Surgalign (SRGAQ) 10-K 8 Jun 20 2019 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	May 19, 2020	Jun. 28, 2019
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY
Trading Symbol	RTIX
Entity Registrant Name	RTI Surgical Holdings, Inc.
Entity Central Index Key	0001760173
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Accelerated Filer
Entity Common Stock, Shares Outstanding		74,564,450
Entity Public Float			$ 319.4
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity File Number	001-38832
Entity Tax Identification Number	83-2540607
Entity Address, Address Line One	520 Lake Cook Road
Entity Address, Address Line Two	Suite 315
Entity Address, City or Town	Deerfield
Entity Address, State or Province	IL
Entity Address, Postal Zip Code	60015
City Area Code	877
Local Phone Number	343-6832
Document Annual Report	true
Document Transition Report	false
Entity Incorporation, State or Country Code	DE
Entity Interactive Data Current	Yes
Security Exchange Name	NASDAQ
Title of 12(b) Security	common stock, $0.001 par value

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current Assets:
Cash and cash equivalents	$ 5,608	$ 10,949
Accounts receivable - less allowances of $5,098 at December 31, 2019 and $2,660 at December 31, 2018	59,288	48,096
Inventories - net	124,149	107,655
Prepaid and other current assets	6,769	8,413
Total current assets	195,814	175,113
Non-current inventories - net	6,637
Property, plant and equipment - net	69,890	77,954
Deferred tax assets - net		17,760
Goodwill	55,384	59,798
Other intangible assets - net	10,492	25,557
Other assets - net	6,292	4,003
Total assets	344,509	360,185
Current Liabilities:
Accounts payable	30,126	26,219
Accrued expenses	33,337	25,865
Current portion of deferred revenue	2,748	4,908
Current portion of short and long term obligations	174,177
Total current liabilities	240,388	56,992
Long-term obligations - less current portion		49,073
Acquisition contingencies	1,130	4,986
Other long-term liabilities	2,017	633
Deferred revenue		744
Total liabilities	243,535	112,428
Commitments and contingencies (Note 22)
Preferred stock Series A, $.001 par value: 5,000,000 shares authorized; 50,000 shares issued and outstanding	66,410	66,226
Stockholders' equity:
Common stock, $.001 par value: 150,000,000 shares authorized; 75,213,515 and 63,469,185 shares issued and outstanding, respectively	75	64
Additional paid-in capital	498,438	433,143
Accumulated other comprehensive loss	(7,629)	(7,270)
Accumulated deficit	(451,179)	(239,537)
Less treasury stock, 1,285,224 and 1,221,180 shares, respectively, at cost	(5,141)	(4,869)
Total stockholders' equity	34,564	181,531
Total liabilities and stockholders' equity	$ 344,509	$ 360,185

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Accounts receivable, allowances	$ 5,098	$ 2,660
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	5,000,000	5,000,000
Preferred stock, shares issued	50,000	50,000
Preferred stock, shares outstanding	50,000	50,000
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	150,000,000	150,000,000
Common stock, shares issued	75,213,515	63,469,185
Common stock, shares outstanding	75,213,515	63,469,185
Treasury stock, shares	1,285,224	1,221,180

Consolidated Statements of Comp

Consolidated Statements of Comprehensive (Loss) Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Statement [Abstract]
Revenues	$ 308,384	$ 280,362	$ 280,349
Costs of processing and distribution	137,259	140,719	137,277
Gross profit	171,125	139,643	143,072
Expenses:
Marketing, general and administrative	157,675	119,724	115,009
Research and development	16,836	14,410	13,315
Severance and restructuring costs	0	2,808	12,016
Gain on acquisition contingency	(76,033)	0	0
Executive transition costs	0	0	2,818
Asset impairment and abandonments	97,341	5,070	4,034
Goodwill impairment	140,003	0	0
Acquisition and integration expenses	17,159	4,943	630
Cardiothoracic closure business divestiture contingency consideration	0	(3,000)	0
Gain on cardiothoracic closure business divestiture	0	0	(34,090)
Total operating expenses	352,981	143,955	113,732
Operating (loss) income	(181,856)	(4,312)	29,340
Other (expense) income:
Interest expense	(12,571)	(2,771)	(3,180)
Interest income	161	35	8
Loss on extinguishment of debt	0	(309)	0
Foreign exchange (loss) gain	(139)	(34)	87
Total other expense - net	(12,549)	(3,079)	(3,085)
(Loss) income before income tax (provision) benefit	(194,405)	(7,391)	26,255
Income tax (provision) benefit	(17,237)	4,268	(19,349)
Net (loss) income	(211,642)	(3,123)	6,906
Convertible preferred dividend	0	(2,120)	(3,723)
Net (loss) income applicable to common shares	(211,642)	(5,243)	3,183
Other comprehensive (loss) income:
Unrealized foreign currency translation loss	(351)	(941)	1,987
Comprehensive (loss) income	$ (211,993)	$ (6,184)	$ 5,170
Net (loss) income per common share - basic	$ (2.91)	$ (0.08)	$ 0.05
Net (loss) income per common share - diluted	$ (2.91)	$ (0.08)	$ 0.05
Weighted average shares outstanding - basic	72,824,308	63,521,703	59,684,289
Weighted average shares outstanding - diluted	72,824,308	63,521,703	60,599,952

Consolidated Statements of Stoc

Consolidated Statements of Stockholders Equity - USD ($) $ in Thousands	Total	Series A Preferred Stock [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Additional Paid-in Capital [Member]Series A Preferred Stock [Member]	Accumulated Other Comprehensive Loss [Member]	Accumulated Deficit [Member]	Treasury Stock [Member]
Beginning Balance at Dec. 31, 2016	$ 164,062		$ 58	$ 417,428		$ (8,316)	$ (244,192)	$ (916)
Net income (loss)	6,906						6,906
Foreign currency translation adjustment	1,987					1,987
Exercise of common stock options	9,181		5	9,176
Stock-based compensation	6,762			6,762
Purchase of treasury stock	(3,474)							(3,474)
Amortization of preferred stock Series A issuance costs		$ (184)			$ (184)
Preferred stock Series A dividend		(3,723)			(3,723)
Ending Balance at Dec. 31, 2017	181,517		63	429,459		(6,329)	(237,286)	(4,390)
Accumulated effect of adoption of the revenue recognition standard	872						872
Net income (loss)	(3,123)						(3,123)
Foreign currency translation adjustment	(941)					(941)
Exercise of common stock options	1,243		1	1,242
Stock-based compensation	4,745			4,745
Purchase of treasury stock	(479)							(479)
Amortization of preferred stock Series A issuance costs		(183)			(183)
Preferred stock Series A dividend		(2,120)			(2,120)
Ending Balance at Dec. 31, 2018	181,531		64	433,143		(7,270)	(239,537)	(4,869)
Net income (loss)	(9,351)
Foreign currency translation adjustment	(393)
Ending Balance at Mar. 31, 2019	233,787
Beginning Balance at Dec. 31, 2018	181,531		64	433,143		(7,270)	(239,537)	(4,869)
Net income (loss)	(9,163)
Foreign currency translation adjustment	2
Ending Balance at Jun. 30, 2019	235,661
Beginning Balance at Dec. 31, 2018	181,531		64	433,143		(7,270)	(239,537)	(4,869)
Net income (loss)	(14,301)
Foreign currency translation adjustment	(1,120)
Ending Balance at Sep. 30, 2019	230,291
Beginning Balance at Dec. 31, 2018	181,531		64	433,143		(7,270)	(239,537)	(4,869)
Net income (loss)	(211,642)						(211,642)
Foreign currency translation adjustment	(351)					(359)
Exercise of common stock options	395			395
Equity instruments issued in connection with Paradigm Spine acquisition - net of fees	60,730		11	60,719
Stock-based compensation	4,367			4,367
Purchase of treasury stock	(272)							(272)
Amortization of preferred stock Series A issuance costs		$ (186)			$ (186)
Ending Balance at Dec. 31, 2019	34,564		$ 75	$ 498,438		$ (7,629)	$ (451,179)	$ (5,141)
Beginning Balance at Mar. 31, 2019	233,787
Net income (loss)	188
Foreign currency translation adjustment	395
Ending Balance at Jun. 30, 2019	235,661
Net income (loss)	(5,138)
Foreign currency translation adjustment	(1,122)
Ending Balance at Sep. 30, 2019	$ 230,291

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Cash flows from operating activities:
Net income (loss)	$ (211,642)	$ (3,123)	$ 6,906
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization expense	22,675	14,579	14,233
Provision for bad debts and product returns	2,937	1,721	946
Provision for inventory write-downs	8,493	15,122	5,066
Amortization of deferred revenue	(4,906)	(4,958)	(4,744)
Deferred income tax provision	17,066	(4,692)	13,573
Stock-based compensation	4,367	4,745	6,660
Asset impairment and abandonments	97,341	5,070	4,034
Cardiothoracic closure business divestiture contingency consideration		(3,000)	(34,090)
Goodwill impairment	140,003	0	0
Gain on acquisition contingency	(76,033)	0	0
Paid in kind interest expense	4,408
Other	673	1,330	2,392
Change in assets and liabilities:
Accounts receivable	(9,013)	(10,829)	5,116
Inventories	(14,219)	(11,957)	1,610
Accounts payable	(974)	8,035	(12,936)
Accrued expenses	4,489	(827)	5,667
Deferred revenue	2,000	2,000	2,000
Other operating assets and liabilities	1,879	4,036	(10,645)
Net cash (used in) provided by operating activities	(9,456)	17,252	5,788
Cash flows from investing activities:
Purchases of property, plant and equipment	(14,426)	(11,042)	(12,301)
Patent and acquired intangible asset costs	(2,007)	(3,695)	(2,266)
Proceeds from sale of building			1,818
Cardiothoracic closure business divestiture		3,000	51,000
Net cash (used in) provided by investing activities	(116,125)	(32,737)	38,251
Cash flows from financing activities:
Proceeds from exercise of common stock options	395	2,356	5,060
Proceeds from long-term obligations	121,500	74,425	6,000
Payments of debt issuance costs	(826)
Payments on long-term obligations	(500)	(71,171)	(43,000)
Payments for treasury stock	(237)	(478)	(3,474)
Other financing activities		(1,039)	(317)
Net cash provided by (used in) financing activities	120,296	4,093	(35,731)
Effect of exchange rate changes on cash and cash equivalents	(56)	(40)	224
Net increase (decrease) in cash and cash equivalents	(5,341)	(11,432)	8,532
Cash and cash equivalents, beginning of period	10,949	22,381	13,849
Cash and cash equivalents, end of period	5,608	10,949	22,381
Supplemental cash flow disclosure:
Cash paid for interest	7,121	3,047	3,023
Cash paid for income taxes, net of refunds	(1,994)	(6,403)	12,142
Non-cash acquisition of property, plant and equipment	1,468	1,217	593
Receivable for executive stock option exercise			1,234
Stock-based compensation related to sale of CT business			102
Increase in accrual for dividend payable		2,120	$ 3,723
Zyga Technology Inc [Member]
Cash flows from investing activities:
Payments to acquire businesses		$ (21,000)
Paradigm Spine [Member]
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Provision for inventory write-downs	513
Gain on acquisition contingency	(72,177)
Cash flows from investing activities:
Payments to acquire businesses	$ (99,692)

Business

Business	12 Months Ended
	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements Abstract
Business	1. Business RTI Surgical Holdings, Inc. (the “Company”), and its subsidiaries recover and process human and animal tissue and manufacture metal and synthetic implants and instruments. The processing transforms the tissue into either conventional or precision machined allograft implants (human) or xenograft implants (animal), while our manufacturing facilities produce metal and synthetic implants. The implants are used for orthopedic and other surgical applications to promote the natural healing of human bone and other human tissue. These implants are distributed domestically and internationally, for use in reconstruction and fracture repair. Going Concern The accompanying consolidated financial statements of the Company have been prepared assuming the Company will continue as a going concern and in accordance with generally accepted accounting principles in the United States of America. The going concern basis of presentation assumes that we will continue in operation one year after the date these financial statements are issued, and we will be able to realize our assets and discharge our liabilities and commitments in the normal course of business. As of December 31, 2019, we had cash of $5,608, a working capital deficiency of $44,574 and an accumulated deficit of $451,179. We had a loss from operations of $181,856 and a net loss of $211,642 for the year ended December 31, 2019. We have suffered losses from operations in the previous two fiscal years and did not generate positive cash flows from operations in fiscal year 2019. The Company is currently projecting that it will not be able to maintain compliance with its financial covenants (fixed charge coverage ratio and leverage ratio) for the quarter ended June 30, 2020, as well as in future periods, in relation to both the JPM Facility and Ares Term Loan agreements. This would constitute an event of default for which the Company’s lenders could demand repayment of these obligations at any time. Should the sale of the OEM Business, as discussed in Note 29, Subsequent Events, not be consummated, the Company will continue to attempt to raise additional debt and/or equity financing to fund future operations and to provide additional working capital. However, there is no assurance that such financing will be consummated or obtained in sufficient amounts necessary to meet the Company’s needs. The Company’s ability to raise additional capital may be adversely impacted by potential worsening global economic conditions and the recent disruptions to, and volatility in, financial markets in the United States and worldwide resulting from the ongoing COVID-19 pandemic. If cash resources are insufficient to satisfy the Company’s on-going cash requirements, the Company will be required to scale back or discontinue its operations entirely. No assurance can be given that any future financing will be available or, if available, that it will be on terms that are satisfactory to the Company. Even if the Company is able to obtain additional financing, it may contain undue restrictions on our operations, in the case of debt financing, or cause substantial dilution for our stockholders, in the case of equity financing. In view of the matters described above, management has concluded that substantial doubt exists with respect to the Company’s ability to continue as a going concern within one year after the date the financial statements are issued. The recoverability of a major portion of the recorded asset amounts shown in the Company’s accompanying consolidated balance sheets is dependent upon continued operations of the Company, which in turn is dependent upon the Company’s ability to meet its funding requirements on a continuous basis, to maintain existing financing and to succeed in its future operations. The Company’s financial statements do not include any adjustment relating to the recoverability and classification of recorded asset amounts and classification of liabilities that might be necessary should the Company be unable to continue in existence.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Principles of Consolidation RTIDS is a taxable not-for-profit Use of Estimates Foreign Currency Translation Fair Value of Financial Instruments Cash and Cash Equivalents Accounts Receivable Allowances Inventories first-in, first-out Non-tissue Property, Plant and Equipment Depreciation is computed on the straight-line method over the following estimated useful lives of the assets: Buildings 25 to 40 years Building improvements and leasehold improvements 8 to 40 years Processing equipment 7 to 10 years Office equipment, furniture and fixtures 5 to 7 years Computer hardware and software 3 to 7 years Surgical instruments 3 to 5 years Debt Issuance Costs— Long-Lived Assets Goodwill Goodwill and Other Intangible Assets Goodwill is tested for impairment by comparing the fair value of the reporting unit to its carrying amount, including goodwill. Prior to 2019, in concluding as to fair value of the reporting unit for purposes of testing goodwill, an income approach and a market approach were utilized. The conclusion from these two approaches were weighted equally and then adjusted to incorporate a control premium or acquisition premium that reflects the additional amount a buyer is willing to pay for elements of control and for a premium that reflects the buyer’s perception of its ability to add value through synergies. In 2019, since the cash flows were negative over the forecast period for the Spine reporting unit, a cost approach was used to determine the fair value of the Spine reporting unit. For the OEM reporting unit, we weighted the income approach 75% and the market approach 25%. We have chosen the weightings because the income approach more fully captures the company specific factors that would not be directly captured in the market approach, as there are no pure publicly traded comparable companies. The income approach employs a discounted cash flow model that considers: 1) assumptions that marketplace participants would use in their estimates of fair value, including the cash flow period, terminal values based on a terminal growth rate and the discount rate; 2) current period actual results; and 3) projected results for future periods that have been prepared and approved by senior management of the Company. The market approach employs market multiples from guideline public companies operating in our industry. Estimates of fair value are derived by applying multiples based on revenue and earnings before interest, taxes, depreciation and amortization (“EBITDA”) adjusted for size and performance metrics relative to peer companies. The cost approach considers the replacement cost adjusted for certain factors. Certain balance sheet items were adjusted to fair value before being utilized in estimating the value of the reporting unit under the cost approach, including inventory, property, plant and equipment, right of use assets, and other intangible assets. All three approaches used in the analysis have a degree of uncertainty. Potential events or changes in circumstances which could impact the key assumptions used in our goodwill impairment evaluation are as follows: • Change in peer group or performance of peer group companies • Change in the Company’s markets and estimates of future operating performance • Change in the Company’s estimated market cost of capital • Change in implied control premiums related to acquisitions in the medical device industry Other Intangible Assets As of December 31, 2019, the Company concluded, through the ASC 360 valuation testing, that factors existed indicating that finite-lived intangible assets in the Spine asset group were impaired. The factors included a change made to the internal organization of the Company in the fourth quarter of 2019. The organizational change resulted in the creation of a new Spine asset group. Prior to the fourth quarter of 2019, the Spine asset group did not exist as the related assets were included in another asset group as it had interdependencies among the utilization of the assets within the group, and therefore, there were no discrete cash flows. The asset group representing the Spine asset group could not support the carrying amount of the finite-lived intangible assets, because the Spine asset group no longer has the benefit of shared resources and cashflows generated by the former asset group that it was previously included in. Thus, we tested the $85,096 carrying amount of intangible assets in the Spine asset group for impairment on December 31, 2019. As a result, for the year ended December 31, 2019, we recorded an impairment charge for all of the finite-lived intangible assets within Spine asset group, totaling $85,096. Revenue Recognition The Company permits returns of implants in accordance with the terms of contractual agreements with customers if the implant is returned in a timely manner, in unopened packaging, and from the normal channels of distribution. Allowances for returns are provided based upon analysis of the Company’s historical patterns of returns matched against the revenues from which they originated. The Company records estimated implant returns, discounts, rebates and other distribution incentives as a reduction of revenue in the same period revenue is recognized. Estimates of implant returns are recorded for anticipated implant returns based on historical distributions and returns information. Estimates of discounts, rebates and other distribution incentives are recorded based on contractual terms, historical experience and trend analysis. Other revenues consist of service processing, tissue recovery fees, biomedical laboratory fees, recognition of previously deferred revenues, shipping fees, distribution of reproductions of our allografts to distributors for demonstration purposes and restocking fees which is included in revenues. Stock-Based Compensation Plans Accounting for Stock Compensation pre-vesting Research and Development Costs Income Taxes year-end Treasury Stock Earnings Per Share For the Year Ended December 31, 2019 2018 2017 Weighted average basic shares 72,824,308 63,521,703 59,684,289 Effect of dilutive securities: Stock options — — 915,663 Weighted average diluted shares 72,824,308 63,521,703 60,599,952 Options to purchase 4,536,461 shares of common stock at prices ranging from $2.09 to $5.23 per share which were outstanding as of December 31, 2019, were not included in the computation of diluted EPS because dilutive shares are not factored into the calculation of EPS when a loss applicable to common shares is reported as they would be anti-dilutive. Options to purchase 4,275,744 shares of common stock at prices ranging from $2.69 to $5.23 per share which were outstanding as of December 31, 2018, were not included in the computation of diluted EPS because dilutive shares are not factored into the calculation of EPS when a loss applicable to common shares is reported as they would be anti-dilutive. Options to purchase 4,662,037 shares of common stock at prices ranging from $2.69 to $8.20 per share which were outstanding as of December 31, 2017, were included in the computation of diluted EPS because dilutive shares are factored into the calculation of EPS when income applicable to common shares is reported. For the years ended December 31, 2019, and 2018, 50,000 shares of convertible preferred stock or 15,152,761 of converted common stock and accrued but unpaid dividends were anti-dilutive on an as if-converted basis and were not included in the computation of diluted net (loss) income per common share.

Recently Issued and Adopted Acc

Recently Issued and Adopted Accounting Standards	12 Months Ended
	Dec. 31, 2019
Accounting Changes and Error Corrections [Abstract]
Recently Issued and Adopted Accounting Standards	3. Recently Issued and Adopted Accounting Standards. Financial Instruments No. 2019-05 Financial Instruments — Credit Losses (Topic 326) 2016-13 825-10, instrument-by-instrument 326-20, held-to-maturity 2019-05 2016-13 In April 2019, the FASB issued ASU No. 2019-04 Codification Improvements to Topic 326, Financial Instruments — Credit Losses, Topic 815, Derivatives and Hedging, and Topic 825, Financial Instruments 2016-01 Financial Instruments — Overall (Subtopic 825-10): 2016-13 Financial Instruments — Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, 2017-12 Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities, 2016-13 2016-13 2019-04. 2017-12 2016-01 In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments — Credit Losses 2016-13 held-to-maturity 2016-13 available-for-sale 2016-13 Fair Value Measurement ASU 2018-13, “Fair Value Measurement (Topic 820): Disclosure Framework — Changes to the Disclosure Requirements for Fair Value Measurement.” 2018-13 2018-13 Leases 2016-02, 2016-02 right-of-use Effective January 1, 2019, the Company adopted Topic 842 using the optional transition method which allowed us to continue to apply Topic 840 in the comparative periods presented. In addition, the Company elected the package of practical expedients, which allowed us to not reassess whether any existing contracts contain a lease, to not reassess historical lease classification as operating or finance leases, and to not reassess initial direct costs. The Company has not elected the practical expedient to use hindsight to determine the lease term for its leases at transition. The Company has also elected the practical expedient allowing us to not separate the lease and non-lease Revenue from Contracts with Customers

Leases

Leases	12 Months Ended
	Dec. 31, 2019
Leases [Abstract]
Leases	4. Leases The Company’s leases are classified as operating leases and includes office space, automobiles, and copiers. The Company does not have any finance leases, and the Company’s operating leases do not have any residual value guarantees, restrictions or covenants. The Company does not have any leases that have not yet commenced as of December 31, 2019. The majority of our leases have remaining lease terms of 1 to 14 years, some of which include options to extend or terminate the leases. The option to extend or terminate is only included in the lease term if the Company is reasonably certain of exercising that option. Operating lease ROU assets are presented within other assets-net non-current A subset of the Company’s automobile and copier leases contain variable payments. The variable lease payments for such automobile leases are based on actual mileage incurred at the standard contractual rate. The variable lease payments for such copier leases are based on actual copies incurred at the standard contractual rate. The variable lease costs for all leases are immaterial. The components of operating lease expense were as follows: For the Year Ended December 31, 2019 Operating lease cost $ 1,659 Short-term operating lease cost 36 Total operating lease cost $ 1,695 Supplemental cash flow information related to operating leases was as follows: For the Year Ended December 31, 2019 Cash paid for amounts included in the measurement of lease liabilities $ 1,558 ROU assets obtained in exchange for lease obligations 103 Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at Assets: Right-of-use Other assets - net $ 2,155 Liabilities: Current Accrued expenses $ 1,159 Noncurrent Other long-term liabilities 1,547 Total operating lease liabilities $ 2,706 As of December 31, 2019, the weighted-average remaining lease term was 5.0 years. The rate implicit on the Company’s leases are not readily determinable nor is it available to the Company from its lessors. Thus, the Company estimates its incremental borrowing rate based on information available at lease commencement in order to discount lease payments to present value. The weighted-average discount rate of the Company’s operating leases was 4.7%, as of December 31, 2019. Based on the income approach, including consideration of present value of market-based rent payments for the applicable properties of the Spine segment leases, the Company recorded a write down of $201 related to a right of use assets. Maturities of operating lease liabilities were as follows: Maturity of Operating Lease Liabilities Balance at 2020 $ 1,261 2021 562 2022 226 2023 159 2024 159 2025 and beyond 716 Total future minimum lease payments 3,083 Less imputed interest (377 ) Total operating lease liabilities $ 2,706 As previously disclosed in our 2018 Annual Report on Form 10-K/A, Maturity of Operating Lease Liabilities Balance at 2019 $ 1,374 2020 806 2021 276 2022 162 2023 166 2024 and beyond 882 Total future minimum lease payments $ 3,666

Segment Reporting

Segment Reporting	12 Months Ended
	Dec. 31, 2019
Segment Reporting [Abstract]
Segment Reporting	5. Segment Reporting The Company has determined its operating segments in accordance with ASC 280 - Segment Reporting. Prior to the fourth quarter of 2019, the Company operated in one operating and reportable segment composed of four franchises: spine; sports; original equipment manufacturer (“OEM”) and international. During the fourth quarter of 2019, changes were made to the internal organization of the Company which resulted in a change in the Company’s operating segments. The overall strategy of the Company is to manage our business in two operating segments, Global Spine (“Spine”) and Global OEM (“OEM”). The Spine segment focuses on sales, distribution and conducting research and development activities focused on the global spine market and the OEM segment focuses on the design, development and manufacturing of biologics and hardware medical technology. Changes were made to align our internal reporting and management structure to focus on the value drivers of each segment. The value drivers of the Spine segment include growth through innovation and acquisition while the value drivers of the OEM segment focus on predetermined and relatively predictable execution. Due to the reassessment of the business lines and our internal reorganization, the Company is now organized into two distinct groupings, Spine and OEM, which are also our operating and reportable segments. Additionally, the 2018 and 2017 revenue franchise data has been recast below to reflect the presentation of the new segment structure. The Spine and OEM reportable segments reflect the way the Company is managed, and for which separate financial information is available and evaluated regularly by the Company’s chief operating decision maker (“CODM”) in deciding how to allocate resources and assess performance. The Company’s Chief Executive Officer is the CODM. The segment revenues and segment net income (loss) for the years ended December 31, 2019, 2018, and 2017 are included in the table below. All revenues are earned from external customers. The Company does not disclose total assets by Spine and OEM as the CODM does not receive or review with regularity assets on a Spine or OEM basis. Additionally, the Company does not disclose long-lived assets by geographic location as no country outside of the United States holds 10% or more of our consolidated Property, Plant and Equipment. The Company’s segment data is as follows: For the Year Ended December 31, 2019 2018 2017 Revenues: Spine $ 118,987 $ 94,436 $ 92,712 OEM 189,397 185,926 187,637 Total $ 308,384 $ 280,362 $ 280,349 Depreciation and amortization: Spine $ 12,779 $ 4,692 $ 3,469 OEM 9,896 9,887 10,764 Total $ 22,675 $ 14,579 $ 14,233 Operating income (loss): Spine $ (30,538 ) $ (20,603 ) $ (9,497 ) OEM 27,152 26,112 24,245 One-time charges Severance and restructuring costs — 2,808 12,016 Executive transition costs — — 2,818 Gain on acquisition contingency (76,033 ) — — Asset impairment and abandonments 97,341 5,070 4,034 Goodwill impairment 140,003 — — Acquisition and integration expenses 17,159 4,943 630 Gain on cardiothoracic closure business divestiture — (3,000 ) (34,090 ) Total one-time charges 178,470 9,821 (14,592 ) Operating income (loss) $ (181,856 ) $ (4,312 ) $ 29,340 Interest expense (12,571 ) (2,771 ) (3,180 ) Interest income 161 35 8 Loss on extinguishment of debt — (309 ) — Foreign exchange (loss) gain (139 ) (34 ) 87 Income (loss) before income tax benefit (provision) $ (194,405 ) $ (7,391 ) $ 26,255 Revenues are attributed to countries based on the location of customer. The following table presents revenues by geographic location: For the Year Ended December 31, 2019 2018 2017 Revenues: North America $ 277,152 $ 254,409 $ 254,385 EMEA 24,252 21,258 19,303 Asia Pacific 4,027 2,996 5,488 Latin America 2,953 1,699 1,173 Total $ 308,384 $ 280,362 $ 280,349 Certain corporate costs have been allocated solely to the Spine reportable segment, including certain executive compensation costs and certain corporate costs including board of directors’ fees and board of directors’ stock-based compensation, public company expenses, legal fees, corporate compliance and communications costs, and business development expenses. The costs that were allocated solely to the Spine reportable segment total $7,855, $11,212, and $9,148 in 2019, 2018, and 2017, respectively. These costs were not allocated to the OEM reportable segment because the basis for the changes to the internal organization of the Company was in contemplation of the pending sale of the OEM business, and these costs are expected to remain with the Spine reportable segment. Such presentation appropriately reflects that manner in which the CODM evaluates the ongoing performance and allocates resources of the Company.

Revenue from Contracts with Cus

Revenue from Contracts with Customers	12 Months Ended
	Dec. 31, 2019
Revenue from Contract with Customer [Abstract]
Revenue from Contracts with Customers	6. Revenue from Contracts with Customers The Company is organized into two business lines, which are also our operating and reportable segments: Spine and OEM. The following table presents revenues from these two segments: Year Ended December 31, 2019 December 31, 2018 Revenues: Spine Segment Domestic $ 97,629 $ 79,812 International 21,358 14,625 OEM Segment OEM 124,184 120,037 Sports 55,339 54,560 International 9,874 11,328 Total revenues from contracts with customers $ 308,384 $ 280,362 The following table presents revenues recognized at a point in time and over time for the years ended December 31, 2019 and 2018: Year Ended December 31, 2019 December 31, 2018 Revenue recognized at a point in time $ 240,469 $ 239,619 Revenue recognized over time 67,915 40,743 Total revenues from contracts with customers $ 308,384 $ 280,362 The Company’s performance obligations consist mainly of transferring control of implants identified in the contracts. Some of the Company’s contracts offer assurance-type warranties in connection with the sale of a product to a customer. Assurance-type warranties provide a customer with assurance that the related product will function as the parties intended because it complies with agreed-upon specifications. Such warranties do not represent a separate performance obligation and are not material to the consolidated financial statements. The opening and closing balances of the Company’s accounts receivable and current and long-term contract liability for the years ended December 31, 2019 and 2018 are as follows: Accounts Contract Contract Opening - January 1, 2019 $ 48,096 $ 5,425 $ 744 Closing - December 31, 2019 59,288 3,378 — Increase/(decrease) 11,192 (2,047 ) (744 ) Accounts Contract Contract Opening - January 1, 2018 $ 38,441 $ 5,978 $ 3,741 Closing - December 31, 2018 48,096 5,425 744 Increase/(decrease) 9,655 (553 ) (2,997 ) As of December 31, 2019, December 31, 2018 and January 1, 2018, $10,633, $6,577 and $2,133, respectively, of unbilled receivables in connection with our exclusively built inventory contracts are included in accounts receivable.

