Orthofix Medical (OFIX) 10-Q 6 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2019	May 03, 2019
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX MEDICAL INC.
Entity Central Index Key	0000884624
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		19,066,984

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Current assets
Cash and cash equivalents	$ 46,668	$ 69,623
Restricted cash	2,540	2,566
Trade accounts receivable, net of allowances of $7,448 and $7,463, respectively	79,615	77,747
Inventories	79,128	76,847
Prepaid expenses and other current assets	16,387	17,856
Total current assets	224,338	244,639
Property, plant and equipment, net	63,727	42,835
Intangible assets, net	56,764	51,897
Goodwill	71,177	72,401
Deferred income taxes	36,575	33,228
Other long-term assets	26,735	21,641
Total assets	479,316	466,641
Current liabilities
Accounts payable	19,643	17,989
Current portion of finance lease liability	359
Other current liabilities	43,652	67,919
Total current liabilities	63,654	85,908
Long-term portion of finance lease liability	20,879
Other long-term liabilities	51,101	45,336
Total liabilities	135,634	131,244
Contingencies (Note 9)
Shareholders’ equity
Common shares $0.10 par value; 50,000,000 shares authorized; 18,790,769 and 18,579,688 issued and outstanding as of March 31, 2019 and December 31, 2018, respectively	1,879	1,858
Additional paid-in capital	252,862	243,165
Retained earnings	87,108	87,078
Accumulated other comprehensive income	1,833	3,296
Total shareholders’ equity	343,682	335,397
Total liabilities and shareholders’ equity	$ 479,316	$ 466,641

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Statement Of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 7,448	$ 7,463
Common shares, par value	$ 0.10	$ 0.10
Common shares, authorized	50,000,000	50,000,000
Common shares, issued	18,790,769	18,579,688
Common shares, outstanding	18,790,769	18,579,688

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Statement [Abstract]
Net sales	$ 109,112	$ 108,709
Cost of sales	23,708	24,147
Gross profit	85,404	84,562
Sales and marketing	53,694	50,268
General and administrative	20,472	19,424
Research and development	9,229	6,937
Acquisition-related amortization and remeasurement (Note 13)	6,457	63
Operating income (loss)	(4,448)	7,870
Interest expense, net	(257)	(183)
Other income (expense), net	(404)	2,912
Income (loss) before income taxes	(5,109)	10,599
Income tax benefit (expense)	6,006	(5,373)
Net income	$ 897	$ 5,226
Net income per common share:
Basic	$ 0.05	$ 0.28
Diluted	$ 0.05	$ 0.27
Weighted average number of common shares:
Basic	18,750,184	18,404,856
Diluted	19,191,146	18,874,591
Other comprehensive income (loss), before tax
Unrealized loss on debt securities	$ (2,593)
Currency translation adjustment	(449)	$ 697
Other comprehensive income (loss) before tax	(3,042)	697
Income tax related to items of other comprehensive income (loss)	641
Other comprehensive income (loss), net of tax	(2,401)	697
Comprehensive income (loss)	$ (1,504)	$ 5,923

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 [Member]
Beginning Balance at Dec. 31, 2017	$ 296,608	$ 1,828	$ 220,591	$ 70,402	$ 3,787
Balance, Shares at Dec. 31, 2017		18,278,833
Cumulative effect adjustment from adoption | ASU 2014-09 [Member]	4,761			4,761
Cumulative effect adjustment from adoption | ASU 2016-16 [Member]	(1,896)			(1,896)
Net income	5,226			5,226
Other comprehensive income (loss), net of tax	697				697
Share-based compensation	3,916		3,916
Common shares issued, net	3,862	$ 13	3,849
Common shares issued, net, Shares		126,511
Ending Balance at Mar. 31, 2018	313,174	$ 1,841	228,356	78,493	4,484
Balance, Shares at Mar. 31, 2018		18,405,344
Beginning Balance at Dec. 31, 2018	$ 335,397	$ 1,858	243,165	87,078	3,296
Balance, Shares at Dec. 31, 2018	18,579,688	18,579,688
Cumulative effect adjustment from adoption | ASU 2016-02 [Member]	$ 71			71
Cumulative effect adjustment from adoption | ASU 2018-02 [Member]	938			(938)	938
Net income	897			897
Other comprehensive income (loss), net of tax	(2,401)				(2,401)
Share-based compensation	5,685		5,685
Common shares issued, net	4,033	$ 21	4,012
Common shares issued, net, Shares		211,081
Ending Balance at Mar. 31, 2019	$ 343,682	$ 1,879	$ 252,862	$ 87,108	$ 1,833
Balance, Shares at Mar. 31, 2019	18,790,769	18,790,769

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities
Net income	$ 897	$ 5,226
Adjustments to reconcile net income to net cash from operating activities
Depreciation and amortization	5,727	4,369
Amortization of operating lease assets, debt costs and other assets	773	375
Provision for doubtful accounts	46	(35)
Deferred income taxes	(1,582)	277
Share-based compensation	5,685	3,916
Interest and gain on valuation of investment securities	(593)	(1,629)
Change in fair value of contingent consideration	5,400
Other	586	208
Changes in operating assets and liabilities, net of effects of acquisitions
Accounts receivable	(2,027)	(4,925)
Inventories	(2,477)	1,664
Prepaid expenses and other current assets	1,427	2,166
Accounts payable	1,883	(4,459)
Other current liabilities	(12,439)	(11,310)
Payment of contingent consideration	(1,340)
Other long-term assets and liabilities	(3,005)	597
Net cash from operating activities	(1,039)	(3,560)
Cash flows from investing activities
Capital expenditures for property, plant and equipment	(4,643)	(2,831)
Capital expenditures for intangible assets	(273)	(607)
Asset acquisitions and other investments	(6,400)	(1,217)
Net cash from investing activities	(11,316)	(4,655)
Cash flows from financing activities
Proceeds from issuance of common shares	6,331	4,378
Payments related to withholdings for share-based compensation	(2,298)	(516)
Payment of contingent consideration	(13,660)
Payments related to finance lease obligation	(99)
Other financing activities	(670)	(165)
Net cash from financing activities	(10,396)	3,697
Effect of exchange rate changes on cash	(230)	417
Net change in cash, cash equivalents, and restricted cash	(22,981)	(4,101)
Cash, cash equivalents, and restricted cash at the beginning of period	72,189	81,157
Cash, cash equivalents, and restricted cash at the end of period	49,208	77,056
Components of cash, cash equivalents and restricted cash at the end of period
Cash and cash equivalents	46,668	77,056
Restricted cash	2,540
Cash, cash equivalents, and restricted cash at the end of period	$ 49,208	77,056
Noncash investing activities:
Purchase of intangible assets		$ 1,181

Business and basis of consolida

Business and basis of consolidation	3 Months Ended
	Mar. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Business and basis of consolidation	1. Business and basis of presentation Orthofix Medical Inc., together with its subsidiaries (the “Company” or “Orthofix”) is a global medical device company focused on musculoskeletal products and therapies. 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, 2018. 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; allowance for doubtful accounts; 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. Prior period reclassifications Certain amortization expense related to intangible assets previously reported in general and administrative expenses have been reclassified to acquisition-related amortization and remeasurement based on use of the underlying intangible asset. This reclassification resulted in a decrease to general and administrative expenses of $0.1 million and an increase in acquisition related amortization and remeasurement expense of $0.1 million for the three months ended March 31, 2018. Change in Reporting Segments The Company has changed its reportable business segments beginning with the first quarter of 2019, to align with changes in how the Company manages its business, reviews operating performance and allocates resources. The Company now reports results under two reportable segments: Global Spine and Global Extremities, and measures operating performance of these two reportable segments based on EBITDA. For additional discussion regarding segments, see Note 12.

Recently adopted accounting sta

Recently adopted accounting standards and recently issued accounting pronouncements	3 Months Ended
	Mar. 31, 2019
Accounting Changes And Error Corrections [Abstract]
Recently adopted accounting standards and recently issued accounting pronouncements	2. Recently adopted accounting standards and recently issued accounting pronouncements Adoption of ASU 2016-02, Leases (Topic 842) In February 2016 the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-02, which changes how lessees account for leases. For most leases, a liability will be recorded on the balance sheet based on the present value of future lease obligations with a corresponding right-of-use asset. For leases classified as operating leases, the Company will recognize lease costs on a straight-line basis based on the combined amortization of the lease obligation and the right-of-use asset. Other leases will be accounted for as finance leases similar to capital leases under the previous accounting standard. Effective January 1, 2019, the Company adopted ASU 2016-02 using a modified retrospective approach. Upon adoption, the Company elected a package of practical expedients permitted within the new standard. The practical expedients adopted allow the Company to carry forward its historical lease classification and to not separate and allocate the consideration paid between lease and non-lease components included within a contract. The Company also adopted an optional transition method that waives the requirement to apply the ASU to the comparative periods presented within the financial statements in the year of adoption. Therefore, results for reporting periods beginning after January 1, 2019 are presented under Topic 842, while prior period amounts are not adjusted and continue to be reported in accordance with the Company’s historic accounting policies under Topic 840. See Note 5 for additional discussion of the Company’s adoption of Topic 842 and its lease accounting policies. Adoption of ASU 2018-02, Income Statement – Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income In February 2018, the FASB issued ASU 2018-02, which allows entities to reclassify from accumulated other comprehensive income to retained earnings stranded tax effects resulting from the Tax Cuts and Jobs Act (the "Tax Act"). The Company adopted this guidance effective January 1, 2019, which resulted in an increase to accumulated other comprehensive income and a decrease in retained earnings of $0.9 million. Other recently adopted accounting guidance In August 2018, the Securities and Exchange Commission (the “SEC” or the “Commission”) issued SEC Final Rule Release No. 33-10532, Disclosure Update and Simplification Recently issued accounting pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Financial Instruments - Credit Losses (ASU 2016-13) Requires that credit losses for certain types of financial instruments be estimated based on expected losses and also modifies the impairment models for available-for-sale debt securities and for purchased financial assets with credit deterioration since their origination. Applied using a modified retrospective approach, with early adoption permitted. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Goodwill (ASU 2017-04) Eliminates Step 2 of the current goodwill impairment test, which requires a hypothetical purchase price allocation to measure goodwill impairment. A goodwill impairment loss will instead be measured at the amount by which a reporting unit's carrying value exceeds its fair value, not to exceed the recorded amount of goodwill. Applied on a prospective basis, with early adoption permitted. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. However, the Company does not expect this ASU to have a significant impact on its financial statements or disclosures. Fair value measurement (ASU 2018-13) Eliminates such disclosures as the amount of and reasons for transfers between Level 1 and Level 2 of the fair value hierarchy and adds new disclosure requirements for Level 3 measurements. Certain of the provisions are to be applied retrospectively with other provisions applied prospectively. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Topic Description of Guidance Effective Date Status of Company's Evaluation Implementation costs in a cloud computing arrangement that is a service contract (ASU 2018-15) Aligns the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software. The accounting for the service element of a hosting arrangement that is a service contract is not affected by the amendments in this update. Applied either retrospectively or prospectively to all implementation costs incurred after the date of adoption. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements.

