80% of our revenue built into those elective procedures, it's just not a pathway to get there.

我們確實相信，當 COVID 落後於我們時，我們絕對擁有到達那裡的基石。但在 COVID 環境中，僅考慮到選修程序的壓力以及我們將 80% 的收入納入這些選修程序的事實，這不是實現目標的途徑。

And Robbie, on your question related to the composition of the 27% adjusted operating margin, our midpoint, it's going to be primarily driven by SG&A. The way we see overall gross margin is, as we talked about in the prepared remarks, we ended 2021 at or about our guide, which was roughly in line with the back half of 2020, so just below 71%.

羅比，關於你關於 27% 調整後營業利潤率的構成的問題，我們的中點，它將主要由 SG&A 驅動。正如我們在準備好的評論中談到的那樣，我們看到整體毛利率的方式是，我們在 2021 年結束時達到或接近我們的指南，這與 2020 年下半年大致一致，因此略低於 71%。

From there into 2022, on adjusted gross margins, you've got, of course, some headwinds, tailwinds. The headwinds being the VBP margin pressure I just spoke about with Vijay as well as the input cost inflation that we're seeing, again, that I just talked about.

從那裡到 2022 年，根據調整後的毛利率，你當然會遇到一些逆風和順風。不利因素是我剛剛與 Vijay 談到的 VBP 利潤率壓力以及我們再次看到的投入成本通脹，我剛才談到了。

In addition, lower volumes will also be a slight headwind. Those will be partially offset by some accretion that we see related to the spin. But net-net, I would expect gross margins year-over-year from '21 to '22 to be down. So the bulk of our improvement in adjusted operating margins from '21 into '22, again, will be primarily driven through SG&A.

此外，較低的交易量也將是一個輕微的逆風。這些將被我們看到的與旋轉相關的一些吸積部分抵消。但淨淨值，我預計從 21 年到 22 年的毛利率將同比下降。因此，從 21 年到 22 年，我們調整後的營業利潤率的大部分改善將主要通過 SG&A 推動。

Our next question comes from Steven Lichtman with Oppenheimer & Company.

我們的下一個問題來自 Oppenheimer & Company 的 Steven Lichtman。

Bryan, on ROSA, I was wondering if you could talk a little bit about the pipeline you see ahead. How are you seeing '22 placement opportunities versus '21? And where are we in terms of the buildout of the opportunity pull-through of knee implants following those ROSA placements?

Bryan，在 ROSA 上，我想知道您能否談談您看到的未來管道。您如何看待 '22 與 '21 的安置機會？在這些 ROSA 植入後，我們在膝關節植入物的機會拉動方面處於什麼位置？

Yes. So the -- I would say that the pipeline is really strong, I mean, that's one of the things that has been a positive surprise during this COVID pressure. There has not been a reduction in demand on robotics, which is, to be honest, when we first started, I thought it would be the case, but we just haven't seen it.

是的。所以 - 我會說管道真的很強大，我的意思是，這是在 COVID 壓力期間令人驚喜的事情之一。對機器人技術的需求並沒有減少，說實話，當我們剛開始的時候，我以為會是這樣，但我們只是沒有看到。

We've seen continued pipeline gets stronger. And what we're finding is that, that pull-through is already happening. We always talk about are we placing robotic systems in a competitive account or a friendly account. What I always go back to is every account, for the most part, has some competitive flavor to it. It's not always homogeneous.

我們已經看到持續的管道變得更加強大。我們發現，這種拉動已經在發生。我們總是談論我們是將機器人系統放在競爭賬戶還是友好賬戶中。我總是回顧的是，在大多數情況下，每個帳戶都有一些競爭的味道。它並不總是同質的。

So even in those accounts that we would consider our platinum accounts, when we place a capital system there, a ROSA system there, we absolutely have an opportunity to convert a competitive surgeon because there will be a competitive surgeon that exists in that platinum account. So that's what's exciting about it is the demand is strong. We continue to see it move in the right direction, and that pull-through is already happening.

因此，即使在那些我們會考慮我們的白金賬戶的賬戶中，當我們在那裡放置一個資本系統，一個 ROSA 系統時，我們絕對有機會轉換一位有競爭力的外科醫生，因為在那個白金賬戶中將存在一位有競爭力的外科醫生。因此，令人興奮的是需求強勁。我們繼續看到它朝著正確的方向發展，並且已經發生了突破。

A big proof point to that is just the fact that in the U.S., we reached that 10% of total knees being done robotically. It doesn't sound like much because I know one of our competitors is much further along than that. But that feels like a pretty good start. And the fact is it's just the beginning of the journey. So yes, so the demand is strong, and I would tell you that the pull-through is real, and it's continuing.

一個重要的證據就是在美國，我們達到了 10% 的膝關節是由機器人完成的。這聽起來並不多，因為我知道我們的競爭對手之一遠不止於此。但這感覺是一個很好的開始。事實上，這只是旅程的開始。所以是的，所以需求很強勁，我會告訴你，拉動是真實的，而且還在繼續。

Great. And then just a follow-up on cash. You're clear on the debt paydown expectations near term. Will M&A be muted as a result? Do you still see opportunities for tuck-in deals?