Acquisition

Acquisition	12 Months Ended
	Dec. 31, 2019
Paradigm Spine [Member]
Acquisition	7. Acquisition of Paradigm Spine, LLC On March 8, 2019, pursuant to the Master Transaction Agreement (the “Master Transaction Agreement”), dated as of November 1, 2018, by and among Legacy RTI, PS Spine Holdco, LLC, a Delaware limited liability company (“PS Spine”), the Company, and Bears Merger Sub, Inc., a Delaware corporation and direct wholly owned subsidiary of the Company (“Merger Sub”), the Company acquired all of the outstanding equity interests of Paradigm, through a transaction in which: (i) PS Spine contributed all of the issued and outstanding equity interests in Paradigm to the Company (the “Contribution”); (ii) Merger Sub merged with and into Legacy RTI (the “Merger”), with Legacy RTI surviving as a wholly owned direct subsidiary of the Company; and (iii) the Company was renamed “RTI Surgical Holdings, Inc.” (collectively, the “Transaction”). Legacy RTI retained its existing name “RTI Surgical, Inc.” Pursuant to the Master Transaction Agreement: (i) each share of common stock, par value $0.001 per share, of Legacy RTI issued and outstanding immediately prior to the Transaction (other than shares held by Legacy RTI as treasury shares or by the Company or Merger Sub immediately prior to the Transaction, which were automatically cancelled and ceased to exist) was converted automatically into one fully paid and non-assessable non-assessable The consideration for the Contribution was $100,000 (the “Cash Consideration Amount”) in cash and 10,729,614 shares of Company common stock (the “Stock Consideration Amount”). The Cash Consideration Amount was adjusted lower by Paradigm’s working capital of $7,000. In addition to the Cash Consideration Amount and the Stock Consideration Amount, the Company may be required to make further cash payments or issue additional shares of Company common stock to PS Spine in an amount up to $50,000 of shares of Company common stock to be valued based upon the Legacy RTI Price and an additional $100,000 of cash and/or Company common stock to be valued at the time of issuance, in each case, if certain revenue targets are achieved between closing, March 8, 2019, and December 31, 2022. The Company estimates the fair value of the contingent liability at acquisition date related to the revenue based earnout to be $72,177 utilizing a Monte-Carlo simulation model. A Monte-Carlo simulation is an analytical method used to estimate fair value by performing a large number of simulations or trial runs and thereby determining a value based on the possible outcomes. Accounted for as a liability to be revalued at each reporting period, the fair value of the contingent liability was measured using Level 3 inputs, which includes weighted average cost of capital and projected revenues and costs. Acquisition and integration related costs, specific to Paradigm, were approximately $15,537, of which approximately $4,143 was incurred during 2018, $11,394 (which includes integration costs of business development expenses of $462 and severance expense of $896) was incurred for the year ended December 31, 2019 and is reflected separately in the accompanying consolidated statements of comprehensive gain (loss). The Company has accounted for the acquisition of Paradigm under ASC 805, Business Combinations The purchase price was comprised as follows: Cash proceeds from second lien credit agreement $ 100,000 Fair market value of securities issued 60,730 Fair market value of contingent earnout 72,177 Total purchase price $ 232,907 In the first quarter of 2019, the Company completed its valuations and purchase price allocations. The table below represents the final allocation of the total purchase price to Paradigm’s tangible and intangible assets and liabilities fair values as of March 8, 2019. Balance at March 8, 2019 Cash $ 307 Accounts receivable 5,220 Inventories 17,647 Other current assets 934 Property, plant and equipment 379 Other non-current assets 1,079 Current liabilities (6,169 ) Lease liabilities (1,079 ) Net tangible assets acquired 18,318 Other intangible assets 79,000 Goodwill 135,589 Total net assets acquired $ 232,907 As of March 8, 2019, the inventory fair value was composed of current inventory of $7,122 and non-current Total net assets acquired as of March 8, 2019, were included in the Company’s only operating segment at that time. Subsequent to the segment change discussed in Note 5, the net assets acquired are included in the Spine segment. Fair values are based on management’s estimates and assumptions including variations of the income approach, the cost approach and the market approach. The Company believes that the acquisition of Paradigm, a spine focused business, offers the potential for substantial strategic and financial benefits. The transaction further advances the Company’s strategic transformation focused on reducing complexity, driving operational excellence and accelerating growth. The Company believes the acquisition will enhance stockholder value through, among other things, enabling the Company to capitalize on the following strategic advantages and opportunities: • Paradigm will strengthen the Company’s spine portfolio with the addition of the coflex ® ® ® PMA-approved • Coflex ® PMA-approved These potential benefits resulted in the Company paying a premium for Paradigm resulting in the recognition of $135,589 of goodwill. The following unaudited pro forma information shows the results of the Paradigm’s operations as though the acquisition had occurred as of the beginning of the prior comparable period, January 1, 2018: For the Year Ended 2019 2018 Revenues $ 37,374 $ 40,810 Net loss (16,547 ) (42,550 ) The pro forma results have been prepared for comparative purposes only and are not necessarily indicative of the actual results of operations had the acquisition taken place as of the beginning of the periods presented, or the results that may occur in the future.
Zyga Technology Inc [Member]
Acquisition	8. Acquisition of Zyga Technology, Inc. On January 4, 2018, the Company acquired Zyga Technology, Inc. (“Zyga”), a spine-focused medical device company that develops and produces innovative minimally invasive devices to treat underserved conditions of the lumbar spine. Zyga’s primary product is the SImmetry ® The Company has accounted for the acquisition of Zyga under ASC 805, Business Combinations The purchase price was financed as follows: Cash proceeds from revolving credit facility $ 18,000 Cash from RTI Surgical 3,000 Total purchase price $ 21,000 In the fourth quarter of 2018, the Company completed its valuation of the purchase price allocation. The table below represents the final allocation of the total consideration to Zyga’s tangible and intangible assets and liabilities fair values as of January 4, 2018. Including acquisition contingencies, the total consideration for the Zyga acquisition was $25,986. Inventories $ 1,099 Accounts receivable 573 Other current assets 53 Property, plant and equipment 151 Other assets 26 Deferred tax assets 4,715 Current liabilities (947 ) Acquisition contingencies (4,986 ) Net tangible assets acquired 684 Other intangible assets 6,760 Goodwill 13,556 Total net assets acquired $ 21,000 Total net assets acquired as of January 4, 2018, are all part of the Company’s only operating segment and reporting unit. Fair values are based on management’s estimates and assumptions including variations of the income approach, the cost approach and the market approach. Other intangible assets include patents of $6,500 with a useful life of 13 years, trademarks of $80 with a useful life of 1 year and selling and marketing relationships of $180 with a useful life of 7 years. The Company believes that the acquisition of Zyga has offered and continues to offer the potential for substantial strategic and financial benefits. The transaction further advances our strategic transformation focused on reducing complexity, driving operational excellence and accelerating growth. The Company believes the acquisition will enhance stockholder value through, among other things, enabling the Company to capitalize on the following strategic advantages and opportunities: • Zyga’s innovative minimally invasive treatment should accentuate our spine portfolio and opens significant opportunities to accelerate our Spine-focused expansion strategy. • Zyga should leverage the core competencies of our Spine franchise by pursuing niche differentiated products, to gain scale and customer retention and support portfolio pull-through. These potential benefits resulted in the Company paying a premium for Zyga resulting in the recognition of $13,556 of goodwill assigned to the Company’s only operating segment and reporting unit. For tax purposes, none of the goodwill is deductible. The following unaudited pro forma information shows the results of the Zyga’s operations as though the acquisition had occurred as of the beginning of the prior comparable period, January 1, 2018. For the Year Ended December 31, 2018 Revenues $ 4,809 Net loss (2,640 ) The pro forma results have been prepared for comparative purposes only and are not necessarily indicative of the actual results of operations had the acquisition taken place as of the beginning of the periods presented, or the results that may occur in the future.

Cardiothoracic Closure Business

Cardiothoracic Closure Business Divestiture	12 Months Ended
	Dec. 31, 2019
Discontinued Operations and Disposal Groups [Abstract]
Cardiothoracic Closure Business Divestiture	9. Cardiothoracic Closure Business Divestiture The Company completed the sale of substantially all of the assets related to its Cardiothoracic closure business (the “CT Business”) to A&E Advanced Closure Systems, LLC (a subsidiary of A&E Medical Corporation) (“A&E”) pursuant to an Asset Purchase Agreement between the Company and A&E, dated August 3, 2017 (the “Asset Purchase Agreement”). The total cash consideration received by the Company under the Asset Purchase Agreement was composed of $54,000, $3,000 of which was held in escrow (the “Escrow Amount”) to satisfy possible indemnification obligations, of which there were none. As such, the Company earned and received the $3,000 cash consideration in the third quarter of 2018. An additional $5,000 in contingent cash consideration is earned if A&E reaches certain revenue milestones (the “Contingent Consideration”). The Company also earned and received an additional $1,000 in consideration for successfully obtaining certain U.S. Food and Drug Administration (“FDA”) regulatory clearance. As a part of the transaction, the Company also entered into a multi-year Contract Manufacturing Agreement with A&E (the “Contract Manufacturing Agreement”). Under the Contract Manufacturing Agreement, the Company agreed to continue to support the CT Business by manufacturing existing products and engineering, developing, and manufacturing potential future products for A&E. The Company elected to account for the Contingent Consideration arrangement including the Escrow Amount, as a gain contingency in accordance with ASC 450 Contingencies. As such, the Contingent Consideration and Escrow Amount were excluded in measuring the fair value of the consideration to be received in connection with the transaction. The calculation of the gain on the CT Business divestiture is as follows: Proceeds from cardiothoracic closure business divestiture $ 51,000 Inventories - net (2,893 ) Property, plant and equipment - net (1,299 ) Goodwill (8,645 ) Other intangible assets - net (280 ) Cardiothoracic closure business divestiture expenses (3,793 ) Gain on cardiothoracic closure business divestiture $ 34,090

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation	10. Stock-Based Compensation The Company’s policy is to grant stock options at an exercise price equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s stock options generally have five to ten-year 2018 Incentive Compensation Plan – Stock Options As of December 31, 2019, there was $1,627 of total unrecognized stock-based compensation expense related to nonvested stock options. That expense is expected to be recognized over a weighted-average period of 3.00 years. Stock options outstanding, exercisable and available for grant at December 31, 2019, are summarized as follows: Weighted Weighted Average Average Remaining Aggregate Number of Exercise Contractual Intrinsic Options Price Life (Years) Value Outstanding at January 1, 2019 4,275,744 $ 3.76 Granted 584,297 3.85 Exercised (118,500 ) 3.34 Forfeited or expired (205,080 ) 4.46 Outstanding at December 31, 2019 4,536,461 $ 3.75 4.01 $ 124 Vested or expected to vest at December 31, 2019 4,301,432 $ 3.73 3.81 $ 97 Exercisable at December 31, 2019 1,085,814 $ 4.10 2.68 $ 3 Available for grant at December 31, 2019 4,186,650 The aggregate intrinsic value in the table above represents the total pre-tax Other information concerning stock options are as follows: For the Year Ended December 31, 2019 2018 2017 Weighted average fair value of stock options granted $ 1.56 $ 2.05 $ 1.66 Aggregate intrinsic value of stock options exercised 161 349 2,786 The aggregate intrinsic value of stock options exercised in a period represents the pre-tax The following weighted-average assumptions were used to determine the fair value of stock options under FASB ASC 718: Year Ended December 31, 2019 2018 2017 Expected term (years) 6.50 6.50 6.50 Risk free interest rate 2.54 % 2.75 % 2.26 % Volatility factor 37.73 % 43.74 % 47.39 % Dividend yield — — — Restricted Stock Awards The value of restricted stock awards is determined by the market value of the Company’s common stock at the date of grant. In 2019, restricted stock awards in the amount of 625,881 shares and 166,922 shares of restricted stock were granted to employees and non-employee Weighted Average Number of Grant Date Shares Fair Value Unvested at January 1, 2019 1,032,715 $ 4.32 Granted 792,803 4.38 Vested (516,491 ) 4.27 Forfeited (81,169 ) 4.86 Unvested at December 31, 2019 1,227,858 $ 4.34 Restricted Stock Units The value of restricted stock units is determined by the market value of the Company’s common stock at the date of grant. In 2019, restricted stock units in the amount of 226,352 units were granted to employees. As of December 31, 2019, there was $815 of total unrecognized stock-based compensation expense related to unvested restricted stock units. That expense is expected to be recognized on a straight-line basis over a weighted-average period of 2.00 years. The following table summarizes information about unvested restricted stock units as of December 31, 2019: Weighted Average Number of Grant Date Shares Fair Value Unvested at January 1, 2019 — $ — Granted 226,352 7.41 Vested — — Forfeited (41,770 ) 7.41 Unvested at December 31, 2019 184,582 $ 7.41 For the years ended December 31, 2019, 2018 and 2017, the Company recognized stock-based compensation as follows: For the Year Ended December 31, 2019 2018 2017 Stock-based compensation: Costs of processing and distribution $ 144 $ 132 $ 132 Marketing, general and administrative 4,163 4,553 6,586 Research and development 60 60 44 Total $ 4,367 $ 4,745 $ 6,762 Inducement Grant President and Chief Executive Office On January 26, 2017, the Company issued an inducement grant to its President and Chief Executive Officer, Mr. Camille Farhat. This grant was in the form of: (1) a restricted stock award agreement (the “Restricted Stock Agreement #1”); (2) another restricted stock award agreement (the “Restricted Stock Agreement #2”); and (3) a stock option agreement. Under the Restricted Stock Agreement #1, the Company granted Mr. Farhat 850,000 shares of restricted common stock. On December 4, 2017, the Company and Mr. Farhat entered into the First Amendment to the Restricted Stock Agreement #1 (the “Amendment”). The Amendment revised the vesting conditions for the Company’s common stock (the “Common Stock”), granted under the Restricted Stock Agreement #1. Under the Restricted Stock Agreement #2, the Company granted Mr. Farhat 150,000 shares of restricted common stock. All of the shares granted to Mr. Farhat under the Restricted Stock Agreement #1, as amended, and the Restricted Stock Agreement #2 have fully vested. Under the Option Agreement, the Company granted Mr. Farhat the option to purchase 1,950,000 shares of common stock. The exercise price for the stock options is $3.20. The stock options will expire on January 26, 2022. The stock options will vest based on the Company’s attainment of three average stock price benchmarks. The first 650,000 shares will vest if the Company’s average publicly traded stock price is over $6.00 for a sixty-consecutive calendar day period. The next 650,000 shares will vest if the Company’s average publicly traded stock price is over $7.00 for a sixty-consecutive calendar day period. The final 650,000 shares will vest if the Company’s average publicly traded stock price is over $8.00 for a sixty-consecutive calendar day period. The vesting of the stock options is cumulative. Chief Financial and Administrative Officer On September 18, 2017, the Company issued an inducement grant to its Chief Financial and Administrative Officer, Mr. Jonathon Singer. This grant was in the form of: (1) a restricted stock award agreement (the “Restricted Stock Agreement”); and (2) a stock option agreement. This inducement grant was made under the RTI Surgical, Inc. 2015 Incentive Compensation Plan, which was filed with the SEC on May 5, 2015. Under the Restricted Stock Agreement, the Company granted Mr. Singer 109,890 shares of restricted stock. All of the shares granted to Mr. Singer under the Restricted Stock Agreement have fully vested. Under the Option Agreement, the Company granted Mr. Singer the option to purchase 306,900 shares of common stock, as of the grant date. The exercise price for the stock options is $4.55 per share. The stock options will expire on September 18, 2027. The stock options will vest based the Company’s attainment of three average stock price benchmarks. The first 102,300 shares will vest if the Company’s average publicly traded stock price is over $7.00 per share for a sixty-consecutive calendar day period. The next 102,300 shares will vest if the Company’s average publicly traded stock price is over $8.00 per share for a sixty-consecutive calendar day period. The final 102,300 shares will vest if the Company’s average publicly traded stock price is over $9.00 per share for a sixty-consecutive calendar day period. The vesting of the stock options is cumulative. President, Global Spine On November 29, 2019, the Company issued an inducement grant to its President of Global Spine, Mr. Terry Rich. This grant was in the form of: (1) a restricted stock award agreement (the “Restricted Stock Agreement”); and (2) a stock option agreement. This inducement grant was made under the RTI Surgical Holdings, Inc., Terry Rich Reserve Compensation Plan. Under the Restricted Stock Agreement, the Company granted Mr. Rich 125,598 shares of restricted stock. On the first anniversary of the grant date, 41,866 shares will vest. The remaining shares will vest on the last day of each calendar quarter at a rate of 10,467 shares per calendar quarter commencing on the fifteenth month following the grant date and continuing for two years year after. Vesting of these shares may accelerate upon the occurrence of certain conditions. Under the Option Agreement, the Company granted Mr. Rich the option to purchase 188,397 shares of common stock (the “Stock Options”), as of the grant date. The exercise price for the Stock Options is $2.09. On the first anniversary of the grant date, 62,799 will vest. The remaining shares will vest on the last day of each calendar quarter at a rate of 15,700 shares per calendar quarter commencing on the fifteenth month following the grant date and continuing for two years after. The vesting of the Stock Options is cumulative.

Inventories

Inventories	12 Months Ended
	Dec. 31, 2019
Inventory Disclosure [Abstract]
Inventories	11. Inventories Inventories by stage of completion are as follows: December 31, 2019 2018 Unprocessed tissue, raw materials and supplies $ 29,552 $ 24,211 Tissue and work in process 35,740 31,796 Implantable tissue and finished goods 65,494 51,648 Total 130,786 107,655 Less current portion 124,149 107,655 Long-term portion $ 6,637 $ — For the years ended December 31, 2019, 2018, and 2017, the Company had inventory write-downs of $9,006, $15,122 and $5,066, respectively, relating primarily to excess quantities and obsolescence of inventories. Included in the amount above, for the year ended December 31, 2019, the Company had inventory write-downs of $513 related to the valuation of the Paradigm acquisition-related inventory. Included in the year ended December 31, 2018, are $1,023 of product obsolescence related to the rationalization of our international distribution infrastructure and $6,559 of inventory write-off related to the abandonment of the Company’s map3 ®

Prepaid and Other Current Asset

Prepaid and Other Current Assets	12 Months Ended
	Dec. 31, 2019
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Prepaid and Other Current Assets	12. Prepaid and Other Current Assets Prepaid and Other Current Assets are as follows: December 31, 2019 2018 Income tax receivable $ 2,803 $ 3,920 Prepaid expenses 1,865 2,013 Other 2,101 2,480 $ 6,769 $ 8,413

Property, Plant and Equipment

Property, Plant and Equipment	12 Months Ended
	Dec. 31, 2019
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment	13. Property, Plant and Equipment Property, plant and equipment are as follows: December 31, 2019 2018 Land $ 2,005 $ 2,020 Buildings and improvements 58,208 58,093 Processing equipment 45,762 42,599 Surgical instruments 541 24,070 Office equipment, furniture and fixtures 1,730 1,877 Computer equipment and software 20,521 18,873 Construction in process 11,717 8,934 140,484 156,466 Less accumulated depreciation (70,594 ) (78,512 ) $ 69,890 $ 77,954 For the years ended December 31, 2019, 2018, and 2017, the Company had depreciation expense in connection with property, plant and equipment of $11,681, $10,619, and $10,513, respectively. For the year ended December 31, 2019, the Company recorded asset impairment and abandonment charges of $11,655, based on impairment indicators within the Spine asset group. For the year ended December 31, 2018, the Company recorded asset impairment and abandonment charges of $1,797, relating to the abandonment of our map3 ® For the year ended December 31, 2019, the Company recorded asset impairment and abandonment charges of $11,856 consisting of $11,655 related to property, plant and equipment and $201 of right-of-use lease assets in the Spine segment. The organizational change in 2019 resulted in the creation of a new Spine asset group. Prior to the fourth quarter of 2019, the Spine asset group did not exist as the related assets were included in another asset group as it had interdependencies among the utilization of the assets within the group, and therefore, there were no discrete cash flows. The newly formed Spine asset group could not support the carrying amount of the property, plant and equipment and the right of use asset, because the Spine asset group no longer has the benefit of shared resources and cashflows generated by the former asset group that it was previously included in. The fair value of property and equipment was measured utilizing an orderly liquidation value of each of the underlying assets. The right-of-use lease assets were measured utilizing a version of the income approach that considers the present value of the market based rent payments for the applicable properties.

Goodwill

Goodwill	12 Months Ended
	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	4. Goodwill The change in the carrying amount of goodwill for the year ended December 31, 2019, is as follows: December 31, 2019 2018 Balance at January 1 $ 59,798 $ 46,242 Goodwill acquired related to Zyga acquisition — 13,556 Goodwill acquired related to Paradigm acquisition 135,589 — Goodwill impairment (140,003 ) — Balance at December 31 $ 55,384 $ 59,798 Goodwill acquired during the year ended December 31, 2019 and 2018, includes the excess of the Paradigm and Zyga, respectively, purchase price over the sum of the amounts assigned to assets acquired less liabilities assumed. The Company considered the abandonment of our map3® implant to be a triggering event for long-lived asset impairment testing. As a result, the Company performed a goodwill impairment analysis on its sole reporting unit during the quarter ended June 30, 2018, and based on the analysis, the Company concluded its goodwill was not impaired. The valuation of goodwill requires management to use significant judgments and estimates including, but not limited to, projected future revenue and cash flows, along with risk-adjusted weighted average cost of capital. Changes in assumptions or market conditions could result in a change in estimated future cash flows and the likelihood of materially different reported results. On March 8, 2019, we acquired Paradigm for a purchase price of approximately $232,907 and recorded goodwill of approximately $135,589. Paradigm was initially included in the Company’s single reporting unit. As noted above in Note 5, the Company reorganized its segments in the fourth quarter of 2019, which resulted in the Company dividing its single reporting unit into a Spine and OEM reporting unit. With the change in reporting units, we performed a relative fair value valuation calculation to allocate the Company’s historical goodwill (existing prior to the Paradigm acquisition) between the two reporting units. The goodwill arising from the Paradigm acquisition was specifically allocated to the Spine reporting unit. The Company concluded specific allocation of the Paradigm goodwill to the Spine reporting unit was most appropriate since Paradigm was recently acquired and the benefits of the acquired goodwill were never realized by the single reporting unit as Paradigm was not integrated. Based on this change in reporting units, we conducted an impairment test before and after the change, and it was concluded that the fair value of our single reporting unit exceeded the carrying value under the previous reporting unit structure. For the impairment test performed immediately subsequent to the change in reporting units on the OEM reporting unit, it was concluded the fair value of goodwill is substantially in excess of its carrying value. For the Spine reporting unit test, it was concluded the carrying value was in excess of the fair value of goodwill. Based on several factors, we weighted the income approach at 75% and the market approach at 25% in determining the fair value of our OEM reporting unit and utilized the cost approach for the Spine reporting unit for the purpose of the impairment test. The test resulted in the fair value of the OEM reporting unit exceeding the carrying value by approximately 54%, and the fair value of the Spine reporting unit could not support the allocated goodwill. As a result, for the year ended December 31, 2019, we recorded an impairment charge of all the goodwill in the Spine reporting unit totaling $140,003.

Other Intangible Assets

Other Intangible Assets	12 Months Ended
	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Other Intangible Assets	15. Other Intangible Assets Other intangible assets are as follows: December 31, 2019 December 31, 2018 Gross Accumulated Net Gross Accumulated Net Patents $ 5,095 $ 2,768 $ 2,327 $ 15,469 $ 4,191 $ 11,278 Acquired licensing rights 1,413 64 1,349 11,671 6,468 5,203 Marketing and procurement and other intangible assets 16,488 9,672 6,816 20,355 11,279 9,076 Total $ 22,996 $ 12,504 $ 10,492 $ 47,495 $ 21,938 $ 25,557 For the years ended December 31, 2019, 2018, and 2017, the Company had amortization expense of other intangible assets of $11,126, $3,960, and $3,720, respectively. As of December 31, 2019, the Company concluded, through the ASC 360 valuation testing, that factors existed indicating that long-lived assets in the Spine segment were impaired. Thus, we tested the carrying amount in the Spine intangibles for impairment on December 31, 2019. The method used to determine the fair value of the Spine asset group was based on a net asset value approach (i.e. a cost approach). As a result, for the year ended December 31, 2019, we recorded an impairment charge for all of the other intangible assets within the Spine segment, totaling $85,096. Included within these impairment charges are $71,958 of other intangible assets, net of amortization, acquired as part of Paradigm. For the year ended December 31, 2018, the Company recorded asset impairment and abandonment charges of $2,718 relating to the abandonment of our map3 ® At December 31, 2019, management’s estimates of future amortization expense for the next five years are as follows: Amortization 2020 $ 2,300 2021 2,300 2022 2,300 2023 700 2024 700

Fair Value Information

Fair Value Information	12 Months Ended
	Dec. 31, 2019
Fair Value Disclosures [Abstract]
Fair Value Information	16. Fair Value Information Fair value is defined as the price that would be received upon the sale of an asset or paid to transfer a liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value maximize the use of observable inputs and minimize the use of unobservable inputs. The fair value hierarchy defines a three-level valuation hierarchy for classification and disclosure of fair value measurements as follows: Level 1 – Quoted prices in active markets for identical assets or liabilities. Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3 – Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities. On March 8, 2019, the Company acquired Paradigm as further explained in Note 7 above. The Company estimated a contingent liability related to the revenue-based earnout of $72,177. The fair value of the contingent liability was measured using Level 3 inputs. Unobservable inputs for the probability weighted model included weighted average cost of capital (unobservable) and company specific projected revenue and costs (unobservable). As of December 31, 2019, Management determined revenue earnout would be $0, as the probability weighted model has been updated based on the current updated forecast for the performance of the Paradigm product portfolio. Beginning in Q4 2019, in conjunction with Spine Leadership change, management reassessed the Paradigm strategy relating to roll-out of the commercial operating model, impact of physician reimbursement and progression of third-party insurance reimbursement and its related impact on the long-term outlook for the business. These items resulted in revisions of our projections and a reduction of the fair value of the earnout liability. As a result, a gain of $72,177 was recognized and is included in gain on acquisition contingency in the consolidated statement of comprehensive (loss) income. On January 4, 2018, the Company acquired Zyga as further explained in Note 8 above. The Company estimates a contingent liability related to the clinical milestone and revenue-based earnout of $4,986. The fair value of the contingent liability was measured using Level 3 inputs. As of December 31, 2019, there was a $3,856 reduction in the contingent liability estimate of the Zyga acquisition revenue-based earnout, as the probability weighted model has been updated based on the current updated forecast for the performance of the Zyga product portfolio. Long-lived assets, including property and equipment and intangible assets subject to amortization were impaired and written down to their estimated fair values during the fourth quarter of 2019 and the second quarter of 2018. Fair value is measured as of the impairment date using Level 3 inputs. For the 2019 impairments, the long-lived asset level 3 fair value was measured base on orderly liquidation value for the Property, plant and equipment and Other assets. The Other intangible assets fair value was measured based on the income approach. Unobservable inputs for the orderly liquidation value included replacement costs (unobservable), physical deterioration estimates (unobservable) and market sales data for comparable assets and unobservable inputs for the income approach included forecasted cash flows generated from use of the intangible assets (unobservable). For the 2018 impairments, the long-lived asset level 3 fair value was determined using a market approach, which used inputs that included replacement costs (unobservable), physical deterioration estimates (unobservable), economic obsolescence (unobservable), and market sales data for comparable assets. The following table summarizes impairments of long-lived assets and the related post impairment fair values of the corresponding assets for the years ended December 31, 2019 and 2018: For the Year Ended December 31, 2019 Impairment Fair Value Property, plant and equipment - net $ 11,655 $ — Other intangible assets - net 85,096 — Other assets - net 201 $ 96,952 $ — For the Year Ended Impairment Fair Value Property, plant and equipment - net $ 1,797 $ — Other intangible assets - net 2,718 — $ 4,515 $ — No impairments on long-lived assets were recorded for the years ended December 31, 2017.

Accrued Expenses

Accrued Expenses	12 Months Ended
	Dec. 31, 2019
Other Liabilities Disclosure [Abstract]
Accrued Expenses	17. Accrued Expenses Accrued expenses are as follows: December 31, 2019 2018 Accrued compensation $ 5,435 $ 8,308 Accrued severance and restructuring costs 136 1,302 Accrued distributor commissions 4,569 3,907 Accrued donor recovery fees 8,921 3,018 Accrued leases 1,159 — Accrued acquisition and integration expenses 2,555 — Other 10,562 9,330 $ 33,337 $ 25,865

