Orthofix Medical (OFIX) 10-K 5 Mar 24 2023 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Mar. 01, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX MEDICAL INC.
Entity Central Index Key	0000884624
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Interactive Data Current	Yes
Entity Common Stock, Shares Outstanding		37,406,644
Entity Public Float			$ 663.4
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
Security Exchange Name	NASDAQ
Document Annual Report	true
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction [Flag]	false
Document Transition Report	false
Auditor Firm ID	42
Auditor Name	Ernst & Young LLP
Auditor Location	Dallas, Texas
Documents Incorporated by Reference	Certain sections of the registrant’s definitive proxy statement to be filed with the Commission in connection with the Orthofix Medical Inc. 2024 Annual Meeting of Shareholders are incorporated by reference in Part III of this Annual Report.

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Current assets
Cash and cash equivalents	$ 33,107	$ 50,700
Restricted cash	4,650
Accounts receivable, net of allowances of $7,130 and $6,419, respectively	128,098	82,857
Inventories	222,166	100,150
Prepaid expenses and other current assets	32,422	22,283
Total current assets	420,443	255,990
Property, plant and equipment net	159,060	58,229
Intangible assets, net	117,490	47,388
Goodwill	194,934	71,317
Other long-term assets	33,388	25,705
Total assets	925,315	458,629
Current liabilities
Accounts payable	58,357	27,598
Current portion of long-term debt	1,250
Current portion of finance lease liability	708	652
Other current liabilities	104,908	55,374
Total current liabilities	165,223	83,624
Long-term debt	93,107
Long-term portion of finance lease liability	18,532	19,239
Other long-term liabilities	49,723	18,906
Total liabilities	326,585	121,769
Contingencies (Note 13)
Shareholders’ equity
Common shares $0.10 par value; 100,000 shares authorized; 37,165 and 20,162 issued and outstanding as of December 31, 2023 and 2022, respectively	3,717	2,016
Additional paid-in capital	746,450	334,969
Retained earnings (accumulated deficit)	(150,144)	1,251
Accumulated other comprehensive loss	(1,293)	(1,376)
Total shareholders’ equity	598,730	336,860
Total liabilities and shareholders’ equity	$ 925,315	$ 458,629

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 7,130	$ 6,419
Common shares, par value	$ 0.10	$ 0.10
Common shares, authorized	100,000,000	100,000,000
Common shares, issued	37,165,000	20,162,000
Common shares, outstanding	37,165,000	20,162,000

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Net sales	$ 746,641	$ 460,713	$ 464,479
Cost of sales	260,368	123,544	114,914
Gross profit	486,273	337,169	349,565
Sales and marketing	385,736	228,810	221,318
General and administrative	144,659	79,966	69,353
Research and development	80,231	49,065	49,621
Acquisition-related amortization and remeasurement (Note 17)	14,757	(7,404)	17,588
Operating loss	(139,110)	(13,268)	(8,315)
Interest expense, net	(8,631)	(1,288)	(1,837)
Other expense, net	(938)	(3,150)	(3,343)
Income (loss) before income taxes	(148,679)	(17,706)	(13,495)
Income tax expense	(2,716)	(2,043)	(24,884)
Net loss	$ (151,395)	$ (19,749)	$ (38,379)
Net loss per common share:
Basic	$ (4.12)	$ (0.98)	$ (1.95)
Diluted	$ (4.12)	$ (0.98)	$ (1.95)
Weighted average number of common shares:
Basic	36,729,258	20,053,548	19,690,593
Diluted	36,729,258	20,053,548	19,690,593
Other comprehensive income (loss), before tax
Unrealized gain (loss) on debt securities	$ (1,334)	$ 395	$ (942)
Currency translation adjustment	1,417	(1,771)	(2,544)
Other comprehensive income (loss), before tax	83	(1,376)	(3,486)
Income tax benefit (expense) related to items of other comprehensive income (loss)			234
Other comprehensive income (loss), net of tax	83	(1,376)	(3,252)
Comprehensive loss	$ (151,312)	$ (21,125)	$ (41,631)

Consolidated Statements of Chan

Consolidated Statements of Changes in Shareholders' Equity - USD ($) $ in Thousands	Total	Common Shares [Member]	Additional Paid-in Capital [Member]	Retained Earnings (Accumulated Deficit) [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		19,424
Net loss	(38,379)			(38,379)
Other comprehensive income (loss), net of tax	(3,252)				(3,252)
Share-based compensation expense	15,432		15,432
Common shares issued, net	6,269	$ 41	6,228
Common shares issued, net, Shares		413
Ending Balance at Dec. 31, 2021	336,934	$ 1,983	313,951	21,000
Balance, Shares at Dec. 31, 2021		19,837
Net loss	(19,749)			(19,749)
Other comprehensive income (loss), net of tax	(1,376)				(1,376)
Share-based compensation expense	18,443		18,443
Common shares issued, net	2,608	$ 33	2,575
Common shares issued, net, Shares		325
Ending Balance at Dec. 31, 2022	$ 336,860	$ 2,016	334,969	1,251	(1,376)
Balance, Shares at Dec. 31, 2022	20,162,000	20,162
Net loss	$ (151,395)			(151,395)
Other comprehensive income (loss), net of tax	83				83
Share-based compensation expense	35,707		35,707
Common shares issued in connection with SeaSpine merger	376,745	$ 1,605	375,140
Common shares issued in connection with SeaSpine merger, Shares		16,047
Common shares issued, net	730	$ 96	634
Common shares issued, net, Shares		956
Ending Balance at Dec. 31, 2023	$ 598,730	$ 3,717	$ 746,450	$ (150,144)	$ (1,293)
Balance, Shares at Dec. 31, 2023	37,165,000	37,165

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities
Net loss	$ (151,395)	$ (19,749)	$ (38,379)
Adjustments to reconcile net loss to net cash from operating activities
Depreciation and amortization	53,063	29,019	29,599
Inventory reserve expenses	27,576	14,907	10,826
Amortization of inventory fair value step up	36,044
Impairment of goodwill			11,756
Amortization of operating lease assets, debt costs, and other assets	7,498	3,056	3,496
Provision for expected credit losses	820	2,095	444
Deferred income taxes	579	314	24,482
Share-based compensation expense	35,707	18,443	15,432
Interest and (gain) loss on the valuation of investment securities	596	(308)	(1,146)
Change in fair value of contingent consideration	(2,700)	(17,200)	(3,575)
Other	423	2,027	1,064
Changes in operating assets and liabilities, net of effects of acquisitions
Accounts receivable	(10,411)	(6,735)	(7,049)
Inventories	(58,051)	(33,040)	(10,207)
Prepaid expenses and other current assets	1,760	(874)	(2,834)
Accounts payable	8,642	2,282	4,253
Other current liabilities	4,069	627	1,013
Contract liability (Note 15)		(4,791)	(9,060)	$ 13,900
Payment of contingent consideration			(6,595)
Other long-term assets and liabilities	27	(1,611)	(5,045)
Net cash from operating activities	(45,753)	(11,538)	18,475
Cash flows from investing activities
Capital expenditures for property, plant and equipment	(60,256)	(21,364)	(17,785)
Capital expenditures for intangible assets	(1,794)	(1,796)	(1,807)
Contingent consideration payments related to asset acquisitions		(1,500)
Purchase of investment securities			(2,171)
Cash acquired in SeaSpine merger	29,419
Other investing activities	(500)	126	(1,250)
Net cash from investing activities	(33,131)	(24,534)	(23,013)
Cash flows from financing activities
Proceeds from credit facilities	174,500
Repayment of borrowings from credit facilities	(79,000)
Payment of debt acquired from SeaSpine merger	(26,899)
Proceeds from issuance of common shares	5,127	4,337	8,824
Payments related to withholdings for share-based compensation	(4,397)	(1,729)	(2,555)
Payment of contingent consideration	(1,000)		(8,405)
Payments related to finance lease obligation	(652)	(2,594)	(537)
Payment of debt issuance costs and other financing activities	(2,357)	(92)	(948)
Net cash from financing activities	65,322	(78)	(3,621)
Effect of exchange rate changes on cash and restricted cash	619	(997)	(815)
Net change in cash, cash equivalents, and restricted cash	(12,943)	(37,147)	(8,974)
Cash, cash equivalents, and restricted cash at the beginning of the year	50,700	87,847	96,821
Cash, cash equivalents, and restricted cash at the end of the year	37,757	50,700	87,847	96,821
Components of cash, cash equivalents, and restricted cash at the end of the year
Cash and cash equivalents	33,107	50,700	87,847
Restricted cash	4,650
Cash, cash equivalents, and restricted cash at the end of the year	$ 37,757	$ 50,700	$ 87,847	$ 96,821

Business and basis of presentat

Business and basis of presentation	12 Months Ended
	Dec. 31, 2023
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” or "Orthofix") merged with SeaSpine Holdings Corporation ("SeaSpine") in January 2023 to form a leading global spine and orthopedics company with a comprehensive portfolio of biologics, innovative spinal hardware, bone growth therapies, specialized orthopedic solutions, and a leading surgical navigation system. Its products are distributed in more than 60 countries worldwide. The Company is headquartered in Lewisville, Texas, where it conducts general business, product development, medical education and manufacturing, and has primary offices in Carlsbad, CA, with a focus on spine and biologics product innovation and surgeon education, and Verona, Italy, with an emphasis on product innovation, production, and medical education for orthopedics. The combined company’s global research and development, commercial and manufacturing footprint also includes facilities and offices in Irvine, CA, Toronto, Canada, Sunnyvale, CA, Wayne, PA, Olive Branch, MS, Maidenhead, UK, Munich, Germany, Paris, France, and São Paulo, Brazil. The merger with SeaSpine was completed on January 5, 2023, with SeaSpine continuing as a wholly-owned subsidiary of Orthofix following the transaction. For additional discussion of the merger with SeaSpine, see Note 4. The shares of common stock of Orthofix, as the corporate parent entity in the combined company structure, continue to trade on NASDAQ under the symbol "OFIX". Basis of Presentation The consolidated financial statements include the financial statements of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions are eliminated in consolidation. Information on our accounting policies and methods used in the preparation of our consolidated financial statements are included, where applicable, in the respective footnotes that follow. Footnote Footnote Reference Business and basis of presentation 1 Significant accounting policies 2 Recently adopted accounting standards and recently issued accounting pronouncements 3 Mergers and acquisitions 4 Inventories 5 Property, plant, and equipment 6 Intangible assets 7 Goodwill 8 Leases 9 Other current liabilities 10 Indebtedness 11 Fair value measurements and investments 12 Commitments and contingencies 13 Shareholders' equity 14 Revenue recognition and accounts receivable 15 Business segment information 16 Acquisition-related amortization and remeasurement 17 Share-based compensation 18 Defined contribution plans and deferred compensation 19 Income taxes 20 Earnings per share 21 Changes in Presentation of Consolidated Financial Statements Certain prior year balances have been reclassified in the consolidated financial statements to conform to current period presentation.

Significant accounting policies

Significant accounting policies	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Significant accounting policies	2. Significant accounting policies The preparation of financial statements in conformity with United States generally accepted accounting principles (“U.S. GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. On an ongoing basis, we evaluate these estimates, including those related to contractual allowances, allowances for expected credit losses, inventories, valuation of intangible assets, goodwill, fair value measurements (including fair value measurements associated with business combinations and/or asset acquisitions), litigation and contingent liabilities, income taxes, and share-based compensation. We base our estimates on historical experience, future expectations, and other relevant assumptions that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates. The following is a discussion of accounting policies and methods used in our consolidated financial statements that are not presented within other footnotes. Market risk In the ordinary course of business, the Company is exposed to the impact of changes in interest rates and foreign currency fluctuations. The Company’s objective is to limit the impact of such movements on earnings and cash flows. In order to achieve this objective, the Company seeks to balance its non-U.S. Dollar denominated income and expenditures. The financial statements for operations outside the U.S. are generally maintained in their respective local currency. All foreign currency denominated balance sheet accounts, except shareholders’ equity, are translated to U.S. Dollars at year end exchange rates, and revenue and expense items are translated at average exchange rates prevailing during the year. Gains and losses resulting from the translation of foreign currency are recorded in the accumulated other comprehensive income (loss) component of shareholders’ equity. Transactional foreign currency gains and losses, including those generated from intercompany operations, are included in other income (expense), net and was a gain of $ 1.6 million, a loss of $ 3.3 million, and a loss of $ 4.0 million for the years ended December 31, 2023, 2022, and 2021 , respectively. Financial instruments and concentration of credit risk Financial instruments that could subject the Company to a concentration of credit risk consist primarily of cash, cash equivalents, and accounts receivable. Generally, cash is held at large financial institutions and cash equivalents consist of highly liquid money market funds. The Company performs ongoing credit evaluations of customers, generally does not require collateral, and maintains a reserve for expected credit losses. The Company believes that a concentration of credit risk related to accounts receivable is limited because customers are geographically dispersed and end users are diversified. Cash, cash equivalents, and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. In November 2023, following the termination of the Second Amended and Restated Credit Agreement with JPMorgan Chase Bank, N.A., as Administrative Agent, and certain lender parties thereto, Bank of America required collateral of approximately $ 4.7 million of the Company’s cash as a banking service obligation. This cash has been reclassified to restricted cash as of December 31, 2023. Investing activities that did not result in cash receipts or cash payments during the years ended December 31, 2023, 2022, and 2021 consisted of the following, which were not included within cash from investing activities in the Company’s consolidated statements of cash flows: (U.S. Dollars, in thousands) 2023 2022 2021 Supplemental disclosure of cash flow information: Noncash investing activities: Intangible assets acquired in asset acquisitions $ — $ 2,000 $ — Advertising costs Advertising costs are expensed as incurred. Advertising costs are included within sales and marketing expense and totaled $ 0.5 million for each of the years ended December 31, 2023, 2022, and 2021 , respectively. Research and development costs, including collaborative arrangements Expenditures for research and development are expensed as incurred. Expenditures related to the Company’s collaborative arrangement with MTF Biologics (“MTF”) are expensed based on the terms of the related agreement. The Company recognized $ 0.8 million, less than $ 0.1 million, and $ 0.8 million in research and development expense for the years ended December 31, 2023, 2022, and 2021, respectively. In October 2020, the Company and Neo Medical SA, a privately held Swiss-based company developing a new generation of products for spinal surgery (“Neo Medical”), entered into a co-development agreement covering the parties’ joint development of single use instruments for cervical spine procedures. In connection with this agreement, the Company is responsible for the payment of variable costs associated with the development of the specified products. Research and development expenses incurred under this collaborative arrangement totaled $ 0.1 million, $ 0.5 million, and $ 0.6 million for the years ended December 31, 2023, 2022, and 2021 , respectively.

Recently adopted accounting sta

Recently adopted accounting standards and recently issued accounting pronouncements	12 Months Ended
	Dec. 31, 2023
Accounting Changes and Error Corrections [Abstract]
Recently adopted accounting standards and recently issued accounting pronouncements	3. Recently adopted accounting standards and recently issued accounting pronouncements Recently Adopted Accounting Standards Adoption of Accounting Standards Update (“ASU”) 2021-10—Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance In November 2021, the Financial Accounting Standards Board (“FASB”) issued ASU 2021-10, which aims to increase the transparency of government assistance by requiring entities to provide information about the nature of the transaction, terms and conditions associated with the transaction, and financial statement line items affected by the transaction. The Company voluntarily elected to early adopt this standard for the year ended December 31, 2021, on a prospective basis. Adoption of this standard did not have a significant impact to the existing disclosures made in relation to government assistance received by the Company in 2020 as part of the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act"). Adoption of ASU 2019-12, Simplifying the accounting for income taxes In December 2019, the FASB issued ASU 2019-12, which reduces the complexity of accounting for income taxes by eliminating certain exceptions to the general principles in Accounting Standards Codification ("ASC") 740, Income Taxes . Additionally, the ASU simplifies U.S. GAAP by amending the requirements related to the accounting for "hybrid" tax regimes and also adding the requirement to evaluate when a step up in the tax basis of goodwill should be considered part of the business combination and when it should be considered a separate transaction. The Company adopted this ASU effective January 1, 2021 , with certain provisions applied retrospectively and other provisions applied prospectively. Adoption of this ASU did not have a material impact to the Company’s consolidated balance sheet, statements of operations, or cash flows. Adoption of ASU 2020-04, Reference Rate Reform (Topic 848) In March 2020, the FASB issued ASU 2020-04, which provided temporary optional guidance to ease the potential financial reporting burden of the expected market transition away from the London Inter-Bank Offered Rate. The new guidance provided optional expedients and exceptions for applying U.S. GAAP to contract modifications, hedge accounting, and other transactions affected by reference rate reform if certain criteria are met through December 31, 2022. The Company adopted this ASU effective March 12, 2020 , the effective date of the ASU, on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s consolidated balance sheet, statements of operations, or cash flows. Adoption of ASU 2021-08, Accounting for Contract Assets and Contract Liabilities with Contracts with Customers In October 2021, the FASB issued ASU 2021-08, which aims to address diversity in practice and inconsistency related to the accounting for acquired revenue contracts with customers in a business combination. The amendments require that an entity recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with Topic 606, Revenue from Contracts with Customers. Adoption of this standard resulted in the recognition of $ 2.2 million in contract liabilities associated with acquired revenue contracts as a result of the Company’s merger with SeaSpine, which closed on January 5, 2023. Recently Issued Accounting Pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions (ASU 2022-03) Clarifies the guidance in Topic 820, Fair Value Measurement , when measuring the fair value of an equity security subject to contractual restrictions that prohibit the sale of an equity security and introduces new disclosure requirements for equity securities subject to contractual sale restrictions. Certain of the provisions are to be applied retrospectively with other provisions applied prospectively. January 1, 2024 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements, but does not expect this ASU to have a material impact on disclosures within the Company's consolidated financial statements. Disclosure Improvements - Codification Amendments in Response to the SEC's Disclosure Update and Simplification Initiative (ASU 2023-06) Adds interim and annual disclosure requirements to a variety of subtopics in the Accounting Standards Codification, including those focusing on accounting changes, earnings per share, debt and repurchase agreements. The guidance will be applied prospectively. The effective date will be the date when the SEC's removal of the related disclosure requirement becomes effective, with early adoption prohibited. Various The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Improvements to Reportable Segment Disclosures (ASU 2023-07) Improve financial reporting by requiring disclosure of incremental segment information on an annual and interim basis for all public entities to enable investors to develop more decision-useful financial analyses. Provisions are to be applied retrospectively to all prior periods presented in financial statements. January 1, 2024 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements; however, the Company expects to disclose additional information in regards to its reportable segments as a result of this ASU, including (i) significant segment expenses regularly provided to the Company's chief operating decision maker ("CODM"), (ii) disclosure of other segment items by reportable segment, and (iii) disclosure of the title and position of the Company's CODM, among other disclosure requirements. Improvements to Income Tax Disclosures (ASU 2023-09) Enhance the transparency and decision usefulness of income tax disclosures to better assess how an entity’s operations and related tax risks and tax planning and operational opportunities affect its tax rate and January 1, 2025 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements.

Mergers and Acquisitions

Mergers and Acquisitions	12 Months Ended
	Dec. 31, 2023
Business Combinations [Abstract]
Mergers and Acquisitions	4. Mergers and acquisitions Merger with SeaSpine On January 5, 2023, the Company and SeaSpine completed an all-stock merger of equals (the "Merger") to create a leading global spine and orthopedics company with highly complementary portfolios of biologics, innovative spinal hardware, bone growth therapies, specialized orthopedic solutions, and a leading surgical navigation system. As a result of the Merger, each share of SeaSpine common stock issued and outstanding immediately prior to the closing of the Merger was converted into the right to receive 0.4163 shares of Orthofix common stock. The Merger is being accounted for as an acquisition of SeaSpine by Orthofix under the acquisition method of accounting for business combinations in accordance with U.S. GAAP. Therefore, Orthofix is treated as the acquirer for accounting purposes. In identifying the acquirer, Orthofix and SeaSpine considered the structure of the transaction and other actions contemplated by the merger agreement (the "Merger Agreement"), relative outstanding share ownership, market values, the composition of the combined company's Board of Directors, and the relative size of Orthofix and SeaSpine. Under the acquisition method of accounting, the assets and liabilities of SeaSpine and its subsidiaries have been recorded at their respective fair values as of the acquisition date. The total estimated fair value of consideration associated with the Merger as of the acquisition date was comprised of: (U.S. Dollars, in thousands, except shares and price per share) Share Consideration: Orthofix common shares to be issued in exchange for SeaSpine common shares 16,047,315 Orthofix closing price per share as of January 4, 2023 $ 22.76 Estimated fair value of shares issued in exchange for SeaSpine common shares $ 365,237 Estimated fair value of Orthofix stock options and RSUs issued in exchange for outstanding SeaSpine equity awards 11,508 Total estimated fair value of consideration $ 376,745 The following table summarizes the estimated fair values of the assets acquired and liabilities assumed at the acquisition date. The Company finalized its valuation of assets acquired and liabilities assumed during the fourth quarter of 2023. Certain acquired assets and liabilities assumed were valued utilizing Level 3 inputs and assumptions. (U.S. Dollars, in thousands) Previously Reported Adjustments Final Acquisition Date Fair Value Assigned Useful Life Assets acquired: Current assets Cash and cash equivalents $ 29,419 $ — $ 29,419 Accounts receivable, net 35,313 — 35,313 Inventories 132,636 — 132,636 Prepaid expenses and other current assets 4,590 — 4,590 Total current assets 201,958 — 201,958 Property, plant, and equipment, net 68,863 — 68,863 Customer relationships 33,100 — 33,100 13 years Developed technology 47,200 — 47,200 6 - 8 years In-process research and development ("IPR&D") 5,750 — 5,750 Indefinite Other long-term assets 20,501 — 20,501 Total identifiable assets acquired $ 377,372 $ — $ 377,372 Liabilities assumed : Current liabilities Accounts payable $ 21,602 $ — $ 21,602 Other current liabilities 43,344 177 43,521 Total current liabilities 64,946 177 65,123 Long-term borrowings under SeaSpine credit facility 26,298 — 26,298 Other long-term liabilities 32,833 ( 10 ) 32,823 Total liabilities assumed 124,077 167 124,244 Net identifiable assets acquired $ 253,295 $ ( 167 ) $ 253,128 Total fair value of consideration transferred 376,745 — 376,745 Residual goodwill $ 123,450 $ 167 $ 123,617 The purchase price exceeded the fair value of the net tangible and identifiable intangible assets acquired in the Merger. As of December 31, 2023 , the Company recorded goodwill totaling $ 123.6 million, which was assigned to the Global Spine reporting segment. Specifically, the goodwill includes the assembled workforce and synergies associated with the combined entity. The goodwill is not deductible for tax purposes. The Company recognized $ 9.9 million in direct acquisition-related costs, which exclude integration-related activities, that were expensed during the year ended December 31, 2023 . These costs are included in the consolidated statements of operations and comprehensive income (loss), primarily within general and administrative expenses. The Company's results of operations included $ 258.9 million of net sales from SeaSpine for the year ended December 31, 2023 , and a net loss attributable to SeaSpine of $ 84.0 million for the year ended December 31, 2023. Unaudited Pro Forma Financial Information Due to the Merger closing on January 5, 2023, all SeaSpine financial results for fiscal year 2023, except for the first four days of January, are included in Orthofix's consolidated statement of operations and comprehensive loss. The following unaudited pro forma financial information for the year ended December 31, 2023, is based on the Company's historical consolidated financial statements adjusted to reflect as if the Merger closed as of January 1, 2022. The unaudited pro-forma information makes certain adjustments to depreciation and amortization expense to reflect the fair value recognized in the purchase price allocation and to remove one-time transaction-related costs. The unaudited pro forma financial information is presented for informational purposes only and is not necessarily indicative of the results of operations that would have been achieved if the Merger closed as of January 1, 2022. For the Year Ended December 31, (U.S. Dollars, in millions) 2023 2022 Net sales $ 746.6 $ 698.2 Net loss $ ( 116.4 ) $ ( 129.2 ) Integration and Restructuring Activities The Company has incurred significant integration and restructuring costs in connection with the Merger. The following table summarizes integration costs incurred for the year ended December 31, 2023, and 2022. For the Year Ended December 31, (U.S. Dollars, in millions) 2023 2022 Compensation-related integration costs $ 17.7 $ — International spine restructuring 1.3 — Fee paid to financial advisor to the Merger 5.5 — Professional fees / consulting fees 5.8 — Product rationalization charges 6.0 — Other costs to complete 1.4 — Total $ 37.7 $ — In the first quarter of 2023, the Company approved and initiated certain restructuring activities to streamline costs and to better align talent with operational needs following the consummation of the Merger. This program was expanded in the third quarter of 2023 to include further restructuring activities related to the Company's international spine business. The Company expects to incur total pre-tax expenses of approximately $ 18.2 million associated with the restructuring activities, which will be recognized within operating expenses. The table below provides a summary of restructuring costs incurred during the period and the resulting liabilities as of December 31, 2023, which are recognized within other current liabilities. (U.S. Dollars, in millions) Balance as of Charges Incurred Payments Made / Currency Translation Adjustment Balance as of U.S. Severance costs $ — $ 11.2 $ ( 10.2 ) $ 1.0 U.S. Retention costs — 5.3 ( 0.3 ) 5.0 U.S. Payroll taxes — 0.7 ( 0.4 ) 0.3 International spine restructuring severance — 1.0 ( 0.3 ) 0.7 Total $ — $ 18.2 $ ( 11.2 ) $ 7.0

Inventories

Inventories	12 Months Ended
	Dec. 31, 2023
Inventory Disclosure [Abstract]
Inventories	5. Inventories Inventories are valued at the lower of cost or estimated net realizable value, after provision for excess, obsolete, or impaired items, which is reviewed and updated on a periodic basis by management. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facility in Italy, cost is determined on a weighted-average basis, which approximates the first-in, first-out (“FIFO”) method. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facilities in Texas and California, standard cost, which approximates actual cost on the FIFO method, is used to value inventory. Standard costs are reviewed by management, at least annually or more often, in the event circumstances indicate a change in cost has occurred. Work-in-process and finished products include material, labor, and production overhead costs. Field and consignment inventory, which represents immediately saleable finished products inventory that is in the possession of the Company’s independent sales representatives or located at third-party customers, such as distributors and hospitals, is included within finished products. December 31, (U.S. Dollars, in thousands) 2023 2022 Raw materials $ 28,390 $ 17,035 Work-in-process 53,510 19,243 Finished products 140,266 63,872 Inventories $ 222,166 $ 100,150 The Company adjusts the value of its inventory to the extent management determines that the cost cannot be recovered due to obsolescence or other factors. In order to make these determinations, management uses estimates of future demand for each product to determine the appropriate inventory reserves and to make corresponding adjustments to the carrying value of these inventories to reflect the lower of cost or estimated net realizable value.

