Surgalign (SRGAQ) 10-Q 30 Jun 20 2020 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2020	Jun. 23, 2020
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q1
Trading Symbol	RTIX
Entity Registrant Name	RTI Surgical Holdings, Inc.
Entity Central Index Key	0001760173
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		74,601,347
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 Quarterly 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

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current Assets:
Cash and cash equivalents	$ 6,557	$ 5,608
Accounts receivable - less allowances of $4,868 at March 31, 2020 and $5,098 at December 31, 2019	54,921	59,288
Inventories - net	126,760	124,149
Prepaid and other current assets	8,422	6,769
Total current assets	196,660	195,814
Non-current inventories - net	5,891	6,637
Property, plant and equipment - net	70,716	69,890
Goodwill	55,384	55,384
Other intangible assets - net	10,023	10,492
Other assets - net	6,396	6,292
Total assets	345,070	344,509
Current Liabilities:
Accounts payable	38,520	30,126
Accrued expenses	37,644	33,337
Current portion of deferred revenue	5,720	2,748
Current portion of short and long-term obligations	175,673	174,177
Total current liabilities	257,557	240,388
Other long-term liabilities	3,633	3,147
Total liabilities	261,190	243,535
Commitments and contingencies (Note 22)
Preferred stock Series A, $.001 par value: 5,000,000 shares authorized; 50,000 shares issued and outstanding	66,456	66,410
Stockholders' equity:
Common stock, $.001 par value: 150,000,000 shares authorized; 75,811,013 and 75,213,515 shares issued and outstanding, respectively	75	75
Additional paid-in capital	499,724	498,438
Accumulated other comprehensive loss	(7,999)	(7,629)
Accumulated deficit	(469,042)	(451,179)
Less treasury stock, 1,334,597 and 1,285,224 shares, respectively, at cost	(5,334)	(5,141)
Total stockholders' equity	17,424	34,564
Total liabilities and stockholders' equity	$ 345,070	$ 344,509

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Statement Of Financial Position [Abstract]
Accounts receivable, allowances	$ 4,868	$ 5,098
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	75,811,013	75,213,515
Common stock, shares outstanding	75,811,013	75,213,515
Treasury stock, shares	1,334,597	1,285,224

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Income Statement [Abstract]
Revenues	$ 73,726	$ 70,021
Costs of processing and distribution	33,273	32,134
Gross profit	40,453	37,887
Expenses:
Marketing, general and administrative	39,217	32,116
Research and development	4,282	4,336
Asset impairment and abandonments	1,879	15
Other general expenses	3,436
Transaction and integration expenses	9,280	8,957
Total operating expenses	58,094	45,424
Operating loss	(17,641)	(7,537)
Other (expense) income:
Interest expense	(3,565)	(1,604)
Interest income	50	131
Foreign exchange loss	(246)	(31)
Total other expense - net	(3,761)	(1,504)
Loss before income tax benefit (expense)	(21,402)	(9,041)
Income tax benefit (expense)	3,539	(310)
Net loss	(17,863)	(9,351)
Net loss applicable to common shares	(17,863)	(9,351)
Other comprehensive (loss) gain:
Unrealized foreign currency translation loss	(370)	(393)
Comprehensive loss	$ (18,233)	$ (9,744)
Net loss per common share - basic	$ (0.24)	$ (0.14)
Net loss per common share - diluted	$ (0.24)	$ (0.14)
Weighted average shares outstanding - basic	75,847,046	65,675,203
Weighted average shares outstanding - diluted	75,847,046	65,675,203

Condensed Consolidated Statem_2

Condensed Consolidated Statement of Stockholders' Equity - USD ($) $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Other Comprehensive Loss [Member]	Accumulated Deficit [Member]	Treasury Stock [Member]
Beginning Balance at Dec. 31, 2018	$ 181,531	$ 64	$ 433,143	$ (7,270)	$ (239,537)	$ (4,869)
Net loss	(9,351)				(9,351)
Foreign currency translation adjustment	(393)			(393)
Exercise of common stock options	284		284
Equity instruments issued in connection with Paradigm Spine acquisition - net of fees	60,730	11	60,719
Stock-based compensation	1,163		1,163
Purchase of treasury stock	(130)					(130)
Amortization of preferred stock series A issuance costs	(46)		(46)
Ending Balance at Mar. 31, 2019	233,788	75	495,263	(7,663)	(248,888)	(4,999)
Beginning Balance at Dec. 31, 2019	34,564	75	498,438	(7,629)	(451,179)	(5,141)
Net loss	(17,863)				(17,863)
Foreign currency translation adjustment	(370)			(370)
Exercise of common stock options	20		20
Stock-based compensation	1,310		1,310
Purchase of treasury stock	(193)					(193)
Amortization of preferred stock series A issuance costs	(44)		(44)
Ending Balance at Mar. 31, 2020	$ 17,424	$ 75	$ 499,724	$ (7,999)	$ (469,042)	$ (5,334)

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Cash flows from operating activities:
Net loss	$ (17,863)	$ (9,351)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization expense	2,239	4,400
Provision for bad debts and product returns	406	233
Provision for inventory write-downs	517	1,530
Amortization of deferred revenue	(1,188)	(1,292)
Deferred income tax benefit	(383)	384
Stock-based compensation	1,310	1,163
Asset impairment and abandonments	1,879	15
Paid in kind interest expense	1,415
Other	277	197
Change in assets and liabilities:
Accounts receivable	3,853	(2,717)
Inventories	(2,706)	(2,190)
Accounts payable	9,437	(7,329)
Accrued expenses	4,412	(2,074)
Deferred revenue	4,161	2,000
Other operating assets and liabilities	(1,250)	(511)
Net cash provided by (used in) operating activities	6,516	(15,557)
Cash flows from investing activities:
Purchases of property, plant and equipment	(5,084)	(3,477)
Patent and acquired intangible asset costs	(286)	(328)
Net cash used in investing activities	(5,370)	(103,726)
Cash flows from financing activities:
Proceeds from exercise of common stock options	20	284
Proceeds from long-term obligations		115,000
Payments of debt issuance costs		(729)
Payments for treasury stock	(193)
Other financing activities		(128)
Net cash (used in) provided by financing activities	(173)	114,427
Effect of exchange rate changes on cash and cash equivalents	(24)	(50)
Net increase (decrease) in cash and cash equivalents	949	(4,906)
Cash and cash equivalents, beginning of period	5,608	10,949
Cash and cash equivalents, end of period	6,557	6,043
Supplemental cash flow disclosure:
Cash paid for interest	2,081	557
Income tax refunds, net of payments	(1,695)	(635)
Non-cash acquisition of property, plant and equipment	$ 247	502
Non-cash common stock issuance		60,730
Paradigm Spine [Member]
Cash flows from investing activities:
Payments to acquire businesses		(99,921)
Supplemental cash flow disclosure:
Non-cash acquisition of Paradigm Spine		$ 60,730

Operations and Organization

Operations and Organization	3 Months Ended
	Mar. 31, 2020
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Operations and Organization	1. Operations and Organization RTI Surgical Holdings, Inc. and Subsidiaries (defined as the “Company” for matters occurring after March 8, 2019) COVID-19 The coronavirus (COVID-19) pandemic, as well as the corresponding governmental response and the Company’s management of the crisis has had a significant impact on the Company’s business. The consequences of the outbreak and impact on the economy continues to evolve and the full extent of the impact is uncertain as of the date of this filing. The outbreak has already brought a significant disruption to the operations of the Company. Hospitals and other medical facilities have canceled elective surgeries, reduced and diverted staffing and diverted resources to patients suffering from the infectious disease and limited hospital access for non-patients, including our direct and indirect sales representatives. Because of the COVID-19 pandemic, surgeons and their patients are required, or are choosing, to defer procedures in which our products otherwise would be used, and many facilities that specialize in the procedures in which our products otherwise would be used have closed or reduced operating hours. These circumstances have negatively impacted the ability of our employees and distributors to effectively market and sell our products. In addition, even after the pandemic has subsided and/or governmental orders no longer prohibit or recommend against performing such procedures, patients may continue to defer such procedures out of concern of being exposed to coronavirus or for other reasons. The COVID-19 pandemic has also caused adverse effects on general commercial activity and the global economy, which has led to an economic slowdown or recession, and which has adversely affected our business, operating results or financial condition. The adverse effect of the pandemic on the broader economy has also negatively affected demand for procedures using our products, and could cause one or more of our distributors, customers, and suppliers to experience financial distress, cancel, postpone or delay orders, be unable to perform under a contract, file for bankruptcy protection, go out of business, or suffer disruptions in their business. This could impact our ability to manufacture and provide products and otherwise operate our business, as well as increase our costs and expenses. The COVID-19 pandemic has also led to and could continue to lead to severe disruption and volatility in the global capital markets, which could increase our cost of future capital and adversely affect our ability to access the capital markets in the future. The above and other continued disruptions to our business as a result of COVID-19 has resulted in a material adverse effect on our business, operating results and financial condition. The full extent to which the COVID-19 pandemic will impact our business will depend on future developments that are highly uncertain and cannot be accurately predicted, including the possibility that new adverse information may emerge concerning COVID-19 and additional actions to contain it or treat its impact may be required. In response to the COVID-19 novel coronavirus pandemic and the resulting federal and local guidelines, on March 31, 2020, the Company notified employees that it will furlough or reduce the hours of over 500 of its U.S.-based employees, beginning on April 6, 2020. While many of those employees have returned to work, the Company cannot predict when it will be able to fully resume normal operations and will continue to carefully monitor the situation and the needs of the business. In addition, most current employees have taken base salary reductions until business conditions improve.

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2020
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Basis of Presentation	2. Basis of Presentation The accompanying unaudited condensed consolidated financial statements include all adjustments, consisting of normal recurring accruals, which the Company considers necessary for a fair presentation of the results of operations for the periods shown. The condensed consolidated financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X, and, therefore, do not include all information and footnotes necessary for a fair presentation of condensed consolidated financial position, results of operations, comprehensive loss and cash flows in conformity with accounting principles generally accepted in the United States of America (“GAAP”). All intercompany balances and transactions have been eliminated in consolidation. The condensed consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries, RTI Surgical, Inc. (defined as “Legacy RTI” for matters occurring after March 8, 2019, and as the “Company” for matters occurring before March 8, 2019), Paradigm Spine, LLC (“Paradigm”), Pioneer Surgical Technology, Inc. (“Pioneer Surgical”), Tutogen Medical, Inc. (“TMI”), and Zyga Technology, Inc. (“Zyga”). The condensed consolidated financial statements also include the accounts of RTI Donor Services, Inc. (“RTIDS”), which is a controlled entity. Prior to the completion of the acquisition of Paradigm, the financial statements were that of RTI Surgical Inc. and subsidiaries. Subsequently, RTI Surgical Holdings, Inc. and Subsidiaries is the successor reporting company. 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 March 31, 2020, we had cash of $6,557, a working capital deficiency of $60,897 and a net loss of $17,863 for the quarter ended March 31, 2020. 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 was unable to maintain compliance with its financial covenant (Leverage Ratio (as defined below)) for the quarter ended March 31, 2020, in relation to the Ares Term Loan agreements. 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. An inability to maintain compliance with any financial covenant, constitutes an event of default for which the Company’s lenders could demand repayment of the obligations at any time. Should the sale of the OEM Business, as discussed in Note 22, Commitments and Contingencies - Sale of the OEM Business, 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.

