Orthofix Medical (OFIX) 10-Q 6 May 22 2022 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2022	May 02, 2022
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2022
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q1
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX MEDICAL INC.
Entity Central Index Key	0000884624
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Current Reporting Status	Yes
Entity Common Stock, Shares Outstanding		19,911,974
Entity File Number	0-19961
Entity Tax Identification Number	98-1340767
Entity Address, Address Line One	3451 Plano Parkway
Entity Address, City or Town	Lewisville
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75056
City Area Code	214
Local Phone Number	937-2000
Entity Incorporation, State or Country Code	DE
Title of 12(b) Security	Common stock, $0.10 par value per share
Security Exchange Name	NASDAQ
Entity Interactive Data Current	Yes
Document Quarterly Report	true
Document Transition Report	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Current assets
Cash and cash equivalents	$ 71,917	$ 87,847
Accounts receivable, net of allowances of $5,389 and $4,944, respectively	72,466	78,560
Inventories	88,832	82,974
Prepaid expenses and other current assets	21,888	20,141
Total current assets	255,103	269,522
Property, plant, and equipment, net	58,513	59,252
Intangible assets, net	50,171	52,666
Goodwill	71,317	71,317
Deferred income taxes	1,930	1,771
Other long-term assets	24,959	22,095
Total assets	461,993	476,623
Current liabilities
Accounts payable	27,448	26,459
Current portion of finance lease liability	610	2,590
Other current liabilities	60,152	76,781
Total current liabilities	88,210	105,830
Long-term portion of finance lease liability	19,730	19,890
Other long-term liabilities	18,478	13,969
Total liabilities	126,418	139,689
Contingencies (Note 7)
Shareholders’ equity
Common shares $0.10 par value; 50,000,000 shares authorized; 19,841,822 and 19,836,937 issued and outstanding as of March 31, 2022 and December 31, 2021, respectively	1,984	1,983
Additional paid-in capital	318,213	313,951
Retained earnings	16,540	21,000
Accumulated other comprehensive loss	(1,162)
Total shareholders’ equity	335,575	336,934
Total liabilities and shareholders’ equity	$ 461,993	$ 476,623

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Statement Of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 5,389	$ 4,944
Common shares, par value	$ 0.10	$ 0.10
Common shares, authorized	50,000,000	50,000,000
Common shares, issued	19,841,822	19,836,937
Common shares, outstanding	19,841,822	19,836,937

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Income Statement [Abstract]
Net sales	$ 106,418	$ 105,593
Cost of sales	28,318	25,914
Gross profit	78,100	79,679
Sales and marketing	54,137	50,785
General and administrative	19,328	16,444
Research and development	11,212	10,897
Acquisition-related amortization and remeasurement (Note 11)	(3,499)	4,469
Operating loss	(3,078)	(2,916)
Interest expense, net	(375)	(417)
Other expense, net	(936)	(2,690)
Loss before income taxes	(4,389)	(6,023)
Income tax benefit (expense)	(71)	207
Net loss	$ (4,460)	$ (5,816)
Net loss per common share:
Basic	$ (0.22)	$ (0.30)
Diluted	$ (0.22)	$ (0.30)
Weighted average number of common shares:
Basic	19,897,695	19,526,872
Diluted	19,897,695	19,526,872
Other comprehensive loss, before tax
Unrealized loss on debt securities	$ (674)	$ (726)
Currency translation adjustment	(488)	(1,027)
Other comprehensive loss, before tax	(1,162)	(1,753)
Income tax benefit related to other comprehensive loss		180
Other comprehensive loss, net of tax	(1,162)	(1,573)
Comprehensive loss	$ (5,622)	$ (7,389)

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Changes in Shareholders' Equity - USD ($) $ in Thousands	Total	Common Shares [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Beginning Balance at Dec. 31, 2020	$ 356,864	$ 1,942	$ 292,291	$ 59,379	$ 3,252
Balance, Shares at Dec. 31, 2020		19,423,874
Net loss	(5,816)			(5,816)
Other comprehensive loss, net of tax	(1,573)				(1,573)
Share-based compensation expense	3,721		3,721
Common shares issued, net	1,622	$ 5	1,617
Common shares issued, net, Shares		50,510
Ending Balance at Mar. 31, 2021	354,818	$ 1,947	297,629	53,563	1,679
Balance, Shares at Mar. 31, 2021		19,474,384
Beginning Balance at Dec. 31, 2021	$ 336,934	$ 1,983	313,951	21,000
Balance, Shares at Dec. 31, 2021	19,836,937	19,836,937
Net loss	$ (4,460)			(4,460)
Other comprehensive loss, net of tax	(1,162)				(1,162)
Share-based compensation expense	4,332		4,332
Common shares issued, net	(69)	$ 1	(70)
Common shares issued, net, Shares		4,885
Ending Balance at Mar. 31, 2022	$ 335,575	$ 1,984	$ 318,213	$ 16,540	$ (1,162)
Balance, Shares at Mar. 31, 2022	19,841,822	19,841,822

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash flows from operating activities
Net loss	$ (4,460)	$ (5,816)
Adjustments to reconcile net loss to net cash from operating activities
Depreciation and amortization	7,516	7,443
Amortization of operating lease assets, debt costs, and other assets	798	889
Provision for expected credit losses	600	(182)
Deferred income taxes	(36)	(971)
Share-based compensation expense	4,332	3,721
Interest and (gain) loss on valuation of investment securities	(9)	(96)
Change in fair value of contingent consideration	(5,500)	1,500
Other	528	24
Changes in operating assets and liabilities, net of effects of acquisitions
Accounts receivable	5,392	2,748
Inventories	(6,211)	16
Prepaid expenses and other current assets	(1,891)	1,993
Accounts payable	1,387	(1,457)
Other current liabilities	(6,993)	(7,719)
Contract liability (Note 9)	(3,395)
Other long-term assets and liabilities	233	348
Net cash from operating activities	(7,709)	2,441
Cash flows from investing activities
Capital expenditures for property, plant and equipment	(5,329)	(4,365)
Capital expenditures for intangible assets	(338)	(416)
Net cash from investing activities	(5,667)	(4,781)
Cash flows from financing activities
Proceeds from issuance of common shares		1,717
Payments related to withholdings for share-based compensation	(69)	(95)
Payments related to finance lease obligation	(2,141)	(127)
Other financing activities	(23)	(385)
Net cash from financing activities	(2,233)	1,110
Effect of exchange rate changes on cash	(321)	(534)
Net change in cash, cash equivalents, and restricted cash	(15,930)	(1,764)
Cash, cash equivalents, and restricted cash at the beginning of period	87,847	96,821
Cash, cash equivalents, and restricted cash at the end of period	71,917	95,057
Components of cash, cash equivalents, and restricted cash at the end of period
Cash and cash equivalents	71,917	94,569
Restricted cash		488
Cash, cash equivalents, and restricted cash at the end of period	$ 71,917	$ 95,057