Property, plant and equipment

Property, plant and equipment	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Property, plant and equipment	6. Property, plant, and equipment Property, plant, and equipment is stated at cost or estimated fair value when acquired as part of a business combination, less accumulated depreciation . Costs include all expenditures necessary to place the asset in service, generally including freight and sales and use taxes. Property, plant, and equipment also includes instrumentation held by customers, which is generally used to facilitate the implantation of the Company’s products. The useful lives of these assets are generally as follows: Years Buildings 25 to 33 Plant and equipment 1 to 10 Instrumentation 3 to 4 Computer software 3 to 7 Furniture and fixtures 4 to 8 The Company evaluates the useful lives of these assets on an annual basis. Depreciation is computed on a straight-line basis over the useful lives of the assets. Depreciation of leasehold improvements is computed over the shorter of the lease term or the useful life of the asset. Total depreciation expense was $ 34.2 million, $ 19.6 million, and $ 20.2 million for the years ended December 31, 2023, 2022, and 2021, respectively. Expenditures for maintenance and repairs and minor renewals and improvements, which do not extend the lives of the respective assets, are expensed as incurred. All other expenditures for renewals and improvements are capitalized. The assets and related accumulated depreciation are adjusted for property retirements and disposals, with the resulting gain or loss included in earnings. Fully depreciated assets remain in the accounts until retired from service. December 31, (U.S. Dollars, in thousands) 2023 2022 Cost Buildings $ 4,103 $ 3,867 Plant and equipment 70,252 48,358 Instrumentation 154,192 92,607 Computer software 43,040 40,685 Furniture and fixtures 11,010 7,917 Construction in progress 41,751 4,515 Finance lease assets 23,337 23,276 Property, plant, and equipment, gross 347,685 221,225 Accumulated depreciation ( 188,625 ) ( 162,996 ) Property, plant, and equipment, net $ 159,060 $ 58,229 The Company capitalizes system development costs related to internal-use software during the application development stage. Costs related to preliminary project activities and post-implementation activities are expensed as incurred. Internal-use software is amortized on a straight-line basis over its estimated useful life, which generally ranges from three to seven years . Long-lived assets are evaluated for impairment annually or whenever events or changes in circumstances have occurred that would indicate impairment. For purposes of the evaluation, the Company groups its long-lived assets with other assets and liabilities at the lowest level of identifiable cash flows if the asset does not generate cash flows independent of other assets and liabilities. If the carrying value of the asset or asset group exceeds the undiscounted cash flows expected to result from the use and eventual disposition of the asset group, the Company will write the carrying value down to fair value in the period identified. The Company generally determines fair value of long-lived assets as the present value of estimated future cash flows. In determining the estimated future cash flows associated with the assets, the Company uses estimates and assumptions about future revenue contributions, cost structures, and remaining useful lives of the asset group. The use of alternative assumptions, including estimated cash flows, discount rates, and alternative estimated remaining useful lives could result in different calculations of impairment.

Intangible assets

Intangible assets	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible assets	7. Intangible assets Intangible assets are recorded at cost, or when acquired as a part of a business combination, at estimated fair value, less accumulated amortization. These assets are amortized on a straight-line basis over the useful lives of the assets, which the Company believes is materially consistent with the pattern of economic benefit provided by the assets. December 31, (U.S. Dollars, in thousands) Weighted Average Amortization Period 2023 2022 Cost Developed technology 7.9 years $ 92,416 $ 43,699 Patents 10.0 years 43,262 40,108 IPR&D Indefinite 4,674 300 Customer relationships 12.1 years 49,197 15,572 License and other 9.6 years 24,584 23,295 Trademarks—finite lived 10.0 years 1,797 1,875 9.5 years 215,930 124,849 Accumulated amortization Developed technology $ ( 28,898 ) $ ( 17,830 ) Patents ( 40,494 ) ( 37,506 ) Customer relationships ( 11,988 ) ( 6,938 ) License and other ( 16,240 ) ( 14,386 ) Trademarks—finite lived ( 820 ) ( 801 ) ( 98,440 ) ( 77,461 ) Intangible assets, net $ 117,490 $ 47,388 Acquired IPR&D represents the fair value assigned to acquired research and development assets that have not reached technological feasibility. In a business combination, the fair value assigned to acquired IPR&D is determined by estimating the remaining costs to develop the acquired technology into commercially viable products, estimating the resulting revenues from the projects, and discounting the net cash flows to present value. The revenue and cost projections used to value acquired IPR&D are, as applicable, reduced based on the probability of success of developing the asset. Additionally, estimated revenues consider the relevant market sizes and growth factors, expected trends in technology, and the nature and expected timing of new product introductions by the Company and its competitors. The rates utilized to discount the net cash flows to their present value are commensurate with the stage of development of the project and uncertainties in the economic estimates used in the projections. Any future costs to further develop the IPR&D subsequent to acquisition are recorded to research and development expense as incurred. IPR&D assets are considered to be indefinite-lived assets until the completion or abandonment of the associated research and development efforts. During the period the assets are considered indefinite-lived, they are not amortized but tested for impairment. Impairment testing is performed at least annually or when a triggering event occurs that could indicate a potential impairment. If and when development is complete, which generally occurs when regulatory approval to market a product is obtained, the associated assets are reclassified to developed technology and are amortized over an assigned useful life that best reflects the economic benefits provided by these assets. Amortization expense for intangible assets was $ 18.9 million, $ 9.4 million, and $ 9.4 million for the years ended December 31, 2023, December 31, 2022, and 2021, respectively. Future amortization expense for intangible assets is estimated as follows: (U.S. Dollars, in thousands) Amortization 2024 $ 20,948 2025 19,849 2026 18,810 2027 18,426 2028 14,890 Thereafter 19,893 Total finite-lived intangible assets, net $ 112,816 Indefinite-lived intangible assets, net 4,674 Intangible assets, net $ 117,490

Goodwill

Goodwill	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	8. Goodwill The Company tests goodwill at least annually for impairment. The Company tests more frequently if indicators are present or changes in circumstances suggest that impairment may exist. These indicators include, among others, declines in sales, earnings, or cash flows, or the development of a material adverse change in the business climate. The Company assesses goodwill for impairment at the reporting unit level, which is defined as an operating segment or one level below an operating segment. The following table presents the net carrying value of goodwill as of December 31, 2023, and 2022, and a rollforward of such balances from December 31, 2022, by reportable segment: (U.S. Dollars, in thousands) Balance as of Goodwill Acquired in the Merger with SeaSpine Impairment Currency translation adjustment Balance as of Global Spine - Gross $ 71,317 $ 123,617 $ — $ — $ 194,934 Global Spine - Accumulated Impairment Loss — — — — $ — Global Spine - Net $ 71,317 $ 123,617 $ — $ — $ 194,934 Global Orthopedics - Gross $ 11,130 $ — $ — $ 347 $ 11,477 Global Orthopedics - Accumulated Impairment Loss ( 11,130 ) — — ( 347 ) $ ( 11,477 ) Global Orthopedics - Net $ — $ — $ — $ — $ — Goodwill, net of accumulated impairment losses $ 71,317 $ 123,617 $ — $ — $ 194,934 In the fourth quarter of 2021, the Company performed a quantitative assessment of its goodwill. The Company estimated the fair value of each reporting unit using a weighted average of fair value derived from both an income approach and a market approach (all Level 3 fair value measurements). Upon estimating the fair value of each of its reporting units, the Company determined its Global Orthopedics reporting unit’s fair value was less than its carrying value of net assets. This resulted in recording a full impairment of the Global Orthopedics goodwill of $ 11.8 million, which was reflected within Acquisition-related amortization and remeasurement. The assessment concluded there were no indicators of impairment for the Global Spine goodwill. In the fourth quarter of 2022, the Company performed a qualitative assessment for its annual goodwill impairment analysis, which did not result in an impairment charge. This qualitative analysis considered all relevant factors specific to the reporting units, including macroeconomic conditions, industry and market considerations, overall financial performance, and relevant entity-specific events. In the third quarter of 2023, the Company announced the termination of its former President and Chief Executive Officer, former Chief Financial Officer, and former Chief Legal Officer, from their respective roles. Immediately following the announcement, the Company’s market capitalization decreased by approximately 30 %, indicating that an impairment may exist. As a result, the Company performed an interim quantitative assessment of its goodwill as of September 30, 2023. The Company estimated the fair value of each reporting unit using a weighted average of the fair value derived from both an income approach and a market approach (all Level 3 fair value measurements). Upon performing its assessment, the Company determined its Global Spine reporting unit's fair value exceed its carrying value of net assets as of September 30, 2023. In the fourth quarter of 2023, the Company performed a qualitative assessment for its annual goodwill impairment analysis, which did not result in an impairment charge. This qualitative analysis considered all relevant factors specific to the reporting units, including macroeconomic conditions, industry and market considerations, overall financial performance, and relevant entity-specific events.

Leases

Leases	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
Leases	9. Leases The Company determines if a contractual arrangement qualifies as a lease at inception. The Company’s leases primarily relate to facilities, vehicles, equipment, and certain contract manufacturing agreements. Lease assets represent the Company’s right to use an underlying asset for the lease term, while lease liabilities represent the obligation to make lease payments arising from the lease. Lease assets and liabilities are recognized at the commencement date based on the present value of lease payments over the lease term. As the Company’s leases do not provide an implicit rate, the Company’s incremental borrowing rate is used as a discount rate, based on the information available at the commencement date, in determining the present value of lease payments. Lease assets also include the impact of any prepayments made and are reduced by the impact of any lease incentives. The Company does not recognize lease liabilities or lease assets on the balance sheet for short-term leases (leases with a lease term of twelve months or less as of the commencement date). Rather, any short-term lease payments are recognized as an expense on a straight-line basis over the lease term. The current period short-term lease expense reasonably reflects the Company's short-term lease commitments. For all classifications of leases, the Company combines lease and non-lease components to account for them as a single lease component. Variable lease payments are excluded from the lease liability and recognized in the period in which the obligation is incurred. Additionally, lease terms may include options to extend or terminate the lease when it is reasonably certain that the Company will exercise the option. A summary of the Company’s lease portfolio as of December 31, 2023, and 2022, is presented in the table below: (U.S. Dollars, in thousands, except lease term and discount rate) Classification December 31, 2023 December 31, 2022 Assets Operating leases Other long-term assets $ 19,869 $ 6,788 Finance leases Property, plant and equipment, net 16,345 17,360 Total lease assets $ 36,214 $ 24,148 Liabilities Current Operating leases Other current liabilities $ 3,477 $ 1,638 Finance leases Current portion of finance lease liability 708 652 Long-term Operating leases Other long-term liabilities 17,125 5,376 Finance leases Long-term portion of finance lease liability 18,532 19,239 Total lease liabilities $ 39,842 $ 26,905 Weighted Average Remaining Lease Term Operating leases 6.2 years 4.5 years Finance leases 16.6 years 17.6 years Weighted Average Discount Rate Operating leases 7.3 % 4.0 % Finance leases 4.4 % 4.4 % The components of lease costs were as follows: (U.S. Dollars, in thousands) For the Year Ended December 31, 2023 For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 Finance lease costs: Amortization of right-of-use assets $ 1,013 $ 1,238 $ 2,049 Interest on finance lease liabilities 857 890 933 Operating lease costs 5,015 2,126 2,234 Short-term lease costs 313 152 213 Variable lease costs 1,883 932 815 Total lease costs $ 9,081 $ 5,338 $ 6,244 Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) For the Year Ended December 31, 2023 For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 7,682 $ 3,805 $ 4,627 Operating cash flows from finance leases 857 885 907 Financing cash flows from finance leases 652 2,594 537 Right-of-use assets obtained in exchange for lease obligations Operating leases 16,688 5,603 589 Finance leases — — 149 A summary of the Company’s remaining lease liabilities as of December 31, 2023, is included below: (U.S. Dollars, in thousands) Operating Finance 2024 $ 4,861 $ 1,538 2025 4,788 1,543 2026 4,607 1,562 2027 3,441 1,593 2028 1,785 1,624 Thereafter 6,766 19,396 Total undiscounted value of lease liabilities 26,248 27,256 Less: Interest ( 5,646 ) ( 8,016 ) Present value of lease liabilities $ 20,602 $ 19,240 Current portion of lease liabilities $ 3,477 $ 708 Long-term portion of lease liabilities 17,125 18,532 Total lease liabilities $ 20,602 $ 19,240

Other current liabilities

Other current liabilities	12 Months Ended
	Dec. 31, 2023
Payables and Accruals [Abstract]
Other current liabilities	10. Other current liabilities December 31, (U.S. Dollars, in thousands) 2023 2022 Accrued expenses $ 12,189 $ 9,611 Salaries, bonuses, employee commissions, and related taxes payable 38,826 18,531 Accrued distributor commissions 22,602 10,483 Accrued litigation and investigation costs 12,077 3,891 Short-term operating lease liability 3,477 1,638 Non-income taxes payable 7,585 6,586 Other payables 8,152 4,634 Other current liabilities $ 104,908 $ 55,374

Indebtedness

Indebtedness	12 Months Ended
	Dec. 31, 2023
Debt Disclosure [Abstract]
Indebtedness	11. Indebtedness The carrying values of the Company’s outstanding debt obligations as of December 31, 2023, and 2022, were as follows: December 31, (U.S. Dollars, in thousands) 2023 2022 Initial Term Loan Principal amount $ 100,000 $ — Unamortized original debt discount ( 4,331 ) — Unamortized debt issuance costs and lenders fees ( 1,312 ) — Total indebtedness from initial term loan 94,357 — Revolving Credit Facilities Principal amount outstanding — — Total indebtedness outstanding $ 94,357 $ — Current portion of long-term debt $ 1,250 $ — Long-term debt 93,107 — Total indebtedness outstanding $ 94,357 $ — The Company paid cash related to interest of $ 5.8 million, $ 1.4 million, and $ 1.5 million for the years ended December 31, 2023, 2022, and 2021, respectively. Financing Agreement On November 6, 2023, the Company, as borrower, and certain subsidiaries of the Company as guarantors, entered into a Financing Agreement (the “Financing Agreement”) with Blue Torch Finance LLC, as administrative agent and collateral agent (the “Agent”), and certain lenders party thereto. The Financing Agreement provides for a $ 100.0 million senior secured term loan (the “Initial Term Loan”), a $ 25.0 million senior secured delayed draw term loan facility (the “Delayed Draw Term Loan”) which, subject to certain conditions specified in the Financing Agreement, may be drawn on or prior to March 30, 2024, and a $ 25.0 million senior secured revolving credit facility (the “Revolving Credit Facility,” and together with the Initial Term Loan and the Delayed Draw Term Loan, the “Credit Facilities”), each of which mature on November 6, 2027 . In connection with entering into the Financing Agreement, the Company repaid in full amounts outstanding and terminated all commitments under the Company’s prior $ 175 million senior secured revolving credit facility evidenced by that certain Second Amended and Restated Credit Agreement, dated as of October 25, 2019, among the Company, certain subsidiaries of the Company as borrowers and guarantors, JPMorgan Chase Bank, N.A., as administrative agent, and the lenders party thereto (as amended, supplemented or otherwise modified, the “Prior Credit Agreement”). The Initial Term Loan was fully funded on the effective date of November 6, 2023. As of December 31, 2023 , the Company had no t made any borrowings under the Delayed Draw Term Loan or the Revolving Credit Facility. However, on January 10, 2024, the Company borrowed $ 15.0 million under the Revolving Credit Facility, which remains outstanding as of the date of this filing. Borrowings under the Financing Agreement were and may be used for, among other things, the repayment in full of the Prior Credit Agreement, working capital and other general corporate purposes of the Company. Borrowings under the Credit Facilities bear interest at a floating rate, which will be, at the Company’s option, either the three-month SOFR rate (subject to a floor of 3.00 % and a credit spread adjustment of 0.26161 %) (the “Adjusted Term SOFR Rate”) plus an applicable margin of 7.25 %, or a base rate plus an applicable margin of 6.25 % . A revolving unused line fee of 2.00 % is payable monthly in arrears based on the average amount of the undrawn portion of each lender’s revolving credit commitments under the Revolving Credit Facility for the preceding month. A delayed draw unused fee equal to the Adjusted Term SOFR Rate plus a margin of 1.00 % is payable monthly in arrears based on the average amount of the undrawn portion of each lender’s delayed draw term loan commitments in respect of the Delayed Draw Term Loan for the preceding month. Certain of the Company’s existing and future material subsidiaries (collectively, the “Guarantors”) are required to guarantee the repayment of the Company’s obligations under the Financing Agreement. The obligations of the Company and each of the Guarantors with respect to the Financing Agreement are secured by a pledge of substantially all assets of the Company and each of the Guarantors, including, without limitation, accounts receivables, deposit accounts, intellectual property, investment property, inventory, equipment and equity interests in their respective subsidiaries. The Financing Agreement contains customary affirmative and negative covenants, including limitations on the Company’s and its subsidiaries ability to incur additional debt, grant or permit additional liens, make investments and acquisitions, merge or consolidate with others, dispose of assets, pay dividends and distributions, pay subordinated indebtedness, and enter into affiliate transactions. In addition, the Financing Agreement contains financial covenants requiring the Company to maintain a minimum level of liquidity at all times, a maximum consolidated leverage ratio (measured on a quarterly basis), and a minimum asset coverage ratio (measured on a monthly basis). The Financing Agreement also includes events of default customary for facilities of this type and upon the occurrence of such events of default, subject to customary cure rights, all outstanding loans under the Credit Facilities may be accelerated and/or the lenders’ commitments terminated. The Financing Agreement contains customary representations and warranties of the Company and the Guarantors. These representations and warranties have been made solely for the benefit of the Agent and the lenders party to the Financing Agreement and such representations and warranties should not be relied on by any other person, including investors. In addition, such representations and warranties (i) have been qualified by disclosures made to the Agent and the lenders in connection with the agreement, (ii) are subject to the materiality standards contained in the agreement which may differ from what may be viewed as material by investors and (iii) were made only as of the date of the agreement or such other date as is specified in the agreement. In conjunction with obtaining the Financing Agreement, the Company paid $ 2.0 million in debt issuance costs and lenders fees. These costs have been allocated amongst each of the Initial Term Loan, Delayed Draw Term Loan, and Revolving Credit Facility and are being amortized over the life of the Financing Agreement. Capitalized debt issuance costs attributable to the Delayed Draw Term Loan and Revolving Credit Facility are included in other long-term assets, net of accumulated amortization, whereas capitalized debt issuance costs associated with the Initial Term Loan are recognized as a direct reduction of the outstanding indebtedness. As of December 31, 2023, and December 31, 2022 , debt issuance costs associated with all credit facilities (whether the Financing Agreement or the Prior Credit Agreement), net of accumulated amortization, were $ 1.9 million and $ 0.7 million, respectively. Debt issuance costs amortized or expensed totaled $ 1.3 million, $ 0.4 million, and $ 0.4 million for each of the years ended December 31, 2023, 2022, and 2021, respectively . Prior Credit Agreement As disclosed above, on October 25, 2019, the Company, and certain of its wholly-owned subsidiaries (collectively with the Company, the “Borrowers”), as borrowers, and certain material subsidiaries of the Company as guarantors, entered into the Prior Credit Agreement with JPMorgan Chase Bank, N.A. (“JPMorgan”), as Administrative Agent, and certain lender parties thereto. The Prior Credit Agreement provided for a $ 300.0 million secured revolving credit facility, amending and restating the revolving credit facility that previously existed with such lenders. The Prior Credit Agreement had a maturity date of October 25, 2024 . On March 1, 2023, the Amended Credit Agreement and the Facility were amended to replace London Inter-Bank Offered Rate ("LIBOR")-based pricing with Secured Overnight Financing Rate ("SOFR")-based pricing. On June 13, 2023, the Company entered into a Limited Consent, Limited Waiver and Second Amendment to the Original Credit Agreement (the "Consent and Amendment"). Under the terms of the Consent and Amendment, the parties agreed to reduce the size of the secured revolving credit facility, off of which certain fees are based, from $ 300.0 million to $ 175.0 million, and to increase the applicable interest rate in certain circumstances. On January 3, 2023, the Company borrowed $ 30.0 million for working capital purposes, including to fund certain Merger-related expenses, under the Prior Credit Agreement. Subsequently, the Company borrowed an additional $ 49.0 million to fund working capital needs whereby, as of the effective date of the Financing Agreement, the Company had $ 79.0 million in principal amount of borrowings outstanding under the Prior Credit Agreement. In connection with entering into the Financing Agreement, the Company repaid in full all amounts outstanding and terminated all commitments under the Prior Credit Agreement. Italian Line of Credit The Company has an unused available Italian line of credit of € 5.5 million ($ 6.1 million and $ 5.9 million) at December 31, 2023, and 2022 , respectively. This unsecured line of credit provides the Company the option to borrow amounts in Italy at interest rates determined at the time of borrowing.