偉大的。然後只是對現金的跟進。您對近期的債務償還預期很清楚。併購會因此而無聲無息嗎？您仍然看到折扣優惠的機會嗎？

Yes. Unfortunately, as we get into the Phase III of our transformation, a big part of Phase III, as we've always talked about, is active portfolio management. And COVID has definitely put a dent in our ability to leverage as much cash as we were hoping to leverage to move that forward.

是的。不幸的是，當我們進入轉型的第三階段時，正如我們一直在談論的那樣，第三階段的很大一部分是積極的投資組合管理。 COVID 無疑削弱了我們利用盡可能多的現金來推動這一進程的能力。

At the same time, even in a pretty cash-constrained environment, we've done a good job of continuing our strategy there. As I mentioned in my prepared remarks, we've done a number of deals, either M&A or partnerships, to ensure that we're building scale in those important faster-growth areas. But we just have not had the amount of firepower we would like, and certainly, that pressure is going to continue.

與此同時，即使在現金相當拮据的環境中，我們在繼續我們的戰略方面也做得很好。正如我在準備好的發言中提到的，我們已經完成了許多交易，無論是併購還是合作，以確保我們在這些重要的快速增長領域建立規模。但我們只是沒有我們想要的火力，而且當然，這種壓力將繼續存在。

Our next question comes from Larry Biegelsen with Wells Fargo.

我們的下一個問題來自富國銀行的拉里·比格爾森。

Bryan, just 2 for me, one on Persona IQ, one on the ASC strategy. Can you talk about what impact you expect Persona IQ to have to revenue in 2022? And the pricing strategy, just remind us again of kind of -- if you -- well, if you're planning to resubmit for the new tech add-on payment. And if not, why?

布萊恩，我只有 2 個，一個關於 Persona IQ，一個關於 ASC 策略。您能否談談您預計 Persona IQ 對 2022 年收入的影響？定價策略，請再次提醒我們——如果你——好吧，如果你打算重新提交新技術附加付款。如果不是，為什麼？

And then just second on the ASC strategy. Just talk -- you've talked about being under-indexed there. What's the plan to change that? And can you grow at or above market in recon before you address this? Or will it be a headwind to growth in the near term?

然後在 ASC 戰略上排名第二。只是談談 - 你已經談到那裡的索引不足。改變它的計劃是什麼？在你解決這個問題之前，你能在偵察市場上增長或高於市場嗎？還是會在短期內阻礙增長？

Sure. So maybe I'll start with the ASC. And believe me, we are already shifting our focus here. We have planned to do it anyway. But obviously, with the results of COVID and pushing more patients to the ASC, we've put that plan on steroids.

當然。所以也許我會從 ASC 開始。相信我，我們已經將重點轉移到了這裡。無論如何，我們都計劃這樣做。但顯然，隨著 COVID 的結果和將更多患者推向 ASC，我們已經將該計劃放在類固醇上。

We've built a -- I guess, first and foremost, a direct selling organization to ensure that we're contracting effectively in that setting. That was almost 0 to 100 people in a relatively short period of time fully dedicated to contracting in the ASC setting. That was probably the first big step.

我們已經建立了一個——我想，首先，一個直銷組織，以確保我們在這種情況下有效地簽約。在相對較短的時間內，幾乎有 0 到 100 人完全致力於在 ASC 環境中進行承包。這可能是邁出的第一步。

Also, driving compensation, right? So operating mechanisms to drive focus there and also compensation to drive focus there. The other thing that we're doing is to make sure that we're filling our product gaps that will give us more presence inside the ASC. That would be like the Relign acquisition in sports, where we had that gap in capital. It would be like Incisive, where we got booms and lights to be able to give more infrastructure to the ASC.

還有，駕駛補償，對吧？因此，驅動焦點的操作機制以及驅動焦點的補償。我們正在做的另一件事是確保我們正在填補我們的產品空白，這將使我們在 ASC 中有更多的存在。這就像在體育領域收購 Relign 一樣，我們在資本上存在差距。就像 Incisive 一樣，我們在那里安裝了吊桿和燈光，以便能夠為 ASC 提供更多的基礎設施。

So those are the things that we're doing right now to be able to get further traction in the ASC, and we're making progress. Do we have more work to do? There's no question. But when I look at our growth in the ASC and I look at our expanding size of our business in ASC, I know that what we're doing today is actually working. So that's ASC.

所以這些是我們現在正在做的事情，以便能夠在 ASC 中獲得進一步的牽引力，我們正在取得進展。我們還有更多工作要做嗎？沒有問題。但是當我看到我們在 ASC 的增長以及我們在 ASC 不斷擴大的業務規模時，我知道我們今天所做的實際上是有效的。這就是 ASC。

On the IQ side, I'll hit maybe the reimbursement question first. We're going to pursue everything we possibly can to try to get incremental reimbursement, but we're not counting on any of it. So our plan today assumes no incremental reimbursement, that this would be captured under DRG that exists today. And that -- even in that, we've built a plan that we think is very favorable to the company.