Short and Long-Term Obligations

Short and Long-Term Obligations	12 Months Ended
	Dec. 31, 2019
Debt Disclosure [Abstract]
Short and Long-Term Obligations	18. Short and Long-Term Obligations Short and long-term obligations are as follows: December 31, 2019 2018 Ares Term loan $ 104,406 $ — JPM facility 71,000 50,000 Less unamortized debt issuance costs (1,229 ) (927 ) Total 174,177 49,073 Less current portion 174,177 — Long-term portion $ — $ 49,073 On June 5, 2018, the Company terminated its 2017 loan agreement with TD Bank, N.A. and First Tennessee Bank National Association. The 2017 loan agreement provided for a revolving credit facility in the aggregate principal amount of $42,500. Borrowings under the 2017 loan agreement had an interest rate per annum equal to monthly LIBOR plus a margin of up to 3.50%. The maturity date of the revolving credit facility was September 15, 2019. On June 5, 2018, the Company, along with its wholly-owned subsidiary, Pioneer Surgical, entered into the 2018 Credit Agreement, as borrowers, with JP Morgan Chase Bank, N.A., as lender (together with the various financial institutions as in the future may become parties thereto, the “JPM Lenders”) and as administrative agent for the JPM Lenders. The 2018 Credit Agreement provides for a revolving credit facility in the aggregate principal amount of up to $100,000 (the “JPM Facility”) (subsequently reduced to $75,000, as described below). The Company and Pioneer Surgical will be able to, at their option, and subject to customary conditions and JPM Lender approval, request an increase to the JPM Facility in an amount not to exceed $50,000. The JPM Facility is guaranteed by the Company’s domestic subsidiaries and is secured by: (i) substantially all of the assets of the Company and Pioneer Surgical; (ii) substantially all of the assets of each of the Company’s domestic subsidiaries; and (iii) 65% of the stock of the Company’s foreign subsidiaries. The CBFR Loans will bear interest at a rate per annum equal to the monthly REVLIBOR30 Rate plus the CBFR Rate. The Company may elect to convert the interest rate for the Eurodollars Loans to a rate per annum equal to the adjusted LIBOR Rate plus the JPM Eurodollar Rate. For all subsequent borrowings, the Company may elect to apply either the CBFR Rate or JPM Eurodollar Rate. The applicable margin is subject to adjustment after the end of each fiscal quarter, based upon the Company’s average quarterly availability. The maturity date of the JPM Facility is June 5, 2023. The Company may make optional prepayments on the JPM Facility without penalty. The Company paid certain customary closing costs and bank fees upon entering into the 2018 Credit Agreement. The Company is subject to certain affirmative and negative covenants, including (but not limited to), covenants limiting the Company’s ability to: incur certain additional indebtedness; create certain liens; enter into sale and leaseback transactions; and consolidate or merge with, or convey, transfer or lease all or substantially all of its assets to another person. The Company is required to maintain a minimum fixed charge coverage ratio of at least 1.00:1.00 (the “JPM Required Minimum Fixed Charge Coverage Ratio”) during either of the following periods (each, a “JPM Covenant Testing Period”): (i) a period beginning on a date that a default has occurred and is continuing under the loan documents entered into by the Company in conjunction with the 2018 Credit Agreement through the first date on which no default has occurred and is continuing; or (ii) a period beginning on a date that availability under the JPM Facility is less than the specified covenant testing threshold and continuing until availability under the JPM Facility is greater than or equal to the specified covenant testing threshold for thirty (30) consecutive days. The JPM Required Minimum Fixed Charge Coverage Ratio is measured on the last day of each calendar month during the JPM Covenant Testing Period (each a “JPM Calculation Date”), and is calculated using the minimum fixed charge coverage ratio for the twelve (12) consecutive months ending on each JPM Calculation Date. The amounts owed under the 2018 Credit Agreement may be accelerated upon the occurrence of certain events of default customary for facilities for similarly rated borrowers. First Amendment to Credit Agreement and Joinder Agreement On March 8, 2019, the Company entered into a First Amendment to Credit Agreement and Joinder Agreement dated as of March 8, 2019 (the “2019 First Amendment”), among the Company, Legacy RTI, as a borrower, Pioneer Surgical, as a borrower, the other loan parties thereto as guarantors, JP Morgan Chase Bank, N.A., as lender (together with the various financial institutions as in the future may become parties thereto) and as administrative agent for the JPM Lenders. The 2019 First Amendment amended the 2018 Credit Agreement by: (i) reducing the aggregate revolving commitments available to Legacy RTI and Pioneer Surgical from $100,000 to $75,000; (ii) joining the Company and Paradigm, and its domestic subsidiaries as guarantors and loan parties to the 2018 Credit Agreement; (iii) permitting the Ares Term Loan (as defined below); and (iv) making certain other changes to the 2018 Credit Agreement consistent with the foregoing including pro rata reductions to certain thresholds that were based on the aggregate commitments under the 2018 Credit Agreement. Second Amendment to Credit Agreement and Joinder Agreement The Company entered into a Second Amendment to Credit Agreement and Joinder Agreement dated as of December 9, 2019 (the “2019 Second Amendment”). The 2019 Second Amendment amended the 2018 Credit Agreement by increasing the aggregate revolving commitments available to Legacy RTI and Pioneer Surgical from $75,000 to $80,000. At December 31, 2019, the interest rate for the JPM Facility was 3.69%. As of December 31, 2019, there was $71,000 outstanding on the JPM Facility and total remaining available credit on the JPM Facility was $9,000. The Company’s ability to access the JPM Facility is subject to and can be limited by the Company’s compliance with the Company’s financial and other covenants. The Company was in compliance with the financial covenants related to the JPM Facility as of December 31, 2019. Second Lien Credit Agreement and Term Loan On March 8, 2019, Legacy RTI entered into a Second Lien Credit Agreement dated as of March 8, 2019 (the “2019 Credit Agreement”), among Legacy RTI, as a borrower, the other loan parties thereto as guarantors (together with Legacy RTI, the “Ares Loan Parties”), Ares, as lender (together with the various financial institutions as in the future may become parties thereto, the “Ares Lenders”) and as administrative agent for the Ares Lenders. The 2019 Credit Agreement provides for a term loan in the principal amount of up to $100,000 (the “Ares Term Loan”). The Ares Term Loan was advanced in a single borrowing on March 8, 2019. The Ares Term Loan is guaranteed by the Company and each of the Company’s domestic subsidiaries and is secured by: (i) substantially all of the assets of Legacy RTI; (ii) substantially all of the assets of the Company; (iii) substantially all of the assets of the Company’s domestic subsidiaries; and (iv) 65% of the stock of the Company’s foreign subsidiaries. The Ares Term Loan will bear interest at a rate per annum equal to, at the option of Legacy RTI: (i) the monthly Base Rate plus an adjustable margin of up to 7.50% (the “Base Rate”); or (ii) the LIBOR plus an adjustable margin of up to 8.50% (the “Ares Eurodollar Rate”). Subject to customary notices, Legacy RTI may elect to convert the Ares Term Loan from Base Rate to Ares Eurodollar Rate or from Ares Eurodollar Rate to Base Rate. The applicable margin is subject to adjustment after the end of each fiscal quarter, based upon the Ares Loan Parties’ total net leverage ratio. At any time during the period commencing on March 8, 2019 and ending on March 8, 2021, if the Ares Loan Parties’ total net leverage ratio is greater than 5.75:1.00, Legacy RTI shall have the option (the “PIK Option”) to elect to pay 50% of the interest that will accrue in the subsequent quarterly period in kind by capitalizing it and adding such amount to the principal balance of the Ares Term Loan. If Legacy RTI exercises the PIK Option, the adjustable margin applicable to the Ares Term Loan shall be increased by 0.75%. The maturity date of the Ares Term Loan is December 5, 2023. Legacy RTI may make optional prepayments on the Ares Term Loan, provided that any such optional prepayments made on or prior to March 8, 2022, shall be subject to a make whole premium or a prepayment price, as the case may be. Legacy RTI is required to make mandatory prepayments of the Ares Term Loan based on excess cash flow and the Ares Loan Parties’ total net leverage ratio, upon the incurrence of certain indebtedness not otherwise permitted under the 2019 Credit Agreement, upon consummation of certain dispositions, and upon the receipt of certain proceeds of casualty events. Legacy RTI was required to pay certain customary closing costs and bank fees upon entering into the 2019 Credit Agreement. Legacy RTI is subject to certain affirmative and negative covenants, including (but not limited to), covenants limiting Legacy RTI’s ability to: incur certain additional indebtedness; create certain liens; enter into sale and leaseback transactions; and consolidate or merge with, or convey, transfer or lease all or substantially all of its assets to another person. During any period beginning on a date that either: (i) a default has occurred and is continuing under the loan documents entered into by Legacy RTI in conjunction with the Credit Agreement (the “Ares Loan Documents”); or (ii) availability under the Ares Term Loan is less than the specified covenant testing threshold, and continuing until either (a) no default has occurred and is continuing under the Ares Loan Documents or (b) availability under the Ares Term Loan is greater than or equal to the specified covenant testing threshold for thirty (30) consecutive days, respectively, (the “Ares Covenant Testing Period”) Legacy RTI is required to maintain a minimum fixed charge coverage ratio of at least 0.91:1.00 (the “Ares Required Minimum Fixed Charge Coverage Ratio”). The Ares Required Minimum Fixed Charge Coverage Ratio is measured on the last day of each calendar month during the Ares Covenant Testing Period (each a “Ares Calculation Date”), and is calculated using the minimum fixed charge coverage ratio for the twelve (12) consecutive months ending on each Ares Calculation Date. The Ares Loan Parties are required to maintain an initial total net leverage ratio of 9.00:1.00, which ratio steps down each fiscal quarter of Legacy RTI resulting in a requirement that the Ares Loan Parties maintain a total net leverage ratio of 3.50:1.00 for the fiscal quarter ending June 30, 2021, and each fiscal quarter ending thereafter. The amounts owed under the 2019 Credit Agreement may be accelerated upon the occurrence of certain events of default customary for facilities for similarly rated borrowers. At December 31, 2019, the interest rate for the Ares Term Loan was 10.49%. The Company was in compliance with the financial covenants related to the Ares Term Loan as of December 31, 2019. For the years ended December 31, 2019, 2018 and 2017, interest expense associated with the amortization of debt issuance costs was $524, $528 and $409, respectively. Included in the year ended December 31, 2019, was $219 of accelerated amortization of debt issuance costs associated with the modification of the 2018 Credit Agreement. For the year ended December 31, 2019, the Company incurred total debt issuance cost of $826. As of December 31, 2019, the Company had approximately $5,608 of cash and cash equivalents and $9,000 of availability under its revolver agreement. The Company’s Ares Term Loan and JPM Facility agreements both contain a leverage to EBITDA covenant, which as of December 31, 2019, required the Company to maintain a 5.0:1 leverage to trailing twelve-month adjusted EBITDA ratio. The debt agreement provides for an increase in the covenant ratio to 5.75:1 for each quarter end during 2020, then reduces to 5.25:1 for the quarters ending March 31, 2021 and June 30, 2021, with a final reduction to 3.50 for each quarter ending thereafter. The Company’s leverage ratio as of December 31, 2019 is approximately 4.96:1. If the Company is unable to execute on its acquisition integration plans or achieve its projected growth and cash flow targets, its available liquidity could be further limited, and its operations may lead to defaults under the borrowing agreements. See Note 1. On April 9, 2020 and on May 8, 2020, the Company received waivers and consent agreements with respect to certain financial statement delivery requirements extending the due dates for delivering the required financial statements under the credit facilities. Further, Pursuant to two Consent Agreements, dated June 1, 2020, one with respect to the JPM Credit Facility and one for the Ares Credit Facility, each of JPM and Ares, respectively, agreed to extend the deadline for the delivery of the fiscal year end 2019 financial statements to June 8, 2020. Further, each of JPM and Ares also agreed to waive the requirement with respect to the going concern qualification.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Income Taxes	19. Income Taxes The Company’s pre-tax income consists of the following components: For the Year Ended December 31, 2019 2018 2017 Pre-tax income: Domestic (U.S., state and local) $ (196,426 ) $ (9,052 ) $ 30,121 Foreign 2,021 1,661 (3,866 ) Total pre-tax income (194,405 ) (7,391 ) 26,255 The Company’s income tax benefit (provision) consists of the following components: For the Year Ended December 31, 2019 2018 2017 Current: Federal $ 503 $ 967 $ (2,910 ) State (147 ) (205 ) (833 ) International 79 (376 ) — Total current 435 386 (3,743 ) Deferred: Federal (12,680 ) 2,356 (14,554 ) State (1,091 ) (2,446 ) (1,052 ) International (3,901 ) 3,972 — Total deferred (17,672 ) 3,882 (15,606 ) Total income tax (provision) benefit $ (17,237 ) $ 4,268 $ (19,349 ) The Company’s deferred tax assets and liabilities consists of the following components: December 31, 2019 December 31, 2018 Deferred Income Tax Deferred Income Tax Assets Liabilities Assets Liabilities Accounts receivable $ 1,184 $ — $ 513 $ — Accrued liabilities 3,481 — 2,358 — Deferred compensation 1,526 — 1,372 — Fixed assets and intangibles 15,898 — — (5,862 ) Inventory 9,817 — 7,631 — Net operating losses 13,242 — 8,198 — Revenue — (59 ) 650 — Tax credits 6,372 — 5,993 — Lease Liability 708 — Right of Use Asset (Leases) — (558 ) Other — (103 ) — — Valuation allowance (51,508 ) — (3,093 ) — Total $ 720 $ (720 ) $ 23,622 $ (5,862 ) On December 22, 2017, the US government enacted the Tax Cuts and Jobs Act of 2017 (the “Tax Legislation”). The Tax Legislation makes broad and complex changes to the U.S. tax code including, but not limited to the following: • Reduction of the U.S. federal corporate tax rate from 35% to 21% • Requiring a transition tax on certain unrepatriated earnings of foreign subsidiaries • Bonus depreciation that will allow for full expensing of qualified property • Elimination of the corporate alternative minimum tax • The repeal of the domestic production activity deduction • Limitations on the deductibility of certain executive compensation • Limitations on net operating losses generated after December 31, 2017 In addition, beginning in 2018, the Tax Legislation includes a global intangible low-taxed On December 22, 2017, the SEC staff issued SAB 118, which provides guidance on accounting for the tax effects of the Tax Legislation. SAB 118 provides a measurement period that should not extend beyond one year from the Tax Legislation enactment date for companies to complete the accounting under ASC 740. In 2018, the Company completed its accounting for the tax effects of the Tax Legislation. As a result, in 2018 the Company recorded a tax benefit of $650, and in 2017, the Company recorded a tax provision of $2,187, relating to the revaluation of deferred tax assets and transition tax. Valuation allowances are established when necessary to reduce deferred tax assets to amounts which are more likely than not to be realized. As such, valuation allowances of $51,508 and $3,093 have been established at December 31, 2019 and December 31, 2018, respectively, against a portion of the deferred tax assets. As of December 31, 2019, the Company has U.S. federal net operating loss carryforwards of $9,911 that will expire in years 2026 through 2037. In addition, the Company has U.S. federal net operating loss carryforwards of $21,950 that will carryforward indefinitely. As of December 31, 2019, the Company has U.S. state net operating loss carryforwards of $51,626, of which, $48,143 will expire in the years 2022 through 2039, and $3,443 will carryforward indefinitely. As of December 31, 2019, the Company has foreign net operating loss carryforwards of $13,496 that will carryforward indefinitely. As of December 31, 2019, the Company has research tax credit carryforwards of $7,111 that will expire in years 2029 through 2038. U.S. income taxes have not been provided on the undistributed earnings of the Company’s foreign subsidiaries. It is not practicable to estimate the amount of tax that might be payable. The Company’s intention is to indefinitely reinvest earnings of its foreign subsidiaries outside of the U.S. The Company evaluates the need for deferred tax asset valuation allowances based on a more likely than not standard. The ability to realize deferred tax assets depends on the ability to generate sufficient taxable income within the carryback or carryforward periods provided for in the tax law for each applicable tax jurisdiction. The Company has evaluated all evidence, both positive and negative, and determined that its deferred tax assets are not more likely than not to be realized as of December 31, 2019. Accordingly, the Company has recorded a valuation allowance in the amount of $51,508 as of December 31, 2019. In making this determination, numerous factors were considered including the going-concern evaluation. As of December 31, 2019, the Company has $1,088 of unrecognized tax benefits, which was recorded net against deferred tax assets in the accompanying consolidated balance sheet. The Company’s unrecognized tax benefits are summarized as follows: For the Year Ended December 31, 2019 2018 2017 Opening balance $ 1,088 $ 1,591 $ 1,591 Reductions based on tax positions related to the current year — — — Additions for tax positions of prior years — — — Reductions for tax positions of prior years — (415 ) — Reductions for expiration of statute of limitations — (88 ) — $ 1,088 $ 1,088 $ 1,591 The unrecognized tax benefits if recognized, would favorably impact the Company’s effective tax rate. The Company’s policy is to recognize interest accrued related to unrecognized tax benefits in interest expense and penalties in the provision for income taxes. Interest and penalties recorded in 2019, 2018 and 2017 and interest and penalties accrued at December 31, 2019 and 2018 were inconsequential. During the year ended December 31, 2018, the Internal Revenue Service (the “IRS”) completed its examination of the Company’s 2015 U.S. federal income tax return. No material adjustments were recorded to the Company’s consolidated financial statements as a result of the examination. The effective tax rate differs from the statutory federal income tax rate for the following reasons: For the Year Ended 2019 2018 2017 Statutory federal rate 21.00 % 21.00 % 35.00 % State income taxes—net of federal tax benefit (1.31 %) (4.58 %) 2.37 % Foreign rate differential — 14.36 % 2.54 % Acquisition expenses — (7.26 %) — Gain on acquisition contingency 8.23 % — — Goodwill impairment and disposal (14.86 %) — 11.52 % Life insurance — (0.98 %) (1.38 %) Officer compensation — (7.88 %) 4.18 % Stock-based compensation — (3.90 %) 6.06 % Tax credits 0.07 % 8.65 % (4.53 %) Tax legislation — 9.23 % 8.33 % Valuation allowances (21.25 %) 21.93 % 6.08 % Uncertain tax positions — 6.86 % — Other reconciling items, net (0.75 %) 0.32 % 3.52 % Effective tax rate (8.87 %) 57.75 % 73.69 %

Preferred Stock

Preferred Stock	12 Months Ended
	Dec. 31, 2019
Equity [Abstract]
Preferred Stock	20. Preferred Stock Preferred stock is as follows: Preferred Preferred Net Balance at January 1, 2017 $ 60,676 $ (660 ) $ 60,016 Accrued dividend 3,723 — 3,723 Amortization of preferred stock issuance costs — 184 184 Balance at December 31, 2017 64,399 (476 ) 63,923 Accrued dividend 2,120 — 2,120 Amortization of preferred stock issuance costs — 183 183 Balance at December 31, 2018 66,519 (293 ) 66,226 Accrued dividend — — — Amortization of preferred stock issuance costs — 184 184 Balance at December 31, 2019 $ 66,519 $ (109 ) $ 66,410 On June 12, 2013, the Company and WSHP Biologics Holdings, LLC, an affiliate of Water Street Healthcare Partners, a leading healthcare-focused private equity firm (“Water Street”), entered into an investment agreement. Pursuant to the terms of the investment agreement, the Company issued $50,000 of convertible preferred equity to Water Street in a private placement which closed on July 16, 2013, with preferred stock issuance costs of $1,290. The preferred stock accrues dividends at a rate of 6% per annum. To the extent dividends are not paid in cash in any quarter, the dividends which have accrued on each outstanding share of preferred stock during such three-month period will accumulate until paid in cash or converted to common stock. The preferred stock will be convertible at the election of the holders into shares of the Company’s common stock at an initial conversion price of $4.39 per share which would result in a conversion ratio of approximately 228 shares of common stock for each share of preferred stock. The preferred stock is convertible at the election of the Company five years after its issuance or at any time if the Company’s common stock closes at or above $7.98 per share for at least 20 consecutive trading days. The Company may, upon 30 days’ notice, redeem the preferred stock, in whole or in part, five years after its issuance at the initial liquidation preference of $1,000 per share of the preferred stock plus an amount per share equal to accrued but unpaid dividends (collectively, the “Liquidation Value”). The holders of the preferred stock may require the Company to redeem their preferred stock, in whole or in part, at the Liquidation Value seven years after its issuance or upon the occurrence of a change of control. On August 1, 2018, the Company and WSHP Biologics Holdings, LLC, a related party, entered into an Amended and Restated Certificate of Designation of Series A Convertible Preferred Stock of RTI Surgical, Inc. (the “Amended and Restated Certificate of Designation”). Pursuant to the Amended and Restated Certificate of Designation: (1) dividends on the Series A Preferred Stock will not accrue after July 16, 2018 (in the event of a default by the Company, dividends will begin accruing and will continue to accrue until the default is cured); (2) the Company may not force a redemption of the Series A Preferred Stock prior to July 16, 2020; and (3) the holders of the Series A Preferred Stock may not convert the Series A Preferred Stock into common stock prior to July 16, 2021 (with certain exceptions). The Company evaluated and concluded on a qualitative basis that the amendment qualifies as modification accounting to the preferred shares, which did not result in a change in the valuation of the shares.

Stockholders' Equity

Stockholders' Equity	12 Months Ended
	Dec. 31, 2019
Equity [Abstract]
Stockholders' Equity	21. Stockholders’ Equity Preferred Stock Common Stock

Executive Transition Costs

Executive Transition Costs	12 Months Ended
	Dec. 31, 2019
Restructuring and Related Activities [Abstract]
Executive Transition Costs	22. Executive Transition Costs The Company recorded Chief Executive Officer retirement and transition costs related to the retirement of our former Chief Executive Officer pursuant to the Executive Transition Agreement dated August 29, 2012 (as amended and extended to date), which resulted in $4,404 of expenses for the year ended December 31, 2016. The total Chief Executive Officer retirement and transition costs were paid in full in 2019. In addition, the Company recorded executive transition costs of $2,818 as a result of hiring a new Chief Executive Officer and Chief Financial and Administrative Officer for the year ended December 31, 2017, separately disclosed on the Consolidated Statements of Comprehensive (Loss) Income. The total executive transition costs of $1,169 which is cash basis was paid in full in 2018. The following table includes a rollforward of executive transition costs included in accrued expenses, see Note 16. Accrued executive transition costs at January 1, 2017 $ 2,406 Executive transition costs accrued in 2017 2,818 Stock-based compensation (1,612 ) Cash payments (1,275 ) Accrued executive transition costs at December 31, 2017 2,337 Executive transition costs accrued in 2018 — Cash payments (2,294 ) Accrued executive transition costs at December 31, 2018 43 Executive transition costs accrued in 2019 — Cash payments (43 ) Accrued executive transition costs at December 31, 2019 $ —

Severance and Restructuring Cos

Severance and Restructuring Costs	12 Months Ended
	Dec. 31, 2019
Employee Severance [Member]
Severance and Restructuring Costs	23. Severance and Restructuring Costs The Company recorded severance and restructuring costs related to the reduction of our organizational structure which resulted in $12,016 of expenses for the year ended December 31, 2017. The total severance and restructuring costs were paid in full in 2018. Severance and restructuring payments were made over periods ranging from one month to twelve months and did not have a material impact on cash flows of the Company in any quarterly period. The Company recorded severance and restructuring costs related to the reduction of our organizational structure which resulted in $2,808 of expenses for the year ended December 31, 2018. The total severance and restructuring costs were paid in full in 2019. Severance and restructuring payments were made over periods ranging from one month to twelve months and did not have a material impact on cash flows of the Company in any quarterly period. As part of the acquisition of Paradigm, management implemented a plan which resulted in $896 of severance expenses for the year ended December 31, 2019. Paradigm severance expenses were offset by previous severance accrual activity and are included in the acquisition and integration expenses within the Consolidated Statements of Comprehensive (Loss) Gain, totaling $626 for the year ended December 31, 2019. The total severance and restructuring costs were paid in full in of 2019. Severance and restructuring payments were made over periods ranging from one month to twelve months and did not have a material impact on cash flows of the Company in any quarterly period. The following table includes a rollforward of severance and restructuring costs included in accrued expenses, see Note 16. Accrued severance and restructuring charges at January 1, 2017 $ 505 Severance and restructuring expenses accrued in 2017 12,016 Severance and restructuring cash payments (8,246 ) Stock based compensation (1,153 ) Accrued severance and restructuring charges at December 31, 2017 3,122 Severance and restructuring expenses accrued in 2018 2,808 Severance and restructuring cash payments (4,628 ) Accrued severance and restructuring charges at December 31, 2018 1,302 Severance and restructuring expenses accrued in 2019 626 Severance and restructuring cash payments (1,792 ) Accrued severance and restructuring charges at December 31, 2019 $ 136

Retirement Benefits

Retirement Benefits	12 Months Ended
	Dec. 31, 2019
Retirement Benefits [Abstract]
Retirement Benefits	24. Retirement Benefits The Company has a qualified 401(k) plan available to all U.S. employees who meet certain eligibility requirements. The 401(k) plan allows each employee to contribute up to the annual maximum allowed under the Internal Revenue Code. The Company has the discretion to make matching contributions up to 6% of the employee’s earnings. For the years ended December 31, 2019, 2018 and 2017, the amounts expensed under the plan were $3,007, $2,757 and $3,036, respectively.

Concentrations of Risk

Concentrations of Risk	12 Months Ended
	Dec. 31, 2019
Risks and Uncertainties [Abstract]
Concentrations of Risk	25. Concentrations of Risk Distribution For the Year Ended December 31, 2019 2018 2017 Percent of revenues derived from: Distributor Zimmer 18 % 21 % 17 % Medtronic 7 % 8 % 9 % Synthes 4 % 5 % 4 % The Company’s distribution agreements are subject to termination by either party for a variety of causes. No assurance can be given that such distribution agreements will be renewed beyond their expiration dates, continue in their current form or at similar rate structures. Any termination or interruption in the distribution of the Company’s implants through one of its major distributors could have a material adverse effect on the Company’s operations. Tissue Supply

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	26. Commitments and Contingencies Agreement to Acquire Paradigm Under the terms of the agreement, the Company paid $100,000 in cash and issued 10,729,614 shares of the Company’s common stock. The shares of Company common stock issued on March 8, 2019, were valued based on the volume weighted average closing trading price for the five trading days prior to the date of execution of the definitive agreement, representing $50,000 of value. In addition, the Company may be required to pay up to an additional $150,000 in a combination of cash and Company common stock based on a revenue earnout consideration. Based on a probability weighted model, the Company estimates a contingent liability related to the revenue based earnout of zero. Acquisition of Zyga Distribution Agreement with A&E Distribution Agreement with Medtronic Distribution Agreement with Zimmer Dental Inc. The Company’s aforementioned revenue recognition methods related to the Zimmer distribution agreements do not result in the deferral of revenue less than amounts that would be refundable in the event the agreements were to be terminated in future periods. Additionally, the Company evaluates the appropriateness of the aforementioned revenue recognition methods on an ongoing basis.

Legal and Regulatory Actions

Legal and Regulatory Actions	12 Months Ended
	Dec. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Legal and Regulatory Actions	27. Legal and Regulatory Actions The Company is, from time to time, involved in litigation relating to claims arising out of its operations in the ordinary course of business. Based on the information currently available to the Company, the Company does not believe that any of these claims that were outstanding as of December 31, 2019 will have a material adverse impact on its financial position or results of operations. The Company’s accounting policy is to accrue for legal costs as they are incurred. Coloplast — co-defendant In addition to claims made directly against the Company, Coloplast, a distributor of TSM’s and certain allografts processed and private labeled for them under a contract with the Company, has also been named as a defendant in individual TSM cases in various federal and state courts. Coloplast requested that the Company indemnify or defend Coloplast in those claims which allege injuries caused by the Company’s allograft implants, and on April 24, 2014, Coloplast sued RTI Surgical, Inc. in the Fourth Judicial District of Minnesota for declaratory relief and breach of contract. On December 11, 2014, Coloplast entered into a settlement agreement with RTI Surgical, Inc. and Tutogen Medical, Inc. (the “Company Parties”) resulting in dismissal of the case. Under the terms of the settlement agreement, the Company Parties are responsible for the defense and indemnification of two categories of present and future claims: (1) tissue only (where Coloplast is solely the distributor of Company processed allograft tissue and no Coloplast-manufactured or distributed synthetic mesh is identified) (“Tissue Only Claims”), and (2) tissue plus non-Coloplast synthetic mesh (“Tissue-Non-Coloplast Tissue-Non-Coloplast Based on the current information available to the Company, the impact that current or any future TSM litigation may have on the Company cannot be reasonably estimated. LifeNet — SEC Investigation

Quarterly Results of Operations

Quarterly Results of Operations (Unaudited)	12 Months Ended
	Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]
Quarterly Results of Operations (Unaudited)	28. Quarterly Results of Operations (Unaudited) The following tables sets forth the results of operations for the periods indicated (The quarterly results of operations for the years ended December 31, 2019 and 2018 reflects our adoption of FASB ASU 2014-09, Year Ended December 31, 2019 First Second Third Fourth (as restated) (as restated) (as restated) Revenues $ 70,021 $ 81,554 $ 76,741 $ 80,068 Gross profit 37,886 46,124 43,223 43,891 Net (loss) income (9,352 ) 188 (5,138 ) (197,340 ) Net (loss) income per common share - basic $ (0.14 ) $ 0.00 $ (0.07 ) $ (2.63 ) Net (loss) income per common share - diluted $ (0.14 ) $ 0.00 $ (0.07 ) $ (2.63 ) Year Ended December 31, 2018 First Second Third Fourth Revenues $ 69,141 $ 70,385 $ 70,450 $ 70,386 Gross profit 33,503 29,899 38,228 38,013 Net (loss) income (1,117 ) (5,802 ) 2,997 799 Net (loss) income per common share - basic $ (0.03 ) $ (0.11 ) $ 0.04 $ 0.01 Net (loss) income per common share - diluted $ (0.03 ) $ (0.11 ) $ 0.04 $ 0.01

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2019
Subsequent Events [Abstract]
Subsequent Events	29. Subsequent Events The Company evaluated subsequent events as of the issuance date of the consolidated financial statements as defined by FASB ASC 855, Subsequent Events Sale of OEM Business On January 13, 2020, we entered into an Equity Purchase Agreement, as amended by that certain First Amendment to Equity Purchase Agreement dated as of March 6, 2020, and that certain Second Amendment to Equity Purchase Agreement dated as of April 27, 2020 (as amended, the “OEM Purchase Agreement”), with Ardi Bidco Ltd., a Delaware corporation and an entity affiliated with Montagu Private Equity LLP (“Montagu”), for the sale (the “Sale”) of the RTI’s business of: (a) providing original equipment manufacturing (“OEM”), including the design, development and manufacture, of private label and custom biological-, metal- and polymer-based implants and instruments that are used in spine, sport medicine, plastic and reconstructive, urology, gynecology and trauma surgical procedures, and (b)processing donated human musculoskeletal and other tissue and bovine and porcine animal tissue in producing allograft and xenograft implants using BIOCLEANSE®, TUTOPLAST® and CANCELLE® SP sterilization processes (i) as represented by RTI’s “Sports” line of business and (ii) as otherwise described in RTI Surgical, Inc.’s Annual Report on Form 10-K 10-K The OEM Purchase Agreement contemplates that, prior to the closing (the “OEM Closing”) of the Sale and each of the agreements ancillary to the OEM Purchase Agreement, (the “Contemplated Transactions”), we will undergo an internal reorganization, pursuant to which, in addition to certain inter-company transfers and mergers, the Company and its subsidiaries will transfer to the OEM Group Companies the assets primarily used in the operation of the OEM Business and the OEM Group Companies will assume certain liabilities that are related to the OEM Business (collectively, the “Reorganization”). In addition to the Reorganization, RTI is required to use reasonable best efforts to separate the assets and liabilities of the U.S. “metals” business and the U.S. “biologics” business into two separate companies prior to the OEM Closing. As part of such separation, another subsidiary of RTI, established to hold the assets and liabilities of the U.S. “metals” business, will constitute an OEM Company and be sold as part of the Contemplated Transactions to an affiliate of the Buyer. The affiliate of the Buyer established for this purpose would be an additional “Buyer” under the OEM Purchase Agreement. The Contemplated Transactions are subject to customary closing conditions, including, among other things, the approval of the Contemplated Transactions by the Company’s stockholders. The parties currently expect to close the Contemplated Transactions in the third quarter of 2020. Following the OEM Closing, the Company will focus exclusively on the design, development and distribution of spinal implants to the global market. Financing Third Amendment to Credit Agreement and Joinder Agreement On April 9, 2020, Legacy RTI entered into a Consent and Third Amendment to Credit Agreement and Joinder Agreement (the “Third Amendment to the 2018 Credit Agreement”), by and among the JPM Loan Parties and the JPM Lenders. The Third Amendment to the 2018 Credit Agreement amended the 2018 Credit Agreement by: (i) extending the deadline for delivery of certain annual audited financial statements of the Company from March 30, 2020 to April 30, 2020, (ii) modifying certain interest rates contained therein to contain a 1.00% floor, (iii) requiring the Company and each other Loan Party to close all of its deposit accounts and securities accounts at Wells Fargo Bank, N.A. or any affiliates thereof, and (iv) making certain other changes to the 2018 Credit Agreement consistent with the foregoing. Fourth Amendment to Credit Agreement and Joinder Agreement On April 27, 2020, Legacy RTI entered into a Fourth Amendment to Credit Agreement (the “Fourth Amendment to the 2018 Credit Agreement”), by and among the JPM Loan Parties and the JPM Lenders. The Fourth Amendment to the 2018 Credit Agreement amends the 2018 Agreement to: (i) provide for a $8,000 block on availability under the 2018 Credit Agreement until the earlier of: (a) the date upon which at least $25,000 of the Second Amendment Incremental Term Loan Commitments (as defined below) have been funded to Legacy RTI in accordance with the 2019 Credit Agreement and evidence of such funding, in form and substance satisfactory to JPM, shall have been received by JPM.; and (b) the date upon which (1) no default or event of default exists under the 2018 Credit Agreement; and (2) Ares notifies Legacy RTI that, for any reason, Second Amendment Incremental Term Loan Commitments have been terminated in accordance with the terms of the 2019 Credit Agreement and evidence of such termination, in form and substance satisfactory to JPMorgan Chase Bank, N.A., shall have been delivered to JPM; (ii) amend the applicable rate with respect to any loan to 2.75% per annum; and (iii) amend the maturity date to the earlier to occur of: (a) June 5, 2023, or any earlier date on which the commitments are reduced to zero or otherwise terminated pursuant to the terms of the 2018 Credit Agreement; and (b) the date that is 30 days prior to the maturity date of the Second Amendment Incremental Term Loan Commitments, as the same may be extended from time to time pursuant to the terms of the 2019 Credit Agreement and such extension is agreed to by the JPM Lenders. First Amendment to Second Lien Credit Agreement On March 3, 2020, the Company entered into a First Amendment to Second Lien Credit Agreement, dated March 3, 2020 (the “2020 First Amendment”), by and among the Ares Loan Parties and the Ares Lenders. The 2020 First Amendment amended the 2019 Credit Agreement: (a) amending the definition of “EBITDA” contained therein; (b) modifying the total net leverage ratio covenant contained therein; and (c) making certain other changes to the 2019 Credit Agreement consistent with the foregoing. These amendments will allow the Company to, among other things, support the investment being made to separate the OEM and Spine businesses in anticipation of the sale of the Company’s OEM business. Second Amendment to Second Lien Credit Agreement On April 27, 2020, the Company entered into a Second Amendment to Second Lien Credit Agreement (the “Second Amendment to the 2019 Agreement”), by and among the Ares Loan Parties and the Ares Lenders. The Second Amendment to the 2019 Agreement amended the 2019 Credit Agreement to: (i) establish an incremental term loan commitment; (ii) provide for certain incremental term loans in an aggregate principal amount not to exceed $30,000 (the “Second Amendment Incremental Loan Commitments”); (iii) provide for a portion of the Second Amendment Incremental Loan Commitments up to $13,500 be available on a delayed-draw basis at any time after the effective date of the Ares Amendment and on or prior to August 31, 2020, subject to certain conditions; iv) increase the Base Rate applicable margin with respect to all Term Loans (other than the Second Amendment Incremental Term Loans) to 12.5% effective on September 1, 2020; and (v) make certain other changes to the 2019 Credit Agreement consistent with the foregoing. Pursuant to the terms of the Ares Amendment, Legacy RTI agreed pay to Ares, for the ratable benefit of each incremental term lender, a fee in an amount equal to 5.0% of the principal amount of the incremental term loan commitments provided by such lender on the effective date of the Ares Amendment. The maturity of the loans advanced under the Second Amendment Incremental Term Commitments (the “Second Amendment Incremental Term Loans”) have a maturity date of April 27, 2021. The Second Amendment Incremental Term Loans must be repaid in their entirety, at which time a takeout fee ranging from $11,250 to $25,500 shall be due and payable (the “Takeout Fee”). The Takeout Fee is inclusive of all interest accruing due and payable with respect to the Second Amendment Incremental Term Loans. The interest rate on the Second Amendment Incremental Term Loans is 12.50% and, commencing on September 1, 2020 and on the first day of each of the next four calendar months thereafter, the interest in respect of the Second Amendment Incremental Term Loans shall increase on each such date, on a cumulative basis, by an additional 1.00% per annum (such that, after the fifth such increase, the Base Rate with respect to the Second Amendment Incremental Term Loans shall equal 17.50% per annum). COVID-19 The COVID-19 pandemic has directly and indirectly adversely impacted the Company’s business, financial condition and operating results. The extent to which these adverse impacts will continue will depend on numerous evolving factors that are highly uncertain, rapidly changing and cannot be predicted with precision or certainty at this time. The spread of COVID-19 has caused many hospitals and other healthcare providers to refocus their care on the surge of the COVID-19 cases and to postpone elective and non-emergent procedures, restrict access to these facilities, and in some cases re-allocate scarce resources to their critically ill patients. These efforts have impacted and could continue to impact our business activities, including our product sales, as many of our products are used in connection with elective surgeries. Many of our employees have been furloughed and although our operations are beginning to increase towards normal levels, we continue to have many employees working remotely. Additionally, these measures are hindering our ability to recruit, vet and hire personnel for key positions. It is unknown how long these disruptions could continue. Due to the challenges created by the furloughs and remote working conditions, on May 11, 2020, we filed a Current Report on Form 8-K to avail ourselves to an extension to file our Quarterly Report on Form 10-Q for the quarterly period ended March 31, 2020, originally due on May 11, 2020, relying on an order issued by the Securities and Exchange Commission on March 25, 2020 pursuant to Section 36 of the Securities Exchange Act of 1934, as amended (Release No. 34-88465), regarding exemptions granted to certain public companies. As noted above, our product sales have been materially reduced as a result of COVID-19. While we are continuing to monitor and evaluate the impact on our business of COVID-19, we have not at this point identified any material impairments, increases in allowances for credit losses, restructuring charges, other expenses, or changes in accounting judgments that have had or are reasonably likely to have a material impact on our financial statements specifically due to the COVID-19 pandemic. However, as the global outbreak of COVID-19 continues to rapidly evolve, it could continue to materially and adversely affect our revenues, financial condition, profitability, and cash flows for an indeterminate period of time. Stockholder Litigation There is currently ongoing stockholder litigation related to the Investigation. A class action complaint was filed by Patricia Lowry against the Company, and certain current and former officers of the Company, in the United States District Court for the Northern District of Illinois on March 23, 2020 demanding a jury trial. A shareholder derivative lawsuit was filed by David Summers on behalf of the Company against certain current and former directors and officers of the Company in the United States District Court for the Northern District of Illinois on June 5, 2020 demanding a jury trial. In the future, we may become subject to additional litigation or governmental proceedings or investigations that could result in additional unanticipated legal costs regardless of the outcome of the litigation. If we are not successful in any such litigation, we may be required to pay substantial damages or settlement costs. Based on the current information available to the Company, the impact that current or any future stockholder litigation may have on the Company cannot be reasonably estimated.