Fair value measurements and inv

Fair value measurements and investments	12 Months Ended
	Dec. 31, 2023
Fair Value Measurements And Investment Disclosure [Abstract]
Fair value measurements and investments	12. Fair value measurements and investments Fair value is defined as the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Non-financial assets and liabilities of the Company measured at fair value include any long-lived assets that are impaired in a currently reported period or equity securities measured at observable prices in orderly transactions. The authoritative guidance also describes three levels of inputs that may be used to measure fair value: Level 1: quoted prices in active markets for identical assets and liabilities Level 2: observable inputs other than quoted prices in active markets for identical assets and liabilities Level 3: unobservable inputs in which there is little or no market data available, which require the reporting entity to develop its own assumptions The Company’s financial instruments include cash equivalents, accounts receivable, accounts payable, long-term secured debt, available for sale debt securities, equity securities, contingent consideration, and deferred compensation plan liabilities. The carrying value of cash equivalents, accounts receivable, and accounts payable approximate fair value due to the short-term maturities of these instruments. The Company’s secured term loan carries a floating rate of interest; therefore, the carrying value of long-term debt is considered to approximate the fair value. The Company’s available for sale debt securities, equity securities, contingent consideration, and deferred compensation plan liabilities are the only financial instruments recorded at fair value on a recurring basis as follows: (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Balance Assets Neo Medical convertible loan agreement $ — $ — $ 6,760 $ 6,760 Neo Medical preferred equity securities — 4,951 — 4,951 Bone Biologics equity securities — — — — Other investments — — 1,309 1,309 Total $ — $ 4,951 $ 8,069 $ 13,020 Liabilities Lattus contingent consideration $ — $ — $ ( 8,500 ) $ ( 8,500 ) Spinal Kinetics contingent consideration — — — — Deferred compensation plan — ( 1,674 ) — ( 1,674 ) Total $ — $ ( 1,674 ) $ — $ ( 10,174 ) (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Balance Assets Neo Medical convertible loan agreements $ — $ — $ 7,140 $ 7,140 Neo Medical preferred equity securities — 6,084 — 6,084 Bone Biologics equity securities — — — — Other Investments — — 1,726 1,726 Total $ — $ 6,084 $ 7,140 $ 14,950 Liabilities Spinal Kinetics contingent consideration $ — $ — $ — $ — Deferred compensation plan — ( 1,515 ) — ( 1,515 ) Total $ — $ ( 1,515 ) $ — $ ( 1,515 ) The fair value of the Company’s deferred compensation plan liabilities is determined based on inputs that are readily available in public markets or that can be derived from information available in publicly quoted markets; therefore, the Company has categorized this liability as a Level 2 financial instrument. Neo Medical Convertible Loan Agreements and Equity Investment On October 1, 2020, the Company purchased shares of Neo Medical’s preferred stock for consideration of $ 5.0 million and entered into a Convertible Loan Agreement (the “Convertible Loan”) pursuant to which Orthofix loaned Neo Medical CHF 4.6 million, or $ 5.0 million at the date of issuance. The Convertible Loan bears interest at 8.0 %, with interest due semi-annually. At each interest payment date, the borrower may elect to capitalize any interest due to the then outstanding principal balance of the loan. The Convertible Loan matures on October 1, 2024 . If a change in control of Neo Medical occurs prior to the maturity date, the Convertible Loan shall become immediately due upon such event. The Convertible Loan may be convertible by either party into shares of Neo Medical’s preferred stock. The Company may convert the loan at its own election at any time prior to the full repayment or settlement of the Convertible Loan. Neo Medical may elect to convert the loan only in the event of a qualified financing event, as defined within the agreement. The price per share at which the loan converts is dependent upon (i) the party electing conversion and (ii) Neo Medical’s price per share in its most recent fundraising activities at the time of conversion, as specified within the agreement. 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 ($ 0.7 million as of the issuance date). In January 2022, the Company elected to convert the Additional Convertible Loan into shares of Neo Medical’s preferred stock. 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 carrying value of the Company’s investment in Neo Medical preferred equity securities for the years ended December 31, 2023, and 2022: (U.S. Dollars, in thousands) 2023 2022 Fair value of Neo Medical preferred equity securities at January 1 $ 6,084 $ 5,413 Conversion of loan into preferred equity securities — 671 Foreign currency remeasurement recognized in other income, net 388 — Unrealized loss recognized in other income (expense), net ( 1,521 ) — Fair value of Neo Medical preferred equity securities at December 31 $ 4,951 $ 6,084 Cumulative unrealized gain (loss) on Neo Medical preferred equity securities ( 720 ) 413 The Convertible Loan is recorded in other current assets as an available for sale debt security as of December 31, 2023, while as of December 31, 2022, this balance was classified within other long-term assets. 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 has categorized this asset as a Level 3 financial asset. 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 credit losses. Impairment resulting from credit losses is recognized within the statement of income, while impairment resulting from other factors is recognized within other comprehensive income (loss). As of December 31, 2023 , the Company has recognized $ 0.3 million in credit losses related to the Convertible Loan. The following table provides a reconciliation of the beginning and ending balances of the Convertible Loan(s), measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2023 2022 Fair value of Neo Medical Convertible Loans at January 1 $ 7,140 $ 7,148 Additions — — Interest recognized in interest income, net 496 436 Foreign currency remeasurement recognized in other income (expense), net 617 ( 67 ) Unrealized gain (loss) recognized in other comprehensive income (loss) ( 1,233 ) 294 Expected credit loss recognized in other income (expense), net ( 260 ) — Conversion of Additional Convertible Loan into preferred equity securities — ( 671 ) Fair value of Neo Medical Convertible Loans at December 31 $ 6,760 $ 7,140 Contractual value of Neo Medical Convertible Loans at December 31 $ 7,020 $ 5,907 Allowance for credit loss recognized in other income (expense), net ( 260 ) — Amortized cost basis of Neo Medical Convertible Loans at December 31 $ 6,760 $ 5,907 The following table provides quantitative information related to certain key assumptions utilized within the valuation of the Convertible Loan as of December 31, 2023: (U.S. Dollars, in thousands) Fair Value as of December 31, 2023 Unobservable inputs Estimate Neo Medical Convertible Loan $ 6,760 Cost of equity discount rate 19.3 % Present value factor 15.3 % Implied volatility 81.1 % Bone Biologics Equity Securities Until August of 2022, the Company held an investment in common stock of Bone Biologics Inc. (“Bone Biologics”), a developer of orthobiologic products. Prior to 2021, the equity securities were considered an investment that did not have a readily determinable fair value as Bone Biologics had very limited trading volumes. As such, the Company measured the investments at cost, less any impairments, plus or minus changes resulting from observable price changes in orderly transactions for an identical or similar investment of the same issuer. In 2021, Bone Biologics completed a public offering of units, with each unit consisting of one share of common stock and one warrant to purchase common shares. As a result, Bone Biologics’ common stock became actively traded on the NASDAQ (ticker BBLG). The Company concluded the investment represented a Level 1 fair value measurement subsequent to the public offering as the common shares subsequently had quoted prices in active markets for identical assets. As such, the Company recorded the investment at fair value, with changes in fair value recorded within other income (expense), net, subsequent to the public offering. The following table presents the changes in fair value recognized for each of the years ended December 31, 2023, 2022, and 2021: (U.S. Dollars, in thousands) 2023 2022 2021 Bone Biologics equity securities at January 1 $ — $ 309 $ — Fair value adjustments and impairments recognized in other income (expense), net — ( 183 ) 309 Proceeds from the disposition of equity securities — ( 126 ) — Bone Biologics equity securities at December 31 $ — $ — $ 309 Other investments Other investments represent other 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 is 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. This balance is classified within other current assets as of December 31, 2023, and was classified in other long-term assets as of December 31, 2022. Spinal Kinetics Contingent Consideration The Company recognized a contingent consideration obligation in connection with the acquisition of Spinal Kinetics in 2018. The fair value of the remaining Spinal Kinetics contingent consideration, attributable to a revenue-based milestone, was concluded to be zero as the Company did not achieve the milestone prior to April 30, 2023, the end of the measurement period for achieving such milestone. The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2023 2022 Spinal Kinetics contingent consideration at January 1 $ — $ 17,200 Decrease in fair value recognized in acquisition-related amortization and remeasurement — ( 17,200 ) Payment made — — Spinal Kinetics contingent consideration at December 31 $ — $ — Lattus Contingent Consideration In connection with the Merger, the Company assumed a contingent consideration obligation under a purchase agreement between SeaSpine and Lattus Spine LLC ("Lattus") executed in December 2022. Under the terms of the agreement, the Company may be required to make installment payments at certain dates based on future net sales of certain products (the "Lateral Products"). The estimated fair value of the Lattus contingent consideration is determined using a Monte Carlo simulation and a discounted cash flow model requiring significant inputs which are not observable in the market. The significant inputs include assumptions related to the timing and probability of certain product launch dates, estimated future sales of Lateral Products, revenue risk-adjusted discount rate, revenue volatility, and discount rates matched to the timing of payments. The following table provides a reconciliation of the beginning and ending balances for the Lattus contingent consideration measured at estimated fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2023 2022 Lattus contingent consideration estimated fair value at January 5 $ 11,200 $ — Decrease in fair value recognized in acquisition-related amortization and remeasurement ( 2,700 ) — Lattus contingent consideration estimated fair value at December 31 $ 8,500 $ — The following table provides quantitative information related to certain key assumptions utilized within the valuation as of December 31, 2023: (U.S. Dollars, in thousands) Fair Value as of Unobservable inputs Estimate Lattus Contingent Consideration $ 8,500 Counterparty discount rate 14.0 % Revenue risk-adjusted discount rate 6.5 %

Commitments and contingencies

Commitments and contingencies	12 Months Ended
	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and contingencies	13. Commitments and contingencies Contingencies policy The Company records accruals for certain outstanding legal proceedings, investigations, or claims when it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. The Company evaluates developments in legal proceedings, investigations, and claims that could affect the amount of any accrual, as well as any developments that would make a loss contingency both probable and reasonably estimable on a quarterly basis. When a loss contingency is not both probable and reasonably estimable, the Company does not accrue the loss. However, if the loss (or an additional loss in excess of the accrual) is at least a reasonable possibility and material, then the Company discloses a reasonable estimate of the possible loss or range of loss, if such reasonable estimate can be made. If the Company cannot make a reasonable estimate of the possible loss, or range of loss, then that is disclosed. In addition, legal fees and other directly related costs are expensed as incurred. In addition to the matters described in the paragraphs 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. Arbitration claims with former executives In September 2023, the Company’s Board of Directors terminated the employment of Keith Valentine, John Bostjancic and Patrick Keran, who had served respectively as the Company’s President and Chief Executive Officer, Chief Financial Officer and Chief Legal Officer. The Board’s decision followed an investigation conducted by independent outside legal counsel and directed and overseen by the Company’s independent directors. As a result of the investigation, the Board determined that each of these executives engaged in repeated inappropriate and offensive conduct that violated multiple code of conduct requirements and was inconsistent with the Company’s values and culture. The Company notified each of Messrs. Valentine, Bostjancic and Keran that their respective terminations were being made for “Cause,” as defined in applicable employment-related agreements (including each executive’s respective Change in Control and Severance Agreement, dated June 19, 2023). The Company also notified each of Messrs. Valentine, Bostjancic and Keran that it did not believe it was required to make any further payments to them, other than payment of salary through September 12, 2023. The Board also requested that Mr. Valentine resign as a director, which he did in October 2023. In January 2024, the Company received written notices of arbitration claims from counsel to Messrs. Valentine, Bostjancic and Keran. Each of the arbitration claims asserts that the respective former executive was wrongfully terminated for “Cause” because the former executive’s conduct did not meet the contractually applicable definition of “Cause.” The claims seek relief for, among other things, alleged breach of contract, defamation, false light invasion of privacy, deceit, as well as indemnification and advancement for attorneys’ fees. The three former executives seek severance payments, as well as the value of forfeited equity grants, under applicable change in control and severance agreements and further damages as a result of purported defamatory statements. The Company disagrees with many of the assertions contained in the written notices of arbitration claims and intends to vigorously defend the asserted claims. Due in part to the preliminary nature of this matter, the Company currently cannot reasonably estimate a possible loss, or range of loss, that may arise from the arbitration claims. 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. In the third quarter of 2022, the Italian Ministry of Health provided guidelines to the Italian regions and provinces on seeking payback of expenditure overruns relating to the years ended December 31, 2015, through December 31, 2018. Since receiving the guidelines, several regions and provinces have requested payment from affected medical device companies, including the Company. The Company has taken legal action to dispute the legality of such measures. The Company accounts for the estimated cost of the IMDP as sales and marketing expense and periodically reassesses the liability based upon current facts and circumstances. As a result, the Company recorded expense of $ 1.3 million for the year ended December 31, 2023, expense of $ 1.2 million for the year ended December 31, 2022, and a benefit of $ 1.2 million for the year ended December 31, 2021, as a result of certain temporary relief provided by the Italian National Healthcare System in response to the COVID-19 pandemic. As of December 31, 2023 , the Company has accrued $ 7.6 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 all legal proceedings are resolved and upon further clarification of the IMDP by the Italian authorities for more recent fiscal years. Commitments The Company is party to certain agreements with distributor partners that provide the Company with an option to purchase, and/or an option for those partners to require the Company to purchase, the distribution business of those partners at specified future dates. At such time, the Company or distributor may (in certain cases, subject to satisfying certain conditions) submit written notice to the other of its intention to exercise its rights and initiate or require the purchase. Upon the receipt of the written notice, the Company and the distributor will work in good faith to consummate the purchase. Under certain of these agreements, the purchase price would be paid in shares of the Company's common stock whereas for others, the purchase price can be paid in cash or shares at the Company’s option. Based on the closing price of the Company's common stock as of December 31, 2023 , assuming all criteria are met and that the options under all the relevant agreements were exercised, the estimated total number of shares the Company would issue under these agreements was approximately 1.6 million shares for agreements that must be settled in shares of the Company’s stock. The Company has received notification from one such distributor, who has notified the Company of its decision to exercise its buyout option. The Company is currently in negotiations with this distributor in regard to the consummation of the potential acquisition.

Shareholder's equity

Shareholder's equity	12 Months Ended
	Dec. 31, 2023
Stockholders' Equity Note [Abstract]
Shareholders' equity	14. Shareholders’ equity Dividends The Company has not historically paid dividends to holders of its common stock. Certain subsidiaries of the Company have restrictions on their ability to pay dividends in certain circumstances pursuant to the Financing Agreement. In the event that the Company decides to pay a dividend to holders of its common stock in the future with dividends received from its subsidiaries, the Company may, based on prevailing rates of taxation, be required to pay additional withholding and income tax on such amounts received from its subsidiaries. Accumulated Other Comprehensive Income (Loss) Accumulated other comprehensive income (loss) is comprised of foreign currency translation adjustments and unrealized gains (losses) on available for sale debt securities. The Company’s policy is to release income tax effects related to items recognized within accumulated other comprehensive income (loss) using a portfolio approach. The components of and changes in accumulated other comprehensive income (loss) are as follows: (U.S. Dollars, in thousands) Currency Neo Medical Convertible Loans Other Investments Accumulated Other Balance at December 31, 2020 $ 1,833 $ 1,419 $ — $ 3,252 Other comprehensive loss ( 2,544 ) ( 942 ) — ( 3,486 ) Income taxes — 234 — 234 Balance at December 31, 2021 $ ( 711 ) $ 711 $ — $ — Other comprehensive income (loss) ( 1,771 ) 294 101 ( 1,376 ) Income taxes — — — — Balance at December 31, 2022 $ ( 2,482 ) $ 1,005 $ 101 $ ( 1,376 ) Other comprehensive income (loss) 1,417 ( 1,233 ) ( 101 ) 83 Income taxes — — — — Balance at December 31, 2023 $ ( 1,065 ) $ ( 228 ) $ — $ ( 1,293 )

Revenue recognition and account

Revenue recognition and accounts receivable	12 Months Ended
	Dec. 31, 2023
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	15. Revenue recognition and accounts receivable Revenue Recognition The Company accounts for a contract when there is (i) approval and commitment from both parties, (ii) the rights of the parties are identified, (iii) payment terms are identified, (iv) the contract has commercial substance, (v) and collectability of consideration is probable. The Company’s contracts may contain one or more performance obligations. If a contract contains more than one performance obligation, the Company allocates the total transaction price to each of the performance obligations based upon the observable standalone selling price of the promised goods or services underlying each performance obligation. The Company recognizes revenue when control of the promised goods or services is transferred to the customer, which typically occurs at a point in time upon shipment, delivery, or utilization, in an amount that reflects the consideration which the Company expects to be entitled to in exchange for the promised goods or services. The consideration for goods or services reflects any fixed amount stated per the contract and estimates for any variable consideration, such as discounts, to the extent that is it probable that a significant reversal of cumulative revenue recognized will not occur when the uncertainty associated with the variable consideration is resolved. The following sections discuss the Company’s revenue recognition policies by significant product category: Bone Growth Therapies Bone Growth Therapies revenue is largely attributable to the U.S. and is comprised of third-party payor transactions and wholesale revenue. The largest portion of Bone Growth Therapies revenue is derived from third-party payors. This includes commercial insurance carriers, health maintenance organizations, preferred provider organizations, and governmental payors, such as Medicare. Revenue is recognized when the product is fitted to and accepted by the patient and all applicable documents required by the third-party payor have been obtained. Amounts paid by third-party payors are generally based on fixed or allowable reimbursement rates. These revenues are recorded at the expected or preauthorized reimbursement rates, net of any contractual allowances or adjustments. Certain billings are subject to review by the third-party payors and may be subject to adjustment. Wholesale revenue is related to the sale of the Company’s bone growth stimulators directly to durable medical equipment suppliers. Wholesale revenues are typically recognized upon shipment and receipt of a confirming purchase order, which is when the customer obtains control of the promised goods. Biologics Biologics revenue is largely attributable to the U.S. and is mostly processed from within our Irvine facility. In addition, we have a long standing collaborative arrangement with MTF that provides exclusive global marketing rights to MTF’s Trinity and FiberFuse product families. Per the terms of the agreement, MTF sources the tissue, processes it to create the allografts, packages, and delivers the tissue to the customer. The Company received marketing fees from MTF based on sales of products covered under the collaborative arrangement. MTF is considered the principal in these arrangements; therefore, the Company recognizes marketing service fees on a net basis within net sales upon shipment of the product to the customer and receipt of a confirming purchase order. Spinal Implants and Global Orthopedics Spinal Implants and Global Orthopedics products are distributed world-wide, with U.S. sales largely comprised of commercial sales and international sales derived from both commercial sales and stocking distributor arrangements. Commercial revenue is largely related to the sale of the Company’s Spinal Implants and Global Orthopedics products to hospital customers. The customer obtains control and revenues are recognized when these products have been utilized and a confirming purchase order has been received from the hospital. Other revenues within the Spinal Implants and Global Orthopedics product categories are derived from stocking distributors, who purchase the Company’s products and then re-sell them directly to customers, such as hospitals. For stocking distributor arrangements, it is the Company’s policy to recognize revenue upon shipment and receipt of a confirming purchase order, which is when the distributor obtains control of the promised goods. The transaction price for revenue recognition is estimated based upon the Company’s historical collection experience with the stocking distributor. Product Sales and Marketing Service Fees The table below presents net sales, which includes product sales and marketing service fees, for each of the years ended December 31, 2023, 2022, and 2021. For the year ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Product sales $ 693,345 $ 405,437 $ 409,554 Marketing service fees 53,296 55,276 54,925 Net sales $ 746,641 $ 460,713 $ 464,479 Marketing service fees are received from MTF based on total sales of biologics tissues and relates solely to the Biologics product category within the Global Spine reporting segment, whereas product sales primarily consist of the sale of Bone Growth Therapies, Spinal Implants, non-MTF sourced Biologics, Enabling Technologies, and Global Orthopedics products. Marketing service fees received from MTF were $ 53.3 million, or approximately 32 % of total Biologics revenues, for the year ended December 31, 2023. As MTF is the single supplier for certain allografts in the Company’s Biologics portfolio, derived from deceased donors for their bone grafts and living donors for their amnion grafts, any event or circumstance that would impact MTF’s continued access to donors or the Company’s ability to market these tissues may adversely impact the Company’s financial results. Revenues exclude any value added or other local taxes, intercompany sales, and trade discounts. Shipping and handling costs for products shipped to customers are included in cost of sales, and were $ 9.5 million, $ 4.2 million, and $ 3.5 million for the years ended December 31, 2023, 2022, and 2021, respectively. Accounts receivable and related allowances Payment terms vary by the type and location of the Company’s customers and the products or services offered. The term between invoicing and when payment is due is not significant. T he Company’s allowance for expected credit losses represents the portion of the receivable’s amortized cost basis that an entity does not expect to collect over the receivable’s contractual life, considering past events, current conditions, and reasonable and supportable forecasts of future economic conditions. The process for estimating the ultimate collection of accounts receivable involves certain assumptions and judgments. The determination of the contractual life of accounts receivable, the aging of outstanding receivables, as well as the historical collections, write-offs, and payor reimbursement experience over the estimated contractual lives of such receivables, are integral parts of the estimation process related to reserves for expected credit losses and the establishment of contractual allowances. Accounts receivable are analyzed on a quarterly basis to assess the adequacy of both reserves for expected credit losses and contractual allowances. Revisions in allowances for expected credit loss estimates are recorded as an adjustment to bad debt expense within sales and marketing expenses. Revisions to contractual allowances are recorded as an adjustment to net sales. These estimates are periodically tested against actual collection experience. In addition, the Company analyzes its receivables by geography and by customer type, where appropriate, in developing estimates for expected credit losses. The following table provides a detail of changes in the Company’s allowance for expected credit losses for the years ended December 31, 2023, and 2022: For the year ended December 31, (U.S. Dollars, in thousands) 2023 2022 Allowance for expected credit losses beginning balance $ 6,419 $ 4,944 Addition resulting from the Merger with SeaSpine 137 — Current period provision for expected credit losses 820 2,095 Write-offs charged against the allowance and other ( 381 ) ( 450 ) Effect of changes in foreign exchange rates 135 ( 170 ) Allowance for expected credit losses ending balance $ 7,130 $ 6,419 The Company will generally sell receivables from certain Italian public hospitals each year to accelerate cash collections. During 2023, 2022, and 2021 , the Company sold € 9.2 million, € 9.2 million, and € 8.4 million ($ 10.0 million, $ 9.6 million, and $ 9.9 million) of receivables, respectively. The related fees for 2023, 2022, and 2021 , were $ 0.4 million, $ 0.3 million, and $ 0.2 million, respectively, which were recorded as interest expense. Accounts receivables sold without recourse are removed from the balance sheet at the time of sale. Contract Liabilities The Company’s contract liabilities largely related to a prepayment of $ 13.9 million received in 2020 from the Centers for Medicare and Medicaid Services ("CMS") as part of the Accelerated and Advance Payment Program of the CARES Act. On October 1, 2020, the President of the United States signed the “Continuing Appropriations Act, 2021 and Other Extensions Act,” which relaxed a number of the Medicare Accelerated and Advance Payment Program’s recoupment terms for providers and suppliers that received funds from the program. In April 2021, Medicare began to recoup 25 % of Medicare payments otherwise owed to the provider or supplier for submitted claims. Recoupment then increased to 50 % of Medicare payments in March 2022. Thus, during these time periods, rather than receiving the full amount of payment for newly submitted claims, the Company’s outstanding balance under the Accelerated and Advance Payment Program was reduced by the recoupment amount until the full balance had been repaid. The following table provides a detail of changes in the Company’s contract liability associated with the Accelerated and Advanced Payment Program for the years ended December 31, 2023, and 2022: For the Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 Contract liability beginning balance $ — $ 4,791 Recoupment recognized in net sales — ( 4,791 ) Contract liability ending balance $ — $ — 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 and totaled $ 0.3 million and $ 1.1 million as of December 31, 2023, and 2022, respectively. Other Contract Assets are amortized on a straight-line basis over the term of the related contract. For the year ended December 31, 2023 , the Company recorded $ 0.4 million in impairment charges related to the termination of certain distribution agreements. No impairments were incurred for other contract assets 2022 . Further, the Company applies the practical expedient to expense sales commissions when incurred, as the applicable amortization period would be for one year or less.

Business segment information

Business segment information	12 Months Ended
	Dec. 31, 2023
Segment Reporting [Abstract]
Business segment information	16. Business segment information The Company's operations are managed through two reporting segments: Global Spine and Global Orthopedics. These reporting segments represent the operating segments for which the Chief Executive Officer, who is also the CODM, reviews financial information and makes resource allocation decisions among businesses. The primary metric used by the CODM in managing the Company is adjusted earnings before interest, tax, depreciation, and amortization (“adjusted EBITDA”, a non-GAAP financial measure). Adjusted EBITDA represents earnings before interest income (expense), income taxes, depreciation, and amortization, and excludes the impact of share-based compensation, gains and losses related to changes in foreign exchange rates, charges related to the SeaSpine merger and other strategic investments, acquisition-related fair value adjustments, gains and/or losses on investments, litigation and investigation charges, charges related to initial compliance with regulations set forth by the European Union Medical Device Regulation, gains and/or losses related to the realized effects the COVID-19 pandemic has had on the Company's business operations, and succession charges. Corporate activities are comprised of operating expenses not directly identifiable within the two reporting segments, such as human resources, finance, legal, and information technology functions. The Company neither discretely allocates assets, other than goodwill, to its operating segments nor evaluates the operating segments using discrete asset information. Global Spine The Global Spine reporting segment offers two primary product categories: (i) Bone Growth Therapies and (ii) Spinal Implants, Biologics, and Enabling Technologies. The Bone Growth Therapies product category manufactures, distributes, sells, and provides support services for market leading devices used adjunctively in high-risk spinal fusion procedures and to treat both nonunion and acute fractures in the orthopedic space. These Class III medical devices are indicated as an adjunctive, noninvasive treatment to improve fusion success rates in the cervical and lumbar spine as well as a therapeutic treatment for non-spine acute and nonunion fractures. This product category uses distributors and a direct sales channel to sell its devices to hospitals, healthcare providers, and patients, in the U.S. Spinal Implants, Biologics, and Enabling Technologies is comprised of (i) a broad portfolio of spine fixation and motion preservation implant products used in surgical procedures of the spine, (ii) one of the most comprehensive biologics portfolios in both the demineralized bone matrix and cellular allograft market segments, and (iii) image-guided surgical solutions to facilitate degenerative, minimally invasive, and complex surgical procedures. Spinal Implants, Biologics, and Enabling Technologies products are sold through a network of distributors and sales representatives to hospitals and healthcare providers on a global basis for Spinal Implants and Enabling Technologies, and primarily within the U.S. for Biologics. Global Orthopedics The Global Orthopedics reporting segment offers products and solutions for limb deformity correction and complex limb reconstruction with a focus on use in trauma, adult and pediatric limb reconstruction, and foot and ankle procedures. This reporting segment specializes in the design, development, and marketing of external and internal fixation orthopedic products that are coupled with enabling digital technologies to serve the complete patient treatment pathway. We sell these products through a global network of distributors and sales representatives to hospitals, healthcare organizations, and healthcare providers. Corporate Corporate activities are comprised of the operating expenses and activities of the Company not necessarily identifiable within the two reporting segments. The table below presents net sales by major product category by reporting segment: Year Ended December 31, 2023 2022 2021 (U.S. Dollars, in thousands) Net Sales Percent of Net Sales Percent of Net Sales Percent of Bone Growth Therapies $ 212,530 28.5 % $ 187,247 40.7 % $ 187,448 40.4 % Spinal Implants, Biologics, and Enabling Technologies 418,789 56.1 % 165,927 36.0 % 171,515 36.9 % Global Spine 631,319 84.6 % 353,174 76.7 % 358,963 77.3 % Global Orthopedics 115,322 15.4 % 107,539 23.3 % 105,516 22.7 % Net sales $ 746,641 100.0 % $ 460,713 100.0 % $ 464,479 100.0 % The following table presents adjusted EBITDA, the primary metric used in managing the Company, by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Adjusted EBITDA by reporting segment Global Spine $ 91,115 $ 62,692 $ 71,086 Global Orthopedics 442 5,267 9,260 Corporate ( 45,272 ) ( 19,406 ) ( 19,084 ) Consolidated adjusted EBITDA $ 46,285 $ 48,553 $ 61,262 Reconciling items: Interest expense, net $ 8,631 $ 1,288 $ 1,837 Depreciation and amortization 53,063 29,019 41,355 Share-based compensation expense 35,707 18,443 15,432 Foreign exchange impact ( 1,581 ) 3,291 3,981 SeaSpine merger-related costs 36,623 12,010 — Strategic investments 2,272 4,018 5,700 Acquisition-related fair value adjustments 33,393 ( 15,595 ) ( 2,014 ) (Gain) loss on investments 1,781 187 ( 644 ) Litigation and investigation costs 14,453 803 33 Medical device regulation 9,446 10,261 8,018 Business interruption - COVID-19 — 2,387 320 Succession charges 1,176 147 739 Loss before income taxes $ ( 148,679 ) $ ( 17,706 ) $ ( 13,495 ) The following table presents depreciation and amortization by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Global Spine $ 41,213 $ 18,213 $ 17,548 Global Orthopedics 7,158 6,696 8,233 Corporate 4,692 4,110 3,818 Total $ 53,063 $ 29,019 $ 29,599 Geographical information The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Global Spine U.S. $ 591,937 $ 332,846 $ 337,455 International 39,382 20,328 21,508 Total Global Spine 631,319 353,174 358,963 Global Orthopedics U.S. $ 28,892 25,997 24,490 International 86,430 81,542 81,026 Total Global Orthopedics 115,322 107,539 105,516 Consolidated U.S. 620,829 358,843 361,945 International 125,812 101,870 102,534 Net sales $ 746,641 $ 460,713 $ 464,479 The following data includes net sales by geographic destination: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 U.S. $ 620,829 $ 358,843 $ 361,945 Italy 20,060 19,098 20,187 Germany 11,467 11,569 13,716 United Kingdom 10,910 10,171 10,552 France 11,096 10,377 10,475 Brazil 6,452 5,668 5,108 Others 65,827 44,987 42,496 Net sales $ 746,641 $ 460,713 $ 464,479 The following data includes property, plant, and equipment by geographic area: (U.S. Dollars, in thousands) 2023 2022 U.S. $ 142,727 $ 44,802 Italy 10,187 8,535 Germany 3,030 3,115 Others 3,116 1,777 Total $ 159,060 $ 58,229

Acquisition-Related Amortizatio

Acquisition-Related Amortization and Remeasurement	12 Months Ended
	Dec. 31, 2023
Acquisition Related Amortization And Remeasurement [Abstract]
Acquisition-Related Amortization and Remeasurement	17. Acquisition-related amortization and remeasurement Acquisition-related amortization and remeasurement consists of (i) the remeasurement of any related contingent consideration arrangement, (ii) amortization related to intangible assets acquired through business combinations or asset acquisitions, (iii) recognized costs associated with acquired IPR&D assets, which are recognized immediately upon acquisition, and (iv) impairments of goodwill related to previously recognized business combinations. Components of acquisition-related amortization and remeasurement for the years ended December 31, 2023, 2022, and 2021, respectively, are as follows: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Changes in fair value of contingent consideration $ ( 2,700 ) $ ( 17,200 ) $ ( 3,575 ) Amortization of acquired intangibles 17,408 8,196 7,907 Acquired IPR&D 49 1,600 1,500 Impairment of Global Orthopedics goodwill — — 11,756 Total $ 14,757 $ ( 7,404 ) $ 17,588 Legion Innovations, LLC Asset Acquisition On December 29, 2022, the Company entered into a technology assignment and royalty agreement with Legion Innovations, LLC, a U.S.-based medical device technology company, whereby the Company acquired intellectual property rights to certain assets. As consideration, the Company agreed to pay $ 0.2 million in January 2023, with additional payments contingent upon reaching future commercialization and revenue-based milestones. The Company accounted for this transaction as an asset acquisition. As the transaction was classified as an asset acquisition, the value of the consideration associated with the contingent milestones will be recognized at the time that applicable contingencies are resolved and consideration is paid or becomes payable. The $ 0.2 million initial payment was accrued as of December 31, 2022, and was recognized as acquired IPR&D costs, which was then immediately expensed. IGEA S.p.A Asset Acquisition In April 2021, the Company entered into an Exclusive License and Distribution Agreement (the “License Agreement”) with IGEA S.p.A (“IGEA”), an Italian manufacturer and distributor of bone and cartilage stimulation systems. As consideration for the License Agreement, the Company agreed to pay up to $ 4.0 million, with certain payments contingent upon reaching an FDA milestone. Of this amount, $ 0.5 million was paid in 2021, which was recognized as acquired IPR&D costs within acquisition-related amortization and remeasurement. The Company accounted for this transaction as an asset acquisition. As the transaction was classified as an asset acquisition, the value of the consideration associated with the contingent milestones are be recognized at the time that applicable contingencies are resolved and consideration is paid or becomes payable. The License Agreement also includes certain minimum purchase requirements. In May 2022, the Company achieved FDA approval pertaining to the acquired technology, triggering a contingent consideration milestone obligation of $ 3.5 million. Of this amount, $ 1.5 million was paid in 2022 and $ 1.0 million was paid in 2023. The remaining $ 1.0 million is accrued within other current liabilities as of December 31, 2023 .