在智商方面，我可能會先解決報銷問題。我們將盡一切可能嘗試獲得增量報銷，但我們不指望其中任何一個。所以我們今天的計劃假設沒有增量報銷，這將在今天存在的 DRG 下得到體現。而且——即便如此，我們已經制定了一個我們認為對公司非常有利的計劃。

And from a revenue standpoint, maybe you can take a step back, IQ really helps us in what I'm going to define as 3 different ways. One is the obvious revenue contribution that we can get. And that can come through a mix benefit because it's going to be a higher-priced item versus a standard implant, but it can also come from competitive conversions.

從收入的角度來看，也許你可以退後一步，IQ 確實可以幫助我們實現我將定義為 3 種不同的方式。一是我們可以獲得的明顯的收入貢獻。這可以通過混合收益來實現，因為與標準植入物相比，它將是一個價格更高的產品，但它也可以來自競爭性轉換。

Now that's going to be biased to the back half, that revenue impact, because we're not going to move to full launch until the back half. But revenue is clearly one of the variables that are going to help us with IQ.

現在這將偏向於後半部分，即收入影響，因為我們要到後半部分才會全面推出。但收入顯然是幫助我們提高智商的變量之一。

Second one is brand reputation, and this matters. This is going to be able to solidify the fact that we are an innovator in our space. And this matters even if a surgeon is not ready for IQ yet. They want to be married, if you will, to a company that's going to be a leader from an innovation standpoint in their space. So it does matter when people are making decisions on who they're going to be linked to, whether you're innovative or not. So that brand reputation is important to us.

第二個是品牌聲譽，這很重要。這將能夠鞏固我們是我們所在領域的創新者這一事實。即使外科醫生還沒有為智商做好準備，這也很重要。如果你願意的話，他們想嫁給一家從創新角度來看將成為其領域領導者的公司。因此，當人們決定與誰聯繫時，無論你是否具有創新精神，這一點都很重要。因此，品牌聲譽對我們很重要。

And the third one is differentiation. This is going to help us differentiate our ZBEdge ecosystem, that robotics and data ecosystem. I truly do believe that robotics decisions from our customers will be influenced by the ecosystem around robotics, not just robotics by itself.

第三個是差異化。這將幫助我們區分我們的 ZBEdge 生態系統，即機器人技術和數據生態系統。我真的相信，我們客戶的機器人決策將受到圍繞機器人技術的生態系統的影響，而不僅僅是機器人本身。

Remember, robotics just does what you tell it. The data collection will eventually tell you what you should do, and then the robotic system could do it for you. We would just make sure that you deliver on it. So that's the way I think about the impact of IQ, not just revenue, but brand reputation and differentiation as well.

請記住，機器人技術只是按您說的做。數據收集最終會告訴你應該做什麼，然後機器人系統可以為你做。我們只會確保您交付它。所以這就是我思考智商影響的方式，不僅僅是收入，還有品牌聲譽和差異化。

Next question comes from Matt Taylor with UBS.

下一個問題來自瑞銀的馬特泰勒。

So I wanted to ask one about operating margins longer term. Obviously, you changed the timing of the '23 goal. Could you just talk about the trajectory of margins that you foresee occurring with your forward outlook?

所以我想問一個關於長期營業利潤率的問題。顯然，你改變了 23 年進球的時機。您能否談談您預見到的與您的遠期展望相關的利潤率軌跡？

And Suky, I know you've talked about margins as being largely revenue dependent. Maybe talk about the importance of revenue growth for driving margins higher and then also some of the things that you're doing with regards to regional profitability and ERP and how those can play into margin growth going forward as well?

Suky，我知道您曾談到利潤率很大程度上取決於收入。也許談談收入增長對提高利潤率的重要性，然後談談你在區域盈利能力和 ERP 方面所做的一些事情，以及這些如何影響未來的利潤率增長？

Yes, sure. So thanks, Matt, for the question. You're right. We did remove our 30% target by the end of '23 because of the ongoing challenges of COVID and the lack of revenue growth. And if you recall, that margin was largely predicated on 3 building blocks. One of the main one was revenue growth, which, obviously, we're just not seeing come through as we've been talking about.

是的，當然。所以謝謝，馬特，這個問題。你是對的。由於 COVID 的持續挑戰和收入增長乏力，我們確實在 23 年底之前取消了 30% 的目標。如果你還記得的話，這個利潤主要是基於 3 個構建塊。主要之一是收入增長，顯然，我們只是沒有看到我們一直在談論的實現。

I think, longer term, we still do have the opportunity in the near term to expand margins. We're not going to size that at this time because we do still think it's largely going to be revenue dependent because. We have to balance in the mix of efficiency that we're seeing across the company, and that we're driving forward with the right level of investment against the business for long-term growth. Because we do see COVID, eventually, it's temporal. And we want to make sure that we can continue to invest against the very strong pipeline we have and commercial execution to make sure that we can grow value over time, not only in a pandemic world, but most importantly, in the post-pandemic world.

我認為，從長期來看，我們在短期內仍有機會擴大利潤率。我們目前不打算調整規模，因為我們仍然認為這在很大程度上將取決於收入，因為。我們必須平衡我們在整個公司看到的效率組合，並且我們正在推動正確的投資水平與業務的長期增長。因為我們確實看到了 COVID，所以最終它是暫時的。我們希望確保我們可以繼續投資於我們擁有的非常強大的管道和商業執行，以確保我們能夠隨著時間的推移增加價值，不僅在大流行的世界，而且最重要的是，在大流行後的世界.