Business and basis of presentat

Business and basis of presentation	3 Months Ended
	Mar. 31, 2022
Organization Consolidation And Presentation Of Financial Statements And Unusual Or Infrequent Items Disclosure [Abstract]
Business and basis of presentation	1. Business and basis of presentation Description of the Business Orthofix Medical Inc. and its subsidiaries (the “Company”) is a global medical device company with a spine and orthopedics focus. The Company’s mission is to deliver innovative, quality-driven solutions while partnering with health care professionals to improve patient mobility. Headquartered in Lewisville, Texas, Orthofix’s spine and orthopedic products are distributed in more than 60 countries via the Company's sales representatives and distributors. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“U.S. GAAP”) for interim financial information and with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. Pursuant to these rules and regulations, certain information and note disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. In the opinion of management, all adjustments (consisting of normal recurring items) considered necessary for a fair statement have been included. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and related notes contained in the Company’s Form 10-K for the year ended December 31, 2021. Operating results for the three months ended March 31, 2022 are not necessarily indicative of the results that may be expected for other interim periods or the year ending December 31, 2022. The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. On an ongoing basis, the Company evaluates its estimates, including those related to revenue recognition; contractual allowances; allowances for expected credit losses; inventories; valuation of intangible assets; goodwill; fair value measurements, including contingent consideration; litigation and contingent liabilities; tax matters; and share-based compensation. Actual results could differ from these estimates.

Recently issued accounting pron

Recently issued accounting pronouncements	3 Months Ended
	Mar. 31, 2022
Accounting Changes And Error Corrections [Abstract]
Recently issued accounting pronouncements	2. Recently issued accounting pronouncements The Company considers the applicability and impact of all accounting standards updates ("ASUs"). Recently issued ASUs not listed were assessed and determined not applicable, or are expected to have minimal impact on the Company's condensed consolidated financial statements. Furthermore, there have been no material changes during the three months ended March 31, 2022, to the Company's application of significant accounting policies and estimates as described in the Company’s Form 10-K for the year ended December 31, 2021.

Inventories

Inventories	3 Months Ended
	Mar. 31, 2022
Inventory Disclosure [Abstract]
Inventories	3. Inventories Inventories were as follows: (U.S. Dollars, in thousands) March 31, December 31, Raw materials $ 11,263 $ 9,589 Work-in-process 14,477 15,096 Finished products 24,553 15,149 Field/consignment 38,539 43,140 Inventories $ 88,832 $ 82,974

Leases

Leases	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Leases	4. Leases A summary of the Company’s lease portfolio as of March 31, 2022, and December 31, 2021, is presented in the table below: (U.S. Dollars, in thousands) Classification March 31, December 31, 2021 Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 7,093 $ 3,155 Finance leases Property, plant and equipment, net 18,120 18,600 Total ROU assets $ 25,213 $ 21,755 Lease Liabilities Current Operating leases Other current liabilities $ 1,461 $ 1,834 Finance leases Current portion of finance lease liability 610 2,590 Long-term Operating leases Other long-term liabilities 5,742 1,443 Finance leases Long-term portion of finance lease liability 19,730 19,890 Total lease liabilities $ 27,543 $ 25,757 Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) Three Months Ended Three Months Ended Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 1,068 $ 1,147 Operating cash flows from finance leases 222 225 Financing cash flows from finance leases 2,141 127 ROU assets obtained in exchange for lease obligations Operating leases 4,470 248 Finance leases — 76

Long-term debt

Long-term debt	3 Months Ended
	Mar. 31, 2022
Debt Disclosure [Abstract]
Long-term debt	5. Long-term debt As of March 31, 2022, the Company had no borrowings outstanding under the secured revolving credit facility and was in compliance with all required financial covenants. In addition, the Company had no borrowings on its € 5.5 million ($ 6.1 million) available lines of credit in Italy as of March 31, 2022.