Share-based compensation

Share-based compensation	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Share-based compensation	18. Share-based compensation At December 31, 2023, and 2022, the Company had stock option and award plans, and a stock purchase plan. Merger with SeaSpine Pursuant to the Merger Agreement, the equity awards of SeaSpine (including stock options and restricted stock units) outstanding as of immediately prior to the closing of the Merger were converted into equity awards denominated in shares of Orthofix common stock. The Company issued options to purchase 1.9 million shares of Orthofix common stock and 0.5 million shares of time-based vesting restricted stock in connection with the conversion of such awards. The estimated fair value of the portion of the SeaSpine equity awards for which the required service period had been completed at the time of the closing of the Merger was treated as purchase consideration. The remaining estimated fair value is recorded as compensation expense over the remainder of the service period associated with the awards. In addition, as part of the Merger, the Board of Directors determined to treat the transaction as a “Change in Control” under applicable agreements and equity plans. Thus, in January 2023, all outstanding and previously granted performance-based and market-based restricted stock units were converted to time-based restricted stock units. 2012 Long Term Incentive Plan The Board of Directors adopted the Amended and Restated 2012 Long-Term Incentive Plan (the “2012 LTIP”) on April 23, 2018, which was subsequently approved by shareholder ratification. The 2012 LTIP provides for the grant of options to purchase shares of the Company’s common stock, stock awards (including restricted stock, unrestricted stock, and stock units), stock appreciation rights, performance-based awards, and other equity-based awards. All of the Company’s employees and the employees of the Company’s subsidiaries and affiliates are eligible and may receive awards under the 2012 LTIP. In addition, the Company’s non-employee directors, consultants, and advisors who perform services for the Company and its subsidiaries and affiliates may receive awards under the 2012 LTIP. Awards granted under the 2012 LTIP expire no later than ten years after the date of grant. At December 31, 2023 , the Company reserves a total of 11.3 million shares of common stock for issuance pursuant to the 2012 LTIP, subject to certain adjustments set forth in the 2012 LTIP. At December 31, 2023 , there were 1.6 million options outstanding under the 2012 LTIP, of which 0.7 million were exercisable. In addition, there were 1.6 million restricted stock units outstanding, some of which contain performance-based vesting conditions, under the 2012 LTIP as of December 31, 2023. SeaSpine 2015 Plan Pursuant to the Merger Agreement, the Company assumed awards outstanding under the SeaSpine Holdings Corporation Amended and Restated 2015 Incentive Award Plan Award Plan (the “SeaSpine 2015 Plan”). The SeaSpine 2015 Plan provides for the grant of options to purchase shares of the Company’s common stock, stock awards (including restricted stock, unrestricted stock, and stock units), stock appreciation rights, performance-based awards and other equity-based awards. All of the Company’s employees and the employees of the Company’s subsidiaries and affiliates are eligible and may receive awards under the SeaSpine 2015 Plan. In addition, the Company’s non-employee directors, consultants, and advisors who perform services for the Company and its subsidiaries and affiliates may receive awards under the SeaSpine 2015 Plan. At December 31, 2023, the Company reserves a total of 3.0 million shares of common stock for issuance pursuant to the SeaSpine 2015 Plan, subject to certain adjustments set forth in the SeaSpine 2015 Plan. At December 31, 2023, there were 1.0 million options outstanding under the SeaSpine 2015 Plan, of which 0.9 million were exercisable. In addition, there were 0.2 million restricted stock units outstanding, some of which contain performance-based vesting conditions, under the SeaSpine 2015 Plan as of December 31, 2023. Inducement Plans In August 2019, the Company appointed a new President of Global Spine, who was then subsequently promoted to President and Chief Executive Officer, a position held until the closing of the merger with SeaSpine on January 5, 2023. As an inducement to accept employment with the Company, the individual was awarded a grant of stock options to acquire up to less than 51 thousand shares of common stock and an award of 15 thousand restricted stock units. As of December 31, 2023 , there were 51 thousand options outstanding under this inducement, all of which were exercisable. Pursuant to the Merger Agreement, the Company assumed awards outstanding under the SeaSpine 2018 Employment Inducement Incentive Award Plan and the SeaSpine 2020 Employment Inducement Incentive Award Plan. As of December 31, 2023 , there were 0.3 million options outstanding under these inducements, 0.2 million of which were exercisable, and 17 thousand unvested restricted stock units outstanding. In January 2023, the Company granted options to acquire up to 0.9 million shares of common stock and awarded 0.5 million restricted stock units to SeaSpine employees as an inducement to continue employment with the Company. As of December 31, 2023 , there were 0.3 million options outstanding under this inducement, none of which were exercisable, and 0.2 million unvested restricted stock units outstanding. Stock Purchase Plan The Second Amended and Restated Stock Purchase Plan, as Amended (the “Stock Purchase Plan”) provides for the issuance of shares of the Company’s common stock to eligible employees and directors of the Company and its subsidiaries that elect to participate in the plan and acquire shares of common stock through payroll deductions (including executive officers). During each purchase period, eligible employees may designate between 1 % and 25 % of their compensation to be deducted for the purchase of common stock under the plan (or such other percentage in order to comply with regulations applicable to employees domiciled in or resident of a member state of the European Union). For eligible directors, the designated percentage will be applied to an amount equal to his or her director compensation paid in cash for the current plan period. The purchase price of the shares under the plan is equal to 85 % of the fair market value on the first day of the plan period or, if lower, on the last day of the plan period. Due to the compensatory nature of such plan, the Company records the related share-based compensation expense in the consolidated statement of operations. Compensation expense is estimated using the Black-Scholes valuation model, with such value recognized as expense over the plan period. As of December 31, 2023 , the aggregate number of shares reserved for issuance under the Stock Purchase Plan is 3.6 million. As of December 31, 2023 , a total of 2.8 million shares had been issued pursuant to the Stock Purchase Plan. Share-Based Compensation Expense Share-based compensation expense is recorded in the same line of the consolidated statements of operations as the employee’s cash compensation. The following tables present the detail of share-based compensation expense by line item in the consolidated statements of income as well as by award type, for the years ended December 31, 2023, 2022, and 2021: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Cost of sales $ 1,901 $ 826 $ 779 Sales and marketing 8,174 3,865 3,385 General and administrative 21,743 12,917 10,289 Research and development 3,889 835 979 Total $ 35,707 $ 18,443 $ 15,432 Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Stock options $ 6,130 $ 1,114 $ 1,893 Time-based restricted stock awards and stock units 27,290 9,452 7,437 Performance-based / Market-based restricted stock units 227 6,425 4,414 Stock purchase plan 2,060 1,452 1,688 Total $ 35,707 $ 18,443 $ 15,432 The income tax benefit related to this expense was $ 5.8 million, $ 3.3 million, and $ 3.1 million for the years ended December 31, 2023, 2022, and 2021, respectively. Stock Options The fair value of time-based stock options is determined using the Black-Scholes valuation model, with such value recognized as expense over the service period, which is typically three to four years, net of actual forfeitures. A summary of the Company’s assumptions used in determining the fair value of the stock options granted during each of the years ended December 31, 2023, 2022, and 2021, is shown in the following table. The Company did not grant any time-based stock options in 2022. Year Ended December 31, 2023 2022 2021 Assumptions: Expected term (in years) 6.0 — 6.0 Expected volatility 36.8 % – 42.3 % — 34.4 % – 34.8 % Risk free interest rate 3.38 % – 4.61 % — 0.83 % – 1.25 % Dividend yield — — — Weighted average grant date fair value $ 8.43 $ — $ 12.33 The expected term of the options granted is estimated based on a number of factors, including the vesting and expiration terms of the award, historical employee exercise behavior for both options that are currently outstanding and options that have been exercised or are expired, and an employee’s average length of service. Expected volatility is based on the historical volatility of the Company’s common stock. The risk-free interest rate is determined based upon a constant U.S. Treasury security rate with a contractual life that approximates the expected term of the option. Summaries of the status of the Company’s stock option plans as of December 31, 2023, and 2022, and changes during the year ended December 31, 2023, are presented below: (In thousands) Options Weighted Weighted Outstanding at December 31, 2022 1,299 $ 39.29 Assumed SeaSpine awards 1,890 $ 36.05 Granted 1,837 $ 19.92 Exercised - $ - Forfeited or expired ( 1,803 ) $ 31.62 Outstanding at December 31, 2023 3,223 $ 30.64 4.97 Vested and expected to vest at December 31, 2023 3,223 $ 30.64 4.97 Exercisable at December 31, 2023 1,828 $ 36.78 2.68 As of December 31, 2023 , the unamortized compensation expense relating to options granted and expected to be recognized was $ 4.8 million. This amount is expected to be recognized through December 2027 over a weighted average period of approximately 1.2 years. The total intrinsic value of options exercised was $ 0.0 million, $ 0.0 million, and $ 0.6 million for the years ended December 31, 2023, 2022, and 2021, respectively. For the year ended December 31, 2023 , we did no t receive any cash from stock option exercises, and thus did no t realize any tax benefit for the tax deductions from stock option exercises. The aggregate intrinsic value of options outstanding and options exercisable as of December 31, 2023 , is calculated as the difference between the exercise price of the underlying options and the market price of the Company’s common stock for options that had exercise prices lower than $ 13.48 , the closing price of the Company’s stock on December 31, 2023 . The aggregate intrinsic value of options outstanding was $ 0.1 million as of December 31, 2023 . The aggregate intrinsic value of options exercisable was $ 0.0 million as of that date. Time-based Restricted Stock Awards and Stock Units Compensation expense for time-based restricted stock awards and stock units, which represents the fair value of the stock measured at the market price at the date of grant, is recognized on a straight-line basis over the vesting period, which is typically three to four years , net of actual forfeitures. The aggregate fair value of time-based restricted stock awards and stock units that vested during the years ended December 31, 2023, 2022, and 2021 , was $ 17.2 million, $ 5.2 million, and $ 9.0 million, respectively. Unamortized compensation expense related to time-based restricted stock awards and stock units amounted to $ 22.6 million at December 31, 2023 . This amount is expected to be recognized through December 2026 over a weighted average period of approximately 1.6 years. The aggregate intrinsic value of time-based restricted stock awards and stock units outstanding was $ 27.5 million as of December 31, 2023. Performance-based and Market-based Restricted Stock Units Certain of the Company's outstanding restricted stock units contain performance-based vested conditions or market-based vesting conditions. As previously discussed, all outstanding performance-based and market-based restricted stock units were converted to time-based restricted stock units in January 2023 upon completion of the Merger based on the Board of Directors' determination to treat the transaction as a "Change in Control" under applicable agreements and equity plans. The fair value of performance-based restricted stock units is calculated based upon the closing stock price at the date of grant. Such value is recognized as expense over the requisite service period beginning in the period in which they are deemed probable to vest, net of actual forfeitures. Vesting probability is assessed based upon forecasted financial metrics or applicable milestones associated with the applicable grant. The fair value of market-based restricted stock units is determined at the date of the grant using the Monte Carlo valuation methodology, with any discounts for post-vesting restrictions estimated using the Chaffe Model. The Monte Carlo methodology incorporates into the valuation the possibility that the market condition may not be satisfied. Such value is recognized on a straight-line basis over the vesting period, net of actual forfeitures. The fair value of performance-based and/or market-based restricted stock units that vested and settled during the years ended December 31, 2023, 2022, and 2021 , totaled $ 0.0 million, $ 0.0 million, and $ 0.0 million, respectively. Unamortized compensation expense for performance-based and/or market-based restricted stock units totaled less than $ 0.1 million at December 31, 2023 , and is expected to be recognized over a weighted average period of approximately 1.0 years. The aggregate intrinsic value of performance-based restricted stock units outstanding was $ 0.1 million as of December 31, 2023. A summary of the status of our time-based and performance-based and/or market-based restricted stock units as of December 31, 2023, and 2022, and changes during the year ended December 31, 2023, are presented below: Time-based Restricted Stock Performance-based and/or Market-based (In thousands) Shares Weighted Shares Weighted Outstanding at December 31, 2022 847 $ 34.18 516 $ 40.29 Assumed SeaSpine awards 490 $ 22.76 — $ — Conversion of performance-based and market-based stock units to time-based stock units 516 $ 40.29 ( 516 ) $ 40.29 Granted 1,496 $ 18.51 13 $ 20.10 Vested and settled ( 749 ) $ 29.04 ( 4 ) $ 22.76 Cancelled ( 560 ) $ 21.12 — $ — Outstanding at December 31, 2023 2,040 $ 26.96 9 $ 22.69

Defined Contribution Plans and

Defined Contribution Plans and deferred compensation	12 Months Ended
	Dec. 31, 2023
Retirement Benefits [Abstract]
Defined contribution plans and deferred compensation	19. Defined contribution plans and deferred compensation Defined Contribution Plans Orthofix sponsors a defined contribution plan (the “401(k) Plan”) covering substantially all full-time U.S. employees. The 401(k) Plan allows participants to contribute up to 80 % of their pre-tax compensation, subject to certain limitations, with the Company matching 100 % of the first 2 % of the employee’s base compensation and 50 % of the next 4 % of the employee’s base compensation if contributed to the 401(k) Plan. During the years ended December 31, 2023, 2022, and 2021 , expenses incurred relating to the 401(k) Plan, including matching contributions, were approximately $ 4.6 million, $ 3.3 million, and $ 2.8 million, respectively. The Company also operates defined contribution plans for its international employees meeting minimum service requirements. The Company’s expenses for such contributions during each of the years ended December 31, 2023, 2022, and 2021 , were $ 1.1 million, $ 1.1 million, and $ 1.2 million, respectively. Effective February 1, 2024, Orthofix amended the 401(k) Plan to allow participants to contribute up to 90 % of their pre-tax compensation, subject to certain limitations, with the Company matching 100 % of the first 4 % of the employee's base compensation. Deferred Compensation Plans Under Italian Law, our Italian subsidiary accrues deferred compensation on behalf of its employees, which is paid on termination of employment. The accrual for deferred compensation is based on a percentage of the employee’s current annual remuneration plus an annual charge. Deferred compensation is also accrued for the leaving indemnity payable to agents in case of dismissal, which is regulated by a national contract and is equal to approximately 4 % of total commissions earned from the Company. The Company’s relations with its Italian employees, who represent 14 % of total employees at December 31, 2023, are governed by the provisions of a National Collective Labor Agreement setting forth mandatory minimum standards for labor relations in the metal mechanic workers industry. The Company is not a party to any other collective bargaining agreement. The balance in other long-term liabilities as of December 31, 2023, and 2022 was $ 1.7 million and $ 1.5 million, respectively, and represents the amount that would be payable if all the employees and agents had terminated employment at that date.

Income taxes

Income taxes	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Income taxes	20. Income taxes Income (loss) before provision for income taxes consisted of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 U.S. $ ( 154,794 ) $ ( 22,318 ) $ ( 5,987 ) Non-U.S. 6,115 4,612 ( 7,508 ) Income (loss) before income taxes $ ( 148,679 ) $ ( 17,706 ) $ ( 13,495 ) The provision for income taxes consists of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 U.S. Current $ 17 $ 1,151 $ ( 607 ) Deferred 1,160 67 24,292 1,177 1,218 23,685 Non-U.S. Current 2,120 578 1,009 Deferred ( 581 ) 247 190 1,539 825 1,199 Income tax expense (benefit) $ 2,716 $ 2,043 $ 24,884 The differences between the income tax provision at the U.S. federal statutory tax rate and the Company’s effective tax rate for the years ended December 31, 2023, 2022, and 2021, consist of the following: 2023 2022 2021 (U.S. Dollars, in thousands, except percentages) Amount Percent Amount Percent Amount Percent Statutory U.S. federal income tax rate $ ( 31,222 ) 21.0 % $ ( 3,718 ) 21.0 % $ ( 2,834 ) 21.0 % State taxes, net of U.S. federal benefit ( 3,452 ) 2.3 ( 1,312 ) 7.4 ( 24 ) 0.2 Foreign rate differential, including withholding taxes ( 738 ) 0.5 475 ( 2.7 ) 480 ( 3.6 ) Valuation allowances, net 28,322 ( 19.0 ) 7,638 ( 43.1 ) 27,819 ( 206.1 ) Foreign income inclusions, net 2,333 ( 1.6 ) 1,018 ( 5.7 ) — — Research credits ( 1,219 ) 0.8 ( 750 ) 4.2 ( 537 ) 4.0 Unrecognized tax benefits, net of settlements 71 — ( 599 ) 3.4 ( 1,363 ) 10.1 Equity compensation 4,210 ( 2.8 ) 1,441 ( 8.1 ) 1,091 ( 8.1 ) Executive compensation 3,030 ( 2.0 ) 697 ( 3.9 ) 456 ( 3.4 ) Contingent consideration — — ( 3,316 ) 18.7 ( 640 ) 4.7 Other, net 1,381 ( 0.9 ) 469 ( 2.6 ) 436 ( 3.2 ) Income tax expense (benefit) /effective rate $ 2,716 ( 1.8 )% $ 2,043 ( 11.5 )% $ 24,884 ( 184.4 )% The Company paid (received or was refunded) cash relating to taxes totaling $ 0.9 million, ($ 0.9 ) million, and $ 4.8 million for the years ended December 31, 2023, 2022, and 2021, respectively. The Company’s deferred tax assets and liabilities are as follows: December 31, (U.S. Dollars, in thousands) 2023 2022 Intangible assets and goodwill $ — $ 5,807 Inventories and related reserves 33,122 17,819 Deferred revenue and cost of goods sold 4,409 3,642 Other accruals and reserves 5,382 2,756 Accrued compensation 14,861 8,795 Provision for expected credit losses 1,821 1,253 Accrued interest 1,227 — Net operating loss and tax credit carryforwards 123,210 40,676 Research and development capitalization 15,174 4,353 Lease liabilities 9,632 6,440 Other, net 5,429 3,767 Total deferred tax assets 214,267 95,308 Valuation allowance ( 200,192 ) ( 83,797 ) Deferred tax asset, net of valuation allowance $ 14,075 $ 11,511 Intangible assets and goodwill $ ( 1,662 ) $ — Withholding taxes ( 10 ) ( 10 ) Property, plant, and equipment ( 5,737 ) ( 5,516 ) Right-of-use lease assets ( 8,755 ) ( 5,771 ) Deferred tax liability $ ( 16,164 ) $ ( 11,297 ) Net deferred tax assets (liabilities) $ ( 2,089 ) $ 214 Reported as: Deferred income tax assets (classified within other long-term assets) $ 2,081 $ 1,470 Deferred income tax liabilities (classified within other long-term liabilities) ( 4,170 ) ( 1,256 ) Net deferred tax assets (liabilities) $ ( 2,089 ) $ 214 The Company historically presented deferred income tax assets as a separate and discrete line item on its consolidated balance sheet; however, as the significance of the asset has decreased as a result of the recognition of valuation allowances, the Company has reclassified this balance to be included within other long-term assets. Deferred income tax liabilities is included in Other Long Term Liabilities. The Company accounts for income taxes using the asset and liability method, under which deferred tax assets and liabilities are recognized for the expected future tax consequences of temporary differences between the financial reporting and income tax basis of assets and liabilities, and for operating losses and credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates in effect for the years in which those items are expected to be realized. Tax law and rate changes are recorded in the period such changes are enacted. The Company establishes a valuation allowance when it is more likely than not that certain deferred tax assets will not be realized in the foreseeable future. The valuation allowance is primarily attributable to net operating loss carryforwards and temporary differences in domestic and certain foreign jurisdictions. The net increase in the valuation allowance of $ 116.4 million during the year principally relates to the existing valuation allowance against the SeaSpine deferred tax assets at the time of the merger. The remaining activity is related to recognizing a full valuation allowance against the net deferred tax asset within the Company’s U.S. and Italy operations. The Company considered many factors when assessing the likelihood of future realization of these deferred tax assets, including recent cumulative losses experienced by the subsidiary, expectations of future taxable income or loss, the carryforward periods available to the Company for tax reporting purposes, and other relevant factors. That increase was partially offset by a decrease of valuation allowances on net operating loss carryforwards in other foreign jurisdictions due to expiration, statutory rate changes, and changes regarding the realizability of net deferred tax assets. It is reasonably possible that the valuation allowance will increase in 2024 due to further losses in certain jurisdictions, offset by decreases related to the expiration of foreign net operating losses. The Company has federal net operating loss carryforwards of $ 331.7 million and federal research and development credits of $ 4.7 million, including amounts from the acquisitions of SeaSpine and Spinal Kinetics. The increase in the current year is primarily related to U.S. Federal net operating loss carryforwards belonging to SeaSpine at the time of the Merger as well as research and development credit carryforwards. These federal carryforwards are subject to limitation under the provisions of Internal Revenue Code Section 382 and will begin to expire in 2026 . The Company has state net operating loss carryforwards of approximately $ 221.4 million, principally related to California, Illinois, Michigan, and New York. Of this amount, $ 157.9 relates to SeaSpine and $ 20.6 million relates to Spinal Kinetics. The increase in state net operating loss carryforwards is primarily due to existing losses acquired from SeaSpine. The SeaSpine state losses begin to expire in 2024 and the Spinal Kinetics state losses begin to expire in 2027 . These carryforwards are subject to limitation under various provisions implemented by each specific state jurisdiction. Additionally, the Company has net operating loss carryforwards in various foreign jurisdictions of approximately $ 129.0 million, which mainly relate to the Company’s Netherlands, Brazil, and Canada operations. The majority of the foreign net operating losses do not expire. The Company also has research and development credits in Canada of $ 0.9 million which begin to expire in 2041 . Unremitted foreign earnings were $ 33.6 million as of December 31, 2023. The Company’s investment in foreign subsidiaries continues to be indefinite in nature; however, the Company may periodically repatriate a portion of these earnings to the extent that it does not incur significant additional tax liability. Quantification of the deferred tax liability, if any, associated with indefinitely reinvested earnings of foreign subsidiaries is not practicable. The Company records a benefit for uncertain tax positions when the weight of available evidence indicates that it is more likely than not, based on an evaluation of the technical merits, that the tax position will be sustained on audit. The tax benefit is measured as the largest amount that is more than 50 % likely to be realized upon settlement. The Company re-evaluates income tax positions periodically to consider changes in facts or circumstances such as changes in or interpretations of tax law, effectively settled issues under audit, and new audit activity. The Company includes interest and any applicable penalties related to income tax issues as part of income tax expense in its consolidated financial statements. The Company’s unrecognized tax benefit was $ 3.0 million and $ 1.7 million for the years ended December 31, 2023, and 2022 , respectively. The Company recorded net interest and penalties expense (benefit) on unrecognized tax benefits of $ 0.2 million, $ 0.1 million, and $( 0.4 ) million for the years ended December 31, 2023, 2022, and 2021 , respectively, and had approximately $1 .1 million and $ 0.9 million accrued for payment of interest and penalties as of December 31, 2023, and 2022 , respectively. Approximately $ 0.4 million would unfavorably impact the Company’s effective tax rate if recognized. The Company believes it is reasonably possible that, in the next 12 months, the amount of unrecognized tax benefits, exclusive of interest and penalties, related to the resolution of federal, state, and foreign matters could be reduced by $ 1.2 million as audits close and statutes expire. A reconciliation of the gross unrecognized tax benefits (excluding interest and penalties) for the years ended December 31, 2023, and 2022, is shown below: (U.S. Dollars, in thousands) 2023 2022 Balance as of January 1, $ 1,743 $ 3,462 Additions for current year tax positions 416 46 Increases for prior year tax positions 815 16 Settlements of prior year tax positions — ( 144 ) Expiration of statutes — ( 1,637 ) Balance as of December 31, $ 2,974 $ 1,743 The Company and its subsidiaries file income tax returns in the U.S. federal jurisdiction and in certain state and foreign jurisdictions, including Italy, as well as other jurisdictions where the Company maintains operations. The statute of limitations with respect to federal and state tax filings is closed for years prior to 2019. The statute of limitations with respect to the major foreign tax filing jurisdictions is closed for years prior to 2018. The Company cannot reasonably determine if any state and local or foreign examinations will have a material impact on its financial statements and cannot predict the timing regarding the resolution of these tax examinations.

