Orthofix Medical (OFIX) 10-Q 28 Oct 19 2019 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2019	Oct. 25, 2019
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q3
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX MEDICAL INC.
Entity Central Index Key	0000884624
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Current Reporting Status	Yes
Entity Common Stock, Shares Outstanding		19,055,154
Entity File Number	0-19961
Entity Tax Identification Number	98-1340767
Entity Address, Address Line One	3451 Plano Parkway
Entity Address, City or Town	Lewisville
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75056
City Area Code	214
Local Phone Number	937-2000
Entity Incorporation, State or Country Code	DE
Title of 12(b) Security	Common stock, $0.10 par value per share
Security Exchange Name	NASDAQ
Entity Interactive Data Current	Yes
Document Quarterly Report	true
Document Transition Report	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Current assets
Cash and cash equivalents	$ 56,849	$ 69,623
Restricted cash	654	2,566
Trade accounts receivable, net of allowances of $4,073 and $7,463, respectively	79,690	77,747
Inventories	80,993	76,847
Prepaid expenses and other current assets	19,617	17,856
Total current assets	237,803	244,639
Property, plant and equipment, net	62,964	42,835
Intangible assets, net	53,613	51,897
Goodwill	71,177	72,401
Deferred income taxes	39,626	33,228
Other long-term assets	10,420	21,641
Total assets	475,603	466,641
Current liabilities
Accounts payable	17,892	17,989
Current portion of finance lease liability	293
Other current liabilities	70,323	67,919
Total current liabilities	88,508	85,908
Long-term portion of finance lease liability	20,767
Other long-term liabilities	59,894	45,336
Total liabilities	169,169	131,244
Contingencies (Note 8)
Shareholders’ equity
Common shares $0.10 par value; 50,000,000 shares authorized; 18,875,184 and 18,579,688 issued and outstanding as of September 30, 2019 and December 31, 2018, respectively	1,888	1,858
Additional paid-in capital	263,064	243,165
Retained earnings	46,063	87,078
Accumulated other comprehensive income (loss)	(4,581)	3,296
Total shareholders’ equity	306,434	335,397
Total liabilities and shareholders’ equity	$ 475,603	$ 466,641

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Statement Of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 4,073	$ 7,463
Common shares, par value	$ 0.10	$ 0.10
Common shares, authorized	50,000,000	50,000,000
Common shares, issued	18,875,184	18,579,688
Common shares, outstanding	18,875,184	18,579,688

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Income Statement [Abstract]
Net sales	$ 113,499	$ 111,708	$ 338,461	$ 331,964
Cost of sales	24,896	24,020	74,416	71,002
Gross profit	88,603	87,688	264,045	260,962
Sales and marketing	54,805	49,898	165,363	151,695
General and administrative	21,090	22,276	63,497	63,658
Research and development	7,982	9,598	26,191	24,426
Acquisition-related amortization and remeasurement (Note 12)	23,608	2,009	31,873	3,491
Operating income (loss)	(18,882)	3,907	(22,879)	17,692
Interest income (expense), net	186	(181)	386	(615)
Other expense, net	(8,146)	(5,054)	(8,786)	(5,785)
Income (loss) before income taxes	(26,842)	(1,328)	(31,279)	11,292
Income tax benefit (expense)	(13,656)	117	(8,869)	(6,352)
Net income (loss)	$ (40,498)	$ (1,211)	$ (40,148)	$ 4,940
Net income (loss) per common share:
Basic	$ (2.14)	$ (0.07)	$ (2.13)	$ 0.26
Diluted	$ (2.14)	$ (0.07)	$ (2.13)	$ 0.26
Weighted average number of common shares:
Basic	18,957,876	18,562,204	18,847,728	18,460,848
Diluted	18,957,876	18,562,204	18,847,728	18,864,169
Other comprehensive income (loss), before tax
Unrealized gain (loss) on debt security		$ 1,240	$ (2,593)	$ 3,200
Reclassification adjustment for amortization of historical unrealized gains on debt security	$ (345)		(1,034)
Reclassification adjustment for other-than-temporary impairment on debt security	(5,193)		(5,193)
Currency translation adjustment	(1,893)	(844)	(2,195)	(1,322)
Other comprehensive income (loss) before tax	(7,431)	396	(11,015)	1,878
Income tax related to other comprehensive income (loss)	1,388	(366)	2,200	(798)
Other comprehensive income (loss), net of tax	(6,043)	30	(8,815)	1,080
Comprehensive income (loss)	$ (46,541)	$ (1,181)	$ (48,963)	$ 6,020

