Paragon 28 (FNA) 10-Q 4 May 23 2023 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2023	Apr. 28, 2023
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q1
Trading Symbol	FNA
Entity Registrant Name	Paragon 28, Inc.
Entity Central Index Key	0001531978
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Current Reporting Status	Yes
Entity Common Stock, Shares Outstanding		82,319,020
Entity Interactive Data Current	Yes
Entity Shell Company	false
Entity File Number	001-40902
Entity Tax Identification Number	27-3170186
Entity Address, Address Line One	14445 Grasslands Drive
Entity Address, City or Town	Englewood
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80112
City Area Code	720
Local Phone Number	1332
Title of 12(b) Security	Common stock, $0.01 par value per share
Security Exchange Name	NYSE
Entity Incorporation, State or Country Code	DE
Document Quarterly Report	true
Document Transition Report	false

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Current assets:
Cash	$ 85,883	$ 38,468
Trade receivables	37,262	37,687
Inventories, net	69,174	60,948
Income taxes receivable	596	615
Other current assets	4,167	4,658
Total current assets	197,082	142,376
Property and equipment, net	66,810	61,938
Intangible assets, net	22,137	22,387
Goodwill	25,465	25,465
Deferred income taxes	354	148
Other assets	1,697	1,795
Total assets	313,545	254,109
Current liabilities:
Accounts payable	20,538	14,939
Accrued expenses	25,446	26,807
Accrued legal settlement	13,000	22,000
Other current liabilities	3,772	3,844
Current maturities of long-term debt	690	728
Income taxes payable	208	184
Total current liabilities	63,654	68,502
Long-term liabilities:
Long-term debt net, less current maturities	42,204	42,182
Other long-term liabilities	1,523	1,628
Deferred income taxes	377	342
Income taxes payable	635	527
Total liabilities	108,393	113,181
Commitments and contingencies (Note 12)
Stockholders' equity:
Common stock, $0.01 par value, 300,000,000 shares authorized; 83,220,392 and 78,684,107 shares issued, and 82,306,873 and 77,770,588 shares outstanding as of March 31, 2023 and December 31, 2022,respectively	821	776
Additional paid in capital	287,286	213,956
Accumulated deficit	(76,841)	(67,789)
Accumulated other comprehensive loss	(132)	(33)
Treasury stock, at cost; 913,519 shares as of March 31, 2023 and December 31, 2022	(5,982)	(5,982)
Total stockholders' equity	205,152	140,928
Total liabilities & stockholders' equity	$ 313,545	$ 254,109

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Mar. 31, 2023	Dec. 31, 2022
Common stock par value	$ 0.01	$ 0.01
Common stock share authorized	300,000,000	300,000,000
Common stock share issued	83,220,392	78,684,107
Common stock shares, outstanding	82,306,873	77,770,588
Treasury stock share issued	913,519	913,519

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Net revenue	$ 52,036	$ 41,371
Cost of goods sold	8,906	6,791
Gross profit	43,130	34,580
Operating expenses
Research and development costs	7,049	5,773
Selling, general, and administrative	43,820	37,242
Total operating expenses	50,869	43,015
Operating loss	(7,739)	(8,435)
Other expense
Other expense	(179)	(101)
Interest expense, net	(1,205)	(668)
Total other expense	(1,384)	(769)
Loss before income taxes	(9,123)	(9,204)
Income tax (benefit) expense	(71)	32
Net loss	(9,052)	(9,236)
Foreign currency translation adjustment	(99)	(324)
Comprehensive loss	$ (9,151)	$ (9,560)
Weighted average number of shares of common stock outstanding:
Basic	80,681,715	76,447,454
Diluted	80,681,715	76,447,454
Net loss per share attributable to common stockholders:
Basic	$ (0.11)	$ (0.12)
Diluted	$ (0.11)	$ (0.12)

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in-Capital	Accumulated Deficit	Accumulated Other Comprehensive Loss	Treasury Stock
Beginning balance, shares at Dec. 31, 2021		76,447,287
Beginning balance at Dec. 31, 2021	$ 192,194	$ 763	$ 197,868	$ (463)	$ 8	$ (5,982)
Net loss	(9,236)			(9,236)
Offering costs associated with initial public offering	(266)		(266)
Options exercised, shares		1,875
Options exercised	12		12
Foreign currency translation	(324)				(324)
Stock-based compensation	2,122		2,122
Ending balance, shares at Mar. 31, 2022		76,449,162
Ending balance at Mar. 31, 2022	184,502	$ 763	199,736	(9,699)	(316)	(5,982)
Beginning balance, shares at Dec. 31, 2022		77,770,588
Beginning balance at Dec. 31, 2022	140,928	$ 776	213,956	(67,789)	(33)	(5,982)
Net loss	(9,052)			(9,052)
Issuance of common stock, shares		4,312,500
Issuance of common stock	$ 68,449	$ 43	68,406
Options exercised, shares	223,785	223,785
Options exercised	$ 1,622	$ 2	1,620
Foreign currency translation	(99)				(99)
Employee stock purchase plan	122		122
Stock-based compensation	3,182		3,182
Ending balance, shares at Mar. 31, 2023		82,306,873
Ending balance at Mar. 31, 2023	$ 205,152	$ 821	$ 287,286	$ (76,841)	$ (132)	$ (5,982)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($)
Common Stock
Issuance costs	$ 831

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cash flows from operating activities
Net loss	$ (9,052)	$ (9,236)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	3,117	3,030
Allowance for doubtful accounts		600
Provision for (reversal of) excess and obsolete inventories	293	(643)
Stock-based compensation	3,182	2,122
Other	180	387
Changes in other assets and liabilities, net of acquisitions:
Accounts receivable	441	(2,240)
Inventories	(8,435)	(2,329)
Accounts payable	5,592	(1,178)
Accrued expenses	(877)	(682)
Accrued legal settlement	(9,000)
Income tax receivable/payable	132	669
Other assets and liabilities	367	(3)
Net cash used in operating activities	(14,060)	9,503
Cash flows from investing activities
Purchases of property and equipment	(7,521)	(23,036)
Proceeds from sale of property and equipment	223	305
Purchases of intangible assets	(254)	(704)
Acquisition of Disior, net of cash received		(18,201)
Net cash used in investing activities	(7,552)	(41,636)
Cash flows from financing activities
Proceeds from draw down on term loan		20,000
Proceeds from issuance of long-term debt		16,000
Payments on long-term debt	(197)	(37)
Payments of debt issuance costs	(7)	(405)
Proceeds from issuance of common stock, net of issuance costs	68,449
Proceeds from exercise of stock options	1,622	12
Payments on earnout liability	(500)
Net cash provided by financing activities	69,367	35,570
Effect of exchange rate changes on cash	(340)	(136)
Net increase (decrease) in cash	47,415	(15,705)
Cash at beginning of period	38,468	109,352
Cash at end of period	85,883	93,647
Supplemental disclosures of cash flow information:
Cash paid for interest	601	273
Purchase of property and equipment included in accounts payable	$ 4,026	$ 1,804

Business and Basis of Presentat

Business and Basis of Presentation	3 Months Ended
	Mar. 31, 2023
Accounting Policies [Abstract]
Business and Basis of Presentation	NOTE 1. BUSINESS AND BASIS OF PRESENTATION Business Paragon 28, Inc. (collectively with its subsidiaries, “we”, “us”, “our”, “P28” or the “Company”) develops, distributes, and sells medical devices in the foot and ankle segment of the orthopedic implant marketplace. Our approach to product development is procedurally focused, resulting in a full range of procedure-specific foot and ankle products designed specifically for foot and ankle anatomy. Our products and product families include plates and plating systems, screws, staples, and nails aimed to address all major foot and ankle procedures including fracture fixation, forefoot or hallux valgus - which includes bunion and hammertoe, ankle, flatfoot or progressive collapsing foot deformity ("PCDF"), charcot foot and orthobiologics. P28 is a United States (“U.S.”) based company incorporated in the State of Delaware, with headquarters in Englewood, Colorado. Our sales representatives and distributors are located globally with the majority concentrated in the U.S., Australia, South Africa, and the United Kingdom. Basis of Presentation and Consolidation The accompanying Condensed Consolidated Financial Statements include the accounts of Paragon 28, Inc. and its subsidiaries, all of which are wholly-owned. The accompanying Condensed Consolidated Financial Statements have been prepared in conformity with accounting principles generally accepted in the U.S. (“U.S. GAAP”) and pursuant to the rules and regulations of the U.S. Securities and Exchange Commission (“SEC”) for interim financial information. Accordingly, they do not include all of the information required by U.S. GAAP for complete financial statements. The interim Condensed Consolidated Financial Statements reflect all adjustments that are of a normal recurring nature and that are considered necessary for a fair representation of the results for the periods presented and should be read in conjunction with the audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2022, which include a complete set of footnote disclosures, including our significant accounting policies. The audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2022 are included in the Company’s Annual filing on Form 10-K filed with the SEC on March 2, 2023. The results for interim periods are not necessarily indicative of the results that may be expected for a full fiscal year or for any other future period. All intercompany balances and transactions have been eliminated in consolidation.

