Orthofix Medical (OFIX) 10-Q 6 Aug 24 2024 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2024	Aug. 02, 2024
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q2
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX MEDICAL INC.
Entity Central Index Key	0000884624
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Current Reporting Status	Yes
Entity Common Stock, Shares Outstanding		38,174,785
Entity File Number	0-19961
Entity Tax Identification Number	98-1340767
Entity Address, Address Line One	3451 Plano Parkway
Entity Address, City or Town	Lewisville
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75056
City Area Code	214
Local Phone Number	937-2000
Entity Incorporation, State or Country Code	DE
Title of 12(b) Security	Common stock, $0.10 par value per share
Security Exchange Name	NASDAQ
Entity Interactive Data Current	Yes
Document Quarterly Report	true
Document Transition Report	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Current assets
Cash and cash equivalents	$ 26,366	$ 33,107
Restricted cash	2,500	4,650
Accounts receivable, net of allowances of $8,368 and $7,130, respectively	125,361	128,098
Inventories	210,040	222,166
Prepaid expenses and other current assets	21,798	32,422
Total current assets	386,065	420,443
Property, plant, and equipment, net	154,111	159,060
Intangible assets, net	108,310	117,490
Goodwill	194,934	194,934
Other long-term assets	38,578	33,388
Total assets	881,998	925,315
Current liabilities
Accounts payable	50,362	58,357
Current portion of long-term debt	4,688	1,250
Current portion of finance lease liability	734	708
Other current liabilities	100,183	104,908
Total current liabilities	155,967	165,223
Long-term debt	113,315	93,107
Long-term portion of finance lease liability	18,160	18,532
Other long-term liabilities	48,552	49,723
Total liabilities	335,994	326,585
Contingencies (Note 8)
Shareholders’ equity
Common shares $0.10 par value; 100,000 shares authorized; 38,039 and 37,165 issued and outstanding as of June 30, 2024, and December 31, 2023, respectively	3,804	3,717
Additional paid-in capital	764,538	746,450
Accumulated deficit	(219,607)	(150,144)
Accumulated other comprehensive loss	(2,731)	(1,293)
Total shareholders’ equity	546,004	598,730
Total liabilities and shareholders’ equity	$ 881,998	$ 925,315

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 8,368	$ 7,130
Common shares, par value	$ 0.1	$ 0.1
Common shares, authorized	100,000,000	100,000,000
Common shares, issued	38,039,000	37,165,000
Common shares, outstanding	38,039,000	37,165,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Income Statement [Abstract]
Net sales	$ 198,620	$ 187,016	$ 387,228	$ 362,220
Cost of sales	63,871	67,465	125,237	132,340
Gross profit	134,749	119,551	261,991	229,880
Sales and marketing	100,224	99,249	200,267	193,040
General and administrative	33,994	34,177	65,642	82,988
Research and development	18,049	19,424	37,541	42,731
Acquisition-related amortization and remeasurement (Note 12)	7,388	3,333	12,784	7,467
Operating loss	(24,906)	(36,632)	(54,243)	(96,346)
Interest expense, net	(4,943)	(1,266)	(9,501)	(2,555)
Other income (expense), net	(2,510)	(20)	(3,784)	656
Loss before income taxes	(32,359)	(37,918)	(67,528)	(98,245)
Income tax expense	(1,084)	(1,508)	(1,935)	(2,119)
Net loss	$ (33,443)	$ (39,426)	$ (69,463)	$ (100,364)
Net loss per common share:
Basic	$ (0.88)	$ (1.07)	$ (1.84)	$ (2.77)
Diluted	$ (0.88)	$ (1.07)	$ (1.84)	$ (2.77)
Weighted average number of common shares:
Basic	38,020	36,762	37,787	36,252
Diluted	38,020	36,762	37,787	36,252
Other comprehensive loss, before tax
Unrealized [gain (loss)] on debt securities		$ 381	$ 1,671	$ 318
Reclassification adjustment for historical unrealized gain on debt security	$ (1,671)		(1,671)
Currency translation adjustment	(400)	457	(1,438)	950
Other comprehensive income (loss), before tax	(2,071)	838	(1,438)	1,268
Other comprehensive income (loss), net of tax	(2,071)	838	(1,438)	1,268
Comprehensive loss	$ (35,514)	$ (38,588)	$ (70,901)	$ (99,096)

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Changes in Shareholders' Equity - USD ($) $ in Thousands	Total	Common Shares [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Beginning Balance at Dec. 31, 2022	$ 336,860	$ 2,016	$ 334,969	$ 1,251	$ (1,376)
Balance, Shares at Dec. 31, 2022		20,162,000
Net loss	(60,938)			(60,938)
Other comprehensive income, net of tax	430				430
Share-based compensation expense	13,020		13,020
Common shares issued in connection with SeaSpine merger, Shares		16,047,000
Common shares issued in connection with SeaSpine merger	376,745	$ 1,605	375,140
Common shares issued, net	(1,958)	$ 26	(1,984)
Common shares issued, net, Shares		254,000
Ending Balance at Mar. 31, 2023	664,159	$ 3,647	721,145	(59,687)	(946)
Balance, Shares at Mar. 31, 2023		36,463,000
Beginning Balance at Dec. 31, 2022	336,860	$ 2,016	334,969	1,251	(1,376)
Balance, Shares at Dec. 31, 2022		20,162,000
Net loss	(100,364)
Other comprehensive income, net of tax	1,268
Ending Balance at Jun. 30, 2023	639,985	$ 3,673	735,533	(99,113)	(108)
Balance, Shares at Jun. 30, 2023		36,733,000
Beginning Balance at Mar. 31, 2023	664,159	$ 3,647	721,145	(59,687)	(946)
Balance, Shares at Mar. 31, 2023		36,463,000
Net loss	(39,426)			(39,426)
Other comprehensive income, net of tax	838				838
Share-based compensation expense	13,246		13,246
Common shares issued, net	1,168	$ 26	1,142
Common shares issued, net, Shares		270,000
Ending Balance at Jun. 30, 2023	639,985	$ 3,673	735,533	(99,113)	(108)
Balance, Shares at Jun. 30, 2023		36,733,000
Beginning Balance at Dec. 31, 2023	$ 598,730	$ 3,717	746,450	(150,144)	(1,293)
Balance, Shares at Dec. 31, 2023	37,165,000	37,165,000
Net loss	$ (36,020)			(36,020)
Other comprehensive income, net of tax	633				633
Share-based compensation expense	8,800		8,800
Common shares issued, net	(1,828)	$ 24	(1,852)
Common shares issued, net, Shares		245
Ending Balance at Mar. 31, 2024	570,315	$ 3,741	753,398	(186,164)	(660)
Balance, Shares at Mar. 31, 2024		37,410,000
Beginning Balance at Dec. 31, 2023	$ 598,730	$ 3,717	746,450	(150,144)	(1,293)
Balance, Shares at Dec. 31, 2023	37,165,000	37,165,000
Net loss	$ (69,463)
Other comprehensive income, net of tax	(1,438)
Ending Balance at Jun. 30, 2024	$ 546,004	$ 3,804	764,538	(219,607)	(2,731)
Balance, Shares at Jun. 30, 2024	38,039,000	38,039,000
Beginning Balance at Mar. 31, 2024	$ 570,315	$ 3,741	753,398	(186,164)	(660)
Balance, Shares at Mar. 31, 2024		37,410,000
Net loss	(33,443)			(33,443)
Other comprehensive income, net of tax	(2,071)				(2,071)
Share-based compensation expense	9,959		9,959
Common shares issued, net	1,244	$ 63	1,181
Common shares issued, net, Shares		629
Ending Balance at Jun. 30, 2024	$ 546,004	$ 3,804	$ 764,538	$ (219,607)	$ (2,731)
Balance, Shares at Jun. 30, 2024	38,039,000	38,039,000