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2019
Business Combinations [Abstract]
Acquisitions	3. Acquisitions Acquisition of Spinal Kinetics, Inc. On April 30, 2018, the Company completed the acquisition of Spinal Kinetics Inc. (“Spinal Kinetics”), a privately held developer and manufacturer of artificial cervical and lumbar discs for $45.0 million in net cash, subject to certain adjustments, plus potential milestone payments of up to $60.0 million in cash. The acquisition date fair value of the consideration transferred was $76.6 million. The results of operations for Spinal Kinetics have been included in the Company’s financial results since the acquisition date, April 30, 2018. For additional discussion regarding the valuation of the contingent consideration, see Note 7. The following table summarizes the fair values of assets acquired and liabilities assumed at the acquisition date. During the first quarter of 2019, the Company finalized its valuation of assets acquired and liabilities assumed, which resulted in an adjustment between deferred income taxes and goodwill. (U.S. Dollars, in thousands) Preliminary Acquisition Date Fair Value as Previously Reported Adjustments Final Acquisition Date Fair Value Assigned Useful Life Assets acquired Cash and cash equivalents $ 6,785 $ — $ 6,785 Restricted cash 30 — 30 Accounts receivable 1,705 — 1,705 Inventories 8,175 — 8,175 Prepaid expenses and other current assets 315 — 315 Property, plant and equipment 2,285 — 2,285 Other long-term assets 320 — 320 Developed technology 12,400 — 12,400 10 years In-process research and development ("IPR&D") 26,800 — 26,800 10 years Tradename 100 — 100 2 years Deferred income taxes 2,374 1,220 3,594 Total identifiable assets acquired $ 61,289 $ 1,220 $ 62,509 Liabilities assumed Accounts payable $ 351 $ — $ 351 Other current liabilities 2,873 (4 ) 2,869 Other long-term liabilities 301 — 301 Total liabilities assumed $ 3,525 $ (4 ) $ 3,521 Goodwill 18,836 (1,224 ) 17,612 Total fair value of consideration transferred $ 76,600 $ — $ 76,600 On February 6, 2019, the Company obtained U.S. Food and Drug Administration (“FDA”) approval of the M6-C artificial cervical disc for patients suffering from cervical disease degeneration and started amortizing IPR&D. The $17.6 million of goodwill recognized was assigned to the Global Spine reporting segment. The Company did not recognize any acquisition related costs during the three months ended March 31, 2019 and recorded $1.5 million of acquisition related costs during the three months ended March 31, 2018. These costs are included in the condensed consolidated statements of operations and comprehensive income (loss) within general and administrative expenses. The following table presents the unaudited pro forma results for the three months ended March 31, 2019 and 2018, which combines the historical results of operations of Orthofix and Spinal Kinetics as though the companies had been combined as of January 1, 2018. The unaudited pro forma information is presented for informational purposes only and is not indicative of the results of operations that would have been achieved if the acquisition had taken place at such time. Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 (unaudited) (unaudited) Net sales $ 109,112 $ 112,455 Net income 897 4,899 Options Medical, LLC Asset Acquisition On January 31, 2019, the Company acquired certain assets of Options Medical, LLC, (“Options Medical”) a medical device distributor based in Florida. Under the terms of the acquisition, the parties agreed to terminate an existing exclusive sales representative agreement, employees of Options Medical became employees of the Company and the Company acquired all customer lists and customer information related to the sale of the Company’s products. As consideration for the assets acquired, the Company paid $6.4 million. Additionally, as an inducement to enter into employment with the Company, the Company provided 25,478 restricted stock units (“RSUs”), with a fair value of $1.4 million, to the Options Medical founder. These RSUs will vest in one-third annual increments beginning on the first anniversary of the grant date and are contingent upon continued employment. The following table summarizes the fair values of assets acquired and liabilities assumed at the acquisition date. (U.S. Dollars, in thousands) Fair Value Balance Sheet Classification Assigned Useful Life Assets acquired Operating lease assets $ 175 Other long-term assets Customer relationships 5,832 Intangible assets, net 10 years Assembled workforce 568 Intangible assets, net 5 years Total identifiable assets acquired $ 6,575 Liabilities assumed Operating lease liability - short-term $ 69 Other current liabilities Operating lease liability - long-term 106 Other long-term liabilities Total liabilities assumed 175 Total fair value of consideration transferred $ 6,400

Inventories

Inventories	3 Months Ended
	Mar. 31, 2019
Inventory Disclosure [Abstract]
Inventories	4. Inventories Inventories were as follows: (U.S. Dollars, in thousands) March 31, 2019 December 31, 2018 Raw materials $ 8,359 $ 8,463 Work-in-process 10,442 13,478 Finished products 60,327 54,906 Inventories $ 79,128 $ 76,847

Leases

Leases	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Leases	5. Leases As discussed in Note 2, the Company adopted ASU No. 2016-02— Leases (Topic 842) (U.S. Dollars, in thousands) December 31, 2018 Impact of Adoption of ASC 842 January 1, 2019 Assets Current assets Cash, cash equivalents, and restricted cash $ 72,189 $ — $ 72,189 Accounts receivable, net 77,747 — 77,747 Inventories 76,847 — 76,847 Prepaid expenses and other current assets 17,856 (15 ) 17,841 Total current assets 244,639 (15 ) 244,624 Property, plant, and equipment, net 42,835 — 42,835 Intangible assets, net and goodwill 124,298 — 124,298 Deferred income taxes 33,228 71 33,299 Other long-term assets 21,641 20,209 41,850 Total assets $ 466,641 $ 20,265 $ 486,906 Liabilities and shareholders’ equity Current liabilities Accounts payable $ 17,989 $ — $ 17,989 Other current liabilities 67,919 2,166 70,085 Total current liabilities 85,908 2,166 88,074 Other long-term liabilities 45,336 18,028 63,364 Total liabilities $ 131,244 $ 20,194 $ 151,438 Shareholders’ equity Common shares 1,858 — 1,858 Additional paid-in capital 243,165 — 243,165 Retained earnings 87,078 71 87,149 Accumulated other comprehensive income 3,296 — 3,296 Total shareholders’ equity 335,397 71 335,468 Total liabilities and shareholders’ equity $ 466,641 $ 20,265 $ 486,906 The Company determines if an arrangement is a lease at inception. The Company’s leases primarily relate to facilities, vehicles, and equipment. Lease assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent the obligation to make lease payments arising from the lease. Lease assets and liabilities are recognized at commencement date based on the present value of lease payments over the lease term. As the Company’s leases do not provide an implicit rate, the Company’s incremental borrowing rate is used as a discount rate, based on the information available at the commencement date, in determining the present value of lease payments. Lease assets also include the impact of any prepayments made and are reduced by impact of any lease incentives. The Company has made an accounting policy election for short-term leases, in that the Company will not recognize a lease liability or lease asset on the balance sheet for leases with a lease term of twelve months or less as of the commencement date. Rather, any short-term lease payments will be recognized as an expense on a straight-line basis over the lease term. The current period short-term lease expense reasonably reflects our short-term lease commitments. The Company has made a policy election for all classifications of leases to combine lease and nonlease components and to account for them as a single lease component. Variable lease payments are excluded from the lease liability and recognized in the period in which the obligation is incurred. Additionally, lease terms may include options to extend or terminate the lease when it is reasonably certain that the Company will exercise the option. During the first quarter of 2019, the Company entered into an amendment for its corporate headquarters lease. As a result, the classification of this lease changed from an operating lease to a finance lease, resulting in an increase to both the lease liability and lease asset of approximately $8.0 million. A summary of the Company’s lease portfolio as of March 31, 2019 is presented in the table below: (U.S. Dollars, in thousands, except lease term and discount rate) Classification March 31, 2019 Assets Operating leases Other long-term assets $ 6,758 Finance leases Property, plant and equipment, net 20,940 Total lease assets 27,698 Liabilities Current Operating leases Other current liabilities 1,764 Finance leases Current portion of finance lease liability 359 Long-term Operating leases Other long-term liabilities 5,028 Finance leases Long-term portion of finance lease liability 20,879 Total lease liabilities $ 28,030 Weighted Average Remaining Lease Term Operating leases 4.7 years Finance leases 21.4 years Weighted Average Discount Rate Operating leases 2.48 % Finance leases 4.38 % The components of lease costs were as follows: (U.S. Dollars, in thousands) Three Months Ended March 31, 2019 Finance lease costs: Amortization of right-of-use assets $ 239 Interest on finance lease liabilities 223 Operating lease costs 540 Short-term lease costs 62 Variable lease costs 152 Total lease costs $ 1,216 Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) Three Months Ended March 31, 2019 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 950 Operating cash flows from finance leases 222 Financing cash flows from finance leases 99 Right-of-use assets obtained in exchange for lease obligations Operating leases 200 Finance leases 21,179 A summary of the Company’s remaining lease liabilities as of March 31, 2019 is included below: (U.S. Dollars, in thousands) Operating Leases Finance Leases Year 1 $ 1,886 $ 1,284 Year 2 1,710 1,042 Year 3 1,525 1,421 Year 4 1,107 1,450 Year 5 178 1,479 Thereafter 830 26,835 Total undiscounted value of lease liabilities $ 7,236 $ 33,511 Less: Interest (444 ) (12,273 ) Present value of lease liabilities $ 6,792 $ 21,238 Current portion of lease liabilities 1,764 359 Long-term portion of lease liabilities 5,028 20,879 Total lease liabilities $ 6,792 $ 21,238