Summary of Significant Accounti

Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	NOTE 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Use of Estimates The preparation of the financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Because future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Any changes in these estimates will be reflected in the Company’s Condensed Consolidated Financial Statements. Significant items subject to such estimates and assumptions include the determination of the collectability of trade receivables, inventory obsolescence, impairment of long-lived assets, recoverability of goodwill and intangible assets, contingent earn-out liabilities, income taxes and stock-based compensation. Foreign Currency Translation The Condensed Consolidated Financial Statements are presented in U.S. dollars. The Company’s non-U.S. subsidiaries have a functional currency (i.e., the currency in which operational activities are primarily conducted) that is other than the U.S. dollar, generally the currency of the country in which such subsidiaries are domiciled. Such subsidiaries’ assets and liabilities are translated into U.S. dollars at quarter-end exchange rates, while revenue and expenses are translated at average exchange rates during the quarter based on the daily closing exchange rates. Adjustments that result from translating amounts from a subsidiary’s functional currency to U.S. dollars are reported in Accumulated Other Comprehensive Loss, net of tax. Business Combinations We allocate the purchase consideration to the identifiable net assets acquired, including intangible assets and liabilities assumed, based on estimated fair values at the date of the acquisition. The excess of the fair value of the purchase consideration over the fair value of the identifiable assets and liabilities, if any, is recorded as goodwill. During the measurement period, which is up to one year from the acquisition date, we may adjust provisional amounts that were recognized at the acquisition date to reflect new information obtained about facts and circumstances that existed as of the acquisition date. Determining the fair value of assets acquired and liabilities assumed requires significant judgment, including the selection of valuation methodologies including the income approach, the cost approach, and the market approach. Significant assumptions used in those methodologies include, but are not limited to, the expected values of the underlying metric, the systematic risk embedded in the underlying metric, the volatility of the underlying metric, the risk-free rate, and the counterparty risk. The use of different valuation methodologies and assumptions is highly subjective and inherently uncertain and, as a result, actual results may differ materially from estimates. Trade Receivables, Less Allowance for Doubtful Accounts The Company estimates an allowance for doubtful accounts based upon an evaluation of the current status of receivables, historical experience, and other factors as necessary. It is reasonably possible that the Company’s estimate of the allowance for doubtful accounts will change. As of March 31, 2023 and December 31, 2022 , the allowance for doubtful accounts was not material. Inventories, Net The Company estimates a reserve for obsolete and slow-moving inventory based on current inventory levels, historical sales and future projected demand. Charges (benefit) for excess and obsolete inventory are included in Cost of goods sold and were $ 293 and $( 643 ) for the three months ended March 31, 2023 and 2022 , respectively. The inventory reserve was $ 17,117 and $ 16,804 as of March 31, 2023 and December 31, 2022 , respectively. Intangibles The costs associated with applying for patents and trademarks are capitalized. Patents are amortized on a straight-line basis over the lesser of the patent’s economic or legal life, which is seventeen years . Costs associated with capitalized patents include third-party attorney fees and other third-party fees as well as costs related to the following: the preparation of patent applications, government filings and registration fees, drawings, computer searches, and translations related to specific patents. Trademarks that are anticipated to be renewed every ten years have an indefinite life and are not amortized but tested for impairment annually. Once it is determined a trademark will no longer be renewed, the trademark is amortized over the remainder of the trademark’s registration period. Customer relationships are amortized over an estimated useful life of three to seven years on a straight-line basis. Other intangibles, which mainly consist of noncompete arrangements, are amortized over an estimated useful life of three years on a straight-line basis. Developed technology is amortized over an estimated useful life of twelve years on a straight-line basis. Amortizable intangible assets are assessed for impairment upon triggering events that indicate that the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to future net undiscounted cash flows expected to be generated by the associated asset. If the asset’s carrying value is determined to not be recoverable, the impairment to be recognized is measured by the amount by which the carrying amount exceeds the fair market value of the intangible assets. No impairment charges were recorded in any of the periods presented. Indefinite-lived trademark assets are reviewed for impairment annually or whenever events or changes in circumstances indicate that the carrying value of an asset may not be recoverable. The Company can elect to first apply the optional qualitative impairment assessment to determine whether the indefinite-lived intangible asset is more-likely-than-not impaired. If, on the basis of the qualitative impairment assessment, an entity asserts that it is more likely than not that the indefinite-lived intangible asset is impaired, the Company would be required to calculate the fair value of the asset for an impairment test. Impairment loss is recognized if the carrying amount of the asset exceeds its fair value. A qualitative assessment considers macroeconomic and other industry-specific factors, such as trends in short-term and long-term interest rates and the ability to access capital, and company specific factors such as trends in revenue generating activities, and merger or acquisition activity. If the Company elects to bypass qualitatively assessing its indefinite-lived intangible assets, or it is not more likely than not that the fair value of the intangible asset exceeds its carrying value, management estimates the fair value of the intangible asset and compares it to the carrying value. The estimated fair value of the intangible asset is established using an income approach based on a discounted cash flow model that includes significant assumptions about the future operating results and cash flows of the intangible asset or assets. Goodwill Goodwill represents the excess of the purchase price as compared to the fair value of net assets acquired and liabilities assumed. Goodwill is not amortized, but is tested for impairment annually or when indications of impairment exist. We can elect to qualitatively assess goodwill for impairment if it is more likely than not that the fair value of a reporting unit exceeds its carrying value. Impairment exists when the carrying amount, including goodwill, of the reporting unit exceeds its fair value, resulting in an impairment charge for this excess (not to exceed the carrying amount of the goodwill). Our annual impairment testing date is October 1. The impairment, if determined, is recorded within Operating expenses in the Condensed Consolidated Statements of Operations and Comprehensive Loss in the period the determination is made. There were no impairments recorded during the periods presented. Contingent Earn-out Consideration Business combinations may include contingent earn-out consideration as part of the purchase price under which the Company will make future payments to the seller upon the achievement of certain milestones. The fair value of the contingent earn-out consideration is estimated as of the acquisition date at the present value of the expected contingent payments and is subsequently remeasured at each balance sheet date. Two methodologies may be considered in the valuation: the scenario-based model (“SBM”) and Monte Carlo simulation. The SBM relies on multiple outcomes to estimate the likelihood of future payoff of the contingent consideration. The resulting earnout payoff is then probability-weighted and discounted at an appropriate risk adjusted rate in order to arrive at the present value of the expected earnout payment. The Monte Carlo simulation is used to value the non-linear contingent considerations based on projected financial metrics. Each trial of the Monte Carlo simulation draws a value from the assumed distribution for the underlying metric. The earnout payoff for each simulation trial is calculated based on that particular simulated path for the underlying metrics and then discounted to present value using the risk-free rate, adjusted for counterparty credit risk. The value of the earnout is estimated as the average value from all simulation trials. The fair value estimates use unobservable inputs that reflect our own assumptions as to the ability of the acquired business to meet the targeted benchmarks and discount rates used in the calculations. The unobservable inputs are defined in ASC Topic 820, “Fair Value Measurements and Disclosures,” as Level 3 inputs. We review the probabilities of achievement of the earnout milestones to determine impact on the fair value of the earnout consideration on a quarterly basis over the earn-out period. Actual results are compared to the estimates and probabilities of achievement used in our forecasts. Should actual results of the acquired business increase or decrease as compared to our estimates and assumptions, the estimated fair value of the contingent earn-out consideration liability will increase or decrease, up to the contractual limit, as applicable. Changes in the estimated fair value of the contingent earn-out consideration are recorded in Other expense in the Consolidated Statements of Operations and Comprehensive Loss and are reflected in the period in which they are identified. Changes in the estimated fair value of the contingent earn-out consideration may materially impact or cause volatility in our operating results. Revenue Recognition Re venue is recorded, net of estimated losses for bad debts, when our performance obligation is satisfied which is when our customers take title of the product, and typically when the product is used in surgery. As such, the timing of revenue recognition may differ from the timing of invoicing to our customers. We have recorded unbilled accounts receivable related to this timing difference of $ 3,657 and $ 4,511 as of March 31, 2023 and December 31, 2022 , respectively. Recently Adopted Accounting Pronouncements In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”), which requires entities to estimate all expected credit losses for certain types of financial instruments, including trade receivables, held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. The updated guidance also expands the disclosure requirements to enable users of financial statements to understand the entity’s assumptions, models and methods for estimating expected credit losses over the entire contractual term of the instrument from the date of initial recognition of that instrument. ASU 2016-13, as subsequently amended for various technical issues, is effective for emerging growth companies following private company adoption dates for fiscal years, and for interim periods within those fiscal years, beginning after December 15, 2022, with early adoption permitted. The Company adopted ASU 2016-13 effective January 1, 2023 . The adoption of this guidance did not have a significant impact on the Company's Condensed Consolidated Financial Statements and related disclosures. In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) (“ASU 2019-12”), which is part of the FASB’s overall simplification initiative to reduce the costs and complexity of applying accounting standards while maintaining or improving the usefulness of the information provided to users of financial statements. ASU 2019-12 simplifies accounting guidance for intra-period allocations, deferred tax liabilities, year-to-date losses in interim periods, franchise taxes, step-up in tax basis of goodwill, separate entity financial statements, and interim recognition of tax laws or rate changes. ASU 2019-12 is effective for emerging growth companies following private company adoption dates in fiscal years beginning after December 15, 2021, and interim periods within fiscal years beginning after December 15, 2022, with early adoption permitted. The Company adopted ASU 2019-12 effective January 1, 2023 . The adoption of this guidance did not have a significant impact on the Company's Condensed Consolidated Financial Statements and related disclosures.