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Changes in Shareholders' Equity - USD ($) $ in Thousands	Total	Common Shares [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Beginning Balance at Dec. 31, 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 (loss)	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, 2017	296,608	$ 1,828	220,591	70,402	3,787
Balance, Shares at Dec. 31, 2017		18,278,833
Net income (loss)	4,940
Other comprehensive income (loss), net of tax	1,080
Ending Balance at Sep. 30, 2018	323,350	$ 1,854	238,422	78,207	4,867
Balance, Shares at Sep. 30, 2018		18,536,716
Beginning Balance at Mar. 31, 2018	313,174	$ 1,841	228,356	78,493	4,484
Balance, Shares at Mar. 31, 2018		18,405,344
Net income (loss)	925			925
Other comprehensive income (loss), net of tax	353				353
Share-based compensation	5,215		5,215
Common shares issued, net	179	$ 8	171
Common shares issued, net, Shares		80,444
Ending Balance at Jun. 30, 2018	319,846	$ 1,849	233,742	79,418	4,837
Balance, Shares at Jun. 30, 2018		18,485,788
Net income (loss)	(1,211)			(1,211)
Other comprehensive income (loss), net of tax	30				30
Share-based compensation	5,261		5,261
Common shares issued, net	(576)	$ 5	(581)
Common shares issued, net, Shares		50,928
Ending Balance at Sep. 30, 2018	323,350	$ 1,854	238,422	78,207	4,867
Balance, Shares at Sep. 30, 2018		18,536,716
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
Net income (loss)	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
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 2018-02 [Member]	$ 938
Net income (loss)	(40,148)
Other comprehensive income (loss), net of tax	(8,815)
Ending Balance at Sep. 30, 2019	$ 306,434	$ 1,888	263,064	46,063	(4,581)
Balance, Shares at Sep. 30, 2019	18,875,184	18,875,184
Beginning Balance at Mar. 31, 2019	$ 343,682	$ 1,879	252,862	87,108	1,833
Balance, Shares at Mar. 31, 2019		18,790,769
Net income (loss)	(547)			(547)
Other comprehensive income (loss), net of tax	(371)				(371)
Share-based compensation	5,849		5,849
Common shares issued, net	(819)	$ 4	(823)
Common shares issued, net, Shares		40,812
Ending Balance at Jun. 30, 2019	347,794	$ 1,883	257,888	86,561	1,462
Balance, Shares at Jun. 30, 2019		18,831,581
Net income (loss)	(40,498)			(40,498)
Other comprehensive income (loss), net of tax	(6,043)				(6,043)
Share-based compensation	5,844		5,844
Common shares issued, net	(663)	$ 5	(668)
Common shares issued, net, Shares		43,603
Ending Balance at Sep. 30, 2019	$ 306,434	$ 1,888	$ 263,064	$ 46,063	$ (4,581)
Balance, Shares at Sep. 30, 2019	18,875,184	18,875,184

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Cash flows from operating activities
Net income (loss)	$ (40,148)	$ 4,940
Adjustments to reconcile net income to net cash from operating activities
Depreciation and amortization	18,180	13,661
Amortization of operating lease assets, debt costs and other assets	2,724	818
Provision for doubtful accounts	861	(571)
Deferred income taxes	(3,309)	(5,082)
Share-based compensation	17,378	14,392
Interest and loss on valuation of investment securities	5,000	3,050
Change in fair value of contingent consideration	28,140	2,689
Other	1,307	1,040
Changes in operating assets and liabilities, net of effects of acquisitions
Accounts receivable	(3,298)	(225)
Inventories	(4,995)	6,880
Prepaid expenses and other current assets	1,637	1,498
Accounts payable	447	(2,788)
Other current liabilities	347	(13,130)
Payment of contingent consideration	(1,340)
Other long-term assets and liabilities	(2,841)	1,657
Net cash from operating activities	20,090	28,829
Cash flows from investing activities
Acquisition of business, net of cash acquired		(43,749)
Capital expenditures for property, plant and equipment	(13,737)	(9,586)
Capital expenditures for intangible assets	(1,144)	(1,138)
Asset acquisitions and other investments	(6,400)	(1,448)
Net cash from investing activities	(21,281)	(55,921)
Cash flows from financing activities
Proceeds from issuance of common shares	6,821	5,866
Payments related to withholdings for share-based compensation	(4,271)	(2,402)
Payment of contingent consideration	(13,660)
Payments related to finance lease obligation	(276)
Other financing activities	(1,224)	(476)
Net cash from financing activities	(12,610)	2,988
Effect of exchange rate changes on cash	(885)	(811)
Net change in cash, cash equivalents, and restricted cash	(14,686)	(24,915)
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	57,503	56,242
Components of cash, cash equivalents and restricted cash at the end of period
Cash and cash equivalents	56,849	53,783
Restricted cash	654	2,459
Cash, cash equivalents, and restricted cash at the end of period	$ 57,503	56,242
Noncash investing activities:
Purchase of intangible assets		1,581
Contingent consideration recognized at acquisition date		$ 25,491