Restatement of Prior Period Qua

Restatement of Prior Period Quarterly Financial Statements (Unaudited)	12 Months Ended
	Dec. 31, 2019
Accounting Changes and Error Corrections [Abstract]
Restatement of Prior Period Quarterly Financial Statements (Unaudited)	30. Restatement of Prior Period Quarterly Financial Statements (Unaudited) As previously disclosed in RTI’s Current Report on Form 8-K filed with the SEC on March 16, 2020, the Audit Committee of the Board of Directors of RTI, with the assistance of independent legal and forensic accounting advisors, conducted an internal investigation of matters relating to the Company’s revenue recognition practices for certain contractual arrangements, primarily with OEM customers, including the accounting treatment, financial reporting and internal controls related to such arrangements (the “Investigation”). Based on the results of the Investigation, the Company has concluded that revenue for certain invoices should have been recognized at a later date than when originally recognized. In response to binding purchase orders from certain OEM customers, goods were shipped and received by the customers before requested delivery dates and agreed-upon delivery windows. In many instances the OEM customers requested or approved the early shipments, but the Company has determined that on other occasions the goods were delivered early without obtaining the customers’ affirmative approval. Some of those unapproved shipments were shipped by employees in order to generate additional revenue and resulted in shipments being pulled from a future quarter into an earlier quarter. In addition, the Company has concluded that in July 2017 an adjustment was improperly made to a product return provision in the Direct Division. The revenue for those shipments is being restated, as well as for other orders that shipped earlier than the purchase order due date in the system for which the Company could not locate evidence that the OEM customers had requested or approved the shipments. In addition, the Company has concluded that in the periods from 2015 through the fourth quarter of 2018, certain adjustments were incorrectly or erroneously made via manual journal entries to accrual/reserve accounts, including a July 2017 adjustment to a product return provision in the Direct Division, among others. Furthermore, certain errors were identified, separately from the Investigation, primarily related to accounting for our 2019 Acquisition of Paradigm Spine, LLC for the first three quarters of 2019. The Company determined to restate its previously issued unaudited condensed consolidated financial statements for the quarters ended March 31, 2019, June 30, 2019, and September 30, 2019. The following tables summarize the impacts of the results on our previously reported unaudited condensed consolidated statements of operations and balances sheets included in our Quarterly Reports on Form 10-Q The following errors in the Company’s quarterly financial statements were identified and corrected as a result of the Investigation: a. Revenue b. Costs of processing and distribution c. Accounts receivable d. Inventories, net e. Deferred tax assets The following errors in the Company’s quarterly financial statements were identified and corrected apart from the Investigation and related to accounting for our 2019 acquisition of Paradigm Spine, LLC for the first three quarters of 2019. ASC 805 Business Combinations a. Costs of processing and distribution b. Marketing, general and administrative c. Current inventories, net d. Non-current non-current e. Deferred tax assets f. Goodwill g. Other intangible assets - net h. Acquisition contingencies In addition to the correction of the errors discussed above, the Company has voluntarily made other immaterial corrections in all periods presented . a. Marketing, general and administrative b. Accounts receivable c. Prepaid and other current assets d. Deferred tax assets - net e. Property, plant & equipment f. Other intangible assets - net g. Other assets - net h. Accounts payable i. Accrued expenses j. Payments for treasury stock Restated Condensed Consolidated Balance Sheets (Unaudited) March 31, June 30, September 30, (as restated) (as restated) (as restated) Assets Current Assets: Cash and cash equivalents $ 6,043 $ 4,518 $ 2,950 Accounts receivable 55,709 55,540 56,545 Inventories - net 115,486 115,454 118,336 Prepaid and other current assets 9,399 8,258 8,156 Total current assets 186,637 183,770 185,987 Non-current 10,261 9,225 8,374 Property, plant and equipment - net 79,500 79,956 81,471 Deferred tax assets - net 17,114 20,230 21,576 Goodwill 194,797 195,067 194,838 Other intangible assets - net 103,006 100,651 97,614 Other assets - net 7,653 7,277 7,006 Total assets $ 598,968 $ 596,176 $ 596,866 Liabilities and Stockholders’ Equity Current Liabilities: Accounts payable $ 23,149 $ 20,600 $ 17,634 Accrued expenses 25,557 25,312 31,714 Current portion of deferred revenue 4,825 4,744 2,748 Total current liabilities 53,531 50,656 52,096 Long-term obligations - less current portion 163,615 165,081 169,137 Acquisition contingencies 77,163 75,573 75,573 Other long-term liabilities 3,065 2,562 2,271 Deferred revenue 1,535 325 1,134 Total liabilities 298,909 294,197 300,211 Preferred stock Series A, $.001 par value: 5,000,000 shares authorized; 50,000 shares issued and outstanding 66,272 66,318 66,364 Stockholders’ equity: Common stock, $.001 par value: 150,000,000 shares authorized; 75,055,225, 75,159,262, and 75,087,917 shares issued and outstanding, respectively 75 75 75 Additional paid-in 495,263 496,596 497,518 Accumulated other comprehensive loss (7,663 ) (7,268 ) (8,390 ) Accumulated deficit (248,889 ) (248,701 ) (253,839 ) Less treasury stock, 1,250,201, 1,257,949 and 1,265,761 shares, respectively, at cost (4,999 ) (5,041 ) (5,073 ) Total stockholders’ equity 233,787 235,661 230,291 Total liabilities and stockholders’ equity $ 598,968 $ 596,176 $ 596,866 Restated Condensed Consolidated Statements of Income (Unaudited) Three Months Ended (as restated) Revenues $ 70,021 Costs of processing and distribution 32,134 Gross profit 37,887 Expenses: Marketing, general and administrative 32,116 Research and development 4,336 Asset impairment and abandonments 15 Acquisition and integration expenses 8,957 Total operating expenses 45,424 Operating (loss) (7,537 ) Other (expense) income: Interest expense (1,604 ) Interest income 131 Foreign exchange (loss) (31 ) Total other expense - net (1,504 ) (Loss) before income tax (provision) (9,041 ) Income tax (provision) (310 ) Net (loss) (9,351 ) Convertible preferred dividend Net (loss) applicable to common shares $ (9,351 ) Other comprehensive (loss): Unrealized foreign currency translation loss (393 ) Comprehensive (loss) $ (9,744 ) Net (loss) per common share - basic $ (0.14 ) Net (loss) per common share - diluted $ (0.14 ) Restated Condensed Consolidated Statements of Income (Unaudited) Six Months Ended (as restated) Revenues $ 151,575 Costs of processing and distribution 67,564 Gross profit 84,011 Expenses: Marketing, general and administrative 73,224 Research and development 8,204 Gain on acquisition contingency (1,590 ) Asset impairment and abandonments 15 Acquisition and integration expenses 10,910 Total operating expenses 90,763 Operating (loss) (6,752 ) Other (expense) income: Interest expense (5,239 ) Interest income 157 Foreign exchange (loss) (50 ) Total other expense - net (5,132 ) (Loss) before income tax benefit (11,884 ) Income tax benefit 2,721 Net (loss) applicable to common shares (9,163 ) Convertible preferred dividend — Net (loss) applicable to common shares $ (9,163 ) Other comprehensive (loss): Unrealized foreign currency translation loss 2 Comprehensive (loss) $ (9,161 ) Net (loss) per common share - basic $ (0.13 ) Net (loss) per common share - diluted $ (0.13 ) Restated Condensed Consolidated Statements of Income (Unaudited) Nine Months Ended (as restated) Revenues $ 228,316 Costs of processing and distribution 101,081 Gross profit 127,235 Expenses: Marketing, general and administrative 112,447 Research and development 12,475 Gain on acquisition contingency (1,590 ) Asset impairment and abandonments 15 Acquisition and integration expenses 14,119 Total operating expenses 137,466 Operating (loss) (10,231 ) Other (expense) income: Interest expense (8,957 ) Interest income 161 Foreign exchange (loss) (128 ) Total other expense - net (8,924 ) (Loss) before income tax benefit (19,155 ) Income tax benefit 4,854 Net (loss) (14,301 ) Convertible preferred dividend — Net (loss) applicable to common shares $ (14,301 ) Other comprehensive (loss): Unrealized foreign currency translation loss (1,120 ) Comprehensive (loss) $ (15,421 ) Net (loss) per common share - basic $ (0.20 ) Net (loss) per common share - diluted $ (0.20 ) 30. Restatement of Prior Period Quarterly Financial Statements (Unaudited) (Continued) Restated Condensed Consolidated Statements of Income (Unaudited) Three Months Ended (as restated) Revenues $ 81,554 Costs of processing and distribution 35,430 Gross profit 46,124 Expenses: Marketing, general and administrative 41,108 Research and development 3,868 Gain on acquisition contingency (1,590 ) Acquisition and integration expenses 1,953 Total operating expenses 45,339 Operating income 785 Other (expense) income: Interest expense (3,635 ) Interest income 26 Foreign exchange (loss) (19 ) Total other expense - net (3,628 ) (Loss) before income tax benefit (2,843 ) Income tax benefit 3,031 Net income 188 Convertible preferred dividend — Net income applicable to common shares $ 188 Other comprehensive income: Unrealized foreign currency translation loss 395 Comprehensive income $ 583 Net income per common share - basic $ 0.00 Net income per common share - diluted $ 0.00 Restated Condensed Consolidated Statements of Income (Unaudited) Three Months Ended (as restated) Revenues $ 76,741 Costs of processing and distribution 33,517 Gross profit 43,224 Expenses: Marketing, general and administrative 39,223 Research and development 4,271 Acquisition and integration expenses 3,209 Total operating expenses 46,703 Operating (loss) (3,479 ) Other (expense) income: Interest expense (3,718 ) Interest income 4 Foreign exchange (loss) (78 ) Total other expense - net (3,792 ) (Loss) before income tax benefit (7,271 ) Income tax benefit 2,133 Net (loss) applicable to common shares (5,138 ) Convertible preferred dividend — Net (loss) applicable to common shares $ (5,138 ) Other comprehensive (loss): Unrealized foreign currency translation loss (1,122 ) Comprehensive (loss) $ (6,260 ) Net (loss) per common share - basic $ (0.07 ) Net (loss) per common share - diluted $ (0.07 ) Restated Condensed Consolidated Statement of Cash Flows (Unaudited) For the Three Months 2019 (as restated) Cash flows from operating activities: Net (loss) $ (9,351 ) Adjustments to reconcile net loss to net cash (used in) operating activities: Depreciation and amortization expense 4,400 Provision for bad debts and product returns 233 Provision for inventory write-downs 1,530 Amortization of deferred revenue (1,292 ) Deferred income tax provision 384 Stock-based compensation 1,163 Other 197 Change in assets and liabilities: Accounts receivable (2,717 ) Inventories (2,190 ) Accounts payable (7,329 ) Accrued expenses (2,074 ) Deferred revenue 2,000 Other operating assets and liabilities (511 ) Net cash (used in) operating activities (15,557 ) Cash flows from investing activities: Purchases of property, plant and equipment (3,477 ) Patent and acquired intangible asset costs (328 ) Cardiothoracic closure business divestiture (99,921 ) Net cash (used in) investing activities (103,726 ) Cash flows from financing activities: Proceeds from exercise of common stock options 284 Proceeds from long-term obligations 115,000 Net (payments) on short-term obligations (729 ) Payments for treasury stock (128 ) Net cash provided by financing activities 114,427 Effect of exchange rate changes on cash and cash equivalents (50 ) Net decrease in cash and cash equivalents (4,906 ) Cash and cash equivalents, beginning of period 10,949 Cash and cash equivalents, end of period $ 6,043 Supplemental cash flow disclosure: Cash paid for interest $ 557 Cash paid for income taxes, net of refunds (635 ) Non-cash acquisition of property, plant and equipment 502 Non-cash acquisition of Paradigm 60,730 Non-cash common stock issuance 60,730 Restated Condensed Consolidated Statement of Cash Flows (Unaudited) For the Six Months 2019 (as restated) Cash flows from operating activities: Net (loss) $ (9,163 ) Adjustments to reconcile net loss to net cash (used in) operating activities: Depreciation and amortization expense 10,308 Provision for bad debts and product returns 899 Provision for inventory write-downs 3,274 Amortization of deferred revenue (2,585 ) Deferred income tax benefit (2,969 ) Stock-based compensation 2,430 Gain on acquisition contingency (1,590 ) Paid in kind interest expense 1,473 Other 877 Change in assets and liabilities: — Accounts receivable (3,141 ) Inventories (2,658 ) Accounts payable (9,751 ) Accrued expenses (2,583 ) Deferred revenue 2,000 Other operating assets and liabilities 240 Net cash (used in) operating activities (12,939 ) Cash flows from investing activities: Purchases of property, plant and equipment (6,912 ) Patent and acquired intangible asset costs (1,126 ) Acquisition of Zyga Technology — Cardiothoracic closure business divestiture (99,921 ) Net cash (used in) investing activities (107,959 ) Cash flows from financing activities: Proceeds from exercise of common stock options 395 Proceeds from long-term obligations 115,000 Net (payments) on short-term obligations (729 ) Payments for treasury stock (172 ) Net cash provided by financing activities 114,494 Effect of exchange rate changes on cash and cash equivalents (27 ) Net decrease in cash and cash equivalents (6,431 ) Cash and cash equivalents, beginning of period 10,949 Cash and cash equivalents, end of period $ 4,518 Supplemental cash flow disclosure: Cash paid for interest $ 2,732 Cash paid for income taxes, net of refunds 1,982 Non-cash acquisition of property, plant and equipment 456 Non-cash acquisition of Paradigm 60,730 Non-cash common stock issuance 60,730 Restated Condensed Consolidated Statement of Cash Flows (Unaudited) For the Nine Months 2019 (as restated) Cash flows from operating activities: Net (loss) $ (14,301 ) Adjustments to reconcile net loss to net cash (used in) operating activities: Depreciation and amortization expense 16,342 Provision for bad debts and product returns 1,050 Provision for inventory write-downs 5,482 Amortization of deferred revenue (3,772 ) Deferred income tax benefit (4,588 ) Stock-based compensation 3,399 Gain on acquisition contingency (1,590 ) Paid in kind interest expense 2,948 Other 1,069 Change in assets and liabilities: — Accounts receivable (4,522 ) Inventories (7,609 ) Accounts payable (12,684 ) Accrued expenses 3,998 Deferred revenue 2,000 Other operating assets and liabilities 273 Net cash (used in) operating activities (12,505 ) Cash flows from investing activities: Purchases of property, plant and equipment (10,882 ) Patent and acquired intangible asset costs (1,786 ) Cardiothoracic closure business divestiture (99,692 ) Net cash (used in) investing activities (112,360 ) Cash flows from financing activities: Proceeds from exercise of common stock options 395 Proceeds from long-term obligations 118,000 Net (payments) on short-term obligations (729 ) Payments on long-term obligations (500 ) Payments for treasury stock (204 ) Net cash provided by financing activities 116,962 Effect of exchange rate changes on cash and cash equivalents (96 ) Net decrease in cash and cash equivalents (7,999 ) Cash and cash equivalents, beginning of period 10,949 Cash and cash equivalents, end of period $ 2,950 Supplemental cash flow disclosure: Cash paid for interest $ 4,941 Cash paid for income taxes, net of refunds 1,982 Non-cash 817 Non-cash 60,730 Non-cash 60,730 Restated Condensed Consolidated Balance Sheet Amounts (Unaudited) As of March 31, 2019 As Previously Reported Adjustments As Restated Accounts receivable $ 55,670 $ 39 $ 55,709 Inventories - net 114,365 1,121 115,486 Prepaid and other current assets 9,860 (461 ) 9,399 Total current assets 185,938 699 186,637 Non-current — 10,261 10,261 Property, plant and equipment - net 79,235 265 79,500 Deferred tax assets - net 16,778 336 17,114 Goodwill 308,345 (113,548 ) 194,797 Other intangible assets - net 25,512 77,494 103,006 Other assets - net 7,918 (265 ) 7,653 Total assets $ 623,726 $ (24,758 ) $ 598,968 Accounts payable $ 23,315 $ (166 ) $ 23,149 Accrued expenses 24,992 565 25,557 Total current liabilities 53,132 399 53,531 Acquisition contingencies 99,962 (22,799 ) 77,163 Total liabilities 321,309 (22,400 ) 298,909 Accumulated deficit (246,531 ) (2,358 ) (248,889 ) Total stockholders’ equity 236,145 (2,358 ) 233,787 Total liabilities and stockholders’ equity $ 623,726 $ (24,758 ) $ 598,968 As of June 30, 2019 As Adjustments As Restated Accounts receivable 56,163 (623 ) 55,540 Inventories - net 127,906 (12,452 ) 115,454 Prepaid and other current assets 8,733 (475 ) 8,258 Total current assets 197,320 (13,550 ) 183,770 Non-current 20,445 (11,220 ) 9,225 Property, plant and equipment - net 79,691 265 79,956 Deferred tax assets - net 19,715 515 20,230 Goodwill 271,429 (76,362 ) 195,067 Other intangible assets - net 25,269 75,382 100,651 Other assets - net 7,542 (265 ) 7,277 Total assets $ 621,411 $ (25,235 ) $ 596,176 Accounts payable $ 20,766 $ (166 ) $ 20,600 Accrued expenses 24,668 644 25,312 Total current liabilities 50,178 478 50,656 Acquisition contingencies 98,372 (22,799 ) 75,573 Total liabilities 316,518 (22,321 ) 294,197 Accumulated deficit (245,787 ) (2,914 ) (248,701 ) Total stockholders’ equity 238,575 (2,914 ) 235,661 Total liabilities and stockholders’ equity $ 621,411 $ (25,235 ) $ 596,176 Restated Condensed Consolidated Balance Sheet Amounts (Unaudited) As of September 30, 2019 As Adjustments As Restated Accounts receivable $ 56,556 $ (11 ) $ 56,545 Inventories - net 130,913 (12,577 ) 118,336 Prepaid and other current assets 8,631 (475 ) 8,156 Total current assets 199,050 (13,063 ) 185,987 Non-current 18,345 (9,971 ) 8,374 Property, plant and equipment - net 81,206 265 81,471 Deferred tax assets - net 20,967 609 21,576 Goodwill 236,547 (41,709 ) 194,838 Other intangible assets - net 24,345 73,269 97,614 Other assets - net 7,271 (265 ) 7,006 Total assets $ 587,731 $ 9,135 $ 596,866 Accounts payable $ 17,800 $ (166 ) $ 17,634 Accrued expenses 31,067 647 31,714 Total current liabilities 51,615 481 52,096 Acquisition contingencies 63,719 11,854 75,573 Total liabilities 287,876 12,335 300,211 Accumulated deficit (250,639 ) (3,200 ) (253,839 ) Total stockholders’ equity 233,491 (3,200 ) 230,291 Total liabilities and stockholders’ equity $ 587,731 $ 9,135 $ 596,866 Restated Condensed Consolidated Statements of Income Amounts (Unaudited) Three Months Ended March 31, 2019 (as reported) (adjustments) (as restated) Revenues $ 69,741 $ 280 $ 70,021 Costs of processing and distribution 31,737 397 32,134 Gross profit 38,004 (117 ) 37,887 Marketing, general and administrative 31,883 233 32,116 Total operating expenses 45,191 233 45,424 Operating (loss) (7,187 ) (350 ) (7,537 ) (Loss) before income tax (provision) (8,691 ) (350 ) (9,041 ) Income tax (provision) (396 ) 86 (310 ) Net (loss) (9,087 ) (264 ) (9,351 ) Comprehensive (loss) $ (9,480 ) $ (264 ) $ (9,744 ) Net (loss) per common share - basic $ (0.14 ) $ (0.00 ) $ (0.14 ) Net (loss) per common share - diluted $ (0.14 ) $ (0.00 ) $ (0.14 ) Restated Condensed Consolidated Statements of Income Amounts (Unaudited) Six Months Ended June 30, 2019 (as reported) (adjustments) (as restated) Revenues $ 152,048 $ (473 ) $ 151,575 Costs of processing and distribution 69,299 (1,735 ) 67,564 Gross profit 82,749 1,262 84,011 Marketing, general and administrative 70,876 2,348 73,224 Total operating expenses 88,415 2,348 90,763 Operating (loss) (5,666 ) (1,086 ) (6,752 ) (Loss) before income tax (provision) (10,798 ) (1,086 ) (11,884 ) Income tax benefit 2,455 266 2,721 Net (loss) (8,343 ) (820 ) (9,163 ) Comprehensive (loss) $ (8,341 ) $ (820 ) $ (9,161 ) Net (loss) per common share - basic $ (0.12 ) $ (0.01 ) $ (0.13 ) Net (loss) per common share - diluted $ (0.12 ) $ (0.01 ) $ (0.13 ) Nine Months Ended September 30, 2019 (as (adjustments) (as Revenues $ 228,177 $ 139 $ 228,316 Costs of processing and distribution 103,941 (2,860 ) 101,081 Gross profit 124,236 2,999 127,235 Marketing, general and administrative 107,983 4,464 112,447 Total operating expenses 133,002 4,464 137,466 Operating (loss) (8,766 ) (1,465 ) (10,231 ) (Loss) before income tax benefit (17,690 ) (1,465 ) (19,155 ) Income tax benefit 4,495 359 4,854 Net (loss) (13,195 ) (1,106 ) (14,301 ) Comprehensive (loss) $ (14,315 ) $ (1,106 ) $ (15,421 ) Net (loss) per common share - basic $ (0.18 ) $ (0.02 ) $ (0.20 ) Net (loss) per common share - diluted $ (0.18 ) $ (0.02 ) $ (0.20 ) Restated Condensed Consolidated Statements of Income Amounts (Unaudited) Three Months Ended June 30, 2019 (as reported) (adjustments) (as restated) Revenues $ 82,307 $ (753 ) $ 81,554 Costs of processing and distribution 37,562 (2,132 ) 35,430 Gross profit 44,745 1,379 46,124 Marketing, general and administrative 38,993 2,115 41,108 Total operating expenses 43,224 2,115 45,339 Operating income 1,521 (736 ) 785 (Loss) before income tax benefit (2,107 ) (736 ) (2,843 ) Income tax benefit 2,851 180 3,031 Net income 744 (556 ) 188 Comprehensive income $ 1,139 $ (556 ) $ 583 Net income per common share - basic $ 0.01 $ (0.01 ) $ 0.00 Net income per common share - diluted $ 0.01 $ (0.01 ) $ 0.00 Three Months Ended September 30, 2019 (as reported) (adjustments) (as restated) Revenues $ 76,129 $ 612 $ 76,741 Costs of processing and distribution 34,642 (1,125 ) 33,517 Gross profit 41,487 1,737 43,224 Marketing, general and administrative 37,107 2,116 39,223 Total operating expenses 44,587 2,116 46,703 Operating (loss) (3,100 ) (379 ) (3,479 ) (Loss) before income tax benefit (6,892 ) (379 ) (7,271 ) Income tax benefit 2,040 93 2,133 Net (loss) (4,852 ) (286 ) (5,138 ) Comprehensive (loss) $ (5,974 ) $ (286 ) $ (6,260 ) Net (loss) per common share - basic $ (0.06 ) $ (0.01 ) $ (0.07 ) Net (loss) per common share - diluted $ (0.06 ) $ (0.01 ) $ (0.07 ) Restated Condensed Consolidated Statement of Cash Flows Amounts (Unaudited) For the Three Months Ended March 31, 2019 As Previously Adjustments As Restated Cash flows from operating activities: Net (loss) $ (9,087 ) $ (264 ) $ (9,351 ) Depreciation and amortization expense 3,696 704 4,400 Deferred income tax provision 470 (86 ) 384 Accounts receivable (2,422 ) (295 ) (2,717 ) Inventories (2,742 ) 552 (2,190 ) Accounts payable (7,253 ) (76 ) (7,329 ) Accrued expenses (1,585 ) (489 ) (2,074 ) Other operating assets and liabilities (593 ) 82 (511 ) Net cash (used in) operating activities (15,685 ) 128 (15,557 ) Cash flows from financing activities Payments for treasury stock — (128 ) (128 ) Net cash used by financing activities 114,555 (128 ) 114,427 For the Six Months Ended June 30, 2019 As Previously Adjustments As Restated Cash flows from operating activities: Net (loss) $ (8,343 ) $ (820 ) $ (9,163 ) Depreciation and amortization expense 7,491 2,817 10,308 Deferred income tax (benefit) (2,703 ) (266 ) (2,969 ) Accounts receivable (3,509 ) 368 (3,141 ) Inventories (1,078 ) (1,580 ) (2,658 ) Accounts payable (9,675 ) (76 ) (9,751 ) Accrued expenses (2,217 ) (366 ) (2,583 ) Other operating assets and liabilities 145 95 240 Net cash (used in) operating activities (13,111 ) 172 (12,939 ) Cash flows from financing activities Payments for treasury stock — (172 ) (172 ) Net cash used by financing activities 114,666 (172 ) 114,494 For the Nine Months Ended September 30, 2019 As Previously Adjustments As Restated Cash flows from operating activities: Net (loss) $ (13,195 ) $ (1,106 ) $ (14,301 ) Depreciation and amortization expense 11,413 4,929 16,342 Deferred income tax (benefit) (4,229 ) (359 ) (4,588 ) Accounts receivable (4,278 ) (244 ) (4,522 ) Inventories (4,904 ) (2,705 ) (7,609 ) Accounts payable (12,608 ) (76 ) (12,684 ) Accrued expenses 4,329 (331 ) 3,998 Other operating assets and liabilities 177 96 273 Net cash (used in) operating activities (12,709 ) 204 (12,505 ) Cash flows from financing activities Payments for treasury stock — (204 ) (204 ) Net cash used by financing activities 117,166 (204 ) 116,962

Schedule II - Valuation and Qua

Schedule II - Valuation and Qualifying Accounts	12 Months Ended
	Dec. 31, 2019
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]
Schedule II - Valuation and Qualifying Accounts	RTI SURGICAL HOLDINGS, INC. AND SUBSIDIARIES Valuation and Qualifying Accounts Years Ended December 31, 2019, 2018 and 2017 (Dollars in thousands) Description Balance at Charged to Deductions- Balance at For the year ended December 31, 2019: Allowance for doubtful accounts $ 2,660 $ 2,582 $ 144 $ 5,098 Allowance for product returns 708 60 138 630 Allowance for excess and obsolescence 15,353 8,558 8,601 15,310 Deferred tax asset valuation allowance 3,093 48,415 0 51,508 For the year ended December 31, 2018: Allowance for doubtful accounts 1,731 1,105 176 2,660 Allowance for product returns 795 616 703 708 Allowance for excess and obsolescence 8,102 15,122 7,871 15,353 Deferred tax asset valuation allowance 7,258 2,368 6,533 3,093 For the year ended December 31, 2017: Allowance for doubtful accounts 1,870 536 675 1,731 Allowance for product returns 582 410 197 795 Allowance for excess and obsolescence 14,798 5,066 11,762 8,102 Deferred tax asset valuation allowance 4,916 1,668 (674 ) 7,258

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation RTIDS is a taxable not-for-profit
Use of Estimates	Use of Estimates
Foreign Currency Translation	Foreign Currency Translation
Fair Value of Financial Instruments	Fair Value of Financial Instruments
Cash and Cash Equivalents	Cash and Cash Equivalents
Accounts Receivable Allowances	Accounts Receivable Allowances
Inventories	Inventories first-in, first-out Non-tissue
Surgical Instruments	Surgical Instruments
Property, Plant and Equipment	Property, Plant and Equipment Depreciation is computed on the straight-line method over the following estimated useful lives of the assets: Buildings 25 to 40 years Building improvements and leasehold improvements 8 to 40 years Processing equipment 7 to 10 years Office equipment, furniture and fixtures 5 to 7 years Computer hardware and software 3 to 7 years Surgical instruments 3 to 5 years
Debt Issuance Costs	Debt Issuance Costs—
Long-Lived Assets	Long-Lived Assets
Goodwill	Goodwill Goodwill and Other Intangible Assets Goodwill is tested for impairment by comparing the fair value of the reporting unit to its carrying amount, including goodwill. Prior to 2019, in concluding as to fair value of the reporting unit for purposes of testing goodwill, an income approach and a market approach were utilized. The conclusion from these two approaches were weighted equally and then adjusted to incorporate a control premium or acquisition premium that reflects the additional amount a buyer is willing to pay for elements of control and for a premium that reflects the buyer’s perception of its ability to add value through synergies. In 2019, since the cash flows were negative over the forecast period for the Spine reporting unit, a cost approach was used to determine the fair value of the Spine reporting unit. For the OEM reporting unit, we weighted the income approach 75% and the market approach 25%. We have chosen the weightings because the income approach more fully captures the company specific factors that would not be directly captured in the market approach, as there are no pure publicly traded comparable companies. The income approach employs a discounted cash flow model that considers: 1) assumptions that marketplace participants would use in their estimates of fair value, including the cash flow period, terminal values based on a terminal growth rate and the discount rate; 2) current period actual results; and 3) projected results for future periods that have been prepared and approved by senior management of the Company. The market approach employs market multiples from guideline public companies operating in our industry. Estimates of fair value are derived by applying multiples based on revenue and earnings before interest, taxes, depreciation and amortization (“EBITDA”) adjusted for size and performance metrics relative to peer companies. The cost approach considers the replacement cost adjusted for certain factors. Certain balance sheet items were adjusted to fair value before being utilized in estimating the value of the reporting unit under the cost approach, including inventory, property, plant and equipment, right of use assets, and other intangible assets. All three approaches used in the analysis have a degree of uncertainty. Potential events or changes in circumstances which could impact the key assumptions used in our goodwill impairment evaluation are as follows: • Change in peer group or performance of peer group companies • Change in the Company’s markets and estimates of future operating performance • Change in the Company’s estimated market cost of capital • Change in implied control premiums related to acquisitions in the medical device industry
Other Intangible Assets	Other Intangible Assets As of December 31, 2019, the Company concluded, through the ASC 360 valuation testing, that factors existed indicating that finite-lived intangible assets in the Spine asset group were impaired. The factors included a change made to the internal organization of the Company in the fourth quarter of 2019. The organizational change resulted in the creation of a new Spine asset group. Prior to the fourth quarter of 2019, the Spine asset group did not exist as the related assets were included in another asset group as it had interdependencies among the utilization of the assets within the group, and therefore, there were no discrete cash flows. The asset group representing the Spine asset group could not support the carrying amount of the finite-lived intangible assets, because the Spine asset group no longer has the benefit of shared resources and cashflows generated by the former asset group that it was previously included in. Thus, we tested the $85,096 carrying amount of intangible assets in the Spine asset group for impairment on December 31, 2019. As a result, for the year ended December 31, 2019, we recorded an impairment charge for all of the finite-lived intangible assets within Spine asset group, totaling $85,096.
Revenue Recognition	Revenue Recognition The Company permits returns of implants in accordance with the terms of contractual agreements with customers if the implant is returned in a timely manner, in unopened packaging, and from the normal channels of distribution. Allowances for returns are provided based upon analysis of the Company’s historical patterns of returns matched against the revenues from which they originated. The Company records estimated implant returns, discounts, rebates and other distribution incentives as a reduction of revenue in the same period revenue is recognized. Estimates of implant returns are recorded for anticipated implant returns based on historical distributions and returns information. Estimates of discounts, rebates and other distribution incentives are recorded based on contractual terms, historical experience and trend analysis. Other revenues consist of service processing, tissue recovery fees, biomedical laboratory fees, recognition of previously deferred revenues, shipping fees, distribution of reproductions of our allografts to distributors for demonstration purposes and restocking fees which is included in revenues.
Stock-Based Compensation Plans	Stock-Based Compensation Plans Accounting for Stock Compensation pre-vesting
Research and Development Costs	Research and Development Costs
Income Taxes	Income Taxes year-end
Treasury Stock	Treasury Stock
Earnings Per Share	Earnings Per Share For the Year Ended December 31, 2019 2018 2017 Weighted average basic shares 72,824,308 63,521,703 59,684,289 Effect of dilutive securities: Stock options — — 915,663 Weighted average diluted shares 72,824,308 63,521,703 60,599,952 Options to purchase 4,536,461 shares of common stock at prices ranging from $2.09 to $5.23 per share which were outstanding as of December 31, 2019, were not included in the computation of diluted EPS because dilutive shares are not factored into the calculation of EPS when a loss applicable to common shares is reported as they would be anti-dilutive. Options to purchase 4,275,744 shares of common stock at prices ranging from $2.69 to $5.23 per share which were outstanding as of December 31, 2018, were not included in the computation of diluted EPS because dilutive shares are not factored into the calculation of EPS when a loss applicable to common shares is reported as they would be anti-dilutive. Options to purchase 4,662,037 shares of common stock at prices ranging from $2.69 to $8.20 per share which were outstanding as of December 31, 2017, were included in the computation of diluted EPS because dilutive shares are factored into the calculation of EPS when income applicable to common shares is reported. For the years ended December 31, 2019, and 2018, 50,000 shares of convertible preferred stock or 15,152,761 of converted common stock and accrued but unpaid dividends were anti-dilutive on an as if-converted basis and were not included in the computation of diluted net (loss) income per common share.
Recently Issued and Adopted Accounting Standards	Recently Issued and Adopted Accounting Standards. Financial Instruments No. 2019-05 Financial Instruments — Credit Losses (Topic 326) 2016-13 825-10, instrument-by-instrument 326-20, held-to-maturity 2019-05 2016-13 In April 2019, the FASB issued ASU No. 2019-04 Codification Improvements to Topic 326, Financial Instruments — Credit Losses, Topic 815, Derivatives and Hedging, and Topic 825, Financial Instruments 2016-01 Financial Instruments — Overall (Subtopic 825-10): 2016-13 Financial Instruments — Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, 2017-12 Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities, 2016-13 2016-13 2019-04. 2017-12 2016-01 In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments — Credit Losses 2016-13 held-to-maturity 2016-13 available-for-sale 2016-13 Fair Value Measurement ASU 2018-13, “Fair Value Measurement (Topic 820): Disclosure Framework — Changes to the Disclosure Requirements for Fair Value Measurement.” 2018-13 2018-13 Leases 2016-02, 2016-02 right-of-use Effective January 1, 2019, the Company adopted Topic 842 using the optional transition method which allowed us to continue to apply Topic 840 in the comparative periods presented. In addition, the Company elected the package of practical expedients, which allowed us to not reassess whether any existing contracts contain a lease, to not reassess historical lease classification as operating or finance leases, and to not reassess initial direct costs. The Company has not elected the practical expedient to use hindsight to determine the lease term for its leases at transition. The Company has also elected the practical expedient allowing us to not separate the lease and non-lease Revenue from Contracts with Customers