Some of the key drivers that I would say beyond revenue growth that can help drive margin expansion in the near term is our establishment of global business services or large shared service regional centers, which we planned for in 2020 and actually implemented in '21. That's going to be a key component of that incremental margin expansion I talked about in '22.

除了收入增長之外，我想說的一些關鍵驅動因素可以在短期內幫助推動利潤增長，這是我們建立全球商業服務或大型共享服務區域中心，我們計劃在 2020 年實施，並在 21 年實際實施。這將是我在 22 年談到的增量利潤率擴張的關鍵組成部分。

But then beyond that, the ability to leverage those beachheads are going to be important. You're right, we're making investments into ERP. Those are generally longer term in nature to actually play through and to get those benefits. So I would see that those benefits coming in post 2023.

但除此之外，利用這些灘頭陣地的能力將很重要。你說得對，我們正在對 ERP 進行投資。這些通常是長期的，可以實際發揮並獲得這些好處。所以我會看到這些好處會在 2023 年後出現。

In addition, we continue to look at and our supply chain is always looking at opportunities to optimize and rationalize our overall manufacturing footprint, but also to continue to combat input cost rises through very aggressive procurement. So those are some of the levers I would think of as in the near term in the absence of revenue growth. But no doubt, revenue growth is going to be the key driver to meaningful margin expansion over the mid and long term.

此外，我們繼續關注並且我們的供應鏈一直在尋找機會來優化和合理化我們的整體製造足跡，同時通過非常積極的採購繼續對抗投入成本的上升。所以這些是我認為在短期內沒有收入增長的一些槓桿。但毫無疑問，收入增長將成為中長期利潤率大幅擴張的關鍵驅動力。

Our next question comes from Rick Wise with Stifel.

我們的下一個問題來自 Rick Wise 和 Stifel。

Maybe going back to COVID. Again, it's hard to ask this question because I know there's a million moving pieces. But as you're reflecting on the sort of early headlines of COVID headwinds clearly easing in the Northeast, I mean, new cases are down dramatically. How are you thinking about how the recovery, the post-COVID recovery, unfolds relative to backlog and sort of delayed procedure volumes? Just how are you thinking about it now as you see the reality start to unfold?

也許回到COVID。再說一次，很難問這個問題，因為我知道有一百萬個移動的部件。但是，當您反思東北地區 COVID 逆風明顯緩解的早期頭條新聞時，我的意思是，新病例急劇下降。您如何看待相對於積壓和延遲手術量的恢復，即 COVID 後的恢復？當你看到現實開始展開時，你現在是怎麼想的？

Yes. So I'll give you a sense of how we built it into our forecast and the guidance that Suky just referenced. We actually try not to get too caught up into this whole concept of the cases are dropping from a COVID standpoint because we're still seeing cancellations that are as high as we've seen in a long time. And so there seems to be other reasons, as I referenced in the prepared remarks, on why we're seeing cancellations versus just ICU beds being taken up by COVID patients.

是的。因此，我將讓您了解我們如何將其構建到我們的預測和 Suky 剛剛引用的指導中。實際上，我們盡量不要過於關注從 COVID 的角度來看病例正在下降的整個概念，因為我們仍然看到很長時間以來的取消率很高。因此，正如我在準備好的評論中提到的，似乎還有其他原因，說明為什麼我們看到取消，而不是 COVID 患者僅佔用 ICU 床位。

So we really, at this point, are assuming that the 2022 impact from COVID will look a lot like the '21. Maybe different timing of peaks and valleys, but we expect, at this point, until we see something that tells us that it's going to be different, that you're going to continue to see a peak come down like we're seeing now, and then it's going to go right back up given the new variant. That's the assumption that we have throughout 2022.

因此，在這一點上，我們真的假設 COVID 對 2022 年的影響看起來很像 21 年。也許高峰和低谷的時間不同，但我們預計，在這一點上，直到我們看到一些東西告訴我們它會有所不同，你會繼續看到一個高峰下降，就像我們現在看到的那樣，然後考慮到新的變體，它會立即恢復。這是我們整個 2022 年的假設。

Now if we set that assumption aside, and we say that we see a peak come down into a valley, if you will, and it never comes back, then that -- completely different game. That gives us an opportunity then to get back to those growth rates that we're seeing back in Q4 of 2019.

現在，如果我們把這個假設放在一邊，我們說我們看到一個高峰跌入一個山谷，如果你願意的話，它永遠不會回來，那麼——完全不同的遊戲。這讓我們有機會回到我們在 2019 年第四季度看到的增長率。

Remember, those growth rates we saw back in Q4 of 2019 about 3.2% or so, that was really before Vitality Index was picking up for us. That was just on the beginning of that Vitality Index moving north. So that would be an exciting environment for us. There's no question about it. But just know that what we built into our guidance is that '22, from an overall impact standpoint, is going to look a lot like '21 when it comes to COVID and staffing pressures.

請記住，我們在 2019 年第四季度看到的增長率約為 3.2% 左右，這確實是在活力指數為我們回升之前。那隻是活力指數向北移動的開始。所以這對我們來說將是一個令人興奮的環境。毫無疑問。但要知道，我們在指導中內置的是，從整體影響的角度來看，在 COVID 和人員壓力方面，'22 看起來很像 '21。

Got you. And on ROSA, again, I mean, clearly, you had a terrific year despite some of the challenges. Where are we with the partial knee rollout? Where are we with the hip rollout both launched last year?