Earnings per share (EPS)

Earnings per share (EPS)	12 Months Ended
	Dec. 31, 2023
Earnings Per Share [Abstract]
Earnings per share (EPS)	21. Earnings per share (EPS) For periods in which non-vested restricted stock awards with nonforfeitable rights to dividends or dividend equivalents (referred to as participating securities) were outstanding, the Company used the two-class method of computing basic and diluted EPS. In other periods, the Company used the treasury stock method of computing basic and diluted EPS. Basic EPS is computed using the weighted average number of common shares outstanding during each of the respective years. Diluted EPS is computed using the weighted average number of common and common equivalent shares outstanding during each of the respective years using the more dilutive of either the treasury stock method or two-class method (if other participating securities were outstanding). The difference between basic and diluted shares, if any, largely results from common equivalent shares, which represents the dilutive effect of the assumed exercise of certain outstanding share options, the assumed vesting of restricted stock granted to employees and directors, or the satisfaction of certain necessary conditions for contingently issuable shares (see Note 18). For each of the three years ended December 31, 2023, 2022, and 2021 , 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 the diluted EPS computations: Year Ended December 31, (In thousands) 2023 2022 2021 Weighted average common shares-basic 36,729 20,054 19,691 Effect of diluted securities: Unexercised stock options and employee stock purchase plan — — — Unvested time-based restricted stock units — — — Weighted average common shares-diluted 36,729 20,054 19,691 There were 6.5 million, 2.3 million and 1.7 million weighted average outstanding options, time-based restricted stock awards and stock units, performance-based stock units, and market-based stock units not included in the diluted earnings per share computation for the years ended December 31, 2023, 2022, and 2021 , respectively, because inclusion of these awards was anti-dilutive or, for performance-based stock units and market-based stock units, all necessary conditions had not been satisfied by the end of the respective period.

Significant accounting polici_2

Significant accounting policies (Policies)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Market risk	Market risk In the ordinary course of business, the Company is exposed to the impact of changes in interest rates and foreign currency fluctuations. The Company’s objective is to limit the impact of such movements on earnings and cash flows. In order to achieve this objective, the Company seeks to balance its non-U.S. Dollar denominated income and expenditures. The financial statements for operations outside the U.S. are generally maintained in their respective local currency. All foreign currency denominated balance sheet accounts, except shareholders’ equity, are translated to U.S. Dollars at year end exchange rates, and revenue and expense items are translated at average exchange rates prevailing during the year. Gains and losses resulting from the translation of foreign currency are recorded in the accumulated other comprehensive income (loss) component of shareholders’ equity. Transactional foreign currency gains and losses, including those generated from intercompany operations, are included in other income (expense), net and was a gain of $ 1.6 million, a loss of $ 3.3 million, and a loss of $ 4.0 million for the years ended December 31, 2023, 2022, and 2021 , respectively.
Financial instruments and concentration of credit risk	Financial instruments and concentration of credit risk Financial instruments that could subject the Company to a concentration of credit risk consist primarily of cash, cash equivalents, and accounts receivable. Generally, cash is held at large financial institutions and cash equivalents consist of highly liquid money market funds. The Company performs ongoing credit evaluations of customers, generally does not require collateral, and maintains a reserve for expected credit losses. The Company believes that a concentration of credit risk related to accounts receivable is limited because customers are geographically dispersed and end users are diversified.
Cash, cash equivalents and restricted cash	Cash, cash equivalents, and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. In November 2023, following the termination of the Second Amended and Restated Credit Agreement with JPMorgan Chase Bank, N.A., as Administrative Agent, and certain lender parties thereto, Bank of America required collateral of approximately $ 4.7 million of the Company’s cash as a banking service obligation. This cash has been reclassified to restricted cash as of December 31, 2023. Investing activities that did not result in cash receipts or cash payments during the years ended December 31, 2023, 2022, and 2021 consisted of the following, which were not included within cash from investing activities in the Company’s consolidated statements of cash flows: (U.S. Dollars, in thousands) 2023 2022 2021 Supplemental disclosure of cash flow information: Noncash investing activities: Intangible assets acquired in asset acquisitions $ — $ 2,000 $ —
Advertising costs	Advertising costs Advertising costs are expensed as incurred. Advertising costs are included within sales and marketing expense and totaled $ 0.5 million for each of the years ended December 31, 2023, 2022, and 2021 , respectively.
Research and development costs, including collaborative arrangements	Research and development costs, including collaborative arrangements Expenditures for research and development are expensed as incurred. Expenditures related to the Company’s collaborative arrangement with MTF Biologics (“MTF”) are expensed based on the terms of the related agreement. The Company recognized $ 0.8 million, less than $ 0.1 million, and $ 0.8 million in research and development expense for the years ended December 31, 2023, 2022, and 2021, respectively. In October 2020, the Company and Neo Medical SA, a privately held Swiss-based company developing a new generation of products for spinal surgery (“Neo Medical”), entered into a co-development agreement covering the parties’ joint development of single use instruments for cervical spine procedures. In connection with this agreement, the Company is responsible for the payment of variable costs associated with the development of the specified products. Research and development expenses incurred under this collaborative arrangement totaled $ 0.1 million, $ 0.5 million, and $ 0.6 million for the years ended December 31, 2023, 2022, and 2021 , respectively.
Recently adopted accounting standards and recently issued accounting pronouncements	Adoption of Accounting Standards Update (“ASU”) 2021-10—Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance In November 2021, the Financial Accounting Standards Board (“FASB”) issued ASU 2021-10, which aims to increase the transparency of government assistance by requiring entities to provide information about the nature of the transaction, terms and conditions associated with the transaction, and financial statement line items affected by the transaction. The Company voluntarily elected to early adopt this standard for the year ended December 31, 2021, on a prospective basis. Adoption of this standard did not have a significant impact to the existing disclosures made in relation to government assistance received by the Company in 2020 as part of the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act"). Adoption of ASU 2019-12, Simplifying the accounting for income taxes In December 2019, the FASB issued ASU 2019-12, which reduces the complexity of accounting for income taxes by eliminating certain exceptions to the general principles in Accounting Standards Codification ("ASC") 740, Income Taxes . Additionally, the ASU simplifies U.S. GAAP by amending the requirements related to the accounting for "hybrid" tax regimes and also adding the requirement to evaluate when a step up in the tax basis of goodwill should be considered part of the business combination and when it should be considered a separate transaction. The Company adopted this ASU effective January 1, 2021 , with certain provisions applied retrospectively and other provisions applied prospectively. Adoption of this ASU did not have a material impact to the Company’s consolidated balance sheet, statements of operations, or cash flows. Adoption of ASU 2020-04, Reference Rate Reform (Topic 848) In March 2020, the FASB issued ASU 2020-04, which provided temporary optional guidance to ease the potential financial reporting burden of the expected market transition away from the London Inter-Bank Offered Rate. The new guidance provided optional expedients and exceptions for applying U.S. GAAP to contract modifications, hedge accounting, and other transactions affected by reference rate reform if certain criteria are met through December 31, 2022. The Company adopted this ASU effective March 12, 2020 , the effective date of the ASU, on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s consolidated balance sheet, statements of operations, or cash flows. Adoption of ASU 2021-08, Accounting for Contract Assets and Contract Liabilities with Contracts with Customers In October 2021, the FASB issued ASU 2021-08, which aims to address diversity in practice and inconsistency related to the accounting for acquired revenue contracts with customers in a business combination. The amendments require that an entity recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with Topic 606, Revenue from Contracts with Customers. Adoption of this standard resulted in the recognition of $ 2.2 million in contract liabilities associated with acquired revenue contracts as a result of the Company’s merger with SeaSpine, which closed on January 5, 2023. Recently Issued Accounting Pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions (ASU 2022-03) Clarifies the guidance in Topic 820, Fair Value Measurement , when measuring the fair value of an equity security subject to contractual restrictions that prohibit the sale of an equity security and introduces new disclosure requirements for equity securities subject to contractual sale restrictions. Certain of the provisions are to be applied retrospectively with other provisions applied prospectively. January 1, 2024 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements, but does not expect this ASU to have a material impact on disclosures within the Company's consolidated financial statements. Disclosure Improvements - Codification Amendments in Response to the SEC's Disclosure Update and Simplification Initiative (ASU 2023-06) Adds interim and annual disclosure requirements to a variety of subtopics in the Accounting Standards Codification, including those focusing on accounting changes, earnings per share, debt and repurchase agreements. The guidance will be applied prospectively. The effective date will be the date when the SEC's removal of the related disclosure requirement becomes effective, with early adoption prohibited. Various The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Improvements to Reportable Segment Disclosures (ASU 2023-07) Improve financial reporting by requiring disclosure of incremental segment information on an annual and interim basis for all public entities to enable investors to develop more decision-useful financial analyses. Provisions are to be applied retrospectively to all prior periods presented in financial statements. January 1, 2024 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements; however, the Company expects to disclose additional information in regards to its reportable segments as a result of this ASU, including (i) significant segment expenses regularly provided to the Company's chief operating decision maker ("CODM"), (ii) disclosure of other segment items by reportable segment, and (iii) disclosure of the title and position of the Company's CODM, among other disclosure requirements. Improvements to Income Tax Disclosures (ASU 2023-09) Enhance the transparency and decision usefulness of income tax disclosures to better assess how an entity’s operations and related tax risks and tax planning and operational opportunities affect its tax rate and January 1, 2025 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements.
Inventories	Inventories are valued at the lower of cost or estimated net realizable value, after provision for excess, obsolete, or impaired items, which is reviewed and updated on a periodic basis by management. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facility in Italy, cost is determined on a weighted-average basis, which approximates the first-in, first-out (“FIFO”) method. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facilities in Texas and California, standard cost, which approximates actual cost on the FIFO method, is used to value inventory. Standard costs are reviewed by management, at least annually or more often, in the event circumstances indicate a change in cost has occurred.
Property, plant and equipment	. Costs include all expenditures necessary to place the asset in service, generally including freight and sales and use taxes. Property, plant, and equipment also includes instrumentation held by customers, which is generally used to facilitate the implantation of the Company’s products. The Company evaluates the useful lives of these assets on an annual basis. Depreciation is computed on a straight-line basis over the useful lives of the assets. Depreciation of leasehold improvements is computed over the shorter of the lease term or the useful life of the asset. Total depreciation expense was $ 34.2 million, $ 19.6 million, and $ 20.2 million for the years ended December 31, 2023, 2022, and 2021, respectively. Expenditures for maintenance and repairs and minor renewals and improvements, which do not extend the lives of the respective assets, are expensed as incurred. All other expenditures for renewals and improvements are capitalized. The assets and related accumulated depreciation are adjusted for property retirements and disposals, with the resulting gain or loss included in earnings. Fully depreciated assets remain in the accounts until retired from service. The Company capitalizes system development costs related to internal-use software during the application development stage. Costs related to preliminary project activities and post-implementation activities are expensed as incurred. Internal-use software is amortized on a straight-line basis over its estimated useful life, which generally ranges from three to seven years . Long-lived assets are evaluated for impairment annually or whenever events or changes in circumstances have occurred that would indicate impairment. For purposes of the evaluation, the Company groups its long-lived assets with other assets and liabilities at the lowest level of identifiable cash flows if the asset does not generate cash flows independent of other assets and liabilities. If the carrying value of the asset or asset group exceeds the undiscounted cash flows expected to result from the use and eventual disposition of the asset group, the Company will write the carrying value down to fair value in the period identified. The Company generally determines fair value of long-lived assets as the present value of estimated future cash flows. In determining the estimated future cash flows associated with the assets, the Company uses estimates and assumptions about future revenue contributions, cost structures, and remaining useful lives of the asset group. The use of alternative assumptions, including estimated cash flows, discount rates, and alternative estimated remaining useful lives could result in different calculations of impairment.
Intangible assets	Intangible assets are recorded at cost, or when acquired as a part of a business combination, at estimated fair value, less accumulated amortization. These assets are amortized on a straight-line basis over the useful lives of the assets, which the Company believes is materially consistent with the pattern of economic benefit provided by the assets.
Goodwill	The Company tests goodwill at least annually for impairment. The Company tests more frequently if indicators are present or changes in circumstances suggest that impairment may exist. These indicators include, among others, declines in sales, earnings, or cash flows, or the development of a material adverse change in the business climate. The Company assesses goodwill for impairment at the reporting unit level, which is defined as an operating segment or one level below an operating segment.
Leases	The Company determines if a contractual arrangement qualifies as a lease at inception. The Company’s leases primarily relate to facilities, vehicles, equipment, and certain contract manufacturing agreements. Lease assets represent the Company’s right to use an underlying asset for the lease term, while lease liabilities represent the obligation to make lease payments arising from the lease. Lease assets and liabilities are recognized at the commencement date based on the present value of lease payments over the lease term. As the Company’s leases do not provide an implicit rate, the Company’s incremental borrowing rate is used as a discount rate, based on the information available at the commencement date, in determining the present value of lease payments. Lease assets also include the impact of any prepayments made and are reduced by the impact of any lease incentives. The Company does not recognize lease liabilities or lease assets on the balance sheet for short-term leases (leases with a lease term of twelve months or less as of the commencement date). Rather, any short-term lease payments are recognized as an expense on a straight-line basis over the lease term. The current period short-term lease expense reasonably reflects the Company's short-term lease commitments. For all classifications of leases, the Company combines lease and non-lease components to account for them as a single lease component. Variable lease payments are excluded from the lease liability and recognized in the period in which the obligation is incurred. Additionally, lease terms may include options to extend or terminate the lease when it is reasonably certain that the Company will exercise the option.
Commitments and contingencies	Contingencies policy The Company records accruals for certain outstanding legal proceedings, investigations, or claims when it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. The Company evaluates developments in legal proceedings, investigations, and claims that could affect the amount of any accrual, as well as any developments that would make a loss contingency both probable and reasonably estimable on a quarterly basis. When a loss contingency is not both probable and reasonably estimable, the Company does not accrue the loss. However, if the loss (or an additional loss in excess of the accrual) is at least a reasonable possibility and material, then the Company discloses a reasonable estimate of the possible loss or range of loss, if such reasonable estimate can be made. If the Company cannot make a reasonable estimate of the possible loss, or range of loss, then that is disclosed. In addition, legal fees and other directly related costs are expensed as incurred.
Revenue Recognition	Revenue Recognition The Company accounts for a contract when there is (i) approval and commitment from both parties, (ii) the rights of the parties are identified, (iii) payment terms are identified, (iv) the contract has commercial substance, (v) and collectability of consideration is probable. The Company’s contracts may contain one or more performance obligations. If a contract contains more than one performance obligation, the Company allocates the total transaction price to each of the performance obligations based upon the observable standalone selling price of the promised goods or services underlying each performance obligation. The Company recognizes revenue when control of the promised goods or services is transferred to the customer, which typically occurs at a point in time upon shipment, delivery, or utilization, in an amount that reflects the consideration which the Company expects to be entitled to in exchange for the promised goods or services. The consideration for goods or services reflects any fixed amount stated per the contract and estimates for any variable consideration, such as discounts, to the extent that is it probable that a significant reversal of cumulative revenue recognized will not occur when the uncertainty associated with the variable consideration is resolved. The following sections discuss the Company’s revenue recognition policies by significant product category: Bone Growth Therapies Bone Growth Therapies revenue is largely attributable to the U.S. and is comprised of third-party payor transactions and wholesale revenue. The largest portion of Bone Growth Therapies revenue is derived from third-party payors. This includes commercial insurance carriers, health maintenance organizations, preferred provider organizations, and governmental payors, such as Medicare. Revenue is recognized when the product is fitted to and accepted by the patient and all applicable documents required by the third-party payor have been obtained. Amounts paid by third-party payors are generally based on fixed or allowable reimbursement rates. These revenues are recorded at the expected or preauthorized reimbursement rates, net of any contractual allowances or adjustments. Certain billings are subject to review by the third-party payors and may be subject to adjustment. Wholesale revenue is related to the sale of the Company’s bone growth stimulators directly to durable medical equipment suppliers. Wholesale revenues are typically recognized upon shipment and receipt of a confirming purchase order, which is when the customer obtains control of the promised goods. Biologics Biologics revenue is largely attributable to the U.S. and is mostly processed from within our Irvine facility. In addition, we have a long standing collaborative arrangement with MTF that provides exclusive global marketing rights to MTF’s Trinity and FiberFuse product families. Per the terms of the agreement, MTF sources the tissue, processes it to create the allografts, packages, and delivers the tissue to the customer. The Company received marketing fees from MTF based on sales of products covered under the collaborative arrangement. MTF is considered the principal in these arrangements; therefore, the Company recognizes marketing service fees on a net basis within net sales upon shipment of the product to the customer and receipt of a confirming purchase order. Spinal Implants and Global Orthopedics Spinal Implants and Global Orthopedics products are distributed world-wide, with U.S. sales largely comprised of commercial sales and international sales derived from both commercial sales and stocking distributor arrangements. Commercial revenue is largely related to the sale of the Company’s Spinal Implants and Global Orthopedics products to hospital customers. The customer obtains control and revenues are recognized when these products have been utilized and a confirming purchase order has been received from the hospital. Other revenues within the Spinal Implants and Global Orthopedics product categories are derived from stocking distributors, who purchase the Company’s products and then re-sell them directly to customers, such as hospitals. For stocking distributor arrangements, it is the Company’s policy to recognize revenue upon shipment and receipt of a confirming purchase order, which is when the distributor obtains control of the promised goods. The transaction price for revenue recognition is estimated based upon the Company’s historical collection experience with the stocking distributor. Product Sales and Marketing Service Fees The table below presents net sales, which includes product sales and marketing service fees, for each of the years ended December 31, 2023, 2022, and 2021. For the year ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Product sales $ 693,345 $ 405,437 $ 409,554 Marketing service fees 53,296 55,276 54,925 Net sales $ 746,641 $ 460,713 $ 464,479 Marketing service fees are received from MTF based on total sales of biologics tissues and relates solely to the Biologics product category within the Global Spine reporting segment, whereas product sales primarily consist of the sale of Bone Growth Therapies, Spinal Implants, non-MTF sourced Biologics, Enabling Technologies, and Global Orthopedics products. Marketing service fees received from MTF were $ 53.3 million, or approximately 32 % of total Biologics revenues, for the year ended December 31, 2023. As MTF is the single supplier for certain allografts in the Company’s Biologics portfolio, derived from deceased donors for their bone grafts and living donors for their amnion grafts, any event or circumstance that would impact MTF’s continued access to donors or the Company’s ability to market these tissues may adversely impact the Company’s financial results. Revenues exclude any value added or other local taxes, intercompany sales, and trade discounts. Shipping and handling costs for products shipped to customers are included in cost of sales, and were $ 9.5 million, $ 4.2 million, and $ 3.5 million for the years ended December 31, 2023, 2022, and 2021, respectively. Accounts receivable and related allowances Payment terms vary by the type and location of the Company’s customers and the products or services offered. The term between invoicing and when payment is due is not significant. T he Company’s allowance for expected credit losses represents the portion of the receivable’s amortized cost basis that an entity does not expect to collect over the receivable’s contractual life, considering past events, current conditions, and reasonable and supportable forecasts of future economic conditions.
Earnings Per Share	For periods in which non-vested restricted stock awards with nonforfeitable rights to dividends or dividend equivalents (referred to as participating securities) were outstanding, the Company used the two-class method of computing basic and diluted EPS. In other periods, the Company used the treasury stock method of computing basic and diluted EPS. Basic EPS is computed using the weighted average number of common shares outstanding during each of the respective years. Diluted EPS is computed using the weighted average number of common and common equivalent shares outstanding during each of the respective years using the more dilutive of either the treasury stock method or two-class method (if other participating securities were outstanding). The difference between basic and diluted shares, if any, largely results from common equivalent shares, which represents the dilutive effect of the assumed exercise of certain outstanding share options, the assumed vesting of restricted stock granted to employees and directors, or the satisfaction of certain necessary conditions for contingently issuable shares (see Note 18).

Significant accounting polici_3

Significant accounting policies (Tables)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Schedule of Supplemental Disclosure of Cash Flow Information	Investing activities that did not result in cash receipts or cash payments during the years ended December 31, 2023, 2022, and 2021 consisted of the following, which were not included within cash from investing activities in the Company’s consolidated statements of cash flows: (U.S. Dollars, in thousands) 2023 2022 2021 Supplemental disclosure of cash flow information: Noncash investing activities: Intangible assets acquired in asset acquisitions $ — $ 2,000 $ —

Mergers and Acquisitions (Table

Mergers and Acquisitions (Tables)	12 Months Ended
	Dec. 31, 2023
Business Combinations [Abstract]
Summary of Estimated Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the estimated fair values of the assets acquired and liabilities assumed at the acquisition date. The Company finalized its valuation of assets acquired and liabilities assumed during the fourth quarter of 2023. Certain acquired assets and liabilities assumed were valued utilizing Level 3 inputs and assumptions. (U.S. Dollars, in thousands) Previously Reported Adjustments Final Acquisition Date Fair Value Assigned Useful Life Assets acquired: Current assets Cash and cash equivalents $ 29,419 $ — $ 29,419 Accounts receivable, net 35,313 — 35,313 Inventories 132,636 — 132,636 Prepaid expenses and other current assets 4,590 — 4,590 Total current assets 201,958 — 201,958 Property, plant, and equipment, net 68,863 — 68,863 Customer relationships 33,100 — 33,100 13 years Developed technology 47,200 — 47,200 6 - 8 years In-process research and development ("IPR&D") 5,750 — 5,750 Indefinite Other long-term assets 20,501 — 20,501 Total identifiable assets acquired $ 377,372 $ — $ 377,372 Liabilities assumed : Current liabilities Accounts payable $ 21,602 $ — $ 21,602 Other current liabilities 43,344 177 43,521 Total current liabilities 64,946 177 65,123 Long-term borrowings under SeaSpine credit facility 26,298 — 26,298 Other long-term liabilities 32,833 ( 10 ) 32,823 Total liabilities assumed 124,077 167 124,244 Net identifiable assets acquired $ 253,295 $ ( 167 ) $ 253,128 Total fair value of consideration transferred 376,745 — 376,745 Residual goodwill $ 123,450 $ 167 $ 123,617
Schedule of Estimated Fair Value of Consideration Associated with Merger	The total estimated fair value of consideration associated with the Merger as of the acquisition date was comprised of: (U.S. Dollars, in thousands, except shares and price per share) Share Consideration: Orthofix common shares to be issued in exchange for SeaSpine common shares 16,047,315 Orthofix closing price per share as of January 4, 2023 $ 22.76 Estimated fair value of shares issued in exchange for SeaSpine common shares $ 365,237 Estimated fair value of Orthofix stock options and RSUs issued in exchange for outstanding SeaSpine equity awards 11,508 Total estimated fair value of consideration $ 376,745
Summary of Pro Forma Financial Information	The unaudited pro forma financial information is presented for informational purposes only and is not necessarily indicative of the results of operations that would have been achieved if the Merger closed as of January 1, 2022. For the Year Ended December 31, (U.S. Dollars, in millions) 2023 2022 Net sales $ 746.6 $ 698.2 Net loss $ ( 116.4 ) $ ( 129.2 )
Summary of Integration Costs Incurred	The following table summarizes integration costs incurred for the year ended December 31, 2023, and 2022. For the Year Ended December 31, (U.S. Dollars, in millions) 2023 2022 Compensation-related integration costs $ 17.7 $ — International spine restructuring 1.3 — Fee paid to financial advisor to the Merger 5.5 — Professional fees / consulting fees 5.8 — Product rationalization charges 6.0 — Other costs to complete 1.4 — Total $ 37.7 $ —
Summary of Restructuring Costs	The table below provides a summary of restructuring costs incurred during the period and the resulting liabilities as of December 31, 2023, which are recognized within other current liabilities. (U.S. Dollars, in millions) Balance as of Charges Incurred Payments Made / Currency Translation Adjustment Balance as of U.S. Severance costs $ — $ 11.2 $ ( 10.2 ) $ 1.0 U.S. Retention costs — 5.3 ( 0.3 ) 5.0 U.S. Payroll taxes — 0.7 ( 0.4 ) 0.3 International spine restructuring severance — 1.0 ( 0.3 ) 0.7 Total $ — $ 18.2 $ ( 11.2 ) $ 7.0