Business Combination

Business Combination	3 Months Ended
	Mar. 31, 2023
Business Combinations [Abstract]
Business Combination	NOTE 3. BUSINESS COMBINATION On January 10, 2022 ("Disior Acquisition Date"), the Company entered into a Securities Purchase Agreement (“SPA”) with Disior LTD. (“Disior”) and acquired 100 % of the outstanding equity of Disior (the "Disior Acquisition"). Disior is a leading three-dimensional analytics pre-operative planning software company based in Helsinki, Finland, focused on the complex foot and ankle anato my. The Disior Acquisition allowed the Company to broaden its capabilities within the pre-operative and intra-operative stages of the foot and ankle care and expand the Company's Smart 28 ecosystem. The aggregate purchase price of the Disior Acquisition was approximately $ 26,246 inclusive of an earn-out provision with a fair value of $ 6,550 and certain net working capital adjustments and deferred payments totaling a net payable of $ 222 . The SPA provided for potential earn-out consideration to the seller in connection with the achievement of certain milestones with various expiration dates through the second anniversary of the Disior Acquisition Date. The earn-out has a maximum payment not to exceed $ 8,000 in the aggregate. If an individual milestone is not met by the specified milestone expiration date, the earn-out related to that specific milestone will not be paid. The acquisition was primarily funded by a $ 20,000 draw on the Company's term loan. The Company has accounted for the acquisition of Disior under ASC Topic 805, Business Combinations (“ASC 805”). Disior’s results of operations are included in the Condensed Consolidated Financial Statements beginning after January 10, 2022, the Disior Acquisition Date. The following table summarizes the purchase price: Consideration paid Cash consideration $ 19,696 Contingent consideration 6,550 Total consideration $ 26,246 Acquisition-related costs, which consisted of fees incurred for advisory, legal, and accounting services, were $ 761 during the year ended December 31, 2022 and were included in Selling, general and administrative expenses in the Company’s Consolidated Statements of Comprehensive Loss. No such acquisition costs were incurred during the three months ended March 31, 2023. The following table summarizes the fair values of the assets acquired and liabilities assumed as of the Disior Acquisition Date: Assets acquired: Cash and cash equivalents $ 1,192 Other current assets 410 Intangible assets 6,800 Goodwill 19,136 Total assets acquired 27,538 Liabilities assumed: Accruals and other current liabilities 615 Deferred tax liabilities, net 677 Total liabilities assumed 1,292 Net assets acquired $ 26,246 Identified intangible assets consist of tradenames and developed technology. The fair value of each were determined with the assistance of an external valuation specialist using a combination of the income, market, cost approach, and relief from royalty rate method, in accordance with ASC 805. The purchase consideration was allocated to the identifiable net assets acquired based on estimated fair values at the date of the acquisition. The excess of the fair value of the purchase consideration over the fair value of the identifiable assets and liabilities, if any, was recorded as goodwill. The goodwill is attributable to the expected synergies with the Company’s existing operations. The useful life on intangible assets was determined by management to be in line with the Company’s policy on intangible assets. Both determinations are outlined in the table below: Fair Value Estimated Useful Life Developed technology $ 6,400 12 Tradenames 400 Indefinite $ 6,800 The entire amount of the purchase price allocated to goodwill will not be deductible for income tax purposes under the Finnish Income Tax Act.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	NOTE 4. GOODWILL AND INTANGIBLE ASSETS Goodwill As of March 31, 2023 and December 31, 2022 , goodwill was $ 25,465 for each period. Intangibles Intangible assets as of March 31, 2023 were as follows: Estimated Useful Life Gross Carrying Amount Accumulated Amortization Net Carrying Amount Trademarks and tradenames, indefinite-lived Indefinite $ 921 $ — $ 921 Patents, definite-lived 18 6,906 2,439 4,467 Customer relationships 3 - 7 1,733 352 1,381 Developed technology 12 17,690 2,333 15,356 Other intangibles 3 30 18 12 Total intangible assets, net $ 27,280 $ 5,142 $ 22,137 Intangible assets as of December 31, 2022, were as follows: Estimated Useful Life Gross Carrying Amount Accumulated Amortization Net Carrying Amount Trademarks, indefinite-lived Indefinite $ 901 $ — $ 901 Patents, definite-lived 16.5 6,671 2,370 4,301 Customer relationships 3 - 7 1,733 279 1,454 Developed technology 12 17,690 1,973 15,717 Other intangibles 3 30 16 14 Total intangible assets, net $ 27,025 $ 4,638 $ 22,387 Amortization expense is included in Selling, general, and administrative expenses and wa s $ 503 a nd $ 771 for the three months ended March 31, 2023 and 2022, respectively. Expected future amortization expense is as follows: 2023 $ 1,515 2024 1,966 2025 1,926 2026 1,926 2027 1,925 No impairment charges related to intangibles and goodwill were recorded for the three months ended March 31, 2023 and 2022 .

Contingent Earn-Out Considerati

Contingent Earn-Out Consideration	3 Months Ended
	Mar. 31, 2023
Business Combinations [Abstract]
Contingent Earn-Out Consideration	NOTE 5. CONTINGENT EARN-OUT CONSIDERATION The following table provides a reconciliation of our Level 3 earn-out liabilities for the three months ended March 31, 2023: Balance, December 31, 2022 $ 3,640 Change in fair value of earn-out liabilities 80 Balance, March 31, 2023 $ 3,720 The current portion of contingent earn-out liabilities is included in Other-current liabilities and the non-current portion is included in Other long-term liabilities on the Condensed Consolidated Balance Sheet. As of March 31, 2023 , the current portion was $ 3,460 and the non-current portion was $ 260 . During t he three months ended March 31, 2023 , we reassessed the estimate of the earn-out liabilities which resulted in a net increase of $ 80 recorded in Other expense within the Condensed Consolidated Statement of Operations and Comprehensive Loss for the three months ended March 31, 2023. One of the milestones associated with the Additive Orthopaedics acquisition and included in Accrued expenses as of December 31, 2022 was paid in cash during the three months ended March 31, 2023 . Three project milestones associated with the Disior acquisition, totaling $ 5,000 and completed during 2022 remain included in Accrued expenses on the Condensed Consolidated Balance Sheet as of March 31, 2023. For additional information on the Additive Orthopaedics acquisition refer to Note 3 to our Consolidated Financial Statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022.

Debt

Debt	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Debt	NOTE 6. DEBT Long-term debt as of March 31, 2023 and December 31, 2022 consists of the following: March 31, 2023 December 31, 2022 MidCap Term Loan $ 30,000 $ 30,000 Zions Term Loan 15,413 15,573 Bank of Ireland Note Payable 50 86 45,463 45,659 Less: deferred issuance costs ( 2,569 ) ( 2,749 ) Total debt, net of issuance costs 42,894 42,910 Less: current portion ( 690 ) ( 728 ) Long-term debt, net, less current maturities $ 42,204 $ 42,182 MidCap Credit Agreements On May 6, 2021, the Company entered into a new credit agreement with MidCap Financial Trust to provide a total of $ 70,000 including up to a $ 30,000 revolving loan (“MidCap Revolving Loan”) and up to a $ 40,000 term loan (“MidCap Term Loan”), secured by substantially all the Company’s assets (“MidCap Credit Agreements”). The MidCap Term Loan was comprised of two tranches, the first of which provided a commitment amount of $ 10,000 , and the second a commitment of $ 30,000 . The MidCap Term Loan and Midcap Revolving Loan bore a variable interest rate of LIBOR plus 6 % and LIBOR plus 3 %, respectively, and mature on the earlier of May 1, 2026 or a change in control event (the "Termination Date"). The entire principal balances of the MidCap Revolving Loan and MidCap Term Loan are due on the Termination Date. Interest payments are payable monthly with optional principal prepayments allowed under the MidCap Credit Agreements. The Midcap Credit Agreements required us to maintain minimum net product sales and minimum consolidated EBITDA, (each term as defined in the Midcap Credit Agreements), for the preceding twelve month period. On November 9, 2022, the Company entered into an amendment to the MidCap Credit Agreements. The amendment to the Midcap Revolving Loan provides up to $ 50,000 in total borrowing capacity. The MidCap amendments modified the MidCap Credit Agreements to include provisions related to the transition from the LIBOR Interest Rate plus Applicable Margin to the SOFR Interest Rate plus Applicable Margin, maintaining the Applicable Margin of 6 % under the MidCap Term Loan and increasing the Applicable Margin from 3 % to 3.75 % under the Midcap Revolving Loan. In addition, the MidCap amendments amended certain covenants, terms and provisions in the Midcap Credit Agreements to, among other things, modify the covenant levels for the Minimum Net Product Sales financial covenant and to remove the Minimum Consolidated EBITDA financial covenant. As of March 31, 2023 , the Company was in compliance with all financial covenants under the amended Midcap Credit Agreements. Total debt issuance costs associated with the MidCap Credit Agreements were $ 2,337 . Amortization expense associated with such debt issuance costs totaled $ 184 and $ 71 , for the three months ended March 31, 2023 and 2022, respectively, and is included in Interest expense on the Condensed Consolidated Statements of Operations and Comprehensive Loss. Zions Term Loan Facility On March 24, 2022, the Company entered into a secured term loan facility (the “Zions Facility”) with Zions Bancorporation, N.A., dba Vectra Bank Colorado, in the principal amount of $ 16,000 . The loans under the Zions Facility (i) bear interest at a variable rate per annum equal to the sum of (a) a one-month Term SOFR based rate, plus (b) 1.75 %, adjusted on a monthly basis and (ii) mature on March 24, 2037 . Principal and interest payments are payable monthly , with optional prepayments allowed without premium or penalty. Effective as of November 10, 2022, the Company entered into the First Amendment to the Zions Facility. The amendment to the Zions Facility amends the financial covenants to require the Company to maintain (i) the Liquidity Ratio, if the Cash Flow as of the last day of any quarter measured on a trailing three month basis is less than or equal to $ 0 , and (ii) the Fixed Charge Coverage Ratio which will be calculated as of the last day of each quarter on a trailing four quarter basis, as well as a certain level of Liquidity, if the Cash Flow is greater than $ 0 . In addition, a Net Revenue Growth covenant was added which will be calculated as of the last day of each quarter on a year-over-year basis. As of March 31, 2023 , the Company was in compliance with all financial covenants under the amended Zions Facility. Total debt issuance costs associated with the Zions Facility were $ 232 . Amortization expense associated with such debt issuance costs totaled $ 4 and $ 0 for the three months ended March 31, 2023 and 2022, respectively, and is included in Interest expense on the Consolidated Statements of Operations and Comprehensive Loss. Bank of Ireland Note Payable On June 12, 2020, the Company entered a term loan with Bank of Ireland in a principal amount of $ 474 (the “Bank of Ireland Note Payable”). The Bank of Ireland Note Payable bears an annual interest rate of 4 % and is due in equal monthly installments over a 36 -month period, including interest. The Bank of Ireland Note Payable contains financial and other customary covenants.

Stockholders' Equity

Stockholders' Equity	3 Months Ended
	Mar. 31, 2023
Stockholders' Equity Note [Abstract]
Stockholders' Equity	NOTE 7. STOCKHOLDERS’ EQUITY Under its Amended and Restated Certificate of Incorporation, the Company has a total of 310,000,000 shares of capital stock authorized for issuance, consisting of 300,000,000 shares of common stock, par value of $ 0.01 per share, and 10,000,000 shares of convertible preferred stock, par value of $ 0.01 per share. Common Stock On January 30, 2023, the Company completed an underwritten public offering ("the Offering") of 6,500,000 shares of its common stock at an offering price of $ 17.00 per share, which consisted of 3,750,000 shares of common stock issued and sold by the Company and 2,750,000 shares of common stock sold by certain selling securityholders. On February 17, 2023, the underwriters exercised in full their option to purchase an additional 562,500 shares and 412,500 shares of common stock from the Company and the selling securityholders, respectively.‌ The Company received aggregate net proceeds from the Offering of approximately $ 68,449 after deducting underwriting discounts and commissions and offering expenses payable by the Company. The sel ling securityholders received aggregate net proceeds from the Offering of approximately $ 50,700 after deducting underwriting discounts and commissions. The Company did not receive any of the proceeds from the sale of shares of Common Stock by the selling securityholders. Treasury Stock The Company did no t purchase any of its common stock during the three months ended March 31, 2023 and 2022 . All previously repurchased shares were recorded in Treasury stock at cost.