Fair value measurements and inv

Fair value measurements and investments	3 Months Ended
	Mar. 31, 2022
Fair Value Measurements And Investment Disclosure [Abstract]
Fair value measurements and investments	6. Fair value measurements and investments The fair value measurements of the Company’s financial assets and liabilities measured on a recurring basis were as follows: March 31, December 31, (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Neo Medical convertible loan agreements $ — $ — $ 5,780 $ 5,780 $ 7,148 Neo Medical preferred equity securities — 6,084 — 6,084 5,413 Bone Biologics equity securities 243 — — 243 309 Other investments — — 1,535 1,535 1,505 Total $ 243 $ 6,084 $ 7,315 $ 13,642 $ 14,375 Liabilities Spinal Kinetics contingent consideration $ — $ — $ ( 11,700 ) $ ( 11,700 ) $ ( 17,200 ) Deferred compensation plan — ( 1,285 ) — ( 1,285 ) ( 1,314 ) Total $ — $ ( 1,285 ) $ ( 11,700 ) $ ( 12,985 ) $ ( 18,514 ) Neo Medical Convertible Loan Agreements and Equity Investment In October 2020, the Company purchased preferred equity securities of Neo Medical SA, a privately held Swiss-based company developing a new generation of products for spinal surgery ("Neo Medical"), for consideration of $ 5.0 million and entered into a Convertible Loan Agreement pursuant to which Orthofix loaned Neo Medical CHF 4.6 million, or $ 5.0 million at the date of issuance (the “Convertible Loan”). In October 2021, the Company entered into an additional Convertible Loan Agreement (the “Additional Convertible Loan”), pursuant to which the Company loaned Neo Medical an additional CHF 0.6 million (funded by the payment of $ 0.7 million as of the issuance date). The equity securities are recorded in other long-term assets and are considered an investment that does not have a readily determinable fair value. As such, the Company measures this investment at cost, less any impairment, plus or minus changes resulting from observable price changes in orderly transactions for identical or similar investments of the same issuer. The table below presents a reconciliation of the beginning and ending balances of the Company’s investment in Neo Medical preferred equity securities: (U.S. Dollars, in thousands) 2022 2021 Fair value of Neo Medical preferred equity securities at January 1 $ 5,413 $ 5,000 Conversion of loan into preferred equity securities 671 — Fair value of Neo Medical preferred equity securities at March 31 6,084 5,000 Cumulative unrealized gain on Neo Medical preferred equity securities 413 — The Company made an election to convert the Additional Convertible Loan into shares of Neo Medical’s preferred equity securities in January 2022. The remaining Convertible Loan is recorded in other long-term assets as an available for sale debt security as of March 31, 2022. The Convertible Loan is recorded at fair value, with applicable interest recorded in interest income. The fair value of the Convertible Loan is based upon significant unobservable inputs, including the use of option-pricing models, Monte Carlo simulations for certain periods, and a probability-weighted discounted cash flows model, requiring the Company to develop its own assumptions. Therefore, the Company categorized these investments as Level 3 financial assets. Some of the more significant unobservable inputs used in the fair value measurement of the Convertible Loan include applicable discount rates, implied volatility, the likelihood and projected timing of repayment or conversion, and projected cash flows in support of the estimated enterprise value of Neo Medical. Holding other inputs constant, changes in these assumptions could result in a significant change in the fair value of the Convertible Loan. If the amortized cost of the Convertible Loan exceeds its estimated fair value, the security is deemed to be impaired, and must be evaluated for the recognition of a credit loss. As of March 31, 2022, the Company has not recognized any credit loss related to the Convertible Loan. The following table provides a reconciliation of the beginning and ending balances of the Convertible Loans, measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2022 2021 Fair value of Neo Medical Convertible Loans at January 1 $ 7,148 $ 7,160 Interest recognized in interest income, net 112 96 Foreign currency remeasurement recognized in other expense, net ( 69 ) ( 330 ) Unrealized loss recognized in other comprehensive income (loss) ( 740 ) ( 726 ) Conversion of loan into preferred equity securities ( 671 ) — Fair value of Neo Medical Convertible Loans at March 31 5,780 6,200 Amortized cost basis of Neo Medical Convertible Loans at March 31 5,581 5,045 The following table provides quantitative information related to certain key assumptions utilized within the valuation as of March 31, 2022: (U.S. Dollars, in thousands) Fair Value as of Unobservable inputs Estimate Neo Medical Convertible Loan $ 5,780 Cost of equity discount rate 16.9 % Implied volatility 71.3 % Bone Biologics Equity Securities The Company holds an investment in common stock of Bone Biologics Inc. (“Bone Biologics”, NASDAQ: BBLG), a developer of orthobiologic products. Changes in the fair value of the investment recorded during the three months ended March 31, 2022 and 2021, are shown in the table below: (U.S. Dollars, in thousands) 2022 2021 Bone Biologics equity securities at January 1 $ 309 $ — Fair value adjustments recognized in other expense, net ( 66 ) — Bone Biologics equity securities at March 31 $ 243 $ — Other investments Other investments represent assets and investments recorded at fair value that are not deemed to be material for disclosure on an individual basis. The fair value of these assets are based upon significant unobservable inputs, such as probability-weighted discounted cash flows models, requiring the Company to develop its own assumptions. Therefore, the Company has categorized these assets as Level 3 financial assets. As of March 31, 2022, this balance was classified within other long-term assets. Contingent Consideration The Company recognized a contingent consideration obligation in connection with the acquisition of Spinal Kinetics in 2018. The Spinal Kinetics contingent consideration consists of potential future milestone payments of up to $ 60.0 million in cash. The milestone payments included (i) $ 15.0 million upon U.S. Food and Drug Administration (“FDA”) approval of the M6-C artificial cervical disc (the “FDA Milestone”) and (ii) revenue-based milestone payments of up to $ 45.0 million in connection with future sales of the acquired artificial discs. Milestones must be achieved within five years of April 30, 2018, to trigger applicable payments. The FDA Milestone was achieved and paid in 2019 and a revenue-based milestone payment, totaling $ 15.0 million, was achieved and paid in 2021 upon meeting certain net sales targets. The estimated fair value of the remaining Spinal Kinetics contingent consideration, attributable to a revenue-based milestone, was $ 11.7 million as of March 31, 2022. The estimated fair value reflects assumptions made by management as of March 31, 2022 , such as the expected timing and volume of elective procedures and the impact of these procedures on future revenues. However, the actual amount ultimately paid could be higher or lower than the fair value of the remaining contingent consideration (ultimate payment will either be $ 30.0 million or the liability will be reversed if the milestone is not met within the required timeline). As of March 31, 2022 , the Company has classified the $ 11.7 million liability within other current liabilities , as the Company currently expects to achieve the remaining milestone in the next twelve months , if achieved . Any changes in fair value are recorded as an operating expense within acquisition-related amortization and remeasurement. The following table provides a reconciliation of the beginning and ending balances for the Spinal Kinetics contingent consideration measured at estimated fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2022 2021 Spinal Kinetics contingent consideration estimated fair value at January 1 $ 17,200 $ 35,400 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement ( 5,500 ) 1,500 Spinal Kinetics contingent consideration estimated fair value at March 31 $ 11,700 $ 36,900 The Company estimated the fair value of the remaining potential revenue-based milestone payment using a Monte Carlo simulation and a discounted cash flow model. This fair value measurement is based on significant inputs that are unobservable in the market and thus represents a Level 3 measurement. The key assumptions in applying the valuation model include the Company’s forecasted future revenues for the Motion Preservation product line (which is derived from the acquired Spinal Kinetics business), the expected timing of payment, applicable discount rates applied, and assumptions for potential volatility of the Company’s forecasted revenue. Significant changes in these assumptions could result in a significantly higher or lower fair value. The following table provides a range of key assumptions used within the valuation as of March 31, 2022: (U.S. Dollars, in thousands) Fair Value as of Valuation Technique Unobservable inputs Range Spinal Kinetics contingent consideration $ 11,700 Discounted cash flow Revenue discount rate 5.9 % - 7.4 % Payment discount rate 3.2 % - 4.7 % Projected year of achievement 2023

Contingencies

Contingencies	3 Months Ended
	Mar. 31, 2022
Commitments And Contingencies Disclosure [Abstract]
Contingencies	7. Contingencies In addition to the matters described below, in the normal course of its business, the Company is involved in various lawsuits from time to time and may be subject to certain other contingencies. The Company believes any losses related to these matters are individually and collectively immaterial as to a possible loss and range of loss. Italian Medical Device Payback (“IMDP”) In 2015, the Italian Parliament introduced rules for entities that supply goods and services to the Italian National Healthcare System. A key provision of the law is a ‘payback’ measure, requiring medical device companies in Italy to make payments to the Italian government if medical device expenditures exceed regional maximum ceilings. Companies are required to make payments equal to a percentage of expenditures exceeding maximum regional caps. There is considerable uncertainty about how the law will operate and what the exact timeline is for finalization. The Company’s current assessment of the IMDP involves significant judgment regarding the expected scope and actual implementation terms of the measure as the latter have not been clarified to date by Italian authorities. The Company accounts for the estimated cost of the IMDP as sales and marketing expense and periodically reassesses this liability based upon current facts and circumstances. As a result, the Company recorded expense of $ 0.3 million and $ 0.4 million for the three months ended March 31, 2022 and 2021, respectively. As of March 31, 2022 , the Company has accrued $ 5.4 million related to the IMDP, which it has classified within other long-term liabilities; however, the actual liability could be higher or lower than the amount accrued once the law has been clarified by the Italian authorities.