Inventories (Tables)

Inventories (Tables)	12 Months Ended
	Dec. 31, 2023
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories are valued at the lower of cost or estimated net realizable value, after provision for excess, obsolete, or impaired items, which is reviewed and updated on a periodic basis by management. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facility in Italy, cost is determined on a weighted-average basis, which approximates the first-in, first-out (“FIFO”) method. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facilities in Texas and California, standard cost, which approximates actual cost on the FIFO method, is used to value inventory. Standard costs are reviewed by management, at least annually or more often, in the event circumstances indicate a change in cost has occurred. Work-in-process and finished products include material, labor, and production overhead costs. Field and consignment inventory, which represents immediately saleable finished products inventory that is in the possession of the Company’s independent sales representatives or located at third-party customers, such as distributors and hospitals, is included within finished products. December 31, (U.S. Dollars, in thousands) 2023 2022 Raw materials $ 28,390 $ 17,035 Work-in-process 53,510 19,243 Finished products 140,266 63,872 Inventories $ 222,166 $ 100,150

Property, plant and equipment (

Property, plant and equipment (Tables)	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Schedule of Useful Lives of Assets	The useful lives of these assets are generally as follows: Years Buildings 25 to 33 Plant and equipment 1 to 10 Instrumentation 3 to 4 Computer software 3 to 7 Furniture and fixtures 4 to 8
Schedule of Property, Plant and Equipment	The assets and related accumulated depreciation are adjusted for property retirements and disposals, with the resulting gain or loss included in earnings. Fully depreciated assets remain in the accounts until retired from service. December 31, (U.S. Dollars, in thousands) 2023 2022 Cost Buildings $ 4,103 $ 3,867 Plant and equipment 70,252 48,358 Instrumentation 154,192 92,607 Computer software 43,040 40,685 Furniture and fixtures 11,010 7,917 Construction in progress 41,751 4,515 Finance lease assets 23,337 23,276 Property, plant, and equipment, gross 347,685 221,225 Accumulated depreciation ( 188,625 ) ( 162,996 ) Property, plant, and equipment, net $ 159,060 $ 58,229

Intangible assets (Tables)

Intangible assets (Tables)	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	Intangible assets are recorded at cost, or when acquired as a part of a business combination, at estimated fair value, less accumulated amortization. These assets are amortized on a straight-line basis over the useful lives of the assets, which the Company believes is materially consistent with the pattern of economic benefit provided by the assets. December 31, (U.S. Dollars, in thousands) Weighted Average Amortization Period 2023 2022 Cost Developed technology 7.9 years $ 92,416 $ 43,699 Patents 10.0 years 43,262 40,108 IPR&D Indefinite 4,674 300 Customer relationships 12.1 years 49,197 15,572 License and other 9.6 years 24,584 23,295 Trademarks—finite lived 10.0 years 1,797 1,875 9.5 years 215,930 124,849 Accumulated amortization Developed technology $ ( 28,898 ) $ ( 17,830 ) Patents ( 40,494 ) ( 37,506 ) Customer relationships ( 11,988 ) ( 6,938 ) License and other ( 16,240 ) ( 14,386 ) Trademarks—finite lived ( 820 ) ( 801 ) ( 98,440 ) ( 77,461 ) Intangible assets, net $ 117,490 $ 47,388
Schedule of Future Amortization Expense	Future amortization expense for intangible assets is estimated as follows: (U.S. Dollars, in thousands) Amortization 2024 $ 20,948 2025 19,849 2026 18,810 2027 18,426 2028 14,890 Thereafter 19,893 Total finite-lived intangible assets, net $ 112,816 Indefinite-lived intangible assets, net 4,674 Intangible assets, net $ 117,490

Goodwill (Tables)

Goodwill (Tables)	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Net Carrying Amount of Goodwill	The following table presents the net carrying value of goodwill as of December 31, 2023, and 2022, and a rollforward of such balances from December 31, 2022, by reportable segment: (U.S. Dollars, in thousands) Balance as of Goodwill Acquired in the Merger with SeaSpine Impairment Currency translation adjustment Balance as of Global Spine - Gross $ 71,317 $ 123,617 $ — $ — $ 194,934 Global Spine - Accumulated Impairment Loss — — — — $ — Global Spine - Net $ 71,317 $ 123,617 $ — $ — $ 194,934 Global Orthopedics - Gross $ 11,130 $ — $ — $ 347 $ 11,477 Global Orthopedics - Accumulated Impairment Loss ( 11,130 ) — — ( 347 ) $ ( 11,477 ) Global Orthopedics - Net $ — $ — $ — $ — $ — Goodwill, net of accumulated impairment losses $ 71,317 $ 123,617 $ — $ — $ 194,934

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
Summary of Lease Portfolio	A summary of the Company’s lease portfolio as of December 31, 2023, and 2022, is presented in the table below: (U.S. Dollars, in thousands, except lease term and discount rate) Classification December 31, 2023 December 31, 2022 Assets Operating leases Other long-term assets $ 19,869 $ 6,788 Finance leases Property, plant and equipment, net 16,345 17,360 Total lease assets $ 36,214 $ 24,148 Liabilities Current Operating leases Other current liabilities $ 3,477 $ 1,638 Finance leases Current portion of finance lease liability 708 652 Long-term Operating leases Other long-term liabilities 17,125 5,376 Finance leases Long-term portion of finance lease liability 18,532 19,239 Total lease liabilities $ 39,842 $ 26,905 Weighted Average Remaining Lease Term Operating leases 6.2 years 4.5 years Finance leases 16.6 years 17.6 years Weighted Average Discount Rate Operating leases 7.3 % 4.0 % Finance leases 4.4 % 4.4 %
Summary of Components of Lease Costs	The components of lease costs were as follows: (U.S. Dollars, in thousands) For the Year Ended December 31, 2023 For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 Finance lease costs: Amortization of right-of-use assets $ 1,013 $ 1,238 $ 2,049 Interest on finance lease liabilities 857 890 933 Operating lease costs 5,015 2,126 2,234 Short-term lease costs 313 152 213 Variable lease costs 1,883 932 815 Total lease costs $ 9,081 $ 5,338 $ 6,244
Summary of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) For the Year Ended December 31, 2023 For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 7,682 $ 3,805 $ 4,627 Operating cash flows from finance leases 857 885 907 Financing cash flows from finance leases 652 2,594 537 Right-of-use assets obtained in exchange for lease obligations Operating leases 16,688 5,603 589 Finance leases — — 149
Summary of Remaining Lease Liabilities	A summary of the Company’s remaining lease liabilities as of December 31, 2023, is included below: (U.S. Dollars, in thousands) Operating Finance 2024 $ 4,861 $ 1,538 2025 4,788 1,543 2026 4,607 1,562 2027 3,441 1,593 2028 1,785 1,624 Thereafter 6,766 19,396 Total undiscounted value of lease liabilities 26,248 27,256 Less: Interest ( 5,646 ) ( 8,016 ) Present value of lease liabilities $ 20,602 $ 19,240 Current portion of lease liabilities $ 3,477 $ 708 Long-term portion of lease liabilities 17,125 18,532 Total lease liabilities $ 20,602 $ 19,240

Other current liabilities (Tabl

Other current liabilities (Tables)	12 Months Ended
	Dec. 31, 2023
Payables and Accruals [Abstract]
Summary of Other Current Liabilities	December 31, (U.S. Dollars, in thousands) 2023 2022 Accrued expenses $ 12,189 $ 9,611 Salaries, bonuses, employee commissions, and related taxes payable 38,826 18,531 Accrued distributor commissions 22,602 10,483 Accrued litigation and investigation costs 12,077 3,891 Short-term operating lease liability 3,477 1,638 Non-income taxes payable 7,585 6,586 Other payables 8,152 4,634 Other current liabilities $ 104,908 $ 55,374

Indebtedness (Tables)

Indebtedness (Tables)	12 Months Ended
	Dec. 31, 2023
Debt Disclosure [Abstract]
Summary of Carrying Values of Outstanding Debt Obligations	The carrying values of the Company’s outstanding debt obligations as of December 31, 2023, and 2022, were as follows: December 31, (U.S. Dollars, in thousands) 2023 2022 Initial Term Loan Principal amount $ 100,000 $ — Unamortized original debt discount ( 4,331 ) — Unamortized debt issuance costs and lenders fees ( 1,312 ) — Total indebtedness from initial term loan 94,357 — Revolving Credit Facilities Principal amount outstanding — — Total indebtedness outstanding $ 94,357 $ — Current portion of long-term debt $ 1,250 $ — Long-term debt 93,107 — Total indebtedness outstanding $ 94,357 $ —

Fair value measurements and i_2

Fair value measurements and investments (Tables)	12 Months Ended
	Dec. 31, 2023
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 Company’s available for sale debt securities, equity securities, contingent consideration, and deferred compensation plan liabilities are the only financial instruments recorded at fair value on a recurring basis as follows: (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Balance Assets Neo Medical convertible loan agreement $ — $ — $ 6,760 $ 6,760 Neo Medical preferred equity securities — 4,951 — 4,951 Bone Biologics equity securities — — — — Other investments — — 1,309 1,309 Total $ — $ 4,951 $ 8,069 $ 13,020 Liabilities Lattus contingent consideration $ — $ — $ ( 8,500 ) $ ( 8,500 ) Spinal Kinetics contingent consideration — — — — Deferred compensation plan — ( 1,674 ) — ( 1,674 ) Total $ — $ ( 1,674 ) $ — $ ( 10,174 ) (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Balance Assets Neo Medical convertible loan agreements $ — $ — $ 7,140 $ 7,140 Neo Medical preferred equity securities — 6,084 — 6,084 Bone Biologics equity securities — — — — Other Investments — — 1,726 1,726 Total $ — $ 6,084 $ 7,140 $ 14,950 Liabilities Spinal Kinetics contingent consideration $ — $ — $ — $ — Deferred compensation plan — ( 1,515 ) — ( 1,515 ) Total $ — $ ( 1,515 ) $ — $ ( 1,515 )
Schedule of Reconciliation of Carrying Value of Investments in Equity Securities	The table below presents a reconciliation of the carrying value of the Company’s investment in Neo Medical preferred equity securities for the years ended December 31, 2023, and 2022: (U.S. Dollars, in thousands) 2023 2022 Fair value of Neo Medical preferred equity securities at January 1 $ 6,084 $ 5,413 Conversion of loan into preferred equity securities — 671 Foreign currency remeasurement recognized in other income, net 388 — Unrealized loss recognized in other income (expense), net ( 1,521 ) — Fair value of Neo Medical preferred equity securities at December 31 $ 4,951 $ 6,084 Cumulative unrealized gain (loss) on Neo Medical preferred equity securities ( 720 ) 413 The
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 contingent consideration measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2023 2022 Spinal Kinetics contingent consideration at January 1 $ — $ 17,200 Decrease in fair value recognized in acquisition-related amortization and remeasurement — ( 17,200 ) Payment made — — Spinal Kinetics contingent consideration at December 31 $ — $ — (U.S. Dollars, in thousands) 2023 2022 Lattus contingent consideration estimated fair value at January 5 $ 11,200 $ — Decrease in fair value recognized in acquisition-related amortization and remeasurement ( 2,700 ) — Lattus contingent consideration estimated fair value at December 31 $ 8,500 $ —
Schedule of Changes in Valuation of Securities	The following table presents the changes in fair value recognized for each of the years ended December 31, 2023, 2022, and 2021: (U.S. Dollars, in thousands) 2023 2022 2021 Bone Biologics equity securities at January 1 $ — $ 309 $ — Fair value adjustments and impairments recognized in other income (expense), net — ( 183 ) 309 Proceeds from the disposition of equity securities — ( 126 ) — Bone Biologics equity securities at December 31 $ — $ — $ 309
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 Loan(s), measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2023 2022 Fair value of Neo Medical Convertible Loans at January 1 $ 7,140 $ 7,148 Additions — — Interest recognized in interest income, net 496 436 Foreign currency remeasurement recognized in other income (expense), net 617 ( 67 ) Unrealized gain (loss) recognized in other comprehensive income (loss) ( 1,233 ) 294 Expected credit loss recognized in other income (expense), net ( 260 ) — Conversion of Additional Convertible Loan into preferred equity securities — ( 671 ) Fair value of Neo Medical Convertible Loans at December 31 $ 6,760 $ 7,140 Contractual value of Neo Medical Convertible Loans at December 31 $ 7,020 $ 5,907 Allowance for credit loss recognized in other income (expense), net ( 260 ) — Amortized cost basis of Neo Medical Convertible Loans at December 31 $ 6,760 $ 5,907
Schedule of Changes in Valuation of Securities	The following table provides quantitative information related to certain key assumptions utilized within the valuation of the Convertible Loan as of December 31, 2023: (U.S. Dollars, in thousands) Fair Value as of December 31, 2023 Unobservable inputs Estimate Neo Medical Convertible Loan $ 6,760 Cost of equity discount rate 19.3 % Present value factor 15.3 % Implied volatility 81.1 % The following table provides quantitative information related to certain key assumptions utilized within the valuation as of December 31, 2023: (U.S. Dollars, in thousands) Fair Value as of Unobservable inputs Estimate Lattus Contingent Consideration $ 8,500 Counterparty discount rate 14.0 % Revenue risk-adjusted discount rate 6.5 %

Shareholders' equity (Tables)

Shareholders' equity (Tables)	12 Months Ended
	Dec. 31, 2023
Stockholders' Equity Note [Abstract]
Components of Changes in Accumulated Other Comprehensive Income (Loss)	The components of and changes in accumulated other comprehensive income (loss) are as follows: (U.S. Dollars, in thousands) Currency Neo Medical Convertible Loans Other Investments Accumulated Other Balance at December 31, 2020 $ 1,833 $ 1,419 $ — $ 3,252 Other comprehensive loss ( 2,544 ) ( 942 ) — ( 3,486 ) Income taxes — 234 — 234 Balance at December 31, 2021 $ ( 711 ) $ 711 $ — $ — Other comprehensive income (loss) ( 1,771 ) 294 101 ( 1,376 ) Income taxes — — — — Balance at December 31, 2022 $ ( 2,482 ) $ 1,005 $ 101 $ ( 1,376 ) Other comprehensive income (loss) 1,417 ( 1,233 ) ( 101 ) 83 Income taxes — — — — Balance at December 31, 2023 $ ( 1,065 ) $ ( 228 ) $ — $ ( 1,293 )

Revenue recognition and accou_2

Revenue recognition and accounts receivable (Tables)	12 Months Ended
	Dec. 31, 2023
Revenue Recognition And Accounts Receivable [Abstract]
Schedule of Net Sales	The table below presents net sales, which includes product sales and marketing service fees, for each of the years ended December 31, 2023, 2022, and 2021. For the year ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Product sales $ 693,345 $ 405,437 $ 409,554 Marketing service fees 53,296 55,276 54,925 Net sales $ 746,641 $ 460,713 $ 464,479
Allowances for Expected Credit Losses	The following table provides a detail of changes in the Company’s allowance for expected credit losses for the years ended December 31, 2023, and 2022: For the year ended December 31, (U.S. Dollars, in thousands) 2023 2022 Allowance for expected credit losses beginning balance $ 6,419 $ 4,944 Addition resulting from the Merger with SeaSpine 137 — Current period provision for expected credit losses 820 2,095 Write-offs charged against the allowance and other ( 381 ) ( 450 ) Effect of changes in foreign exchange rates 135 ( 170 ) Allowance for expected credit losses ending balance $ 7,130 $ 6,419
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 years ended December 31, 2023, and 2022: For the Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 Contract liability beginning balance $ — $ 4,791 Recoupment recognized in net sales — ( 4,791 ) Contract liability ending balance $ — $ —

Business segment information (T

Business segment information (Tables)	12 Months Ended
	Dec. 31, 2023
Segment Reporting [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: Year Ended December 31, 2023 2022 2021 (U.S. Dollars, in thousands) Net Sales Percent of Net Sales Percent of Net Sales Percent of Bone Growth Therapies $ 212,530 28.5 % $ 187,247 40.7 % $ 187,448 40.4 % Spinal Implants, Biologics, and Enabling Technologies 418,789 56.1 % 165,927 36.0 % 171,515 36.9 % Global Spine 631,319 84.6 % 353,174 76.7 % 358,963 77.3 % Global Orthopedics 115,322 15.4 % 107,539 23.3 % 105,516 22.7 % Net sales $ 746,641 100.0 % $ 460,713 100.0 % $ 464,479 100.0 %
Summary of EBITDA by Reporting Segment	The following table presents adjusted EBITDA, the primary metric used in managing the Company, by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Adjusted EBITDA by reporting segment Global Spine $ 91,115 $ 62,692 $ 71,086 Global Orthopedics 442 5,267 9,260 Corporate ( 45,272 ) ( 19,406 ) ( 19,084 ) Consolidated adjusted EBITDA $ 46,285 $ 48,553 $ 61,262 Reconciling items: Interest expense, net $ 8,631 $ 1,288 $ 1,837 Depreciation and amortization 53,063 29,019 41,355 Share-based compensation expense 35,707 18,443 15,432 Foreign exchange impact ( 1,581 ) 3,291 3,981 SeaSpine merger-related costs 36,623 12,010 — Strategic investments 2,272 4,018 5,700 Acquisition-related fair value adjustments 33,393 ( 15,595 ) ( 2,014 ) (Gain) loss on investments 1,781 187 ( 644 ) Litigation and investigation costs 14,453 803 33 Medical device regulation 9,446 10,261 8,018 Business interruption - COVID-19 — 2,387 320 Succession charges 1,176 147 739 Loss before income taxes $ ( 148,679 ) $ ( 17,706 ) $ ( 13,495 )
Schedule of Depreciation and Amortization by Reporting Segment	The following table presents depreciation and amortization by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Global Spine $ 41,213 $ 18,213 $ 17,548 Global Orthopedics 7,158 6,696 8,233 Corporate 4,692 4,110 3,818 Total $ 53,063 $ 29,019 $ 29,599
Summary of Net Sales by Geographic Destination	The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Global Spine U.S. $ 591,937 $ 332,846 $ 337,455 International 39,382 20,328 21,508 Total Global Spine 631,319 353,174 358,963 Global Orthopedics U.S. $ 28,892 25,997 24,490 International 86,430 81,542 81,026 Total Global Orthopedics 115,322 107,539 105,516 Consolidated U.S. 620,829 358,843 361,945 International 125,812 101,870 102,534 Net sales $ 746,641 $ 460,713 $ 464,479 The following data includes net sales by geographic destination: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 U.S. $ 620,829 $ 358,843 $ 361,945 Italy 20,060 19,098 20,187 Germany 11,467 11,569 13,716 United Kingdom 10,910 10,171 10,552 France 11,096 10,377 10,475 Brazil 6,452 5,668 5,108 Others 65,827 44,987 42,496 Net sales $ 746,641 $ 460,713 $ 464,479
Summary of Property, Plant and Equipment of Reporting Segments by Geographic Area	The following data includes property, plant, and equipment by geographic area: (U.S. Dollars, in thousands) 2023 2022 U.S. $ 142,727 $ 44,802 Italy 10,187 8,535 Germany 3,030 3,115 Others 3,116 1,777 Total $ 159,060 $ 58,229

Acquisition-Related Amortizat_2

Acquisition-Related Amortization and Remeasurement (Tables)	12 Months Ended
	Dec. 31, 2023
Acquisition Related Amortization And Remeasurement [Abstract]
Components of Acquisition-Related Amortization and Remeasurement	ended December 31, 2023, 2022, and 2021, respectively, are as follows: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Changes in fair value of contingent consideration $ ( 2,700 ) $ ( 17,200 ) $ ( 3,575 ) Amortization of acquired intangibles 17,408 8,196 7,907 Acquired IPR&D 49 1,600 1,500 Impairment of Global Orthopedics goodwill — — 11,756 Total $ 14,757 $ ( 7,404 ) $ 17,588

Share-based compensation (Table

Share-based compensation (Tables)	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Schedule of Share-Based Compensation by Line Item in Consolidated Statements of Income	The following tables present the detail of share-based compensation expense by line item in the consolidated statements of income as well as by award type, for the years ended December 31, 2023, 2022, and 2021: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Cost of sales $ 1,901 $ 826 $ 779 Sales and marketing 8,174 3,865 3,385 General and administrative 21,743 12,917 10,289 Research and development 3,889 835 979 Total $ 35,707 $ 18,443 $ 15,432 Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 Stock options $ 6,130 $ 1,114 $ 1,893 Time-based restricted stock awards and stock units 27,290 9,452 7,437 Performance-based / Market-based restricted stock units 227 6,425 4,414 Stock purchase plan 2,060 1,452 1,688 Total $ 35,707 $ 18,443 $ 15,432
Schedule of Assumptions Used in Determining Fair Value of Stock Options	The fair value of time-based stock options is determined using the Black-Scholes valuation model, with such value recognized as expense over the service period, which is typically three to four years, net of actual forfeitures. A summary of the Company’s assumptions used in determining the fair value of the stock options granted during each of the years ended December 31, 2023, 2022, and 2021, is shown in the following table. The Company did not grant any time-based stock options in 2022. Year Ended December 31, 2023 2022 2021 Assumptions: Expected term (in years) 6.0 — 6.0 Expected volatility 36.8 % – 42.3 % — 34.4 % – 34.8 % Risk free interest rate 3.38 % – 4.61 % — 0.83 % – 1.25 % Dividend yield — — — Weighted average grant date fair value $ 8.43 $ — $ 12.33
Schedule of Stock Option Plans	Summaries of the status of the Company’s stock option plans as of December 31, 2023, and 2022, and changes during the year ended December 31, 2023, are presented below: (In thousands) Options Weighted Weighted Outstanding at December 31, 2022 1,299 $ 39.29 Assumed SeaSpine awards 1,890 $ 36.05 Granted 1,837 $ 19.92 Exercised - $ - Forfeited or expired ( 1,803 ) $ 31.62 Outstanding at December 31, 2023 3,223 $ 30.64 4.97 Vested and expected to vest at December 31, 2023 3,223 $ 30.64 4.97 Exercisable at December 31, 2023 1,828 $ 36.78 2.68
Schedule of Changes in Time-Based and Market-Based Restricted Stock Awards and Stock Units	A summary of the status of our time-based and performance-based and/or market-based restricted stock units as of December 31, 2023, and 2022, and changes during the year ended December 31, 2023, are presented below: Time-based Restricted Stock Performance-based and/or Market-based (In thousands) Shares Weighted Shares Weighted Outstanding at December 31, 2022 847 $ 34.18 516 $ 40.29 Assumed SeaSpine awards 490 $ 22.76 — $ — Conversion of performance-based and market-based stock units to time-based stock units 516 $ 40.29 ( 516 ) $ 40.29 Granted 1,496 $ 18.51 13 $ 20.10 Vested and settled ( 749 ) $ 29.04 ( 4 ) $ 22.76 Cancelled ( 560 ) $ 21.12 — $ — Outstanding at December 31, 2023 2,040 $ 26.96 9 $ 22.69

Income taxes (Tables)

Income taxes (Tables)	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Schedule of Income (Loss) Before Provision for Income Taxes	Income (loss) before provision for income taxes consisted of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 U.S. $ ( 154,794 ) $ ( 22,318 ) $ ( 5,987 ) Non-U.S. 6,115 4,612 ( 7,508 ) Income (loss) before income taxes $ ( 148,679 ) $ ( 17,706 ) $ ( 13,495 )
Schedule of Provision for Income Taxes	The provision for income taxes consists of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2023 2022 2021 U.S. Current $ 17 $ 1,151 $ ( 607 ) Deferred 1,160 67 24,292 1,177 1,218 23,685 Non-U.S. Current 2,120 578 1,009 Deferred ( 581 ) 247 190 1,539 825 1,199 Income tax expense (benefit) $ 2,716 $ 2,043 $ 24,884
Schedule of Effective Income Tax Rate Reconciliation for Continuing Operations	The differences between the income tax provision at the U.S. federal statutory tax rate and the Company’s effective tax rate for the years ended December 31, 2023, 2022, and 2021, consist of the following: 2023 2022 2021 (U.S. Dollars, in thousands, except percentages) Amount Percent Amount Percent Amount Percent Statutory U.S. federal income tax rate $ ( 31,222 ) 21.0 % $ ( 3,718 ) 21.0 % $ ( 2,834 ) 21.0 % State taxes, net of U.S. federal benefit ( 3,452 ) 2.3 ( 1,312 ) 7.4 ( 24 ) 0.2 Foreign rate differential, including withholding taxes ( 738 ) 0.5 475 ( 2.7 ) 480 ( 3.6 ) Valuation allowances, net 28,322 ( 19.0 ) 7,638 ( 43.1 ) 27,819 ( 206.1 ) Foreign income inclusions, net 2,333 ( 1.6 ) 1,018 ( 5.7 ) — — Research credits ( 1,219 ) 0.8 ( 750 ) 4.2 ( 537 ) 4.0 Unrecognized tax benefits, net of settlements 71 — ( 599 ) 3.4 ( 1,363 ) 10.1 Equity compensation 4,210 ( 2.8 ) 1,441 ( 8.1 ) 1,091 ( 8.1 ) Executive compensation 3,030 ( 2.0 ) 697 ( 3.9 ) 456 ( 3.4 ) Contingent consideration — — ( 3,316 ) 18.7 ( 640 ) 4.7 Other, net 1,381 ( 0.9 ) 469 ( 2.6 ) 436 ( 3.2 ) Income tax expense (benefit) /effective rate $ 2,716 ( 1.8 )% $ 2,043 ( 11.5 )% $ 24,884 ( 184.4 )%
Schedule of Deferred Tax Assets and Liabilities	The Company’s deferred tax assets and liabilities are as follows: December 31, (U.S. Dollars, in thousands) 2023 2022 Intangible assets and goodwill $ — $ 5,807 Inventories and related reserves 33,122 17,819 Deferred revenue and cost of goods sold 4,409 3,642 Other accruals and reserves 5,382 2,756 Accrued compensation 14,861 8,795 Provision for expected credit losses 1,821 1,253 Accrued interest 1,227 — Net operating loss and tax credit carryforwards 123,210 40,676 Research and development capitalization 15,174 4,353 Lease liabilities 9,632 6,440 Other, net 5,429 3,767 Total deferred tax assets 214,267 95,308 Valuation allowance ( 200,192 ) ( 83,797 ) Deferred tax asset, net of valuation allowance $ 14,075 $ 11,511 Intangible assets and goodwill $ ( 1,662 ) $ — Withholding taxes ( 10 ) ( 10 ) Property, plant, and equipment ( 5,737 ) ( 5,516 ) Right-of-use lease assets ( 8,755 ) ( 5,771 ) Deferred tax liability $ ( 16,164 ) $ ( 11,297 ) Net deferred tax assets (liabilities) $ ( 2,089 ) $ 214 Reported as: Deferred income tax assets (classified within other long-term assets) $ 2,081 $ 1,470 Deferred income tax liabilities (classified within other long-term liabilities) ( 4,170 ) ( 1,256 ) Net deferred tax assets (liabilities) $ ( 2,089 ) $ 214
Schedule of Gross Unrecognized Tax Benefits (Excluding Interest and Penalties)	A reconciliation of the gross unrecognized tax benefits (excluding interest and penalties) for the years ended December 31, 2023, and 2022, is shown below: (U.S. Dollars, in thousands) 2023 2022 Balance as of January 1, $ 1,743 $ 3,462 Additions for current year tax positions 416 46 Increases for prior year tax positions 815 16 Settlements of prior year tax positions — ( 144 ) Expiration of statutes — ( 1,637 ) Balance as of December 31, $ 2,974 $ 1,743