Business and basis of consolida

Business and basis of consolidation	9 Months Ended
	Sep. 30, 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 has been reclassified to acquisition-related amortization and remeasurement based on use of the underlying intangible asset. This reclassification resulted in decreases to general and administrative expenses of $0.4 million and $0.8 million for the three and nine months ended September 30, 2018, respectively, and increases in acquisition related amortization and remeasurement expense of $0.4 million and $0.8 million for the three and nine months ended September 30, 2018, respectively. 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 earnings before interest, tax, depreciation, and amortization (“EBITDA”). For additional discussion regarding segments, see Note 11.

Recently adopted accounting sta

Recently adopted accounting standards and recently issued accounting pronouncements	9 Months Ended
	Sep. 30, 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 Accounting Standards Update (“ASU”) 2016-02, Leases (Topic 842) In February 2016 the Financial Accounting Standards Board (“FASB”) issued 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 Co mpany’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), and subsequent amendments 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 has formed an implementation team to evaluate the impact this ASU will have on its consolidated financial statements. Based on the Company's preliminary evaluation, the ASU is expected to primarily impact trade accounts receivable; however, the Company is continuing to evaluate 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. However, the Company does not expect this ASU to have a significant impact on its financial statements but may have significant impact on disclosures for any level 3 assets or liabilities. 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 plans to adopt this ASU prospectively to all implementation costs incurred after the date of adoption and 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 material impact to its consolidated financial statements.

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 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: (U.S. Dollars, in thousands) Final Acquisition Date Fair Value Assigned Useful Life Assets acquired 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 Developed technology 12,400 10 years In-process research and development ("IPR&D") 26,800 10 years Tradename 100 2 years Deferred income taxes 3,594 Total identifiable assets acquired $ 62,509 Liabilities assumed 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 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 and nine months ended September 30, 2019 and recorded $0.3 million and $3.3 million of acquisition related costs during the three and nine months ended September 30, 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 and nine months ended September 30, 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 September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 (unaudited) (unaudited) (unaudited) (unaudited) Net sales $ 113,499 $ 111,708 $ 338,461 $ 336,882 Net income (loss) (40,498 ) (923 ) (40,148 ) 5,276 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	9 Months Ended
	Sep. 30, 2019
Inventory Disclosure [Abstract]
Inventories	4. Inventories Inventories were as follows: (U.S. Dollars, in thousands) September 30, 2019 December 31, 2018 Raw materials $ 7,760 $ 8,463 Work-in-process 10,532 13,478 Finished products 62,701 54,906 Inventories $ 80,993 $ 76,847