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Cash flows from operating activities
Net loss	$ (69,463)	$ (100,364)
Adjustments to reconcile net loss to net cash from operating activities
Depreciation and amortization	28,894	25,997
Inventory reserve expenses	13,759	17,057
Amortization of inventory fair value step up	6,094	21,085
Amortization of operating lease assets, debt costs, and other assets	2,986	3,319
Provision for expected credit losses	1,573	490
Deferred income taxes	1,180	815
Share-based compensation expense	18,759	26,266
Change in valuation of investment securities	3,992	(492)
Change in fair value of contingent consideration	4,240	(1,300)
Other	4,863	(372)
Changes in operating assets and liabilities, net of effects of acquisitions
Accounts receivable	710	5,615
Inventories	(8,571)	(33,168)
Prepaid expenses and other current assets	2,717	275
Accounts payable	(7,501)	1,800
Other current liabilities	(9,977)	(6,425)
Other long-term assets and liabilities	(3,866)	(134)
Net cash used in operating activities	(9,611)	(39,536)
Cash flows from investing activities
Capital expenditures for property, plant, and equipment	(19,887)	(23,823)
Capital expenditures for intangible assets	(646)	(831)
Cash acquired in the SeaSpine merger		29,419
Other investing activities	(50)	(500)
Net cash provided by (used in) investing activities	(20,583)	4,265
Cash flows from financing activities
Proceeds from issuance of common shares	3,191	2,377
Payments related to tax withholdings for share-based compensation	(3,775)	(3,167)
Payments related to finance lease obligation	(346)	(320)
Borrowings under credit facility	40,000	51,000
Repayment of borrowings from credit facility	(15,000)
Payment of debt acquired from SeaSpine merger		(26,899)
Contingent consideration milestone payment		(920)
Payment of debt issuance costs and other financing activities	(2,392)	(280)
Net cash provided by financing activities	21,678	21,791
Effect of exchange rate changes on cash	(375)	387
Net change in cash and cash equivalents	(8,891)	(13,093)
Cash, cash equivalents, and restricted cash at the beginning of period	37,757	50,700
Cash, cash equivalents, and restricted cash at the end of period	28,866	37,607
Components of cash, cash equivalents, and restricted cash at the end of period
Cash and cash equivalents	26,366	37,607
Restricted cash	2,500
Cash, cash equivalents, and restricted cash at the end of period	28,866	$ 37,607
Noncash investing activities - Purchase of intangible assets	$ 50

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024	Jun. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (33,443)	$ (36,020)	$ (39,426)	$ (60,938)	$ (69,463)	$ (100,364)

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Jun. 30, 2024
Trading Arrangements, by Individual
Title	directors or officers
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Rule 10b5-1 Arrangement Modified	false
Non-Rule 10b5-1 Arrangement Modified	false

Business and basis of presentat

Business and basis of presentation	6 Months Ended
	Jun. 30, 2024
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. (the “Company” or "Orthofix") is 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, Maidenhead, UK, Munich, Germany, Paris, France, and São Paulo, Brazil. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“U.S. GAAP”) for interim financial information and with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. Pursuant to these rules and regulations, certain information and note disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. In the opinion of management, all adjustments (consisting of normal recurring items) considered necessary for a fair statement have been included. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and related notes contained in the Company’s Form 10-K for the year ended December 31, 2023. Operating results for the three and six months ended June 30, 2024, are not necessarily indicative of the results that may be expected for other interim periods or the year ending December 31, 2024. The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. On an ongoing basis, the Company evaluates its estimates, including those related to revenue recognition; contractual allowances; allowances for expected credit losses; inventories; valuation of intangible assets; goodwill; fair value measurements, including contingent consideration; litigation and contingent liabilities; tax matters; and share-based compensation. Actual results could differ from these estimates.

Recently adopted accounting sta

Recently adopted accounting standards, recently issued accounting pronouncements	6 Months Ended
	Jun. 30, 2024
Accounting Changes and Error Corrections [Abstract]
Recently adopted accounting standards, recently issued accounting pronouncements	2. Recently adopted accounting standards, recently issued accounting pronouncements Adoption of Accounting Standards Update ("ASU") 2022-03 - Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions In June 2022, the Financial Accounting Standards Board ("FASB") issued ASU 2022-03, which 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 and to introduce new disclosure requirements. The Company adopted this standard effective January 1, 2024, on a prospective basis. Adoption of this standard did not have a material impact to the Company's consolidated balance sheet, statements of operations, or cash flows, but did modify the Company's disclosures related to certain investments. Refer to Note 7 for the Company's updated disclosures on investments in equity securities subject to capital sale restrictions. Adoption of ASU 2023-07 - Improvements to Reportable Segment Disclosures In November 2023, the FASB issued ASU 2023-07, which enhances and improves disclosures about operating segment's revenues, measures of profit/loss, and expenses to enable investors to better understand an entity's overall performance and assess potential future cash flows. The amendment requires that an entity disclose (i) significant expenses that are regularly provided to the Chief Operating Decision Maker ("CODM"), (ii) other segment items by reportable segment including a description of its composition, (iii) all annual disclosures required by Topic 280 in interim periods, (iv) additional measures of a segment's profit or loss used by the CODM in assessing segment performance and allocation of resources, and (v) title and position of the CODM and an explanation of how the CODM uses the reported measure(s) of segment profit or loss. The Company adopted this standard effective January 1, 2024, on a prospective basis. Refer to Note 11 for the Company's updated business segment disclosures. Recently Issued Accounting Pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation 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 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. Other recently issued ASUs, excluding those ASUs which have already been disclosed as adopted or described above, were assessed and determined not applicable, or are expected to have minimal impact on the Company's condensed consolidated financial statements.

Merger and Acquisitions

Merger and Acquisitions	6 Months Ended
	Jun. 30, 2024
Business Combinations [Abstract]
Merger and Acquisitions	3. 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. During the fourth quarter of 2023, the Company finalized its valuation of assets acquired and liabilities assumed. The following table summarizes the fair value of assets acquired and liabilities assumed at the acquisition date: (U.S. Dollars, in thousands) Final Acquisition Date Fair Value Assigned Useful Life Assets acquired: 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 Customer relationships 33,100 13 years Developed technology 47,200 6 - 8 years In-process research and development ("IPR&D") 5,750 Indefinite Other long-term assets 20,501 Total identifiable assets acquired $ 377,372 Liabilities assumed : 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 The Company recognized ($ 0.1 ) million and $ 0.1 million in direct acquisition-related costs, which excluded integration-related activities that were expensed during the three and six months ended June 30, 2024 , respectively, compared to $ 3.3 million and $ 9.8 million expensed during the three and six months ended June 30, 2023 , respectively. These costs are included in the condensed consolidated statements of operations and comprehensive loss, primarily within general and administrative expenses. The Company's results of operations included net sales from SeaSpine of $ 71.5 million and $ 142.0 million for the three and six months ended June 30, 2024 , respectively, and net losses of $ 20.4 million and $ 34.7 million from SeaSpine for the three and six months ended June 30, 2024 , respectively. This compares to $ 64.4 million and $ 125.3 million of net sales from SeaSpine for the three and six months ended June 30, 2023 , respectively, and net losses of $ 24.9 million and $ 52.8 million for the three and six months ended June 30, 2023, respectively. Due to the completion of the Merger on January 5, 2023, all SeaSpine financial results for fiscal year 2023, except for the first four days of January, were included in the Company's condensed consolidated statement of operations and comprehensive loss. Therefore, the Company did not prepare unaudited pro forma financial information for the three and six months ended June 30, 2023 or 2024 , on the basis that the Merger was completed on January 1, 2023.