Accumulated other comprehensive

Accumulated other comprehensive loss	3 Months Ended
	Mar. 31, 2022
Equity [Abstract]
Accumulated other comprehensive loss	8. Accumulated other comprehensive loss The components of and changes in accumulated other comprehensive loss were as follows: (U.S. Dollars, in thousands) Currency Neo Medical Convertible Loans Other Investments Accumulated Other Balance at December 31, 2021 $ ( 711 ) $ 711 $ — $ — Other comprehensive income (loss) ( 488 ) ( 740 ) 66 ( 1,162 ) Income taxes — — — — Balance at March 31, 2022 $ ( 1,199 ) $ ( 29 ) $ 66 $ ( 1,162 )

Revenue recognition and account

Revenue recognition and accounts receivable	3 Months Ended
	Mar. 31, 2022
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	9. Revenue recognition and accounts receivable Revenue Recognition The Company has two reporting segments, which consist of Global Spine and Global Orthopedics. Within the Global Spine reporting segment there are three product categories: Bone Growth Therapies, Spinal Implants, and Biologics. The table below presents net sales by major product category by reporting segment: Three Months Ended March 31, (U.S. Dollars, in thousands) 2022 2021 Change Bone Growth Therapies $ 41,948 $ 42,947 - 2.3 % Spinal Implants 26,615 25,701 3.6 % Biologics 14,092 13,692 2.9 % Global Spine 82,655 82,340 0.4 % Global Orthopedics 23,763 23,253 2.2 % Net sales $ 106,418 $ 105,593 0.8 % Product Sales and Marketing Service Fees The table below presents product sales and marketing service fees, which are both components of net sales: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Product sales $ 92,608 $ 92,263 Marketing service fees 13,810 13,330 Net sales $ 106,418 $ 105,593 Product sales primarily consist of the sale of bone growth therapies devices, spinal implants products, and orthopedics products. Marketing service fees are received from MTF Biologics based on total sales of biologics tissues and relate solely to the Global Spine reporting segment. Accounts receivable and related allowances The following table provides a detail of changes in the Company’s allowance for expected credit losses for the three months ended March 31, 2022 and 2021 : (U.S. Dollars, in thousands) Three Months Ended March 31, 2022 2021 Allowance for expected credit losses beginning balance $ 4,944 $ 4,848 Current period provision (recovery) for expected credit losses 600 ( 182 ) Write-offs charged against the allowance and other ( 104 ) ( 46 ) Effect of changes in foreign exchange rates ( 51 ) ( 114 ) Allowance for expected credit losses ending balance $ 5,389 $ 4,506 Contract Liabilities The Company’s contract liabilities largely relate to a prepayment of $ 13.9 million received in April 2020 from the Centers for Medicare and Medicaid Service ("CMS") as part of the Accelerated and Advance Payment Program of the Coronavirus Aid, Relief, and Economic Security Act. The Company has classified the entire balance of this contract liability within other current liabilities based upon the Company’s estimates of when such funds will be recouped. The following table provides a detail of changes in the Company’s contract liability associated with the Accelerated and Advanced Payment Program for the three months ended March 31, 2022 and 2021: (U.S. Dollars, in thousands) Three Months Ended March 31, 2022 2021 Contract liability beginning balance $ 4,791 $ 13,851 Recoupment recognized in net sales ( 3,395 ) — Contract liability ending balance $ 1,396 $ 13,851 Other Contract Assets The Company’s contract assets, excluding accounts receivable (“Other Contract Assets”), largely consist of payments made to certain distributors to obtain contracts, gain access to customers in certain territories, and to provide the benefit of the exclusive distribution of the Company's products. Other Contract Assets are included in other long-term assets or other current assets, dependent upon the original term of the related agreement, and totaled $ 1.2 million and $ 1.4 million as of March 31, 2022 and December 31, 2021 , respectively.

Business segment information

Business segment information	3 Months Ended
	Mar. 31, 2022
Segment Reporting [Abstract]
Business segment information	10. Business segment information The Company has two reporting segments: Global Spine and Global Orthopedics. The primary metric used in managing the Company is earnings before interest, tax, depreciation, and amortization (“EBITDA”). Corporate activities are comprised of operating expenses and activities not directly identifiable within the two reporting segments, such as human resources, finance, legal, and information technology functions. The table below presents EBITDA by reporting segment: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Global Spine $ 15,893 $ 11,895 Global Orthopedics ( 3,096 ) ( 2,229 ) Corporate ( 9,295 ) ( 7,829 ) Total EBITDA $ 3,502 $ 1,837 Depreciation and amortization ( 7,516 ) ( 7,443 ) Interest expense, net ( 375 ) ( 417 ) Loss before income taxes $ ( 4,389 ) $ ( 6,023 ) Geographical information The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Global Spine U.S. $ 77,066 $ 77,755 International 5,589 4,585 Total Global Spine 82,655 82,340 Global Orthopedics U.S. 5,327 5,591 International 18,436 17,662 Total Global Orthopedics 23,763 23,253 Consolidated U.S. 82,393 83,346 International 24,025 22,247 Net sales $ 106,418 $ 105,593

Acquisition-Related Amortizatio

Acquisition-Related Amortization and Remeasurement	3 Months Ended
	Mar. 31, 2022
Acquisition Related Amortization And Remeasurement [Abstract]
Acquisition-Related Amortization and Remeasurement	11. Acquisition-related amortization and remeasurement Acquisition-related amortization and remeasurement consists of (i) amortization related to intangible assets acquired through business combinations or asset acquisitions, (ii) the remeasurement of any related contingent consideration arrangements, and (iii) recognized costs associated with acquired in-process research and development (“IPR&D”) assets, which are recognized immediately upon acquisition. Components of acquisition-related amortization and remeasurement are as follows: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Amortization of acquired intangibles $ 2,001 $ 1,969 Changes in fair value of contingent consideration ( 5,500 ) 1,500 Acquired IPR&D — 1,000 Total $ ( 3,499 ) $ 4,469