得到你。在 ROSA 上，我的意思是，很明顯，儘管面臨一些挑戰，你還是度過了非常棒的一年。我們在哪裡進行部分膝關節展開？我們在哪裡推出了去年推出的臀部？

And maybe as part of your comment, Bryan, about the new product pipeline being stronger than ever, I don't know whether there's a ROSA component there. What's next? What's coming? What are your priorities now to keep this momentum going?

也許作為你評論的一部分，Bryan，關於新產品管道比以往任何時候都更強大，我不知道那裡是否有 ROSA 組件。下一步是什麼？什麼來了？為了保持這種勢頭，您現在的優先事項是什麼？

Yes. So ROSA overall, as I've said before, our primary knee is going really well. The pipeline is as strong as it's been. The pull-through is there. The penetration in our overall procedures is coming up, moving in the direction that we had hoped. I think it will leave and unlock more value when COVID subsides because that is obviously impacting our ability to get procedures even in those accounts where we have ROSA, but it's definitely moving in the right direction.

是的。所以 ROSA 整體上，正如我之前所說的，我們的主膝蓋進展非常順利。管道和以前一樣強大。拉通就在那裡。我們整個程序的滲透正在上升，朝著我們希望的方向前進。我認為，當 COVID 消退時，它會留下並釋放更多價值，因為這顯然會影響我們獲得程序的能力，即使是在我們擁有 ROSA 的那些賬戶中，但它肯定朝著正確的方向發展。

Partial is the same thing. I'll just step back there, too. The partial knee application was an important one for us. Because I think, as most people know, we have a very high market share position in partial knee. So to be able to bring a robotic platform with that application is really important for us, and we have a lot of opportunity then to go to those accounts that are using our partial knee and try to move them to robotics.

部分是一樣的。我也只會退後一步。部分膝關節應用對我們來說很重要。因為我認為，正如大多數人所知，我們在偏膝方面擁有非常高的市場份額。因此，能夠為我們帶來一個帶有該應用程序的機器人平台對我們來說非常重要，我們有很多機會去訪問那些使用我們的部分膝關節並嘗試將它們轉移到機器人技術的帳戶。

And the hip is going well, too. It's really kind of a combination of ROSA Hip and Avenir Complete. One of the fastest growth subcategories of hip, as I think everybody knows now, is direct anterior approach. And both of those, the Avenir Complete as well as the ROSA application that we launched first, goes directly at that fast-growth submarket.

臀部也進展順利。它真的是 ROSA Hip 和 Avenir Complete 的結合。正如我想現在每個人都知道的那樣，髖關節增長最快的子類別之一是直接前路入路。我們首先推出的 Avenir Complete 和 ROSA 應用程序都直接進入了這個快速增長的子市場。

Now later this year, we also have another application that we're going to launch in hip that will go after the posterior approach. So we'll have everything locked up from a hip standpoint. But those are the things that we're pretty excited about. Stepping back from that, just ROSA, I feel really good. I'm not going to get into a lot of the things we're launching that we haven't talked about already, but just some of the things we talked about a lot.

現在，今年晚些時候，我們還將推出另一個應用程序，我們將在髖關節中推出該應用程序，該應用程序將用於後路入路。因此，我們將從時尚的角度鎖定所有內容。但這些都是我們非常興奮的事情。退後一步，只是 ROSA，我感覺非常好。我不會討論我們正在發布的很多我們還沒有談論過的事情，而只是我們談論了很多的一些事情。

Persona Revision, I mean, this is one that has been driving really strong growth for us for 2 years, and we expect that to continue. It's not just the Revision conversion, it's the universe of primary needs that are still competitive where they're using us for Revision. We're going after that business, and there's a real opportunity, again, in the hundreds of millions of dollars for us.

Persona Revision，我的意思是，這已經為我們推動了 2 年的強勁增長，我們預計這種情況會繼續下去。這不僅僅是 Revision 轉換，在他們使用我們進行 Revision 的地方仍然具有競爭力的主要需求領域。我們正在追求這項業務，並且再次為我們提供了數億美元的真正機會。

And then when you look at outside of ROSA, IQ. We're just getting started on Persona IQ, and I talked about the 3 different ways that can bring value. I absolutely expect that to be a true provider of revenue for us. And then ZBEdge, just in total, ZBEdge is getting a lot of traction. It's creating brand awareness for this company to be a leading-edge organization, and that does drive revenue growth for us.

然後，當您查看 ROSA 之外的 IQ 時。我們剛剛開始研究 Persona IQ，我談到了可以帶來價值的 3 種不同方式。我絕對希望這將成為我們真正的收入提供者。然後是 ZBEdge，總的來說，ZBEdge 獲得了很大的吸引力。它正在為這家公司創造品牌知名度，使其成為領先的組織，這確實推動了我們的收入增長。

So those are just a few of the things that we have that we're excited about. And we talked about it, so I'll talk about it again. We have a cementless Persona coming that has a different form factor. They should remove all stops for us to be able to move cementless forward. That has been nascent for us. It's a real opportunity. We're below 10% penetration in cementless, but we have all kinds of headroom associated with that.