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Estimated Useful Lives of Assets	Depreciation is computed on the straight-line method over the following estimated useful lives of the assets: Buildings 25 to 40 years Building improvements and leasehold improvements 8 to 40 years Processing equipment 7 to 10 years Office equipment, furniture and fixtures 5 to 7 years Computer hardware and software 3 to 7 years Surgical instruments 3 to 5 years
Reconciliation of Common Shares used in Calculation of Basic and Diluted EPS	A reconciliation of the number of common shares used in the calculation of basic and diluted EPS is presented below: For the Year Ended December 31, 2019 2018 2017 Weighted average basic shares 72,824,308 63,521,703 59,684,289 Effect of dilutive securities: Stock options — — 915,663 Weighted average diluted shares 72,824,308 63,521,703 60,599,952

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2019
Leases [Abstract]
Schedule of Operating Leases	The components of operating lease expense were as follows: For the Year Ended December 31, 2019 Operating lease cost $ 1,659 Short-term operating lease cost 36 Total operating lease cost $ 1,695
Schedule of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to operating leases was as follows: For the Year Ended December 31, 2019 Cash paid for amounts included in the measurement of lease liabilities $ 1,558 ROU assets obtained in exchange for lease obligations 103
Schedule of Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at Assets: Right-of-use Other assets - net $ 2,155 Liabilities: Current Accrued expenses $ 1,159 Noncurrent Other long-term liabilities 1,547 Total operating lease liabilities $ 2,706
Schedule of Maturities of Operating Lease Liabilities	Maturities of operating lease liabilities were as follows: Maturity of Operating Lease Liabilities Balance at 2020 $ 1,261 2021 562 2022 226 2023 159 2024 159 2025 and beyond 716 Total future minimum lease payments 3,083 Less imputed interest (377 ) Total operating lease liabilities $ 2,706
Future Minimum Lease Commitments Under Non-Cancelable Operating Leases Prior to Adoption of ASC 842	As previously disclosed in our 2018 Annual Report on Form 10-K/A, Maturity of Operating Lease Liabilities Balance at 2019 $ 1,374 2020 806 2021 276 2022 162 2023 166 2024 and beyond 882 Total future minimum lease payments $ 3,666

Segment Reporting (Tables)

Segment Reporting (Tables)	12 Months Ended
	Dec. 31, 2019
Segment Reporting [Abstract]
Summary of Segment Data	The Company’s segment data is as follows: For the Year Ended December 31, 2019 2018 2017 Revenues: Spine $ 118,987 $ 94,436 $ 92,712 OEM 189,397 185,926 187,637 Total $ 308,384 $ 280,362 $ 280,349 Depreciation and amortization: Spine $ 12,779 $ 4,692 $ 3,469 OEM 9,896 9,887 10,764 Total $ 22,675 $ 14,579 $ 14,233 Operating income (loss): Spine $ (30,538 ) $ (20,603 ) $ (9,497 ) OEM 27,152 26,112 24,245 One-time charges Severance and restructuring costs — 2,808 12,016 Executive transition costs — — 2,818 Gain on acquisition contingency (76,033 ) — — Asset impairment and abandonments 97,341 5,070 4,034 Goodwill impairment 140,003 — — Acquisition and integration expenses 17,159 4,943 630 Gain on cardiothoracic closure business divestiture — (3,000 ) (34,090 ) Total one-time charges 178,470 9,821 (14,592 ) Operating income (loss) $ (181,856 ) $ (4,312 ) $ 29,340 Interest expense (12,571 ) (2,771 ) (3,180 ) Interest income 161 35 8 Loss on extinguishment of debt — (309 ) — Foreign exchange (loss) gain (139 ) (34 ) 87 Income (loss) before income tax benefit (provision) $ (194,405 ) $ (7,391 ) $ 26,255
Summary of Revenues by Geographic Location	The following table presents revenues by geographic location: For the Year Ended December 31, 2019 2018 2017 Revenues: North America $ 277,152 $ 254,409 $ 254,385 EMEA 24,252 21,258 19,303 Asia Pacific 4,027 2,996 5,488 Latin America 2,953 1,699 1,173 Total $ 308,384 $ 280,362 $ 280,349

Revenue from Contracts with C_2

Revenue from Contracts with Customers (Tables)	12 Months Ended
	Dec. 31, 2019
Revenue from Contract with Customer [Abstract]
Revenue Recognition from Four Categories	The following table presents revenues from these two segments: Year Ended December 31, 2019 December 31, 2018 Revenues: Spine Segment Domestic $ 97,629 $ 79,812 International 21,358 14,625 OEM Segment OEM 124,184 120,037 Sports 55,339 54,560 International 9,874 11,328 Total revenues from contracts with customers $ 308,384 $ 280,362
Contract with Customer, Asset and Liability	The opening and closing balances of the Company’s accounts receivable and current and long-term contract liability for the years ended December 31, 2019 and 2018 are as follows: Accounts Contract Contract Opening - January 1, 2019 $ 48,096 $ 5,425 $ 744 Closing - December 31, 2019 59,288 3,378 — Increase/(decrease) 11,192 (2,047 ) (744 ) Accounts Contract Contract Opening - January 1, 2018 $ 38,441 $ 5,978 $ 3,741 Closing - December 31, 2018 48,096 5,425 744 Increase/(decrease) 9,655 (553 ) (2,997 )
Revenue Recognized at a Point in Time and Over Time	The following table presents revenues recognized at a point in time and over time for the years ended December 31, 2019 and 2018: Year Ended December 31, 2019 December 31, 2018 Revenue recognized at a point in time $ 240,469 $ 239,619 Revenue recognized over time 67,915 40,743 Total revenues from contracts with customers $ 308,384 $ 280,362

Acquisition (Tables)

Acquisition (Tables)	12 Months Ended
	Dec. 31, 2019
Zyga Technology Inc [Member]
Acquisition Purchase Price	The purchase price was financed as follows: Cash proceeds from revolving credit facility $ 18,000 Cash from RTI Surgical 3,000 Total purchase price $ 21,000
Pro Forma Information of Operations	The following unaudited pro forma information shows the results of the Zyga’s operations as though the acquisition had occurred as of the beginning of the prior comparable period, January 1, 2018. For the Year Ended December 31, 2018 Revenues $ 4,809 Net loss (2,640 )
Summary of Final Allocation of Total Consideration to Tangible and Intangible Assets and Liabilities	The table below represents the final allocation of the total consideration to Zyga’s tangible and intangible assets and liabilities fair values as of January 4, 2018. Inventories $ 1,099 Accounts receivable 573 Other current assets 53 Property, plant and equipment 151 Other assets 26 Deferred tax assets 4,715 Current liabilities (947 ) Acquisition contingencies (4,986 ) Net tangible assets acquired 684 Other intangible assets 6,760 Goodwill 13,556 Total net assets acquired $ 21,000
Paradigm Spine [Member]
Acquisition Purchase Price	The purchase price was comprised as follows: Cash proceeds from second lien credit agreement $ 100,000 Fair market value of securities issued 60,730 Fair market value of contingent earnout 72,177 Total purchase price $ 232,907
Summary of Changes to Fair Value of Acquired Assets and Liabilities	The table below represents the final allocation of the total purchase price to Paradigm’s tangible and intangible assets and liabilities fair values as of March 8, 2019. Balance at March 8, 2019 Cash $ 307 Accounts receivable 5,220 Inventories 17,647 Other current assets 934 Property, plant and equipment 379 Other non-current assets 1,079 Current liabilities (6,169 ) Lease liabilities (1,079 ) Net tangible assets acquired 18,318 Other intangible assets 79,000 Goodwill 135,589 Total net assets acquired $ 232,907
Pro Forma Information of Operations	The following unaudited pro forma information shows the results of the Paradigm’s operations as though the acquisition had occurred as of the beginning of the prior comparable period, January 1, 2018: For the Year Ended 2019 2018 Revenues $ 37,374 $ 40,810 Net loss (16,547 ) (42,550 )

Cardiothoracic Closure Busine_2

Cardiothoracic Closure Business Divestiture (Tables)	12 Months Ended
	Dec. 31, 2019
Discontinued Operations and Disposal Groups [Abstract]
Schedule of Calculation of Gain of CT Business Divestiture	The calculation of the gain on the CT Business divestiture is as follows: Proceeds from cardiothoracic closure business divestiture $ 51,000 Inventories - net (2,893 ) Property, plant and equipment - net (1,299 ) Goodwill (8,645 ) Other intangible assets - net (280 ) Cardiothoracic closure business divestiture expenses (3,793 ) Gain on cardiothoracic closure business divestiture $ 34,090

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2019
Schedule of Weighted-Average Assumptions Used to Determine Fair Value of Options	The following weighted-average assumptions were used to determine the fair value of stock options under FASB ASC 718: Year Ended December 31, 2019 2018 2017 Expected term (years) 6.50 6.50 6.50 Risk free interest rate 2.54 % 2.75 % 2.26 % Volatility factor 37.73 % 43.74 % 47.39 % Dividend yield — — —
Stock Options Outstanding, Exercisable and Available for Grant	Stock options outstanding, exercisable and available for grant at December 31, 2019, are summarized as follows: Weighted Weighted Average Average Remaining Aggregate Number of Exercise Contractual Intrinsic Options Price Life (Years) Value Outstanding at January 1, 2019 4,275,744 $ 3.76 Granted 584,297 3.85 Exercised (118,500 ) 3.34 Forfeited or expired (205,080 ) 4.46 Outstanding at December 31, 2019 4,536,461 $ 3.75 4.01 $ 124 Vested or expected to vest at December 31, 2019 4,301,432 $ 3.73 3.81 $ 97 Exercisable at December 31, 2019 1,085,814 $ 4.10 2.68 $ 3 Available for grant at December 31, 2019 4,186,650
Other Information Concerning Stock Options	Other information concerning stock options are as follows: For the Year Ended December 31, 2019 2018 2017 Weighted average fair value of stock options granted $ 1.56 $ 2.05 $ 1.66 Aggregate intrinsic value of stock options exercised 161 349 2,786
Unvested Restricted Stock Awards	The following table summarizes information about unvested restricted stock awards as of December 31, 2019: Weighted Average Number of Grant Date Shares Fair Value Unvested at January 1, 2019 1,032,715 $ 4.32 Granted 792,803 4.38 Vested (516,491 ) 4.27 Forfeited (81,169 ) 4.86 Unvested at December 31, 2019 1,227,858 $ 4.34
Stock-Based Compensation Recognized	For the years ended December 31, 2019, 2018 and 2017, the Company recognized stock-based compensation as follows: For the Year Ended December 31, 2019 2018 2017 Stock-based compensation: Costs of processing and distribution $ 144 $ 132 $ 132 Marketing, general and administrative 4,163 4,553 6,586 Research and development 60 60 44 Total $ 4,367 $ 4,745 $ 6,762
Restricted Stock Units [Member]
Unvested Restricted Stock Awards	The following table summarizes information about unvested restricted stock units as of December 31, 2019: Weighted Average Number of Grant Date Shares Fair Value Unvested at January 1, 2019 — $ — Granted 226,352 7.41 Vested — — Forfeited (41,770 ) 7.41 Unvested at December 31, 2019 184,582 $ 7.41

Inventories (Tables)

Inventories (Tables)	12 Months Ended
	Dec. 31, 2019
Inventory Disclosure [Abstract]
Components of Inventories	Inventories by stage of completion are as follows: December 31, 2019 2018 Unprocessed tissue, raw materials and supplies $ 29,552 $ 24,211 Tissue and work in process 35,740 31,796 Implantable tissue and finished goods 65,494 51,648 Total 130,786 107,655 Less current portion 124,149 107,655 Long-term portion $ 6,637 $ —

Prepaid and Other Current Ass_2

Prepaid and Other Current Assets (Tables)	12 Months Ended
	Dec. 31, 2019
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Schedule of Prepaid and Other Current Assets	Prepaid and Other Current Assets are as follows: December 31, 2019 2018 Income tax receivable $ 2,803 $ 3,920 Prepaid expenses 1,865 2,013 Other 2,101 2,480 $ 6,769 $ 8,413

Property, Plant and Equipment (

Property, Plant and Equipment (Tables)	12 Months Ended
	Dec. 31, 2019
Property, Plant and Equipment [Abstract]
Components of Property, Plant and Equipment	Property, plant and equipment are as follows: December 31, 2019 2018 Land $ 2,005 $ 2,020 Buildings and improvements 58,208 58,093 Processing equipment 45,762 42,599 Surgical instruments 541 24,070 Office equipment, furniture and fixtures 1,730 1,877 Computer equipment and software 20,521 18,873 Construction in process 11,717 8,934 140,484 156,466 Less accumulated depreciation (70,594 ) (78,512 ) $ 69,890 $ 77,954

Goodwill (Tables)

Goodwill (Tables)	12 Months Ended
	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The change in the carrying amount of goodwill for the year ended December 31, 2019, is as follows: December 31, 2019 2018 Balance at January 1 $ 59,798 $ 46,242 Goodwill acquired related to Zyga acquisition — 13,556 Goodwill acquired related to Paradigm acquisition 135,589 — Goodwill impairment (140,003 ) — Balance at December 31 $ 55,384 $ 59,798

Other Intangible Assets (Tables

Other Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Components of Other Intangible Assets	Other intangible assets are as follows: December 31, 2019 December 31, 2018 Gross Accumulated Net Gross Accumulated Net Patents $ 5,095 $ 2,768 $ 2,327 $ 15,469 $ 4,191 $ 11,278 Acquired licensing rights 1,413 64 1,349 11,671 6,468 5,203 Marketing and procurement and other intangible assets 16,488 9,672 6,816 20,355 11,279 9,076 Total $ 22,996 $ 12,504 $ 10,492 $ 47,495 $ 21,938 $ 25,557
Estimates of Future Amortization Expense	At December 31, 2019, management’s estimates of future amortization expense for the next five years are as follows: Amortization 2020 $ 2,300 2021 2,300 2022 2,300 2023 700 2024 700

Fair Value Information (Tables)

Fair Value Information (Tables)	12 Months Ended
	Dec. 31, 2019
Fair Value Disclosures [Abstract]
Summary of Impairments of Long-Lived Assets and Related Post Impairment Fair Values	The following table summarizes impairments of long-lived assets and the related post impairment fair values of the corresponding assets for the years ended December 31, 2019 and 2018: For the Year Ended December 31, 2019 Impairment Fair Value Property, plant and equipment - net $ 11,655 $ — Other intangible assets - net 85,096 — Other assets - net 201 $ 96,952 $ — For the Year Ended Impairment Fair Value Property, plant and equipment - net $ 1,797 $ — Other intangible assets - net 2,718 — $ 4,515 $ —

Accrued Expenses (Tables)

Accrued Expenses (Tables)	12 Months Ended
	Dec. 31, 2019
Other Liabilities Disclosure [Abstract]
Accrued Expenses	Accrued expenses are as follows: December 31, 2019 2018 Accrued compensation $ 5,435 $ 8,308 Accrued severance and restructuring costs 136 1,302 Accrued distributor commissions 4,569 3,907 Accrued donor recovery fees 8,921 3,018 Accrued leases 1,159 — Accrued acquisition and integration expenses 2,555 — Other 10,562 9,330 $ 33,337 $ 25,865

Short and Long-Term Obligatio_2

Short and Long-Term Obligations (Tables)	12 Months Ended
	Dec. 31, 2019
Debt Disclosure [Abstract]
Short and Long-Term Obligations	Short and long-term obligations are as follows: December 31, 2019 2018 Ares Term loan $ 104,406 $ — JPM facility 71,000 50,000 Less unamortized debt issuance costs (1,229 ) (927 ) Total 174,177 49,073 Less current portion 174,177 — Long-term portion $ — $ 49,073

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Summary of Pre-Tax Income	The Company’s pre-tax income consists of the following components: For the Year Ended December 31, 2019 2018 2017 Pre-tax income: Domestic (U.S., state and local) $ (196,426 ) $ (9,052 ) $ 30,121 Foreign 2,021 1,661 (3,866 ) Total pre-tax income (194,405 ) (7,391 ) 26,255
Schedule of Income Tax Benefit (Provision)	The Company’s income tax benefit (provision) consists of the following components: For the Year Ended December 31, 2019 2018 2017 Current: Federal $ 503 $ 967 $ (2,910 ) State (147 ) (205 ) (833 ) International 79 (376 ) — Total current 435 386 (3,743 ) Deferred: Federal (12,680 ) 2,356 (14,554 ) State (1,091 ) (2,446 ) (1,052 ) International (3,901 ) 3,972 — Total deferred (17,672 ) 3,882 (15,606 ) Total income tax (provision) benefit $ (17,237 ) $ 4,268 $ (19,349 )
Schedule of Deferred Tax Assets and Liabilities	The Company’s deferred tax assets and liabilities consists of the following components: December 31, 2019 December 31, 2018 Deferred Income Tax Deferred Income Tax Assets Liabilities Assets Liabilities Accounts receivable $ 1,184 $ — $ 513 $ — Accrued liabilities 3,481 — 2,358 — Deferred compensation 1,526 — 1,372 — Fixed assets and intangibles 15,898 — — (5,862 ) Inventory 9,817 — 7,631 — Net operating losses 13,242 — 8,198 — Revenue — (59 ) 650 — Tax credits 6,372 — 5,993 — Lease Liability 708 — Right of Use Asset (Leases) — (558 ) Other — (103 ) — — Valuation allowance (51,508 ) — (3,093 ) — Total $ 720 $ (720 ) $ 23,622 $ (5,862 )
Summary of Unrecognized Tax Benefits	The Company’s unrecognized tax benefits are summarized as follows: For the Year Ended December 31, 2019 2018 2017 Opening balance $ 1,088 $ 1,591 $ 1,591 Reductions based on tax positions related to the current year — — — Additions for tax positions of prior years — — — Reductions for tax positions of prior years — (415 ) — Reductions for expiration of statute of limitations — (88 ) — $ 1,088 $ 1,088 $ 1,591
Schedule of Effective Tax Rate	The effective tax rate differs from the statutory federal income tax rate for the following reasons: For the Year Ended 2019 2018 2017 Statutory federal rate 21.00 % 21.00 % 35.00 % State income taxes—net of federal tax benefit (1.31 %) (4.58 %) 2.37 % Foreign rate differential — 14.36 % 2.54 % Acquisition expenses — (7.26 %) — Gain on acquisition contingency 8.23 % — — Goodwill impairment and disposal (14.86 %) — 11.52 % Life insurance — (0.98 %) (1.38 %) Officer compensation — (7.88 %) 4.18 % Stock-based compensation — (3.90 %) 6.06 % Tax credits 0.07 % 8.65 % (4.53 %) Tax legislation — 9.23 % 8.33 % Valuation allowances (21.25 %) 21.93 % 6.08 % Uncertain tax positions — 6.86 % — Other reconciling items, net (0.75 %) 0.32 % 3.52 % Effective tax rate (8.87 %) 57.75 % 73.69 %

Preferred Stock (Tables)

Preferred Stock (Tables)	12 Months Ended
	Dec. 31, 2019
Equity [Abstract]
Schedule of Preferred Stock	Preferred stock is as follows: Preferred Preferred Net Balance at January 1, 2017 $ 60,676 $ (660 ) $ 60,016 Accrued dividend 3,723 — 3,723 Amortization of preferred stock issuance costs — 184 184 Balance at December 31, 2017 64,399 (476 ) 63,923 Accrued dividend 2,120 — 2,120 Amortization of preferred stock issuance costs — 183 183 Balance at December 31, 2018 66,519 (293 ) 66,226 Accrued dividend — — — Amortization of preferred stock issuance costs — 184 184 Balance at December 31, 2019 $ 66,519 $ (109 ) $ 66,410

Severance and Restructuring C_2

Severance and Restructuring Costs (Tables)	12 Months Ended
	Dec. 31, 2019
Chief Executive Officer And Chief Financial And Administrative Officer [Member]
Schedule of Restructuring Charges	paid in full in 2018. The following table includes a rollforward of executive transition costs included in accrued expenses, see Note 16. Accrued executive transition costs at January 1, 2017 $ 2,406 Executive transition costs accrued in 2017 2,818 Stock-based compensation (1,612 ) Cash payments (1,275 ) Accrued executive transition costs at December 31, 2017 2,337 Executive transition costs accrued in 2018 — Cash payments (2,294 ) Accrued executive transition costs at December 31, 2018 43 Executive transition costs accrued in 2019 — Cash payments (43 ) Accrued executive transition costs at December 31, 2019 $ —
Employee Severance [Member]
Schedule of Restructuring Charges	Thefollowing table includes a rollforward of severance and restructuring costs included in accrued expenses, see Note 16. Accrued severance and restructuring charges at January 1, 2017 $ 505 Severance and restructuring expenses accrued in 2017 12,016 Severance and restructuring cash payments (8,246 ) Stock based compensation (1,153 ) Accrued severance and restructuring charges at December 31, 2017 3,122 Severance and restructuring expenses accrued in 2018 2,808 Severance and restructuring cash payments (4,628 ) Accrued severance and restructuring charges at December 31, 2018 1,302 Severance and restructuring expenses accrued in 2019 626 Severance and restructuring cash payments (1,792 ) Accrued severance and restructuring charges at December 31, 2019 $ 136

Concentrations of Risk (Tables)

Concentrations of Risk (Tables)	12 Months Ended
	Dec. 31, 2019
Risks and Uncertainties [Abstract]
Schedule of Percentage of Total Revenues Derived from Company's Largest Distributors	The following table presents percentage of total revenues derived from the Company’s largest distributors: For the Year Ended December 31, 2019 2018 2017 Percent of revenues derived from: Distributor Zimmer 18 % 21 % 17 % Medtronic 7 % 8 % 9 % Synthes 4 % 5 % 4 %

Quarterly Results of Operatio_2

Quarterly Results of Operations (Unaudited) (Tables)	12 Months Ended
	Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]
Schedule of Quarterly Results of Operations	The following tables sets forth the results of operations for the periods indicated (The quarterly results of operations for the years ended December 31, 2019 and 2018 reflects our adoption of FASB ASU 2014-09, Year Ended December 31, 2019 First Second Third Fourth (as restated) (as restated) (as restated) Revenues $ 70,021 $ 81,554 $ 76,741 $ 80,068 Gross profit 37,886 46,124 43,223 43,891 Net (loss) income (9,352 ) 188 (5,138 ) (197,340 ) Net (loss) income per common share - basic $ (0.14 ) $ 0.00 $ (0.07 ) $ (2.63 ) Net (loss) income per common share - diluted $ (0.14 ) $ 0.00 $ (0.07 ) $ (2.63 ) Year Ended December 31, 2018 First Second Third Fourth Revenues $ 69,141 $ 70,385 $ 70,450 $ 70,386 Gross profit 33,503 29,899 38,228 38,013 Net (loss) income (1,117 ) (5,802 ) 2,997 799 Net (loss) income per common share - basic $ (0.03 ) $ (0.11 ) $ 0.04 $ 0.01 Net (loss) income per common share - diluted $ (0.03 ) $ (0.11 ) $ 0.04 $ 0.01