Recently Issued Accounting Stan

Recently Issued Accounting Standards	3 Months Ended
	Mar. 31, 2020
Accounting Changes And Error Corrections [Abstract]
Recently Issued Accounting Standards	3. In March 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting (“ASU 2020-04”), which provides optional expedients and exceptions for applying U.S. GAAP to contracts, hedging relationships and other transactions affected by the discontinuation of the London Interbank Offered Rate (LIBOR) and other interbank offered rates. This guidance is effective beginning on March 12, 2020 through December 31, 2022. The Company adopted ASU 2020-04 and it did not have an impact on its condensed consolidated financial statements. In May 2019, the FASB ASU Financial Instruments — Credit Losses (Topic 326) 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 Financial Instruments — Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities; Financial Instruments — Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities, In June 2016, the FASB issued ASU 2016-13, Financial Instruments — Credit Losses (Topic326): Measurement of Credit Losses on Financial Instruments Credit losses for trade receivables is determined based on historical information, current information and reasonable and supportable forecasts. The Company has concluded that the adoption of the standard was not material as the composition of the trade receivables at the reporting date is consistent with that used in developing the historical credit-loss percentages. Further, the risk characteristics of the Company’s customer and composition of the portfolio have not changed significantly over time. In August 2018, the FASB issued Accounting Standards Update (“ASU”) 2018-13, “Fair Value Measurement (Topic 820): Disclosure Framework — Changes to the Disclosure Requirements for Fair Value Measurement.”

Leases

Leases	3 Months Ended
	Mar. 31, 2020
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 March 31, 2020. The Company’s leases have remaining lease terms of 1 to 9 years, some of which include options to extend or terminate the leases. The option to extend 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 on the condensed consolidated balance sheet. The current portion of operating lease liabilities are presented within accrued expenses, and the non-current portion of operating lease liabilities are presented within other long-term liabilities on the condensed consolidated balance sheet. 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 Three Months Ended For the Three Months Ended March 31, 2020 March 31, 2019 Operating lease cost $ 376 $ 344 Short-term operating lease cost — 36 Total operating lease cost $ 376 $ 380 Supplemental cash flow information related to operating leases was as follows: For the Three Months Ended For the Three Months Ended March 31, 2020 March 31, 2019 Cash paid for amounts included in the measurement of lease liabilities $ 374 $ 294 ROU assets obtained in exchange for lease obligations — 34 Supplemental balance sheet information related to operating leases was as follows: Balance at Balance at Balance Sheet Classification March 31, 2020 December 31, 2019 Assets: Right-of-use assets Other assets - net $ 2,205 $ 2,155 Liabilities: Current Accrued expenses $ 1,132 $ 1,159 Noncurrent Other long-term liabilities 1,629 1,547 Total operating lease liabilities $ 2,761 $ 2,706 As of March 31, 2020, the weighted-average remaining lease term was 4.5 years. The Company’s lease agreements do not provide a readily determinable implicit rate nor is it available to the Company from its lessors. Instead, 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 March 31, 2020. As of March 31, 2020, maturities of operating lease liabilities were as follows: Balance at Maturity of Operating Lease Liabilities March 31, 2020 2020 (remaining) $ 1,021 2021 774 2022 297 2023 160 2024 159 2025 and beyond 716 Total future minimum lease payments 3,127 Less imputed interest (366 ) Total $ 2,761

Segment Reporting

Segment Reporting	3 Months Ended
	Mar. 31, 2020
Segment Reporting [Abstract]
Segment Reporting	5. Segment Reporting The Company has determined its operating segments in accordance with ASC 280 - Segment Reporting. 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. 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. The Company is now organized into two distinct groupings, Spine and OEM, which are also our operating and reportable segments. As the adoption of the new structure was done in the fourth quarter of 2019, the comparative period of March 31, 2019 has been restated to conform to the new segment presentation. 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 three months ended March 31, 2020 and 2019 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 percent or more of our consolidated Property, Plant and Equipment. For the Three Months Ended March 31, 2020 2019 Revenues: Spine $ 27,109 $ 24,377 OEM 46,617 45,644 Total $ 73,726 $ 70,021 Depreciation and amortization: Spine $ 91 $ 2,400 OEM 2,148 2,000 Total $ 2,239 $ 4,400 Operating income (loss) Spine $ (9,179 ) $ (4,323 ) OEM 6,133 5,758 Unallocated corporate costs Asset impairment and abandonments 1,879 15 Other general expenses 3,436 - Transaction and integration expenses 9,280 8,957 Total unallocated corporate costs 14,595 8,972 Operating loss $ (17,641 ) $ (7,537 ) Interest expense (3,565 ) (1,604 ) Interest income 50 131 Foreign exchange loss (246 ) (31 ) Loss before income tax benefit (expense) $ (21,402 ) $ (9,041 ) The following table presents revenues by geographic location: For the Three Months Ended March 31, 2020 2019 (In thousands) Revenues: North America $ 66,813 $ 63,054 EMEA 5,735 5,583 Asia Pacific 919 482 Latin America 259 902 Total revenues $ 73,726 $ 70,021 The following table presents percentage of total revenues derived from the Company’s largest distributors: For the Three Month Ended March 31, 2020 2019 Percent of revenues derived from: Distributor Zimmer Biomet Holdings, Inc. 17 % 21 % Medtronic, PLC 6 % 8 % DePuy Synthes 6 % 4 % 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. 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	3 Months Ended
	Mar. 31, 2020
Revenue From Contract With Customer [Abstract]
Revenue from Contracts with Customers	6. 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 for the three months ended March 31, 2020 and 2019: For the Three Month Ended March 31, 2020 2019 Revenues: Spine Segment Domestic $ 22,276 $ 20,219 International 4,833 4,158 OEM Segment OEM 30,217 28,999 Sports 14,320 13,836 International 2,080 2,809 Total revenues from contracts with customers $ 73,726 $ 70,021 The following table presents revenues recognized at a point in time and over time for the three months ended March 31, 2020 and 2019: For the Three Month Ended March 31, 2020 2019 Revenue recognized at a point in time $ 55,109 $ 54,096 Revenue recognized over time 18,617 15,925 Total revenues from contracts with customers $ 73,726 $ 70,021 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 condensed consolidated financial statements. The opening and closing balances of the Company’s accounts receivable, contract asset and current and long-term contract liability for the three months ended March 31, 2020 and 2019 are as follows: Contract Contract Liability Accounts Liability (Long- Receivable (Current) Term) Opening Balance, January 1, 2020 $ 59,288 $ 3,378 $ - Closing Balance, March 31, 2020 54,921 6,237 - Increase/(decrease) (4,367 ) 2,859 - Contract Contract Liability Accounts Liability (Long- Receivable (Current) Term) Opening Balance, January 1, 2019 $ 48,096 $ 5,425 $ 744 Closing Balance, March 31, 2019 55,709 5,498 1,535 Increase/(decrease) 7,613 73 791 As of March 31, 2020 and December 31, 2019, $9,281 and $10,633 of unbilled receivables in connection with our exclusively built inventory contracts are included in accounts receivable.

Acquisition of Paradigm Spine,

Acquisition of Paradigm Spine, LLC	3 Months Ended
	Mar. 31, 2020
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 share of Company common stock , par value $0.001 per share; (ii) each share of Series A convertible preferred 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 share of Series A convertible preferred stock, par value $0.001 per share, of the Company; and (iii) each stock option and restricted stock award granted by Legacy RTI was converted into a stock option or restricted stock award, as applicable, of the Company with respect to an equivalent number of shares of the Company common stock on the same terms and conditions as were applicable prior to the closing. 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 related to the revenue-based earnout of $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 f The Company has accounted for the acquisition of Paradigm under Accounting Standards Codification (“ASC”) 805, Business Combinations The purchase price was financed as follows: (In thousands) 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 (In thousands) 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 inventory of $10,525. Total net assets acquired as of March 8, 2019, were all part of the Company’s only operating segment at that time. 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® Interlaminar Stabilization® device. Coflex is a differentiated and minimally invasive motion preserving stabilization implant that is FDA PMA-approved for the treatment of moderate to severe lumbar spinal stenosis (“LSS”) in conjunction with decompression. • Coflex allows the Company to provide surgeons who treat patients with moderate to severe LSS with a PMA-approved device supported by more than 12 years of clinical data. These potential benefits resulted in the Company paying a premium for Paradigm resulting in the recognition of $135,589 of goodwill assigned to the Company’s only operating segment and reporting unit at the time of the Paradigm acquisition. The amount of Paradigm’s revenues and net loss since the March 8, 2019, acquisition date, included in the Company’s condensed consolidated statement of comprehensive (loss) gain for the three months ended March 31, 2019, excluding acquisition and integration related costs of approximately $8,957, are $1,992 and $95, respectively. 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, 2019, (in thousands): For the Three Months Ended March 31, 2019 Revenues $ 8,970 Net loss applicable to common shares (6,803 ) 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.