所以這些只是我們興奮的一些事情。我們談到了它，所以我會再談一次。我們將推出具有不同外形的無水泥角色。他們應該消除所有的障礙，讓我們能夠在沒有水泥的情況下前進。這對我們來說是新生事物。這是一個真正的機會。我們在非水泥領域的滲透率低於 10%，但我們有各種與之相關的淨空。

And that new form factor coming later this year will open that door as well. So a lot to be excited about for sure. As I referenced before, the pipeline is strong, and we expect our Vitality Index to continue to move in the right direction.

今年晚些時候推出的新外形也將打開這扇門。所以肯定有很多值得興奮的地方。正如我之前提到的，管道很強大，我們預計我們的活力指數將繼續朝著正確的方向發展。

Our next question comes from Chris Pasquale with Guggenheim.

我們的下一個問題來自古根海姆的 Chris Pasquale。

Suky, I want to start just following up on the VBP impact to make sure we're thinking about this right. Are you saying that the dollar impact is going to be the same in '22 versus '21 across hips and knees, and now trauma is included in that as well, but it's just going to be spread out differently throughout the year? And maybe just help us with how the impact was recognized in '21. Did you have anything in the third quarter? Or is it really all packed into the fourth quarter?

Suky，我想開始跟進 VBP 的影響，以確保我們正在考慮這個問題。你是說 22 年和 21 年的美元影響在臀部和膝蓋上是一樣的，現在創傷也包括在其中，但它會在一年中以不同的方式分佈？也許只是幫助我們了解在 21 年如何認識到影響。你在第三季度有什麼事情嗎？還是真的全部打包到第四季度？

Yes. Good question. So we do see, to your first point, overall, the revenue impact, top line impact against recon or large joints and trauma being roughly about the same year-over-year. So again, no material headwind, tailwind based on where we stand today.

是的。好問題。因此，我們確實看到，就您的第一點而言，總體而言，收入影響、對偵察或大關節和創傷的頂線影響與去年同期大致相同。再說一次，根據我們今天的立場，沒有實質性的逆風，順風。

The impact, I said, will be different by quarter. So you really didn't have any impact in Q1 to Q2 of 2021. And so therefore, you've got pricing impact in the first half of this year, '22, which is being compared to a non-VBP first half of '21. So the pressure is going to be more acute on that year-over-year comparison.

我說過，影響會因季度而異。因此，您在 2021 年第一季度至第二季度確實沒有任何影響。因此，您在今年上半年（22 年）對定價產生了影響，與非 VBP 上半年相比21.因此，與去年同期相比，壓力將更加嚴峻。

As you move to the second half, you had a modest level of impact in the third quarter around some inventory contraction, but not material. The really big impact was mostly in Q4. If you think about all the numbers that we provided to you today in some of our earlier commentary, it was worth roughly about 400 basis points of growth in the fourth quarter.

隨著您進入下半年，您在第三季度對一些庫存收縮產生了適度的影響，但不是實質性的。真正的重大影響主要發生在第四季度。如果您考慮一下我們今天在早些時候的一些評論中提供給您的所有數字，那麼第四季度的增長大約值 400 個基點。

So that's where you're going to feel the biggest impact in 2022. This year, it will be more of a tailwind for us because we won't have to cross over that one time that we took in '21. So again, sorry, Chris, a lot of numbers there, if there's -- that, in any way, it's confusing. I can help clarify.

所以這就是你將在 2022 年感受到最大影響的地方。今年，這對我們來說將是一種順風，因為我們不必跨越 21 年的那一次。再說一次，對不起，克里斯，那裡有很多數字，如果有的話——無論如何，這令人困惑。我可以幫忙澄清一下。

Yes. The one thing I will say, from a dollar standpoint relative to revenue, there's that consistency and differences in quarterization of it, but that's consistent. But in margin, it will be more of a negative impact in 2022. And as Suky referenced before, about 50 bps of headwind for us and margin profile due to VBP in 2022.

是的。我要說的一件事是，從相對於收入的美元的角度來看，它的四分之一存在一致性和差異性，但這是一致的。但在利潤率方面，這將在 2022 年產生更多負面影響。正如 Suky 之前提到的，由於 2022 年的 VBP，我們和利潤率狀況將面臨約 50 個基點的逆風。

That is helpful. And then, Bryan, I just wanted to follow up on the cementless opportunity. This was, really, alongside robotics, one of the things you guys were highlighting a few years ago as a significant potential mix driver for you across the Hip and Knee businesses. And it seems like it's gotten off to a much slower start here than we would have thought at that time. What was it about the prior Persona cementless that really didn't allow you to gain as much traction there as you were hoping? And how does this next version fix that?

這很有幫助。然後，布萊恩，我只是想跟進這個無水泥的機會。事實上，這與機器人技術一起，是你們幾年前強調的事情之一，是髖關節和膝關節業務的重要潛在混合驅動因素。似乎它的起步比我們當時想像的要慢得多。之前的 Persona 沒有水泥，是什麼讓你沒有像你希望的那樣獲得盡可能多的牽引力？下一個版本如何解決這個問題？

Yes, it is that, actually. We -- again, we have a form factor that we feel -- we felt confident with that was already kind of in the mix. But when we get it out there in the -- and surgeons look at it, they don't feel as comfortable with the keel design that we want on a go-forward basis.