Inventories

Inventories	6 Months Ended
	Jun. 30, 2024
Inventory Disclosure [Abstract]
Inventories	4. Inventories Inventories were as follows: (U.S. Dollars, in thousands) June 30, December 31, (Unaudited) Raw materials $ 29,455 $ 28,390 Work-in-process 57,115 53,510 Finished products 123,470 140,266 Inventories $ 210,040 $ 222,166

Leases

Leases	6 Months Ended
	Jun. 30, 2024
Leases [Abstract]
Leases	5. Leases A summary of the Company's lease portfolio as of June 30, 2024, and December 31, 2023, is presented in the table below: (U.S. Dollars, in thousands) Classification June 30, December 31, (Unaudited) Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 18,579 $ 19,869 Finance leases Property, plant and equipment, net 15,839 16,345 Total ROU assets $ 34,418 $ 36,214 Lease Liabilities Current Operating leases Other current liabilities $ 3,733 $ 3,477 Finance leases Current portion of finance lease liability 734 708 Long-term Operating leases Other long-term liabilities 15,710 17,125 Finance leases Long-term portion of finance lease liability 18,160 18,532 Total lease liabilities $ 38,337 $ 39,842 Supplemental cash flow information related to leases was as follows: (Unaudited, U.S. Dollars, in thousands) Six Months Ended Six Months Ended Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 4,311 $ 3,751 Operating cash flows from finance leases 417 428 Financing cash flows from finance leases 346 320 ROU assets obtained in exchange for lease obligations Operating leases 721 15,368 Finance leases — —

Long-term debt

Long-term debt	6 Months Ended
	Jun. 30, 2024
Debt Disclosure [Abstract]
Long-term debt	6. Long-term debt The carrying values of the Company's outstanding debt obligations as of June 30, 2024, and December 31, 2023, were as follows: (U.S. Dollars, in thousands) June 30, December 31, (Unaudited) Initial Term Loan and Delayed Draw Term Loan Principal amount $ 125,000 $ 100,000 Unamortized original debt discount ( 3,769 ) ( 4,331 ) Unamortized debt issuance costs and lenders fees ( 3,228 ) ( 1,312 ) Total indebtedness from initial term loan and delayed draw term loan 118,003 94,357 Revolving Credit Facilities Principal amount outstanding — — Total indebtedness outstanding $ 118,003 $ 94,357 Current portion of long-term debt $ 4,688 $ 1,250 Long-term debt 113,315 93,107 Total indebtedness outstanding $ 118,003 $ 94,357 On January 10, 2024, the Company borrowed $ 15.0 million under its senior secured revolving credit facility (the "Revolving Credit Facility") as part of its Financing Agreement with Blue Torch Finance LLC. On March 22, 2024, the secured delayed draw term loan facility (the "Delayed Draw Term Loan") of $ 25.0 million was fully funded and the proceeds were used to repay the $ 15.0 million outstanding under the Revolving Credit Facility. 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). As of June 30, 2024, the Company was in compliance with all required financial covenants. On March 15, 2024, the Company entered into Amendment No.1 to the Financing Agreement with Blue Torch Finance LLC (the "First Amendment"). Under the terms of the First Amendment, the parties agreed to reduce the number of business days to submit a notice of borrowing for the Delayed Draw Term Loan, and redefine certain terms within the asset coverage financial covenant. The maturity date remains November 6, 2027, for each of the Initial Term Loan, Delayed Draw Term Loan, and Revolving Credit Facility. As of June 30, 2024 , the Company had no borrowings on its available lines of credit in Italy, which provide up to an aggregate amount of € 5.5 million ($ 5.9 million).

Fair value measurements and inv

Fair value measurements and investments	6 Months Ended
	Jun. 30, 2024
Fair Value Measurements And Investment Disclosure [Abstract]
Fair value measurements and investments	7. Fair value measurements and investments The fair value measurements of the Company’s financial assets and liabilities measured on a recurring basis were as follows: June 30, December 31, (Unaudited, U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Neo Medical convertible loan agreement $ — $ — $ — $ — $ 6,760 Neo Medical preferred equity securities — 10,942 — 10,942 4,951 Other investments — — — — 1,309 Total $ — $ 10,942 $ — $ 10,942 $ 13,020 Liabilities Lattus contingent consideration $ — $ — $ ( 12,740 ) $ ( 12,740 ) $ ( 8,500 ) Deferred compensation plan — ( 1,644 ) — ( 1,644 ) ( 1,674 ) Total $ — $ ( 1,644 ) $ ( 12,740 ) $ ( 14,384 ) $ ( 10,174 ) Neo Medical Convertible Loan Agreement and Equity Investment Since October 2020, the Company has held preferred equity securities of Neo Medical SA, a privately held Swiss-based company developing a new generation of products for spinal surgery ("Neo Medical") and a Convertible Loan Agreement, pursuant to which the Company loaned Neo Medical CHF 4.6 million, or $ 5.0 million, at the date of issuance (the “Convertible Loan”). In April 2024, the Company converted the Convertible Loan into shares of Neo Medical preferred equity securities. The preferred 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 Company's equity investment with Neo Medical is subject to certain sales restrictions, such as right of first refusal, tag-along provisions, and drag-along provisions. Permitted transfers include (i) sales of shares to an affiliate of such shareholder, (ii) transfer of shares as part of a compensation package offered to employees, or (iii) Neo Medical may repurchase shares at a price no greater than that originally paid by the shareholder. The table below presents a reconciliation of the beginning and ending balances of the Company’s investment in Neo Medical preferred equity securities: (Unaudited, U.S. Dollars, in thousands) 2024 2023 Fair value of Neo Medical preferred equity securities at January 1 $ 4,951 $ 6,084 Conversion of loan into preferred equity securities 8,224 — Foreign currency remeasurement recognized in other income (expense), net — — Unrealized loss recognized in other expense, net ( 2,233 ) — Fair value of Neo Medical preferred equity securities at June 30 $ 10,942 $ 6,084 Cumulative unrealized gain (loss) on Neo Medical preferred equity securities $ ( 2,953 ) $ 413 The following table provides a reconciliation of the beginning and ending balances of the Convertible Loan, which was measured at fair value using significant unobservable inputs: (Unaudited, U.S. Dollars, in thousands) 2024 2023 Fair value of Neo Medical Convertible Loan at January 1 $ 6,760 $ 7,140 Gains (losses) recorded for the period Recognized in other comprehensive income 1,671 117 Interest recognized in interest income, net 162 238 Foreign currency remeasurement recognized in other income (expense), net ( 602 ) 195 Reversal of expected credit loss recognized in other income (expense), net 260 — Conversion into preferred equity securities ( 8,224 ) — Realized foreign currency loss recognized in other income (expense), net ( 27 ) — Fair value of Neo Medical Convertible Loan at June 30 $ — $ 7,690 Contractual value of Neo Medical Convertible Loan at June 30 $ — $ 6,340 Allowance for credit loss recognized in other income (expense), net — — Amortized cost basis of Neo Medical Convertible Loan at June 30 $ — $ 6,340 Other Investments Other investments represent assets and investments recorded at fair value that are not deemed to be material for disclosure on an individual basis. The fair value of these assets is based upon significant unobservable inputs, such as probability-weighted discounted cash flow models, requiring the Company to develop its own assumptions. Therefore, the Company has categorized these assets as Level 3 financial assets. 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 estimated future sales of the products, revenue risk-adjusted discount rates, 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): (Unaudited, U.S. Dollars, in thousands) 2024 2023 Lattus contingent consideration estimated fair value at January 1 $ 8,500 $ — Contingent consideration assumed in the Merger — 11,200 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement 4,240 ( 1,300 ) Lattus contingent consideration estimated fair value at June 30 $ 12,740 $ 9,900 The following table provides quantitative information related to certain key assumptions utilized within the valuation as of June 30, 2024: (Unaudited, U.S. Dollars, in thousands) Fair Value as of Unobservable inputs Estimate Lattus Contingent Consideration $ 12,740 Counterparty discount rates 13.7 % - 14.3 % Revenue risk-adjusted discount rates 7.5 % - 8.2 %

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	8. Commitments and Contingencies 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 (the "Board") 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. Commitments As a result of the Merger, the Company became party to agreements with certain distributor partners that provide the Company with an option to purchase, and 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 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 June 30, 2024 , assuming the options under all the relevant agreements were exercised, the estimated total number of shares the Company would issue under these agreements was approximately 0.3 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. 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. In July 2024, the Italian Constitutional Court issued two judgments following public hearings on the matter held in May 2024. These judgments (i) declared the payback system itself as constitutionally legitimate and (ii) extended previously communicated reductions in the payback liability for certain fiscal years to all medical device companies, regardless of whether or not they had waived their legal claims on the matter. 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 an expense of $ 0.3 million and $ 0.6 million for the three and six months ended June 30, 2024 , respectively, and an expense of $ 0.3 million and $ 0.6 million for the three and six months ended June 30, 2023, respectively. As of June 30, 2024 , the Company has accrued $ 8.0 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.