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
	Mar. 31, 2020
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock-Based Compensation	8. 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 contractual terms and vest over a one to five-year period from the date of grant. The Company’s policy is to grant restricted stock awards at a fair value equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s restricted stock awards generally vest over one to three-year periods. 2018 Incentive Compensation Plan – On April 30, 2018, the Company’s stockholders approved and adopted the 2018 Incentive Compensation Plan (the “2018 Plan”). The 2018 Plan provides for the grant of incentive and nonqualified stock options and restricted stock to key employees, including officers and directors of the Company and consultants and advisors. The 2018 Plan allows for up to 5,726,035 shares of common stock to be issued with respect to awards granted. Stock Options As of March 31, 2020, there was $2,915 of total unrecognized stock-based compensation related to nonvested stock options. The expense related to these stock options is expected to be recognized over a weighted-average period of 3.64 years. The following table summarizes information about stock options outstanding, exercisable and available for grant as of March 31, 2020: Weighted Weighted Average Average Remaining Aggregate Number of Exercise Contractual Intrinsic Shares Price Life (Years) Value Outstanding at January 1, 2020 4,536,461 $ 3.75 Granted 742,693 4.21 Exercised (5,000 ) 4.02 Forfeited or expired (27,169 ) 4.84 Outstanding at March 31, 2020 5,246,985 $ 3.81 4.36 $ - Vested or expected to vest at March 31, 2020 4,808,298 $ 3.78 4.06 $ - Exercisable at March 31, 2020 1,378,307 $ 3.66 2.78 $ - Available for grant at March 31, 2020 2,546,823 The aggregate intrinsic value in the table above represents the total pre-tax intrinsic value of stock options for which the fair market value of the underlying common stock exceeded the respective stock option exercise price. Estimated forfeitures are based on the Company’s historical forfeiture activity. Compensation expense recognized for all option grants is net of estimated forfeitures and is recognized over the awards’ respective requisite service periods. Other information concerning stock options are as follows: For the Three Months Ended March 31, 2020 2019 Weighted average fair value of stock options granted $ 3.02 $ 1.98 Aggregate intrinsic value of stock options exercised 3 140 The aggregate intrinsic value of stock options exercised in a period represents the pre-tax cumulative difference, for the stock options exercised during the period, between the fair market value of the underlying common stock and the stock option exercise prices. Restricted Stock Awards As of March 31, 2020, there was $4,942 of total unrecognized stock-based compensation related to unvested restricted stock awards. That expense is expected to be recognized on a straight-line basis over a weighted-average period of 1.89 years. The following table summarizes information about unvested restricted stock awards as of March 31, 2020: Weighted Average Number of Grant Date Shares Fair Value Unvested at January 1, 2020 1,227,858 $ 4.34 Granted 916,803 4.22 Vested (373,891 ) 4.58 Forfeited (22,301 ) 4.65 Unvested at March 31, 2020 1,748,469 $ 4.22 Restricted Stock Units As of March 31, 2020, there was $691 of total unrecognized stock-based compensation related to unvested restricted stock units. That expense is expected to be recognized on a straight-line basis over a weighted-average period of 1.75 years. The following table summarizes information about unvested restricted stock units as of March 31, 2020: Weighted Average Number of Grant Date Shares Fair Value Unvested at January 1, 2020 184,582 $ 7.41 Granted — — Vested — — Forfeited — — Unvested at March 31, 2020 184,582 $ 7.41 For the three months ended March 31, 2020 and 2019, the Company recognized stock-based compensation as follows: For the Three Month Ended March 31, 2020 2019 Stock-based compensation: Costs of processing and distribution $ 36 $ 36 Marketing, general and administrative 1,259 1,112 Research and development 15 15 Total $ 1,310 $ 1,163

Net Income Per Common Share

Net Income Per Common Share	3 Months Ended
	Mar. 31, 2020
Earnings Per Share [Abstract]
Net Income Per Common Share	9. Net Income Per Common Share A reconciliation of the number of shares of common stock used in the calculation of basic and diluted net income per common share is presented below: For the Three Month Ended March 31, 2020 2019 Basic shares 75,847,046 65,675,203 Effect of dilutive securities: Stock options — — Diluted shares 75,847,046 65,675,203 For the three months ended March 31, 2020 and 2019, approximately 2,837,404 and 1,422,304, respectively, of issued stock options were not included in the computation of diluted net loss per common share because they were anti-dilutive because their exercise price exceeded the market price. For the three months ended March 31, 2020 and 2019, options to purchase 313,010 and 806,802, respectively, shares of common stock were not included in the computation of diluted loss per share because dilutive shares are not factored into this calculation when net loss is reported. For the three months ended March 31, 2020 and 2019

Inventories

Inventories	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Inventories	10. Inventories Inventories by stage of completion are as follows: March 31, December 31, 2020 2019 Unprocessed tissue, raw materials and supplies $ 29,699 $ 29,552 Tissue and work in process 36,511 35,740 Implantable tissue and finished goods 66,441 65,494 Total 132,651 130,786 Less current portion 126,760 124,149 Long-term portion $ 5,891 $ 6,637 For the three months ended March 31, 2020 and 2019, the Company had inventory write-downs of $517 and $1,530, respectively, relating primarily to product obsolescence. As of March 31, 2020, the long-term portion of inventory relates to finished goods.

Prepaid and Other Current Asset

Prepaid and Other Current Assets	3 Months Ended
	Mar. 31, 2020
Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract]
Prepaid and Other Current Assets	11. Prepaid and Other Current Assets Prepaid and Other Current Assets are as follows: March 31, December 31, 2020 2019 Income tax receivable $ 3,963 $ 2,803 Prepaid expenses 4,081 1,865 Other 378 2,101 $ 8,422 $ 6,769

Property, Plant and Equipment

Property, Plant and Equipment	3 Months Ended
	Mar. 31, 2020
Property Plant And Equipment [Abstract]
Property, Plant and Equipment	12. Property, Plant and Equipment Property, plant and equipment are as follows: March 31, December 31, 2020 2019 Land $ 1,988 $ 2,005 Buildings and improvements 57,954 58,208 Processing equipment 46,889 45,762 Surgical instruments 696 541 Office equipment, furniture and fixtures 1,669 1,730 Computer equipment and software 20,615 20,521 Construction in process 13,170 11,717 142,981 140,484 Less accumulated depreciation (72,265 ) (70,594 ) $ 70,716 $ 69,890 For the three months ended March 31, 2020 and 2019, the Company had depreciation expense in connection with property, plant and equipment of $1,766 and $3,443, respectively. For the three months ended March 31, 2020, the Company recorded asset impairment and abandonment charges of $1,879, related to property, plant and equipment in the Spine segment. The Spine asset group could not support the newly capitalized carrying amount of the property, plant and equipment, because the Spine asset group has projected negative cash flows over the weighted average useful life of the long-lived assets in the asset group. The fair value of property and equipment was measured utilizing an orderly liquidation value of each of the underlying assets.

Goodwill

Goodwill	3 Months Ended
	Mar. 31, 2020
Goodwill And Intangible Assets Disclosure [Abstract]
Goodwill	13. Goodwill The change in the carrying amount of goodwill for the three months ended March 31, December 31, 2020 2019 Balance at January 1 $ 55,384 $ 59,798 Goodwill acquired related to Paradigm acquisition — 135,589 Goodwill impairment - (140,003 ) Balance at end of period $ 55,384 $ 55,384 On March 8, 2019, we acquired Paradigm for a purchase price of approximately $232,907 and recorded goodwill of approximately $135,589. The goodwill arising from the Paradigm acquisition was specifically allocated to the Spine reporting unit. For the impairment test performed in 2019, it was concluded the fair value of goodwill is substantially in excess of our carrying value. For the Spine reporting unit test for the year ended December 31, 2019, it was concluded the carrying value was in excess of the fair value of goodwill and we recorded an impairment charge of all the goodwill in the Spine reporting unit totaling $140,003.

Other Intangible Assets

Other Intangible Assets	3 Months Ended
	Mar. 31, 2020
Goodwill And Intangible Assets Disclosure [Abstract]
Other Intangible Assets	14. Other intangible assets are as follows: March 31, 2020 December 31, 2019 Gross Net Gross Net Carrying Accumulated Carrying Carrying Accumulated Carrying Amount Amortization Amount Amount Amortization Amount Patents $ 5,118 $ 2,867 $ 2,251 $ 5,095 $ 2,768 $ 2,327 Acquired licensing rights 1,413 109 1,304 1,413 64 1,349 Marketing and procurement and other intangible assets 16,495 10,027 6,468 16,488 9,672 6,816 Total $ 23,026 $ 13,003 $ 10,023 $ 22,996 $ 12,504 $ 10,492 For the three months ended March 31, 2020 and 2019, the Company had amortization expense of other intangible assets of $473 and $957, respectively. At March 31, 2020, management’s estimates of future amortization expense for the next five years are as follows: Amortization Expense 2020 (remaining) 1,725 2021 2,300 2022 2,300 2023 700 2024 700 2025 700

Fair Value Information

Fair Value Information	3 Months Ended
	Mar. 31, 2020
Fair Value Disclosures [Abstract]
Fair Value Information	15. 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. Long-lived assets, including property and equipment subject to amortization were impaired and written down to their estimated fair values during the first quarter of 2020. Fair value is measured as of the impairment date using Level 3 inputs. For the 2020 impairments, the long-lived asset level 3 fair value was measured base on orderly liquidation value for the Property, plant and equipment. 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). The following table summarizes impairments of long-lived assets and the related post impairment fair values of the corresponding assets for the three months ended March 31, 2020. For the three Months Ended March 31, 2020 Impairment Fair Value Property, plant and equipment - net 1,879 - $ 1,879 $ -

Accrued Expenses

Accrued Expenses	3 Months Ended
	Mar. 31, 2020
Other Liabilities Disclosure [Abstract]
Accrued Expenses	1 6 . Accrued Expenses Accrued expenses are as follows: March 31, December 31, 2020 2019 Accrued compensation $ 7,795 $ 5,435 Accrued severance and restructuring costs - 136 Accrued distributor commissions 3,868 4,569 Accrued donor recovery fees 8,161 8,921 Accrued leases 1,132 1,159 Accrued transactions and integration expenses 3,170 2,555 Other 13,518 10,562 $ 37,644 $ 33,337

Short and Long-Term Obligations

Short and Long-Term Obligations	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Short and Long-Term Obligations	17. Short and Long-Term Obligations Short and long-term obligations are as follows: March 31, December 31, 2020 2019 Ares Term loan $ 105,822 $ 104,406 JPM Facility 71,000 71,000 Less unamortized debt issuance costs (1,149 ) (1,229 ) Total 175,673 174,177 Less current portion 175,673 174,177 Long-term portion $ - $ - On June 5, 2018, the Company, along with its wholly-owned subsidiary, Pioneer Surgical, entered into that certain Credit Agreement (the “2018 Credit Agreement”), as borrowers, with JPMorgan Chase Bank, N.A. (“JPM”), 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, and later increased to $80,000, in each case, as described below). The Company and Pioneer Surgical will be able to, at their option, request an increase to the JPM Facility in an amount not to exceed $50,000, subject to customary conditions and the approval of JPM and the JPM Lender providing such increase amount. 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 Company may elect to apply either the CBFR or Eurodollar rate to any borrowing. The CBFR loans will bear interest at a rate per annum equal to the monthly REVLIBOR30 Rate plus the Adjusted LIBO 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. The applicable margin was subject to adjustment after the end of each fiscal quarter, based upon the Company’s average quarterly availability (subsequently modified by the Fourth Amendment to the 2018 Credit Agreement (as defined below)). The maturity date of the JPM Facility is June 5, 2023 (subsequently modified by the Fourth Amendment to the 2018 Credit Agreement (as defined below)). 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”) on each JPM Calculation Date (as defined below) 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 as 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 The Company entered into a Second Amendment to Credit 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 March 31, 2020, the interest rate applicable to CBFR loans and Eurodollars under the JPM Facility was 3.58%. As of March 31, 2020, 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 March 31, 2020. 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 Capital Corporation (“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”) (subsequently increased to $130,000 as described below). The Ares Term Loan was advanced in a single borrowing on March 8, 2019 (other than any increase thereto as described below). 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”) (as the Base Rate and the Ares Eurodollar Rate were subsequently modified as described below). 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’ Leverage Ratio (as subsequently modified as described below). At any time during the period commencing on March 8, 2019 and ending on March 8, 2021, if the Ares Loan Parties’ Leverage Ratio is greater than 4.50:1.00, 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’ 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 JPM 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 each 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 Ares Loan Parties are required to maintain an initial 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 (as subsequently modified as described below), 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 March 31, 2020, the interest rate for the Ares Term Loan was 10.41%. The Company was in compliance with the financial covenants related to the Ares Term Loan as of March 31, 2020. For the three months ended March 31, 2020 and 2019, i nterest expense associated with the amortization of debt issuance costs was As of March 31, 2020, the Company had approximately $6,557 of cash and cash equivalents and $9,000 of availability under the 2018 Credit Agreement. For the three months ended March 31, 2020, the Company provided approximately $6,516 of cash in its operations. The 2019 Credit Agreement contains a debt to EBITDA covenant, which requires the Company to maintain a 5.75:1 Leverage Ratio for each quarter ending in 2020, including the fiscal quarter ended March 31, 2020. The 2019 Credit Agreement provides that the Leverage Ratio reduces to 5.25:1 for the quarters ending March 31, 2021 and June 30, 2021, with a final reduction to 3.50:1 for each quarter ending thereafter. Our Leverage Ratio as of March 31, 2020 is approximately 5.98:1. The Company was unable to comply with the debt to EBITDA covenant leverage ratio, and this event constitutes an event of default for which the Company’s lender could demand repayment of these obligations at any time. 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 Term Loan, each of JPM, the JPM Lenders, Ares and the Ares Lenders, 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, the JPM Lenders, Ares and the Ares Lenders also agreed to waive the requirement with respect to the going concern qualification.

