A month has gone by since the last earnings report for Zimmer Biomet (ZBH). Shares have lost about 7.2% in that time frame, underperforming the S&P 500.Will the recent negative trend continue leading up to its next earnings release, or is Zimmer due for a breakout? Before we dive into how investors and analysts have reacted as of late, let's take a quick look at its most recent earnings report in order to get a better handle on the important drivers. Zimmer Biomet Q1 Sales Up Y/YZimmer Biomet posted first-quarter 2021 adjusted earnings per share (EPS) of $1.71, beating the Zacks Consensus Estimate by 13.2%. The figure edged past the year-ago adjusted number by 0.6% year over year.The quarter’s adjustments include certain inventory amortization, restructuring, quality remediation, acquisition, integration, and related costs among others.On a reported basis, the company registered earnings of 94 cents per share against loss of $2.46 a year ago.Revenue DetailsFirst-quarter net sales of $1.85 billion were up 3.6% (up 0.8% at constant exchange rate or CER) year over year. The figure exceeded the Zacks Consensus Estimate by 6.3%.Segmental DetailsDuring the first quarter, sales generated in the Americas totaled $1.12 billion (up 13% year over year at CER) while the same in EMEA (Europe, the Middle East and Africa) grossed $384.2 million (down 10.3% year over year at CER). Asia-Pacific registered 15.5% rise at CER to $348.2 million.SegmentsSales in the Knees unit declined 5.2% year over year at CER to $614.3 million. Hips recorded a 0.3% improvement at CER to $447 million. Revenues in the S.E.T. (Sports Medicine, Extremities and Trauma) unit increased 7.2% year over year to $417.6 million.Among other segments, Dental & Spine rose 9.6% at CER to $246 million. Other revenues were down 2.5% to $122.5 million.For investors’ note, CMFT (Craniomaxillofacial and Thoracic) products, previously reported in the Dental, Spine & CMFT category, are now included in the S.E.T. category. Meanwhile, the company is progressing with the planned spin-off procedure of the dental & spine arm.MarginsGross margin, after excluding intangible asset amortization, was 72%, reflecting a contraction of 65 basis points (bps) in the first quarter. Selling, general and administrative expenses were down 7.1% to $770.1 million. Research and development expenses declined 4.1% to $94.4 million. Adjusted operating margin expanded 454 bps to 25.3% during the quarter.Cash PositionZimmer Biomet exited the first quarter of 2021 with cash and cash equivalents of $724.3 million compared with $802.1 million at fourth-quarter end. Long-term debt at the end of the reported quarter totaled $7.54 billion compared with $7.63 billion at the end of the sequentially-last quarter.Cumulative net cash provided by operating activities at the end of the first quarter was $246.5 million compared with $450.9 million in the year-ago period.2021 GuidanceThis time, the company provided its financial guidance for 2021.Reported revenue growth is expected in the range of 14% to 17% compared with the last year.Adjusted EPS for the full year is expected in the range of $7.60 to $8.00.The Zacks Consensus Estimate for 2021 adjusted earnings is pegged at $7.65 on revenues of $7.94 billion.How Have Estimates Been Moving Since Then?In the past month, investors have witnessed an upward trend in estimates revision.VGM ScoresCurrently, Zimmer has a nice Growth Score of B, however its Momentum Score is doing a bit better with an A. Charting a somewhat similar path, the stock was allocated a grade of B on the value side, putting it in the top 40% for this investment strategy.Overall, the stock has an aggregate VGM Score of A. If you aren't focused on one strategy, this score is the one you should be interested in.OutlookEstimates have been broadly trending upward for the stock, and the magnitude of these revisions looks promising. Notably, Zimmer has a Zacks Rank #3 (Hold). We expect an in-line return from the stock in the next few months.Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report Zimmer Biomet Holdings, Inc. (ZBH): Free Stock Analysis Report To read this article on Zacks.com click here.