Share-based compensation

Share-based compensation	3 Months Ended
	Mar. 31, 2022
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Share-based compensation	12. Share-based compensation Components of share-based compensation expense are as follows: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Cost of sales $ 211 $ 178 Sales and marketing 981 717 General and administrative 3,218 2,529 Research and development ( 78 ) 297 Total $ 4,332 $ 3,721 Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Stock options $ 359 $ 661 Time-based restricted stock awards and units 2,170 1,727 Market-based / performance-based restricted stock units 1,444 897 Stock purchase plan 359 436 Total $ 4,332 $ 3,721 During the three months ended March 31, 2022 and 2021 , the Company issued 4,885 and 50,510 shares, respectively, of common stock related to stock purchase plan issuances, stock option exercises, and the vesting of restricted stock awards and units.

Income taxes

Income taxes	3 Months Ended
	Mar. 31, 2022
Income Tax Disclosure [Abstract]
Income taxes	13. Income taxes Generally, income tax provisions for interim periods are based on an estimated annual income tax rate, adjusted for discrete tax items, with any changes affecting the estimated annual effective tax rate recorded in the interim period in which the change occurs. Due to the impact of losses not benefitted by the Company’s U.S. and Italian operations, the Company determined the estimated annual effective tax rate method would not provide a reliable estimate of the Company’s overall annual effective tax rate. As such, the Company has calculated the tax provision using the actual effective rate for the three months ended March 31, 2022. Due to the impact of temporary differences on the U.S. current tax liability without any deferred tax benefit, the actual effective rate may vary in future quarters. For the three months ended March 31, 2022 and 2021, the effective tax rate was ( 1.6 %) and 3.4 %, respectively. The primary factors affecting the Company’s effective tax rate for the three months ended March 31, 2022 , were certain losses not benefitted.

Earnings per share ("EPS")

Earnings per share ("EPS")	3 Months Ended
	Mar. 31, 2022
Earnings Per Share [Abstract]
Earnings per share ("EPS")	14. Earnings per share (“EPS”) The Company uses the two-class method of computing basic EPS due to the existence of non-vested restricted stock awards with nonforfeitable rights to dividends or dividend equivalents (referred to as participating securities). For the three months ended March 31, 2022, no significant adjustments were made to net income for purposes of calculating basic and diluted EPS. The following is a reconciliation of the weighted average shares used in diluted EPS computations. Three Months Ended 2022 2021 Weighted average common shares-basic 19,897,695 19,526,872 Effect of dilutive securities Unexercised stock options and stock purchase plan — — Unvested restricted stock awards and units — — Weighted average common shares-diluted 19,897,695 19,526,872 There were 2,461,446 and 2,037,663 weighted average outstanding (i) stock options and (ii) restricted stock awards and units, respectively, not included in the diluted EPS computation for the three months ended March 31, 2022 and 2021 , respectively, because inclusion of these awards was anti-dilutive or, for performance-based and market-based restricted stock units, all necessary conditions had not been satisfied by the end of the respective period.

Inventories (Tables)

Inventories (Tables)	3 Months Ended
	Mar. 31, 2022
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories were as follows: (U.S. Dollars, in thousands) March 31, December 31, Raw materials $ 11,263 $ 9,589 Work-in-process 14,477 15,096 Finished products 24,553 15,149 Field/consignment 38,539 43,140 Inventories $ 88,832 $ 82,974

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Summary of Lease Portfolio	A summary of the Company’s lease portfolio as of March 31, 2022, and December 31, 2021, is presented in the table below: (U.S. Dollars, in thousands) Classification March 31, December 31, 2021 Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 7,093 $ 3,155 Finance leases Property, plant and equipment, net 18,120 18,600 Total ROU assets $ 25,213 $ 21,755 Lease Liabilities Current Operating leases Other current liabilities $ 1,461 $ 1,834 Finance leases Current portion of finance lease liability 610 2,590 Long-term Operating leases Other long-term liabilities 5,742 1,443 Finance leases Long-term portion of finance lease liability 19,730 19,890 Total lease liabilities $ 27,543 $ 25,757
Summary of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) Three Months Ended Three Months Ended Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 1,068 $ 1,147 Operating cash flows from finance leases 222 225 Financing cash flows from finance leases 2,141 127 ROU assets obtained in exchange for lease obligations Operating leases 4,470 248 Finance leases — 76

Fair value measurements and i_2

Fair value measurements and investments (Tables)	3 Months Ended
	Mar. 31, 2022
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis	The fair value measurements of the Company’s financial assets and liabilities measured on a recurring basis were as follows: March 31, December 31, (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Neo Medical convertible loan agreements $ — $ — $ 5,780 $ 5,780 $ 7,148 Neo Medical preferred equity securities — 6,084 — 6,084 5,413 Bone Biologics equity securities 243 — — 243 309 Other investments — — 1,535 1,535 1,505 Total $ 243 $ 6,084 $ 7,315 $ 13,642 $ 14,375 Liabilities Spinal Kinetics contingent consideration $ — $ — $ ( 11,700 ) $ ( 11,700 ) $ ( 17,200 ) Deferred compensation plan — ( 1,285 ) — ( 1,285 ) ( 1,314 ) Total $ — $ ( 1,285 ) $ ( 11,700 ) $ ( 12,985 ) $ ( 18,514 )
Schedule of Reconciliation of Investments in Equity Securities	The table below presents a reconciliation of the beginning and ending balances of the Company’s investment in Neo Medical preferred equity securities: (U.S. Dollars, in thousands) 2022 2021 Fair value of Neo Medical preferred equity securities at January 1 $ 5,413 $ 5,000 Conversion of loan into preferred equity securities 671 — Fair value of Neo Medical preferred equity securities at March 31 6,084 5,000 Cumulative unrealized gain on Neo Medical preferred equity securities 413 —
Schedule of Changes in Valuation of Securities	Changes in the fair value of the investment recorded during the three months ended March 31, 2022 and 2021, are shown in the table below: (U.S. Dollars, in thousands) 2022 2021 Bone Biologics equity securities at January 1 $ 309 $ — Fair value adjustments recognized in other expense, net ( 66 ) — Bone Biologics equity securities at March 31 $ 243 $ —
Schedule of Reconciliation For Contingent Consideration Measured At Fair Value Using Significant Unobservable Inputs	The following table provides a reconciliation of the beginning and ending balances for the Spinal Kinetics contingent consideration measured at estimated fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2022 2021 Spinal Kinetics contingent consideration estimated fair value at January 1 $ 17,200 $ 35,400 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement ( 5,500 ) 1,500 Spinal Kinetics contingent consideration estimated fair value at March 31 $ 11,700 $ 36,900
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Schedule of Reconciliation For Convertible Loans Measured At Fair Value Using Significant Unobservable Inputs	The following table provides a reconciliation of the beginning and ending balances of the Convertible Loans, measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2022 2021 Fair value of Neo Medical Convertible Loans at January 1 $ 7,148 $ 7,160 Interest recognized in interest income, net 112 96 Foreign currency remeasurement recognized in other expense, net ( 69 ) ( 330 ) Unrealized loss recognized in other comprehensive income (loss) ( 740 ) ( 726 ) Conversion of loan into preferred equity securities ( 671 ) — Fair value of Neo Medical Convertible Loans at March 31 5,780 6,200 Amortized cost basis of Neo Medical Convertible Loans at March 31 5,581 5,045
Schedule of Changes in Valuation of Securities	The following table provides quantitative information related to certain key assumptions utilized within the valuation as of March 31, 2022: (U.S. Dollars, in thousands) Fair Value as of Unobservable inputs Estimate Neo Medical Convertible Loan $ 5,780 Cost of equity discount rate 16.9 % Implied volatility 71.3 % The following table provides a range of key assumptions used within the valuation as of March 31, 2022: (U.S. Dollars, in thousands) Fair Value as of Valuation Technique Unobservable inputs Range Spinal Kinetics contingent consideration $ 11,700 Discounted cash flow Revenue discount rate 5.9 % - 7.4 % Payment discount rate 3.2 % - 4.7 % Projected year of achievement 2023