是的，實際上就是這樣。我們 - 再次，我們有一個我們認為的形式因素 - 我們對已經在混合中感到自信。但是，當我們把它拿出來時——並且外科醫生看著它，他們對我們在前進的基礎上想要的龍骨設計感到不舒服。

And remember, when you're talking cementless, you want to make sure that you really get good contact between the implant and the bone. And as a result of that, we've changed the design of that connection, if you will. And that, talking to surgeons already about the design that's going to be coming, they have a lot more confidence in the safety of that connection. And that's the reason why we changed the form factor.

請記住，當您談論非骨水泥時，您要確保植入物和骨骼之間確實有良好的接觸。因此，如果您願意，我們已經更改了該連接的設計。而且，已經與外科醫生討論了即將到來的設計，他們對這種連接的安全性更有信心。這就是我們改變外形的原因。

So it's not so much our inability to sell cementless in concert, in particular, with robotics, it's more around that form factor and the confidence people have in that form factor to get the feel that they're looking for. And we feel very confident about what we're going to be launching later this year.

因此，與其說我們無法銷售無水泥產品，尤其是機器人技術，更多的是圍繞這種形式因素以及人們對這種形式因素的信心，以獲得他們正在尋找的感覺。我們對今年晚些時候推出的產品充滿信心。

And again, I look at it to say, as much as I'm frustrated by the fact that we have not had the right design, I know one is coming. And I'd probably rather be at the 10% now when I think of future growth opportunities and be able to increase that penetration over time when we do launch that product.

再一次，我看著它說，儘管我對我們沒有正確的設計感到沮喪，但我知道一個即將到來。當我想到未來的增長機會時，我可能更願意現在處於 10%，並且當我們推出該產品時能夠隨著時間的推移增加滲透率。

Our next question comes from Shagun Singh with RBC.

我們的下一個問題來自 RBC 的 Shagun Singh。

I was just wondering if you can talk about trends exiting January and into early February, especially since the U.S. peak, it appears to have occurred around January 13, even though there were regional variations and they continue to be. You did call out seeing more cancellations and also that COVID pressures will continue throughout the year. So I'm just trying to figure out if you can provide more color and if your guidance is realistic or conservative.

我只是想知道您是否可以談論從 1 月到 2 月初的趨勢，特別是自美國高峰以來，它似乎發生在 1 月 13 日左右，儘管存在地區差異並且它們繼續存在。您確實呼籲看到更多的取消，而且 COVID 壓力將在全年持續存在。所以我只是想弄清楚你是否可以提供更多顏色，以及你的指導是現實的還是保守的。

Yes, Shagun. Thanks for the question. This is Suky. So as we said, we provided, I think, pretty good color on Q1, where we expect it to be about flattish, but that includes a 130 basis point tailwind from selling days. So on an underlying basis, it's really down year-over-year.

是的，沙貢。謝謝你的問題。這是蘇琪。因此，正如我們所說，我認為我們在第一季度提供了相當不錯的顏色，我們預計它會持平，但這包括來自銷售日的 130 個基點的順風。因此，從根本上看，它確實是逐年下降。

January was definitely more pressured than what we saw in December exiting 2021. And we continue to see very high cancellation rates coming into the beginning part of February. So we think what we've seen so far continues to support that first quarter color that I talked about.

1 月份的壓力肯定比我們在 2021 年 12 月看到的壓力更大。我們繼續看到 2 月初的取消率非常高。所以我們認為到目前為止我們所看到的繼續支持我談到的第一季度的顏色。

And I think it's important to note that while Omicron cases maybe in some markets starting to -- people are characterizing that as plateauing, there is still a residual effect on staffing shortages, which, in some part, are linked to Omicron. But there are other factors that are driving staffing shortages.

而且我認為重要的是要注意，雖然 Omicron 案件可能在某些市場開始 - 人們將其描述為穩定期，但對人員短缺仍有殘餘影響，這在某種程度上與 Omicron 有關。但還有其他因素導致人員短缺。

So just because we see a decrease in overall Omicron cases does not mean you're going to see a one-for-one reduction in staffing shortages, which continues to be a headwind for us. So short story, everything that we're seeing so far in January and the very beginning of February continues to support that first quarter call we provided.

因此，僅僅因為我們看到整體 Omicron 案件減少並不意味著您會看到一對一的人員短缺減少，這對我們來說仍然是一個不利因素。這麼短的故事，我們在 1 月份和 2 月初看到的一切繼續支持我們提供的第一季度電話會議。

I got it. And then just one other question on operating margins. Maybe you can help us with the cadence if you haven't touched on it. And I'm especially curious with respect to the 150 basis points benefit from the spin. How should we think about the time line there for you to achieve that, especially given the context that you do have higher corporate cost allocations in the near term?