Accumulated other comprehensive

Accumulated other comprehensive loss	6 Months Ended
	Jun. 30, 2024
Equity [Abstract]
Accumulated other comprehensive loss	9. Accumulated other comprehensive loss The components of and changes in accumulated other comprehensive loss were as follows: (Unaudited, U.S. Dollars, in thousands) Currency Neo Medical Convertible Loan Other Investments Accumulated Other Balance at December 31, 2023 $ ( 1,065 ) $ ( 228 ) $ — $ ( 1,293 ) Other comprehensive income (loss) ( 1,438 ) 1,671 — 233 Income taxes — — — — Reclassification adjustment to: Other expense, net — ( 1,671 ) — ( 1,671 ) Balance at June 30, 2024 $ ( 2,503 ) $ ( 228 ) $ — $ ( 2,731 )

Revenue recognition and account

Revenue recognition and accounts receivable	6 Months Ended
	Jun. 30, 2024
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	10. Revenue recognition and accounts receivable Revenue Recognition The Company has two reporting segments: Global Spine and Global Orthopedics. Within the Global Spine reporting segment, there are two product categories: (i) Bone Growth Therapies, and (ii) Spinal Implants, Biologics, and Enabling Technologies. The table below presents net sales by product category by reporting segment: Three Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 59,135 $ 52,662 12.3 % Spinal Implants, Biologics, and Enabling Technologies 108,899 105,314 3.4 % Global Spine 168,034 157,976 6.4 % Global Orthopedics 30,586 29,040 5.3 % Net sales $ 198,620 $ 187,016 6.2 % Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 111,612 $ 100,376 11.2 % Spinal Implants, Biologics, and Enabling Technologies 217,715 206,806 5.3 % Global Spine 329,327 307,182 7.2 % Global Orthopedics 57,901 55,038 5.2 % Net sales $ 387,228 $ 362,220 6.9 % Product Sales and Marketing Service Fees The table below presents product sales and marketing service fees, which are both components of net sales: Three Months Ended June 30, Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Product sales $ 185,417 $ 174,078 $ 361,248 $ 336,326 Marketing service fees 13,203 12,938 25,980 25,894 Net sales $ 198,620 $ 187,016 $ 387,228 $ 362,220 Product sales primarily consist of the sale of bone growth therapies devices, spinal implants, certain biologics, enabling technologies, and orthopedics products. Marketing service fees are received from MTF Biologics (“MTF”) based on total sales of biologics tissues sourced from MTF and relate solely to the Global Spine reporting segment. The Company partners with MTF to provide certain allograft solutions (HCT/Ps) for various spine, orthopedic and other bone repair needs, with this partnership allowing the Company to exclusively market certain biologic offerings. Accounts receivable and related allowances The following table provides a detail of changes in the Company’s allowance for expected credit losses for the three and six months ended June 30, 2024 and 2023: Three Months Ended June 30, Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Allowance for expected credit losses beginning balance $ 8,398 $ 6,691 $ 7,130 $ 6,419 Addition resulting from the Merger with SeaSpine — — — 137 Current period provision for expected credit losses 197 282 1,573 490 Write-offs charged against the allowance and other ( 184 ) 6 ( 203 ) ( 120 ) Effect of changes in foreign exchange rates ( 43 ) 36 ( 132 ) 89 Allowance for expected credit losses ending balance $ 8,368 $ 7,015 $ 8,368 $ 7,015

Business segment information

Business segment information	6 Months Ended
	Jun. 30, 2024
Segment Reporting [Abstract]
Business segment information	11. 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, 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. The following table presents adjusted EBITDA, the primary metric used in managing the Company, by reporting segment: Three Months Ended June 30, Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Adjusted EBITDA by reporting segment Global Spine $ 27,688 $ 21,258 $ 47,578 $ 36,239 Global Orthopedics 179 ( 135 ) ( 1,313 ) ( 91 ) Adjusted EBITDA $ 27,867 $ 21,123 $ 46,265 $ 36,148 Reconciling items: Corporate operating expenses $ 11,234 $ 11,204 $ 21,967 $ 23,025 Interest expense, net 4,943 1,266 9,501 2,555 Depreciation and amortization 14,032 13,327 28,894 25,997 Share-based compensation expense 9,959 13,246 18,759 26,266 Foreign exchange impact 851 ( 269 ) 2,439 ( 852 ) SeaSpine merger-related costs 5,897 8,206 10,376 28,946 Strategic investments 311 309 431 970 Acquisition-related fair value adjustments 6,117 8,149 10,334 19,785 Interest and loss on investments 1,813 — 1,553 — Litigation and investigation costs ( 277 ) 1,291 1,983 1,760 Succession charges 5,346 262 7,556 262 Medical device regulation — 2,050 — 5,679 Loss before income taxes $ ( 32,359 ) $ ( 37,918 ) $ ( 67,528 ) $ ( 98,245 ) The following table presents depreciation and amortization by reporting segment: Three Months Ended June 30, Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Global Spine $ 11,044 $ 10,368 $ 22,973 $ 19,967 Global Orthopedics 2,191 1,719 4,398 3,348 Corporate 797 1,240 1,523 2,682 Total $ 14,032 $ 13,327 $ 28,894 $ 25,997 Geographical information The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Global Spine U.S. $ 159,191 $ 147,360 $ 311,056 $ 286,817 International 8,843 10,616 18,271 20,365 Total Global Spine 168,034 157,976 329,327 307,182 Global Orthopedics U.S. 7,742 7,223 15,896 13,859 International 22,844 21,817 42,005 41,179 Total Global Orthopedics 30,586 29,040 57,901 55,038 Consolidated U.S. 166,933 154,583 326,952 300,676 International 31,687 32,433 60,276 61,544 Net sales $ 198,620 $ 187,016 $ 387,228 $ 362,220 The following data includes net sales by geographic area: Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 U.S. $ 166,933 $ 154,583 $ 326,952 $ 300,676 Italy 5,257 5,262 10,259 10,117 France 3,510 2,811 6,026 5,271 United Kingdom 2,623 2,540 5,254 5,320 Germany 2,393 2,721 4,498 5,359 Brazil 1,708 1,882 3,236 2,765 Others 16,196 17,217 31,003 32,712 Net Sales $ 198,620 $ 187,016 $ 387,228 $ 362,220 The following data includes property, plant, and equipment by geographic area: (U.S. Dollars, in thousands) June 30, December 31, (Unaudited) U.S. $ 138,757 $ 142,727 Italy 9,571 10,187 Germany 2,388 3,030 Others 3,395 3,116 Total $ 154,111 $ 159,060

Acquisition-Related Amortizatio

Acquisition-Related Amortization and Remeasurement	6 Months Ended
	Jun. 30, 2024
Acquisition Related Amortization And Remeasurement [Abstract]
Acquisition-Related Amortization and Remeasurement	12. Acquisition-related amortization and remeasurement Acquisition-related amortization and remeasurement consists of (i) amortization related to intangible assets acquired through business combinations or asset acquisitions and (ii) remeasurement of any related contingent consideration arrangements, which are recognized immediately upon acquisition. Components of acquisition-related amortization and remeasurement are as follows: Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Amortization of acquired intangibles $ 4,318 $ 4,633 $ 8,544 $ 8,767 Changes in fair value of contingent consideration 3,070 ( 1,300 ) 4,240 ( 1,300 ) Total $ 7,388 $ 3,333 $ 12,784 $ 7,467

Share-based compensation

Share-based compensation	6 Months Ended
	Jun. 30, 2024
Share-Based Payment Arrangement [Abstract]
Share-based compensation	13. Share-based compensation Components of share-based compensation expense are as follows: Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Cost of sales $ 514 $ 482 $ 1,090 $ 953 Sales and marketing 1,436 2,551 3,103 4,800 General and administrative 7,447 9,167 12,995 18,271 Research and development 562 1,046 1,571 2,242 Total $ 9,959 $ 13,246 $ 18,759 $ 26,266 Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Stock options $ 1,382 $ 2,397 $ 2,500 $ 5,153 Market-based stock options 499 — 826 — Time-based restricted stock awards and units 6,254 10,235 12,127 20,081 Market-based / performance-based restricted stock units 1,303 113 2,141 113 Stock purchase plan 521 501 1,165 919 Total $ 9,959 $ 13,246 $ 18,759 $ 26,266 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. During the three months ended June 30, 2024, and 2023 , the Company issued 0.6 million and 0.3 million shares, respectively, of common stock related to stock purchase plan issuances, stock option exercises, and the vesting of restricted stock awards and units. During the six months ended June 30, 2024, and 2023 , the Company issued 0.9 million and 0.5 million shares, respectively, of common stock related to stock purchase plan issuances, stock option exercises, and the vesting of restricted stock awards and units. Inducement plans During 2024, the Company has appointed several new executives, including a new President and Chief Executive Officer, Chief Financial Officer, Chief People & Business Operations Officer, Chief Legal Officer, President of Global Spine, Chief Investor Relations and Communications Officer, President of Global Operations and Quality, and Chief Human Resources Officer. As inducements to accept employment with the Company, the individuals were awarded grants including, dependent on the individual, (i) market-based and/or time-based stock options, (ii) time-based restricted stock units, (iii) time-based cliff vesting restricted stock units, and (iv) market-based restricted stock units, valued in the aggregate across all award types at approximately $ 21.4 million.