Restatement of Prior Period Q_2

Restatement of Prior Period Quarterly Financial Statements (Unaudited) (Tables)	12 Months Ended
	Dec. 31, 2019
Accounting Changes and Error Corrections [Abstract]
Schedule of Restated Consolidated Balance Sheets (Unaudited)	Restated Condensed Consolidated Balance Sheets (Unaudited) March 31, June 30, September 30, (as restated) (as restated) (as restated) Assets Current Assets: Cash and cash equivalents $ 6,043 $ 4,518 $ 2,950 Accounts receivable 55,709 55,540 56,545 Inventories - net 115,486 115,454 118,336 Prepaid and other current assets 9,399 8,258 8,156 Total current assets 186,637 183,770 185,987 Non-current 10,261 9,225 8,374 Property, plant and equipment - net 79,500 79,956 81,471 Deferred tax assets - net 17,114 20,230 21,576 Goodwill 194,797 195,067 194,838 Other intangible assets - net 103,006 100,651 97,614 Other assets - net 7,653 7,277 7,006 Total assets $ 598,968 $ 596,176 $ 596,866 Liabilities and Stockholders’ Equity Current Liabilities: Accounts payable $ 23,149 $ 20,600 $ 17,634 Accrued expenses 25,557 25,312 31,714 Current portion of deferred revenue 4,825 4,744 2,748 Total current liabilities 53,531 50,656 52,096 Long-term obligations - less current portion 163,615 165,081 169,137 Acquisition contingencies 77,163 75,573 75,573 Other long-term liabilities 3,065 2,562 2,271 Deferred revenue 1,535 325 1,134 Total liabilities 298,909 294,197 300,211 Preferred stock Series A, $.001 par value: 5,000,000 shares authorized; 50,000 shares issued and outstanding 66,272 66,318 66,364 Stockholders’ equity: Common stock, $.001 par value: 150,000,000 shares authorized; 75,055,225, 75,159,262, and 75,087,917 shares issued and outstanding, respectively 75 75 75 Additional paid-in 495,263 496,596 497,518 Accumulated other comprehensive loss (7,663 ) (7,268 ) (8,390 ) Accumulated deficit (248,889 ) (248,701 ) (253,839 ) Less treasury stock, 1,250,201, 1,257,949 and 1,265,761 shares, respectively, at cost (4,999 ) (5,041 ) (5,073 ) Total stockholders’ equity 233,787 235,661 230,291 Total liabilities and stockholders’ equity $ 598,968 $ 596,176 $ 596,866 Restated Condensed Consolidated Balance Sheet Amounts (Unaudited) As of March 31, 2019 As Previously Reported Adjustments As Restated Accounts receivable $ 55,670 $ 39 $ 55,709 Inventories - net 114,365 1,121 115,486 Prepaid and other current assets 9,860 (461 ) 9,399 Total current assets 185,938 699 186,637 Non-current — 10,261 10,261 Property, plant and equipment - net 79,235 265 79,500 Deferred tax assets - net 16,778 336 17,114 Goodwill 308,345 (113,548 ) 194,797 Other intangible assets - net 25,512 77,494 103,006 Other assets - net 7,918 (265 ) 7,653 Total assets $ 623,726 $ (24,758 ) $ 598,968 Accounts payable $ 23,315 $ (166 ) $ 23,149 Accrued expenses 24,992 565 25,557 Total current liabilities 53,132 399 53,531 Acquisition contingencies 99,962 (22,799 ) 77,163 Total liabilities 321,309 (22,400 ) 298,909 Accumulated deficit (246,531 ) (2,358 ) (248,889 ) Total stockholders’ equity 236,145 (2,358 ) 233,787 Total liabilities and stockholders’ equity $ 623,726 $ (24,758 ) $ 598,968 As of June 30, 2019 As Adjustments As Restated Accounts receivable 56,163 (623 ) 55,540 Inventories - net 127,906 (12,452 ) 115,454 Prepaid and other current assets 8,733 (475 ) 8,258 Total current assets 197,320 (13,550 ) 183,770 Non-current 20,445 (11,220 ) 9,225 Property, plant and equipment - net 79,691 265 79,956 Deferred tax assets - net 19,715 515 20,230 Goodwill 271,429 (76,362 ) 195,067 Other intangible assets - net 25,269 75,382 100,651 Other assets - net 7,542 (265 ) 7,277 Total assets $ 621,411 $ (25,235 ) $ 596,176 Accounts payable $ 20,766 $ (166 ) $ 20,600 Accrued expenses 24,668 644 25,312 Total current liabilities 50,178 478 50,656 Acquisition contingencies 98,372 (22,799 ) 75,573 Total liabilities 316,518 (22,321 ) 294,197 Accumulated deficit (245,787 ) (2,914 ) (248,701 ) Total stockholders’ equity 238,575 (2,914 ) 235,661 Total liabilities and stockholders’ equity $ 621,411 $ (25,235 ) $ 596,176 Restated Condensed Consolidated Balance Sheet Amounts (Unaudited) As of September 30, 2019 As Adjustments As Restated Accounts receivable $ 56,556 $ (11 ) $ 56,545 Inventories - net 130,913 (12,577 ) 118,336 Prepaid and other current assets 8,631 (475 ) 8,156 Total current assets 199,050 (13,063 ) 185,987 Non-current 18,345 (9,971 ) 8,374 Property, plant and equipment - net 81,206 265 81,471 Deferred tax assets - net 20,967 609 21,576 Goodwill 236,547 (41,709 ) 194,838 Other intangible assets - net 24,345 73,269 97,614 Other assets - net 7,271 (265 ) 7,006 Total assets $ 587,731 $ 9,135 $ 596,866 Accounts payable $ 17,800 $ (166 ) $ 17,634 Accrued expenses 31,067 647 31,714 Total current liabilities 51,615 481 52,096 Acquisition contingencies 63,719 11,854 75,573 Total liabilities 287,876 12,335 300,211 Accumulated deficit (250,639 ) (3,200 ) (253,839 ) Total stockholders’ equity 233,491 (3,200 ) 230,291 Total liabilities and stockholders’ equity $ 587,731 $ 9,135 $ 596,866
Schedule of Restated Condensed Consolidated Statements of Income (Unaudited)	Restated Condensed Consolidated Statements of Income (Unaudited) Three Months Ended (as restated) Revenues $ 70,021 Costs of processing and distribution 32,134 Gross profit 37,887 Expenses: Marketing, general and administrative 32,116 Research and development 4,336 Asset impairment and abandonments 15 Acquisition and integration expenses 8,957 Total operating expenses 45,424 Operating (loss) (7,537 ) Other (expense) income: Interest expense (1,604 ) Interest income 131 Foreign exchange (loss) (31 ) Total other expense - net (1,504 ) (Loss) before income tax (provision) (9,041 ) Income tax (provision) (310 ) Net (loss) (9,351 ) Convertible preferred dividend Net (loss) applicable to common shares $ (9,351 ) Other comprehensive (loss): Unrealized foreign currency translation loss (393 ) Comprehensive (loss) $ (9,744 ) Net (loss) per common share - basic $ (0.14 ) Net (loss) per common share - diluted $ (0.14 ) Restated Condensed Consolidated Statements of Income (Unaudited) Six Months Ended (as restated) Revenues $ 151,575 Costs of processing and distribution 67,564 Gross profit 84,011 Expenses: Marketing, general and administrative 73,224 Research and development 8,204 Gain on acquisition contingency (1,590 ) Asset impairment and abandonments 15 Acquisition and integration expenses 10,910 Total operating expenses 90,763 Operating (loss) (6,752 ) Other (expense) income: Interest expense (5,239 ) Interest income 157 Foreign exchange (loss) (50 ) Total other expense - net (5,132 ) (Loss) before income tax benefit (11,884 ) Income tax benefit 2,721 Net (loss) applicable to common shares (9,163 ) Convertible preferred dividend — Net (loss) applicable to common shares $ (9,163 ) Other comprehensive (loss): Unrealized foreign currency translation loss 2 Comprehensive (loss) $ (9,161 ) Net (loss) per common share - basic $ (0.13 ) Net (loss) per common share - diluted $ (0.13 ) Restated Condensed Consolidated Statements of Income (Unaudited) Nine Months Ended (as restated) Revenues $ 228,316 Costs of processing and distribution 101,081 Gross profit 127,235 Expenses: Marketing, general and administrative 112,447 Research and development 12,475 Gain on acquisition contingency (1,590 ) Asset impairment and abandonments 15 Acquisition and integration expenses 14,119 Total operating expenses 137,466 Operating (loss) (10,231 ) Other (expense) income: Interest expense (8,957 ) Interest income 161 Foreign exchange (loss) (128 ) Total other expense - net (8,924 ) (Loss) before income tax benefit (19,155 ) Income tax benefit 4,854 Net (loss) (14,301 ) Convertible preferred dividend — Net (loss) applicable to common shares $ (14,301 ) Other comprehensive (loss): Unrealized foreign currency translation loss (1,120 ) Comprehensive (loss) $ (15,421 ) Net (loss) per common share - basic $ (0.20 ) Net (loss) per common share - diluted $ (0.20 ) Restated Condensed Consolidated Statements of Income (Unaudited) Three Months Ended (as restated) Revenues $ 81,554 Costs of processing and distribution 35,430 Gross profit 46,124 Expenses: Marketing, general and administrative 41,108 Research and development 3,868 Gain on acquisition contingency (1,590 ) Acquisition and integration expenses 1,953 Total operating expenses 45,339 Operating income 785 Other (expense) income: Interest expense (3,635 ) Interest income 26 Foreign exchange (loss) (19 ) Total other expense - net (3,628 ) (Loss) before income tax benefit (2,843 ) Income tax benefit 3,031 Net income 188 Convertible preferred dividend — Net income applicable to common shares $ 188 Other comprehensive income: Unrealized foreign currency translation loss 395 Comprehensive income $ 583 Net income per common share - basic $ 0.00 Net income per common share - diluted $ 0.00 Restated Condensed Consolidated Statements of Income (Unaudited) Three Months Ended (as restated) Revenues $ 76,741 Costs of processing and distribution 33,517 Gross profit 43,224 Expenses: Marketing, general and administrative 39,223 Research and development 4,271 Acquisition and integration expenses 3,209 Total operating expenses 46,703 Operating (loss) (3,479 ) Other (expense) income: Interest expense (3,718 ) Interest income 4 Foreign exchange (loss) (78 ) Total other expense - net (3,792 ) (Loss) before income tax benefit (7,271 ) Income tax benefit 2,133 Net (loss) applicable to common shares (5,138 ) Convertible preferred dividend — Net (loss) applicable to common shares $ (5,138 ) Other comprehensive (loss): Unrealized foreign currency translation loss (1,122 ) Comprehensive (loss) $ (6,260 ) Net (loss) per common share - basic $ (0.07 ) Net (loss) per common share - diluted $ (0.07 ) Restated Condensed Consolidated Statements of Income Amounts (Unaudited) Three Months Ended March 31, 2019 (as reported) (adjustments) (as restated) Revenues $ 69,741 $ 280 $ 70,021 Costs of processing and distribution 31,737 397 32,134 Gross profit 38,004 (117 ) 37,887 Marketing, general and administrative 31,883 233 32,116 Total operating expenses 45,191 233 45,424 Operating (loss) (7,187 ) (350 ) (7,537 ) (Loss) before income tax (provision) (8,691 ) (350 ) (9,041 ) Income tax (provision) (396 ) 86 (310 ) Net (loss) (9,087 ) (264 ) (9,351 ) Comprehensive (loss) $ (9,480 ) $ (264 ) $ (9,744 ) Net (loss) per common share - basic $ (0.14 ) $ (0.00 ) $ (0.14 ) Net (loss) per common share - diluted $ (0.14 ) $ (0.00 ) $ (0.14 ) Restated Condensed Consolidated Statements of Income Amounts (Unaudited) Six Months Ended June 30, 2019 (as reported) (adjustments) (as restated) Revenues $ 152,048 $ (473 ) $ 151,575 Costs of processing and distribution 69,299 (1,735 ) 67,564 Gross profit 82,749 1,262 84,011 Marketing, general and administrative 70,876 2,348 73,224 Total operating expenses 88,415 2,348 90,763 Operating (loss) (5,666 ) (1,086 ) (6,752 ) (Loss) before income tax (provision) (10,798 ) (1,086 ) (11,884 ) Income tax benefit 2,455 266 2,721 Net (loss) (8,343 ) (820 ) (9,163 ) Comprehensive (loss) $ (8,341 ) $ (820 ) $ (9,161 ) Net (loss) per common share - basic $ (0.12 ) $ (0.01 ) $ (0.13 ) Net (loss) per common share - diluted $ (0.12 ) $ (0.01 ) $ (0.13 ) Nine Months Ended September 30, 2019 (as (adjustments) (as Revenues $ 228,177 $ 139 $ 228,316 Costs of processing and distribution 103,941 (2,860 ) 101,081 Gross profit 124,236 2,999 127,235 Marketing, general and administrative 107,983 4,464 112,447 Total operating expenses 133,002 4,464 137,466 Operating (loss) (8,766 ) (1,465 ) (10,231 ) (Loss) before income tax benefit (17,690 ) (1,465 ) (19,155 ) Income tax benefit 4,495 359 4,854 Net (loss) (13,195 ) (1,106 ) (14,301 ) Comprehensive (loss) $ (14,315 ) $ (1,106 ) $ (15,421 ) Net (loss) per common share - basic $ (0.18 ) $ (0.02 ) $ (0.20 ) Net (loss) per common share - diluted $ (0.18 ) $ (0.02 ) $ (0.20 ) Restated Condensed Consolidated Statements of Income Amounts (Unaudited) Three Months Ended June 30, 2019 (as reported) (adjustments) (as restated) Revenues $ 82,307 $ (753 ) $ 81,554 Costs of processing and distribution 37,562 (2,132 ) 35,430 Gross profit 44,745 1,379 46,124 Marketing, general and administrative 38,993 2,115 41,108 Total operating expenses 43,224 2,115 45,339 Operating income 1,521 (736 ) 785 (Loss) before income tax benefit (2,107 ) (736 ) (2,843 ) Income tax benefit 2,851 180 3,031 Net income 744 (556 ) 188 Comprehensive income $ 1,139 $ (556 ) $ 583 Net income per common share - basic $ 0.01 $ (0.01 ) $ 0.00 Net income per common share - diluted $ 0.01 $ (0.01 ) $ 0.00 Three Months Ended September 30, 2019 (as reported) (adjustments) (as restated) Revenues $ 76,129 $ 612 $ 76,741 Costs of processing and distribution 34,642 (1,125 ) 33,517 Gross profit 41,487 1,737 43,224 Marketing, general and administrative 37,107 2,116 39,223 Total operating expenses 44,587 2,116 46,703 Operating (loss) (3,100 ) (379 ) (3,479 ) (Loss) before income tax benefit (6,892 ) (379 ) (7,271 ) Income tax benefit 2,040 93 2,133 Net (loss) (4,852 ) (286 ) (5,138 ) Comprehensive (loss) $ (5,974 ) $ (286 ) $ (6,260 ) Net (loss) per common share - basic $ (0.06 ) $ (0.01 ) $ (0.07 ) Net (loss) per common share - diluted $ (0.06 ) $ (0.01 ) $ (0.07 )
Schedule of Restated Condensed Consolidated Statement of Cash Flows (Unaudited)	For the Three Months 2019 (as restated) Cash flows from operating activities: Net (loss) $ (9,351 ) Adjustments to reconcile net loss to net cash (used in) operating activities: Depreciation and amortization expense 4,400 Provision for bad debts and product returns 233 Provision for inventory write-downs 1,530 Amortization of deferred revenue (1,292 ) Deferred income tax provision 384 Stock-based compensation 1,163 Other 197 Change in assets and liabilities: Accounts receivable (2,717 ) Inventories (2,190 ) Accounts payable (7,329 ) Accrued expenses (2,074 ) Deferred revenue 2,000 Other operating assets and liabilities (511 ) Net cash (used in) operating activities (15,557 ) Cash flows from investing activities: Purchases of property, plant and equipment (3,477 ) Patent and acquired intangible asset costs (328 ) Cardiothoracic closure business divestiture (99,921 ) Net cash (used in) investing activities (103,726 ) Cash flows from financing activities: Proceeds from exercise of common stock options 284 Proceeds from long-term obligations 115,000 Net (payments) on short-term obligations (729 ) Payments for treasury stock (128 ) Net cash provided by financing activities 114,427 Effect of exchange rate changes on cash and cash equivalents (50 ) Net decrease in cash and cash equivalents (4,906 ) Cash and cash equivalents, beginning of period 10,949 Cash and cash equivalents, end of period $ 6,043 Supplemental cash flow disclosure: Cash paid for interest $ 557 Cash paid for income taxes, net of refunds (635 ) Non-cash acquisition of property, plant and equipment 502 Non-cash acquisition of Paradigm 60,730 Non-cash common stock issuance 60,730 Restated Condensed Consolidated Statement of Cash Flows (Unaudited) For the Six Months 2019 (as restated) Cash flows from operating activities: Net (loss) $ (9,163 ) Adjustments to reconcile net loss to net cash (used in) operating activities: Depreciation and amortization expense 10,308 Provision for bad debts and product returns 899 Provision for inventory write-downs 3,274 Amortization of deferred revenue (2,585 ) Deferred income tax benefit (2,969 ) Stock-based compensation 2,430 Gain on acquisition contingency (1,590 ) Paid in kind interest expense 1,473 Other 877 Change in assets and liabilities: — Accounts receivable (3,141 ) Inventories (2,658 ) Accounts payable (9,751 ) Accrued expenses (2,583 ) Deferred revenue 2,000 Other operating assets and liabilities 240 Net cash (used in) operating activities (12,939 ) Cash flows from investing activities: Purchases of property, plant and equipment (6,912 ) Patent and acquired intangible asset costs (1,126 ) Acquisition of Zyga Technology — Cardiothoracic closure business divestiture (99,921 ) Net cash (used in) investing activities (107,959 ) Cash flows from financing activities: Proceeds from exercise of common stock options 395 Proceeds from long-term obligations 115,000 Net (payments) on short-term obligations (729 ) Payments for treasury stock (172 ) Net cash provided by financing activities 114,494 Effect of exchange rate changes on cash and cash equivalents (27 ) Net decrease in cash and cash equivalents (6,431 ) Cash and cash equivalents, beginning of period 10,949 Cash and cash equivalents, end of period $ 4,518 Supplemental cash flow disclosure: Cash paid for interest $ 2,732 Cash paid for income taxes, net of refunds 1,982 Non-cash acquisition of property, plant and equipment 456 Non-cash acquisition of Paradigm 60,730 Non-cash common stock issuance 60,730 Restated Condensed Consolidated Statement of Cash Flows (Unaudited) For the Nine Months 2019 (as restated) Cash flows from operating activities: Net (loss) $ (14,301 ) Adjustments to reconcile net loss to net cash (used in) operating activities: Depreciation and amortization expense 16,342 Provision for bad debts and product returns 1,050 Provision for inventory write-downs 5,482 Amortization of deferred revenue (3,772 ) Deferred income tax benefit (4,588 ) Stock-based compensation 3,399 Gain on acquisition contingency (1,590 ) Paid in kind interest expense 2,948 Other 1,069 Change in assets and liabilities: — Accounts receivable (4,522 ) Inventories (7,609 ) Accounts payable (12,684 ) Accrued expenses 3,998 Deferred revenue 2,000 Other operating assets and liabilities 273 Net cash (used in) operating activities (12,505 ) Cash flows from investing activities: Purchases of property, plant and equipment (10,882 ) Patent and acquired intangible asset costs (1,786 ) Cardiothoracic closure business divestiture (99,692 ) Net cash (used in) investing activities (112,360 ) Cash flows from financing activities: Proceeds from exercise of common stock options 395 Proceeds from long-term obligations 118,000 Net (payments) on short-term obligations (729 ) Payments on long-term obligations (500 ) Payments for treasury stock (204 ) Net cash provided by financing activities 116,962 Effect of exchange rate changes on cash and cash equivalents (96 ) Net decrease in cash and cash equivalents (7,999 ) Cash and cash equivalents, beginning of period 10,949 Cash and cash equivalents, end of period $ 2,950 Supplemental cash flow disclosure: Cash paid for interest $ 4,941 Cash paid for income taxes, net of refunds 1,982 Non-cash 817 Non-cash 60,730 Non-cash 60,730 For the Three Months Ended March 31, 2019 As Previously Adjustments As Restated Cash flows from operating activities: Net (loss) $ (9,087 ) $ (264 ) $ (9,351 ) Depreciation and amortization expense 3,696 704 4,400 Deferred income tax provision 470 (86 ) 384 Accounts receivable (2,422 ) (295 ) (2,717 ) Inventories (2,742 ) 552 (2,190 ) Accounts payable (7,253 ) (76 ) (7,329 ) Accrued expenses (1,585 ) (489 ) (2,074 ) Other operating assets and liabilities (593 ) 82 (511 ) Net cash (used in) operating activities (15,685 ) 128 (15,557 ) Cash flows from financing activities Payments for treasury stock — (128 ) (128 ) Net cash used by financing activities 114,555 (128 ) 114,427 For the Six Months Ended June 30, 2019 As Previously Adjustments As Restated Cash flows from operating activities: Net (loss) $ (8,343 ) $ (820 ) $ (9,163 ) Depreciation and amortization expense 7,491 2,817 10,308 Deferred income tax (benefit) (2,703 ) (266 ) (2,969 ) Accounts receivable (3,509 ) 368 (3,141 ) Inventories (1,078 ) (1,580 ) (2,658 ) Accounts payable (9,675 ) (76 ) (9,751 ) Accrued expenses (2,217 ) (366 ) (2,583 ) Other operating assets and liabilities 145 95 240 Net cash (used in) operating activities (13,111 ) 172 (12,939 ) Cash flows from financing activities Payments for treasury stock — (172 ) (172 ) Net cash used by financing activities 114,666 (172 ) 114,494 For the Nine Months Ended September 30, 2019 As Previously Adjustments As Restated Cash flows from operating activities: Net (loss) $ (13,195 ) $ (1,106 ) $ (14,301 ) Depreciation and amortization expense 11,413 4,929 16,342 Deferred income tax (benefit) (4,229 ) (359 ) (4,588 ) Accounts receivable (4,278 ) (244 ) (4,522 ) Inventories (4,904 ) (2,705 ) (7,609 ) Accounts payable (12,608 ) (76 ) (12,684 ) Accrued expenses 4,329 (331 ) 3,998 Other operating assets and liabilities 177 96 273 Net cash (used in) operating activities (12,709 ) 204 (12,505 ) Cash flows from financing activities Payments for treasury stock — (204 ) (204 ) Net cash used by financing activities 117,166 (204 ) 116,962

Business - Additional Informati

Business - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended			6 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Deferred provision benefit [Abstract]
Cash	$ 2,950	$ 4,518	$ 6,043	$ 4,518	$ 2,950	$ 5,608	$ 10,949
Working capital deficiency						44,574
Accumulated deficit	253,839	248,701	248,889	248,701	253,839	451,179	239,537
Loss from operations	3,479	(785)	7,537	6,752	10,231	181,856	4,312	$ (29,340)
Net (loss) income	$ 5,138	$ (188)	$ 9,351	$ 9,163	$ 14,301	$ 211,642	$ 3,123	$ (6,906)

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Estimated Useful Lives of Assets (Detail)	12 Months Ended
	Dec. 31, 2019
Buildings [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	25 years
Buildings [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	40 years
Building Improvements and Leasehold Improvements [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	8 years
Building Improvements and Leasehold Improvements [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	40 years
Processing Equipment [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	7 years
Processing Equipment [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	10 years
Office Equipment, Furniture and Fixtures [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	5 years
Office Equipment, Furniture and Fixtures [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	7 years
Computer Hardware And Software [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	3 years
Computer Hardware And Software [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	7 years
Surgical Instruments [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	3 years
Surgical Instruments [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Estimated Useful Life of Assets	5 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Additional Information (Detail) $ / shares in Units, $ in Thousands	3 Months Ended		12 Months Ended
	Dec. 31, 2019USD ($)Reporting_unit$ / sharesshares	Sep. 30, 2019Reporting_unit	Dec. 31, 2019USD ($)$ / sharesshares	Dec. 31, 2018USD ($)$ / sharesshares	Dec. 31, 2017USD ($)$ / sharesshares
Summary Of Significant Accounting Policies [Line Items]
Number of reporting unit | Reporting_unit	2	1
Goodwill descreption			We weighted the income approach 75% and the market approach 25%.
Repurchase of common stock	64,044		64,044	107,109	745,122
Repurchase of common stock, value | $			$ 272	$ 479	$ 3,474
Convertible Preferred Stock [Member]
Summary Of Significant Accounting Policies [Line Items]
Antidilutive securities excluded from computation of earnings per share			50,000	50,000	50,000
Convertible Common Stock [Member]
Summary Of Significant Accounting Policies [Line Items]
Antidilutive securities excluded from computation of earnings per share			15,152,761
Patents [Member] | Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets			8 years
Patents [Member] | Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets			16 years
Acquired Exclusivity Rights [Member]
Summary Of Significant Accounting Policies [Line Items]
Acquired exclusivity rights, remaining amortization period			8 years
Licensing Rights [Member] | Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets			5 years
Licensing Rights [Member] | Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets			25 years
Spine Asset Group [Member]
Summary Of Significant Accounting Policies [Line Items]
Finite-lived intangible assets carry amount | $	$ 85,096		$ 85,096
Spine Asset Group [Member] | Finite-Lived Intangible Assets [Member]
Summary Of Significant Accounting Policies [Line Items]
Impairment charge | $			$ 85,096
Stock Option [Member]
Summary Of Significant Accounting Policies [Line Items]
Antidilutive securities excluded from computation of earnings per share			4,536,461	4,275,744	4,662,037
Stock Option [Member] | Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Common stock price per share | $ / shares	$ 2.09		$ 2.09	$ 2.69	$ 2.69
Stock Option [Member] | Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Common stock price per share | $ / shares	$ 5.23		$ 5.23	$ 5.23	$ 8.20

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Reconciliation of Common Shares used in Calculation of Basic and Diluted EPS (Detail) - shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Accounting Policies [Abstract]
Weighted average basic shares	72,824,308	63,521,703	59,684,289
Effect of dilutive securities:
Stock options	0	0	915,663
Weighted average diluted shares	72,824,308	63,521,703	60,599,952

Recently Issued and Adopted A_2

Recently Issued and Adopted Accounting Standards - Additional Information (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Jan. 01, 2019
Operating lease, right-of-use asset		$ 3,164
Operating lease, liability	$ 2,706	$ 3,155
Maximum [Member]
Lease term	12 months

Leases - Additional Information

Leases - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2019USD ($)
Operating lease, description	The Company does not have any finance leases and the Company's operating leases do not have any residual value guarantees, restrictions or covenants.
Lessee, operating lease, existence of residual value guarantees, restrictions or covenants	false
Lease not yet commenced, description	The Company does not have any leases that have not yet commenced as of December 31, 2019.
Lease not yet commenced, option to extend	The option to extend is only included in the lease term if the Company is reasonably certain of exercising that option.
Operating lease remaining term	5 years
Weighted-average discount rate, operating leases	4.70%
Operating lease right of use asset write Off	$ 201
Minimum [Member]
Operating lease remaining term	1 year
Maximum [Member]
Operating lease remaining term	14 years

Leases - Schedule of Operating

Leases - Schedule of Operating Leases (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)
Leases [Abstract]
Operating lease cost	$ 1,659
Short-term operating lease cost	36
Total operating lease cost	$ 1,695

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Cash Flow Information Related to Lease (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 1,558
ROU assets obtained in exchange for lease obligations	$ 103

Leases - Schedule of Suppleme_2

Leases - Schedule of Supplemental Balance Sheet Information Related to Leases (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Jan. 01, 2019
Right-of-use assets		$ 3,164
Current	$ 1,159
Total operating lease liabilities	2,706	$ 3,155
Other Assets [Member]
Right-of-use assets	2,155
Accrued Expenses [Member]
Current	1,159
Other Long Term Liabilities [Member]
Noncurrent	$ 1,547

Leases - Schedule of Maturities

Leases - Schedule of Maturities of Operating Lease Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Jan. 01, 2019
Leases [Abstract]
2020	$ 1,261
2021	562
2022	226
2023	159
2024	159
2025 and beyond	716
Total future minimum lease payments	3,083
Less imputed interest	(377)
Total operating lease liabilities	$ 2,706	$ 3,155

Leases - Future Minimum Lease C

Leases - Future Minimum Lease Commitments Under Non-Cancelable Operating Leases Prior to Adoption of ASC 842 (Detail) $ in Thousands	Dec. 31, 2018USD ($)
Leases [Abstract]
2019	$ 1,374
2020	806
2021	276
2022	162
2023	166
2024 and beyond	882
Total future minimum lease payments	$ 3,666

Segment Reporting - Additional

Segment Reporting - Additional Information (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)
Lines of business	2
Spine [Member]
Operating Cost	$ 7,855	$ 11,212	$ 9,148

Segment Reporting - Summary of

Segment Reporting - Summary of Segment Data (Detail) - USD ($) $ in Thousands	3 Months Ended								6 Months Ended	9 Months Ended	12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment Reporting Information [Line Items]
Revenues	$ 80,068	$ 76,741	$ 81,554	$ 70,021	$ 70,386	$ 70,450	$ 70,385	$ 69,141	$ 151,575	$ 228,316	$ 308,384	$ 280,362	$ 280,349
Depreciation and amortization											22,675	14,579	14,233
Severance and restructuring costs				15							0	2,808	12,016
Executive transition costs											0	0	2,818
Gain on acquisition contingency			(1,590)						(1,590)	(1,590)	(76,033)	0	0
Asset impairment and abandonments									15	15	97,341	5,070	4,034
Goodwill impairment							$ 0				140,003	0	0
Acquisition and integration expenses		3,209	1,953	8,957					10,910	14,119	17,159	4,943	630
Gain on cardiothoracic closure business divestiture											0	0	(34,090)
Operating (loss) income		(3,479)	785	(7,537)					(6,752)	(10,231)	(181,856)	(4,312)	29,340
Interest expense		(3,718)	(3,635)	(1,604)					(5,239)	(8,957)	(12,571)	(2,771)	(3,180)
Interest income		4	26	131					157	161	161	35	8
Loss on extinguishment of debt											0	(309)	0
Foreign exchange (loss) gain		(78)	(19)	(31)					(50)	(128)	(139)	(34)	87
(Loss) income before income tax (provision) benefit		$ (7,271)	$ (2,843)	$ (9,041)					$ (11,884)	$ (19,155)	(194,405)	(7,391)	26,255
Segment Reconciling Items [Member]
Segment Reporting Information [Line Items]
Severance and restructuring costs												2,808	12,016
Executive transition costs													2,818
Gain on acquisition contingency											(76,033)
Asset impairment and abandonments											97,341	5,070	4,034
Goodwill impairment											140,003
Acquisition and integration expenses											17,159	4,943	630
Gain on cardiothoracic closure business divestiture												(3,000)	(34,090)
Total one-time charges											178,470	9,821	(14,592)
Spine [Member]
Segment Reporting Information [Line Items]
Revenues											118,987	94,436	92,712
Depreciation and amortization											12,779	4,692	3,469
Spine [Member] | Segment Reconciling Items [Member]
Segment Reporting Information [Line Items]
Operating (loss) income											(30,538)	(20,603)	(9,497)
Oem Segment [Member]
Segment Reporting Information [Line Items]
Revenues											189,397	185,926	187,637
OEM [Member]
Segment Reporting Information [Line Items]
Revenues											124,184	120,037
Depreciation and amortization											9,896	9,887	10,764
OEM [Member] | Segment Reconciling Items [Member]
Segment Reporting Information [Line Items]
Operating (loss) income											$ 27,152	$ 26,112	$ 24,245

Segment Reporting - Summary o_2

Segment Reporting - Summary of Revenues by Geographic Location (Detail) - USD ($) $ in Thousands	3 Months Ended								6 Months Ended	9 Months Ended	12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Disaggregation of Revenue [Line Items]
Revenues	$ 80,068	$ 76,741	$ 81,554	$ 70,021	$ 70,386	$ 70,450	$ 70,385	$ 69,141	$ 151,575	$ 228,316	$ 308,384	$ 280,362	$ 280,349
North America [Member]
Disaggregation of Revenue [Line Items]
Revenues											277,152	254,409	254,385
EMEA [Member]
Disaggregation of Revenue [Line Items]
Revenues											24,252	21,258	19,303
Asia Pacific [Member]
Disaggregation of Revenue [Line Items]
Revenues											4,027	2,996	5,488
Latin America [Member]
Disaggregation of Revenue [Line Items]
Revenues											$ 2,953	$ 1,699	$ 1,173

Revenue from Contracts with C_3

Revenue from Contracts with Customers - Additional Information (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)Business	Dec. 31, 2018USD ($)	Jan. 01, 2018USD ($)
Revenue from Contract with Customer [Abstract]
Number of business lines | Business	2
Unbilled receivables in connection with our exclusively built inventory contracts | $	$ 10,633	$ 6,577	$ 2,133

Revenue from Contracts with C_4

Revenue from Contracts with Customers - Revenue Recognition from Two Business Lines (Detail) - USD ($) $ in Thousands

3 Months Ended

6 Months Ended

9 Months Ended

12 Months Ended

Dec. 31, 2019

Sep. 30, 2019

Jun. 30, 2019

Mar. 31, 2019

Dec. 31, 2018

Sep. 30, 2018

Jun. 30, 2018

Mar. 31, 2018

Jun. 30, 2019

Sep. 30, 2019

Dec. 31, 2019

Dec. 31, 2018

Dec. 31, 2017

Disaggregation of Revenue [Line Items]

Revenues

$ 80,068

$ 76,741

$ 81,554

$ 70,021

$ 70,386

$ 70,450

$ 70,385

$ 69,141

$ 151,575

$ 228,316

$ 308,384

$ 280,362

$ 280,349

Domestic [Member]

Disaggregation of Revenue [Line Items]

Revenues

97,629

79,812

International [Member]

Disaggregation of Revenue [Line Items]

Revenues

21,358

14,625

OEM [Member]

Disaggregation of Revenue [Line Items]

Revenues

124,184

120,037

Sports [Member]

Disaggregation of Revenue [Line Items]

Revenues

55,339

54,560

International [Member]

Disaggregation of Revenue [Line Items]

Revenues

$ 9,874

$ 11,328

Revenue from Contracts with C_5

Revenue from Contracts with Customers - Revenues Recognized at a Point in Time and Over Time (Detail) - USD ($) $ in Thousands

3 Months Ended

6 Months Ended

9 Months Ended

12 Months Ended

Dec. 31, 2019

Sep. 30, 2019

Jun. 30, 2019

Mar. 31, 2019

Dec. 31, 2018

Sep. 30, 2018

Jun. 30, 2018

Mar. 31, 2018

Jun. 30, 2019

Sep. 30, 2019

Dec. 31, 2019

Dec. 31, 2018

Dec. 31, 2017

Disaggregation of Revenue [Line Items]

Revenues

$ 80,068

$ 76,741

$ 81,554

$ 70,021

$ 70,386

$ 70,450

$ 70,385

$ 69,141

$ 151,575

$ 228,316

$ 308,384

$ 280,362

$ 280,349

Transferred at Point in Time [Member]

Disaggregation of Revenue [Line Items]

Revenues

240,469

239,619

Transferred over Time [Member]

Disaggregation of Revenue [Line Items]

Revenues

$ 67,915

$ 40,743

Revenue from Contracts with C_6

Revenue from Contracts with Customers - Contract with Customer, Asset and Liability (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2017
Revenue from Contract with Customer [Abstract]
Accounts receivable	$ 59,288	$ 48,096	$ 56,545	$ 55,540	$ 55,709	$ 38,441
Contract Liability (Current)	3,378	5,425				5,978
Contract Liability (Long- Term)		744				$ 3,741
Accounts Receivable, Increase/(decrease)	11,192	9,655
Contract Liability (Current), Increase/(decrease)	(2,047)	(553)
Contract Liability (Long-Term), Increase/(decrease)	$ (744)	$ (2,997)

Acquisition of Paradigm Spine,

Acquisition of Paradigm Spine, LLC - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	Mar. 08, 2019	Mar. 31, 2019	Jun. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Sep. 30, 2019
Business Acquisition [Line Items]
Common stock par value		$ 0.001	$ 0.001	$ 0.001	$ 0.001		$ 0.001
Severance expenses		$ 15		$ 0	$ 2,808	$ 12,016
Master Transaction Agreement [Member]
Business Acquisition [Line Items]
Common stock par value	$ 0.001
Master Transaction Agreement [Member] | One Fully Paid And Nonassessable [Member]
Business Acquisition [Line Items]
Common stock par value	$ 0.001
Paradigm Spine [Member]
Business Acquisition [Line Items]
Potential debt to finance business combination	$ 100,000
Number of common stock to be issued at closing, shares	10,729,614
Cash consideration threshold working capital amount	$ 7,000
Potential debt to finance business combination	100,000
Contingent liability	72,177			0
Acquisition and integration expenses			$ 15,537	11,394	$ 4,143
Business development expenses				462
Severance expenses				896
Inventory fair value, current	7,122
Inventory fair value, noncurrent	10,525
Goodwill acquired	135,589			$ 135,589
Paradigm Spine [Member] | Maximum [Member]
Business Acquisition [Line Items]
Number of common stock to be issued at closing, value	$ 50,000
Series A Preferred Stock [Member] | Master Transaction Agreement [Member]
Business Acquisition [Line Items]
Common stock par value	$ 0.001
Series A Preferred Stock [Member] | Master Transaction Agreement [Member] | One Fully Paid And Nonassessable [Member]
Business Acquisition [Line Items]
Common stock par value	$ 0.001

Acquisition of Paradigm Spine_2

Acquisition of Paradigm Spine, LLC - Acquisition Purchase Price (Detail) - USD ($) $ in Thousands	Mar. 08, 2019	Mar. 31, 2019	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Cash proceeds from second lien credit agreement		$ 115,000	$ 115,000	$ 118,000	$ 121,500	$ 74,425	$ 6,000
Paradigm Spine [Member]
Business Acquisition [Line Items]
Cash proceeds from second lien credit agreement	$ 100,000
Fair market value of securities issued	60,730
Fair market value of contingent earnout	72,177
Total purchase price	$ 232,907				$ 99,692

Acquisition of Paradigm Spine_3

Acquisition of Paradigm Spine, LLC - Summary of Changes to Fair Value of Acquired Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Mar. 08, 2019	Dec. 31, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Goodwill	$ 55,384	$ 194,838	$ 195,067	$ 194,797		$ 59,798	$ 46,242
Paradigm Spine [Member]
Business Acquisition [Line Items]
Cash					$ 307
Accounts receivable					5,220
Inventories					17,647
Other current assets					934
Property, plant and equipment					379
Other non-current assets					1,079
Current liabilities					(6,169)
Lease liabilities					(1,079)
Net tangible assets acquired					18,318
Other intangible assets					79,000
Goodwill					135,589
Total net assets acquired					$ 232,907

Acquisition of Paradigm Spine_4

Acquisition of Paradigm Spine, LLC. - Pro Forma Information of Operations (Detail) - Paradigm Spine [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Business Acquisition, Pro Forma Information [Line Items]
Revenues	$ 37,374	$ 40,810
Net loss	$ (16,547)	$ (42,550)

Acquisition of Zyga Technology

Acquisition of Zyga Technology Inc. - Additional Information (Detail) - USD ($) $ in Thousands	Jan. 04, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019
Business Acquisition [Line Items]
Goodwill			$ 55,384	$ 59,798	$ 46,242	$ 194,838	$ 195,067	$ 194,797
Zyga Technology Inc [Member]
Business Acquisition [Line Items]
Payments to acquire businesses	$ 21,000
Cash from RTI Surgical	3,000			$ 21,000
Earnout consideration	4,986
Acquisition related costs	1,430	$ 800			$ 630
Total considerations including acquisition contingencies	25,986
Other intangible assets	6,760
Goodwill	13,556
Zyga Technology Inc [Member] | Patents [Member]
Business Acquisition [Line Items]
Other intangible assets	$ 6,500
Other intangible assets, useful life	13 years
Zyga Technology Inc [Member] | Trademarks [Member]
Business Acquisition [Line Items]
Other intangible assets	$ 80
Other intangible assets, useful life	1 year
Zyga Technology Inc [Member] | Marketing-Related Intangible Assets [Member]
Business Acquisition [Line Items]
Other intangible assets	$ 180
Other intangible assets, useful life	7 years
Zyga Technology Inc [Member] | Revolving Credit Facility [Member]
Business Acquisition [Line Items]
Cash proceeds from revolving credit facility	$ 18,000
Zyga Technology Inc [Member] | Clinical Milestone [Member]
Business Acquisition [Line Items]
Earnout consideration	1,100
Zyga Technology Inc [Member] | Revenue Earnout [Member] | Maximum [Member]
Business Acquisition [Line Items]
Earnout consideration	$ 35,000
Zyga Technology Inc [Member] | Earn Out Payment [Member]
Business Acquisition [Line Items]
Reduction in contingent liability			$ 3,856

Acquisition of Zyga Technolog_2

Acquisition of Zyga Technology Inc.- Purchase Price (Detail) - Zyga Technology Inc [Member] - USD ($) $ in Thousands	Jan. 04, 2018	Dec. 31, 2018
Business Acquisition [Line Items]
Cash from RTI Surgical	$ 3,000	$ 21,000
Total purchase price	21,000
Revolving Credit Facility [Member]
Business Acquisition [Line Items]
Cash proceeds from revolving credit facility	$ 18,000

Acquisition of Zyga Technolog_3

Acquisition of Zyga Technology Inc.- Final Allocation of Total Consideration Tangible and Intangible Assets and Liabilities Fair Values (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Jan. 04, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Acquisition contingencies	$ (1,130)	$ (75,573)	$ (75,573)	$ (77,163)	$ (4,986)
Goodwill	$ 55,384	$ 194,838	$ 195,067	$ 194,797	$ 59,798		$ 46,242
Zyga Technology Inc [Member]
Business Acquisition [Line Items]
Inventories						$ 1,099
Accounts receivable						573
Other current assets						53
Property, plant and equipment						151
Other assets						26
Deferred tax assets						4,715
Current liabilities						(947)
Acquisition contingencies						(4,986)
Net tangible assets acquired						684
Other intangible assets						6,760
Goodwill						13,556
Total net assets acquired						$ 21,000

Acquisition of Zyga Technolog_4

Acquisition of Zyga Technology Inc.- Proforma Information (Detail) - Zyga Technology Inc [Member] $ in Thousands	12 Months Ended
	Dec. 31, 2018USD ($)
Business Acquisition [Line Items]
Revenues	$ 4,809
Net loss	$ (2,640)

Cardiothoracic Closure Busine_3

Cardiothoracic Closure Business Divestiture - Additional Information (Detail) - USD ($) $ in Thousands	Aug. 03, 2017	Sep. 30, 2018	Dec. 31, 2018	Dec. 31, 2017
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from divestiture of businesses			$ 3,000	$ 51,000
Discontinued Operations, Disposed of by Sale [Member] | Cardiothoracic [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from divestiture of businesses	$ 54,000
Escrow deposit	3,000
Cash consideration	(51,000)	$ 3,000
Contingent consideration earned upon certain revenue milestones	5,000
Contingent cash consideration receivable	$ 1,000

Schedule of Calculation of Gain

Schedule of Calculation of Gain of CT Business Divestiture (Detail) - USD ($) $ in Thousands	Aug. 03, 2017	Sep. 30, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain on cardiothoracic closure business divestiture			$ 0	$ 0	$ 34,090
Discontinued Operations, Disposed of by Sale [Member] | Cardiothoracic [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from cardiothoracic closure business divestiture	$ 51,000	$ (3,000)
Inventories - net	(2,893)
Property, plant and equipment - net	(1,299)
Goodwill	(8,645)
Other intangible assets - net	(280)
Cardiothoracic closure business divestiture expenses	(3,793)
Gain on cardiothoracic closure business divestiture	$ 34,090