Loss Per Share

Loss Per Share	3 Months Ended
	Mar. 31, 2023
Earnings Per Share [Abstract]
Loss Per Share	NOTE 8. LOSS PER SHARE Basic net loss per share is computed by dividing net loss attributable to common stockholders (the numerator) by the weighted average number of common stock outstanding for the period (the denominator). Diluted net income per share of common stock attributable to common stockholders is computed by dividing net income by the weighted average number of shares of common stock outstanding during the period adjusted for the dilutive effects of common stock equivalents using the treasury stock method or the method based on the nature of such securities. In periods when losses from operations are reported, the weighted-average number of shares of common stock outstanding excludes common stock equivalents because their inclusion would be anti-dilutive. The computation of net loss per share for the three months ended March 31, 2023 and 2022, respectively was as follows: Three Months Ended March 31, 2023 2022 Net loss $ ( 9,052 ) $ ( 9,236 ) Weighted-average common stock outstanding: Basic 80,681,715 76,447,454 Diluted 80,681,715 76,447,454 Loss per share: Basic $ ( 0.11 ) $ ( 0.12 ) Diluted $ ( 0.11 ) $ ( 0.12 ) The following outstanding potentially dilutive securities were excluded from the calculation of diluted net loss per share attributable to common stockholders because their impact would have been antidilutive for the period presented: Three Months Ended March 31, 2023 2022 Stock options 6,523,783 7,955,083 Restricted stock units 1,420,135 79,886

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
	Mar. 31, 2023
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	NOTE 9. STOCK-BASED COMPENSATION Employee Stock Purchase Plan The Employee Stock Purchase Plan (“ESPP”) was adopted by the Company’s Board of Directors on October 8, 2021. The 2021 Plan was adopted by the Company’s stockholders on October 19, 2021 and became effective on the date prior to the date of the effectiveness of the registration statement on Form S-1 filed by the Company. The ESPP initially provides participating employees with the opportunity to purchase up to an aggregate of 1,329,040 shares of the Company’s common stock at 85 % of the market price at the lesser of the date the purchase right is granted or exercisable. The Company currently holds offerings consisting of six month periods commencing on January 1 and July 1 of each calendar year, with a single purchase date at the end of the purchase period on June 30 and December 31 of each calendar year. The ESPP provides that the number of shares reserved and available for issuance will automatically increase each January 1, beginning on January 1, 2022 and ending on January 1, 2031, by the lesser of 1 % of all classes of the Company’s common stock outstanding on the immediately preceding December 31, or such smaller number of shares as determined by the Company’s Board or the committee. On January 1, 2023, the number of shares reserved and available for issuance for the ESPP was increased by 777,705 shares. As of March 31, 2023 , 2,832,250 shares remained available for issuance. Eligible employees can contribute up to 15 % of their gross base earnings for purchases under the ESPP through regular payroll deductions. Purchase of shares under the ESPP is limited for each employee at $ 25,000 worth of the Company’s shares of common stock (determined using the lesser of (i) the market price of a share of common stock on the first day of an applicable purchase period and (ii) the market price of a share of common stock on the purchase date) for each calendar year in which a purchase right is outstanding. The Company did no t issue any shares upon exercise of purchase rights during the three months ended March 31, 2023 and 2022. The Company recognizes compensation expense on a straight-line basis over the service period. During the three months ended March 31, 2023 and 2022, the Company recognized $ 122 and $ 0 , respectively, of compensation expense related to the ESPP. Below are the assumptions used for the three months ended March 31, 2023 in determining the fair value of shares under the ESPP. There was no offering period during the three months ended March 31, 2022. Three Months Ended March 31, 2023 Expected volatility 60.33 % Expected dividends — Expected term (in years) 0.50 Discount rate 15.00 % Risk-free rate 4.77 % 2021 Incentive Award Plan The 2021 Incentive Award Plan (“2021 Plan”) was adopted by the Company’s Board of Directors on October 8, 2021. The 2021 Plan was adopted by the Company’s stockholders on October 19, 2021 and became effective on the date prior to the date of the effectiveness of the registration statement on Form S-1 filed by the Company. The 2021 Plan authorizes the Company to issue an initial aggregate maximum number of shares of common stock equal to (i) 7,641,979 shares plus (ii) a number of shares that are available for issuance under the 2011 Plan plus (iii) any shares that are subject to 2011 Plan that become available for issuance (via expiration, forfeitures, etc.) plus (iv) an increase commencing on January 1, 2022 and continuing annually on the anniversary thereof through January 1, 2031, equal to the lesser of (a) 5 % of the shares of all classes of the Company’s common stock outstanding on the last day of the immediately preceding calendar year or (b) such smaller number of shares as determined by the Company’s Board or the committee. On January 1, 2023, the number of shares reserved and available for issuance for the 2021 Plan was increased by 3,888,529 shares. As of March 31, 2023 , the Company had reserved 13,497,048 shares of common stock for future grants. Stock Options During the three months ended March 31, 2023 , the Company granted certain contractors of the Company an aggregate of 225,000 time-based options at a weighted average strike price of $ 18.33 During the three months ended March 31, 2022 , the Company granted certain officers and contractors of the Company an aggregate of 154,500 time-based options at a weighted average strike price of $ 15.05 . The Company received cash in the amount o f $ 1,622 an d $ 12 from the exercise of stock options for the three months ended March 31, 2023 and 2022, respectively. The tax benefit from equity options exercised w as $ 376 and $ 3 f or the three months ended March 31, 2023 and 2022, respectively. During the three months ended March 31, 2023 and 2022, the Company recognized $ 1,756 and $ 2,014 , respectively, of compensation expense related to stock options. Stock-based compensation expenses are recorded in Selling, general and administrative expenses in the Condensed Consolidated Statements of Operations and Comprehensive Loss. The following summarizes the Company’s stock option plan and the activity for the three months ended March 31, 2023. Shares Weighted-Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Outstanding, December 31, 2022 6,538,536 $ 10.02 7.36 Granted 225,000 18.33 Exercised or released ( 223,785 ) 7.25 Forfeited or expired ( 15,968 ) 16.51 Outstanding, March 31, 2023 6,523,783 $ 10.38 7.19 Exercisable, March 31, 2023 3,950,421 $ 7.54 6.56 Vested and expected to vest at March 31, 2023 6,514,442 $ 10.37 7.19 The aggregate intrinsic value of the options outstanding as of March 31, 2023 is $ 43,972 . The aggregate intrinsic value of exercisable options as of March 31, 2023 is $ 37,648 . The aggregate intrinsic value of options exercised during the three months ended March 31, 2023 is $ 2,557 . The weighted average fair value of options granted during the three months ended March 31, 2023 and 2022 was $ 11.79 and $ 8.25 , respectively, on the dates of grant. As of March 31, 2023, there was approximately $ 19,102 total unrecognized compensation cost related to non-vested stock-based compensation arrangements, which is expected to be recognized over a weighted average period of 2.72 years. Below are the assumptions used for the three months ended March 31, 2023 and 2022 in determining the fair value of each option award: Three Months Ended March 31, 2023 2022 Expected volatility 66.20 % 57.00 % Expected dividends — — Expected term (in years) 6.25 6.25 Risk-free rate 4.11 % 1.69 % Restricted Stock Units Restricted Stock Units (“RSUs”) granted under the 2021 Plan have a ten-year contractual term and typically vest over a three or four-year period, contingent upo n continued service with the Company. During the three months ended March 31, 2023 , 458,970 RSUs were granted to certain officers and employees of the Company. During the three months ended March 31, 2022, no RSUs were granted. All RSUs granted in 2023 were time-based awards. RSU activity under the 2021 Plan is as follows for the three months ended March 31, 2023: Restricted Stock Units Weighted-Average Fair Value Outstanding, December 31, 2022 964,054 $ 17.74 Granted 458,970 17.88 Vested ― ― Forfeited or expired ( 2,889 ) 17.82 Outstanding, March 31, 2023 1,420,135 $ 17.79 Vested and expected to vest at March 31, 2023 1,401,121 $ 17.78 During the three months ended March 31, 2023 and 2022, the Company recogni zed $ 1,426 a nd $ 108 , respectively, of compensation expense related to RSUs. Stock-based compensation expenses are recorded in Selling, general and administrative expenses in the Condensed Consolidated Statements of Operations and Comprehensive Loss. As of March 31, 2023 , there was approximately $ 22,109 total unrecognized compensation cost related to non-vested RSUs, which is expected to be recognized over a weighted average period of 3.59 years.

Employee Benefit Plan

Employee Benefit Plan	3 Months Ended
	Mar. 31, 2023
Retirement Benefits [Abstract]
Employee Benefit Plan	NOTE 10. EMPLOYEE BENEFIT PLAN The Company sponsors a defined contribution plan for eligible employees who are 21 years of age with three months of service can voluntarily contribute up to 100 % of their eligible compensation. The Company has elected a Safe Harbor plan in which the Company must contribute 3 % of eligible compensation. In addition, the Company may make discretionary contributions which are determined and authorized by the Board of Directors each plan year. The Company made contributions to its employee benefit plan of $ 313 and $ 213 for the three months ended March 31, 2023 and 2022 , respectively.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2023
Income Tax Disclosure [Abstract]
Income Taxes	NOTE 11. INCOME TAXES The effective tax rates for the three months ended March 31, 2023 and 2022 are as follows: Three Months Ended March 31, 2023 2022 Effective tax rate 0.778 % ( 0.356 %) For the three months ended March 31, 2023 and 2022 , the Company recorded an income tax benefit of $ 71 and income tax expense of $ 32 , respectively. The Company’s 2023 and 2022 income tax expense and rates differed from the amount of income tax determined by applying the U.S. Federal income tax rate to pre-tax income primarily as a result of the U.S., Finland, U.K., Germany and Italy jurisdictions that have a full valuation allowance recorded on deferred tax assets. In addition, the tax rate is lower than the U.S. statutory federal tax rate as a result of foreign earnings that are taxed at lower tax rates. The Company continues to monitor the realization of its deferred tax assets and assesses the need for a valuation allowance. The Company analyzes available positive and negative evidence to determine if a valuation allowance is needed based on the weight of the evidence. This objectively verifiable evidence includes the current & prior two years' profit and loss positions after considering pre-tax book income plus or minus permanent adjustments as well as other positive & negative evidence available. This process requires management to make estimates, assumptions, and judgments that are uncertain in nature. The Company has established a valuation allowance with respect to deferred tax assets in the U.S., Finland, U.K., Germany, and Italy and continues to monitor and assess potential valuation allowances in all its jurisdictions.