Long-term debt

Long-term debt	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Long-term debt	6. Long-term debt As of March 31, 2019, the Company had no borrowings under its five year $125 million secured revolving credit facility. In addition, the Company had no borrowings on its €5.5 million ($6.2 million) available line of credit in Italy as of March 31, 2019. The Company is in compliance with all required financial covenants as of March 31, 2019.

Fair value measurements

Fair value measurements	3 Months Ended
	Mar. 31, 2019
Fair Value Disclosures [Abstract]
Fair value measurements	7. Fair value measurements The fair value of the Company’s financial assets and liabilities measured on a recurring basis were as follows: March 31, 2019 December 31, 2018 (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Treasury securities $ 471 $ — $ — $ 471 $ 490 Bone Biologics equity warrants — — — — — Bone Biologics equity securities — 219 — 219 219 eNeura debt security — — — — 17,820 eNeura warrant — — 491 491 — Total $ 471 $ 219 $ 491 $ 1,181 $ 18,529 Liabilities Contingent consideration $ — $ — $ (18,960 ) $ (18,960 ) $ (28,560 ) Deferred compensation plan — (1,254 ) — (1,254 ) (1,275 ) Total $ — $ (1,254 ) $ (18,960 ) $ (20,214 ) $ (29,835 ) Bone Biologics Equity Warrants and Securities The Company holds investments in common stock and warrants to purchase shares of common stock of Bone Biologics. The Company’s common stock investments are recorded within other long-term assets while the warrants are considered to have a fair value of zero. The equity securities are considered investments that do not have readily determinable fair values. As such, the Company measures these investments at cost, less any impairments, plus or minus changes resulting from observable price changes in orderly transactions for identical or similar investments of the same issuer. The changes in valuation of these securities for the three months ended March 31, 2019 and 2018 are shown below: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Bone Biologics equity securities and warrants beginning balance $ 219 $ 2,768 Impact of adoption of ASU 2016-01 recognized in other income, net — 1,629 Purchase of additional common stock — 500 Bone Biologics equity securities and warrants ending balance $ 219 $ 4,897 eNeura Debt Security and Warrant The Company holds a debt security of eNeura, Inc., a privately held medical technology company that is developing devices for the treatment of migraines. The debt security was originally set to mature on March 4, 2019 . Prior to the restructuring on March 1, 2019, the debt security was accounted for as an available for sale debt security at fair value and included within other long-term assets. The fair value was based upon significant unobservable inputs, including the use of a discounted cash flow model and assumptions regarding the expected payback period for the debt security, requiring the Company For additional discussion regarding the Restructured Debt Security, see Note 7. The Warrant is recorded at fair value and included in other long-term assets. The fair value of the Warrant is based on significant unobservable inputs, including the use of a discounted cash flow model and an option-pricing model, requiring the Company to develop its own assumptions; therefore, the Company has categorized this asset as a Level 3 financial asset. As of March 31, 2019, the fair value of the Warrant was $0.5 million. The following table provides a reconciliation of the beginning and ending balances for the eNeura debt security and warrant measured and reflected in the condensed consolidated balance sheets at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2019 2018 eNeura debt security and warrant at January 1 $ 17,820 $ 16,050 Gains or losses recorded for the period Recognized in other comprehensive income (loss) (2,593 ) — Change in classification of debt security to held to maturity (15,227 ) — Issuance of warrant as consideration for extension 491 eNeura debt security and warrant at March 31 $ 491 $ 16,050 Contingent Consideration The contingent consideration at the acquisition date of Spinal Kinetics consisted of potential future milestone payments of up to $60.0 million in cash. The milestone payments included (i) up to $15.0 million if the FDA grants approval of Spinal Kinetics’ M6-C artificial cervical disc (the “FDA Milestone”) and (ii) revenue-based milestone payments of up to $45.0 million in connection with future sales of the M6-C artificial cervical disc and the M6-L artificial lumbar disc. Milestones must be achieved within five years of April 30, 2018 to trigger applicable payments. On February 6, 2019, the Company obtained FDA approval of the M6-C artificial cervical disc. This approval triggered the Company’s payment obligation of $15.0 million for the achievement of the FDA Milestone and such obligation was paid on February 14, 2019. The fair value of the remaining contingent consideration was $19.0 million as of March 31, 2019; however, the actual amount ultimately paid could be higher or lower than the fair value of the remaining contingent consideration. The remaining liability attributable to the revenue-based milestones is included within other long-term liabilities. Any changes in fair value are recorded as an operating expense and included within acquisition-related amortization and remeasurement. The Company estimated the fair value of the remaining potential future revenue-based milestone payments using a Monte Carlo simulation. This fair value measurement is based on significant inputs that are unobservable in the market, and thus represents a Level 3 measurement. The key assumptions in applying the Monte Carlo valuation model include the Company’s forecasted future revenues for Spinal Kinetics products, discount rate applied, and assumptions for potential volatility of the Company’s forecasted revenue. Significant changes in these assumptions could result in a significantly higher or lower fair value. The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2019 Contingent consideration at January 1 $ 28,560 Increase in fair value recognized in operating expenses 5,400 Payment made (15,000 ) Contingent consideration at March 31 $ 18,960

Investments

Investments	3 Months Ended
	Mar. 31, 2019
Investments Debt And Equity Securities [Abstract]
Investments	8. Investments As a result of the restructuring of the eNeura debt security discussed in Note 7, the eNeura debt security was reclassified from an available for sale debt security to a held to maturity debt security at its fair value on the date of the restructuring. The unrealized gain included in accumulated other comprehensive income at the restructuring date continues to be included in other comprehensive income and is now being amortized to interest income over the remaining life of the Restructured Debt Security. The Restructured Debt Security will be evaluated for impairment based on management’s estimate of future cash collections discounted using the debt security’s original effective interest rate of 8%. Management’s estimate of future cash flows involves significant judgment regarding the timing, expected events, and amount of future cash collections. Decreases in management’s estimate of future cash collections could result in significant charges to bad debt expense. As of March 31, 2019, the Company’s amortized cost basis in the Restructured Note was $ 14.7 million, which also represents its carrying value, compared to an estimated fair value of $ 15.6 million and an unpaid principal balance of $ 15.0 million.

Contingencies

Contingencies	3 Months Ended
	Mar. 31, 2019
Commitments And Contingencies Disclosure [Abstract]
Contingencies	9. Contingencies In addition to the matters described below, in the normal course of its business, the Company is involved in various lawsuits from time to time and may be subject to certain other contingencies. The Company believes any losses related to these matters are individually and collectively immaterial as to a possible loss and range of loss. Italian Medical Device Payback (“IMDP”) In 2015, the Italian Parliament introduced rules for entities that supply goods and services to the Italian National Healthcare System. The healthcare law is expected to impact the business and financial reporting of companies operating in the medical technology sector that sell medical devices in Italy. A key provision of the law is a ‘payback’ measure, requiring companies selling medical devices in Italy to make payments to the Italian government if medical device expenditures exceed regional maximum ceilings. Companies are required to make payments equal to a percentage of expenditures exceeding maximum regional caps. There is considerable uncertainty about how the law will operate and what the exact timeline is for finalization. The Company’s current assessment of the IMDP involves significant judgment regarding the expected scope and actual implementation terms of the measure as the latter have not been clarified to date by Italian authorities. The Company accounts for the estimated cost of the IMDP as sales and marketing expense and recorded expense of $0.3 million for the three months ended March 31, 2019 and 2018, respectively. As of March 31, 2019, the Company has accrued $3.9 million related to the IMDP, which it has classified within other long-term liabilities; however, the actual liability could be higher or lower than the amount accrued once the law has been clarified by the Italian authorities. Brazil In July 2018, the Federal Prosecution Service in Rio de Janeiro and representatives from the Brazilian antitrust authority inspected the offices of more than 30 companies, including the Company’s office in São Paulo, as part of an investigation into tender irregularities in the medical device industry. Before doing so, the authorities obtained a court order affecting the Company’s (and other companies’) local bank accounts resulting in the freezing of approximately $2.5 million of the Company’s cash, which the Company reclassified to restricted cash. On April 3, 2019, the Company’s appeal regarding the freezing of its local bank accounts was heard by the Brazil Federal Court of Appeals of Rio de Janeiro, in which the Court ordered the unfreezing of the Company’s cash. The cash was then returned without any restrictions in April 2019.