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	Nov. 29, 2019	Dec. 04, 2017	Sep. 18, 2017	Jan. 29, 2017	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock, stock options exercise price					100.00%
Percentage of market value of common stock, restricted stock award granted					100.00%
Granted, Number of Options					584,297
2018 Equity Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares of common stock allowed to be issued					5,726,035
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized stock-based compensation					$ 1,627
Stock-based compensation awards, weighted-average period recognized					3 years
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized stock-based compensation					$ 2,676
Stock-based compensation awards, weighted-average period recognized					1 year 7 months 2 days
Shares granted					792,803
Restricted Stock [Member] | Employee [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted					625,881
Restricted Stock [Member] | Non-Employee [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted					166,922
Restricted Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized stock-based compensation					$ 815
Stock-based compensation awards, weighted-average period recognized					2 years
Shares granted					226,352
Restricted Stock Units [Member] | Employee [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted					226,352
Restricted Stock Agreement #1 [Member] | Common Stock [Member] | Mr. Camille Farhat [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted		850,000
Restricted Stock Agreement #2 [Member] | Common Stock [Member] | Mr. Camille Farhat [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted		150,000
Option Agreement [Member] | Mr. Camille Farhat [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement exercise price				$ 3.20
Share-based compensation arrangement expiration date				Jan. 26, 2022
Option Agreement [Member] | Mr. Camille Farhat [Member] | Average Stock Price Benchmark One [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest				650,000
Stock-based compensation award, vesting rights description					Company's average publicly traded stock price is over $6.00 for a sixty-consecutive calendar day period.
Option Agreement [Member] | Mr. Camille Farhat [Member] | Average Stock Price Benchmark Two [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest				650,000
Stock-based compensation award, vesting rights description					Company's average publicly traded stock price is over $7.00 for a sixty-consecutive calendar day period.
Option Agreement [Member] | Mr. Camille Farhat [Member] | Average Stock Price Benchmark Three [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest				650,000
Stock-based compensation award, vesting rights description					Company's average publicly traded stock price is over $8.00 for a sixty-consecutive calendar day period.
Option Agreement [Member] | Mr. Jonathon Singer [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement exercise price			$ 4.55
Share-based compensation arrangement expiration date			Sep. 18, 2027
Option Agreement [Member] | Mr. Jonathon Singer [Member] | Average Stock Price Benchmark One [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest			102,300
Stock-based compensation award, vesting rights description					Company's average publicly traded stock price is over $7.00 per share for a sixty-consecutive calendar day period.
Option Agreement [Member] | Mr. Jonathon Singer [Member] | Average Stock Price Benchmark Two [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest			102,300
Stock-based compensation award, vesting rights description					Company's average publicly traded stock price is over $8.00 per share for a sixty-consecutive calendar day period.
Option Agreement [Member] | Mr. Jonathon Singer [Member] | Average Stock Price Benchmark Three [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest			102,300
Stock-based compensation award, vesting rights description					Company's average publicly traded stock price is over $9.00 per share for a sixty-consecutive calendar day period.
Option Agreement [Member] | Mr. Terry Rich [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement exercise price	$ 2.09
Option Agreement [Member] | Mr. Terry Rich [Member] | Average Stock Price Benchmark One [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest	62,799
Stock-based compensation award, vesting rights description					On the first anniversary of the Grant Date
Option Agreement [Member] | Mr. Terry Rich [Member] | Average Stock Price Benchmark Two [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest	15,700
Stock-based compensation award, vesting rights description					Per calendar quarter commencing on the fifteenth month following the Grant Date and continuing for two years after.
Option Agreement [Member] | Common Stock [Member] | Mr. Camille Farhat [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Number of Options				1,950,000
Option Agreement [Member] | Common Stock [Member] | Mr. Jonathon Singer [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Number of Options			306,900
Option Agreement [Member] | Common Stock [Member] | Mr. Terry Rich [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Number of Options	188,397
Restricted Stock Agreement [Member] | Mr. Terry Rich [Member] | Average Stock Price Benchmark One [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest	41,866
Stock-based compensation award, vesting rights description					On the first anniversary of the Grant Date
Restricted Stock Agreement [Member] | Mr. Terry Rich [Member] | Average Stock Price Benchmark Two [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation arrangement by share based payment award number of options expected to vest	10,467
Stock-based compensation award, vesting rights description					Per calendar quarter commencing on the fifteenth month following the Grant Date and continuing for two years year after.
Restricted Stock Agreement [Member] | Common Stock [Member] | Mr. Jonathon Singer [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted			109,890
Restricted Stock Agreement [Member] | Common Stock [Member] | Mr. Terry Rich [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted	125,598
Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Contractual term of stock options granted					5 years
Minimum [Member] | Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period					1 year
Minimum [Member] | Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period					1 year
Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Contractual term of stock options granted					10 years
Maximum [Member] | Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period					5 years
Maximum [Member] | Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period					3 years

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Weighted-Average Assumptions Used to Determine Fair Value of Options (Detail)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Share-based Payment Arrangement [Abstract]
Expected term (years)	6 years 6 months	6 years 6 months	6 years 6 months
Risk free interest rate	2.54%	2.75%	2.26%
Volatility factor	37.73%	43.74%	47.39%
Dividend yield	0.00%	0.00%	0.00%

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock Options Outstanding, Exercisable and Available for Grant (Detail) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)$ / sharesshares
Share-based Payment Arrangement [Abstract]
Outstanding, Number of Options	4,275,744
Granted, Number of Options	584,297
Exercised, Number of Options	(118,500)
Forfeited or expired, Number of Options	(205,080)
Outstanding, Number of Options	4,536,461
Vested or expected to vest, Number of Options	4,301,432
Exercisable, Number of Options	1,085,814
Available for grant, Number of Options	4,186,650
Outstanding, Weighted Average Exercise Price | $ / shares	$ 3.76
Granted, Weighted Average Exercise Price | $ / shares	3.85
Exercised, Weighted Average Exercise Price | $ / shares	3.34
Forfeited or expired, Weighted Average Exercise Price | $ / shares	4.46
Outstanding, Weighted Average Exercise Price | $ / shares	3.75
Vested or expected to vest, Weighted Average Exercise Price | $ / shares	3.73
Exercisable, Weighted Average Exercise Price | $ / shares	$ 4.10
Outstanding, Weighted Average Remaining Contractual Life (Years)	4 years 4 days
Vested or expected to vest, Weighted Average Remaining Contractual Life (Years)	3 years 9 months 22 days
Exercisable, Weighted Average Remaining Contractual Life (Years)	2 years 8 months 5 days
Outstanding, Aggregate Intrinsic Value | $	$ 124
Vested or expected to vest, Aggregate Intrinsic Value | $	97
Exercisable, Aggregate Intrinsic Value | $	$ 3

Stock-Based Compensation - Othe

Stock-Based Compensation - Other Information Concerning Stock Options (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Share-based Payment Arrangement [Abstract]
Weighted average fair value of stock options granted	$ 1.56	$ 2.05	$ 1.66
Aggregate intrinsic value of stock options exercised	$ 161	$ 349	$ 2,786

Stock-Based Compensation - Unve

Stock-Based Compensation - Unvested Restricted Stock Awards (Detail)	12 Months Ended
	Dec. 31, 2019$ / sharesshares
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beginning Balance, Number of shares | shares	1,032,715
Granted, Number of shares | shares	792,803
Vested, Number of shares | shares	(516,491)
Forfeited, Number of shares | shares	(81,169)
Ending Balance, Number of shares | shares	1,227,858
Beginning Balance, Weighted Average Grant Date Fair Value | $ / shares	$ 4.32
Granted, Weighted Average Grant Date Fair Value | $ / shares	4.38
Vested, Weighted Average Grant Date Fair Value | $ / shares	4.27
Forfeited, Weighted Average Grant Date Fair Value | $ / shares	4.86
Ending Balance, Weighted Average Grant Date Fair Value | $ / shares	$ 4.34
Restricted Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Number of shares | shares	226,352
Forfeited, Number of shares | shares	(41,770)
Ending Balance, Number of shares | shares	184,582
Granted, Weighted Average Grant Date Fair Value | $ / shares	$ 7.41
Forfeited, Weighted Average Grant Date Fair Value | $ / shares	7.41
Ending Balance, Weighted Average Grant Date Fair Value | $ / shares	$ 7.41

Stock-Based Compensation - St_2

Stock-Based Compensation - Stock-Based Compensation Recognized (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 4,367	$ 4,745	$ 6,762
Costs of Processing and Distribution [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	144	132	132
Marketing General and Administrative [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	4,163	4,553	6,586
Research and Development Expense [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 60	$ 60	$ 44

Inventories - Components of Inv

Inventories - Components of Inventories (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Unprocessed tissue, raw materials and supplies	$ 29,552				$ 24,211
Tissue and work in process	35,740				31,796
Implantable tissue and finished goods	65,494				51,648
Total	130,786				107,655
Less current portion	124,149	$ 118,336	$ 115,454	$ 115,486	$ 107,655
Long-term portion	$ 6,637	$ 8,374	$ 9,225	$ 10,261

Inventories - Additional Inform

Inventories - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended	9 Months Ended	12 Months Ended
	Mar. 31, 2019	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Inventory [Line Items]
Provision for inventory write downs	$ 1,530	$ 3,274	$ 5,482	$ 8,493	$ 15,122	$ 5,066
Adjustments [Member]
Inventory [Line Items]
Provision for inventory write downs				9,006
Paradigm Spine [Member]
Inventory [Line Items]
Provision for inventory write downs				$ 513
International distribution infrastructure [Member]
Inventory [Line Items]
Provision for inventory write downs					1,023
Map3 Implant [Member]
Inventory [Line Items]
Provision for inventory write downs					$ 6,559

Prepaid and Other Current Ass_3

Prepaid and Other Current Assets - Schedule of Prepaid and Other Current Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Income tax receivable	$ 2,803				$ 3,920
Prepaid expenses	1,865				2,013
Other	2,101				2,480
Prepaid and other current assets	$ 6,769	$ 8,156	$ 8,258	$ 9,399	$ 8,413

Property, Plant and Equipment -

Property, Plant and Equipment - Components of Property, Plant and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	$ 140,484				$ 156,466
Less accumulated depreciation	(70,594)				(78,512)
Property, plant and equipment, net	69,890	$ 81,471	$ 79,956	$ 79,500	77,954
Land [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	2,005				2,020
Building and Improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	58,208				58,093
Processing Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	45,762				42,599
Surgical Instruments [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	541				24,070
Office Equipment, Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	1,730				1,877
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	20,521				18,873
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	$ 11,717				$ 8,934

Property, Plant and Equipment_2

Property, Plant and Equipment - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Depreciation expense in connection with property, plant and equipment	$ 11,681	$ 10,619	$ 10,513
Asset impairment and abandonments	201
U S Facility [Member]
Property, Plant and Equipment [Line Items]
long term assets	3,539
Map3 Implant [Member]
Property, Plant and Equipment [Line Items]
Asset impairment and abandonments	11,856	$ 1,797
Property, Plant and Equipment [Member] | Spine [Member]
Property, Plant and Equipment [Line Items]
Asset impairment and abandonments	11,655
Right of use lease asset [Member]
Property, Plant and Equipment [Line Items]
Asset impairment and abandonments	$ 201

Goodwill - Schedule of Goodwill

Goodwill - Schedule of Goodwill (Detail) - USD ($) $ in Thousands	Mar. 08, 2019	Jun. 30, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Goodwill [Line Items]
Beginning Balance			$ 59,798	$ 46,242
Goodwill impairment		$ 0	(140,003)	0	$ 0
Ending Balance			55,384	59,798	$ 46,242
Zyga Technology Inc [Member]
Goodwill [Line Items]
Goodwill acquired				$ 13,556
Paradigm Spine [Member]
Goodwill [Line Items]
Goodwill acquired	$ 135,589		$ 135,589
Ending Balance	$ 135,589

Goodwill - Additional Informati

Goodwill - Additional Information (Detail) $ in Thousands	Mar. 08, 2019USD ($)	Jun. 30, 2018USD ($)	Dec. 31, 2019USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)
Goodwill [Line Items]
Goodwill impairment		$ 0	$ 140,003	$ 0	$ 0
Paradigm Spine [Member]
Goodwill [Line Items]
Total purchase price	$ 232,907		99,692
Goodwill acquired	$ 135,589		$ 135,589
Paradigm Spine [Member] | Valuation, Income Approach [Member]
Goodwill [Line Items]
Equity securities, fv-ni, measurement input	0.75
Paradigm Spine [Member] | Valuation, Market Approach [Member]
Goodwill [Line Items]
Equity securities, fv-ni, measurement input	0.25
Fair value exceeding the carrying value	54.00%

Other Intangible Assets - Compo

Other Intangible Assets - Components of Other Intangible Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 22,996	$ 47,495
Accumulated Amortization	12,504	21,938
Net Carrying Amount	10,492	25,557
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	5,095	15,469
Accumulated Amortization	2,768	4,191
Net Carrying Amount	2,327	11,278
Licensing Rights [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	1,413	11,671
Accumulated Amortization	64	6,468
Net Carrying Amount	1,349	5,203
Marketing and Procurement and Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	16,488	20,355
Accumulated Amortization	9,672	11,279
Net Carrying Amount	$ 6,816	$ 9,076

Other Intangible Assets - Addit

Other Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Schedule Of Other Intangible Assets [Line Items]
Amorization expense of other intangible assets	$ 11,126	$ 3,960	$ 3,720
Impairment charges	85,096	2,718
Spine [Member]
Schedule Of Other Intangible Assets [Line Items]
Impairment charges	85,096
Map3 Implant [Member]
Schedule Of Other Intangible Assets [Line Items]
Impairment charges		$ 2,718
Paradigm Spine [Member] | Spine [Member]
Schedule Of Other Intangible Assets [Line Items]
Impairment charges	$ 71,958

Other Intangible Assets - Estim

Other Intangible Assets - Estimates of Future Amortization Expense (Detail) $ in Thousands	Dec. 31, 2019USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2020	$ 2,300
2021	2,300
2022	2,300
2023	700
2024	$ 700

Fair Value Information - Additi

Fair Value Information - Additional Information (Detail) - USD ($)	3 Months Ended	6 Months Ended	9 Months Ended	12 Months Ended
	Jun. 30, 2019	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Mar. 08, 2019	Jan. 04, 2018
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Gain on acquisition contingencies line	$ 1,590,000	$ 1,590,000	$ 1,590,000	$ 76,033,000	$ 0	$ 0
Impairment on long-lived assets				11,655,000	$ 1,797,000	$ 0
Zyga Technology Inc [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Contingent liability								$ 4,986,000
Zyga Technology Inc [Member] | Earn Out Payment [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Reduction in contingent liability				3,856,000
Paradigm Spine [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Contingent liability				0			$ 72,177,000
Gain on acquisition contingencies line				$ 72,177,000

Fair Value Information - Summar

Fair Value Information - Summary of Impairments of Long-Lived Assets and Related Post Impairment Fair Values (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Fair Value Disclosures [Abstract]
Property, plant and equipment - net, impairment	$ 11,655,000	$ 1,797,000	$ 0
Other intangible assets - net, impairment	85,096,000	2,718,000
Other assets - net	201,000
Impairment	$ 96,952,000	$ 4,515,000

Accrued Expenses - Accrued Expe

Accrued Expenses - Accrued Expenses (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Payables and Accruals [Abstract]
Accrued compensation	$ 5,435				$ 8,308
Accrued severance and restructuring costs	136				1,302
Accrued distributor commissions	4,569				3,907
Accrued donor recovery fees	8,921				3,018
Accrued leases	1,159
Accrued acquisition and integration expenses	2,555
Other	10,562				9,330
Total accrued expenses	$ 33,337	$ 31,714	$ 25,312	$ 25,557	$ 25,865

Short and Long-Term Obligatio_3

Short and Long-Term Obligations - Short and Long-Term Obligations (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Debt Disclosure [Abstract]
Ares Term loan	$ 104,406				$ 0
JPM facility	71,000				50,000
Less unamortized debt issuance costs	(1,229)				(927)
Debt and capital lease obligation, total	174,177				49,073
Less current portion	$ 174,177
Long-term portion		$ 169,137	$ 165,081	$ 163,615	$ 49,073

Short and Long-Term Obligatio_4

Short and Long-Term Obligations - Additional Information (Detail) - USD ($) $ in Thousands	Dec. 09, 2019	Mar. 08, 2019	Jun. 05, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Jun. 30, 2021	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019
Line of credit remaining borrowing capacity				$ 9,000
Amortization of debt issuance cost				219
Debt issuance cost				826
Cash and cash equivalents				$ 5,608	$ 10,949			$ 2,950	$ 4,518	$ 6,043
Leverage to adjusted EBITDA ratio				500.00%
Covenant ratio for first quarter				575.00%
Covenant ratio for second quarter				525.00%
Covenant ratio for third quarter				525.00%
Covenant ratio for fourth quarter				350.00%
Leverage ratio				496.00%
Revolving Credit Facility [Member]
Credit facility, variable interest rate				3.69%
Line of credit outstanding amount				$ 71,000
Line of credit remaining borrowing capacity				9,000
Amortization of debt issuance cost				$ 524	$ 528	$ 409
Ares Term Loans [Member]
Debt instrument, maturity date				Dec. 5, 2023
Interest rate on term loan				10.49%
2017 Loan Agreement [Member] | Revolving Credit Facility [Member]
Credit facility, original borrowing capacity			$ 42,500
Debt instrument, maturity date			Sep. 15, 2019
2017 Loan Agreement [Member] | Revolving Credit Facility [Member] | London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate			3.50%
2018 Loan Agreement [Member]
Percentage of foreign subsidiaries stock held as collateral			65.00%
Credit facility guaranteed description				The JPM Facility is guaranteed by the Company's domestic subsidiaries and is secured by (i) substantially all of the assets of the Company and Pioneer Surgical; (ii) substantially all of the assets of each of the Company's domestic subsidiaries; and (iii) 65% of the stock of the Company's foreign subsidiaries.
Minimum fixed charge coverage ratio			100.00%
Covenant Terms of Credit Facility				The Company is subject to certain affirmative and negative covenants, including (but not limited to), covenants limiting the Company's ability to incur certain additional indebtedness; create certain liens; enter into sale and leaseback transactions; and consolidate or merge with, or convey, transfer or lease all or substantially all of its assets to another person. The Company is required to maintain a minimum fixed charge coverage ratio of at least 1.001.00 (the "JPM Required Minimum Fixed Charge Coverage Ratio") during either of the following periods (each, a "JPM Covenant Testing Period") (i) a period beginning on a date that a default has occurred and is continuing under the loan documents entered into by the Company in conjunction with the 2018 Credit Agreement through the first date on which no default has occurred and is continuing; or (ii) a period beginning on a date that availability under the JPM Facility is less than the specified covenant testing threshold and continuing until availability under the JPM Facility is greater than or equal to the specified covenant testing threshold for thirty (30) consecutive days.
2018 Loan Agreement [Member] | Revolving Credit Facility [Member]
Credit facility, original borrowing capacity	$ 75,000	$ 100,000
Revolving line of credit commitment reduction amount	$ 80,000	75,000
2018 Loan Agreement [Member] | Revolving Credit Facility [Member] | Maximum [Member]
Credit facility, additional borrowing capacity			$ 50,000
2019 Loan Agreement [Member]
Paid in kind option to pay interest				50.00%
Increase in term loan interest rate				0.75%
2019 Loan Agreement [Member] | London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate				8.50%
2019 Loan Agreement [Member] | Base Rate [Member]
Debt Instrument, Basis Spread on Variable Rate				7.50%
2019 Loan Agreement [Member] | Ares Term Loans [Member]
Credit facility, original borrowing capacity		$ 100,000
Percentage of foreign subsidiaries stock held as collateral			65.00%
Covenant Terms of Credit Facility				The Ares Term Loan is guaranteed by the Company and each of the Company's domestic subsidiaries and is secured by (i) substantially all of the assets of Legacy RTI; (ii) substantially all of the assets of the Company; (iii) substantially all of the assets of the Company's domestic subsidiaries; and (iv) 65% of the stock of the Company's foreign subsidiaries.
Minimum fixed charge coverage ratio				91.00%
Net leverage ratio				900.00%
2019 Loan Agreement [Member] | Ares Term Loans [Member] | Forecast [Member]
Net leverage ratio							3.30%

Income Taxes - Schedule of Pre-

Income Taxes - Schedule of Pre-Tax Income (Detail) - USD ($) $ in Thousands	3 Months Ended			6 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income (Loss) from Continuing Operations before Equity Method Investments, Income Taxes, Noncontrolling Interest [Abstract]
Domestic (U.S., state and local)						$ (196,426)	$ (9,052)	$ 30,121
Foreign						2,021	1,661	(3,866)
Total pre-tax income	$ (7,271)	$ (2,843)	$ (9,041)	$ (11,884)	$ (19,155)	$ (194,405)	$ (7,391)	$ 26,255

Income Taxes - Schedule of Inco

Income Taxes - Schedule of Income Tax Benefit (Provision) (Detail) - USD ($) $ in Thousands	3 Months Ended			6 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Current:
Federal						$ 503	$ 967	$ (2,910)
State						(147)	(205)	(833)
International						79	(376)
Total current						435	386	(3,743)
Deferred:
Federal						(12,680)	2,356	(14,554)
State						(1,091)	(2,446)	(1,052)
International						(3,901)	3,972
Total deferred			$ (384)	$ 2,969	$ 4,588	(17,672)	3,882	(15,606)
Total income tax (provision) benefit	$ 2,133	$ 3,031	$ (310)	$ 2,721	$ 4,854	$ (17,237)	$ 4,268	$ (19,349)

Income Taxes - Schedule of Defe

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Accounts receivable	$ 1,184	$ 513
Fixed assets and intangibles		(5,862)
Accrued liabilities	3,481	2,358
Revenue	(59)
Deferred compensation	1,526	1,372
Right of Use Asset (Leases)	(558)
Fixed assets and intangibles	15,898
Inventory	9,817	7,631
Net operating losses	13,242	8,198
Revenue		650
Tax credits	6,372	5,993
Lease Liability	708
Right of Use Asset (Leases)	0	0
Other	(103)
Valuation allowance	(51,508)	(3,093)
Total	(720)	(5,862)
Total	$ 720	$ 23,622

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Taxes [Line Items]
Deferred tax assets	21.00%	21.00%	35.00%
Income tax expense (benefit) due to change in tax rate		$ (650)	$ 2,187
Domestic deferred tax assets, valuation allowances	$ 51,508	3,093
Research tax credit carryforwards	$ 7,111
Research tax credit carryforwards, expiration start	2029
Research tax credit carryforwards, expiration end	2038
Unrecognized tax benefits	$ 1,088	$ 1,088	$ 1,591	$ 1,591
Domestic Tax Authority [Member]
Income Taxes [Line Items]
Net operating loss carryforwards, subject to expiration	9,911
Net operating loss carryforwards, not subject to expiration	$ 21,950
Net operating loss carryforwards, expiration year start	2026
Net operating loss carryforwards, expiration year end	2037
State and Local Jurisdiction [Member]
Income Taxes [Line Items]
Net operating loss carryforwards, subject to expiration	$ 48,143
Net operating loss carryforwards, not subject to expiration	$ 3,443
Net operating loss carryforwards, expiration year start	2022
Net operating loss carryforwards, expiration year end	2039
Net operating loss carryforwards, subject to expiration	$ 51,626
Foreign Tax Authority [Member]
Income Taxes [Line Items]
Net operating loss carryforwards, not subject to expiration	$ 13,496

Income Taxes - Summary of Unrec

Income Taxes - Summary of Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Opening balance	$ 1,088	$ 1,591	$ 1,591
Reductions based on tax positions related to the current year	0	0	0
Additions for tax positions of prior years	0	0	0
Reductions for tax positions of prior years		(415)
Reductions for expiration of statute of limitations		(88)
Unrecognized tax benefits	$ 1,088	$ 1,088	$ 1,591

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Tax Rate (Detail)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Statutory federal rate	21.00%	21.00%	35.00%
State income taxes-net of federal tax benefit	(1.31%)	(4.58%)	2.37%
Foreign rate differential		14.36%	2.54%
Acquisition expenses		(7.26%)
Gain on acquisition contingency	8.23%
Goodwill impairment and disposal	(14.86%)		11.52%
Life insurance		(0.98%)	(1.38%)
Officer compensation		(7.88%)	4.18%
Stock-based compensation		(3.90%)	6.06%
Tax credits	0.07%	8.65%	(4.53%)
Tax legislation		9.23%	8.33%
Valuation allowances	(21.25%)	21.93%	6.08%
Uncertain tax positions		6.86%
Other reconciling items, net	(0.75%)	(0.32%)	3.52%
Effective tax rate	(8.87%)	57.75%	73.69%

Preferred Stock - Schedule of P

Preferred Stock - Schedule of Preferred Stock (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2016
Temporary Equity [Line Items]
Accrued dividend		$ 2,120	$ 3,723
Amortization of preferred stock issuance costs	$ 184	183	184
Net Total	66,410	66,226	63,923	$ 66,364	$ 66,318	$ 66,272	$ 60,016
Series A Preferred Stock [Member]
Temporary Equity [Line Items]
Accrued dividend		2,120	3,723
Amortization of preferred stock issuance costs	184	183	184
Net Total	66,519	66,519	64,399				60,676
Preferred stock issuance cost	$ (109)	$ (293)	$ (476)				$ (660)

Preferred Stock - Additional In

Preferred Stock - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	Jul. 16, 2013	Jun. 12, 2013	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Series A Preferred Stock [Member]
Temporary Equity [Line Items]
Preferred stock issuance cost			$ (109)	$ (293)	$ (476)	$ (660)
Private Placement [Member] | Convertible Preferred Stock [Member]
Temporary Equity [Line Items]
Convertible preferred stock issued		$ 50,000
Preferred stock issuance cost	$ 1,290
Private Placement [Member] | Series A Preferred Stock [Member]
Temporary Equity [Line Items]
Preferred stock dividend rate	6.00%
Preferred stock conversion price per share			$ 4.39
Convertible preferred stock, shares issued upon conversion			228
Convertible preferred stock, stock price trigger			$ 7.98
Convertible preferred stock, Description of Conversion			The Preferred Stock will be convertible at the election of the holders into shares of the Company's common stock at an initial conversion price of $4.39 per share which would result in a conversion ratio of approximately 228 shares of common stock for each share of Preferred Stock. The Preferred Stock is convertible at the election of the Company five years after its issuance or at any time if the Company's common stock closes at or above $7.98 per share for at least 20 consecutive trading days.
Convertible preferred stock, stagnation period for conversion			5 years
Convertible preferred stock, consecutive trading days			20 days
Convertible preferred stock, liquidation preference per share			$ 1,000
Convertible referred stock, stockholders stagnation period for conversion			7 years

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Detail) - shares	12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Equity [Abstract]
Preferred stock, shares authorized	5,000,000	5,000,000	5,000,000	5,000,000	5,000,000
Preferred stock, shares issued	50,000	50,000	50,000	50,000	50,000
Preferred stock, shares outstanding	50,000	50,000	50,000	50,000	50,000
Common stock, shares authorized	150,000,000	150,000,000	150,000,000	150,000,000	150,000,000
Common stock, voting rights description	Holders of common stock are entitled to one vote for each share held at all stockholder meetings.

Executive Transition Costs - Ad

Executive Transition Costs - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Restructuring Cost and Reserve [Line Items]
Executive transition costs	$ 1,169
Former Chief Executive Officer [Member]
Restructuring Cost and Reserve [Line Items]
Executive transition costs			$ 4,404
Chief Executive Officer And Chief Financial And Administrative Officer [Member]
Restructuring Cost and Reserve [Line Items]
Executive transition costs		$ 2,818

Executive Transition Costs - Sc

Executive Transition Costs - Schedule of Restructuring Charges (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Restructuring Cost and Reserve [Line Items]
Executive transition costs accrued in 2017	$ 0	$ 0	$ (2,818)
Stock-based compensation	(4,367)	(4,745)	(6,762)
Chief Executive Officer And Chief Financial And Administrative Officer [Member]
Restructuring Cost and Reserve [Line Items]
Accrued executive transition costs, beginning balance	43	2,337	2,406
Executive transition costs accrued in 2017			2,818
Stock-based compensation			(1,612)
Cash payments	$ (43)	(2,294)	(1,275)
Accrued executive transition costs, ending balance		$ 43	$ 2,337

Severance and Restructuring C_3

Severance and Restructuring Costs - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Restructuring Cost and Reserve [Line Items]
Severance and restructuring costs		$ 2,808	$ 12,016
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Severance and restructuring costs	$ 626	$ 2,808	$ 12,016
Paradigm Spine [Member] | Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Severance and restructuring costs	$ 896

Severance and Restructuring C_4

Severance and Restructuring Costs - Schedule of Restructuring Charges (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Restructuring Cost and Reserve [Line Items]
Accrued severance and restructuring charges, beginning balance	$ 1,302
Accrued severance and restructuring charges, beginning balance		$ 2,808	$ 12,016
Accrued severance and restructuring charges, ending balance	136	1,302
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Accrued severance and restructuring charges, beginning balance	1,302	3,122	505
Accrued severance and restructuring charges, beginning balance	626	2,808	12,016
Severance and restructuring cash payments	(1,792)	(4,628)	(8,246)
Stock based compensation			(1,153)
Accrued severance and restructuring charges, ending balance	$ 136	$ 1,302	$ 3,122

Retirement Benefits - Additiona

Retirement Benefits - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Defined Contribution Plan Disclosure [Line Items]
Amounts expensed	$ 3,007	$ 2,757	$ 3,036
Plan name	401(k) plan
Maximum [Member]
Defined Contribution Plan Disclosure [Line Items]
Employer matching contribution, percent of match	6.00%

Concentrations of Risk - Additi

Concentrations of Risk - Additional Information (Detail)	Dec. 31, 2019Company
Segment Reporting [Abstract]
Number of independent companies	14
Number of distribution companies	3

Concentrations of Risk - Schedu

Concentrations of Risk - Schedule of Percentage of Total Revenues Derived from Company's Largest Distributors (Detail) - Distributors Concentration Risk [Member] - Sales Revenue, Net [Member]	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Zimmer [Member]
Concentration Risk [Line Items]
Percentage of sales revenue	18.00%	21.00%	17.00%
Medtronic [Member]
Concentration Risk [Line Items]
Percentage of sales revenue	7.00%	8.00%	9.00%
Synthes [Member]
Concentration Risk [Line Items]
Percentage of sales revenue	4.00%	5.00%	4.00%

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($)	Mar. 08, 2019	Jan. 04, 2018	Aug. 03, 2017	Sep. 30, 2010	Sep. 30, 2018	Dec. 31, 2019	Dec. 31, 2018
A&E Medical Corporation [Member]
Commitment And Contingencies [Line Items]
Payments to acquire businesses			$ 54,000,000		$ 3,000,000
Escrow deposit			3,000,000
Escrow amount to satisfy possible indemnification obligations			0
Renew distribution agreement						The term automatically renews for successive five-year periods, unless either party provides written notice of its intent not to renew at least one year prior to the expiration of the initial term or the applicable renewal period. Neither party provided notice of non-renewal on or before December 31, 2016, thereby triggering the five-year automatic renewal period upon the expiration of the initial term. The distribution agreement will therefore continue at least through December 31, 2022.
Zimmer [Member]
Commitment And Contingencies [Line Items]
Initial agreement term				10 years
Upfront payment				$ 13,000,000
Upfront payment period				10 days
If A&E Medical Corporation Reaches Certain Milestones [Member] | A&E Medical Corporation [Member]
Commitment And Contingencies [Line Items]
Payments to acquire businesses			5,000,000
Successfully Obtaining Certain FDA Regulatory Clearance [Member] | A&E Medical Corporation [Member]
Commitment And Contingencies [Line Items]
Payments to acquire businesses			$ 1,000,000
Paradigm Spine [Member]
Commitment And Contingencies [Line Items]
Agreement to acquire business	$ 300,000,000
Cash to be paid at closing	150,000,000
Potential debt to finance business combination	$ 100,000,000
Number of common stock to be issued at closing, shares	10,729,614
Number of common stock to be issued at closing, value	$ 50,000,000
Revenue based earnout considerations	0
Cash from RTI Surgical	232,907,000					$ 99,692,000
Earnout consideration	72,177,000					$ 0
Paradigm Spine [Member] | Maximum [Member]
Commitment And Contingencies [Line Items]
Revenue based earnout considerations	$ 150,000,000
Zyga Technology Inc [Member]
Commitment And Contingencies [Line Items]
Date of merger agreement		Jan. 4, 2018
Payments to acquire businesses		$ 21,000,000
Cash from RTI Surgical		3,000,000					$ 21,000,000
Earnout consideration		4,986,000
Zyga Technology Inc [Member] | Clinical Milestones [Member]
Commitment And Contingencies [Line Items]
Earnout consideration		1,000,000
Zyga Technology Inc [Member] | Earn Out Payment [Member]
Commitment And Contingencies [Line Items]
Revenue based earnout consideration		35,000,000
Zyga Technology Inc [Member] | Clinical and Revenue Milestones Earnout Payment [Member]
Commitment And Contingencies [Line Items]
Earnout consideration		1,130,000
Zyga Technology Inc [Member] | Revolving Credit Facility [Member]
Commitment And Contingencies [Line Items]
Cash proceeds from credit facility		$ 18,000,000