Commitments And Contingencies

Commitments And Contingencies	3 Months Ended
	Mar. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	NOTE 12. COMMITMENTS AND CONTINGENCIES Legal Proceedings We are involved in various lawsuits, claims, inquiries, and other regulatory and compliance matters, most of which are routine to the nature of our business. When it is probable that a loss will be incurred and where a range of the loss can be reasonably‌ estimated, the best estimate within the range is accrued. When the best estimate within the range cannot be determined, the low end of the range is accrued. The ultimate resolution of these claims could affect future results of operations should our exposure be materially different from our estimates or should liabilities be incurred that were not previously accrued. Potential insurance reimbursements are not offset against potential liabilities. On November 28, 2022, the Company entered into a settlement agreement with Stryker Corp. to settle two complaints filed against the Company and any Company counter claims for a total amount of $ 26,000 paid by the Company to Stryker Corp (the “Settlement Amount”). The Settlement Amount was scheduled to be paid by the Company in three separate installments consisting of: (i) $ 5,000 on or by December 16, 2022, (ii) $ 8,000 at any time between January 1, 2023 and January 16, 2023, and (iii) $ 13,000 at any time between April 1, 2023 and April 17, 2023. As of March 31, 2023, the Company remitted payment on the first and second installments of $ 5,000 and $ 8,000 , respectively, and subsequent to quarter end, the Company remitted the third and final payment of $ 13,000 on April 14, 2023. For additional information refer to Note 14 of our Consolidated Financial Statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022.

Related Party Transactions

Related Party Transactions	3 Months Ended
	Mar. 31, 2023
Related Party Transactions [Abstract]
Related Party Transactions	NOTE 13. RELATED PARTY TRANSACTIONS The Company has a license agreement dated July 1, 2017 for certain intellectual property with an entity that is affiliated with one of the directors of the Company, under which the Company pays a royalty of four percent ( 4 %) of net revenue related to the licensed intellectual property for the 15 years following the date of first sale, including a minimum annual payment of $ 250 . The term of the agreement is 20 years and it automatically renews for five-year periods thereafter. Payments to the entity under this license agreement totaled $ 45 and $ 163 for the three months ended March 31, 2023 and 2022, respectively. Amounts payable to this entity as of March 31, 2023 and December 31, 2022 were $ 187 and $ 164 , respectively. The Company paid professional services fees to a related party totaling $ 0 and $ 125 for the three months ended March 31, 2023 and 2022, respectively, and such fees are included in Selling, general, and administrative expense in the Condensed Consolidated Statements of Operations and Comprehensive Loss. Amounts payable as of March 31, 2023 and December 31, 2022 to this related party were $ 115 and $ 0 , respectively.

Segment and Geographic Informat

Segment and Geographic Information	3 Months Ended
	Mar. 31, 2023
Segment Reporting [Abstract]
Segment and Geographic Information	NOTE 14. SEGMENT AND GEOGRAPHIC INFORMATION The following table represents total net revenue by geographic area, based on the location of the customer for the three months ended March 31, 2023 and 2022, respectively. Three Months Ended March 31, 2023 2022 United States $ 44,981 $ 36,023 International 7,055 5,348 Total net revenue $ 52,036 $ 41,371 No individual country with net revenue originating outside of the United States accounted for more than 10% of consolidated net revenue for three months ended March 31, 2023 and 2022. The following table represents total non-current assets, excluding deferred taxes, by geographic area as of March 31, 2023 and December 31, 2022, respectively. March 31, 2023 December 31, 2022 United States $ 83,431 $ 79,458 Finland 25,447 25,581 Other International 7,231 6,546 Total assets $ 116,109 $ 111,585

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2023
Accounting Policies [Abstract]
Basis of Presentation and Consolidation	Basis of Presentation and Consolidation The accompanying Condensed Consolidated Financial Statements include the accounts of Paragon 28, Inc. and its subsidiaries, all of which are wholly-owned. The accompanying Condensed Consolidated Financial Statements have been prepared in conformity with accounting principles generally accepted in the U.S. (“U.S. GAAP”) and pursuant to the rules and regulations of the U.S. Securities and Exchange Commission (“SEC”) for interim financial information. Accordingly, they do not include all of the information required by U.S. GAAP for complete financial statements. The interim Condensed Consolidated Financial Statements reflect all adjustments that are of a normal recurring nature and that are considered necessary for a fair representation of the results for the periods presented and should be read in conjunction with the audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2022, which include a complete set of footnote disclosures, including our significant accounting policies. The audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2022 are included in the Company’s Annual filing on Form 10-K filed with the SEC on March 2, 2023. The results for interim periods are not necessarily indicative of the results that may be expected for a full fiscal year or for any other future period. All intercompany balances and transactions have been eliminated in consolidation.
Use of Estimates	Use of Estimates The preparation of the financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Because future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Any changes in these estimates will be reflected in the Company’s Condensed Consolidated Financial Statements. Significant items subject to such estimates and assumptions include the determination of the collectability of trade receivables, inventory obsolescence, impairment of long-lived assets, recoverability of goodwill and intangible assets, contingent earn-out liabilities, income taxes and stock-based compensation.
Foreign Currency Translation	Foreign Currency Translation The Condensed Consolidated Financial Statements are presented in U.S. dollars. The Company’s non-U.S. subsidiaries have a functional currency (i.e., the currency in which operational activities are primarily conducted) that is other than the U.S. dollar, generally the currency of the country in which such subsidiaries are domiciled. Such subsidiaries’ assets and liabilities are translated into U.S. dollars at quarter-end exchange rates, while revenue and expenses are translated at average exchange rates during the quarter based on the daily closing exchange rates. Adjustments that result from translating amounts from a subsidiary’s functional currency to U.S. dollars are reported in Accumulated Other Comprehensive Loss, net of tax.
Business Combinations	Business Combinations We allocate the purchase consideration to the identifiable net assets acquired, including intangible assets and liabilities assumed, based on estimated fair values at the date of the acquisition. The excess of the fair value of the purchase consideration over the fair value of the identifiable assets and liabilities, if any, is recorded as goodwill. During the measurement period, which is up to one year from the acquisition date, we may adjust provisional amounts that were recognized at the acquisition date to reflect new information obtained about facts and circumstances that existed as of the acquisition date. Determining the fair value of assets acquired and liabilities assumed requires significant judgment, including the selection of valuation methodologies including the income approach, the cost approach, and the market approach. Significant assumptions used in those methodologies include, but are not limited to, the expected values of the underlying metric, the systematic risk embedded in the underlying metric, the volatility of the underlying metric, the risk-free rate, and the counterparty risk. The use of different valuation methodologies and assumptions is highly subjective and inherently uncertain and, as a result, actual results may differ materially from estimates.
Trade Receivables, Less Allowance for Doubtful Accounts	Trade Receivables, Less Allowance for Doubtful Accounts The Company estimates an allowance for doubtful accounts based upon an evaluation of the current status of receivables, historical experience, and other factors as necessary. It is reasonably possible that the Company’s estimate of the allowance for doubtful accounts will change. As of March 31, 2023 and December 31, 2022 , the allowance for doubtful accounts was not material.
Inventories, Net	Inventories, Net The Company estimates a reserve for obsolete and slow-moving inventory based on current inventory levels, historical sales and future projected demand. Charges (benefit) for excess and obsolete inventory are included in Cost of goods sold and were $ 293 and $( 643 ) for the three months ended March 31, 2023 and 2022 , respectively. The inventory reserve was $ 17,117 and $ 16,804 as of March 31, 2023 and December 31, 2022 , respectively.
Intangibles	Intangibles The costs associated with applying for patents and trademarks are capitalized. Patents are amortized on a straight-line basis over the lesser of the patent’s economic or legal life, which is seventeen years . Costs associated with capitalized patents include third-party attorney fees and other third-party fees as well as costs related to the following: the preparation of patent applications, government filings and registration fees, drawings, computer searches, and translations related to specific patents. Trademarks that are anticipated to be renewed every ten years have an indefinite life and are not amortized but tested for impairment annually. Once it is determined a trademark will no longer be renewed, the trademark is amortized over the remainder of the trademark’s registration period. Customer relationships are amortized over an estimated useful life of three to seven years on a straight-line basis. Other intangibles, which mainly consist of noncompete arrangements, are amortized over an estimated useful life of three years on a straight-line basis. Developed technology is amortized over an estimated useful life of twelve years on a straight-line basis. Amortizable intangible assets are assessed for impairment upon triggering events that indicate that the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to future net undiscounted cash flows expected to be generated by the associated asset. If the asset’s carrying value is determined to not be recoverable, the impairment to be recognized is measured by the amount by which the carrying amount exceeds the fair market value of the intangible assets. No impairment charges were recorded in any of the periods presented. Indefinite-lived trademark assets are reviewed for impairment annually or whenever events or changes in circumstances indicate that the carrying value of an asset may not be recoverable. The Company can elect to first apply the optional qualitative impairment assessment to determine whether the indefinite-lived intangible asset is more-likely-than-not impaired. If, on the basis of the qualitative impairment assessment, an entity asserts that it is more likely than not that the indefinite-lived intangible asset is impaired, the Company would be required to calculate the fair value of the asset for an impairment test. Impairment loss is recognized if the carrying amount of the asset exceeds its fair value. A qualitative assessment considers macroeconomic and other industry-specific factors, such as trends in short-term and long-term interest rates and the ability to access capital, and company specific factors such as trends in revenue generating activities, and merger or acquisition activity. If the Company elects to bypass qualitatively assessing its indefinite-lived intangible assets, or it is not more likely than not that the fair value of the intangible asset exceeds its carrying value, management estimates the fair value of the intangible asset and compares it to the carrying value. The estimated fair value of the intangible asset is established using an income approach based on a discounted cash flow model that includes significant assumptions about the future operating results and cash flows of the intangible asset or assets.
Goodwill	Goodwill Goodwill represents the excess of the purchase price as compared to the fair value of net assets acquired and liabilities assumed. Goodwill is not amortized, but is tested for impairment annually or when indications of impairment exist. We can elect to qualitatively assess goodwill for impairment if it is more likely than not that the fair value of a reporting unit exceeds its carrying value. Impairment exists when the carrying amount, including goodwill, of the reporting unit exceeds its fair value, resulting in an impairment charge for this excess (not to exceed the carrying amount of the goodwill). Our annual impairment testing date is October 1. The impairment, if determined, is recorded within Operating expenses in the Condensed Consolidated Statements of Operations and Comprehensive Loss in the period the determination is made. There were no impairments recorded during the periods presented.
Contingent Earn-Out Consideration	Contingent Earn-out Consideration Business combinations may include contingent earn-out consideration as part of the purchase price under which the Company will make future payments to the seller upon the achievement of certain milestones. The fair value of the contingent earn-out consideration is estimated as of the acquisition date at the present value of the expected contingent payments and is subsequently remeasured at each balance sheet date. Two methodologies may be considered in the valuation: the scenario-based model (“SBM”) and Monte Carlo simulation. The SBM relies on multiple outcomes to estimate the likelihood of future payoff of the contingent consideration. The resulting earnout payoff is then probability-weighted and discounted at an appropriate risk adjusted rate in order to arrive at the present value of the expected earnout payment. The Monte Carlo simulation is used to value the non-linear contingent considerations based on projected financial metrics. Each trial of the Monte Carlo simulation draws a value from the assumed distribution for the underlying metric. The earnout payoff for each simulation trial is calculated based on that particular simulated path for the underlying metrics and then discounted to present value using the risk-free rate, adjusted for counterparty credit risk. The value of the earnout is estimated as the average value from all simulation trials. The fair value estimates use unobservable inputs that reflect our own assumptions as to the ability of the acquired business to meet the targeted benchmarks and discount rates used in the calculations. The unobservable inputs are defined in ASC Topic 820, “Fair Value Measurements and Disclosures,” as Level 3 inputs. We review the probabilities of achievement of the earnout milestones to determine impact on the fair value of the earnout consideration on a quarterly basis over the earn-out period. Actual results are compared to the estimates and probabilities of achievement used in our forecasts. Should actual results of the acquired business increase or decrease as compared to our estimates and assumptions, the estimated fair value of the contingent earn-out consideration liability will increase or decrease, up to the contractual limit, as applicable. Changes in the estimated fair value of the contingent earn-out consideration are recorded in Other expense in the Consolidated Statements of Operations and Comprehensive Loss and are reflected in the period in which they are identified. Changes in the estimated fair value of the contingent earn-out consideration may materially impact or cause volatility in our operating results.
Revenue Recognition	Revenue Recognition Re venue is recorded, net of estimated losses for bad debts, when our performance obligation is satisfied which is when our customers take title of the product, and typically when the product is used in surgery. As such, the timing of revenue recognition may differ from the timing of invoicing to our customers. We have recorded unbilled accounts receivable related to this timing difference of $ 3,657 and $ 4,511 as of March 31, 2023 and December 31, 2022 , respectively.
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”), which requires entities to estimate all expected credit losses for certain types of financial instruments, including trade receivables, held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. The updated guidance also expands the disclosure requirements to enable users of financial statements to understand the entity’s assumptions, models and methods for estimating expected credit losses over the entire contractual term of the instrument from the date of initial recognition of that instrument. ASU 2016-13, as subsequently amended for various technical issues, is effective for emerging growth companies following private company adoption dates for fiscal years, and for interim periods within those fiscal years, beginning after December 15, 2022, with early adoption permitted. The Company adopted ASU 2016-13 effective January 1, 2023 . The adoption of this guidance did not have a significant impact on the Company's Condensed Consolidated Financial Statements and related disclosures. In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) (“ASU 2019-12”), which is part of the FASB’s overall simplification initiative to reduce the costs and complexity of applying accounting standards while maintaining or improving the usefulness of the information provided to users of financial statements. ASU 2019-12 simplifies accounting guidance for intra-period allocations, deferred tax liabilities, year-to-date losses in interim periods, franchise taxes, step-up in tax basis of goodwill, separate entity financial statements, and interim recognition of tax laws or rate changes. ASU 2019-12 is effective for emerging growth companies following private company adoption dates in fiscal years beginning after December 15, 2021, and interim periods within fiscal years beginning after December 15, 2022, with early adoption permitted. The Company adopted ASU 2019-12 effective January 1, 2023 . The adoption of this guidance did not have a significant impact on the Company's Condensed Consolidated Financial Statements and related disclosures.