Accumulated other comprehensi_2

Accumulated other comprehensive loss (Tables)	3 Months Ended
	Mar. 31, 2022
Equity [Abstract]
Components of Changes in Accumulated Other Comprehensive Loss	The components of and changes in accumulated other comprehensive loss were as follows: (U.S. Dollars, in thousands) Currency Neo Medical Convertible Loans Other Investments Accumulated Other Balance at December 31, 2021 $ ( 711 ) $ 711 $ — $ — Other comprehensive income (loss) ( 488 ) ( 740 ) 66 ( 1,162 ) Income taxes — — — — Balance at March 31, 2022 $ ( 1,199 ) $ ( 29 ) $ 66 $ ( 1,162 )

Revenue recognition and accou_2

Revenue recognition and accounts receivable (Tables)	3 Months Ended
	Mar. 31, 2022
Revenue Recognition And Accounts Receivable [Abstract]
Schedule of Net Sales by Major Product Category by Reporting Segment	The table below presents net sales by major product category by reporting segment: Three Months Ended March 31, (U.S. Dollars, in thousands) 2022 2021 Change Bone Growth Therapies $ 41,948 $ 42,947 - 2.3 % Spinal Implants 26,615 25,701 3.6 % Biologics 14,092 13,692 2.9 % Global Spine 82,655 82,340 0.4 % Global Orthopedics 23,763 23,253 2.2 % Net sales $ 106,418 $ 105,593 0.8 %
Schedule of Components Net Sales	The table below presents product sales and marketing service fees, which are both components of net sales: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Product sales $ 92,608 $ 92,263 Marketing service fees 13,810 13,330 Net sales $ 106,418 $ 105,593
Allowances for Expected Credit Losses	The following table provides a detail of changes in the Company’s allowance for expected credit losses for the three months ended March 31, 2022 and 2021 : (U.S. Dollars, in thousands) Three Months Ended March 31, 2022 2021 Allowance for expected credit losses beginning balance $ 4,944 $ 4,848 Current period provision (recovery) for expected credit losses 600 ( 182 ) Write-offs charged against the allowance and other ( 104 ) ( 46 ) Effect of changes in foreign exchange rates ( 51 ) ( 114 ) Allowance for expected credit losses ending balance $ 5,389 $ 4,506
Schedule of Changes in Contract Liability	The following table provides a detail of changes in the Company’s contract liability associated with the Accelerated and Advanced Payment Program for the three months ended March 31, 2022 and 2021: (U.S. Dollars, in thousands) Three Months Ended March 31, 2022 2021 Contract liability beginning balance $ 4,791 $ 13,851 Recoupment recognized in net sales ( 3,395 ) — Contract liability ending balance $ 1,396 $ 13,851

Business segment information (T

Business segment information (Tables)	3 Months Ended
	Mar. 31, 2022
Segment Reporting [Abstract]
Summary of EBITDA by Reporting Segment	The table below presents EBITDA by reporting segment: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Global Spine $ 15,893 $ 11,895 Global Orthopedics ( 3,096 ) ( 2,229 ) Corporate ( 9,295 ) ( 7,829 ) Total EBITDA $ 3,502 $ 1,837 Depreciation and amortization ( 7,516 ) ( 7,443 ) Interest expense, net ( 375 ) ( 417 ) Loss before income taxes $ ( 4,389 ) $ ( 6,023 )
Summary of Net Sales by Geographic Destination for each Reporting Segment	The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Global Spine U.S. $ 77,066 $ 77,755 International 5,589 4,585 Total Global Spine 82,655 82,340 Global Orthopedics U.S. 5,327 5,591 International 18,436 17,662 Total Global Orthopedics 23,763 23,253 Consolidated U.S. 82,393 83,346 International 24,025 22,247 Net sales $ 106,418 $ 105,593

Acquisition-Related Amortizat_2

Acquisition-Related Amortization and Remeasurement (Tables)	3 Months Ended
	Mar. 31, 2022
Acquisition Related Amortization And Remeasurement [Abstract]
Schedule of Acquisition-Related Amortization and Remeasurement	Components of acquisition-related amortization and remeasurement are as follows: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Amortization of acquired intangibles $ 2,001 $ 1,969 Changes in fair value of contingent consideration ( 5,500 ) 1,500 Acquired IPR&D — 1,000 Total $ ( 3,499 ) $ 4,469

Share-based compensation (Table

Share-based compensation (Tables)	3 Months Ended
	Mar. 31, 2022
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Schedule of Components of Share-Based Compensation Expense	Components of share-based compensation expense are as follows: Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Cost of sales $ 211 $ 178 Sales and marketing 981 717 General and administrative 3,218 2,529 Research and development ( 78 ) 297 Total $ 4,332 $ 3,721 Three Months Ended (U.S. Dollars, in thousands) 2022 2021 Stock options $ 359 $ 661 Time-based restricted stock awards and units 2,170 1,727 Market-based / performance-based restricted stock units 1,444 897 Stock purchase plan 359 436 Total $ 4,332 $ 3,721