Legal and Regulatory Actions -

Legal and Regulatory Actions - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2019LitigationClaim
Commitments and Contingencies Disclosure [Abstract]
Outstanding claims | Litigation	0
Claims for which the Company Parties are providing defense and indemnification | Claim	1,139

Quarterly Results of Operatio_3

Quarterly Results of Operations (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								6 Months Ended	9 Months Ended	12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Quarterly Financial Information [Line Items]
Revenues	$ 80,068	$ 76,741	$ 81,554	$ 70,021	$ 70,386	$ 70,450	$ 70,385	$ 69,141	$ 151,575	$ 228,316	$ 308,384	$ 280,362	$ 280,349
Gross profit	43,891	43,224	46,124	37,887	38,013	38,228	29,899	33,503	84,011	127,235	171,125	139,643	143,072
Net (loss) income	$ (197,340)	$ (5,138)	$ 188	$ (9,351)	$ 799	$ 2,997	$ (5,802)	$ (1,117)	$ (9,163)	$ (14,301)	$ (211,642)	$ (5,243)	$ 3,183
Net (loss) income per common share:
Net (loss) income per common share - basic	$ (2.63)	$ (0.07)	$ 0	$ (0.14)	$ 0.01	$ 0.04	$ (0.11)	$ (0.03)	$ (0.13)	$ (0.20)	$ (2.91)	$ (0.08)	$ 0.05
Net (loss) income per common share - diluted	$ (2.63)	$ (0.07)	$ 0	$ (0.14)	$ 0.01	$ 0.04	$ (0.11)	$ (0.03)	$ (0.13)	$ (0.20)	$ (2.91)	$ (0.08)	$ 0.05
Adjustments [Member]
Quarterly Financial Information [Line Items]
Gross profit		$ 43,223		$ 37,886
Net (loss) income				$ (9,352)

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) - USD ($) $ in Thousands	Apr. 27, 2020	Apr. 09, 2020	Jan. 13, 2020	Dec. 31, 2019	Dec. 31, 2018
Subsequent Event [Line Items]
Line of credit				$ 71,000	$ 50,000
Subsequent Event [Member] | Ardi Bidco Ltd. [Member] | Disposal Group Held-for-sale Not Discontinued Operations [Member]
Subsequent Event [Line Items]
Consideration received or receivable for disposal of assets			$ 440,000
Subsequent Event [Member] | Ardi Bidco Ltd. [Member] | Third Amendment To Credit Agreement And Joinder Agreement [Member]
Subsequent Event [Line Items]
Modifying certain interest rates contained		1.00%
Subsequent Event [Member] | Ardi Bidco Ltd. [Member] | Fourth Amendment To Credit Agreement And Joinder Agreement [Member]
Subsequent Event [Line Items]
Line of credit	$ 8,000
Annual interest rate on loan applicable	2.75%
Loan maturity date	Jun. 5, 2023
Subsequent Event [Member] | Ardi Bidco Ltd. [Member] | Fourth Amendment To Credit Agreement And Joinder Agreement [Member] | Minimum [Member]
Subsequent Event [Line Items]
Incremental term loan commitments	$ 25,000
Subsequent Event [Member] | Ardi Bidco Ltd. [Member] | Second Amendment To Second Lien Credit Agreement [Member]
Subsequent Event [Line Items]
Percentage of aggregate principal amount of Incremental Term Loan	5.00%
Effective base rate applicable	12.50%
Second Amendment Incremental Term Loans description	The interest rate on the Second Amendment Incremental Term Loans is 12.50% and, commencing on September 1, 2020 and on the first day of each of the next four calendar months thereafter, the interest in respect of the Second Amendment Incremental Term Loans shall increase on each such date, on a cumulative basis, by an additional 1.00% per annum (such that, after the fifth such increase, the Base Rate with respect to the Second Amendment Incremental Term Loans shall equal 17.50% per annum).
Subsequent Event [Member] | Ardi Bidco Ltd. [Member] | Second Amendment To Second Lien Credit Agreement [Member] | Minimum [Member]
Subsequent Event [Line Items]
loan takeout fee	$ 25,500
Subsequent Event [Member] | Ardi Bidco Ltd. [Member] | Second Amendment To Second Lien Credit Agreement [Member] | Maximum [Member]
Subsequent Event [Line Items]
Incremental term loan commitments	13,500
Aggregate principal amount of incremental term loan facilities, Maximum	30,000
loan takeout fee	$ 11,250

Restatement of Prior Period Q_3

Restatement of Prior Period Quarterly Financial Statements (Unaudited) - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended								6 Months Ended	9 Months Ended	12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Mar. 08, 2019
Error Corrections and Prior Period Adjustments Revision [Line Items]
Revenues	$ 80,068	$ 76,741	$ 81,554	$ 70,021	$ 70,386	$ 70,450	$ 70,385	$ 69,141	$ 151,575	$ 228,316	$ 308,384	$ 280,362	$ 280,349
Costs of processing and distribution		33,517	35,430	32,134					67,564	101,081	137,259	140,719	137,277
Accounts receivable	59,288	56,545	55,540	55,709	48,096				55,540	56,545	59,288	48,096	38,441
Current inventories, net	124,149	118,336	115,454	115,486	107,655				115,454	118,336	124,149	107,655
Deferred tax assets		21,576	20,230	17,114	17,760				20,230	21,576		17,760
Marketing, general and administrative		39,223	41,108	32,116					73,224	112,447	157,675	119,724	115,009
Non-current inventories, net	6,637	8,374	9,225	10,261					9,225	8,374	6,637
Goodwill	55,384	194,838	195,067	194,797	59,798				195,067	194,838	55,384	59,798	46,242
Other intangible assets - net	10,492	97,614	100,651	103,006	25,557				100,651	97,614	10,492	25,557
Acquisition contingencies	1,130	75,573	75,573	77,163	4,986				75,573	75,573	1,130	4,986
Prepaid and other current assets	6,769	8,156	8,258	9,399	8,413				8,258	8,156	6,769	8,413
Property, plant & equipment	69,890	81,471	79,956	79,500	77,954				79,956	81,471	69,890	77,954
Other assets - net	6,292	7,006	7,277	7,653	4,003				7,277	7,006	6,292	4,003
Accounts payable	30,126	17,634	20,600	23,149	26,219				20,600	17,634	30,126	26,219
Accrued expenses	$ 33,337	31,714	25,312	25,557	$ 25,865				25,312	31,714	33,337	25,865
Payments for treasury stock				128					172	204	$ 237	$ 478	$ 3,474
Paradigm Spine [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Goodwill														$ 135,589
Restatement Adjustments [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Revenues		612	(753)	280					(473)	139
Costs of processing and distribution		(1,125)	(2,132)	397					(1,735)	(2,860)
Accounts receivable		(11)	(623)	39					(623)	(11)
Current inventories, net		(12,577)	(12,452)	1,121					(12,452)	(12,577)
Deferred tax assets		609	515	336					515	609
Marketing, general and administrative		2,116	2,115	233					2,348	4,464
Non-current inventories, net		(9,971)	(11,220)	10,261					(11,220)	(9,971)
Goodwill		(41,709)	(76,362)	(113,548)					(76,362)	(41,709)
Other intangible assets - net		73,269	75,382	77,494					75,382	73,269
Acquisition contingencies		11,854	(22,799)	(22,799)					(22,799)	11,854
Prepaid and other current assets		(475)	(475)	(461)					(475)	(475)
Property, plant & equipment		265	265	265					265	265
Other assets - net		(265)	(265)	(265)					(265)	(265)
Accounts payable		(166)	(166)	(166)					(166)	(166)
Accrued expenses		647	644	565					644	647
Payments for treasury stock				128					172	204
Restatement Adjustments [Member] | Revenue Recognition [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Revenues		600	(800)	300
Costs of processing and distribution		100		100
Accounts receivable		300	(300)	400					(300)	300
Current inventories, net		100	100	(100)					100	100
Deferred tax assets		(600)	(500)	(600)					(500)	(600)
Restatement Adjustments [Member] | Revenue Recognition [Member] | Maximum [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Costs of processing and distribution			(200)
Restatement Adjustments [Member] | Business Acquisition [Member] | Paradigm Spine [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Costs of processing and distribution		(1,200)	(1,900)	300
Current inventories, net		(12,600)	(12,600)	1,200					(12,600)	(12,600)
Deferred tax assets		500	300	200					300	500
Marketing, general and administrative		2,100	2,100	700
Non-current inventories, net		(10,000)	(11,200)	10,300					(11,200)	(10,000)
Goodwill		(41,700)	(76,400)	(113,500)					(76,400)	(41,700)
Other intangible assets - net		74,100	76,200	78,300					76,200	74,100
Acquisition contingencies		11,900	(22,800)	(22,800)					(22,800)	11,900
Restatement Adjustments [Member] | Immaterial Error Correction [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Accounts receivable		(300)	(300)	(400)					(300)	(300)
Deferred tax assets		700	700	700					700	700
Marketing, general and administrative		100	100	500
Other intangible assets - net		(800)	(800)	(800)					(800)	(800)
Prepaid and other current assets		(500)	(500)	(500)					(500)	(500)
Property, plant & equipment		300	300	300					300	300
Other assets - net		(300)	(300)	(300)					(300)	(300)
Accounts payable		(200)	(200)	(200)					(200)	(200)
Accrued expenses		600	600	600					$ 600	$ 600
Payments for treasury stock		$ 200	$ 200	$ 100

Restatement of Prior Period Q_4

Restatement of Prior Period Quarterly Financial Statements (Unaudited) - Restated Condensed Consolidated Balance Sheets (Unaudited) (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Current Assets:
Cash and cash equivalents	$ 5,608	$ 2,950	$ 4,518	$ 6,043	$ 10,949
Accounts receivable	59,288	56,545	55,540	55,709	48,096	$ 38,441
Inventories - net	124,149	118,336	115,454	115,486	107,655
Prepaid and other current assets	6,769	8,156	8,258	9,399	8,413
Total current assets	195,814	185,987	183,770	186,637	175,113
Non-current inventories - net	6,637	8,374	9,225	10,261
Property, plant and equipment - net	69,890	81,471	79,956	79,500	77,954
Deferred tax assets - net		21,576	20,230	17,114	17,760
Goodwill	55,384	194,838	195,067	194,797	59,798	46,242
Other intangible assets - net	10,492	97,614	100,651	103,006	25,557
Other assets - net	6,292	7,006	7,277	7,653	4,003
Total assets	344,509	596,866	596,176	598,968	360,185
Current Liabilities:
Accounts payable	30,126	17,634	20,600	23,149	26,219
Accrued expenses	33,337	31,714	25,312	25,557	25,865
Current portion of deferred revenue	2,748	2,748	4,744	4,825	4,908
Total current liabilities	240,388	52,096	50,656	53,531	56,992
Long-term obligations - less current portion		169,137	165,081	163,615	49,073
Acquisition contingencies	1,130	75,573	75,573	77,163	4,986
Other long-term liabilities	2,017	2,271	2,562	3,065	633
Deferred revenue		1,134	325	1,535	744
Total liabilities	243,535	300,211	294,197	298,909	112,428
Preferred stock Series A, $.001 par value: 5,000,000 shares authorized; 50,000 shares issued and outstanding	66,410	66,364	66,318	66,272	66,226	63,923	$ 60,016
Stockholders' equity:
Common stock, $.001 par value: 150,000,000 shares authorized; 75,055,225, 75,159,262, and 75,087,917 shares issued and outstanding, respectively	75	75	75	75	64
Additional paid-incapital	498,438	497,518	496,596	495,263	433,143
Accumulated other comprehensive loss	(7,629)	(8,390)	(7,268)	(7,663)	(7,270)
Accumulated deficit	(451,179)	(253,839)	(248,701)	(248,889)	(239,537)
Less treasury stock, 1,250,201, 1,257,949 and 1,265,761 shares, respectively, at cost	(5,141)	(5,073)	(5,041)	(4,999)	(4,869)
Total stockholders' equity	34,564	230,291	235,661	233,787	181,531	$ 181,517	$ 164,062
Total liabilities and stockholders' equity	$ 344,509	$ 596,866	$ 596,176	$ 598,968	$ 360,185

Restatement of Prior Period Q_5

Restatement of Prior Period Quarterly Financial Statements (Unaudited) - Restated Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) (Detail) - $ / shares	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Prior Period Adjustment [Abstract]
Preferred stock, par value	$ 0.001	$ 0.001	$ 0.001	$ 0.001	$ 0.001
Preferred stock, shares authorized	5,000,000	5,000,000	5,000,000	5,000,000	5,000,000
Preferred stock, shares issued	50,000	50,000	50,000	50,000	50,000
Preferred stock, shares outstanding	50,000	50,000	50,000	50,000	50,000
Common stock, par value	$ 0.001	$ 0.001	$ 0.001	$ 0.001	$ 0.001
Common stock, shares authorized	150,000,000	150,000,000	150,000,000	150,000,000	150,000,000
Common stock, shares issued	75,213,515	75,087,917	75,159,262	75,055,225	63,469,185
Common stock, shares outstanding	75,213,515	75,087,917	75,159,262	75,055,225	63,469,185
Treasury stock, shares	1,285,224	1,265,761,000	1,257,949,000	1,250,201,000	1,221,180

Restatement of Prior Period Q_6

Restatement of Prior Period Quarterly Financial Statements (Unaudited) - Restated Condensed Consolidated Statements of Income (Unaudited) (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								6 Months Ended	9 Months Ended	12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Prior Period Adjustment [Abstract]
Revenues	$ 80,068	$ 76,741	$ 81,554	$ 70,021	$ 70,386	$ 70,450	$ 70,385	$ 69,141	$ 151,575	$ 228,316	$ 308,384	$ 280,362	$ 280,349
Costs of processing and distribution		33,517	35,430	32,134					67,564	101,081	137,259	140,719	137,277
Gross profit	43,891	43,224	46,124	37,887	38,013	38,228	29,899	33,503	84,011	127,235	171,125	139,643	143,072
Expenses:
Marketing, general and administrative		39,223	41,108	32,116					73,224	112,447	157,675	119,724	115,009
Research and development		4,271	3,868	4,336					8,204	12,475	16,836	14,410	13,315
Gain on acquisition contingency			(1,590)						(1,590)	(1,590)	(76,033)	0	0
Asset impairment and abandonments				15							0	2,808	12,016
Asset impairment and abandonments									15	15	97,341	5,070	4,034
Acquisition and integration expenses		3,209	1,953	8,957					10,910	14,119	17,159	4,943	630
Total operating expenses		46,703	45,339	45,424					90,763	137,466	352,981	143,955	113,732
Operating (loss) income		(3,479)	785	(7,537)					(6,752)	(10,231)	(181,856)	(4,312)	29,340
Other (expense) income:
Interest expense		(3,718)	(3,635)	(1,604)					(5,239)	(8,957)	(12,571)	(2,771)	(3,180)
Interest income		4	26	131					157	161	161	35	8
Foreign exchange (loss) gain		(78)	(19)	(31)					(50)	(128)	(139)	(34)	87
Total other expense - net		(3,792)	(3,628)	(1,504)					(5,132)	(8,924)	(12,549)	(3,079)	(3,085)
(Loss) income before income tax (provision) benefit		(7,271)	(2,843)	(9,041)					(11,884)	(19,155)	(194,405)	(7,391)	26,255
Income tax benefit (provision)		2,133	3,031	(310)					2,721	4,854	(17,237)	4,268	(19,349)
Net (loss) income		(5,138)	188	(9,351)					(9,163)	(14,301)	(211,642)	(3,123)	6,906
Convertible preferred dividend		0	0	0					0	0	0	(2,120)	(3,723)
Net (loss) income applicable to common shares	$ (197,340)	(5,138)	188	(9,351)	$ 799	$ 2,997	$ (5,802)	$ (1,117)	(9,163)	(14,301)	(211,642)	(5,243)	3,183
Other comprehensive (loss) income:
Unrealized foreign currency translation loss		(1,122)	395	(393)					2	(1,120)	(351)	(941)	1,987
Comprehensive (loss) income		$ (6,260)	$ 583	$ (9,744)					$ (9,161)	$ (15,421)	$ (211,993)	$ (6,184)	$ 5,170
Net (loss) income per common share - basic	$ (2.63)	$ (0.07)	$ 0	$ (0.14)	$ 0.01	$ 0.04	$ (0.11)	$ (0.03)	$ (0.13)	$ (0.20)	$ (2.91)	$ (0.08)	$ 0.05
Net (loss) income per common share - diluted	$ (2.63)	$ (0.07)	$ 0	$ (0.14)	$ 0.01	$ 0.04	$ (0.11)	$ (0.03)	$ (0.13)	$ (0.20)	$ (2.91)	$ (0.08)	$ 0.05

Restatement of Prior Period Q_7

Restatement of Prior Period Quarterly Financial Statements (Unaudited) - Restated Condensed Consolidated Statement of Cash Flows (Unaudited) (Detail) - USD ($) $ in Thousands	Mar. 08, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Cash flows from operating activities:
Net loss				$ (9,351)	$ (9,163)	$ (14,301)	$ 211,642	$ 3,123	$ (6,906)
Adjustments to reconcile net loss to net cash (used in) provided by operating activities:
Depreciation and amortization expense				4,400	10,308	16,342	22,675	14,579	14,233
Provision for bad debts and product returns				233	899	1,050	2,937	1,721	946
Provision for inventory write-downs				1,530	3,274	5,482	8,493	15,122	5,066
Amortization of deferred revenue				(1,292)	(2,585)	(3,772)	(4,906)	(4,958)	(4,744)
Deferred income tax provision				384	(2,969)	(4,588)	17,066	(4,692)	13,573
Stock-based compensation				1,163	2,430	3,399	4,367	4,745	6,660
Gain on acquisition contingency			$ (1,590)		(1,590)	(1,590)	(76,033)	0	0
Paid in kind interest expense					1,473	2,948	4,408
Other				197	877	1,069	673	1,330	2,392
Change in assets and liabilities:
Accounts receivable				(2,717)	(3,141)	(4,522)	(9,013)	(10,829)	5,116
Inventories				(2,190)	(2,658)	(7,609)	(14,219)	(11,957)	1,610
Accounts payable				(7,329)	(9,751)	(12,684)	974	(8,035)	12,936
Accrued expenses				(2,074)	(2,583)	3,998	(4,489)	827	(5,667)
Deferred revenue				2,000	2,000	2,000	2,000	2,000	2,000
Other operating assets and liabilities				(511)	240	273	1,879	4,036	(10,645)
Net cash (used in) provided by operating activities				(15,557)	(12,939)	(12,505)	(9,456)	17,252	5,788
Cash flows from investing activities:
Purchases of property, plant and equipment				(3,477)	(6,912)	(10,882)	(14,426)	(11,042)	(12,301)
Patent and acquired intangible asset costs				(328)	(1,126)	(1,786)	(2,007)	(3,695)	(2,266)
Cardiothoracic closure business divestiture				(99,921)	(99,921)	(99,692)
Net cash (used in) provided by investing activities				(103,726)	(107,959)	(112,360)	(116,125)	(32,737)	38,251
Cash flows from financing activities:
Proceeds from exercise of common stock options				284	395	395	395	2,356	5,060
Proceeds from long-term obligations				115,000	115,000	118,000	121,500	74,425	6,000
Net (payments) proceeds from short-term obligations				(729)	(729)	(729)
Payments on long-term obligations						(500)	(500)	(71,171)	(43,000)
Payments for treasury stock				(128)	(172)	(204)	(237)	(478)	(3,474)
Net cash provided by (used in) financing activities				114,427	114,494	116,962	120,296	4,093	(35,731)
Effect of exchange rate changes on cash and cash equivalents				(50)	(27)	(96)	(56)	(40)	224
Net decrease in cash and cash equivalents				(4,906)	(6,431)	(7,999)	(5,341)	(11,432)	8,532
Cash and cash equivalents, beginning of period		$ 4,518	6,043	10,949	10,949	10,949	10,949	22,381	13,849
Cash and cash equivalents, end of period		$ 2,950	$ 4,518	6,043	4,518	2,950	5,608	10,949	22,381
Supplemental cash flow disclosure:
Cash paid for interest				557	2,732	4,941	7,121	3,047	3,023
Cash paid for income taxes, net of refunds				(635)	1,982	1,982	(1,994)	(6,403)	12,142
Non-cash acquisition of property, plant and equipment				502	456	817	1,468	$ 1,217	$ 593
Non-cash common stock issuance				60,730	60,730	60,730
Paradigm Spine [Member]
Adjustments to reconcile net loss to net cash (used in) provided by operating activities:
Provision for inventory write-downs							513
Gain on acquisition contingency							$ (72,177)
Cash flows from financing activities:
Proceeds from long-term obligations	$ 100,000
Supplemental cash flow disclosure:
Non-cash acquisition of Paradigm				$ 60,730	$ 60,730	$ 60,730

Restatement of Prior Period Q_8

Restatement of Prior Period Quarterly Financial Statements (Unaudited) - Restated Condensed Consolidated Balance Sheet Amounts (Unaudited) (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Error Corrections and Prior Period Adjustments Revision [Line Items]
Accounts receivable	$ 59,288	$ 56,545	$ 55,540	$ 55,709	$ 48,096	$ 38,441
Inventories - net	124,149	118,336	115,454	115,486	107,655
Prepaid and other current assets	6,769	8,156	8,258	9,399	8,413
Total current assets	195,814	185,987	183,770	186,637	175,113
Non-current inventories - net	6,637	8,374	9,225	10,261
Property, plant and equipment - net	69,890	81,471	79,956	79,500	77,954
Deferred tax assets - net		21,576	20,230	17,114	17,760
Goodwill	55,384	194,838	195,067	194,797	59,798	46,242
Other intangible assets - net	10,492	97,614	100,651	103,006	25,557
Other assets - net	6,292	7,006	7,277	7,653	4,003
Total assets	344,509	596,866	596,176	598,968	360,185
Accounts payable	30,126	17,634	20,600	23,149	26,219
Accrued expenses	33,337	31,714	25,312	25,557	25,865
Total current liabilities	240,388	52,096	50,656	53,531	56,992
Acquisition contingencies	1,130	75,573	75,573	77,163	4,986
Total liabilities	243,535	300,211	294,197	298,909	112,428
Accumulated deficit	(451,179)	(253,839)	(248,701)	(248,889)	(239,537)
Total stockholders' equity	34,564	230,291	235,661	233,787	181,531	$ 181,517	$ 164,062
Total liabilities and stockholders' equity	$ 344,509	596,866	596,176	598,968	$ 360,185
As Previously Reported [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Accounts receivable		56,556	56,163	55,670
Inventories - net		130,913	127,906	114,365
Prepaid and other current assets		8,631	8,733	9,860
Total current assets		199,050	197,320	185,938
Non-current inventories - net		18,345	20,445
Property, plant and equipment - net		81,206	79,691	79,235
Deferred tax assets - net		20,967	19,715	16,778
Goodwill		236,547	271,429	308,345
Other intangible assets - net		24,345	25,269	25,512
Other assets - net		7,271	7,542	7,918
Total assets		587,731	621,411	623,726
Accounts payable		17,800	20,766	23,315
Accrued expenses		31,067	24,668	24,992
Total current liabilities		51,615	50,178	53,132
Acquisition contingencies		63,719	98,372	99,962
Total liabilities		287,876	316,518	321,309
Accumulated deficit		(250,639)	(245,787)	(246,531)
Total stockholders' equity		233,491	238,575	236,145
Total liabilities and stockholders' equity		587,731	621,411	623,726
Restatement Adjustments [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Accounts receivable		(11)	(623)	39
Inventories - net		(12,577)	(12,452)	1,121
Prepaid and other current assets		(475)	(475)	(461)
Total current assets		(13,063)	(13,550)	699
Non-current inventories - net		(9,971)	(11,220)	10,261
Property, plant and equipment - net		265	265	265
Deferred tax assets - net		609	515	336
Goodwill		(41,709)	(76,362)	(113,548)
Other intangible assets - net		73,269	75,382	77,494
Other assets - net		(265)	(265)	(265)
Total assets		9,135	(25,235)	(24,758)
Accounts payable		(166)	(166)	(166)
Accrued expenses		647	644	565
Total current liabilities		481	478	399
Acquisition contingencies		11,854	(22,799)	(22,799)
Total liabilities		12,335	(22,321)	(22,400)
Accumulated deficit		(3,200)	(2,914)	(2,358)
Total stockholders' equity		(3,200)	(2,914)	(2,358)
Total liabilities and stockholders' equity		$ 9,135	$ (25,235)	$ (24,758)

Restatement of Prior Period Q_9

Restatement of Prior Period Quarterly Financial Statements (Unaudited) - Restated Condensed Consolidated Statement of Income Amounts (Unaudited) (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								6 Months Ended	9 Months Ended	12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Error Corrections and Prior Period Adjustments Revision [Line Items]
Revenues	$ 80,068	$ 76,741	$ 81,554	$ 70,021	$ 70,386	$ 70,450	$ 70,385	$ 69,141	$ 151,575	$ 228,316	$ 308,384	$ 280,362	$ 280,349
Costs of processing and distribution		33,517	35,430	32,134					67,564	101,081	137,259	140,719	137,277
Gross profit	$ 43,891	43,224	46,124	37,887	$ 38,013	$ 38,228	$ 29,899	$ 33,503	84,011	127,235	171,125	139,643	143,072
Marketing, general and administrative		39,223	41,108	32,116					73,224	112,447	157,675	119,724	115,009
Total operating expenses		46,703	45,339	45,424					90,763	137,466	352,981	143,955	113,732
Operating (loss) income		(3,479)	785	(7,537)					(6,752)	(10,231)	(181,856)	(4,312)	29,340
(Loss) income before income tax (provision) benefit		(7,271)	(2,843)	(9,041)					(11,884)	(19,155)	(194,405)	(7,391)	26,255
Income tax benefit (provision)		2,133	3,031	(310)					2,721	4,854	(17,237)	4,268	(19,349)
Net (loss) income		(5,138)	188	(9,351)					(9,163)	(14,301)	(211,642)	(3,123)	6,906
Comprehensive (loss) income		$ (6,260)	$ 583	$ (9,744)					$ (9,161)	$ (15,421)	$ (211,993)	$ (6,184)	$ 5,170
Net (loss) income per common share - basic	$ (2.63)	$ (0.07)	$ 0	$ (0.14)	$ 0.01	$ 0.04	$ (0.11)	$ (0.03)	$ (0.13)	$ (0.20)	$ (2.91)	$ (0.08)	$ 0.05
Net (loss) income per common share - diluted	$ (2.63)	$ (0.07)	$ 0	$ (0.14)	$ 0.01	$ 0.04	$ (0.11)	$ (0.03)	$ (0.13)	$ (0.20)	$ (2.91)	$ (0.08)	$ 0.05
As Previously Reported [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Revenues		$ 76,129	$ 82,307	$ 69,741					$ 152,048	$ 228,177
Costs of processing and distribution		34,642	37,562	31,737					69,299	103,941
Gross profit		41,487	44,745	38,004					82,749	124,236
Marketing, general and administrative		37,107	38,993	31,883					70,876	107,983
Total operating expenses		44,587	43,224	45,191					88,415	133,002
Operating (loss) income		(3,100)	1,521	(7,187)					(5,666)	(8,766)
(Loss) income before income tax (provision) benefit		(6,892)	(2,107)	(8,691)					(10,798)	(17,690)
Income tax benefit (provision)		2,040	2,851	(396)					2,455	4,495
Net (loss) income		(4,852)	744	(9,087)					(8,343)	(13,195)
Comprehensive (loss) income		$ (5,974)	$ 1,139	$ (9,480)					$ (8,341)	$ (14,315)
Net (loss) income per common share - basic		$ (0.06)	$ 0.01	$ (0.14)					$ (0.12)	$ (0.18)
Net (loss) income per common share - diluted		$ (0.06)	$ 0.01	$ (0.14)					$ (0.12)	$ (0.18)
Restatement Adjustments [Member]
Error Corrections and Prior Period Adjustments Revision [Line Items]
Revenues		$ 612	$ (753)	$ 280					$ (473)	$ 139
Costs of processing and distribution		(1,125)	(2,132)	397					(1,735)	(2,860)
Gross profit		1,737	1,379	(117)					1,262	2,999
Marketing, general and administrative		2,116	2,115	233					2,348	4,464
Total operating expenses		2,116	2,115	233					2,348	4,464
Operating (loss) income		(379)	(736)	(350)					(1,086)	(1,465)
(Loss) income before income tax (provision) benefit		(379)	(736)	(350)					(1,086)	(1,465)
Income tax benefit (provision)		93	180	86					266	359
Net (loss) income		(286)	(556)	(264)					(820)	(1,106)
Comprehensive (loss) income		$ (286)	$ (556)	$ (264)					$ (820)	$ (1,106)
Net (loss) income per common share - basic		$ (0.01)	$ (0.01)	$ 0					$ (0.01)	$ (0.02)
Net (loss) income per common share - diluted		$ (0.01)	$ (0.01)	$ 0					$ (0.01)	$ (0.02)

Restatement of Prior Period _10

Restatement of Prior Period Quarterly Financial Statements (Unaudited) - Restated Condensed Consolidated Statement of Cash Flows Amounts (Unaudited) (Detail) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended	9 Months Ended	12 Months Ended
	Mar. 31, 2019	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Cash flows from operating activities:
Net income (loss)	$ (9,351)	$ (9,163)	$ (14,301)	$ 211,642	$ 3,123	$ (6,906)
Depreciation and amortization expense	4,400	10,308	16,342	22,675	14,579	14,233
Deferred income tax (provision) benefit	384	(2,969)	(4,588)	17,672	(3,882)	15,606
Accounts receivable	(2,717)	(3,141)	(4,522)	(9,013)	(10,829)	5,116
Inventories	(2,190)	(2,658)	(7,609)	(14,219)	(11,957)	1,610
Accounts payable	(7,329)	(9,751)	(12,684)	974	(8,035)	12,936
Accrued expenses	(2,074)	(2,583)	3,998	(4,489)	827	(5,667)
Other operating assets and liabilities	(511)	240	273	1,879	4,036	(10,645)
Net cash (used in) provided by operating activities	(15,557)	(12,939)	(12,505)	(9,456)	17,252	5,788
Cash flows from financing activities
Payments for treasury stock	(128)	(172)	(204)	(237)	(478)	(3,474)
Net cash used by financing activities	114,427	114,494	116,962	$ 120,296	$ 4,093	$ (35,731)
As Previously Reported [Member]
Cash flows from operating activities:
Net income (loss)	(9,087)	(8,343)	(13,195)
Depreciation and amortization expense	3,696	7,491	11,413
Deferred income tax (provision) benefit	470	(2,703)	(4,229)
Accounts receivable	(2,422)	(3,509)	(4,278)
Inventories	(2,742)	(1,078)	(4,904)
Accounts payable	(7,253)	(9,675)	(12,608)
Accrued expenses	(1,585)	(2,217)	4,329
Other operating assets and liabilities	(593)	145	177
Net cash (used in) provided by operating activities	(15,685)	(13,111)	(12,709)
Cash flows from financing activities
Net cash used by financing activities	114,555	114,666	117,166
Restatement Adjustments [Member]
Cash flows from operating activities:
Net income (loss)	(264)	(820)	(1,106)
Depreciation and amortization expense	704	2,817	4,929
Deferred income tax (provision) benefit	(86)	(266)	(359)
Accounts receivable	(295)	368	(244)
Inventories	552	(1,580)	(2,705)
Accounts payable	(76)	(76)	(76)
Accrued expenses	(489)	(366)	(331)
Other operating assets and liabilities	82	95	96
Net cash (used in) provided by operating activities	128	172	204
Cash flows from financing activities
Payments for treasury stock	(128)	(172)	(204)
Net cash used by financing activities	$ (128)	$ (172)	$ (204)

Schedule II - Valuation and Q_2

Schedule II - Valuation and Qualifying Accounts (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Allowance for Doubtful Accounts [Member]
Valuation And Qualifying Accounts Disclosure [Line Items]
Balance at Beginning of Period	$ 2,660	$ 1,731	$ 1,870
Charged to Costs and Expenses	2,582	1,105	536
Deductions- Write-offs, Payments	144	176	675
Balance at End of Period	5,098	2,660	1,731
Allowance for Product Returns [Member]
Valuation And Qualifying Accounts Disclosure [Line Items]
Balance at Beginning of Period	708	795	582
Charged to Costs and Expenses	60	616	410
Deductions- Write-offs, Payments	138	703	197
Balance at End of Period	630	708	795
Allowance for Excess and Obsolescence [Member]
Valuation And Qualifying Accounts Disclosure [Line Items]
Balance at Beginning of Period	15,353	8,102	14,798
Charged to Costs and Expenses	8,558	15,122	5,066
Deductions- Write-offs, Payments	8,601	7,871	11,762
Balance at End of Period	15,310	15,353	8,102
Deferred Tax Asset Valuation Allowance [Member]
Valuation And Qualifying Accounts Disclosure [Line Items]
Balance at Beginning of Period	3,093	7,258	4,916
Charged to Costs and Expenses	48,415	2,368	1,668
Deductions- Write-offs, Payments	0	6,533	(674)
Balance at End of Period	$ 51,508	$ 3,093	$ 7,258