Business Combination (Tables)

Business Combination (Tables) - Disior LTD.	3 Months Ended
	Mar. 31, 2023
Business Acquisition [Line Items]
Summary of Purchase Consideration Transferred	The following table summarizes the purchase price: Consideration paid Cash consideration $ 19,696 Contingent consideration 6,550 Total consideration $ 26,246
Summary of Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the fair values of the assets acquired and liabilities assumed as of the Disior Acquisition Date: Assets acquired: Cash and cash equivalents $ 1,192 Other current assets 410 Intangible assets 6,800 Goodwill 19,136 Total assets acquired 27,538 Liabilities assumed: Accruals and other current liabilities 615 Deferred tax liabilities, net 677 Total liabilities assumed 1,292 Net assets acquired $ 26,246
Useful Life Determination of Assets	The useful life on intangible assets was determined by management to be in line with the Company’s policy on intangible assets. Both determinations are outlined in the table below: Fair Value Estimated Useful Life Developed technology $ 6,400 12 Tradenames 400 Indefinite $ 6,800

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible assets as of March 31, 2023 were as follows: Estimated Useful Life Gross Carrying Amount Accumulated Amortization Net Carrying Amount Trademarks and tradenames, indefinite-lived Indefinite $ 921 $ — $ 921 Patents, definite-lived 18 6,906 2,439 4,467 Customer relationships 3 - 7 1,733 352 1,381 Developed technology 12 17,690 2,333 15,356 Other intangibles 3 30 18 12 Total intangible assets, net $ 27,280 $ 5,142 $ 22,137 Intangible assets as of December 31, 2022, were as follows: Estimated Useful Life Gross Carrying Amount Accumulated Amortization Net Carrying Amount Trademarks, indefinite-lived Indefinite $ 901 $ — $ 901 Patents, definite-lived 16.5 6,671 2,370 4,301 Customer relationships 3 - 7 1,733 279 1,454 Developed technology 12 17,690 1,973 15,717 Other intangibles 3 30 16 14 Total intangible assets, net $ 27,025 $ 4,638 $ 22,387
Schedule of Expected Future Amortization Expense	Expected future amortization expense is as follows: 2023 $ 1,515 2024 1,966 2025 1,926 2026 1,926 2027 1,925

Contingent Earn-Out Considera_2

Contingent Earn-Out Consideration (Tables)	3 Months Ended
	Mar. 31, 2023
Business Combinations [Abstract]
Schedule of Reconciliation Level 3 Earn-out Liabilities	The following table provides a reconciliation of our Level 3 earn-out liabilities for the three months ended March 31, 2023: Balance, December 31, 2022 $ 3,640 Change in fair value of earn-out liabilities 80 Balance, March 31, 2023 $ 3,720

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	Long-term debt as of March 31, 2023 and December 31, 2022 consists of the following: March 31, 2023 December 31, 2022 MidCap Term Loan $ 30,000 $ 30,000 Zions Term Loan 15,413 15,573 Bank of Ireland Note Payable 50 86 45,463 45,659 Less: deferred issuance costs ( 2,569 ) ( 2,749 ) Total debt, net of issuance costs 42,894 42,910 Less: current portion ( 690 ) ( 728 ) Long-term debt, net, less current maturities $ 42,204 $ 42,182

Loss Per Share (Tables)

Loss Per Share (Tables)	3 Months Ended
	Mar. 31, 2023
Earnings Per Share [Abstract]
Summary of Computation of Net Loss Per Share	The computation of net loss per share for the three months ended March 31, 2023 and 2022, respectively was as follows: Three Months Ended March 31, 2023 2022 Net loss $ ( 9,052 ) $ ( 9,236 ) Weighted-average common stock outstanding: Basic 80,681,715 76,447,454 Diluted 80,681,715 76,447,454 Loss per share: Basic $ ( 0.11 ) $ ( 0.12 ) Diluted $ ( 0.11 ) $ ( 0.12 )
Summary of Potentially Dilutive Securities Excluded from Calculation of Diluted Net Loss Per Share Attributable to Common Stockholders	The following outstanding potentially dilutive securities were excluded from the calculation of diluted net loss per share attributable to common stockholders because their impact would have been antidilutive for the period presented: Three Months Ended March 31, 2023 2022 Stock options 6,523,783 7,955,083 Restricted stock units 1,420,135 79,886

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2023
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Assumptions used in Determining Fair Value of Employee Stock Purchase Plan	Below are the assumptions used for the three months ended March 31, 2023 in determining the fair value of shares under the ESPP. There was no offering period during the three months ended March 31, 2022. Three Months Ended March 31, 2023 Expected volatility 60.33 % Expected dividends — Expected term (in years) 0.50 Discount rate 15.00 % Risk-free rate 4.77 %
Assumptions used in Determining Fair Value of Stock Options	Below are the assumptions used for the three months ended March 31, 2023 and 2022 in determining the fair value of each option award: Three Months Ended March 31, 2023 2022 Expected volatility 66.20 % 57.00 % Expected dividends — — Expected term (in years) 6.25 6.25 Risk-free rate 4.11 % 1.69 %
Summary of Stock Option Activity	The following summarizes the Company’s stock option plan and the activity for the three months ended March 31, 2023. Shares Weighted-Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Outstanding, December 31, 2022 6,538,536 $ 10.02 7.36 Granted 225,000 18.33 Exercised or released ( 223,785 ) 7.25 Forfeited or expired ( 15,968 ) 16.51 Outstanding, March 31, 2023 6,523,783 $ 10.38 7.19 Exercisable, March 31, 2023 3,950,421 $ 7.54 6.56 Vested and expected to vest at March 31, 2023 6,514,442 $ 10.37 7.19
2021 Plans
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Schedule of RSU Activity	RSU activity under the 2021 Plan is as follows for the three months ended March 31, 2023: Restricted Stock Units Weighted-Average Fair Value Outstanding, December 31, 2022 964,054 $ 17.74 Granted 458,970 17.88 Vested ― ― Forfeited or expired ( 2,889 ) 17.82 Outstanding, March 31, 2023 1,420,135 $ 17.79 Vested and expected to vest at March 31, 2023 1,401,121 $ 17.78

Income Taxes (Tables)

Income Taxes (Tables)	3 Months Ended
	Mar. 31, 2023
Income Tax Disclosure [Abstract]
Schedule of Effective Tax Rates	The effective tax rates for the three months ended March 31, 2023 and 2022 are as follows: Three Months Ended March 31, 2023 2022 Effective tax rate 0.778 % ( 0.356 %)