Income taxes

Income taxes	6 Months Ended
	Jun. 30, 2024
Income Tax Disclosure [Abstract]
Income taxes	14. Income taxes Generally, income tax provisions for interim periods are based on an estimated annual income tax rate, adjusted for discrete tax items, with any changes affecting the estimated annual effective tax rate recorded in the interim period in which the change occurs. Due to the impact of losses not benefited by the Company’s U.S. and Italian operations, the Company determined the estimated annual effective tax rate method would not provide a reliable estimate of the Company’s overall annual effective tax rate. As such, the Company has calculated the tax provision using the actual effective rate for the three and six months ended June 30, 2024. Due to the impact of temporary differences on the U.S. current tax liability without any deferred tax benefit, the actual effective rate may vary in future quarters. For the three months ended June 30, 2024, and 2023, the effective tax rate was ( 3.3 %) and ( 4.0 %) , respectively. For the six months ended June 30, 2024, and 2023, the effective tax rate was ( 2.9 %) and ( 2.2 %) , respectively. The primary factors affecting the Company’s effective tax rate for the three and six months ended June 30, 2024 , were certain losses not benefited and tax amortization on certain acquired intangibles.

Earnings per share ("EPS")

Earnings per share ("EPS")	6 Months Ended
	Jun. 30, 2024
Earnings Per Share [Abstract]
Earnings per share ("EPS")	15. Earnings per share (“EPS”) For the three and six months ended June 30, 2024 , no adjustments were made to net income for purposes of calculating basic and diluted EPS. The following is a reconciliation of the weighted average shares used in diluted EPS computations. Three Months Ended Six Months Ended (Unaudited, In thousands) 2024 2023 2024 2023 Weighted average common shares-basic 38,020 36,762 37,787 36,252 Effect of dilutive securities Unexercised stock options and stock purchase plan — — — — Unvested restricted stock units — — — — Weighted average common shares-diluted 38,020 36,762 37,787 36,252 There were 7.1 million and 7.0 million weighted average outstanding stock options and restricted stock units not included in the diluted EPS computation for the three months ended June 30, 2024, and 2023 , respectively, and 6.9 million and 7.1 million weighted average outstanding stock options and restricted stock units not included in the diluted EPS computation for the six months ended June 30, 2024, and 2023 , respectively, because inclusion of these awards was anti-dilutive.

Recently adopted accounting s_2

Recently adopted accounting standards, recently issued accounting pronouncements (Policies)	6 Months Ended
	Jun. 30, 2024
Accounting Changes and Error Corrections [Abstract]
Recently adopted accounting standards and recently issued accounting pronouncements	Recently Issued Accounting Pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation 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 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. Other recently issued ASUs, excluding those ASUs which have already been disclosed as adopted or described above, were assessed and determined not applicable, or are expected to have minimal impact on the Company's condensed consolidated financial statements.

Merger and Acquisitions (Tables

Merger and Acquisitions (Tables)	6 Months Ended
	Jun. 30, 2024
Business Combinations [Abstract]
Summary of Estimated Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the fair value of assets acquired and liabilities assumed at the acquisition date: (U.S. Dollars, in thousands) Final Acquisition Date Fair Value Assigned Useful Life Assets acquired: 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 Customer relationships 33,100 13 years Developed technology 47,200 6 - 8 years In-process research and development ("IPR&D") 5,750 Indefinite Other long-term assets 20,501 Total identifiable assets acquired $ 377,372 Liabilities assumed : 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

Inventories (Tables)

Inventories (Tables)	6 Months Ended
	Jun. 30, 2024
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories were as follows: (U.S. Dollars, in thousands) June 30, December 31, (Unaudited) Raw materials $ 29,455 $ 28,390 Work-in-process 57,115 53,510 Finished products 123,470 140,266 Inventories $ 210,040 $ 222,166

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2024
Leases [Abstract]
Summary of Lease Portfolio	A summary of the Company's lease portfolio as of June 30, 2024, and December 31, 2023, is presented in the table below: (U.S. Dollars, in thousands) Classification June 30, December 31, (Unaudited) Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 18,579 $ 19,869 Finance leases Property, plant and equipment, net 15,839 16,345 Total ROU assets $ 34,418 $ 36,214 Lease Liabilities Current Operating leases Other current liabilities $ 3,733 $ 3,477 Finance leases Current portion of finance lease liability 734 708 Long-term Operating leases Other long-term liabilities 15,710 17,125 Finance leases Long-term portion of finance lease liability 18,160 18,532 Total lease liabilities $ 38,337 $ 39,842
Summary of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases was as follows: (Unaudited, U.S. Dollars, in thousands) Six Months Ended Six Months Ended Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 4,311 $ 3,751 Operating cash flows from finance leases 417 428 Financing cash flows from finance leases 346 320 ROU assets obtained in exchange for lease obligations Operating leases 721 15,368 Finance leases — —

Long-term debt (Tables)

Long-term debt (Tables)	6 Months Ended
	Jun. 30, 2024
Debt Disclosure [Abstract]
Summary of Carrying Values of Outstanding Debt Obligations	The carrying values of the Company's outstanding debt obligations as of June 30, 2024, and December 31, 2023, were as follows: (U.S. Dollars, in thousands) June 30, December 31, (Unaudited) Initial Term Loan and Delayed Draw Term Loan Principal amount $ 125,000 $ 100,000 Unamortized original debt discount ( 3,769 ) ( 4,331 ) Unamortized debt issuance costs and lenders fees ( 3,228 ) ( 1,312 ) Total indebtedness from initial term loan and delayed draw term loan 118,003 94,357 Revolving Credit Facilities Principal amount outstanding — — Total indebtedness outstanding $ 118,003 $ 94,357 Current portion of long-term debt $ 4,688 $ 1,250 Long-term debt 113,315 93,107 Total indebtedness outstanding $ 118,003 $ 94,357

Fair value measurements and i_2

Fair value measurements and investments (Tables)	6 Months Ended
	Jun. 30, 2024
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis	The fair value measurements of the Company’s financial assets and liabilities measured on a recurring basis were as follows: June 30, December 31, (Unaudited, U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Neo Medical convertible loan agreement $ — $ — $ — $ — $ 6,760 Neo Medical preferred equity securities — 10,942 — 10,942 4,951 Other investments — — — — 1,309 Total $ — $ 10,942 $ — $ 10,942 $ 13,020 Liabilities Lattus contingent consideration $ — $ — $ ( 12,740 ) $ ( 12,740 ) $ ( 8,500 ) Deferred compensation plan — ( 1,644 ) — ( 1,644 ) ( 1,674 ) Total $ — $ ( 1,644 ) $ ( 12,740 ) $ ( 14,384 ) $ ( 10,174 )
Schedule of Reconciliation of Investments in Equity Securities	The table below presents a reconciliation of the beginning and ending balances of the Company’s investment in Neo Medical preferred equity securities: (Unaudited, U.S. Dollars, in thousands) 2024 2023 Fair value of Neo Medical preferred equity securities at January 1 $ 4,951 $ 6,084 Conversion of loan into preferred equity securities 8,224 — Foreign currency remeasurement recognized in other income (expense), net — — Unrealized loss recognized in other expense, net ( 2,233 ) — Fair value of Neo Medical preferred equity securities at June 30 $ 10,942 $ 6,084 Cumulative unrealized gain (loss) on Neo Medical preferred equity securities $ ( 2,953 ) $ 413
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 Lattus contingent consideration measured at estimated fair value using significant unobservable inputs (Level 3): (Unaudited, U.S. Dollars, in thousands) 2024 2023 Lattus contingent consideration estimated fair value at January 1 $ 8,500 $ — Contingent consideration assumed in the Merger — 11,200 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement 4,240 ( 1,300 ) Lattus contingent consideration estimated fair value at June 30 $ 12,740 $ 9,900
Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Schedule of Reconciliation For Convertible Loans Measured At Fair Value Using Significant Unobservable Inputs	(Unaudited, U.S. Dollars, in thousands) 2024 2023 Fair value of Neo Medical Convertible Loan at January 1 $ 6,760 $ 7,140 Gains (losses) recorded for the period Recognized in other comprehensive income 1,671 117 Interest recognized in interest income, net 162 238 Foreign currency remeasurement recognized in other income (expense), net ( 602 ) 195 Reversal of expected credit loss recognized in other income (expense), net 260 — Conversion into preferred equity securities ( 8,224 ) — Realized foreign currency loss recognized in other income (expense), net ( 27 ) — Fair value of Neo Medical Convertible Loan at June 30 $ — $ 7,690 Contractual value of Neo Medical Convertible Loan at June 30 $ — $ 6,340 Allowance for credit loss recognized in other income (expense), net — — Amortized cost basis of Neo Medical Convertible Loan at June 30 $ — $ 6,340
Schedule of Changes in Valuation of Securities	The following table provides quantitative information related to certain key assumptions utilized within the valuation as of June 30, 2024: (Unaudited, U.S. Dollars, in thousands) Fair Value as of Unobservable inputs Estimate Lattus Contingent Consideration $ 12,740 Counterparty discount rates 13.7 % - 14.3 % Revenue risk-adjusted discount rates 7.5 % - 8.2 %