Other long-term liabilities

Other long-term liabilities	3 Months Ended
	Mar. 31, 2020
Other Liabilities Noncurrent [Abstract]
Other long-term liabilities	1 8 . Other long-term liabilities Other long-term liabilities are as follows: March 31, December 31, 2020 2019 Acquisition contingencies $ 1,130 $ 1,130 Lease obligations 1,629 1,547 Other 874 470 $ 3,633 $ 3,147 Acquisition contingencies represent the Company’s fair value estimate of the Zyga acquisition clinical and revenue

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2020
Income Tax Disclosure [Abstract]
Income Taxes	1 9 . Income Taxes 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. Accordingly, the Company has recorded valuation allowances in the amount of $55,488 and $51,508 at March 31, 2020 and December 31, 2019, respectively. In making this determination, numerous factors were considered including the going-concern evaluation. On March 27, 2020, the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) was enacted by the United States Congress. As a result of the enactment of the CARES Act, net operating losses (“NOL’s”) can now be carried back for five years and resulted in the Company recognizing approximately $3.5 million of a tax receivable.

Preferred Stock

Preferred Stock	3 Months Ended
	Mar. 31, 2020
Equity [Abstract]
Preferred Stock	20 . Preferred Stock 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 accrued 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. On August 1, 2018, the Company and Water Street, 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 the amendment qualifies as modification accounting to the preferred shares, which did not result in a change in the valuation of the shares. Preferred stock is as follows: Preferred Stock Liquidation Preferred Stock Issuance Net Value Costs Total Balance at January 1, 2020 $ 66,519 $ (109 ) $ 66,410 Amortization of preferred stock issuance costs — 46 46 Balance at March 31, 2020 $ 66,519 $ (63 ) $ 66,456 Preferred Stock Liquidation Preferred Stock Issuance Net Value Costs Total Balance at January 1, 2019 $ 66,519 $ (293 ) $ 66,226 Amortization of preferred stock issuance costs — 46 46 Balance at March 31, 2019 $ 66,519 $ (247 ) $ 66,272

Severance and Restructuring Cos

Severance and Restructuring Costs	3 Months Ended
	Mar. 31, 2020
Employee Severance [Member]
Severance and Restructuring Costs	21. Severance and Restructuring Costs As part of the acquisition of Paradigm in 2019, management implemented a plan for which remaining outstanding balances at December 31, 2019 were fully paid out at March 31, 2020 Accrued severance and restructuring costs at January 1, 2020 $ 136 Severance and restructuring costs accrued in 2020 - Subtotal severance and restructuring costs 136 Severance and restructuring related cash payments (136 ) Accrued severance and restructuring charges at March 31, 2020 $ -

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	2 2 . Commitments and Contingencies 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 for the year ended December 31, 2019, filed with the SEC on June 8, 2020, in each case for clauses (a) and (b), as currently produced at RTI’s facilities in Alachua, Florida; Marquette, Michigan; Greenville, North Carolina; and Tutogen Medical GmbH’s facility in Neunkirchen, Germany (together, the “OEM Business”; provided that the “OEM Business” shall not be deemed to include the marketing, sale or direct distribution of surgical implants, instruments, or biologics used in the treatment of conditions affecting the spine (x) as represented by RTI’s “Spine” or “International” lines of business and (y) as otherwise described in RTI Surgical, Inc.’s Annual Report on Form 10-K for the year ended December 31, 2018, filed with the SEC on March 5, 2019), for a purchase price of $440 million, subject to certain adjustments. More specifically, pursuant to the terms of the OEM Purchase Agreement, the Company will sell all of the issued and outstanding shares of RTI OEM, LLC (which, prior to the Sale, is required to convert to a corporation and change its name to “RTI Surgical, Inc.”), Tutogen Medical (United States), Inc. and Tutogen Medical GmbH (the “OEM Companies” and, together with a wholly-owned subsidiary, RTI Donor Services, Inc., the “OEM Group Companies”). 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. Agreement to Acquire Paradigm – On March 8, 2019, pursuant to the Master Transaction Agreement, the Company acquired Paradigm in a cash and stock transaction valued at up to $300,000, consisting of $150,000 on March 8, 2019, plus potential future milestone payments. Established in 2005, Paradigm’s primary product is the coflex® Interlaminar Stabilization® device, a differentiated and minimally invasive motion preserving stabilization implant that is FDA premarket approved for the treatment of moderate to severe lumbar spinal stenosis in conjunction with decompression. 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 – O n January 4, 2018, the Company acquired Zyga, a leading 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® Sacroiliac Joint Fusion System. Under the terms of the merger agreement dated January 4, 2018, the Company acquired Zyga for $21,000 in consideration paid at closing (consisting of borrowings of $18,000 on its revolving credit facility and $3,000 cash on hand), $1,000 contingent upon the successful achievement of a clinical milestone, and a revenue based earnout consideration of up to an additional $35,000. Based on a probability weighted model, the Company estimates a contingent liability related to the clinical and revenue milestones of $1,130. Distribution Agreement with Medtronic – On October 12, 2013, the Company entered into a replacement distribution agreement with Medtronic, plc. (“Medtronic”), pursuant to which Medtronic will distribute certain allograft implants for use in spinal, general orthopedic and trauma surgery. Under the terms of this distribution agreement, Medtronic will be a non-exclusive distributor except for certain specified implants for which Medtronic will be the exclusive distributor. Medtronic will maintain its exclusivity with respect to these specified implants unless the cumulative fees received by us from Medtronic for these specified implants decline by a certain amount during any trailing 12-month period. The initial term of this distribution agreement was to have been through December 31, 2017. 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. Distribution Agreement with Zimmer Dental Inc. - On September 3, 2010, the Company entered into an exclusive distribution agreement with Zimmer Dental, Inc. (“Zimmer Dental”), a subsidiary of Zimmer, with an effective date of September 30, 2010, as amended from time to time. The Agreement was assigned to Biomet 3i, LLC (“Biomet”), an affiliate of Zimmer Dental, on January 1, 2016. The Agreement has an initial term of ten years. Under the terms of this distribution agreement, the Company agreed to supply sterilized allograft and xenograft implants at an agreed upon transfer price, and Biomet agreed to be the exclusive distributor of the implants for dental and oral applications worldwide (except Ukraine), subject to certain Company obligations under an existing distribution agreement with a third party with respect to certain implants for the dental market. In consideration for Biomet’s exclusive distribution rights, Biomet agreed to the following: 1) payment to the Company of $13,000 within ten days of the effective date (the “Upfront Payment”); 2) annual exclusivity fees (“Annual Exclusivity Fees”) paid annually as long as Biomet maintains exclusivity for the term of the contract to be paid at the beginning of each calendar year; and 3) annual purchase minimums to maintain exclusivity. Upon occurrence of an event that materially and adversely affects Biomet’s ability to distribute the implants, Biomet may be entitled to certain refund rights with respect to the then current Annual Exclusivity Fee, where such refund would be in an amount limited by a formula specified in this agreement that is based substantially on the occurrence’s effect on Biomet’s revenues. The Upfront Payment, the Annual Exclusivity Fees and the fees associated with distributions of processed tissue are considered to be a single performance obligation. Accordingly, the Upfront Payment and the Annual Exclusivity Fees are deferred as received and are being recognized as other revenues over the term of this distribution agreement based on the expected contractual annual purchase minimums relative to the total contractual minimum purchase requirements in this distribution agreement. Additionally, the Company considered the potential impact of this distribution agreement’s contractual refund provisions and does not expect these provisions to impact future expected revenue related to this distribution agreement. 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 Actions

Legal Actions	3 Months Ended
	Mar. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Legal Actions	2 3 . Legal 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 March 31, 2020 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 — The Company is presently named as co-defendant along with other companies in a small percentage of the transvaginal surgical mesh (“TSM”) mass tort claims being brought in various state and federal courts. The TSM litigation has as its catalyst various Public Health Notifications issued by the FDA with respect to the placement of certain TSM implants that were the subject of 510k regulatory clearance prior to their distribution. The Company does not process or otherwise manufacture for distribution in the U.S. any implants that were the subject of these FDA Public Health Notifications. The Company denies any allegations against it and intends to continue to vigorously defend itself. 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 Claims”) (the Tissue Only Claims and the Tissue-Non-Coloplast Claims being collectively referred to as “Indemnified Claims”). As of March 31, 2020, there are a cumulative total of 1,137 Indemnified Claims for which the Company Parties are providing defense and indemnification. The defense and indemnification of these cases are covered under the Company’s insurance policy subject to a reservation of rights by the insurer. 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 — On June 27, 2018, LifeNet Health, Inc. (“LifeNet”) filed a patent infringement lawsuit in the United States District Court for the Middle District of Florida (since moved to the Northern District of Florida) claiming infringement of five of its patents by the Company. The suit requests damages, enhanced damages, reimbursement of costs and expenses, reasonable attorney fees, and an injunction. The asserted patents are now expired. On April 7, 2019, the Court granted the Company’s request to stay the lawsuit pending the U.S. Patent Trial and Appeal Board’s (PTAB) decision whether to institute review of the patentability of LifeNet’s patents. On August 12, 2019 the PTAB instituted review of three LifeNet patents, and on September 3 the PTAB instituted review of the remaining two. Final decisions with respect to the patentability of LifeNet’s patents (which may be appealed by either party) is expected to take place in the second half of 2020. The Company continues to believe the suit is without merit and will vigorously defend its position. Securities Class Action— There is currently ongoing stockholder litigation related to the Company’s Investigation (as defined below). A class action complaint was filed by Patricia Lowry, a purported shareholder of the Company, 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 asserting claims under Sections 10(b) and 20(a) the Securities Exchange Act of 1934 (the “Exchange Act”) and demanding a jury trial (“Lowry Action”). In the Lowry Action, another purported shareholder of the Company has filed a motion seeking to be appointed as Lead Plaintiff and for the court to appoint her counsel as Lead Counsel. The court has not yet ruled on that motion. 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. The Company’s accounting policy is to accrue for legal costs as they are incurred.