我得到了它。然後是關於營業利潤率的另一個問題。如果你還沒有接觸到它，也許你可以幫助我們調整節奏。我對從旋轉中受益的 150 個基點特別好奇。我們應該如何考慮您實現這一目標的時間線，特別是考慮到您在短期內確實有更高的公司成本分配？

Sure. So on the margin case, it's really -- our margin is very correlated and linked to revenue. And so as we said, revenue will be more pressured in the first half of the year versus the second half of the year, especially because of the pressure we're seeing in the first quarter. And so we would expect margins to follow that same cadence.

當然。所以在保證金的情況下，真的 - 我們的保證金與收入非常相關並與收入掛鉤。正如我們所說，與下半年相比，今年上半年的收入壓力將更大，尤其是因為我們在第一季度看到的壓力。因此，我們預計利潤率將遵循同樣的節奏。

It will be more pressured in the first half, but most acutely in the first quarter, not atypical from what we saw in 2021 regarding seasonality and the impact of COVID. So that's how we see the cadence of that operating margin, again, most acute down in Q1 and then recovery as we move through the rest of the year, with revenue recovery as we talked about.

上半年壓力會更大，但在第一季度壓力最大，這與我們在 2021 年看到的季節性和 COVID 的影響不同。因此，這就是我們如何看待營業利潤率的節奏，再次，在第一季度下降最嚴重，然後隨著我們在今年剩餘時間裡的恢復而恢復，正如我們所談到的那樣，收入恢復。

Relative to the spin, I think you're going to see that 150 basis points start to manifest relatively quickly here in 2022. We have already started to attack some of those corporate stranded costs and are going to continue to fight our way through that. But that's how we see operating margins so far.

相對於旋轉，我認為你會看到 150 個基點在 2022 年開始相對較快地顯現出來。我們已經開始解決一些企業擱淺成本，並將繼續努力克服這一點。但這就是我們迄今為止看到的營業利潤率。

We'll take our next question from Matt Miksic with Credit Suisse.

我們將回答瑞士信貸的 Matt Miksic 的下一個問題。

Just one question, if I could. On the strength in EMEA knees was one question that I thought would be worth fleshing out, if you have just a minute, then I'll just leave it at that.

如果可以的話，只有一個問題。關於歐洲、中東和非洲地區膝蓋的力量是一個我認為值得充實的問題，如果你只有一分鐘，那我就留在這裡。

Yes. I would just say that we see, almost right now, that EMEA seems to be ahead of schedule relative to what we're seeing in the U.S. and other parts of the world. I'm not sure why that is. But you did see some relief that we saw in EMEA because you did see a kind of that downward trend in Omicron.

是的。我只想說，我們幾乎現在就看到，相對於我們在美國和世界其他地區看到的情況，EMEA 似乎提前了。我不確定為什麼會這樣。但是你確實看到了我們在 EMEA 看到的一些緩解，因為你確實看到了 Omicron 的一種下降趨勢。

And also, you're seeing some policy shifts, which I think is going to be really important on a go-forward basis, where you've got countries like the U.K. and Spain and others that are looking at this to say, "Listen, Omicron is acting more like an endemic phase now, and we're going to change some of our restrictions associated with COVID." And I think that those policy changes are going to be an important factor in COVID eventually getting behind us.

而且，您會看到一些政策轉變，我認為這在向前發展的基礎上非常重要，英國和西班牙等國家以及其他正在關注此事的國家會說：“聽著，Omicron 現在的行為更像是一個流行階段，我們將改變一些與 COVID 相關的限制。”而且我認為這些政策變化將成為 COVID 最終落後於我們的一個重要因素。

It's not just COVID itself, but it's going to have to be these policy shifts that we're seeing kind of led right now by Europe. That would be something we'd like to see across the world actually. But that's the only thing I could probably point out is that just a little bit ahead of the curve in COVID impact than the rest of the world.

不僅僅是 COVID 本身，而且我們現在看到的這些政策轉變必須是由歐洲主導的。實際上，這將是我們希望在世界各地看到的東西。但這是我唯一可能指出的一點，即在 COVID 影響方面比世界其他地區稍微領先一點。

That concludes today's question-and-answer session.

今天的問答環節到此結束。

Yes. No, thank you. I think it was the last question. I can jump in here and just close out. So thank you, everybody, for joining. If you have questions that you didn't get asked or answered, please feel free to reach out to the IR team. I know we're speaking to many of you today, tomorrow and this week, but we're always available.

是的。不，謝謝。我想這是最後一個問題。我可以跳進去然後關閉。所以，謝謝大家的加入。如果您有沒有被問到或回答的問題，請隨時與 IR 團隊聯繫。我知道我們今天、明天和本週將與你們中的許多人交談，但我們隨時待命。

Also, just a reminder that the ZimVie Investor Day is beginning at 11 a.m. Eastern Time. Information to join that webcast and the materials are posted on the IR page of our website. And of course, if you have any questions on that front, please feel free to reach out to the IR team as well.

另外，提醒一下 Zimvie 投資者日從東部時間上午 11 點開始。加入該網絡廣播的信息和材料發佈在我們網站的 IR 頁面上。當然，如果您在這方面有任何疑問，也請隨時與 IR 團隊聯繫。

Thank you, everyone, for joining today, and have a good day.

謝謝大家今天的加入，祝您有美好的一天。

Thank you again for participating in today's conference call. You may now disconnect.

再次感謝您參加今天的電話會議。您現在可以斷開連接。