Accumulated other comprehensi_2

Accumulated other comprehensive loss (Tables)	6 Months Ended
	Jun. 30, 2024
Equity [Abstract]
Components of Changes in Accumulated Other Comprehensive Loss	The components of and changes in accumulated other comprehensive loss were as follows: (Unaudited, U.S. Dollars, in thousands) Currency Neo Medical Convertible Loan Other Investments Accumulated Other Balance at December 31, 2023 $ ( 1,065 ) $ ( 228 ) $ — $ ( 1,293 ) Other comprehensive income (loss) ( 1,438 ) 1,671 — 233 Income taxes — — — — Reclassification adjustment to: Other expense, net — ( 1,671 ) — ( 1,671 ) Balance at June 30, 2024 $ ( 2,503 ) $ ( 228 ) $ — $ ( 2,731 )

Revenue recognition and accou_2

Revenue recognition and accounts receivable (Tables)	6 Months Ended
	Jun. 30, 2024
Revenue Recognition And Accounts Receivable [Abstract]
Schedule of Net Sales by Product Category by Reporting Segment	The table below presents net sales by product category by reporting segment: Three Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 59,135 $ 52,662 12.3 % Spinal Implants, Biologics, and Enabling Technologies 108,899 105,314 3.4 % Global Spine 168,034 157,976 6.4 % Global Orthopedics 30,586 29,040 5.3 % Net sales $ 198,620 $ 187,016 6.2 % Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 111,612 $ 100,376 11.2 % Spinal Implants, Biologics, and Enabling Technologies 217,715 206,806 5.3 % Global Spine 329,327 307,182 7.2 % Global Orthopedics 57,901 55,038 5.2 % Net sales $ 387,228 $ 362,220 6.9 %
Schedule of Components Net Sales	The table below presents product sales and marketing service fees, which are both components of net sales: Three Months Ended June 30, Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Product sales $ 185,417 $ 174,078 $ 361,248 $ 336,326 Marketing service fees 13,203 12,938 25,980 25,894 Net sales $ 198,620 $ 187,016 $ 387,228 $ 362,220
Allowances for Expected Credit Losses	The following table provides a detail of changes in the Company’s allowance for expected credit losses for the three and six months ended June 30, 2024 and 2023: Three Months Ended June 30, Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Allowance for expected credit losses beginning balance $ 8,398 $ 6,691 $ 7,130 $ 6,419 Addition resulting from the Merger with SeaSpine — — — 137 Current period provision for expected credit losses 197 282 1,573 490 Write-offs charged against the allowance and other ( 184 ) 6 ( 203 ) ( 120 ) Effect of changes in foreign exchange rates ( 43 ) 36 ( 132 ) 89 Allowance for expected credit losses ending balance $ 8,368 $ 7,015 $ 8,368 $ 7,015

Business segment information (T

Business segment information (Tables)	6 Months Ended
	Jun. 30, 2024
Segment Reporting [Abstract]
Summary of EBITDA by Reporting Segment	The following table presents adjusted EBITDA, the primary metric used in managing the Company, by reporting segment: Three Months Ended June 30, Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Adjusted EBITDA by reporting segment Global Spine $ 27,688 $ 21,258 $ 47,578 $ 36,239 Global Orthopedics 179 ( 135 ) ( 1,313 ) ( 91 ) Adjusted EBITDA $ 27,867 $ 21,123 $ 46,265 $ 36,148 Reconciling items: Corporate operating expenses $ 11,234 $ 11,204 $ 21,967 $ 23,025 Interest expense, net 4,943 1,266 9,501 2,555 Depreciation and amortization 14,032 13,327 28,894 25,997 Share-based compensation expense 9,959 13,246 18,759 26,266 Foreign exchange impact 851 ( 269 ) 2,439 ( 852 ) SeaSpine merger-related costs 5,897 8,206 10,376 28,946 Strategic investments 311 309 431 970 Acquisition-related fair value adjustments 6,117 8,149 10,334 19,785 Interest and loss on investments 1,813 — 1,553 — Litigation and investigation costs ( 277 ) 1,291 1,983 1,760 Succession charges 5,346 262 7,556 262 Medical device regulation — 2,050 — 5,679 Loss before income taxes $ ( 32,359 ) $ ( 37,918 ) $ ( 67,528 ) $ ( 98,245 )
Schedule of Depreciation and Amortization by Reporting Segment	The following table presents depreciation and amortization by reporting segment: Three Months Ended June 30, Six Months Ended June 30, (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Global Spine $ 11,044 $ 10,368 $ 22,973 $ 19,967 Global Orthopedics 2,191 1,719 4,398 3,348 Corporate 797 1,240 1,523 2,682 Total $ 14,032 $ 13,327 $ 28,894 $ 25,997
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: Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Global Spine U.S. $ 159,191 $ 147,360 $ 311,056 $ 286,817 International 8,843 10,616 18,271 20,365 Total Global Spine 168,034 157,976 329,327 307,182 Global Orthopedics U.S. 7,742 7,223 15,896 13,859 International 22,844 21,817 42,005 41,179 Total Global Orthopedics 30,586 29,040 57,901 55,038 Consolidated U.S. 166,933 154,583 326,952 300,676 International 31,687 32,433 60,276 61,544 Net sales $ 198,620 $ 187,016 $ 387,228 $ 362,220 The following data includes net sales by geographic area: Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 U.S. $ 166,933 $ 154,583 $ 326,952 $ 300,676 Italy 5,257 5,262 10,259 10,117 France 3,510 2,811 6,026 5,271 United Kingdom 2,623 2,540 5,254 5,320 Germany 2,393 2,721 4,498 5,359 Brazil 1,708 1,882 3,236 2,765 Others 16,196 17,217 31,003 32,712 Net Sales $ 198,620 $ 187,016 $ 387,228 $ 362,220
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) June 30, December 31, (Unaudited) U.S. $ 138,757 $ 142,727 Italy 9,571 10,187 Germany 2,388 3,030 Others 3,395 3,116 Total $ 154,111 $ 159,060

Acquisition-Related Amortizat_2

Acquisition-Related Amortization and Remeasurement (Tables)	6 Months Ended
	Jun. 30, 2024
Acquisition Related Amortization And Remeasurement [Abstract]
Components of Acquisition-Related Amortization and Remeasurement	Components of acquisition-related amortization and remeasurement are as follows: Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Amortization of acquired intangibles $ 4,318 $ 4,633 $ 8,544 $ 8,767 Changes in fair value of contingent consideration 3,070 ( 1,300 ) 4,240 ( 1,300 ) Total $ 7,388 $ 3,333 $ 12,784 $ 7,467