Regulatory Actions

Regulatory Actions	3 Months Ended
	Mar. 31, 2020
Text Block [Abstract]
Regulatory Actions	2 4 . Regulatory Actions SEC Investigation — As previously disclosed in the 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”). The Investigation was precipitated by an investigation by the SEC initially related to the periods 2014 through 2016. The SEC investigation is ongoing, and the Company is cooperating with the SEC in its investigation. Based on the current information available to the Company the financial or other impact of the Investigation cannot be reasonably determined. Environmental Protection Agency— On January 28, 2020, RTI received an Opportunity to Show Cause letter from the United States Environmental Protection Agency (“EPA”). The letter alleged potential violations of hazardous waste regulations at the Company’s Alachua, Florida facilities based on a November 20, 2019 inspection conducted by EPA, and offered the Company the opportunity to meet with EPA to explain why EPA should not take any formal enforcement action. The Company held a virtual meeting with EPA on May 19, 2020 to discuss the corrective actions it had taken in response to EPA’s letter. During subsequent discussions, EPA has indicated that it intends to impose a penalty on the Company related to the allegations in the letter. The Company has recorded a liability for the amount the EPA has communicated they intend to impose on the Company related to the allegations in the letter which is included in accrued expenses in the condensed consolidated balance sheet. The Company is in negotiations with EPA.

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2020
Subsequent Events [Abstract]
Subsequent Events	2 5 . 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 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 on or before June 19, 2020, 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, JPM 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 defined below), 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 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 Credit Agreement”), by and among the Ares Loan Parties and the Ares Lenders. The Second Amendment to the 2019 Credit 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 Second Amendment to the 2019 Credit Agreement, 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). Derivative Lawsuits —Two derivative lawsuits have also been filed on behalf of the Company, naming it as a nominal defendant, and demanding a jury trial. On June 5, 2020, David Summers filed a shareholder derivative lawsuit against certain current and former directors and officers of the Company (as well as the Company as a nominal defendant), in the United States District Court for the Northern District of Illinois asserting statutory claims under Sections 10(b), 14(a) and 20(a) of the Exchange Act, as well as common law claims for breach of fiduciary duty, unjust enrichment and corporate waste. Thereafter, on June 12, 2020, a similar shareholder derivative lawsuit asserting the same claims was filed in the same court by Niall Campbell on behalf of the Company against the same current and former directors and officers of the Company (as well as the Company as a nominal defendant). The Company intends to seek to have the derivative lawsuits reassigned to the judge overseeing the Lowry Action and then to have the derivative lawsuits consolidated into a single derivative action. In the future, we may become subject to additional derivative litigation. Although the Company could be subject to additional unanticipated legal costs associated with any such derivative litigation, it would also be entitled to any monetary award in any successful derivative lawsuit brought on its behalf. Based on the current information available to the Company, the impact that current or any future derivative litigation may have on the Company cannot be reasonably estimated.

Recently Issued Accounting St_2

Recently Issued Accounting Standards (Policies)	3 Months Ended
	Mar. 31, 2020
Accounting Changes And Error Corrections [Abstract]
Recently Issued Accounting Standards	In March 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting (“ASU 2020-04”), which provides optional expedients and exceptions for applying U.S. GAAP to contracts, hedging relationships and other transactions affected by the discontinuation of the London Interbank Offered Rate (LIBOR) and other interbank offered rates. This guidance is effective beginning on March 12, 2020 through December 31, 2022. The Company adopted ASU 2020-04 and it did not have an impact on its condensed consolidated financial statements. In May 2019, the FASB ASU Financial Instruments — Credit Losses (Topic 326) 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 Financial Instruments — Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities; Financial Instruments — Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities, In June 2016, the FASB issued ASU 2016-13, Financial Instruments — Credit Losses (Topic326): Measurement of Credit Losses on Financial Instruments Credit losses for trade receivables is determined based on historical information, current information and reasonable and supportable forecasts. The Company has concluded that the adoption of the standard was not material as the composition of the trade receivables at the reporting date is consistent with that used in developing the historical credit-loss percentages. Further, the risk characteristics of the Company’s customer and composition of the portfolio have not changed significantly over time. In August 2018, the FASB issued Accounting Standards Update (“ASU”) 2018-13, “Fair Value Measurement (Topic 820): Disclosure Framework — Changes to the Disclosure Requirements for Fair Value Measurement.”

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2020
Leases [Abstract]
Schedule of Operating Leases	The components of operating lease expense were as follows: For the Three Months Ended For the Three Months Ended March 31, 2020 March 31, 2019 Operating lease cost $ 376 $ 344 Short-term operating lease cost — 36 Total operating lease cost $ 376 $ 380
Schedule of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to operating leases was as follows: For the Three Months Ended For the Three Months Ended March 31, 2020 March 31, 2019 Cash paid for amounts included in the measurement of lease liabilities $ 374 $ 294 ROU assets obtained in exchange for lease obligations — 34
Schedule of Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to operating leases was as follows: Balance at Balance at Balance Sheet Classification March 31, 2020 December 31, 2019 Assets: Right-of-use assets Other assets - net $ 2,205 $ 2,155 Liabilities: Current Accrued expenses $ 1,132 $ 1,159 Noncurrent Other long-term liabilities 1,629 1,547 Total operating lease liabilities $ 2,761 $ 2,706
Schedule of Maturities of Operating Lease Liabilities	As of March 31, 2020, maturities of operating lease liabilities were as follows: Balance at Maturity of Operating Lease Liabilities March 31, 2020 2020 (remaining) $ 1,021 2021 774 2022 297 2023 160 2024 159 2025 and beyond 716 Total future minimum lease payments 3,127 Less imputed interest (366 ) Total $ 2,761

Segment Reporting (Tables)

Segment Reporting (Tables)	3 Months Ended
	Mar. 31, 2020
Segment Reporting [Abstract]
Summary of Segment Data	The segment revenues and segment net income (loss) for the three months ended March 31, 2020 and 2019 are included in the table below. For the Three Months Ended March 31, 2020 2019 Revenues: Spine $ 27,109 $ 24,377 OEM 46,617 45,644 Total $ 73,726 $ 70,021 Depreciation and amortization: Spine $ 91 $ 2,400 OEM 2,148 2,000 Total $ 2,239 $ 4,400 Operating income (loss) Spine $ (9,179 ) $ (4,323 ) OEM 6,133 5,758 Unallocated corporate costs Asset impairment and abandonments 1,879 15 Other general expenses 3,436 - Transaction and integration expenses 9,280 8,957 Total unallocated corporate costs 14,595 8,972 Operating loss $ (17,641 ) $ (7,537 ) Interest expense (3,565 ) (1,604 ) Interest income 50 131 Foreign exchange loss (246 ) (31 ) Loss before income tax benefit (expense) $ (21,402 ) $ (9,041 )
Summary of Revenues by Geographic Location	The following table presents revenues by geographic location: For the Three Months Ended March 31, 2020 2019 (In thousands) Revenues: North America $ 66,813 $ 63,054 EMEA 5,735 5,583 Asia Pacific 919 482 Latin America 259 902 Total revenues $ 73,726 $ 70,021
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 Three Month Ended March 31, 2020 2019 Percent of revenues derived from: Distributor Zimmer Biomet Holdings, Inc. 17 % 21 % Medtronic, PLC 6 % 8 % DePuy Synthes 6 % 4 %

Revenue from Contracts with C_2

Revenue from Contracts with Customers (Tables)	3 Months Ended
	Mar. 31, 2020
Revenue From Contract With Customer [Abstract]
Revenue Recognition from Two Business Lines	The following table presents revenues from these two segments for the three months ended March 31, 2020 and 2019: For the Three Month Ended March 31, 2020 2019 Revenues: Spine Segment Domestic $ 22,276 $ 20,219 International 4,833 4,158 OEM Segment OEM 30,217 28,999 Sports 14,320 13,836 International 2,080 2,809 Total revenues from contracts with customers $ 73,726 $ 70,021
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 three months ended March 31, 2020 and 2019: For the Three Month Ended March 31, 2020 2019 Revenue recognized at a point in time $ 55,109 $ 54,096 Revenue recognized over time 18,617 15,925 Total revenues from contracts with customers $ 73,726 $ 70,021
Contract with Customer, Asset and Liability	The opening and closing balances of the Company’s accounts receivable, contract asset and current and long-term contract liability for the three months ended March 31, 2020 and 2019 are as follows: Contract Contract Liability Accounts Liability (Long- Receivable (Current) Term) Opening Balance, January 1, 2020 $ 59,288 $ 3,378 $ - Closing Balance, March 31, 2020 54,921 6,237 - Increase/(decrease) (4,367 ) 2,859 - Contract Contract Liability Accounts Liability (Long- Receivable (Current) Term) Opening Balance, January 1, 2019 $ 48,096 $ 5,425 $ 744 Closing Balance, March 31, 2019 55,709 5,498 1,535 Increase/(decrease) 7,613 73 791

Acquisition of Paradigm Spine_2

Acquisition of Paradigm Spine, LLC (Tables) - Paradigm Spine [Member]	3 Months Ended
	Mar. 31, 2020
Acquisition Purchase Price	The purchase price was financed as follows: (In thousands) 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 (In thousands) 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, 2019, (in thousands): For the Three Months Ended March 31, 2019 Revenues $ 8,970 Net loss applicable to common shares (6,803 )

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2020
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock Options Outstanding, Exercisable and Available for Grant	The following table summarizes information about stock options outstanding, exercisable and available for grant as of March 31, 2020: Weighted Weighted Average Average Remaining Aggregate Number of Exercise Contractual Intrinsic Shares Price Life (Years) Value Outstanding at January 1, 2020 4,536,461 $ 3.75 Granted 742,693 4.21 Exercised (5,000 ) 4.02 Forfeited or expired (27,169 ) 4.84 Outstanding at March 31, 2020 5,246,985 $ 3.81 4.36 $ - Vested or expected to vest at March 31, 2020 4,808,298 $ 3.78 4.06 $ - Exercisable at March 31, 2020 1,378,307 $ 3.66 2.78 $ - Available for grant at March 31, 2020 2,546,823
Other Information Concerning Stock Options	Other information concerning stock options are as follows: For the Three Months Ended March 31, 2020 2019 Weighted average fair value of stock options granted $ 3.02 $ 1.98 Aggregate intrinsic value of stock options exercised 3 140
Unvested Restricted Stock Units	The following table summarizes information about unvested restricted stock awards as of March 31, 2020: Weighted Average Number of Grant Date Shares Fair Value Unvested at January 1, 2020 1,227,858 $ 4.34 Granted 916,803 4.22 Vested (373,891 ) 4.58 Forfeited (22,301 ) 4.65 Unvested at March 31, 2020 1,748,469 $ 4.22 Weighted Average Number of Grant Date Shares Fair Value Unvested at January 1, 2020 184,582 $ 7.41 Granted — — Vested — — Forfeited — — Unvested at March 31, 2020 184,582 $ 7.41
Stock-Based Compensation Recognized	For the three months ended March 31, 2020 and 2019, the Company recognized stock-based compensation as follows: For the Three Month Ended March 31, 2020 2019 Stock-based compensation: Costs of processing and distribution $ 36 $ 36 Marketing, general and administrative 1,259 1,112 Research and development 15 15 Total $ 1,310 $ 1,163