Earnings per share ("EPS") (Tab

Earnings per share ("EPS") (Tables)	3 Months Ended
	Mar. 31, 2022
Earnings Per Share [Abstract]
Schedule of Reconciliation of Weighted Average Shares Used in Diluted EPS	The following is a reconciliation of the weighted average shares used in diluted EPS computations. Three Months Ended 2022 2021 Weighted average common shares-basic 19,897,695 19,526,872 Effect of dilutive securities Unexercised stock options and stock purchase plan — — Unvested restricted stock awards and units — — Weighted average common shares-diluted 19,897,695 19,526,872

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Inventory Disclosure [Abstract]
Raw materials	$ 11,263	$ 9,589
Work-in-process	14,477	15,096
Finished products	24,553	15,149
Field/consignment	38,539	43,140
Inventories	$ 88,832	$ 82,974

Leases - Summary of Lease Portf

Leases - Summary of Lease Portfolio (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Right-of-use assets ("ROU assets")
Operating leases	$ 7,093	$ 3,155
Operating lease, right-of-use asset, statement of financial position [Extensible List]	Other long-term assets	Other long-term assets
Finance leases	$ 18,120	$ 18,600
Finance lease, right-of-use asset, statement of financial position [Extensible List]	Property, plant, and equipment, net	Property, plant, and equipment, net
Total ROU assets	$ 25,213	$ 21,755
Current
Operating leases	$ 1,461	$ 1,834
Operating lease, liability, current, statement of financial position [Extensible List]	Other current liabilities	Other current liabilities
Finance leases	$ 610	$ 2,590
Long-term
Operating leases	$ 5,742	$ 1,443
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Other long-term liabilities	Other long-term liabilities
Finance leases	$ 19,730	$ 19,890
Total lease liabilities	$ 27,543	$ 25,757

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 1,068	$ 1,147
Operating cash flows from finance leases	222	225
Financing cash flows from finance leases	2,141	127
ROU assets obtained in exchange for lease obligations
Operating leases	$ 4,470	248
Finance leases		$ 76

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail) - Mar. 31, 2022 - Italy [Member]	USD ($)	EUR (€)
Debt Instrument [Line Items]
Amount outstanding under lines of credit	$ 0
Maximum borrowing capacity	$ 6,100,000	€ 5,500,000

Fair Value Measurements and I_3

Fair Value Measurements and Investments - Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 13,642	$ 14,375
Deferred compensation plan, Liabilities	(1,285)	(1,314)
Liabilities fair value, Total	(12,985)	(18,514)
Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(11,700)	(17,200)
Convertible Loan Agreement | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	5,780	7,148
Preferred Equity Securities [Member] | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,084	5,413
Equity Securities [Member] | Bone Biologics Inc
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	243	309
Other Investments [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,535	$ 1,505
Fair Value, Inputs, Level 1 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	243
Fair Value, Inputs, Level 1 [Member] | Equity Securities [Member] | Bone Biologics Inc
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	243
Fair Value, Inputs, Level 2 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,084
Deferred compensation plan, Liabilities	(1,285)
Liabilities fair value, Total	(1,285)
Fair Value, Inputs, Level 2 [Member] | Preferred Equity Securities [Member] | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,084
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	7,315
Liabilities fair value, Total	(11,700)
Fair Value, Inputs, Level 3 [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(11,700)
Fair Value, Inputs, Level 3 [Member] | Convertible Loan Agreement | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	5,780
Fair Value, Inputs, Level 3 [Member] | Other Investments [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 1,535

Fair Value Measurements and I_4

Fair Value Measurements and Investments - Additional Information (Detail) SFr in Millions, $ in Millions	Apr. 30, 2018USD ($)	Oct. 31, 2020USD ($)	Mar. 31, 2022USD ($)	Dec. 31, 2021USD ($)	Oct. 31, 2021USD ($)	Oct. 31, 2021CHF (SFr)	Oct. 31, 2020CHF (SFr)
Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Milestone achievement period	5 years		12 months
Payment for contingent consideration liability			$ 30
Spinal Kinetics [Member] | Other Current Liabilities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Consideration transferred			11.7
Maximum [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments	$ 60
US Food And Drug Administration [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments	15
Revenue Milestone [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments				$ 15
Revenue Milestone [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments	$ 45
Consideration transferred			$ 11.7
Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Convertible loans		$ 5			$ 0.7	SFr 0.6	SFr 4.6
Preferred Stock | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Amount of Preferred stock consideration		$ 5

Fair Value Measurements and I_5

Fair Value Measurements and Investments - Schedule of Reconciliation of Investments in Equity Securities (Detail) - Preferred Stock [Member] - Neo Medical [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Fair value of equity securities beginning balance	$ 5,413	$ 5,000
Conversion of loan into preferred equity securities	671	0
Fair value of equity securities Ending balance	6,084	5,000
Cumulative unrealized gain on Neo Medical preferred equity securities	$ 413	$ 0

Fair Value Measurements and I_6

Fair Value Measurements and Investments - Schedule of Reconciliation For Contingent Consideration Measured At Fair Value Using Significant Unobservable Inputs (Level 3) (Detail) - Neo Medical [Member] - Fair Value, Inputs, Level 3 [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of convertible loans beginning balance	$ 7,148	$ 7,160
Interest recognized in interest income, net	112	96
Foreign currency remeasurement recognized in other expense, net	(69)	(330)
Unrealized loss recognized in other comprehensive income (loss)	(740)	(726)
Conversion of loan into preferred equity securities	(671)
Fair value of convertible loans ending balance	5,780	6,200
Amortized cost basis of Neo Medical Convertible Loan at March 31	$ 5,581	$ 5,045