Earnings per share (EPS) (Table

Earnings per share (EPS) (Tables)	12 Months Ended
	Dec. 31, 2023
Earnings Per Share [Abstract]
Schedule of Reconciliation of Weighted Average Shares Used in the Diluted EPS	The following is a reconciliation of the weighted average shares used in the diluted EPS computations: Year Ended December 31, (In thousands) 2023 2022 2021 Weighted average common shares-basic 36,729 20,054 19,691 Effect of diluted securities: Unexercised stock options and employee stock purchase plan — — — Unvested time-based restricted stock units — — — Weighted average common shares-diluted 36,729 20,054 19,691

Significant Accounting Polici_4

Significant Accounting Policies - Additional Information (Detail) - USD ($)	1 Months Ended	12 Months Ended
	Nov. 30, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Summary Of Significant Accounting Policies [Line Items]
Banking service obligation	$ 4,700,000
Advertising costs		$ 500,000	$ 500,000	$ 500,000
Musculoskeletal Transplant Foundation ("MTF") [Member]
Summary Of Significant Accounting Policies [Line Items]
Expenditures for other research and development		800,000		800,000
Neo Medical SA [Member]
Summary Of Significant Accounting Policies [Line Items]
Expenditures for other research and development		100,000	500,000	600,000
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Transactional foreign currency gains and (losses), including those generated from intercompany operations		$ 1,600,000	(3,300,000)	$ (4,000,000)
Maximum [Member] | Musculoskeletal Transplant Foundation ("MTF") [Member]
Summary Of Significant Accounting Policies [Line Items]
Expenditures for other research and development			$ 100,000

Significant accounting polici_5

Significant accounting policies - Schedule of Supplemental Disclosure of Cash Flow Information (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Noncash investing activities:
Intangible assets acquired in asset acquisitions	$ 2,000

Recently Adopted Accounting S_2

Recently Adopted Accounting Standards and Recently Issued Accounting Pronouncements - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Contract liabilities revenue recognized	$ 2,200
Impairment of goodwill			$ 11,756
CARES Act of 2020 funds received		$ (4,791)	$ (9,060)	$ 13,900
ASU 2020-04 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Mar. 12, 2020
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]	true
ASU 2019-12 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 01, 2021
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]	true

Mergers and acquisitions - Addi

Mergers and acquisitions - Additional Information (Detail) - USD ($) $ in Thousands		3 Months Ended	12 Months Ended
	Jan. 05, 2023	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Conversion of stock, shares converted	0.4163
Goodwill			$ 123,617
Net sales			746,641	$ 460,713	$ 464,479
Net loss			(151,395)	(19,749)	(38,379)
Pre tax expenses		$ 18,200	1,176	147	739
Global Spine [Member]
Business Acquisition [Line Items]
Goodwill			123,617
Net sales			631,319	$ 353,174	$ 358,963
SeaSpine Holdings Corporation [Member]
Business Acquisition [Line Items]
Direct acquisition-related costs			9,900
Net sales			258,900
Net loss			$ 84,000

Mergers and acquisitions - Sche

Mergers and acquisitions - Schedule of Estimated Fair Value of Consideration Associated with Merger (Detail) - SeaSpine Holdings Corporation [Member] - USD ($) $ / shares in Units, $ in Thousands		12 Months Ended
	Jan. 05, 2023	Dec. 31, 2023
Business Acquisition [Line Items]
Orthofix common shares to be issued in exchange for SeaSpine common shares	16,047,315	1,600,000
Orthofix closing price per share as of January 4, 2023	$ 22.76
Estimated fair value of shares issued in exchange for SeaSpine common shares	$ 365,237
Estimated fair value of Orthofix stock options and RSUs issued in exchange for outstanding SeaSpine equity awards	11,508
Total estimated fair value of consideration	$ 376,745

Mergers and acquisitions - Summ

Mergers and acquisitions - Summary of Fair Values of Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands		12 Months Ended
	Jan. 05, 2023	Dec. 31, 2023	Dec. 31, 2022
Current liabilities
Residual goodwill		$ 194,934	$ 71,317
Assigned Useful Life		9 years 6 months
In-Process Research and Development ("IPR&D") [Member]
Current liabilities
Assigned Useful Life		Indefinite
Customer Relationships [Member]
Current liabilities
Assigned Useful Life		12 years 1 month 6 days
Developed Technology [Member]
Current liabilities
Assigned Useful Life		7 years 10 months 24 days
SeaSpine Holdings Corporation [Member]
Current assets
Cash and cash equivalents	$ 29,419
Accounts receivable, net	35,313
Inventories	132,636
Prepaid expenses and other current assets	4,590
Total current assets	201,958
Property, plant, and equipment, net	68,863
Other long-term assets	20,501
Total identifiable assets acquired	377,372
Current liabilities
Accounts payable	21,602
Other current liabilities	43,521
Total current liabilities	65,123
Long-term borrowings under SeaSpine credit facility	26,298
Other long-term liabilities	32,823
Total liabilities assumed	124,244
Net identifiable assets acquired	253,128
Total fair value of consideration transferred	376,745
Residual goodwill	123,617
SeaSpine Holdings Corporation [Member] | Customer Relationships [Member]
Current assets
Finite lived intangible assets, net acquired	$ 33,100
Current liabilities
Assigned Useful Life	13 years
SeaSpine Holdings Corporation [Member] | Developed Technology [Member]
Current assets
Finite lived intangible assets, net acquired	$ 47,200
SeaSpine Holdings Corporation [Member] | Developed Technology [Member] | Minimum [Member]
Current liabilities
Assigned Useful Life	6 years
SeaSpine Holdings Corporation [Member] | Developed Technology [Member] | Maximum [Member]
Current liabilities
Assigned Useful Life	8 years
SeaSpine Holdings Corporation [Member] | In Process Research and Development [Member]
Current assets
Finite lived intangible assets, net acquired	$ 5,750
Current liabilities
Assigned Useful Life	Indefinite
Previously Reported [Member] | SeaSpine Holdings Corporation [Member]
Current assets
Cash and cash equivalents	$ 29,419
Accounts receivable, net	35,313
Inventories	132,636
Prepaid expenses and other current assets	4,590
Total current assets	201,958
Property, plant, and equipment, net	68,863
Other long-term assets	20,501
Total identifiable assets acquired	377,372
Current liabilities
Accounts payable	21,602
Other current liabilities	43,344
Total current liabilities	64,946
Long-term borrowings under SeaSpine credit facility	26,298
Other long-term liabilities	32,833
Total liabilities assumed	124,077
Net identifiable assets acquired	253,295
Total fair value of consideration transferred	376,745
Residual goodwill	123,450
Previously Reported [Member] | SeaSpine Holdings Corporation [Member] | Customer Relationships [Member]
Current assets
Finite lived intangible assets, net acquired	33,100
Previously Reported [Member] | SeaSpine Holdings Corporation [Member] | Developed Technology [Member]
Current assets
Finite lived intangible assets, net acquired	47,200
Previously Reported [Member] | SeaSpine Holdings Corporation [Member] | In Process Research and Development [Member]
Current assets
Finite lived intangible assets, net acquired	5,750
Adjustments [Member] | SeaSpine Holdings Corporation [Member]
Current liabilities
Other current liabilities	177
Total current liabilities	177
Other long-term liabilities	(10)
Total liabilities assumed	167
Net identifiable assets acquired	(167)
Residual goodwill	$ 167

Mergers and acquisitions - Su_2

Mergers and acquisitions - Summary of Pro Forma Financial Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Business Combinations [Abstract]
Net sales	$ 746.6	$ 698.2
Net loss	$ (116.4)	$ (129.2)

Mergers and acquisitions - Su_3

Mergers and acquisitions - Summary of Integration Costs Incurred (Details) - Seaspine Holdings Corporation [Member] $ in Millions	12 Months Ended
	Dec. 31, 2023 USD ($)
Business Acquisition [Line Items]
Compensation-related integration costs	$ 17.7
International spine restructuring	1.3
Fee paid to financial advisor to the Merger	5.5
Professional fees / consulting fees	5.8
Product rationalization charges	6
Other costs to complete	1.4
Total	$ 37.7

Mergers and acquisitions - Su_4

Mergers and acquisitions - Summary of Restructuring Costs (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Restructuring Cost and Reserve [Line Items]
Charges Incurred	$ 18,200	$ 1,176	$ 147	$ 739
Retention Costs [Member] | Seaspine Holdings Corporation [Member]
Restructuring Cost and Reserve [Line Items]
Charges Incurred		18,200
Payments Made / Currency Translation Adjustment		(11,200)
Balance as of December 31, 2023		7,000
U.S. Severance Costs [Member] | Seaspine Holdings Corporation [Member]
Restructuring Cost and Reserve [Line Items]
Charges Incurred		11,200
Payments Made / Currency Translation Adjustment		(10,200)
Balance as of December 31, 2023		1,000
U S Retention Costs [Member] | Seaspine Holdings Corporation [Member]
Restructuring Cost and Reserve [Line Items]
Charges Incurred		5,300
Payments Made / Currency Translation Adjustment		(300)
Balance as of December 31, 2023		5,000
U S Payroll Taxes [Member] | Seaspine Holdings Corporation [Member]
Restructuring Cost and Reserve [Line Items]
Charges Incurred		700
Payments Made / Currency Translation Adjustment		(400)
Balance as of December 31, 2023		300
International Spine Restructuring Severance [Member] | Seaspine Holdings Corporation [Member]
Restructuring Cost and Reserve [Line Items]
Charges Incurred		1,000
Payments Made / Currency Translation Adjustment		(300)
Balance as of December 31, 2023		$ 700

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Raw materials	$ 28,390	$ 17,035
Work-in-process	53,510	19,243
Finished products	140,266	63,872
Inventories	$ 222,166	$ 100,150

Property, Plant and Equipment -

Property, Plant and Equipment - Schedule of Useful Lives of the Assets (Detail)	Dec. 31, 2023
Minimum [Member] | Buildings [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	25 years
Minimum [Member] | Plant and equipment [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	1 year
Minimum [Member] | Instrumentation [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	3 years
Minimum [Member] | Computer software [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	3 years
Minimum [Member] | Furniture and fixtures [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	4 years
Maximum [Member] | Buildings [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	33 years
Maximum [Member] | Plant and equipment [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	10 years
Maximum [Member] | Instrumentation [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	4 years
Maximum [Member] | Computer software [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	7 years
Maximum [Member] | Furniture and fixtures [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	8 years

Property, Plant and Equipment_2

Property, Plant and Equipment - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Property Plant And Equipment [Line Items]
Depreciation expense	$ 34.2	$ 19.6	$ 20.2
Internal-use Software [Member] | Minimum [Member]
Property Plant And Equipment [Line Items]
Estimated useful life	3 years
Internal-use Software [Member] | Maximum [Member]
Property Plant And Equipment [Line Items]
Estimated useful life	7 years

Property, Plant and Equipment_3

Property, Plant and Equipment - Schedule of Property, Plant and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	$ 347,685	$ 221,225
Accumulated depreciation	(188,625)	(162,996)
Property, plant, and equipment, net	159,060	58,229
Buildings [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	4,103	3,867
Plant and equipment [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	70,252	48,358
Instrumentation [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	154,192	92,607
Computer software [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	43,040	40,685
Furniture and fixtures [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	11,010	7,917
Construction in progress [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	41,751	4,515
Finance lease assets [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	$ 23,337	$ 23,276

Intangible Assets - Schedule of

Intangible Assets - Schedule of Intangible Assets (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 215,930	$ 124,849
Accumulated amortization	(98,440)	(77,461)
Intangible assets, net	$ 117,490	47,388
Weighted Average Amortization Period	9 years 6 months
Patents [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 43,262	40,108
Accumulated amortization	$ (40,494)	(37,506)
Weighted Average Amortization Period	10 years
Developed Technology [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 92,416	43,699
Accumulated amortization	$ (28,898)	(17,830)
Weighted Average Amortization Period	7 years 10 months 24 days
Customer Relationships [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 49,197	15,572
Accumulated amortization	$ (11,988)	(6,938)
Weighted Average Amortization Period	12 years 1 month 6 days
Licenses and Other [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 24,584	23,295
Accumulated amortization	$ (16,240)	(14,386)
Weighted Average Amortization Period	9 years 7 months 6 days
Trademarks-Finite Lived [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 1,797	1,875
Accumulated amortization	$ (820)	(801)
Weighted Average Amortization Period	10 years
In-Process Research and Development ("IPR&D") [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 4,674	$ 300
Weighted Average Amortization Period	Indefinite

Intangible Assets - Additional

Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Finite And Indefinite Lived Intangible Assets [Abstract]
Amortization of intangible assets	$ 18.9	$ 9.4	$ 9.4

Intangible Assets - Schedule _2

Intangible Assets - Schedule of Future Amortization Expense (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
2024	$ 20,948
2025	19,849
2026	18,810
2027	18,426
2028	14,890
Thereafter	19,893
Total finite-lived intangible assets, net	112,816
Indefinite-lived intangible assets, net	4,674
Intangible assets, net	$ 117,490	$ 47,388

Goodwill - Additional Informati

Goodwill - Additional Information (Detail) - USD ($)	3 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2023	Dec. 31, 2021
Goodwill [Line Items]
Impairment of goodwill			$ 11,756,000
Percentage of market capitalization decreased due to termination	30%
Global Orthopedics [Member]
Goodwill [Line Items]
Impairment of goodwill			$ 11,756,000
Global Spine [Member]
Goodwill [Line Items]
Impairment of goodwill		$ 0

Goodwill - Schedule of Net Carr

Goodwill - Schedule of Net Carrying Amount of Goodwill (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($)
Goodwill [Line Items]
Goodwill, net Beginning Balance	$ 71,317
Goodwill acquired in the merger, net	123,617
Goodwill, net Ending Balance	194,934
Global Spine [Member]
Goodwill [Line Items]
Goodwill, gross Beginning balance	71,317
Goodwill acquired in the merger, gross	123,617
Goodwill, gross Ending balance	194,934
Goodwill, net Beginning Balance	71,317
Goodwill acquired in the merger, net	123,617
Goodwill, net Ending Balance	194,934
Global Orthopedics [Member]
Goodwill [Line Items]
Goodwill, gross Beginning balance	11,130
Goodwill gross, Currency translation adjustment	347
Goodwill, gross Ending balance	11,477
Accumulated Impairment Loss Beginning balance	(11,130)
Accumulated Impairment Loss, Currency translation adjustment	(347)
Accumulated Impairment Loss Ending balance	$ (11,477)

Leases - Summary of Lease Portf

Leases - Summary of Lease Portfolio (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Assets
Operating leases	$ 19,869	$ 6,788
Operating lease, right-of-use asset, statement of financial position [Extensible List]	Other long-term assets	Other long-term assets
Finance leases	$ 16,345	$ 17,360
Finance lease, right-of-use asset, statement of financial position [Extensible List]	Property, plant and equipment net	Property, plant and equipment net
Total lease assets	$ 36,214	$ 24,148
Current
Operating leases	$ 3,477	$ 1,638
Operating lease, liability, current, statement of financial position [Extensible List]	Other current liabilities	Other current liabilities
Finance leases	$ 708	$ 652
Long-term
Operating leases	$ 17,125	$ 5,376
Operating lease, liability, noncurrent, statement of financial position [Extensible List]	Other long-term liabilities	Other long-term liabilities
Finance leases	$ 18,532	$ 19,239
Total lease liabilities	$ 39,842	$ 26,905
Weighted Average Remaining Lease Term
Operating leases	6 years 2 months 12 days	4 years 6 months
Finance leases	16 years 7 months 6 days	17 years 7 months 6 days
Weighted Average Discount Rate
Operating leases	7.30%	4%
Finance leases	4.40%	4.40%

Leases - Summary of Components

Leases - Summary of Components of Lease Costs (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Finance lease costs:
Amortization of right-of-use assets	$ 1,013	$ 1,238	$ 2,049
Interest on finance lease liabilities	857	890	933
Operating lease costs	5,015	2,126	2,234
Short-term lease costs	313	152	213
Variable lease costs	1,883	932	815
Total lease costs	$ 9,081	$ 5,338	$ 6,244

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 7,682	$ 3,805	$ 4,627
Operating cash flows from finance leases	857	885	907
Financing cash flows from finance leases	652	2,594	537
Right-of-use assets obtained in exchange for lease obligations
Operating leases	$ 16,688	$ 5,603	589
Finance leases			$ 149

Leases - Summary of Remaining L

Leases - Summary of Remaining Lease Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Operating Leases
2024	$ 4,861
2025	4,788
2026	4,607
2027	3,441
2028	1,785
Thereafter	6,766
Total undiscounted value of lease liabilities	26,248
Less: Interest	(5,646)
Present value of lease liabilities	20,602
Current portion of lease liabilities	3,477	$ 1,638
Long-term portion of lease liabilities	17,125	5,376
Total lease liabilities	20,602
Finance Leases
2024	1,538
2025	1,543
2026	1,562
2027	1,593
2028	1,624
Thereafter	19,396
Total undiscounted value of lease liabilities	27,256
Less: Interest	(8,016)
Present value of lease liabilities	19,240
Current portion of finance lease liability	708	652
Long-term portion of finance lease liability	18,532	$ 19,239
Total lease liabilities	$ 19,240

Other Current Liabilities - Sum

Other Current Liabilities - Summary of Other Current Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Accrued expenses	$ 12,189	$ 9,611
Salaries, bonuses, employee commissions, and related taxes payable	38,826	18,531
Accrued distributor commissions	22,602	10,483
Accrued litigation and investigation costs	12,077	3,891
Short-term operating lease liability	3,477	1,638
Non-income taxes payable	7,585	6,586
Other payables	8,152	4,634
Other current liabilities	$ 104,908	$ 55,374

Indebtedness - Summary of Carry

Indebtedness - Summary of Carrying Values of Outstanding Debt Obligations (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Debt Instrument [Line Items]
Current portion of long-term debt	$ 1,250
Long-term debt	93,107
Total initial indebtedness outstanding	94,357
Initial Term Loan [Member]
Debt Instrument [Line Items]
Principal amount outstanding	100,000
Unamortized original debt discount	(4,331)
Unamortized debt issuance costs and lenders fees	(1,312)
Total initial indebtedness outstanding	94,357
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Total initial indebtedness outstanding	$ 94,357

Indebtedness- Additional Inform

Indebtedness- Additional Information (Detail)			12 Months Ended
	Nov. 06, 2023 USD ($)	Oct. 25, 2019 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Jan. 10, 2024 USD ($)	Dec. 31, 2023 EUR (€)	Jun. 13, 2023 USD ($)	Jan. 04, 2023 USD ($)	Jan. 03, 2023 USD ($)
Debt Instrument [Line Items]
Repayment of borrowings			$ 79,000,000
Debt issuance costs paid			2,357,000	$ 92,000	$ 948,000
Cash paid to interest			5,800,000	1,400,000	1,500,000
Italy [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity			6,100,000	5,900,000			€ 5,500,000
Initial Term Loan [Member]
Debt Instrument [Line Items]
Debt issuance costs and lenders fees			$ 1,312,000
Financing Agreement [Member]
Debt Instrument [Line Items]
Debt issuance costs and lenders fees	$ 2,000,000
Financing Agreement [Member] | Blue Torch Finance LLC [Member]
Debt Instrument [Line Items]
Line of credit facility interest rate description			Borrowings under the Credit Facilities bear interest at a floating rate, which will be, at the Company’s option, either the three-month SOFR rate (subject to a floor of 3.00% and a credit spread adjustment of 0.26161%) (the “Adjusted Term SOFR Rate”) plus an applicable margin of 7.25%, or a base rate plus an applicable margin of 6.25%
Financing Agreement [Member] | Base Rate [Member] | Blue Torch Finance LLC [Member]
Debt Instrument [Line Items]
Interest rate	6.25%
Financing Agreement [Member] | Floor Rate [Member] | Blue Torch Finance LLC [Member]
Debt Instrument [Line Items]
Interest rate	3%
Financing Agreement [Member] | Credit Spread Adjustment [Member] | Blue Torch Finance LLC [Member]
Debt Instrument [Line Items]
Interest rate	0.26161%
Financing Agreement [Member] | Adjusted Term SOFR Rate [Member] | Blue Torch Finance LLC [Member]
Debt Instrument [Line Items]
Interest rate	7.25%
Financing Agreement [Member] | Revolving Credit Facility [Member] | Blue Torch Finance LLC [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 25,000,000
Maturity date	Nov. 06, 2027
Borrowings			$ 0
Repayment of borrowings	$ 175,000,000
Percentage of unused line fee payable	2%
Financing Agreement [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Blue Torch Finance LLC [Member]
Debt Instrument [Line Items]
Borrowings						$ 15,000,000
Financing Agreement [Member] | Initial Term Loan [Member] | Blue Torch Finance LLC [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 100,000,000
Maturity date	Nov. 06, 2027
Financing Agreement [Member] | Delayed Draw Term Loan [Member] | Blue Torch Finance LLC [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 25,000,000
Maturity date	Nov. 06, 2027
Borrowings			0
Percentage of unused line fee payable	1%
Financing Agreement or Prior Credit Agreement [Member]
Debt Instrument [Line Items]
Debt issuance costs, net of accumulated amortization			1,900,000	700,000
Debt issuance costs amortized or expensed			$ 1,300,000	$ 400,000	$ 400,000
Prior Credit Agreement [Member]
Debt Instrument [Line Items]
Maturity date		Oct. 25, 2024
Borrowings	$ 79,000,000								$ 49,000,000	$ 30,000,000
Prior Credit Agreement [Member] | Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 300,000,000						$ 175,000,000

Fair Value Measurements and I_3

Fair Value Measurements and Investments - Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis (Detail) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 13,020	$ 14,950
Deferred compensation plan, Liabilities	(1,674)	(1,515)
Liabilities fair value, Total	(10,174)	(1,515)
Lattus [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities fair value, Total	(8,500)
Convertible Loan Agreements [Member] | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,760	7,140
Preferred Equity Securities [Member] | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	4,951	6,084
Other Investments [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,309	1,726
Fair Value, Inputs, Level 2 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	4,951	6,084
Deferred compensation plan, Liabilities	(1,674)	(1,515)
Liabilities fair value, Total	(1,674)	(1,515)
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	4,951	6,084
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	8,069	7,140
Fair Value, Inputs, Level 3 [Member] | Lattus [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities fair value, Total	(8,500)
Fair Value, Inputs, Level 3 [Member] | Convertible Loan Agreements [Member] | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,760	7,140
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	$ 1,309	$ 1,726

Fair Value Measurements and I_4

Fair Value Measurements and Investments - Additional Information (Detail) - Neo Medical [Member] SFr in Millions, $ in Millions	Oct. 01, 2020 USD ($)	Dec. 31, 2023 USD ($)	Oct. 31, 2021 USD ($)	Oct. 31, 2021 CHF (SFr)	Oct. 01, 2020 CHF (SFr)
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Convertible loans	$ 5		$ 0.7	SFr 0.6	SFr 4.6
Convertible loans interest rate	8%				8%
Maturity date	Oct. 01, 2024
Convertible loan credit losses		$ 0.3
Preferred Stock [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 Carrying Value of Investments in Equity Securities (Detail) - Preferred Stock [Member] - Neo Medical [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of equity securities beginning balance	$ 6,084	$ 5,413
Conversion of loan into preferred equity securities		671
Foreign currency remeasurement recognized in other income, net	388
Unrealized loss recognized in other income (expense), net	(1,521)
Fair value of equity securities Ending balance	4,951	6,084
Cumulative unrealized gain (loss) on Neo Medical preferred equity securities	$ (720)	$ 413