Accumulated other comprehensive

Accumulated other comprehensive Income	3 Months Ended
	Mar. 31, 2019
Equity [Abstract]
Accumulated other comprehensive Income	10. Accumulated other comprehensive income The components of and changes in accumulated other comprehensive income were as follows: (U.S. Dollars, in thousands) Currency Translation Adjustments Debt Security Accumulated Other Comprehensive Income Balance at December 31, 2018 $ (2,386 ) $ 5,682 $ 3,296 Cumulative effect adjustment from adoption of ASU 2018-02 — 938 938 Other comprehensive loss (449 ) (2,593 ) (3,042 ) Income taxes — 641 641 Balance at March 31, 2019 $ (2,835 ) $ 4,668 $ 1,833

Revenue recognition and account

Revenue recognition and accounts receivable	3 Months Ended
	Mar. 31, 2019
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	11. Revenue recognition and accounts receivable Revenue Recognition The Company has two reporting segments, which consist of Global Spine and Global Extremities. Within the Global Spine reporting segment there are three product categories: Bone Growth Therapies, Spinal Implants and Biologics. The tables below present net sales by major product category by reporting segment: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Change Bone Growth Therapies $ 47,283 $ 46,163 2.4 % Spinal Implants 22,903 20,707 10.6 % Biologics 15,732 14,335 9.7 % Global Spine 85,918 81,205 5.8 % Global Extremities 23,194 27,504 -15.7 % Net sales $ 109,112 $ 108,709 0.4 % Product Sales and Marketing Service Fees The table below presents net sales, which includes product sales and marketing service fees, for the three months ended March 31, 2019 and 2018. Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Product sales $ 93,934 $ 94,889 Marketing service fees 15,178 13,820 Net sales $ 109,112 $ 108,709 Product sales primarily consist of the sale of bone growth therapy devices and internal and external fixation products. Marketing service fees are received from MTF Biologics based on total sales of biologics tissues and relate solely to the Global Spine reporting segment. Revenues exclude any value added or other local taxes, intercompany sales and trade discounts. Shipping and handling costs for products shipped to customers are included in cost of sales. Other Contract Assets The Company’s contract assets, excluding trade accounts receivable (“other contract assets”), largely consist of payments made to certain distributors to obtain contracts, gain access to customers in certain territories, and to provide the benefit of the exclusive distribution of Orthofix products. Other contract assets are included in other long-term assets or other current assets, dependent upon the original term of the related agreement, and totaled $2.7 million and $1.9 million as of March 31, 2019, and December 31, 2018, respectively.

Business segment information

Business segment information	3 Months Ended
	Mar. 31, 2019
Segment Reporting [Abstract]
Business segment information	12. Business segment information During the first quarter of 2019, the Company changed its reporting segments from four reporting segments, previously reported as Bone Growth Therapies, Spinal Implants, Biologics, and Orthofix Extremities, to two reporting segments: Global Spine and Global Extremities. Additionally, the Company changed the performance measure used to evaluate segment performance from Non-GAAP net margin to earnings before interest income (expense), net, income taxes, depreciation and amortization (“EBITDA”). These changes were made to align how the chief operating decision maker manages the business, reviews operating performance and allocates resources. The Company has revised its segment reporting to represent how the business is now managed and restated prior periods to conform to the current segment presentation. As part of the change in reporting segments, the Company performed a quantitative assessment of goodwill immediately prior to and subsequently following the change in reporting segments. The analysis did not result in an impairment. In addition, the net carrying value of goodwill that was previously reported under the prior reporting segments (i) Bone Growth Therapies (ii) Spinal Implants and (iii) Biologics have been consolidated and are included within the Global Spine reporting segment as of March 31, 2019. As mentioned above, the primary metric used in managing the Company is EBITDA. The table below presents EBITDA by reporting segment: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Global Spine $ 10,575 $ 18,825 Global Extremities (173 ) 3,328 Corporate (9,527 ) (7,002 ) Total EBITDA $ 875 $ 15,151 Depreciation and amortization (5,727 ) (4,369 ) Interest expense, net (257 ) (183 ) Income (loss) before income taxes $ (5,109 ) $ 10,599 Geographical information The table below present net sales by geographic destination for each reporting unit and for the consolidated Company: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Global Spine U.S. $ 79,526 $ 78,038 International 6,392 3,167 Total Global Spine 85,918 81,205 Global Extremities U.S. 6,598 6,916 International 16,596 20,588 Total Global Extremities 23,194 27,504 Consolidated U.S. 86,124 84,954 International 22,988 23,755 Net sales $ 109,112 $ 108,709

Acquisition-Related Amortizatio

Acquisition-Related Amortization and Remeasurement	3 Months Ended
	Mar. 31, 2019
Acquisition Related Amortization And Remeasurement [Abstract]
Acquisition-Related Amortization and Remeasurement	13. Acquisition-related amortization and remeasurement Acquisition-related amortization and remeasurement consists of amortization related to intangible assets acquired through business combinations or asset acquisitions and the remeasurement of any related contingent consideration arrangement. Components of acquisition-related amortization and remeasurement for the three months ended March 31, 2019 and 2018, respectively, are as follows: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Changes in fair value of contingent consideration $ 5,400 $ — Amortization of acquired intangibles 1,057 63 Acquisition-related amortization and remeasurement $ 6,457 $ 63

Share-based compensation

Share-based compensation	3 Months Ended
	Mar. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Share-based compensation	14. Share-based compensation The following tables present the detail of share-based compensation by line item in the condensed consolidated statements of operations and comprehensive income (loss) as well as by award type: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Cost of sales $ 187 $ 125 Sales and marketing 610 449 General and administrative 4,564 3,045 Research and development 324 297 Total $ 5,685 $ 3,916 Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Stock options $ 2,112 $ 622 Time-based restricted stock awards and units 1,706 1,447 Performance-based restricted stock awards and units — 489 Market-based restricted stock units 1,347 953 Stock purchase plan 520 405 Total $ 5,685 $ 3,916 During the three months ended March 31, 2019 and 2018, the Company issued 211,081 and 126,511 shares, respectively, of common stock related to stock purchase plan issuances, stock option exercises and the vesting of restricted stock awards and units. Share-Based Compensation Modifications During the first quarter of 2019, the Company entered into a Transition and Retirement Agreement (the “Retirement Agreement”) with the Company’s President and Chief Executive Officer. As part of the Retirement Agreement, certain time-based stock options and restricted stock awards were modified to accelerate the vesting to the retirement date. In addition, stock options were modified to extend the post-termination exercise period from 18 months under a standard qualified retirement to up to four years, dependent upon the remaining contractual term of the options. The Company recognized approximately $2.1 million in share-based compensation expense during the three months ended March 31, 2019, related to the Retirement Agreement which was charged to general and administrative expense in the condensed consolidated statements of operations and comprehensive income (loss).

Income taxes

Income taxes	3 Months Ended
	Mar. 31, 2019
Income Tax Disclosure [Abstract]
Income taxes	15. Income taxes Income tax provisions for interim periods are based on an estimated annual income tax rate, adjusted for discrete tax items. As a result, the Company’s interim effective tax rates may vary significantly from the statutory tax rate and the annual effective tax rate. For the three months ended March 31, 2019 and 2018, the effective tax rate on continuing operations was 117.6% and 50.7%, respectively. The primary factors affecting the Company’s effective tax rate for the three months ended March 31, 2019, were increased limits on executive compensation, financial expenses not deductible for tax purposes, and benefits related to effective settlement of the 2015 federal tax examination and statute expirations. During the first quarter of 2019, the Internal Revenue Service concluded an examination of the Company’s federal income tax return for 2015, which resulted in a benefit of $1.8 million. The Company believes it is reasonably possible that, in the next 12 months, the amount of unrecognized tax benefits related to the resolution of federal, state and foreign matters could be reduced by $13.0 million to $13.4 million as audits close and statutes expire.

Earnings per share ("EPS")

Earnings per share ("EPS")	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Earnings per share ("EPS")	16. Earnings per share (“EPS”) The Company uses the two-class method of computing basic EPS due to the existence of non-vested restricted stock awards with nonforfeitable rights to dividends or dividend equivalents (referred to as participating securities). For the three months ended March 31, 2019 and 2018, no significant adjustments were made to net income for purposes of calculating basic and diluted EPS. The following is a reconciliation of the weighted average shares used in diluted EPS computations. Three Months Ended March 31, 2019 2018 Weighted average common shares-basic 18,750,184 18,404,856 Effect of dilutive securities Unexercised stock options and stock purchase plan 277,992 308,537 Unvested restricted stock awards and units 162,970 161,198 Weighted average common shares-diluted 19,191,146 18,874,591 There were 484,421 and 122,678 weighted average outstanding stock options and restricted stock awards and units not included in the diluted EPS computation for the three months ended March 31, 2019 and 2018, respectively, because inclusion of these awards was anti-dilutive or, for performance-based and market-based restricted stock awards and units, all necessary conditions had not been satisfied by the end of the respective period.

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2019
Subsequent Events [Abstract]
Subsequent Events	17. Subsequent Events On April 3, 2019, the Company’s appeal regarding the freezing of its local bank accounts in Brazil was heard by the Brazil Federal Court of Appeals of Rio de Janeiro, in which the Court ordered the unfreezing of the Company’s cash. Approximately $2.5 million was then returned without any restrictions in April 2019. For additional discussion regarding the matter, see Note 9.