Share-based compensation (Table

Share-based compensation (Tables)	6 Months Ended
	Jun. 30, 2024
Share-Based Payment Arrangement [Abstract]
Schedule of Components of Share-Based Compensation Expense	Components of share-based compensation expense are as follows: Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Cost of sales $ 514 $ 482 $ 1,090 $ 953 Sales and marketing 1,436 2,551 3,103 4,800 General and administrative 7,447 9,167 12,995 18,271 Research and development 562 1,046 1,571 2,242 Total $ 9,959 $ 13,246 $ 18,759 $ 26,266 Three Months Ended Six Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 2024 2023 Stock options $ 1,382 $ 2,397 $ 2,500 $ 5,153 Market-based stock options 499 — 826 — Time-based restricted stock awards and units 6,254 10,235 12,127 20,081 Market-based / performance-based restricted stock units 1,303 113 2,141 113 Stock purchase plan 521 501 1,165 919 Total $ 9,959 $ 13,246 $ 18,759 $ 26,266

Earnings per share ("EPS") (Tab

Earnings per share ("EPS") (Tables)	6 Months Ended
	Jun. 30, 2024
Earnings Per Share [Abstract]
Schedule of Reconciliation of Weighted Average Shares Used in Diluted EPS	The following is a reconciliation of the weighted average shares used in diluted EPS computations. Three Months Ended Six Months Ended (Unaudited, In thousands) 2024 2023 2024 2023 Weighted average common shares-basic 38,020 36,762 37,787 36,252 Effect of dilutive securities Unexercised stock options and stock purchase plan — — — — Unvested restricted stock units — — — — Weighted average common shares-diluted 38,020 36,762 37,787 36,252

Merger and acquisitions - Addit

Merger and acquisitions - Additional Information (Detail) - USD ($) $ in Thousands		3 Months Ended				6 Months Ended
	Jan. 05, 2023	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024	Jun. 30, 2023
Business Acquisition [Line Items]
Conversion of stock, shares converted	0.4163
Net sales		$ 198,620		$ 187,016		$ 387,228	$ 362,220
Net loss		(33,443)	$ (36,020)	(39,426)	$ (60,938)	(69,463)	(100,364)
SeaSpine Holdings Corporation [Member]
Business Acquisition [Line Items]
Direct acquisition-related costs		(100)		3,300		100	9,800
Net sales		71,500		64,400		142,000	125,300
Net loss		$ 20,400		$ 24,900		$ 34,700	$ 52,800

Merger and acquisitions - Summa

Merger and acquisitions - Summary of Fair Values of Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands	Jan. 05, 2023	Jun. 30, 2024	Dec. 31, 2023
Current liabilities
Residual goodwill		$ 194,934	$ 194,934
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

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Inventory Disclosure [Abstract]
Raw materials	$ 29,455	$ 28,390
Work-in-process	57,115	53,510
Finished products	123,470	140,266
Inventories	$ 210,040	$ 222,166

Leases - Summary of Lease Portf

Leases - Summary of Lease Portfolio (Detail) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Right-of-use assets ("ROU assets")
Operating leases	$ 18,579	$ 19,869
Operating lease, right-of-use asset, statement of financial position [Extensible List]	Other long-term assets	Other long-term assets
Finance leases	$ 15,839	$ 16,345
Finance lease, right-of-use asset, statement of financial position [Extensible List]	Property, plant, and equipment, net	Property, plant, and equipment, net
Total ROU assets	$ 34,418	$ 36,214
Current
Operating leases	$ 3,733	$ 3,477
Operating lease, liability, current, statement of financial position [Extensible List]	Other current liabilities	Other current liabilities
Finance leases	$ 734	$ 708
Long-term
Operating leases	$ 15,710	$ 17,125
Operating lease, liability, noncurrent, statement of financial position [Extensible List]	Other long-term liabilities	Other long-term liabilities
Finance leases	$ 18,160	$ 18,532
Total lease liabilities	$ 38,337	$ 39,842

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 4,311	$ 3,751
Operating cash flows from finance leases	417	428
Financing cash flows from finance leases	346	320
ROU assets obtained in exchange for lease obligations
Operating leases	$ 721	$ 15,368

Long-Term Debt - Summary of Car

Long-Term Debt - Summary of Carrying Values of Outstanding Debt Obligations (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Current portion of long-term debt	$ 4,688	$ 1,250
Long-term debt	113,315	93,107
Total initial indebtedness outstanding	118,003	94,357
Initial Term Loan and Delayed Draw Term Loan
Debt Instrument [Line Items]
Principal amount outstanding	125,000	100,000
Unamortized original debt discount	(3,769)	(4,331)
Unamortized debt issuance costs and lenders fees	(3,228)	(1,312)
Total initial indebtedness outstanding	118,003	94,357
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Total initial indebtedness outstanding	$ 118,003	$ 94,357

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail)		6 Months Ended
	Mar. 22, 2024 USD ($)	Jun. 30, 2024 USD ($)	Jun. 30, 2024 EUR (€)	Jan. 10, 2024 USD ($)
Debt Instrument [Line Items]
Repayments of lines of credit		$ 15,000,000
Revolving Credit Facility [Member] | Financing Agreement [Member] | Blue Torch Finance L L C [Member]
Debt Instrument [Line Items]
Borrowings				$ 15,000,000
Repayments of lines of credit	$ 15,000,000
Delayed Draw Term Loan [Member] | Financing Agreement [Member] | Blue Torch Finance L L C [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 25,000,000
Italy [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		5,900,000	€ 5,500,000
Borrowings		$ 0

Fair Value Measurements and I_3

Fair Value Measurements and Investments - Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 10,942	$ 13,020
Deferred compensation plan, Liabilities	(1,644)	(1,674)
Liabilities fair value, Total	(14,384)	(10,174)
Lattus [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(12,740)
Liabilities fair value, Total		(8,500)
Convertible Loan Agreement [Member] | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value		6,760
Preferred Equity Securities [Member] | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	10,942	4,951
Other Investments [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value		$ 1,309
Fair Value, Inputs, Level 2 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	10,942
Deferred compensation plan, Liabilities	(1,644)
Liabilities fair value, Total	(1,644)
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	10,942
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities fair value, Total	(12,740)
Fair Value, Inputs, Level 3 [Member] | Lattus [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	$ (12,740)

Fair Value Measurements and I_4

Fair Value Measurements and Investments - Additional Information (Detail) - Oct. 31, 2020 SFr in Millions, $ in Millions	USD ($)	CHF (SFr)
Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Convertible loans	$ 5	SFr 4.6

Fair Value Measurements and I_5

Fair Value Measurements and Investments - Schedule of Reconciliation of Investments in Equity Securities (Detail) - Preferred Stock [Member] - Neo Medical [Member] - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of equity securities beginning balance	$ 4,951	$ 6,084
Conversion of loan into preferred equity securities	8,224
Unrealized loss recognized in other expense, net	(2,233)
Fair value of equity securities Ending balance	10,942	6,084
Cumulative unrealized gain (loss) on Neo Medical preferred equity securities	$ (2,953)	$ 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	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of convertible loan beginning balance	$ 6,760	$ 7,140
Gains (losses) recorded for the period
Recognized in other comprehensive income	1,671	117
Interest recognized in interest income, net	162	238
Foreign currency remeasurement recognized in other income (expense), net	(602)	195
Reversal of expected credit loss recognized in other income (expense), net	260
Conversion into preferred equity securities	(8,224)
Realized foreign currency loss recognized in other income (expense), net	$ (27)
Fair value of convertible loan ending balance		7,690
Contractual value of Neo Medical Convertible Loan at June 30		6,340
Amortized cost basis of Neo Medical Convertible Loan at June 30		$ 6,340

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) - Lattus Spine [Member] - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Contingent consideration	$ 12,740
Minimum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Counterparty discount rates	13.70%
Revenue risk-adjusted discount rates	7.50%
Maximum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Counterparty discount rates	14.30%
Revenue risk-adjusted discount rates	8.20%
Fair Value, Inputs, Level 3 [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Contingent consideration estimated fair value	$ 8,500
Contingent consideration		$ 11,200
Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement	4,240	(1,300)
Contingent consideration estimated fair value at June 30	$ 12,740	$ 9,900

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) shares in Millions, $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024 USD ($)	Jun. 30, 2023 USD ($)	Jun. 30, 2024 USD ($) Executive shares	Jun. 30, 2023 USD ($)
Other Commitments [Line Items]
Number of former executives seeking severance payments | Executive			3
Estimated sales and marketing expense (benefit)	$ 0.3	$ 0.3	$ 0.6	$ 0.6
Accrued other long-term liabilities	$ 8		$ 8
SeaSpine [Member]
Other Commitments [Line Items]
Number of shares issued under acquisition | shares			0.3