Fair Value Measurements and I_7

Fair Value Measurements and Investments - Schedule of Valuation Methodology and Unobservable Inputs for Level 3 Assets and Liabilities Measured at Fair Value (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)	Mar. 31, 2021USD ($)
Spinal Kinetics [Member] | Revenue Discount Rate
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Consideration transferred	$ 11,700
Spinal Kinetics [Member] | Revenue Discount Rate | Minimum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement input	5.9
Spinal Kinetics [Member] | Revenue Discount Rate | Maximum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement input	7.4
Spinal Kinetics [Member] | Payment Discount Rate | Minimum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement input	3.2
Spinal Kinetics [Member] | Payment Discount Rate | Maximum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement input	4.7
Spinal Kinetics [Member] | Projected Year of Achievement
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement period	2023
Spinal Kinetics [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Spinal Kinetics contingent consideration estimated fair value at January 1	$ 17,200	$ 35,400
Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement	(5,500)	1,500
Spinal Kinetics contingent consideration estimated fair value at March 31	11,700	$ 36,900
Neo Medical [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Neo Medical Convertible Loan	$ 5,780
Fair value implied volatility	71.30%
Fair value discount rate	16.90%

Fair Value Measurements and I_8

Fair Value Measurements and Investments - Schedule of Change in Valuation of Securities (Detail) - Bone Biologics Inc [Member] $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Equity securities beginning balance	$ 309
Fair value adjustments recognized in other expense, net	(66)
Equity securities ending balance	$ 243

Contingencies - Additional Info

Contingencies - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Commitments And Contingencies Disclosure [Abstract]
Estimated sales and marketing expense (benefit)	$ 0.3	$ 0.4
Accrued other long-term liabilities	$ 5.4

Accumulated other comprehensi_3

Accumulated other comprehensive loss - Components of Changes in Accumulated Other Comprehensive Loss (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 336,934
Ending Balance	335,575
Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(711)
Other comprehensive income (loss)	(488)
Ending Balance	(1,199)
Neo Medical [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	711
Other comprehensive income (loss)	(740)
Ending Balance	(29)
Accumulated Other Comprehensive Income (Loss) [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Other comprehensive income (loss)	(1,162)
Ending Balance	(1,162)
Other Investments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Other comprehensive income (loss)	66
Ending Balance	$ 66

Revenue Recognition and Accou_3

Revenue Recognition and Accounts Receivable - Schedule of Net Sales by Major Product Category by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 106,418	$ 105,593
Change	0.80%
Bone Growth Therapies [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 41,948	42,947
Change	(2.30%)
Spinal Implants [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 26,615	25,701
Change	3.60%
Biologics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 14,092	13,692
Change	2.90%
Global Spine [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 82,655	82,340
Change	0.40%
Global Orthopedics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 23,763	$ 23,253
Change	2.20%

Revenue Recognition and Accou_4

Revenue Recognition and Accounts Receivable - Schedule of Components of Net Sales (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Revenue Recognition [Abstract]
Product sales	$ 92,608	$ 92,263
Marketing service fees	13,810	13,330
Net sales	$ 106,418	$ 105,593

Revenue Recognition and Accou_5

Revenue Recognition and Accounts Receivable - Schedule of Allowance for Expected Credit Losses (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Revenue Recognition [Abstract]
Allowance for expected credit losses beginning balance	$ 4,944	$ 4,848
Current period provision (recovery) for expected credit losses	600	(182)
Write-offs charged against the allowance and other	(104)	(46)
Effect of changes in foreign exchange rates	(51)	(114)
Allowance for expected credit losses ending balance	$ 5,389	$ 4,506

Revenue Recognition and Accou_6

Revenue Recognition and Accounts Receivable - Additional Information (Detail) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended
	Apr. 30, 2020	Mar. 31, 2022	Dec. 31, 2021
Revenue Recognition And Accounts Receivable [Line Items]
CARES Act of 2020 funds received	$ 13,900	$ (3,395)
Other Long-Term Assets or Other Current Assets [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Other contract assets		$ 1,200	$ 1,400

Revenue Recognition and Accou_7

Revenue Recognition and Accounts Receivable - Schedule of Changes In Contract Liability (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Revenue Recognition [Abstract]
Contract liability beginning balance	$ 4,791	$ 13,851
Recoupment recognized in net sales	(3,395)	0
Contract liability ending balance	$ 1,396	$ 13,851

Business Segment Information -

Business Segment Information - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2022Segment
Segment Reporting [Abstract]
Number of reporting segments	2

Business Segment Information _2

Business Segment Information - Summary of EBIDTA by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Segment Reporting Information [Line Items]
Total EBITDA	$ 3,502	$ 1,837
Depreciation and amortization	(7,516)	(7,443)
Interest expense, net	(375)	(417)
Loss before income taxes	(4,389)	(6,023)
Operating Segments [Member] | Global Spine [Member]
Segment Reporting Information [Line Items]
Total EBITDA	15,893	11,895
Operating Segments [Member] | Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Total EBITDA	(3,096)	(2,229)
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Total EBITDA	$ (9,295)	$ (7,829)

Business Segment Information _3

Business Segment Information - Summary of Net Sales by Geographic Destination for Each Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 106,418	$ 105,593
Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	82,655	82,340
Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	23,763	23,253
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	82,393	83,346
U.S. [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	77,066	77,755
U.S. [Member] | Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	5,327	5,591
International [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	24,025	22,247
International [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	5,589	4,585
International [Member] | Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 18,436	$ 17,662

Acquisition-Related Amortizat_3

Acquisition-Related Amortization and Remeasurement - Components of Acquisition-Related Amortization and Remeasurement (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Acquisition Related Amortization And Remeasurement [Abstract]
Amortization of acquired intangibles	$ 2,001	$ 1,969
Changes in fair value of contingent consideration	(5,500)	1,500
Acquired IPR&D		1,000
Total	$ (3,499)	$ 4,469

Share-based Compensation - Sche

Share-based Compensation - Schedule of Components of Share-Based Compensation Expense (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 4,332	$ 3,721
Stock options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	359	661
Time-based Restricted Stock Awards and Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	2,170	1,727
Market-based / Performance-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,444	897
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	359	436
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	211	178
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	981	717
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	3,218	2,529
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 78	$ 297

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Shares issued under stock purchase plan, stock option exercises and restricted stock awards and units	4,885	50,510

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Components Of Income Tax Expense Benefit [Line Items]
Income tax effective rate	(1.60%)	3.40%

Earnings Per Share ("EPS") - Sc

Earnings Per Share ("EPS") - Schedule of Reconciliation of Weighted Average Shares Used in Diluted EPS (Detail) - shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Earnings Per Share [Line Items]
Weighted average common shares-basic	19,897,695	19,526,872
Effect of dilutive securities
Weighted average common shares-diluted	19,897,695	19,526,872

Earnings Per Share ("EPS") - Ad

Earnings Per Share ("EPS") - Additional Information (Detail) - shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Restricted Stock Units [Member] | Outstanding Stock Options [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Weighted average outstanding options, awards and units not included in diluted earnings per share	2,461,446	2,037,663