Recently adopted accounting s_2

Recently adopted accounting standards and recently issued accounting pronouncements (Policies)	3 Months Ended
	Mar. 31, 2019
Accounting Changes And Error Corrections [Abstract]
Recently adopted accounting standards and recently issued accounting pronouncements	Adoption of ASU 2016-02, Leases (Topic 842) In February 2016 the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-02, which changes how lessees account for leases. For most leases, a liability will be recorded on the balance sheet based on the present value of future lease obligations with a corresponding right-of-use asset. For leases classified as operating leases, the Company will recognize lease costs on a straight-line basis based on the combined amortization of the lease obligation and the right-of-use asset. Other leases will be accounted for as finance leases similar to capital leases under the previous accounting standard. Effective January 1, 2019, the Company adopted ASU 2016-02 using a modified retrospective approach. Upon adoption, the Company elected a package of practical expedients permitted within the new standard. The practical expedients adopted allow the Company to carry forward its historical lease classification and to not separate and allocate the consideration paid between lease and non-lease components included within a contract. The Company also adopted an optional transition method that waives the requirement to apply the ASU to the comparative periods presented within the financial statements in the year of adoption. Therefore, results for reporting periods beginning after January 1, 2019 are presented under Topic 842, while prior period amounts are not adjusted and continue to be reported in accordance with the Company’s historic accounting policies under Topic 840. See Note 5 for additional discussion of the Company’s adoption of Topic 842 and its lease accounting policies. Adoption of ASU 2018-02, Income Statement – Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income In February 2018, the FASB issued ASU 2018-02, which allows entities to reclassify from accumulated other comprehensive income to retained earnings stranded tax effects resulting from the Tax Cuts and Jobs Act (the "Tax Act"). The Company adopted this guidance effective January 1, 2019, which resulted in an increase to accumulated other comprehensive income and a decrease in retained earnings of $0.9 million. Other recently adopted accounting guidance In August 2018, the Securities and Exchange Commission (the “SEC” or the “Commission”) issued SEC Final Rule Release No. 33-10532, Disclosure Update and Simplification Recently issued accounting pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Financial Instruments - Credit Losses (ASU 2016-13) Requires that credit losses for certain types of financial instruments be estimated based on expected losses and also modifies the impairment models for available-for-sale debt securities and for purchased financial assets with credit deterioration since their origination. Applied using a modified retrospective approach, with early adoption permitted. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Goodwill (ASU 2017-04) Eliminates Step 2 of the current goodwill impairment test, which requires a hypothetical purchase price allocation to measure goodwill impairment. A goodwill impairment loss will instead be measured at the amount by which a reporting unit's carrying value exceeds its fair value, not to exceed the recorded amount of goodwill. Applied on a prospective basis, with early adoption permitted. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. However, the Company does not expect this ASU to have a significant impact on its financial statements or disclosures. Fair value measurement (ASU 2018-13) Eliminates such disclosures as the amount of and reasons for transfers between Level 1 and Level 2 of the fair value hierarchy and adds new disclosure requirements for Level 3 measurements. Certain of the provisions are to be applied retrospectively with other provisions applied prospectively. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Topic Description of Guidance Effective Date Status of Company's Evaluation Implementation costs in a cloud computing arrangement that is a service contract (ASU 2018-15) Aligns the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software. The accounting for the service element of a hosting arrangement that is a service contract is not affected by the amendments in this update. Applied either retrospectively or prospectively to all implementation costs incurred after the date of adoption. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements.

Acquisitions (Tables)

Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2019
Business Acquisition [Line Items]
Summary of Unaudited Pro forma Results	The following table presents the unaudited pro forma results for the three months ended March 31, 2019 and 2018, Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 (unaudited) (unaudited) Net sales $ 109,112 $ 112,455 Net income 897 4,899
Spinal Kinetics [Member]
Business Acquisition [Line Items]
Summary of Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the fair values of assets acquired and liabilities assumed at the acquisition date. During the first quarter of 2019, the Company finalized its valuation of assets acquired and liabilities assumed, which resulted in an adjustment between deferred income taxes and goodwill. (U.S. Dollars, in thousands) Preliminary Acquisition Date Fair Value as Previously Reported Adjustments Final Acquisition Date Fair Value Assigned Useful Life Assets acquired Cash and cash equivalents $ 6,785 $ — $ 6,785 Restricted cash 30 — 30 Accounts receivable 1,705 — 1,705 Inventories 8,175 — 8,175 Prepaid expenses and other current assets 315 — 315 Property, plant and equipment 2,285 — 2,285 Other long-term assets 320 — 320 Developed technology 12,400 — 12,400 10 years In-process research and development ("IPR&D") 26,800 — 26,800 10 years Tradename 100 — 100 2 years Deferred income taxes 2,374 1,220 3,594 Total identifiable assets acquired $ 61,289 $ 1,220 $ 62,509 Liabilities assumed Accounts payable $ 351 $ — $ 351 Other current liabilities 2,873 (4 ) 2,869 Other long-term liabilities 301 — 301 Total liabilities assumed $ 3,525 $ (4 ) $ 3,521 Goodwill 18,836 (1,224 ) 17,612 Total fair value of consideration transferred $ 76,600 $ — $ 76,600
Options Medical [Member]
Business Acquisition [Line Items]
Summary of Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the fair values of assets acquired and liabilities assumed at the acquisition date. (U.S. Dollars, in thousands) Fair Value Balance Sheet Classification Assigned Useful Life Assets acquired Operating lease assets $ 175 Other long-term assets Customer relationships 5,832 Intangible assets, net 10 years Assembled workforce 568 Intangible assets, net 5 years Total identifiable assets acquired $ 6,575 Liabilities assumed Operating lease liability - short-term $ 69 Other current liabilities Operating lease liability - long-term 106 Other long-term liabilities Total liabilities assumed 175 Total fair value of consideration transferred $ 6,400

Inventories (Tables)

Inventories (Tables)	3 Months Ended
	Mar. 31, 2019
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories were as follows: (U.S. Dollars, in thousands) March 31, 2019 December 31, 2018 Raw materials $ 8,359 $ 8,463 Work-in-process 10,442 13,478 Finished products 60,327 54,906 Inventories $ 79,128 $ 76,847

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2019
Summary of Lease Portfolio	A summary of the Company’s lease portfolio as of March 31, 2019 is presented in the table below: (U.S. Dollars, in thousands, except lease term and discount rate) Classification March 31, 2019 Assets Operating leases Other long-term assets $ 6,758 Finance leases Property, plant and equipment, net 20,940 Total lease assets 27,698 Liabilities Current Operating leases Other current liabilities 1,764 Finance leases Current portion of finance lease liability 359 Long-term Operating leases Other long-term liabilities 5,028 Finance leases Long-term portion of finance lease liability 20,879 Total lease liabilities $ 28,030 Weighted Average Remaining Lease Term Operating leases 4.7 years Finance leases 21.4 years Weighted Average Discount Rate Operating leases 2.48 % Finance leases 4.38 %
Summary of Components of Lease Costs	The components of lease costs were as follows: (U.S. Dollars, in thousands) Three Months Ended March 31, 2019 Finance lease costs: Amortization of right-of-use assets $ 239 Interest on finance lease liabilities 223 Operating lease costs 540 Short-term lease costs 62 Variable lease costs 152 Total lease costs $ 1,216
Summary of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) Three Months Ended March 31, 2019 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 950 Operating cash flows from finance leases 222 Financing cash flows from finance leases 99 Right-of-use assets obtained in exchange for lease obligations Operating leases 200 Finance leases 21,179
Summary of Remaining Lease Liabilities	A summary of the Company’s remaining lease liabilities as of March 31, 2019 is included below: (U.S. Dollars, in thousands) Operating Leases Finance Leases Year 1 $ 1,886 $ 1,284 Year 2 1,710 1,042 Year 3 1,525 1,421 Year 4 1,107 1,450 Year 5 178 1,479 Thereafter 830 26,835 Total undiscounted value of lease liabilities $ 7,236 $ 33,511 Less: Interest (444 ) (12,273 ) Present value of lease liabilities $ 6,792 $ 21,238 Current portion of lease liabilities 1,764 359 Long-term portion of lease liabilities 5,028 20,879 Total lease liabilities $ 6,792 $ 21,238
ASU 2016-02 [Member]
Summary of Net Impact of Adoption Balance Sheet	The net impact of adoption to the Company’s balance sheet as of January 1, 2019 is presented in the table below. The standard did not have a material impact to the Company’s condensed consolidated statements of operations and comprehensive income (loss) or cash flows. (U.S. Dollars, in thousands) December 31, 2018 Impact of Adoption of ASC 842 January 1, 2019 Assets Current assets Cash, cash equivalents, and restricted cash $ 72,189 $ — $ 72,189 Accounts receivable, net 77,747 — 77,747 Inventories 76,847 — 76,847 Prepaid expenses and other current assets 17,856 (15 ) 17,841 Total current assets 244,639 (15 ) 244,624 Property, plant, and equipment, net 42,835 — 42,835 Intangible assets, net and goodwill 124,298 — 124,298 Deferred income taxes 33,228 71 33,299 Other long-term assets 21,641 20,209 41,850 Total assets $ 466,641 $ 20,265 $ 486,906 Liabilities and shareholders’ equity Current liabilities Accounts payable $ 17,989 $ — $ 17,989 Other current liabilities 67,919 2,166 70,085 Total current liabilities 85,908 2,166 88,074 Other long-term liabilities 45,336 18,028 63,364 Total liabilities $ 131,244 $ 20,194 $ 151,438 Shareholders’ equity Common shares 1,858 — 1,858 Additional paid-in capital 243,165 — 243,165 Retained earnings 87,078 71 87,149 Accumulated other comprehensive income 3,296 — 3,296 Total shareholders’ equity 335,397 71 335,468 Total liabilities and shareholders’ equity $ 466,641 $ 20,265 $ 486,906