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	3 Months Ended
	Mar. 31, 2020
Earnings Per Share [Abstract]
Reconciliation of Common Stock used in Calculation of Basic and Diluted Earnings Per Share	A reconciliation of the number of shares of common stock used in the calculation of basic and diluted net income per common share is presented below: For the Three Month Ended March 31, 2020 2019 Basic shares 75,847,046 65,675,203 Effect of dilutive securities: Stock options — — Diluted shares 75,847,046 65,675,203

Inventories (Tables)

Inventories (Tables)	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Components of Inventories	Inventories by stage of completion are as follows: March 31, December 31, 2020 2019 Unprocessed tissue, raw materials and supplies $ 29,699 $ 29,552 Tissue and work in process 36,511 35,740 Implantable tissue and finished goods 66,441 65,494 Total 132,651 130,786 Less current portion 126,760 124,149 Long-term portion $ 5,891 $ 6,637

Prepaid and Other Current Ass_2

Prepaid and Other Current Assets (Tables)	3 Months Ended
	Mar. 31, 2020
Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract]
Schedule of Prepaid and Other Current Assets	Prepaid and Other Current Assets are as follows: March 31, December 31, 2020 2019 Income tax receivable $ 3,963 $ 2,803 Prepaid expenses 4,081 1,865 Other 378 2,101 $ 8,422 $ 6,769

Property, Plant and Equipment (

Property, Plant and Equipment (Tables)	3 Months Ended
	Mar. 31, 2020
Property Plant And Equipment [Abstract]
Components of Property, Plant and Equipment	Property, plant and equipment are as follows: March 31, December 31, 2020 2019 Land $ 1,988 $ 2,005 Buildings and improvements 57,954 58,208 Processing equipment 46,889 45,762 Surgical instruments 696 541 Office equipment, furniture and fixtures 1,669 1,730 Computer equipment and software 20,615 20,521 Construction in process 13,170 11,717 142,981 140,484 Less accumulated depreciation (72,265 ) (70,594 ) $ 70,716 $ 69,890

Goodwill (Tables)

Goodwill (Tables)	3 Months Ended
	Mar. 31, 2020
Goodwill And Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The change in the carrying amount of goodwill for the three months ended March 31, December 31, 2020 2019 Balance at January 1 $ 55,384 $ 59,798 Goodwill acquired related to Paradigm acquisition — 135,589 Goodwill impairment - (140,003 ) Balance at end of period $ 55,384 $ 55,384

Other Intangible Assets (Tables

Other Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2020
Goodwill And Intangible Assets Disclosure [Abstract]
Components of Other Intangible Assets	Other intangible assets are as follows: March 31, 2020 December 31, 2019 Gross Net Gross Net Carrying Accumulated Carrying Carrying Accumulated Carrying Amount Amortization Amount Amount Amortization Amount Patents $ 5,118 $ 2,867 $ 2,251 $ 5,095 $ 2,768 $ 2,327 Acquired licensing rights 1,413 109 1,304 1,413 64 1,349 Marketing and procurement and other intangible assets 16,495 10,027 6,468 16,488 9,672 6,816 Total $ 23,026 $ 13,003 $ 10,023 $ 22,996 $ 12,504 $ 10,492
Estimates of Future Amortization Expense	At March 31, 2020, management’s estimates of future amortization expense for the next five years are as follows: Amortization Expense 2020 (remaining) 1,725 2021 2,300 2022 2,300 2023 700 2024 700 2025 700

Fair Value Information (Tables)

Fair Value Information (Tables)	3 Months Ended
	Mar. 31, 2020
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 three months ended March 31, 2020. For the three Months Ended March 31, 2020 Impairment Fair Value Property, plant and equipment - net 1,879 - $ 1,879 $ -

Accrued Expenses (Tables)

Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2020
Other Liabilities Disclosure [Abstract]
Accrued Expenses	Accrued expenses are as follows: March 31, December 31, 2020 2019 Accrued compensation $ 7,795 $ 5,435 Accrued severance and restructuring costs - 136 Accrued distributor commissions 3,868 4,569 Accrued donor recovery fees 8,161 8,921 Accrued leases 1,132 1,159 Accrued transactions and integration expenses 3,170 2,555 Other 13,518 10,562 $ 37,644 $ 33,337

Short and Long-Term Obligatio_2

Short and Long-Term Obligations (Tables)	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Short and Long-Term Obligations	Short and long-term obligations are as follows: March 31, December 31, 2020 2019 Ares Term loan $ 105,822 $ 104,406 JPM Facility 71,000 71,000 Less unamortized debt issuance costs (1,149 ) (1,229 ) Total 175,673 174,177 Less current portion 175,673 174,177 Long-term portion $ - $ -

Other long-term liabilities (Ta

Other long-term liabilities (Tables)	3 Months Ended
	Mar. 31, 2020
Other Liabilities Noncurrent [Abstract]
Summary of Other long-term liabilities	Other long-term liabilities are as follows: March 31, December 31, 2020 2019 Acquisition contingencies $ 1,130 $ 1,130 Lease obligations 1,629 1,547 Other 874 470 $ 3,633 $ 3,147

Preferred Stock (Tables)

Preferred Stock (Tables)	3 Months Ended
	Mar. 31, 2020
Equity [Abstract]
Schedule of Preferred Stock	Preferred stock is as follows: Preferred Stock Liquidation Preferred Stock Issuance Net Value Costs Total Balance at January 1, 2020 $ 66,519 $ (109 ) $ 66,410 Amortization of preferred stock issuance costs — 46 46 Balance at March 31, 2020 $ 66,519 $ (63 ) $ 66,456 Preferred Stock Liquidation Preferred Stock Issuance Net Value Costs Total Balance at January 1, 2019 $ 66,519 $ (293 ) $ 66,226 Amortization of preferred stock issuance costs — 46 46 Balance at March 31, 2019 $ 66,519 $ (247 ) $ 66,272

Severance and Restructuring C_2

Severance and Restructuring Costs (Tables)	3 Months Ended
	Mar. 31, 2020
Employee Severance [Member]
Schedule of Restructuring Charges	Accrued severance and restructuring costs at January 1, 2020 $ 136 Severance and restructuring costs accrued in 2020 - Subtotal severance and restructuring costs 136 Severance and restructuring related cash payments (136 ) Accrued severance and restructuring charges at March 31, 2020 $ -

Operations and Organization - A

Operations and Organization - Additional Information (Detail) - Minimum [Member]	3 Months Ended
	Mar. 31, 2020CountryEmployee
Operations And Organization [Line Items]
Number of countries that receive distribution | Country	50
COVID-19 [Member]
Operations And Organization [Line Items]
Number of employees on furlough or reduce the hours | Employee	500

Basis of Presentation - Additio

Basis of Presentation - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Cash	$ 6,557		$ 5,608
Working capital deficiency	60,897
Net (loss) income	$ 17,863	$ 9,351
Substantial doubt exists with respect to going concern within one year	true

Leases - Additional Information

Leases - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2020
Lessee Lease Description [Line Items]
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 March 31, 2020.
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	4 years 6 months
Weighted-average discount rate, operating leases	4.70%
Minimum [Member]
Lessee Lease Description [Line Items]
Operating lease remaining term	1 year
Maximum [Member]
Lessee Lease Description [Line Items]
Operating lease remaining term	9 years

Leases - Schedule of Operating

Leases - Schedule of Operating Leases (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Leases [Abstract]
Operating lease cost	$ 376	$ 344
Short-term operating lease cost		36
Total operating lease cost	$ 376	$ 380

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Cash Flow Information Related to Lease (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 374	$ 294
ROU assets obtained in exchange for lease obligations		$ 34

Leases - Schedule of Suppleme_2

Leases - Schedule of Supplemental Balance Sheet Information Related to Leases (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current	$ 1,132	$ 1,159
Total operating lease liabilities	2,761	2,706
Other Assets [Member]
Right-of-use assets	2,205	2,155
Accrued Expenses [Member]
Current	1,132	1,159
Other Long Term Liabilities [Member]
Noncurrent	$ 1,629	$ 1,547

Leases - Schedule of Maturities

Leases - Schedule of Maturities of Operating Lease Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Leases [Abstract]
2020 (remaining)	$ 1,021
2021	774
2022	297
2023	160
2024	159
2025 and beyond	716
Total future minimum lease payments	3,127
Less imputed interest	(366)
Total	$ 2,761	$ 2,706

Segment Reporting - Summary of

Segment Reporting - Summary of Segment Data (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Segment Reporting Information [Line Items]
Revenues	$ 73,726	$ 70,021
Depreciation and amortization	2,239	4,400
Operating income (loss)	(17,641)	(7,537)
Asset impairment and abandonments	1,879	15
Other general expenses	3,436
Transaction and integration expenses	9,280	8,957
Interest expense	(3,565)	(1,604)
Interest income	50	131
Foreign exchange loss	(246)	(31)
Loss before income tax benefit (expense)	(21,402)	(9,041)
Spine [Member]
Segment Reporting Information [Line Items]
Revenues	27,109	24,377
Depreciation and amortization	91	2,400
OEM [Member]
Segment Reporting Information [Line Items]
Revenues	46,617	45,644
Depreciation and amortization	2,148	2,000
Segment Reconciling Items [Member]
Segment Reporting Information [Line Items]
Asset impairment and abandonments	1,879	15
Other general expenses	3,436
Transaction and integration expenses	9,280	8,957
Total unallocated corporate costs	14,595	8,972
Segment Reconciling Items [Member] | Spine [Member]
Segment Reporting Information [Line Items]
Operating income (loss)	(9,179)	(4,323)
Segment Reconciling Items [Member] | OEM [Member]
Segment Reporting Information [Line Items]
Operating income (loss)	$ 6,133	$ 5,758

Segment Reporting - Summary o_2

Segment Reporting - Summary of Revenues by Geographic Location (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Disaggregation of Revenue [Line Items]
Revenues	$ 73,726	$ 70,021
North America [Member]
Disaggregation of Revenue [Line Items]
Revenues	66,813	63,054
EMEA [Member]
Disaggregation of Revenue [Line Items]
Revenues	5,735	5,583
Asia Pacific [Member]
Disaggregation of Revenue [Line Items]
Revenues	919	482
Latin America [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 259	$ 902