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	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of convertible loans beginning balance	$ 7,140	$ 7,148
Interest recognized in interest income, net	496	436
Foreign currency remeasurement recognized in other income (expense), net	617	(67)
Unrealized gain (loss) recognized in other comprehensive income (loss)	(1,233)	294
Expected credit loss recognized in other income (expense), net	(260)
Conversion of Additional Convertible Loan into preferred equity securities		(671)
Fair value of convertible loans ending balance	6,760	7,140
Contractual value of Neo Medical Convertible Loans at December 31	7,020	5,907
Allowance for credit loss recognized in other income (expense), net	(260)
Amortized cost basis of Neo Medical Convertible Loans at December 31	$ 6,760	$ 5,907

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) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Spinal Kinetics [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Contingent consideration estimated fair value		$ 17,200
Decrease in fair value recognized in acquisition-related amortization and remeasurement		(17,200)
Neo Medical [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Neo Medical Convertible Loan	$ 6,760
Fair value discount rate	19.30%
Present value factor	15.30%
Fair value implied volatility	81.10%
Lattus Spine [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Consideration transferred	$ 8,500
Counterparty discount rate	14%
Revenue risk-adjusted discount rate	6.50%
Lattus Spine [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Contingent consideration estimated fair value	$ 11,200
Decrease in fair value recognized in acquisition-related amortization and remeasurement	(2,700)
Contingent consideration estimated fair value at December 31	$ 8,500	$ 11,200

Fair Value Measurements and I_8

Fair Value Measurements and Investments - Schedule of Change in Valuation of Securities (Detail) - Bone Biologics Inc [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Equity securities beginning balance	$ 309
Fair value adjustments and impairments recognized in other income (expense), net	(183)	$ 309
Proceeds from the disposition of equity securities	$ (126)
Equity securities ending balance		$ 309

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) $ in Millions		12 Months Ended
	Jan. 05, 2023 shares	Dec. 31, 2023 USD ($) Executive shares	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Other Commitments [Line Items]
Number of former executives seeking severance payments | Executive		3
Accrued other long-term liabilities		$ 7.6
Estimated sales and marketing expense (benefit)		$ 1.3	$ 1.2	$ (1.2)
SeaSpine [Member]
Other Commitments [Line Items]
Number of shares issued under acquisition | shares	16,047,315	1,600,000

Shareholders' Equity - Componen

Shareholders' Equity - Components of Changes in Accumulated Other Comprehensive Income (Loss) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 336,860	$ 336,934	$ 356,864
Ending Balance	598,730	336,860	336,934
Other Investments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	101
Other comprehensive income (loss)	(101)	101	0
Ending Balance		101
Convertible Loan [Member] | Neo Medical SA [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	1,005	711	1,419
Other comprehensive income (loss)	(1,233)	294	(942)
Income taxes			234
Ending Balance	(228)	1,005	711
Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(2,482)	(711)	1,833
Other comprehensive income (loss)	1,417	(1,771)	(2,544)
Ending Balance	(1,065)	(2,482)	(711)
Accumulated Other Comprehensive Income (Loss) [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(1,376)		3,252
Other comprehensive income (loss)	83	(1,376)	(3,486)
Income taxes			$ 234
Ending Balance	$ (1,293)	$ (1,376)

Revenue Recognition and Accou_3

Revenue Recognition and Accounts Receivable - Schedule of Net Sales (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenue Recognition [Abstract]
Product sales	$ 693,345	$ 405,437	$ 409,554
Marketing service fees	53,296	55,276	54,925
Net sales	$ 746,641	$ 460,713	$ 464,479

Revenue Recognition and Accou_4

Revenue Recognition and Accounts Receivable - Additional Information (Detail) € in Millions	1 Months Ended		12 Months Ended
	Mar. 31, 2022	Apr. 30, 2021	Dec. 31, 2023 USD ($)	Dec. 31, 2023 EUR (€)	Dec. 31, 2022 USD ($)	Dec. 31, 2022 EUR (€)	Dec. 31, 2021 USD ($)	Dec. 31, 2021 EUR (€)	Dec. 31, 2020 USD ($)
Revenue Recognition And Accounts Receivable [Line Items]
Marketing service fees			$ 53,296,000		$ 55,276,000		$ 54,925,000
Cost of sales			260,368,000		123,544,000		114,914,000
Addition resulting from the Merger with SeaSpine			137,000
Sale of receivables			10,000,000	€ 9.2	9,600,000	€ 9.2	9,900,000	€ 8.4
Related fees recorded as interest expense			400,000		300,000		200,000
CARES Act of 2020 funds received					(4,791,000)		(9,060,000)		$ 13,900,000
Medicare recoupment	0.50	0.25
Contract liability, total							4,791,000
Other Asset Impairment Charges			400,000
Other Contract Assets [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Other contract assets impairment					0
Other Long-Term Assets [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Other contract assets			300,000		1,100,000
Shipping and Handling Costs [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Cost of sales			9,500,000		$ 4,200,000		$ 3,500,000
Biologics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Marketing service fees			$ 53,300,000
Marketing service fee as percentage of segment revenues			32%	32%

Revenue Recognition and Accou_5

Revenue Recognition and Accounts Receivable - Schedule of Allowance for Expected Credit Losses (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Accounts, Notes, Loans and Financing Receivable [Line Items]
Allowance for expected credit losses beginning balance	$ 6,419	$ 4,944
Addition resulting from the Merger with SeaSpine	137
Current period provision for expected credit losses	820	2,095
Write-offs charged against the allowance and other	(381)	(450)
Effect of changes in foreign exchange rates	135	(170)
Allowance for expected credit losses ending balance	$ 7,130	$ 6,419

Revenue Recognition and Accou_6

Revenue Recognition and Accounts Receivable - Schedule of Changes In Contract Liability (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Revenue Recognition [Abstract]
Contract liability beginning balance	$ 4,791
Recoupment recognized in net sales	$ (4,791)

Business Segment Information -

Business Segment Information - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2023 Segment
Segment Reporting [Abstract]
Number of reporting segments	2

Business Segment Information _2

Business Segment Information - Schedule of Net Sales by Major Product Category by Reporting Segment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Net Sales	$ 746,641	$ 460,713	$ 464,479
Percent of Total Net Sales	100%	100%	100%
Bone Growth Therapies [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 212,530	$ 187,247	$ 187,448
Percent of Total Net Sales	28.50%	40.70%	40.40%
Spinal Implants, Biologics, and Enabling Technologies [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 418,789	$ 165,927	$ 171,515
Percent of Total Net Sales	56.10%	36%	36.90%
Global Spine [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 631,319	$ 353,174	$ 358,963
Percent of Total Net Sales	84.60%	76.70%	77.30%
Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 115,322	$ 107,539	$ 105,516
Percent of Total Net Sales	15.40%	23.30%	22.70%

Business Segment Information _3

Business Segment Information - Summary of EBIDTA by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Consolidated adjusted EBITDA		$ 46,285	$ 48,553	$ 61,262
Interest expense, net		8,631	1,288	1,837
Depreciation and amortization		53,063	29,019	41,355
Share-based compensation expense		35,707	18,443	15,432
Foreign exchange impact		(1,581)	3,291	3,981
SeaSpine merger-related costs		36,623	12,010
Strategic investments		2,272	4,018	5,700
Acquisition-related fair value adjustments		33,393	(15,595)	(2,014)
(Gain) loss on investments		1,781	187	(644)
Litigation and investigation costs		14,453	803	33
Medical device regulation		9,446	10,261	8,018
Business interruption - COVID-19			2,387	320
Succession charges	$ 18,200	1,176	147	739
Income (loss) before income taxes		(148,679)	(17,706)	(13,495)
Operating Segments [Member] | Global Spine [Member]
Segment Reporting Information [Line Items]
Consolidated adjusted EBITDA		91,115	62,692	71,086
Operating Segments [Member] | Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Consolidated adjusted EBITDA		442	5,267	9,260
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Consolidated adjusted EBITDA		$ (45,272)	$ (19,406)	$ (19,084)

Business Segment Information _4

Business Segment Information - Schedule of Depreciation and Amortization by Reporting Segment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 53,063	$ 29,019	$ 29,599
Operating Segments [Member] | Global Spine [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	41,213	18,213	17,548
Operating Segments [Member] | Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	7,158	6,696	8,233
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 4,692	$ 4,110	$ 3,818

Business Segment Information _5

Business Segment Information - Summary of Net Sales by Geographic Destination for Each Reporting Segment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 746,641	$ 460,713	$ 464,479
Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	631,319	353,174	358,963
Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	115,322	107,539	105,516
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	620,829	358,843	361,945
U.S. [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	591,937	332,846	337,455
U.S. [Member] | Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	28,892	25,997	24,490
International [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	125,812	101,870	102,534
International [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	39,382	20,328	21,508
International [Member] | Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 86,430	$ 81,542	$ 81,026

Business Segment Information _6

Business Segment Information - Summary of Net Sales by Geographic Destination (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 746,641	$ 460,713	$ 464,479
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	620,829	358,843	361,945
Italy [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	20,060	19,098	20,187
Germany [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	11,467	11,569	13,716
United Kingdom [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	10,910	10,171	10,552
France [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	11,096	10,377	10,475
Brazil [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	6,452	5,668	5,108
Others [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 65,827	$ 44,987	$ 42,496

Business Segment Information _7

Business Segment Information - Summary of Property, Plant and Equipment of Reporting Segments by Geographic Area (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	$ 159,060	$ 58,229
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	142,727	44,802
Italy [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	10,187	8,535
Germany [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	3,030	3,115
Others [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	$ 3,116	$ 1,777

Acquisition-Related Amortizat_3

Acquisition-Related Amortization and Remeasurement - Components of Acquisition-Related Amortization and Remeasurement (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Research And Development Arrangement Contract To Perform For Others [Line Items]
Changes in fair value of contingent consideration	$ (2,700)	$ (17,200)	$ (3,575)
Amortization of acquired intangibles	17,408	8,196	7,907
Acquired IPR&D	49	1,600	1,500
Impairment of goodwill			11,756
Total	$ (14,757)	$ (7,404)	17,588
Global Orthopedics [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Impairment of goodwill			$ 11,756

Acquisition-Related Amortizat_4

Acquisition-Related Amortization and Remeasurement - Additional Information (Details) - License Agreement [Member] - USD ($) $ in Millions		1 Months Ended
	Dec. 29, 2022	May 31, 2022	Apr. 30, 2021	Dec. 31, 2023	Dec. 31, 2022
Research And Development Arrangement Contract To Perform For Others [Line Items]
Consideration agreed to pay with additional payments contingent upon reaching future commercialization and revenue-based milestones	$ 0.2
Initial payment accrued					$ 0.2
Contingent Payment Upon Reaching FDA Milestone			$ 4
Amount Received for the year		$ 1.5	$ 0.5
Contingent consideration milestone obligation		$ 3.5
Other Current Liabilities [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Contingent consideration accrued				$ 1	$ 1

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - USD ($)	1 Months Ended		12 Months Ended
	Jan. 31, 2023	Aug. 31, 2019	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Options outstanding			3,223,000	1,299,000
Options exercisable			1,828,000
Income tax benefit related to expense			$ 5,800,000	$ 3,300,000	$ 3,100,000
Exercised stock option amount			0
Realized tax benefit amount			$ 0
Closing stock price			$ 13.48
Share-based compensation			$ 35,707,000	18,443,000	15,432,000
SeaSpine [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Options outstanding			300,000
Options exercisable			0
Number of options issued in connection with conversion of awards			1,900,000
Number of time based RSU issued in exchange for equity awards			500,000
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation			$ 21,743,000	12,917,000	10,289,000
Maximum [Member] | SeaSpine [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Common stock acqure under stock option	900,000
Global Spine [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Options outstanding			51,000
Options exercisable			51,000
Share based compensation grants of restricted stock unit		15,000
Global Spine [Member] | Maximum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Common stock acqure under stock option		51,000
2012 LTIP Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Award Contractual term			10 years
Amount of shares reserved for issuance			11,300,000
Options outstanding			1,600,000
Options exercisable			700,000
SeaSpine 2015 Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Amount of shares reserved for issuance			3,000,000
Options outstanding			1,000,000
Options exercisable			900,000
Stock Purchase Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Amount of shares reserved for issuance			3,600,000
Maximum percentage of compensation eligible employees to be deducted for purchase of common stock			25%
Purchase price of shares equivalent to fair market value			85%
Shares issued under stock purchase plan			2,800,000
Stock Purchase Plan [Member] | Minimum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Percentage of compensation eligible employees to be deducted for purchase of common stock			1%
Seaspin 2018 and 2020 Employment Inducement Incentive Award Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Options outstanding			300,000
Options exercisable			200,000
Restricted Stock Units [Member] | SeaSpine [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unvested restricted stock and stock units outstanding			200,000
Share based compensation grants of restricted stock unit	500,000
Restricted Stock Units [Member] | 2012 LTIP Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unvested restricted stock and stock units outstanding			1,600,000
Restricted Stock Units [Member] | SeaSpine 2015 Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unvested restricted stock and stock units outstanding			200,000
Restricted Stock Units [Member] | Seaspin 2018 and 2020 Employment Inducement Incentive Award Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unvested restricted stock and stock units outstanding			17,000
Market-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Weighted-average period for unamortized compensation cost expected to be recognized			1 year
Share based compensation, fair market value of restricted stock units vested			$ 0	0	0
Market-based Restricted Stock Units [Member] | Maximum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unamortized compensation expense			100,000
Stock options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unamortized compensation expense			$ 4,800,000
Weighted-average period for unamortized compensation cost expected to be recognized			1 year 2 months 12 days
Total intrinsic value of options exercised			$ 0	0	600,000
Aggregate intrinsic value of options outstanding			100,000
Aggregate intrinsic value of options exercisable			0
Share-based compensation			$ 6,130,000	1,114,000	1,893,000
Time-based Restricted Stock Awards and Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share based compensation grants of restricted stock unit			1,496,000
Unamortized compensation expense			$ 22,600,000
Weighted-average period for unamortized compensation cost expected to be recognized			1 year 7 months 6 days
Non-vested shares, vested in period			$ 17,200,000	5,200,000	9,000,000
Aggregate intrinsic value of restricted stock outstanding			27,500,000
Share-based compensation			$ 27,290,000	$ 9,452,000	$ 7,437,000
Time-based Restricted Stock Awards and Stock Units [Member] | Maximum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Vesting period			4 years
Time-based Restricted Stock Awards and Stock Units [Member] | Minimum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Vesting period			3 years
Performance-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Aggregate intrinsic value of restricted stock outstanding			$ 100,000

Share-based Compensation - Sche

Share-based Compensation - Schedule of Share-Based Compensation by Line Item in Consolidated Statements of Income (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 35,707	$ 18,443	$ 15,432
Outstanding Stock Options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	6,130	1,114	1,893
Time-based Restricted Stock Awards and Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	27,290	9,452	7,437
Performance-based / Market-based restricted stock units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	227	6,425	4,414
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	2,060	1,452	1,688
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,901	826	779
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	8,174	3,865	3,385
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	21,743	12,917	10,289
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 3,889	$ 835	$ 979

Share-based Compensation - Sc_2

Share-based Compensation - Schedule of Assumptions Used in Determining Fair Value of Stock Options Granted (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2021
Share-Based Compensation Arrangement by Share-Based Payment Award, Fair Value Assumptions and Methodology [Abstract]
Expected term (in years)	6 years	6 years
Expected volatility, minimum	36.80%	34.40%
Expected volatility, maximum	42.30%	34.80%
Risk free interest rate, minimum	3.38%	0.83%
Risk free interest rate, maximum	4.61%	1.25%
Weighted average grant date fair value	$ 8.43	$ 12.33

Share-based Compensation - Sc_3

Share-based Compensation - Schedule of Stock Option Plans (Detail)	12 Months Ended
	Dec. 31, 2023 $ / shares shares
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Outstanding at the beginning of the period (in shares)	1,299,000
Granted	1,837,000
Forfeited or expired	(1,803,000)
Outstanding at the end of the period (in shares)	3,223,000
Vested and expected to vest	3,223,000
Exercisable (in shares)	1,828,000
Outstanding at the beginning of the period (in dollars per share) | $ / shares	$ 39.29
Granted | $ / shares	19.92
Forfeited or expired | $ / shares	31.62
Outstanding at the end of the period (in dollars per share) | $ / shares	30.64
Vested and expected to vest | $ / shares	30.64
Exercisable | $ / shares	$ 36.78
Options outstanding, weighted average remaining contractual term	4 years 11 months 19 days
Options vested and expected, weighted average remaining contractual term	4 years 11 months 19 days
Options exercisable, weighted average remaining contractual term	2 years 8 months 4 days
SeaSpine [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Assumed SeaSpine awards	1,890,000
Outstanding at the end of the period (in shares)	300,000
Exercisable (in shares)	0
Assumed SeaSpine awards | $ / shares	$ 36.05

Share-based Compensation - Sc_4

Share-based Compensation - Schedule of Changes in Time-Based and Market-Based Restricted Stock Awards and Stock Units (Detail) shares in Thousands	12 Months Ended
	Dec. 31, 2023 $ / shares shares
Time-based Restricted Stock Awards and Stock Units [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Outstanding at December 31, 2022 | shares	847
Conversion of performance-based and market-based stock units to time-based stock units (in shares) | shares	516
Granted (in shares) | shares	1,496
Vested and settled (in shares) | shares	(749)
Cancelled (in shares) | shares	(560)
Outstanding at December 31, 2023 | shares	2,040
Outstanding at December 31, 2022 | $ / shares	$ 34.18
Conversion of performance-based and market-based stock units to time-based stock units (in dollars per share) | $ / shares	40.29
Granted (in dollars per share) | $ / shares	18.51
Vested and settled (in dollars per share) | $ / shares	29.04
Cancelled (in dollars per share) | $ / shares	21.12
Outstanding at December 31, 2023 | $ / shares	$ 26.96
Time-based Restricted Stock Awards and Stock Units [Member] | SeaSpine [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Assumed SeaSpine awards (in shares) | shares	490
Assumed SeaSpine awards (in dollars per share) | $ / shares	$ 22.76
Performance-based and/or Market-based Restricted Stock Units [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Outstanding at December 31, 2022 | shares	516
Conversion of performance-based and market-based stock units to time-based stock units (in shares) | shares	(516)
Granted (in shares) | shares	13
Vested and settled (in shares) | shares	(4)
Outstanding at December 31, 2023 | shares	9
Outstanding at December 31, 2022 | $ / shares	$ 40.29
Conversion of performance-based and market-based stock units to time-based stock units (in dollars per share) | $ / shares	40.29
Granted (in dollars per share) | $ / shares	20.1
Vested and settled (in dollars per share) | $ / shares	22.76
Outstanding at December 31, 2023 | $ / shares	$ 22.69

Defined Contribution Plans an_2

Defined Contribution Plans and Deferred Compensation - Additional Information (Detail) - USD ($) $ in Millions		12 Months Ended
	Feb. 01, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Defined Contribution Plan Disclosure [Line Items]
Amount of deferred compensation payable		$ 1.7	$ 1.5
U.S. [Member]
Defined Contribution Plan Disclosure [Line Items]
Employee contribution limit per calendar year (as a percent of compensation)		80%
Employer match of employee contributions of first level of eligible compensation (as a percent)		100%
Percentage of eligible compensation, matched by employer, level one		2%
Employer match of employee contributions of second level of eligible compensation (as a percent)		50%
Percentage of eligible compensation matched by employer, level two		4%
Expenses incurred for contribution plans		$ 4.6	3.3	$ 2.8
Foreign Plan [Member]
Defined Contribution Plan Disclosure [Line Items]
Expenses incurred for contribution plans		$ 1.1	$ 1.1	$ 1.2
Italy [Member]
Defined Contribution Plan Disclosure [Line Items]
Annual deferred compensation provision for leaving indemnity, as a percentage of total commissions earned		4%
Italy [Member] | Labor Force Concentration Risk [Member] | National Collective Labor Agreement [Member]
Defined Contribution Plan Disclosure [Line Items]
Number of employees, percentage		14%
Subsequent Event [Member] | U.S. [Member]
Defined Contribution Plan Disclosure [Line Items]
Employee contribution limit per calendar year (as a percent of compensation)	90%
Employer match of employee contributions of first level of eligible compensation (as a percent)	100%
Percentage of eligible compensation, matched by employer, level one	4%

Income Taxes - Schedule of Inco

Income Taxes - Schedule of Income (Loss) Before Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
U.S.	$ (154,794)	$ (22,318)	$ (5,987)
Non-U.S.	6,115	4,612	(7,508)
Income (loss) before income taxes	$ (148,679)	$ (17,706)	$ (13,495)

Income Taxes - Schedule of Prov

Income Taxes - Schedule of Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
U.S.
Current	$ 17	$ 1,151	$ (607)
Deferred	1,160	67	24,292
Total U.S	1,177	1,218	23,685
Non-U.S.
Current	2,120	578	1,009
Deferred	(581)	247	190
Total Non U.S	1,539	825	1,199
Income tax expense (benefit)	$ 2,716	$ 2,043	$ 24,884

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Income Tax Rate Reconciliation for Continuing Operations (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Statutory U.S. federal income tax rate	$ (31,222)	$ (3,718)	$ (2,834)
State taxes, net of U.S. federal benefit	(3,452)	(1,312)	(24)
Foreign rate differential, including withholding taxes	(738)	475	480
Valuation allowances, net	28,322	7,638	27,819
Foreign income inclusions, net	2,333	1,018
Research credits	(1,219)	(750)	(537)
Unrecognized tax benefits, net of settlements	71	(599)	(1,363)
Equity compensation	4,210	1,441	1,091
Executive compensation	3,030	697	456
Contingent consideration		(3,316)	(640)
Other, net	1,381	469	436
Income tax expense (benefit)	$ 2,716	$ 2,043	$ 24,884
Statutory U.S. federal income tax rate	21%	21%	21%
State taxes, net of U.S. federal benefit	2.30%	7.40%	0.20%
Foreign rate differential, including withholding taxes	0.50%	(2.70%)	(3.60%)
Valuation allowances, net	(19.00%)	(43.10%)	(206.10%)
Foreign income inclusions, net	(1.60%)	(5.70%)
Research credits	0.80%	4.20%	4%
Unrecognized tax benefits, net of settlements		3.40%	10.10%
Equity compensation	(2.80%)	(8.10%)	(8.10%)
Executive compensation	(2.00%)	(3.90%)	(3.40%)
Contingent consideration		18.70%	4.70%
Other, net	(0.90%)	(2.60%)	(3.20%)
Income tax expense (benefit) /effective rate	(1.80%)	(11.50%)	(184.40%)

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Components Of Income Tax Expense Benefit [Line Items]
Tax paid (received or refunded) cash	$ 900	$ (900)	$ 4,800
Unremitted foreign earnings	$ 33,600
Minimum percentage of income tax benefit	50%
Gross unrecognized tax benefit	$ 3,000	1,700
Net interest and penalties on unrecognized tax benefits	200	100	$ (400)
Accrued interest and penalties related to unrecognized tax benefits	100	900
Unrecognized tax benefits that would impact effective tax rate	400
Unrecognized tax benefits expected reduction		$ (1,637)
Decrease in unrecognized tax benefits, exclusive of interest and penalties	1,200
SeaSpine [Member]
Components Of Income Tax Expense Benefit [Line Items]
Net increase in valuation allowance	116,400
State [Member]
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	221,400
State [Member] | SeaSpine [Member]
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	$ 157,900
Operating loss carryforwards, expiration year	2024
State [Member] | Spinal Kinetics [Member]
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	$ 20,600
Operating loss carryforwards, expiration year	2027
Federal [Member]
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	$ 331,700
Operating loss carryforwards, expiration year	2026
Research and development credits	$ 4,700
Foreign Tax Authority
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	$ 129,000
Operating loss carryforwards, expiration year	2041
Research and development credits	$ 900

Income Taxes - Schedule of Defe

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Intangible assets and goodwill		$ 5,807
Inventories and related reserves	$ 33,122	17,819
Deferred revenue and cost of goods sold	4,409	3,642
Other accruals and reserves	5,382	2,756
Accrued compensation	14,861	8,795
Provision for expected credit losses	1,821	1,253
Accrued interest	1,227
Net operating loss and tax credit carryforwards	123,210	40,676
Research and development capitalization	15,174	4,353
Lease liabilities	9,632	6,440
Other, net	5,429	3,767
Total deferred tax assets	214,267	95,308
Valuation allowance	(200,192)	(83,797)
Deferred tax asset, net of valuation allowance	14,075	11,511
Intangible assets and goodwill	(1,662)
Withholding taxes	(10)	(10)
Property, plant, and equipment	(5,737)	(5,516)
Right-of-use lease assets	(8,755)	(5,771)
Deferred tax liability	(16,164)	(11,297)
Net deferred tax assets (liabilities)	(2,089)
Net deferred tax assets (liabilities)		214
Reported as:
Deferred income taxes (classified within other long-term assets)	2,081	1,470
Deferred income tax liabilities (classified within other long-term liabilities)	$ (4,170)	(1,256)
Net deferred tax assets (liabilities)		$ 214

Income Taxes - Schedule of Gros

Income Taxes - Schedule of Gross Unrecognized Tax Benefits (Excluding Interest and Penalties) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Beginning Balance	$ 1,743	$ 3,462
Additions for current year tax positions	416	46
Increases for prior year tax positions	815	16
Settlements of prior year tax positions		(144)
Expiration of statutes		(1,637)
Ending Balance	$ 2,974	$ 1,743

Earnings Per Share (EPS) - Sche

Earnings Per Share (EPS) - Schedule of Reconciliation of Weighted Average Shares Used in the Diluted EPS (Detail) - shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Earnings Per Share [Line Items]
Weighted average common shares-basic	36,729,258	20,053,548	19,690,593
Effect of diluted securities:
Weighted average common shares-diluted	36,729,258	20,053,548	19,690,593

Earnings Per Share (EPS) - Addi

Earnings Per Share (EPS) - Additional Information (Detail) - shares shares in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Time Based Restricted Stock Awards And Stock Units, Performance Based Stock Units And Market Based Stock Units [Member] | Outstanding Stock Options [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Weighted average outstanding options, awards not included in diluted earnings per share	6.5	2.3	1.7