Segment and Geographic Inform_2

Segment and Geographic Information (Tables)	3 Months Ended
	Mar. 31, 2023
Segment Reporting [Abstract]
Schedule of Total Net Revenue by Geographic Area	The following table represents total net revenue by geographic area, based on the location of the customer for the three months ended March 31, 2023 and 2022, respectively. Three Months Ended March 31, 2023 2022 United States $ 44,981 $ 36,023 International 7,055 5,348 Total net revenue $ 52,036 $ 41,371
Schedule of Total Non-current Assets, Excluding Deferred Taxes, by Geographic Area	The following table represents total non-current assets, excluding deferred taxes, by geographic area as of March 31, 2023 and December 31, 2022, respectively. March 31, 2023 December 31, 2022 United States $ 83,431 $ 79,458 Finland 25,447 25,581 Other International 7,231 6,546 Total assets $ 116,109 $ 111,585

Summary of Significant Accoun_3

Summary of Significant Accounting Policies - Additional Information (Details) - USD ($)	3 Months Ended		12 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Impairment of intangible asset, finite-lived	$ 0		$ 0
Impairment of goodwill	0	$ 0	0
Charges (benefit) for excess and obsolete inventory included in cost of goods sold	293,000	$ (643,000)
Inventory reserve	17,117,000		16,804,000
Unbilled accounts receivable	$ 3,657,000		$ 4,511,000
ASU 2016-13
Finite-Lived Intangible Assets [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 01, 2023
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]	true
ASU 2019-12
Finite-Lived Intangible Assets [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 01, 2023
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]	true
Patents
Finite-Lived Intangible Assets [Line Items]
Amortization period	17 years
Developed Technology
Finite-Lived Intangible Assets [Line Items]
Estimated useful life	12 years		12 years
Customer Relationships | Minimum
Finite-Lived Intangible Assets [Line Items]
Estimated useful life	3 years		3 years
Customer Relationships | Maximum
Finite-Lived Intangible Assets [Line Items]
Estimated useful life	7 years		7 years
Other Intangibles
Finite-Lived Intangible Assets [Line Items]
Estimated useful life	3 years		3 years

Business Combination - Addition

Business Combination - Additional Information (Details) - USD ($)		3 Months Ended		12 Months Ended
	Jan. 10, 2022	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Business Acquisition [Line Items]
Cash consideration			$ 18,201,000
Proceeds from revolving credit facility			$ 20,000,000
Disior LTD.
Business Acquisition [Line Items]
Acquired percentage	100%
Aggregate purchase price of acquisition	$ 26,246,000
Contingent earn-out consideration, estimated fair value	6,550,000
Net working capital adjustments and deferred payments, net payable	222,000
Cash consideration	19,696,000
Maximum earn out payment	8,000,000
Acquisition related costs		$ 0
Disior LTD. | Measurement Period Adjustments
Business Acquisition [Line Items]
Aggregate purchase price of acquisition	26,246,000
Disior LTD. | Term Loan
Business Acquisition [Line Items]
Proceeds from revolving credit facility	$ 20,000,000
Disior LTD. | Selling, General, and Administrative Expenses
Business Acquisition [Line Items]
Acquisition related costs				$ 761,000

Business Combination - Summary

Business Combination - Summary of Purchase Consideration Transferred (Details) - USD ($) $ in Thousands		3 Months Ended
	Jan. 10, 2022	Mar. 31, 2022
Consideration paid
Cash consideration		$ 18,201
Disior LTD.
Consideration paid
Cash consideration	$ 19,696
Contingent consideration	6,550
Total consideration	$ 26,246

Business Combination - Summar_2

Business Combination - Summary of Fair Values of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022	Jan. 10, 2022
Assets acquired:
Goodwill	$ 25,465	$ 25,465
Disior LTD.
Assets acquired:
Cash and cash equivalents			$ 1,192
Other current assets			410
Intangible assets			6,800
Goodwill			19,136
Total assets acquired			27,538
Liabilities assumed:
Accruals and other current liabilities			615
Deferred tax liabilities, net			677
Total liabilities assumed			1,292
Net assets acquired			$ 26,246

Business Combination - Useful L

Business Combination - Useful Life Determination of Assets (Details) - Disior LTD. $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($)
Business Acquisition [Line Items]
Fair Value	$ 6,800
Developed Technology
Business Acquisition [Line Items]
Fair Value	$ 6,400
Estimated Useful Life (in years)	12 years
Tradenames
Business Acquisition [Line Items]
Fair Value	$ 400

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Additional Information (Details) - USD ($)	3 Months Ended		12 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Goodwill	$ 25,465,000		$ 25,465,000
Impairment charges related to intangibles	0	$ 0
Impairment charges related to goodwill	0	0	$ 0
Selling, General, and Administrative Expenses
Finite-Lived Intangible Assets [Line Items]
Amortization expense	$ 503,000	$ 771,000

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Amount	$ 27,280	$ 27,025
Accumulated Amortization	5,142	4,638
Net Carrying Amount	22,137	22,387
Trademarks and Tradenames, Indefinite-Lived
Indefinite Lived Intangible Assets By Major Class [Line Items]
Net Carrying Amount	$ 921	$ 901
Patents, Definite-Lived
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	18 years	16 years 6 months
Gross Carrying Amount	$ 6,906	$ 6,671
Accumulated Amortization	2,439	2,370
Net Carrying Amount	4,467	4,301
Customer Relationships
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Amount	1,733	1,733
Accumulated Amortization	352	279
Net Carrying Amount	$ 1,381	$ 1,454
Customer Relationships | Minimum
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	3 years	3 years
Customer Relationships | Maximum
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	7 years	7 years
Developed Technology
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	12 years	12 years
Gross Carrying Amount	$ 17,690	$ 17,690
Accumulated Amortization	2,333	1,973
Net Carrying Amount	$ 15,356	$ 15,717
Other Intangibles
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	3 years	3 years
Gross Carrying Amount	$ 30	$ 30
Accumulated Amortization	18	16
Net Carrying Amount	$ 12	$ 14

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Schedule of Expected Future Amortization Expense (Details) $ in Thousands	Mar. 31, 2023 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2023	$ 1,515
2024	1,966
2025	1,926
2026	1,926
2027	$ 1,925

Contingent Earn-Out Considera_3

Contingent Earn-Out Consideration - Schedule of Reconciliation of Level 3 Earn-Out Liabilities (Details) - USD ($) $ in Thousands		3 Months Ended
	Jan. 10, 2022	Mar. 31, 2023
Business Acquisition [Line Items]
Beginning Balance		$ 3,640
Change in fair value of earnout liabilities		80
Ending Balance		$ 3,720
Disior LTD.
Business Acquisition [Line Items]
Acquisition date fair value of earn-out liabilities	$ 6,550

Contingent Earn-Out Considera_4

Contingent Earn-Out Consideration - Additional Information (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($)
Business Acquisition, Contingent Consideration [Line Items]
Contingent earn-out liability, current	$ 3,460
Contingent earn-out liability, Non current	260
Net increase (decrease) in estimate of earn-out liabilities	80
Accrued Expenses
Business Acquisition, Contingent Consideration [Line Items]
Achieved milestones reclassified to accrued expenses	$ 5,000

Debt - Schedule of Long-term De

Debt - Schedule of Long-term Debt Instruments (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Debt, gross amount	$ 45,463	$ 45,659
Less: deferred issuance costs	(2,569)	(2,749)
Total debt, net of issuance costs	42,894	42,910
Less: current portion	(690)	(728)
Long-term debt net, less current maturities	42,204	42,182
MidCap Term Loan
Debt Instrument [Line Items]
Debt, gross amount	30,000	30,000
Bank of Ireland Note Payable
Debt Instrument [Line Items]
Debt, gross amount	50	86
Zions Term Loan Facility [Member]
Debt Instrument [Line Items]
Debt, gross amount	$ 15,413	$ 15,573

Debt - MidCap Credit Agreements

Debt - MidCap Credit Agreements - Additional Information (Details) - USD ($)			3 Months Ended
	Nov. 09, 2022	May 06, 2021	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Debt Instrument [Line Items]
Debt, gross amount			$ 45,463,000		$ 45,659,000
Total debt issuance costs			2,569,000		$ 2,749,000
MidCap Credit Agreements
Debt Instrument [Line Items]
Debt, gross amount		$ 70,000,000
Debt issuance cost before amortization			2,337,000
MidCap Credit Agreements | Interest Expense
Debt Instrument [Line Items]
Amortization expense			$ 184,000	$ 71,000
MidCap Credit Agreements | Term Loan
Debt Instrument [Line Items]
Debt, gross amount		$ 40,000,000
Expiration date		May 01, 2026
MidCap Credit Agreements | Term Loan | LIBOR
Debt Instrument [Line Items]
Variable interest rate		6%
MidCap Credit Agreements | Term Loan | SOFR
Debt Instrument [Line Items]
Variable interest rate	6%
MidCap Credit Agreements | Term Loan, First Commitment
Debt Instrument [Line Items]
Debt, gross amount		$ 10,000,000
MidCap Credit Agreements | Term Loan, Second Commitment
Debt Instrument [Line Items]
Debt, gross amount		30,000,000
MidCap Credit Agreements | Revolving Loan
Debt Instrument [Line Items]
Total borrowing capacity	$ 50,000,000	$ 30,000,000
Expiration date		May 01, 2026
MidCap Credit Agreements | Revolving Loan | LIBOR
Debt Instrument [Line Items]
Variable interest rate	3%	3%
MidCap Credit Agreements | Revolving Loan | SOFR
Debt Instrument [Line Items]
Variable interest rate	3.75%

Debt - Zions Term Loan Facility

Debt - Zions Term Loan Facility - Additional Information (Details) - USD ($)			3 Months Ended
	Nov. 10, 2022	Mar. 24, 2022	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Line Of Credit Facility [Line Items]
Total debt issuance costs			$ 2,569,000		$ 2,749,000
Secured Term Loan Facility
Line Of Credit Facility [Line Items]
Principal amount		$ 16,000,000
Maturity date		Mar. 24, 2037
Debt, frequency of payment		monthly
Threshold amount of operating cash flow to calculate liquidity ratio	$ 0			$ 0
Threshold Amount of Operating Cash Flow to Calculate Fixed Charge Coverage Ratio	$ 0
Amortization of debt issuance costs			4,000
Secured Term Loan Facility | SOFR
Line Of Credit Facility [Line Items]
Variable interest rate		1.75%
Zions Facility [Member]
Line Of Credit Facility [Line Items]
Total debt issuance costs			$ 232,000

Debt - Bank of Ireland Note Pay

Debt - Bank of Ireland Note Payable - Additional Information (Details) - Bank of Ireland Note Payable - USD ($)		3 Months Ended
	Jun. 12, 2020	Mar. 31, 2023
Debt Instrument [Line Items]
Principal amount	$ 474,000
Interest rate	4%
Debt, frequency of payment	monthly
Debt instrument term	36 months
Debt payment terms		The Bank of Ireland Note Payable bears an annual interest rate of 4% and is due in equal monthly installments over a 36-month period, including interest.