Segment Reporting - Schedule of

Segment Reporting - Schedule of Percentage of Total Revenues Derived from Company's Largest Distributors (Detail) - Distributors Concentration Risk [Member] - Sales Revenue, Net [Member]	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Zimmer [Member]
Concentration Risk [Line Items]
Percentage of sales revenue	17.00%	21.00%
Medtronic [Member]
Concentration Risk [Line Items]
Percentage of sales revenue	6.00%	8.00%
DePuy Synthes [Member]
Concentration Risk [Line Items]
Percentage of sales revenue	6.00%	4.00%

Revenue from Contracts with C_3

Revenue from Contracts with Customers - Additional Information (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)SegmentBusiness	Dec. 31, 2019USD ($)
Revenue From Contract With Customer [Abstract]
Number of reportable segment | Segment	2
Number of business lines | Business	2
Unbilled receivables in connection with our exclusively built inventory contracts | $	$ 9,281	$ 10,633

Revenue from Contracts with C_4

Revenue from Contracts with Customers - Revenue Recognition from Two Business Lines (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Disaggregation Of Revenue [Line Items]
Revenues	$ 73,726	$ 70,021
Domestic [Member]
Disaggregation Of Revenue [Line Items]
Revenues	22,276	20,219
International [Member]
Disaggregation Of Revenue [Line Items]
Revenues	4,833	4,158
OEM [Member]
Disaggregation Of Revenue [Line Items]
Revenues	30,217	28,999
Sports [Member]
Disaggregation Of Revenue [Line Items]
Revenues	14,320	13,836
International [Member]
Disaggregation Of Revenue [Line Items]
Revenues	$ 2,080	$ 2,809

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
	Mar. 31, 2020	Mar. 31, 2019
Disaggregation Of Revenue [Line Items]
Revenues	$ 73,726	$ 70,021
Transferred at Point in Time [Member]
Disaggregation Of Revenue [Line Items]
Revenues	55,109	54,096
Transferred over Time [Member]
Disaggregation Of Revenue [Line Items]
Revenues	$ 18,617	$ 15,925

Revenue from Contracts with C_6

Revenue from Contracts with Customers - Contract with Customer, Asset and Liability (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Jan. 01, 2020	Dec. 31, 2019	Jan. 01, 2019
Revenue From Contract With Customer [Abstract]
Accounts Receivable	$ 54,921	$ 55,709	$ 59,288	$ 59,288	$ 48,096
Contract Liability (Current)	6,237	5,498	$ 3,378		5,425
Contract Liability (Long- Term)		1,535			$ 744
Accounts Receivable, Increase/(decrease)	(4,367)	7,613
Contract Liability (Current), Increase/(decrease)	$ 2,859	73
Contract Liability (Long-Term), Increase/(decrease)		$ 791

Acquisition of Paradigm Spine_3

Acquisition of Paradigm Spine, LLC - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	Mar. 08, 2019	Mar. 31, 2019	Dec. 31, 2019	Mar. 31, 2020	Dec. 31, 2018
Business Acquisition [Line Items]
Common stock par value			$ 0.001	$ 0.001
Goodwill			$ 55,384	$ 55,384	$ 59,798
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
Acquisition and integration expenses		$ 8,957	15,537
Business development expenses			462
Severance expenses			$ 896
Inventory fair value, current	7,122
Inventory fair value, noncurrent	10,525
Goodwill	135,589
Revenue		1,992
Net loss		$ 95
Paradigm Spine [Member] | Maximum [Member]
Business Acquisition [Line Items]
Number of common stock to be issued at closing, value	$ 50,000
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

Acquisition of Paradigm Spine_4

Acquisition of Paradigm Spine, LLC - Acquisition Purchase Price (Detail) - USD ($) $ in Thousands	Mar. 08, 2019	Mar. 31, 2019
Business Acquisition [Line Items]
Cash proceeds from second lien credit agreement		$ 115,000
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	$ 99,921

Acquisition of Paradigm Spine_5

Acquisition of Paradigm Spine, LLC - Summary of Changes to Fair Value of Acquired Assets and Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019	Mar. 08, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Goodwill	$ 55,384	$ 55,384		$ 59,798
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_6

Acquisition of Paradigm Spine, LLC. - Pro Forma Information of Operations (Detail) - Paradigm Spine [Member] $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Business Acquisition, Pro Forma Information [Line Items]
Revenues	$ 8,970
Net loss applicable to common shares	$ (6,803)

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)shares
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%
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized stock-based compensation	$ 2,915
Stock-based compensation awards, weighted-average period recognized	3 years 7 months 20 days
Stock Option [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Contractual term of stock options granted	5 years
Stock-based compensation award, vesting period	1 year
Stock Option [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Contractual term of stock options granted	10 years
Stock-based compensation award, vesting period	5 years
Restricted Stock Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized stock-based compensation	$ 4,942
Stock-based compensation awards, weighted-average period recognized	1 year 10 months 20 days
Restricted Stock Awards [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period	1 year
Restricted Stock Awards [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period	3 years
Restricted Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized stock-based compensation	$ 691
Stock-based compensation awards, weighted-average period recognized	1 year 9 months
2018 Equity Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares of common stock allowed to be issued | shares	5,726,035

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock Options Outstanding, Exercisable and Available for Grant (Detail)	3 Months Ended
	Mar. 31, 2020$ / sharesshares
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Outstanding, Number of Shares	4,536,461
Granted, Number of Shares	742,693
Exercised, Number of Shares	(5,000)
Forfeited or expired, Number of Shares	(27,169)
Outstanding, Number of Shares	5,246,985
Vested or expected to vest, Number of Shares	4,808,298
Exercisable, Number of Shares	1,378,307
Available for grant, Number of Shares	2,546,823
Outstanding, Weighted Average Exercise Price | $ / shares	$ 3.75
Granted, Weighted Average Exercise Price | $ / shares	4.21
Exercised, Weighted Average Exercise Price | $ / shares	4.02
Forfeited or expired, Weighted Average Exercise Price | $ / shares	4.84
Outstanding, Weighted Average Exercise Price | $ / shares	3.81
Vested or expected to vest, Weighted Average Exercise Price | $ / shares	3.78
Exercisable, Weighted Average Exercise Price | $ / shares	$ 3.66
Outstanding, Weighted Average Remaining Contractual Life (Years)	4 years 4 months 9 days
Vested or expected to vest, Weighted Average Remaining Contractual Life (Years)	4 years 21 days
Exercisable, Weighted Average Remaining Contractual Life (Years)	2 years 9 months 10 days

Stock-Based Compensation - Othe

Stock-Based Compensation - Other Information Concerning Stock Options (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Weighted average fair value of stock options granted	$ 3.02	$ 1.98
Aggregate intrinsic value of stock options exercised	$ 3	$ 140

Stock-Based Compensation - Unve

Stock-Based Compensation - Unvested Restricted Stock Awards (Detail)	3 Months Ended
	Mar. 31, 2020$ / sharesshares
Restricted Stock Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beginning Balance, Number of shares | shares	1,227,858
Granted, Number of shares | shares	916,803
Vested, Number of shares | shares	(373,891)
Forfeited, Number of shares | shares	(22,301)
Ending Balance, Number of shares | shares	1,748,469
Beginning Balance, Weighted Average Grant Date Fair Value | $ / shares	$ 4.34
Granted, Weighted Average Grant Date Fair Value | $ / shares	4.22
Vested, Weighted Average Grant Date Fair Value | $ / shares	4.58
Forfeited, Weighted Average Grant Date Fair Value | $ / shares	4.65
Ending Balance, Weighted Average Grant Date Fair Value | $ / shares	$ 4.22
Restricted Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beginning Balance, Number of shares | shares	184,582
Forfeited, Number of shares | shares	0
Ending Balance, Number of shares | shares	184,582
Beginning Balance, Weighted Average Grant Date Fair Value | $ / shares	$ 7.41
Forfeited, Weighted Average Grant Date Fair Value | $ / shares	0
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	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 1,310	$ 1,163
Costs of Processing and Distribution [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	36	36
Marketing General and Administrative [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	1,259	1,112
Research and Development Expense [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 15	$ 15

Net Income Per Common Share - R

Net Income Per Common Share - Reconciliation of Common Stock Used in Calculation of Basic and Diluted Earnings Per Share (Detail) - shares	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Earnings Per Share [Abstract]
Basic shares	75,847,046	65,675,203
Effect of dilutive securities:
Stock options	0	0
Diluted shares	75,847,046	65,675,203

Net Income Per Common Share - A

Net Income Per Common Share - Additional Information (Detail) - shares	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Convertible Preferred Stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential Dilutive Securities included in computation of diluted EPS	50,000	50,000
Convertible Common Stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential Dilutive Securities included in computation of diluted EPS	15,152,761	15,152,761
Common Stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive stock excluded from the computation of diluted EPS	313,010	806,802
Stock Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive stock excluded from the computation of diluted EPS	2,837,404	1,422,304

Inventories - Components of Inv

Inventories - Components of Inventories (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Inventory Disclosure [Abstract]
Unprocessed tissue, raw materials and supplies	$ 29,699	$ 29,552
Tissue and work in process	36,511	35,740
Implantable tissue and finished goods	66,441	65,494
Total	132,651	130,786
Less current portion	126,760	124,149
Long-term portion	$ 5,891	$ 6,637

Inventories - Additional Inform

Inventories - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Inventory Disclosure [Abstract]
Provision for inventory write-downs	$ 517	$ 1,530

Prepaid and Other Current Ass_3

Prepaid and Other Current Assets - Schedule of Prepaid and Other Current Assets (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract]
Income tax receivable	$ 3,963	$ 2,803
Prepaid expenses	4,081	1,865
Other	378	2,101
Prepaid and other current assets	$ 8,422	$ 6,769

Property, Plant and Equipment -

Property, Plant and Equipment - Components of Property, Plant and Equipment (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	$ 142,981	$ 140,484
Less accumulated depreciation	(72,265)	(70,594)
Property, plant and equipment, net	70,716	69,890
Land [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	1,988	2,005
Building and Improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	57,954	58,208
Processing Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	46,889	45,762
Surgical Instruments [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	696	541
Office Equipment, Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	1,669	1,730
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	20,615	20,521
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	$ 13,170	$ 11,717

Property, Plant and Equipment_2

Property, Plant and Equipment - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Property, Plant and Equipment [Line Items]
Depreciation expense in connection with property, plant and equipment	$ 1,766	$ 3,443
Property, Plant and Equipment [Member] | Spine [Member]
Property, Plant and Equipment [Line Items]
Asset impairment and abandonments	$ 1,879

Goodwill - Schedule of Goodwill

Goodwill - Schedule of Goodwill (Detail) - USD ($) $ in Thousands	Mar. 08, 2019	Dec. 31, 2019
Goodwill [Line Items]
Beginning Balance		$ 59,798
Goodwill impairment		(140,003)
Ending Balance		55,384
Paradigm Spine [Member]
Goodwill [Line Items]
Goodwill acquired	$ 135,589	$ 135,589
Ending Balance	$ 135,589