Fair value measurements (Tables

Fair value measurements (Tables)	3 Months Ended
	Mar. 31, 2019
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis	The fair value of the Company’s financial assets and liabilities measured on a recurring basis were as follows: March 31, 2019 December 31, 2018 (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Treasury securities $ 471 $ — $ — $ 471 $ 490 Bone Biologics equity warrants — — — — — Bone Biologics equity securities — 219 — 219 219 eNeura debt security — — — — 17,820 eNeura warrant — — 491 491 — Total $ 471 $ 219 $ 491 $ 1,181 $ 18,529 Liabilities Contingent consideration $ — $ — $ (18,960 ) $ (18,960 ) $ (28,560 ) Deferred compensation plan — (1,254 ) — (1,254 ) (1,275 ) Total $ — $ (1,254 ) $ (18,960 ) $ (20,214 ) $ (29,835 )
Schedule of Changes in Valuation of Securities	The changes in valuation of these securities for the three months ended March 31, 2019 and 2018 are shown below: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Bone Biologics equity securities and warrants beginning balance $ 219 $ 2,768 Impact of adoption of ASU 2016-01 recognized in other income, net — 1,629 Purchase of additional common stock — 500 Bone Biologics equity securities and warrants ending balance $ 219 $ 4,897
Schedule of Reconciliation For Contingent Consideration Measured At Fair Value Using Significant Unobservable Inputs	The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2019 Contingent consideration at January 1 $ 28,560 Increase in fair value recognized in operating expenses 5,400 Payment made (15,000 ) Contingent consideration at March 31 $ 18,960
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Schedule of Reconciliation of Debt Security and Warrant	The following table provides a reconciliation of the beginning and ending balances for the eNeura debt security and warrant measured and reflected in the condensed consolidated balance sheets at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2019 2018 eNeura debt security and warrant at January 1 $ 17,820 $ 16,050 Gains or losses recorded for the period Recognized in other comprehensive income (loss) (2,593 ) — Change in classification of debt security to held to maturity (15,227 ) — Issuance of warrant as consideration for extension 491 eNeura debt security and warrant at March 31 $ 491 $ 16,050

Accumulated other comprehensi_2

Accumulated other comprehensive Income (Tables)	3 Months Ended
	Mar. 31, 2019
Equity [Abstract]
Components of Changes in Accumulated Other Comprehensive Income (Loss)	The components of and changes in accumulated other comprehensive income were as follows: (U.S. Dollars, in thousands) Currency Translation Adjustments Debt Security Accumulated Other Comprehensive Income Balance at December 31, 2018 $ (2,386 ) $ 5,682 $ 3,296 Cumulative effect adjustment from adoption of ASU 2018-02 — 938 938 Other comprehensive loss (449 ) (2,593 ) (3,042 ) Income taxes — 641 641 Balance at March 31, 2019 $ (2,835 ) $ 4,668 $ 1,833

Revenue recognition and accou_2

Revenue recognition and accounts receivable (Tables)	3 Months Ended
	Mar. 31, 2019
Revenue Recognition And Accounts Receivable [Abstract]
Schedule of Net Sales by Major Product Category by Reporting Segment	The tables below present net sales by major product category by reporting segment: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Change Bone Growth Therapies $ 47,283 $ 46,163 2.4 % Spinal Implants 22,903 20,707 10.6 % Biologics 15,732 14,335 9.7 % Global Spine 85,918 81,205 5.8 % Global Extremities 23,194 27,504 -15.7 % Net sales $ 109,112 $ 108,709 0.4 %
Schedule of Net Sales	The table below presents net sales, which includes product sales and marketing service fees, for the three months ended March 31, 2019 and 2018. Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Product sales $ 93,934 $ 94,889 Marketing service fees 15,178 13,820 Net sales $ 109,112 $ 108,709

Business segment information (T

Business segment information (Tables)	3 Months Ended
	Mar. 31, 2019
Segment Reporting [Abstract]
Summary of EBIDTA by Reporting Segment	As mentioned above, the primary metric used in managing the Company is EBITDA. The table below presents EBITDA by reporting segment: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Global Spine $ 10,575 $ 18,825 Global Extremities (173 ) 3,328 Corporate (9,527 ) (7,002 ) Total EBITDA $ 875 $ 15,151 Depreciation and amortization (5,727 ) (4,369 ) Interest expense, net (257 ) (183 ) Income (loss) before income taxes $ (5,109 ) $ 10,599
Summary of Net Sales by Geographic Destination for Each Reporting Unit	Geographical information The table below present net sales by geographic destination for each reporting unit and for the consolidated Company: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Global Spine U.S. $ 79,526 $ 78,038 International 6,392 3,167 Total Global Spine 85,918 81,205 Global Extremities U.S. 6,598 6,916 International 16,596 20,588 Total Global Extremities 23,194 27,504 Consolidated U.S. 86,124 84,954 International 22,988 23,755 Net sales $ 109,112 $ 108,709

Acquisition-Related Amortizat_2

Acquisition-Related Amortization and Remeasurement (Tables)	3 Months Ended
	Mar. 31, 2019
Acquisition Related Amortization And Remeasurement [Abstract]
Components of Acquisition-Related Amortization and Remeasurement	Components of acquisition-related amortization and remeasurement for the three months ended March 31, 2019 and 2018, respectively, are as follows: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Changes in fair value of contingent consideration $ 5,400 $ — Amortization of acquired intangibles 1,057 63 Acquisition-related amortization and remeasurement $ 6,457 $ 63

Share-based compensation (Table

Share-based compensation (Tables)	3 Months Ended
	Mar. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Schedule of Share-Based Compensation by Line Item in Condensed Consolidated Statements of Operations and Comprehensive Income (Loss)	The following tables present the detail of share-based compensation by line item in the condensed consolidated statements of operations and comprehensive income (loss) as well as by award type: Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Cost of sales $ 187 $ 125 Sales and marketing 610 449 General and administrative 4,564 3,045 Research and development 324 297 Total $ 5,685 $ 3,916 Three Months Ended March 31, (U.S. Dollars, in thousands) 2019 2018 Stock options $ 2,112 $ 622 Time-based restricted stock awards and units 1,706 1,447 Performance-based restricted stock awards and units — 489 Market-based restricted stock units 1,347 953 Stock purchase plan 520 405 Total $ 5,685 $ 3,916

Earnings per share ("EPS") (Tab

Earnings per share ("EPS") (Tables)	3 Months Ended
	Mar. 31, 2019
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 March 31, 2019 2018 Weighted average common shares-basic 18,750,184 18,404,856 Effect of dilutive securities Unexercised stock options and stock purchase plan 277,992 308,537 Unvested restricted stock awards and units 162,970 161,198 Weighted average common shares-diluted 19,191,146 18,874,591

Business and Basis of Presentat

Business and Basis of Presentation - Additional Information (Detail) $ in Millions	3 Months Ended
	Mar. 31, 2019Segment	Mar. 31, 2018USD ($)
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Number Of Reporting Units | Segment	2
General and Administrative Expenses [Member]
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Prior period reclassification adjustment		$ (0.1)
Acquisition Related Amortization and Remeasurement Expense [Member]
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Prior period reclassification adjustment		$ 0.1

Recently Adopted Accounting S_3

Recently Adopted Accounting Standards and Recently Issued Accounting Pronouncements - Additional Information (Detail) $ in Millions	Jan. 01, 2019USD ($)
ASU 2018-02 [Member]
Summary Of Significant Accounting Policies [Line Items]
Increase to accumulated other comprehensive income and a decrease in retained earnings	$ 0.9

Acquisitions - Additional Infor

Acquisitions - Additional Information (Detail) - USD ($) shares in Millions	Jan. 31, 2019	Apr. 30, 2018	Mar. 31, 2019	Mar. 31, 2018	Feb. 06, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Goodwill			$ 71,177,000			$ 72,401,000
Consideration for the asssets acquired	$ 6,400,000
Options Medical Founder [Member]
Business Acquisition [Line Items]
Share based compensation, grant of restricted stock units	25,478
Share based compensation, grant fair value of restricted stock units	$ 1,400,000
Share based compensation, vesting rights of RSUs	33.33%
Spinal Kinetics [Member]
Business Acquisition [Line Items]
Business acquisition date		Apr. 30, 2018
Business acquisition conversion of shares into net cash subject to adjustments		$ 45,000,000
Fair value of the consideration transferred		76,600,000
Goodwill		17,612,000
Acquisition related costs			0	$ 1,500,000
Revenue from acquisition			3,100,000
Net loss from Acquisition			$ 4,000,000
Spinal Kinetics [Member] | Global Spine [Member]
Business Acquisition [Line Items]
Goodwill					$ 17,600,000
Spinal Kinetics [Member] | Maximum [Member]
Business Acquisition [Line Items]
Future milestone payments		$ 60,000,000