Stockholders Equity - Additiona

Stockholders Equity - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands		3 Months Ended
	Jan. 30, 2023	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022	Oct. 08, 2021
Class of Stock [Line Items]
Options reserved for future grant					310,000,000
Common stock share authorized		300,000,000		300,000,000	300,000,000
Common stock par value		$ 0.01		$ 0.01	$ 0.01
Convertible preferred stock, authorized					10,000,000
Convertible preferred stock, par value					$ 0.01
Net proceeds after deducting underwriting discounts and commissions	$ 68,449	$ 68,449
Treasury stock repurchase shares		0	0
Common Stock
Class of Stock [Line Items]
Number of aggregate issued	6,500,000	4,312,500
Price per share	$ 17
Shares sold by Company | Common Stock
Class of Stock [Line Items]
Number of shares issued and sold	3,750,000
Selling securityholders
Class of Stock [Line Items]
Net proceeds after deducting underwriting discounts and commissions	$ 50,700
Selling securityholders | Common Stock
Class of Stock [Line Items]
Number of shares issued and sold	2,750,000
Underwriters Option to Purchase Additional Shares | Maximum
Class of Stock [Line Items]
Number of shares issued and sold	562,500
Underwriters Option to Purchase Additional Shares | Common Stock
Class of Stock [Line Items]
Number of shares issued and sold	412,500

Loss Per Share - Summary of Com

Loss Per Share - Summary of Computation of Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Net loss attributable to common stockholders
Net loss	$ (9,052)	$ (9,236)
Weighted-average common stock outstanding:
Basic	80,681,715	76,447,454
Diluted	80,681,715	76,447,454
Loss per share, Basic:
Basic	$ (0.11)	$ (0.12)
Loss per share, Diluted:
Diluted	$ (0.11)	$ (0.12)

Loss Per Share - Summary of Pot

Loss Per Share - Summary of Potentially Dilutive Securities Excluded from Calculation of Diluted Net Loss Per Share Attributable to Common Stockholders (Details) - shares	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Stock Options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of dilutive net loss per share	6,523,783	7,955,083
Restricted Stock Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of dilutive net loss per share	1,420,135	79,886

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands			3 Months Ended
	Jan. 01, 2023	Oct. 19, 2021	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022	Oct. 08, 2021
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Options granted			225,000
Offering period				0
Options reserved for future grants						310,000,000
Employee contribution percentage			100%
Cash received from exercise of stock options			$ 1,622	$ 12
Weighted average strike price			$ 10.38		$ 10.02
Time-based Stock Options | Certain Officers and Contractors
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Options granted			225,000	154,500
Weighted average strike price			$ 18.33	$ 15.05
Stock Options
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Compensation expense			$ 1,756	$ 2,014
Cash received from exercise of stock options			1,622	12
Tax benefit from equity options exercised			376	$ 3
Aggregate intrinsic value of options outstanding			43,972
Aggregate intrinsic value of exercisable options			37,648
Aggregate intrinsic value of options exercised			$ 2,557
Weighted average fair value of options granted			$ 11.79	$ 8.25
Total unrecognized compensation cost related to non-vested stock awards			$ 19,102
Total unrecognized compensation cost related to non-vested stock awards, weighted average recognition period			2 years 8 months 19 days
Restricted Stock Units
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Compensation expense			$ 1,426	$ 108
Total unrecognized compensation cost related to non-vested stock awards			$ 22,109
Total unrecognized compensation cost related to non-vested stock awards, weighted average recognition period			3 years 7 months 2 days
2021 Plans
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Options reserved for future grants			13,497,048
Percentage of shares issued from outstanding number of shares		5%
Number of shares reserved and available for issuance increase (decrease)	3,888,529
2021 Plans | Restricted Stock Units
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Contractual term			10 years
Vesting, description			Restricted Stock Units (“RSUs”) granted under the 2021 Plan have a ten-year contractual term and typically vest over a three or four-year period, contingent upon continued service with the Company.
Number of shares granted			458,970	0
Forfeited			2,889
Employee Stock Purchase Plan
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Stock options permitted to grant		1,329,040
Shares issued			0	0
Shares available for issuance			2,832,250
Percentage of shares issued from outstanding number of shares		1%
Number of shares reserved and available for issuance increase (decrease)	777,705
Compensation expense			$ 122	$ 0
Employee contribution percentage			15%
Market price of shares authorized percentage		85%
Maximum purchase value of shares available for each employee			$ 25,000
Minimum | 2021 Plans | Restricted Stock Units
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Vesting period			3 years
Maximum | 2021 Plans
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Stock options permitted to grant		7,641,979
Maximum | 2021 Plans | Restricted Stock Units
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Vesting period			4 years

Stock Based Compensation - Assu

Stock Based Compensation - Assumptions used in Determining Fair Value (Details)	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Employee Stock Purchase Plan
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Expected volatility	60.33%
Expected dividends	0%
Expected term (in years)	6 months
Discount rate	15%
Risk-free rate	4.77%
Stock Options
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Expected volatility	66.20%	57%
Expected dividends	0%	0%
Expected term (in years)	6 years 3 months	6 years 3 months
Risk-free rate	4.11%	1.69%

Stock-Based Compensation - Summ

Stock-Based Compensation - Summary of Stock Option Activity (Details) - $ / shares	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Shares Outstanding, Beginning Balance	6,538,536
Shares, Granted	225,000
Shares, Exercised or Released	(223,785)
Shares, Forfeited or Expired	(15,968)
Shares Outstanding, Ending Balance	6,523,783	6,538,536
Shares, Exercisable	3,950,421
Shares, Vested and Expected To Vest	6,514,442
Weighted-Average Exercise Price, Beginning Balance	$ 10.02
Weighted-Average Exercise Price, Granted	18.33
Weighted-Average Exercise Price, Exercised or Released	7.25
Weighted-Average Exercise Price, Forfeited or Expired	16.51
Weighted-Average Exercise Price, Ending Balance	10.38	$ 10.02
Weighted-Average Exercise Price, Exercisable	7.54
Weighted-Average Exercise Price, Vested and Expected To Vest	$ 10.37
Weighted-Average Remaining Contractual Term (Years)	7 years 2 months 8 days	7 years 4 months 9 days
Weighted-Average Remaining Contractual Term (Years), Exercisable	6 years 6 months 21 days
Weighted-Average Remaining Contractual Term (Years), Vested and expected to vest	7 years 2 months 8 days

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of RSU Activity (Details) - 2021 Plans - Restricted Stock Units - $ / shares	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Outstanding, Beginning balance	964,054
Granted	458,970	0
Vested	0
Forfeited or expired	(2,889)
Outstanding, Ending balance	1,420,135
Vested and expected to vest	1,401,121
Weighted Average Fair Value, Beginning balance	$ 17.74
Weighted Average Fair Value, Granted	17.88
Weighted Average Fair Value, Vested	0
Weighted Average Fair Value, Forfeited or expired	17.82
Weighted Average Fair Value, Ending balance	17.79
Weighted Average Fair Value, Vested and expected to vest	$ 17.78

Employee Benefit Plan - Additio

Employee Benefit Plan - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Retirement Benefits [Abstract]
Defined contribution plan, description	The Company sponsors a defined contribution plan for eligible employees who are 21 years of age with three months of service can voluntarily contribute up to 100% of their eligible compensation.
Defined contribution plan minimum annual contributions per employee percent	3%
Defined benefit plan, plan assets, contributions by employer	$ 313	$ 213
Defined contribution plan, maximum percentage of eligible compensation for voluntary contribution	100%

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Tax Rates (Details)	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Income Tax Disclosure [Abstract]
Effective tax rate	0.778%	(0.356%)

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Income Tax Disclosure [Abstract]
Income tax (benefit) expense	$ (71)	$ 32

Commitments And Contigencies -

Commitments And Contigencies - Additional Information (Details) - Settlement Agreement - Stryker Corp. - USD ($) $ in Thousands			3 Months Ended
	Apr. 14, 2023	Nov. 28, 2022	Mar. 31, 2023
Loss Contingencies [Line Items]
Settlement amount		$ 26,000
First Installment to be Paid, On or by December 16, 2022
Loss Contingencies [Line Items]
Settlement amount		5,000
Payment on settlement amount			$ 5,000
Second Installment to be Paid, January 1, 2023 - January 16, 2023
Loss Contingencies [Line Items]
Settlement amount		8,000
Payment on settlement amount			$ 8,000
Third Installment to be Paid, April 1, 2023 - April 17, 2023
Loss Contingencies [Line Items]
Settlement amount		$ 13,000
Third Installment to be Paid, April 1, 2023 - April 17, 2023 | Subsequent Event
Loss Contingencies [Line Items]
Payment on settlement amount	$ 13,000

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - Director - License Agreement - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Related Party Transaction [Line Items]
Percentage of revenue paid as royalty	4%
Royalty estimated useful life	15 years
Related party transaction term of agreement	20 years
Related party transaction, agreement renewal term	5 years
Due to related parties	$ 115		$ 0
Due to related parties	187		$ 164
Payments to related party	45	$ 163
Selling, general and administrative expenses from transactions with related party	0	$ 125
Annual Payment Threshold [Member] | Minimum
Related Party Transaction [Line Items]
Due to related parties	$ 250

Segment and Geographic Inform_3

Segment and Geographic Information - Additional Information (Details) - Country	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
International
Segment Reporting Information [Line Items]
Number of countries accounted more than ten percent of net revenue	0	0

Segment and Geographic Inform_4

Segment and Geographic Information - Schedule of Total Net Revenue by Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Segment Reporting Information [Line Items]
Total net revenue	$ 52,036	$ 41,371
United States
Segment Reporting Information [Line Items]
Total net revenue	44,981	36,023
International
Segment Reporting Information [Line Items]
Total net revenue	$ 7,055	$ 5,348

Segment and Geographic Inform_5

Segment and Geographic Information - Schedule of Total Non-current Assets, Excluding Deferred Taxes, by Geographic Area (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Segment Reporting Information [Line Items]
Total assets	$ 116,109	$ 111,585
United States
Segment Reporting Information [Line Items]
Total assets	83,431	79,458
Finland
Segment Reporting Information [Line Items]
Total assets	25,447	25,581
Other International
Segment Reporting Information [Line Items]
Total assets	$ 7,231	$ 6,546