Accumulated other comprehensi_3

Accumulated other comprehensive loss - Components of Changes in Accumulated Other Comprehensive Loss (Detail) $ in Thousands	6 Months Ended
	Jun. 30, 2024 USD ($)
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 598,730
Accumulated Other Comprehensive Loss Reclassification Adjustment [Abstract]
Ending Balance	546,004
Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(1,065)
Other comprehensive income (loss)	(1,438)
Accumulated Other Comprehensive Loss Reclassification Adjustment [Abstract]
Ending Balance	(2,503)
Neo Medical [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(228)
Other comprehensive income (loss)	1,671
Accumulated Other Comprehensive Loss Reclassification Adjustment [Abstract]
Other expense, net	(1,671)
Ending Balance	(228)
Accumulated Other Comprehensive Loss [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(1,293)
Other comprehensive income (loss)	233
Accumulated Other Comprehensive Loss Reclassification Adjustment [Abstract]
Other expense, net	(1,671)
Ending Balance	(2,731)
Other Investments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 0

Revenue Recognition and Accou_3

Revenue Recognition and Accounts Receivable - Schedule of Net Sales by Product Category by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 198,620	$ 187,016	$ 387,228	$ 362,220
Change	6.20%		6.90%
Bone Growth Therapies [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 59,135	52,662	$ 111,612	100,376
Change	12.30%		11.20%
Spinal Implants, Biologics, and Enabling Technologies [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 108,899	105,314	$ 217,715	206,806
Change	3.40%		5.30%
Global Spine [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 168,034	157,976	$ 329,327	307,182
Change	6.40%		7.20%
Global Orthopedics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 30,586	$ 29,040	$ 57,901	$ 55,038
Change	5.30%		5.20%

Revenue Recognition and Accou_4

Revenue Recognition and Accounts Receivable - Schedule of Components of Net Sales (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Revenue Recognition [Abstract]
Product sales	$ 185,417	$ 174,078	$ 361,248	$ 336,326
Marketing service fees	13,203	12,938	25,980	25,894
Net sales	$ 198,620	$ 187,016	$ 387,228	$ 362,220

Revenue Recognition and Accou_5

Revenue Recognition and Accounts Receivable - Schedule of Allowance for Expected Credit Losses (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Accounts, Notes, Loans and Financing Receivable [Line Items]
Allowance for expected credit losses beginning balance	$ 8,398	$ 6,691	$ 7,130	$ 6,419
Addition resulting from the Merger with SeaSpine				137
Current period provision for expected credit losses	197	282	1,573	490
Write-offs charged against the allowance and other	(184)	6	(203)	(120)
Effect of changes in foreign exchange rates	(43)	36	(132)	89
Allowance for expected credit losses ending balance	$ 8,368	$ 7,015	$ 8,368	$ 7,015

Business Segment Information -

Business Segment Information - Additional Information (Detail)	6 Months Ended
	Jun. 30, 2024 Segment
Segment Reporting [Abstract]
Number of reporting segments	2

Business Segment Information _2

Business Segment Information - Summary of EBIDTA by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Segment Reporting Information [Line Items]
Adjusted EBITDA	$ 27,867	$ 21,123	$ 46,265	$ 36,148
Corporate operating expenses	11,234	11,204	21,967	23,025
Interest expense, net	4,943	1,266	9,501	2,555
Depreciation and amortization	14,032	13,327	28,894	25,997
Share-based compensation expense	9,959	13,246	18,759	26,266
Foreign exchange impact	851	(269)	2,439	(852)
SeaSpine merger-related costs	5,897	8,206	10,376	28,946
Strategic investments	311	309	431	970
Acquisition-related fair value adjustments	6,117	8,149	10,334	19,785
Interest and loss on investments	1,813		1,553
Litigation and investigation costs	(277)	1,291	1,983	1,760
Succession charges	5,346	262	7,556	262
Medical device regulation		2,050		5,679
Loss before income taxes	(32,359)	(37,918)	(67,528)	(98,245)
Operating Segments [Member] | Global Spine [Member]
Segment Reporting Information [Line Items]
Adjusted EBITDA	27,688	21,258	47,578	36,239
Operating Segments [Member] | Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Adjusted EBITDA	$ 179	$ (135)	$ (1,313)	$ (91)

Business Segment Information _3

Business Segment Information - Schedule of Depreciation and Amortization by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 14,032	$ 13,327	$ 28,894	$ 25,997
Operating Segments [Member] | Global Spine [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	11,044	10,368	22,973	19,967
Operating Segments [Member] | Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	2,191	1,719	4,398	3,348
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 797	$ 1,240	$ 1,523	$ 2,682

Business Segment Information _4

Business Segment Information - Summary of Net Sales by Geographic Destination for Each Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 198,620	$ 187,016	$ 387,228	$ 362,220
Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	168,034	157,976	329,327	307,182
Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	30,586	29,040	57,901	55,038
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	166,933	154,583	326,952	300,676
U.S. [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	159,191	147,360	311,056	286,817
U.S. [Member] | Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	7,742	7,223	15,896	13,859
International [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	31,687	32,433	60,276	61,544
International [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	8,843	10,616	18,271	20,365
International [Member] | Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 22,844	$ 21,817	$ 42,005	$ 41,179

Business Segment Information _5

Business Segment Information - Summary of Net Sales by Geographic Destination (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 198,620	$ 187,016	$ 387,228	$ 362,220
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	166,933	154,583	326,952	300,676
Italy [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	5,257	5,262	10,259	10,117
France [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	3,510	2,811	6,026	5,271
United Kingdom [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	2,623	2,540	5,254	5,320
Germany [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	2,393	2,721	4,498	5,359
Brazil [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	1,708	1,882	3,236	2,765
Others [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 16,196	$ 17,217	$ 31,003	$ 32,712

Business Segment Information _6

Business Segment Information - Summary of Property, Plant and Equipment of Reporting Segments by Geographic Area (Detail) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	$ 154,111	$ 159,060
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	138,757	142,727
Italy [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	9,571	10,187
Germany [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	2,388	3,030
Others [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	$ 3,395	$ 3,116

Acquisition-Related Amortizat_3

Acquisition-Related Amortization and Remeasurement - Components of Acquisition-Related Amortization and Remeasurement (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Acquisition Related Amortization And Remeasurement [Abstract]
Amortization of acquired intangibles	$ 4,318	$ 4,633	$ 8,544	$ 8,767
Changes in fair value of contingent consideration	3,070	(1,300)	4,240	(1,300)
Total	$ 7,388	$ 3,333	$ 12,784	$ 7,467

Share-based Compensation - Sche

Share-based Compensation - Schedule of Components of Share-Based Compensation Expense (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 9,959	$ 13,246	$ 18,759	$ 26,266
Employee Stock Option
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,382	2,397	2,500	5,153
Market-based Stock Options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	499		826
Time-based Restricted Stock Awards and Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	6,254	10,235	12,127	20,081
Market-based / Performance-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,303	113	2,141	113
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	521	501	1,165	919
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	514	482	1,090	953
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,436	2,551	3,103	4,800
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	7,447	9,167	12,995	18,271
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 562	$ 1,046	$ 1,571	$ 2,242

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - USD ($) shares in Millions, $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Shares issued under stock purchase plan, stock option exercises and restricted stock awards and units	0.6	0.3	0.9	0.5
Shares granted, value			$ 21.4
SeaSpine [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Number of options issued in connection with conversion of awards			1.9
Number of time based RSU issued in exchange for equity awards			0.5

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail)	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Components Of Income Tax Expense Benefit [Line Items]
Income tax effective rate	(3.30%)	(4.00%)	(2.90%)	(2.20%)

Earnings Per Share ("EPS") - Sc

Earnings Per Share ("EPS") - Schedule of Reconciliation of Weighted Average Shares Used in Diluted EPS (Detail) - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Earnings Per Share [Line Items]
Weighted average common shares-basic	38,020	36,762	37,787	36,252
Effect of dilutive securities
Weighted average common shares-diluted	38,020	36,762	37,787	36,252

Earnings Per Share ("EPS") - Ad

Earnings Per Share ("EPS") - Additional Information (Detail) - shares shares in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Restricted Stock Units [Member] | Outstanding Stock Options [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Weighted average outstanding options, awards and units not included in diluted earnings per share	7.1	7	6.9	7.1