Becker's Spine Review

24 DEVICES & IMPLANTS Zimmer Biomet's worldwide knee sales plummet 46.8% in Q2, hitting $374M By Angie Stewart Zimmer Biomet reported sharp sales declines across all product categories in the second quarter. Eight takeaways from the company's latest earnings re- port: 1. Zimmer's net sales were $1.23 billion in the second quarter, down 38.3 percent from the same period in 2019. 2. Zimmer recorded a net loss of $206.6 million in the second quarter, with adjusted net earnings of $10.2 mil- lion. Second-quarter diluted loss per share was $1. Diluted earnings per share dropped 97.4 percent year over year, hitting $0.05. 3. In the Americas, net sales from knee products were $221 million, down 46.7 percent year over year. Total net sales from knees were down 46.8 percent year over year at $374.2 million. 4. Hip product net sales in the Americas were $170.7 mil- lion, representing a milder year-over-year decline of 32.6 percent. e global decrease for hips was 31.1 percent, leaving Zimmer with $329.7 million in overall net sales for that category in the second quarter. 5. e sports medicine, extremities and trauma category saw a 29.2 percent year-over-year drop in net sales, ending the second quarter with $252.6 million. Net sales for den- tal, spine and craniomaxillofacial and thoracic products were down nearly 38 percent at $182.5 million. 6. In the second quarter, Zimmer used $52.8 million of net cash in operating activities. Zimmer ended the quar- ter with $713.4 million in cash and cash equivalents on its balance sheet. 7. e company paid $49.6 million in dividends and de- clared a dividend of $0.24 per share in the second quarter, when it also refinanced $1.5 billion in debt due April 1. By renegotiating terms of its $1.5 billion revolver, Zimmer secured an additional $1 billion credit facility with no out- standing borrowings. 8. COVID-19 caused a worldwide decline in elective pro- cedure volumes, hurting Zimmer Biomet's performance in the three months ended June 30 and leading the compa- ny to pull its full-year guidance. To position itself for long- term growth amid lingering fallout from the pandemic, Zimmer is "investing aggressively" in primary growth initiatives, as well as research and development programs, according to President and CEO Bryan Hanson. n Augmented reality in spine — Where we stand and what's to come By Alan Condon A ugmented reality-assisted spine surgery became a reality in June when two neurosurgeons from Johns Hopkins Medicine in Baltimore performed a pair of spine proce- dures with a new FDA-approved device. Six things to know about AR in spine: 1. Neurosurgeons Daniel Sciubba, MD, and Timothy Witham, MD, performed the first AR-assisted spine surgeries with the Augmed- ics Xvision Spine System, which allows for real-time 3D visualiza- tion of the spinal anatomy during surgery. 2. Augmedics, a Chicago-based startup, received FDA clearance for its Xvision Spine System in December, and plans to research additional surgical applications for the system. 3. The system features a headset designed to function as if the surgeon has X-ray vision into the patient's anatomy to accurately navigate instru- ments and implants while looking at the patient instead of a screen. 4. Nevada spinal neurosurgeon James Lynch, MD, was reported- ly the first physician in private practice to use the Xvision Spine System. "It has all the advantages of a neuronavigation platform, yet it's more cost-effective for hospitals and ambulatory surgery centers, especially in this current climate." 5. Interest in AR has grown significantly in spine over the past de- cade, coming from a desire to limit complications associated with instrumented spine surgery and improve procedural efficiency. 6. The accuracy and reproducibility of the technology will become more evident over time, according to Mark Mikhael, MD, of NorthShore Or- thopaedic Institute and Illinois Bone & Joint Institute in Chicago. Future applications may seek to further improve its navigational capabilities and facilitate the placement of pedicle screws with robotic systems. n Louisiana hospital surpasses 1,000 robotic surgeries in under 2 years By Alan Condon C ovington, La.-based Avala Hospital has completed more than 1,000 robotic surgeries in less than two years, accord- ing to a July 15 news release. Three things to know: 1. In 2018, the hospital acquired three surgical robots — two Mako systems for hip and knee replacement procedures and the Excel- siusGPS system for spine surgery. 2. This year, it added a third Mako robot to its collection. 3. K. Samer Shamieh, MD, serves as medical director and lead spine surgeon for Avala. n

• Cover