Acquisitions - Summary of Fair

Acquisitions - Summary of Fair Values of Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands	Jan. 31, 2019	Apr. 30, 2018	Mar. 31, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Goodwill			$ 71,177	$ 72,401
Spinal Kinetics [Member]
Business Acquisition [Line Items]
Cash and cash equivalents		$ 6,785
Restricted cash		30
Accounts receivable		1,705
Inventories		8,175
Prepaid expenses and other current assets		315
Property, plant and equipment		2,285
Other long-term assets		320
Deferred income taxes		3,594
Total identifiable assets acquired		62,509
Accounts payable		351
Other current liabilities		2,869
Other long-term liabilities		301
Total liabilities assumed		3,521
Goodwill		17,612
Total fair value of consideration transferred		76,600
Spinal Kinetics [Member] | Previously Reported [Member]
Business Acquisition [Line Items]
Cash and cash equivalents		6,785
Restricted cash		30
Accounts receivable		1,705
Inventories		8,175
Prepaid expenses and other current assets		315
Property, plant and equipment		2,285
Other long-term assets		320
Deferred income taxes		2,374
Total identifiable assets acquired		61,289
Accounts payable		351
Other current liabilities		2,873
Other long-term liabilities		301
Total liabilities assumed		3,525
Goodwill		18,836
Total fair value of consideration transferred		76,600
Spinal Kinetics [Member] | Adjustments [Member]
Business Acquisition [Line Items]
Deferred income taxes		1,220
Total identifiable assets acquired		1,220
Other current liabilities		(4)
Total liabilities assumed		(4)
Goodwill		(1,224)
Options Medical [Member]
Business Acquisition [Line Items]
Total identifiable assets acquired	$ 6,575
Total liabilities assumed	175
Total fair value of consideration transferred	6,400
Options Medical [Member] | Operating Lease Liability - Short-term [Member]
Business Acquisition [Line Items]
Other current liabilities	69
Options Medical [Member] | Operating Lease Liability - Long-term [Member]
Business Acquisition [Line Items]
Other long-term liabilities	106
Options Medical [Member] | Operating Lease Assets [Member]
Business Acquisition [Line Items]
Other long-term assets	175
Developed Technology [Member] | Spinal Kinetics [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 12,400
Assigned Useful Life		10 years
Developed Technology [Member] | Spinal Kinetics [Member] | Previously Reported [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 12,400
In-process Research and Development ("IPR&D") [Member] | Spinal Kinetics [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 26,800
Assigned Useful Life		10 years
In-process Research and Development ("IPR&D") [Member] | Spinal Kinetics [Member] | Previously Reported [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 26,800
Tradename [Member] | Spinal Kinetics [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 100
Assigned Useful Life		2 years
Tradename [Member] | Spinal Kinetics [Member] | Previously Reported [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 100
Customer Relationships [Member] | Options Medical [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired	$ 5,832
Assigned Useful Life	10 years
Assembled Workforce [Member] | Options Medical [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired	$ 568
Assigned Useful Life	5 years

Acquisitions - Summary of Unaud

Acquisitions - Summary of Unaudited Pro forma Results (Detail) - Spinal Kinetics [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Business Acquisition [Line Items]
Net sales	$ 109,112	$ 112,455
Net income	$ 897	$ 4,899

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Raw materials	$ 8,359	$ 8,463
Work-in-process	10,442	13,478
Finished products	60,327	54,906
Inventories	$ 79,128	$ 76,847

Leases - Additional Information

Leases - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Jan. 01, 2019
Leases [Abstract]
Additional lease assets		$ 20.2
Additional lease liabilities		$ 20.5
Increase in finance lease liability	$ 8
Increase in finance lease asset	$ 8

Leases - Summary of Net Impact

Leases - Summary of Net Impact of Adoption Balance Sheet (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Jan. 01, 2019	Dec. 31, 2018	Mar. 31, 2018	Dec. 31, 2017
Current assets
Cash, cash equivalents, and restricted cash	$ 49,208		$ 72,189	$ 77,056	$ 81,157
Accounts receivable, net	79,615		77,747
Inventories	79,128		76,847
Prepaid expenses and other current assets	16,387		17,856
Total current assets	224,338		244,639
Property, plant, and equipment, net	63,727		42,835
Intangible assets, net and goodwill			124,298
Deferred income taxes	36,575		33,228
Other long-term assets	26,735		21,641
Total assets	479,316		466,641
Current liabilities
Accounts payable	19,643		17,989
Other current liabilities	43,652		67,919
Total current liabilities	63,654		85,908
Other long-term liabilities	51,101		45,336
Total liabilities	135,634		131,244
Shareholders’ equity
Common shares $0.10 par value; 50,000,000 shares authorized; 18,790,769 and 18,579,688 issued and outstanding as of March 31, 2019 and December 31, 2018, respectively	1,879		1,858
Additional paid-in capital	252,862		243,165
Retained earnings	87,108		87,078
Accumulated other comprehensive income	1,833		3,296
Total shareholders’ equity	343,682		335,397	$ 313,174	$ 296,608
Total liabilities and shareholders’ equity	$ 479,316		466,641
ASU 2016-02 [Member]
Current assets
Cash, cash equivalents, and restricted cash		$ 72,189
Accounts receivable, net		77,747
Inventories		76,847
Prepaid expenses and other current assets		17,841
Total current assets		244,624
Property, plant, and equipment, net		42,835
Intangible assets, net and goodwill		124,298
Deferred income taxes		33,299
Other long-term assets		41,850
Total assets		486,906
Current liabilities
Accounts payable		17,989
Other current liabilities		70,085
Total current liabilities		88,074
Other long-term liabilities		63,364
Total liabilities		151,438
Shareholders’ equity
Common shares $0.10 par value; 50,000,000 shares authorized; 18,790,769 and 18,579,688 issued and outstanding as of March 31, 2019 and December 31, 2018, respectively		1,858
Additional paid-in capital		243,165
Retained earnings		87,149
Accumulated other comprehensive income		3,296
Total shareholders’ equity		335,468
Total liabilities and shareholders’ equity		$ 486,906
ASU 2016-02 [Member] | Impact of Adoption of ASC 842 [Member]
Current assets
Prepaid expenses and other current assets			(15)
Total current assets			(15)
Deferred income taxes			71
Other long-term assets			20,209
Total assets			20,265
Current liabilities
Other current liabilities			2,166
Total current liabilities			2,166
Other long-term liabilities			18,028
Total liabilities			20,194
Shareholders’ equity
Retained earnings			71
Total shareholders’ equity			71
Total liabilities and shareholders’ equity			$ 20,265

Leases - Summary of Lease Portf

Leases - Summary of Lease Portfolio (Detail) $ in Thousands	Mar. 31, 2019USD ($)
Assets
Operating leases	$ 6,758
Operating lease, right-of-use asset, statement of financial position [Extensible List]	us-gaap:OtherAssetsNoncurrent
Finance leases	$ 20,940
Finance lease, right-of-use asset, statement of financial position [Extensible List]	us-gaap:PropertyPlantAndEquipmentNet
Total lease assets	$ 27,698
Current
Operating leases	$ 1,764
Operating lease, liability, current, statement of financial position [Extensible List]	us-gaap:OtherLiabilitiesCurrent
Finance leases	$ 359
Long-term
Operating leases	$ 5,028
Operating lease, liability, noncurrent, statement of financial position [Extensible List]	us-gaap:OtherLiabilitiesNoncurrent
Finance leases	$ 20,879
Total lease liabilities	$ 28,030
Weighted Average Remaining Lease Term
Operating leases	4 years 8 months 12 days
Finance leases	21 years 4 months 24 days
Weighted Average Discount Rate
Operating leases	2.48%
Finance leases	4.38%

Leases - Summary of Components

Leases - Summary of Components of Lease Costs (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Finance lease costs:
Amortization of right-of-use assets	$ 239
Interest on finance lease liabilities	223
Operating lease costs	540
Short-term lease costs	62
Variable lease costs	152
Total lease costs	$ 1,216

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 950
Operating cash flows from finance leases	222
Financing cash flows from finance leases	99
Right-of-use assets obtained in exchange for lease obligations
Operating leases	200
Finance leases	$ 21,179

Leases - Summary of Remaining L

Leases - Summary of Remaining Lease Liabilities (Detail) $ in Thousands	Mar. 31, 2019USD ($)
Operating Leases
Year 1	$ 1,886
Year 2	1,710
Year 3	1,525
Year 4	1,107
Year 5	178
Thereafter	830
Total undiscounted value of lease liabilities	7,236
Less: Interest	(444)
Present value of lease liabilities	6,792
Current portion of lease liabilities	1,764
Long-term portion of lease liabilities	5,028
Total lease liabilities	6,792
Finance Leases
Year 1	1,284
Year 2	1,042
Year 3	1,421
Year 4	1,450
Year 5	1,479
Thereafter	26,835
Total undiscounted value of lease liabilities	33,511
Less: Interest	(12,273)
Present value of lease liabilities	21,238
Current portion of lease liabilities	359
Long-term portion of lease liabilities	20,879
Total lease liabilities	$ 21,238

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2019USD ($)	Mar. 31, 2019EUR (€)	Aug. 31, 2015USD ($)
Italy [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 6,200,000	€ 5,500,000
Amount outstanding under lines of credit	$ 0
2015 Credit Agreement [Member] | Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Debt instrument term (in years)	5 years
Maximum borrowing capacity			$ 125,000,000
Amount outstanding under lines of credit	$ 0

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Warrant [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 500
Fair Value, Measurements, Recurring [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,181	$ 18,529
Contingent consideration	(18,960)	(28,560)
Deferred compensation plan, Liabilities	(1,254)	(1,275)
Liabilities fair value, Total	(20,214)	(29,835)
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	471
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	219
Deferred compensation plan, Liabilities	(1,254)
Liabilities fair value, Total	(1,254)
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	491
Contingent consideration	(18,960)
Liabilities fair value, Total	(18,960)
Fair Value, Measurements, Recurring [Member] | Treasury Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	471	490
Fair Value, Measurements, Recurring [Member] | Treasury Securities [Member] | Fair Value, Inputs, Level 1 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	471
Fair Value, Measurements, Recurring [Member] | Equity Securities [Member] | Bone Biologics Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	219	219
Fair Value, Measurements, Recurring [Member] | Equity Securities [Member] | Fair Value, Inputs, Level 2 [Member] | Bone Biologics Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	219
Fair Value, Measurements, Recurring [Member] | Debt Security [Member] | eNeura Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value		$ 17,820
Fair Value, Measurements, Recurring [Member] | Warrant [Member] | eNeura Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	491
Fair Value, Measurements, Recurring [Member] | Warrant [Member] | Fair Value, Inputs, Level 3 [Member] | eNeura Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 491