Goodwill - Additional Informati

Goodwill - Additional Information (Detail) - USD ($) $ in Thousands	Mar. 08, 2019	Dec. 31, 2019
Goodwill [Line Items]
Goodwill impairment		$ 140,003
Paradigm Spine [Member]
Goodwill [Line Items]
Total purchase price	$ 232,907
Goodwill acquired	$ 135,589	$ 135,589

Other Intangible Assets - Compo

Other Intangible Assets - Components of Other Intangible Assets (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 23,026	$ 22,996
Accumulated Amortization	13,003	12,504
Net Carrying Amount	10,023	10,492
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	5,118	5,095
Accumulated Amortization	2,867	2,768
Net Carrying Amount	2,251	2,327
Licensing Rights [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	1,413	1,413
Accumulated Amortization	109	64
Net Carrying Amount	1,304	1,349
Marketing and Procurement and Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	16,495	16,488
Accumulated Amortization	10,027	9,672
Net Carrying Amount	$ 6,468	$ 6,816

Other Intangible Assets - Addit

Other Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Goodwill And Intangible Assets Disclosure [Abstract]
Amortization expense of other intangible assets	$ 473	$ 957

Other Intangible Assets - Estim

Other Intangible Assets - Estimates of Future Amortization Expense (Detail) $ in Thousands	Mar. 31, 2020USD ($)
Goodwill And Intangible Assets Disclosure [Abstract]
2020 (remaining)	$ 1,725
2021	2,300
2022	2,300
2023	700
2024	700
2025	$ 700

Fair Value Information - Summar

Fair Value Information - Summary of Impairments of Long-Lived Assets and Related Post Impairment Fair Values (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)
Fair Value Disclosures [Abstract]
Property, plant and equipment - net, Impairment	$ 1,879
Impairment	$ 1,879

Accrued Expenses - Accrued Expe

Accrued Expenses - Accrued Expenses (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Payables And Accruals [Abstract]
Accrued compensation	$ 7,795	$ 5,435
Accrued severance and restructuring costs		136
Accrued distributor commissions	3,868	4,569
Accrued donor recovery fees	8,161	8,921
Accrued leases	1,132	1,159
Accrued transactions and integration expenses	3,170	2,555
Other	13,518	10,562
Total accrued expenses	$ 37,644	$ 33,337

Short and Long-Term Obligatio_3

Short and Long-Term Obligations - Short and Long-Term Obligations (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Debt Disclosure [Abstract]
Ares Term loan	$ 105,822	$ 104,406
JPM Facility	71,000	71,000
Less unamortized debt issuance costs	(1,149)	(1,229)
Debt and capital lease obligation, total	175,673	174,177
Less current portion	175,673	174,177
Long-term portion	$ 0	$ 0

Short and Long-Term Obligatio_4

Short and Long-Term Obligations - Additional Information (Detail) $ in Thousands	Dec. 09, 2019USD ($)	Mar. 08, 2019USD ($)	Mar. 31, 2020USD ($)	Mar. 31, 2019USD ($)	Jun. 30, 2021	Dec. 31, 2019USD ($)	Jun. 05, 2018USD ($)
Line of Credit Facility [Line Items]
Amortization of debt issuance cost				$ 219
Debt issuance cost				729
Cash and cash equivalents			$ 6,557			$ 5,608
Cash provided by operations			$ 6,516	(15,557)
Revolving Credit Facility [Member]
Line of Credit Facility [Line Items]
Debt instrument, maturity date			Jun. 5, 2023
Credit facility, variable interest rate			3.58%
Line of credit outstanding amount			$ 71,000
Line of credit remaining borrowing capacity			9,000
Amortization of debt issuance cost			$ 81	$ 283
Ares Term Loans [Member]
Line of Credit Facility [Line Items]
Debt instrument, maturity date			Dec. 5, 2023
Interest rate on term loan			10.41%
2018 Loan Agreement [Member]
Line of Credit Facility [Line Items]
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							1
Covenant Terms of Credit Facility			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”) on each JPM Calculation Date (as defined below) 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.
Line of credit remaining borrowing capacity			$ 9,000
2018 Loan Agreement [Member] | Revolving Credit Facility [Member]
Line of Credit Facility [Line Items]
Credit facility, original borrowing capacity	$ 75,000	$ 100,000					$ 100,000
Revolving line of credit commitment reduction amount	$ 80,000	75,000
Revolving line of credit commitment increased amount		80,000
2018 Loan Agreement [Member] | Revolving Credit Facility [Member] | Maximum [Member]
Line of Credit Facility [Line Items]
Credit facility, additional borrowing capacity							$ 50,000
2019 Loan Agreement [Member]
Line of Credit Facility [Line Items]
Minimum leverage ratio			450.00%
Increase in term loan interest rate			0.75%
Paid in kind option to pay interest			50.00%
Leverage ratio			575.00%
Leverage ratio reduction limit for second quarter			525.00%
Leverage ratio reduction limit for third quarter			525.00%
Leverage ratio final reduction for each quarter thereafter			350.00%
Leverage ratio limit unable to comply with the debt to EBITDA covenant			598.00%
2019 Loan Agreement [Member] | Base Rate [Member]
Line of Credit Facility [Line Items]
Debt Instrument, Basis Spread on Variable Rate			7.50%
2019 Loan Agreement [Member] | London Interbank Offered Rate (LIBOR) [Member]
Line of Credit Facility [Line Items]
Debt Instrument, Basis Spread on Variable Rate			8.50%
2019 Loan Agreement [Member] | Ares Term Loans [Member]
Line of Credit Facility [Line Items]
Credit facility, original borrowing capacity		100,000
Percentage of foreign subsidiaries stock held as collateral							65.00%
Credit facility, increased borrowing capacity		$ 130,000
Term loan guaranteed description			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			9
2019 Loan Agreement [Member] | Ares Term Loans [Member] | Scenario, Forecast [Member]
Line of Credit Facility [Line Items]
Net leverage ratio					3.50

Other Long-Term Liabilities - S

Other Long-Term Liabilities - Summary of Other Long-term Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Other Long Term Liabilities [Line Items]
Other	$ 874	$ 470
Total other long-term liabilities	3,633	3,147
Other Long Term Liabilities [Member]
Other Long Term Liabilities [Line Items]
Lease obligations	1,629	1,547
Zyga Technology Inc [Member]
Other Long Term Liabilities [Line Items]
Acquisition contingencies	$ 1,130	$ 1,130

Other Long Term Liabilities - A

Other Long Term Liabilities - Additional Information (Detail) $ in Thousands	Mar. 31, 2020USD ($)
Zyga Technology Inc [Member] | Clinical and Revenue Milestones Payment [Member]
Other Long Term Liabilities [Line Items]
Revenue contingencies	$ 1,130

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 27, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Domestic deferred tax assets, valuation allowances	$ 55,488		$ 51,508
Net operating losses carried back period	5 years
Income tax receivable		$ 3,500

Preferred Stock - Additional In

Preferred Stock - Additional Information (Detail) - USD ($) $ in Thousands	Jul. 16, 2013	Jun. 12, 2013	Mar. 31, 2020	Dec. 31, 2019	Mar. 31, 2019	Dec. 31, 2018
Temporary Equity [Line Items]
Preferred stock issuance cost			$ (63)	$ (109)	$ (247)	$ (293)
Private Placement [Member]
Temporary Equity [Line Items]
Preferred stock dividend rate	6.00%
Private Placement [Member] | Convertible Preferred Stock [Member]
Temporary Equity [Line Items]
Convertible preferred stock issued		$ 50,000
Preferred stock issuance cost	$ 1,290

Preferred Stock - Schedule of P

Preferred Stock - Schedule of Preferred Stock (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019	Dec. 31, 2018
Temporary Equity [Line Items]
Preferred Stock Liquidation Value	$ 66,519	$ 66,519	$ 66,519	$ 66,519
Amortization of preferred stock issuance costs	46	46
Preferred Stock Issuance Costs	(63)	(247)	(109)	(293)
Net Total	$ 66,456	$ 66,272	$ 66,410	$ 66,226

Severance and Restructuring C_3

Severance and Restructuring Costs - Schedule of Restructuring Charges (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)
Restructuring Cost and Reserve [Line Items]
Accrued severance and restructuring charges, beginning balance	$ 136
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Accrued severance and restructuring charges, beginning balance	136
Subtotal severance and restructuring costs	136
Severance and restructuring related cash payments	(136)
Accrued severance and restructuring charges, ending balance

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Thousands	Mar. 08, 2019	Jan. 04, 2018	Oct. 12, 2013	Sep. 30, 2010	Mar. 31, 2020	Mar. 31, 2019	Jan. 13, 2020
Medtronic [Member]
Commitment And Contingencies [Line Items]
Decline in cumulative fees received, trailing period			12 months
Distribution agreement automatic renewal term			5 years
Period prior to expiration of initial term for notice			1 year
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.
Paradigm Spine [Member]
Commitment And Contingencies [Line Items]
Agreement to acquire business	$ 300,000
Cash to be paid at closing	150,000
Potential debt to finance business combination	$ 100,000
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
Revenue based earnout considerations	0
Payments to acquire businesses	232,907
Cash from RTI Surgical	232,907					$ 99,921
Earnout consideration	72,177
Paradigm Spine [Member] | Maximum [Member]
Commitment And Contingencies [Line Items]
Revenue based earnout considerations	$ 150,000
Zyga Technology Inc [Member]
Commitment And Contingencies [Line Items]
Date of merger agreement		Jan. 4, 2018
Payments to acquire businesses		$ 21,000
Cash from RTI Surgical		3,000
Zyga Technology Inc [Member] | Clinical Milestones [Member]
Commitment And Contingencies [Line Items]
Earnout consideration		1,000
Zyga Technology Inc [Member] | Earn Out Payment [Member]
Commitment And Contingencies [Line Items]
Revenue based earnout consideration		35,000
Zyga Technology Inc [Member] | Clinical and Revenue Milestones Earnout Payment [Member]
Commitment And Contingencies [Line Items]
Earnout consideration		1,130
Zyga Technology Inc [Member] | Revolving Credit Facility [Member]
Commitment And Contingencies [Line Items]
Cash proceeds from credit facility		$ 18,000
Ardi Bidco Ltd. [Member] | Disposal Group Held-for-sale Not Discontinued Operations [Member]
Commitment And Contingencies [Line Items]
Consideration received or receivable for disposal of assets							$ 440,000
Biomet [Member] | Zimmer [Member]
Commitment And Contingencies [Line Items]
Initial agreement term				10 years
Upfront payment				$ 13,000
Upfront payment period				10 days

Legal Actions - Additional Info

Legal Actions - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2020Claim
Commitments And Contingencies Disclosure [Abstract]
Claims for which the Company Parties are providing defense and indemnification	1,137

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) $ in Thousands	Apr. 27, 2020USD ($)	Mar. 31, 2020USD ($)Lawsuit	Apr. 09, 2020	Dec. 31, 2019USD ($)
Subsequent Event [Line Items]
Line of credit		$ 71,000		$ 71,000
Number of lawsuits filed on behalf of company | Lawsuit		2
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