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Detail) - USD ($)	Mar. 01, 2019	Feb. 14, 2019	Apr. 30, 2018	Mar. 31, 2019	Feb. 06, 2019
Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Milestone achievement period			5 years
Spinal Kinetics [Member] | Other Long-term Liabilities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration				$ 19,000,000
Maximum [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments			$ 60,000,000
US Food And Drug Administration [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments			15,000,000		$ 15,000,000
Payments obligation for contigent consideration		$ 15,000,000
Revenue Milestone [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments			$ 45,000,000
Fair Value, Inputs, Level 3 [Member] | Warrant [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value of warrant				$ 500,000
eNeura Inc [Member] | Amended and Restated Senior Secured Promissory Note [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Debt maturity date				Mar. 4, 2019
Debt securities, maturity date description				Amended and Restated Senior Secured Promissory Note with eNeura (the “Restructured Debt Security”) to restructure the debt security, which extended the maturity date to the earlier of (i) March 4, 2022, (ii) the effective date of a change in control, or (iii) the effective date of an initial public offering by eNeura and which also eliminated the conversion feature included within the original note.
Warrant exercisable price per share	$ 0.01
Warrant contractual term	10 years
Percentage of number of warrant issued equal to outstanding principal and accrued interest on debt security	10.00%
Debt security subject to certain anti-dilution provision price per share	$ 1
Common Stock [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value of warrants				$ 0

Fair Value Measurements - Sch_2

Fair Value Measurements - Schedule of Change in Valuation of Securities (Detail) - Bone Biologics Inc [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Equity securities and warrants beginning balance	$ 219	$ 2,768
Purchase of additional common stock	0	500
Equity securities and warrants ending balance	219	4,897
ASU 2016-01 [Member]
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Impact of adoption of ASU 2016-01 recognized in other income, net	$ 0	$ 1,629

Fair Value Measurements - Sch_3

Fair Value Measurements - Schedule of Reconciliation of Debt Security and Warrant (Detail) - eNeura Inc [Member] - Debt Security and Warrant [Member] - Fair Value, Inputs, Level 3 [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Beginning balance	$ 17,820	$ 16,050
Gains or losses recorded for the period
Recognized in other comprehensive income (loss)	(2,593)	0
Change in classification of debt security to held to maturity	(15,227)	0
Issuance of warrant as consideration for extension	491	0
Ending balance	$ 491	$ 16,050

Fair Value Measurements - Sch_4

Fair Value Measurements - Schedule of Reconciliation For Contingent Consideration Measured At Fair Value Using Significant Unobservable Inputs (Level 3) (Detail) - Fair Value, Inputs, Level 3 [Member] $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Acquisition date fair value	$ 28,560
Increase in fair value recognized in operating expenses	5,400
Payment made	(15,000)
Contingent consideration at March 31	$ 18,960

Investments - Additional Inform

Investments - Additional Information (Detail) - ENeura Restructured Debt Security [Member] $ in Millions	Mar. 31, 2019USD ($)
Debt Instrument [Line Items]
Original effective interest rate of debt security	8.00%
Restructured Note, amortized cost	$ 14.7
Estimated fair value of debt securities	15.6
Unpaid principal balance of debt securities	$ 15

Contingencies - Additional Info

Contingencies - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Jul. 31, 2018
Commitments And Contingencies Disclosure [Abstract]
Accrued other long-term liabilities	$ 3.9
Estimated sales and marketing expense	$ 0.3	$ 0.3
Freezing amount in cash resulted from court pending legal action issued			$ 2.5

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Income - Components of Changes in Accumulated Other Comprehensive Income (Loss) (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 335,397	$ 296,608
Other comprehensive loss	(3,042)
Income taxes	641
Ending Balance	343,682	313,174
ASU 2018-02 [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Cumulative effect adjustment from adoption of ASU 2018-02	938
Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(2,386)
Other comprehensive loss	(449)
Ending Balance	(2,835)
Debt Security [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	5,682
Other comprehensive loss	(2,593)
Income taxes	641
Ending Balance	4,668
Debt Security [Member] | ASU 2018-02 [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Cumulative effect adjustment from adoption of ASU 2018-02	938
Accumulated Other Comprehensive Income [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	3,296	3,787
Ending Balance	1,833	$ 4,484
Accumulated Other Comprehensive Income [Member] | ASU 2018-02 [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Cumulative effect adjustment from adoption of ASU 2018-02	$ 938

Revenue Recognition and Accou_3

Revenue Recognition and Accounts Receivable - Schedule of Net Sales Major Product Category by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 109,112	$ 108,709
Change	0.40%
Bone Growth Therapies [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 47,283	46,163
Change	2.40%
Spinal Implants [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 22,903	20,707
Change	10.60%
Biologics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 15,732	14,335
Change	9.70%
Global Spine [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 85,918	81,205
Change	5.80%
Global Extremities [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 23,194	$ 27,504
Change	(15.70%)

Revenue Recognition and Accou_4

Revenue Recognition and Accounts Receivable - Schedule of Net Sales (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenue Recognition [Abstract]
Product sales	$ 93,934	$ 94,889
Marketing service fees	15,178	13,820
Net sales	$ 109,112	$ 108,709

Revenue Recognition and Accou_5

Revenue Recognition and Accounts Receivable - Additional Information (Detail) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Other Long-Term Assets or Other Current Assets [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Other contract assets	$ 2.7	$ 1.9

Business Segment Information -

Business Segment Information - Additional Information (Detail) - Segment	3 Months Ended	12 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Segment Reporting [Abstract]
Number of reporting segments	2	4

Business Segment Information _2

Business Segment Information - Summary of EBIDTA by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Segment Reporting Information [Line Items]
Total EBITDA	$ 875	$ 15,151
Depreciation and amortization	(5,727)	(4,369)
Interest expense, net	(257)	(183)
Income (loss) before income taxes	(5,109)	10,599
Operating Segments [Member] | Global Spine [Member]
Segment Reporting Information [Line Items]
Total EBITDA	10,575	18,825
Operating Segments [Member] | Global Extremities [Member]
Segment Reporting Information [Line Items]
Total EBITDA	(173)	3,328
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Total EBITDA	$ (9,527)	$ (7,002)

Business Segment Information _3

Business Segment Information - Summary of Net Sales by Geographic Destination for Each Reporting Unit (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	$ 109,112	$ 108,709
Global Spine [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	85,918	81,205
Global Extremities [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	23,194	27,504
U.S. [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	86,124	84,954
U.S. [Member] | Global Spine [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	79,526	78,038
U.S. [Member] | Global Extremities [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	6,598	6,916
International [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	22,988	23,755
International [Member] | Global Spine [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	6,392	3,167
International [Member] | Global Extremities [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	$ 16,596	$ 20,588

Acquisition-Related Amortizat_3

Acquisition-Related Amortization and Remeasurement - Components of Acquisition-Related Amortization and Remeasurement (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Acquisition Related Amortization And Remeasurement [Abstract]
Changes in fair value of contingent consideration	$ 5,400
Amortization of acquired intangibles	1,057	$ 63
Acquisition-related amortization and remeasurement	$ 6,457	$ 63

Share-based Compensation - Sche

Share-based Compensation - Schedule of Share-Based Compensation by Line Item in Condensed Consolidated Statements of Operations (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 5,685	$ 3,916
Stock options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	2,112	622
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	1,706	1,447
Performance-based Restricted Stock Awards and Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense		489
Market-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,347	953
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	520	405
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	187	125
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	610	449
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	4,564	3,045
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 324	$ 297

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Shares issued under stock purchase plan, stock option exercises and restricted stock awards and units	211,081	126,511
Share-based compensation expense	$ 5,685	$ 3,916
Transition and Retirement Agreement [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share based compensation, post-termination exercise period original term	18 months
Maximum [Member] | Transition and Retirement Agreement [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share based compensation, post-termination exercise period revised term	4 years
President and Chief Executive Officer [Member] | Transition and Retirement Agreement [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense	$ 2,100

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Components Of Income Tax Expense Benefit [Line Items]
Income tax effective rate	117.60%	50.70%
Income tax (benefit)	$ (6,006)	$ 5,373
Internal Revenue Service [Member]
Components Of Income Tax Expense Benefit [Line Items]
Income tax (benefit)	(1,800)
Minimum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	13,000
Maximum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	$ 13,400

Earnings Per Share ("EPS") - Sc

Earnings Per Share ("EPS") - Schedule of Reconciliation of Weighted Average Shares Used in Diluted EPS (Detail) - shares	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Earnings Per Share [Line Items]
Weighted average common shares-basic	18,750,184	18,404,856
Effect of dilutive securities
Weighted average common shares-diluted	19,191,146	18,874,591
Stock Options And Stock Purchase Plan [Member]
Effect of dilutive securities
Effect of diluted securities	277,992	308,537
Restricted Stock Units [Member]
Effect of dilutive securities
Effect of diluted securities	162,970	161,198

Earnings Per Share ("EPS") - Ad

Earnings Per Share ("EPS") - Additional Information (Detail) - shares	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
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	484,421	122,678

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) $ in Millions	1 Months Ended
	Apr. 30, 2019USD ($)
Subsequent Event [Member] | Brazil [Member]
Subsequent Event [Line Items]
Unfreezing cash amount returned from bank	$ 2.5