Leases

Leases	9 Months Ended
	Sep. 30, 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 r epresent 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 rat e, 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 re duced 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 September 30, 2019 is presented in the table below: (U.S. Dollars, in thousands, except lease term and discount rate) Classification September 30, 2019 Assets Operating leases Other long-term assets $ 5,894 Finance leases Property, plant and equipment, net 20,451 Total lease assets 26,345 Liabilities Current Operating leases Other current liabilities 1,798 Finance leases Current portion of finance lease liability 293 Long-term Operating leases Other long-term liabilities 4,205 Finance leases Long-term portion of finance lease liability 20,767 Total lease liabilities $ 27,063 Weighted Average Remaining Lease Term Operating leases 4.3 years Finance leases 20.9 years Weighted Average Discount Rate Operating leases 2.45 % Finance leases 4.38 % The components of lease costs were as follows: (U.S. Dollars, in thousands) Three Months ended September 30, 2019 Nine Months Ended September 30, 2019 Finance lease costs: Amortization of right-of-use assets $ 244 $ 728 Interest on finance lease liabilities 233 687 Operating lease costs 538 1,618 Short-term lease costs 61 195 Variable lease costs 173 501 Total lease costs $ 1,249 $ 3,729 Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) Nine Months Ended September 30, 2019 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 3,037 Operating cash flows from finance leases 687 Financing cash flows from finance leases 276 Right-of-use assets obtained in exchange for lease obligations Operating leases 598 Finance leases 21,179 A summary of the Company’s remaining lease liabilities as of September 30, 2019 is included below: (U.S. Dollars, in thousands) Operating Leases Finance Leases 2019 $ 505 $ 321 2020 $ 1,863 $ 1,013 2021 $ 1,654 $ 1,414 2022 $ 1,333 $ 1,442 2023 $ 250 $ 1,471 Thereafter $ 782 $ 27,207 Total undiscounted value of lease liabilities $ 6,387 $ 32,868 Less: Interest (384 ) (11,808 ) Present value of lease liabilities $ 6,003 $ 21,060 Current portion of lease liabilities 1,798 293 Long-term portion of lease liabilities 4,205 20,767 Total lease liabilities $ 6,003 $ 21,060

Long-term debt

Long-term debt	9 Months Ended
	Sep. 30, 2019
Debt Disclosure [Abstract]
Long-term debt	6. Long-term debt As of September 30, 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 ($6.0 million) available lines of credit in Italy as of September 30, 2019. The Company was in compliance with all required financial covenants as of September 30, 2019. On October 25, 2019, the Company, and certain of its wholly-owned subsidiaries (collectively with the Company, the “Borrowers”), as borrowers, and certain material subsidiaries of the Company as guarantors, entered into a Second Amended and Restated Credit Agreement (the “Amended Credit Agreement”). The Amended Credit Agreement provides for a $300 million secured revolving credit facility maturing on October 25, 2024 (the “Facility”), and amends and restates the previous $125 million secured revolving credit facility. As of October 28, 2019, the Borrowers have not made any borrowings under the Amended Credit Agreement. Borrowings under the Amended Credit Agreement may be used for, among other things, working capital and other general corporate purposes of the Company and its subsidiaries (including permitted acquisitions and permitted payments of dividends and other distributions). The Facility is available in US Dollars with up to $150 million of the Facility available to be borrowed in Euros and Pounds Sterling (the “Agreed Currencies”). The Facility further permits up to $50 million to be utilized for the issuance of letters of credit in the Agreed Currencies. The Borrowers have the ability to increase the amount of the Facility, which increases may take the form of increases to the revolving credit commitments or the issuance of new term A loans, by an aggregate amount of up to the greater of $150 million or an incremental amount such that the total amount of the Facility does not exceed 350% of consolidated EBITDA of the Company (as determined for the four fiscal quarter period most recently ended for which financial statements are available), upon satisfaction of customary conditions precedent for such increases or incremental loans and receipt of additional commitments by one or more existing or new lenders. Borrowings under the Facility bear interest at a floating rate, which will be, at the Borrowers’ option, either LIBOR plus an applicable margin ranging from 1.25% to 2.25%, or a base rate plus an applicable margin ranging from 0.25% to 1.25% (in each case subject to adjustment based on the Company’s total net leverage ratio). An unused fee ranging from 0.15% to 0.25% (subject to adjustment based on the Company’s total net leverage ratio) is payable quarterly in arrears based on the daily amount of the undrawn portion of each lender’s revolving credit commitments under the Facility. Fees are payable on outstanding letters of credit at a rate equal to the applicable margin for LIBOR loans, plus certain customary fees payable solely to the issuer of the letter of credit. Certain of the Company’s existing and future material subsidiaries (collectively, the “Guarantors”) are required to guarantee the repayment of the Borrowers’ obligations under the Amended Credit Agreement. The obligations of the Borrowers and each of the Guarantors with respect to the Amended Credit Agreement are secured by a pledge of substantially all of the personal property assets of the Borrowers and each of the Guarantors, including accounts receivables, deposit accounts, intellectual property, investment property, inventory, equipment and equity interests in their respective subsidiaries. The Amended Credit Agreement contains customary affirmative and negative covenants, including limitations on the Company’s and its subsidiaries ability to incur additional debt, grant or permit additional liens, make investments and acquisitions, merge or consolidate with others, dispose of assets, pay dividends and distributions, pay subordinated indebtedness and enter into affiliate transactions. In addition, the Amended Credit Agreement contains financial covenants requiring the Company on a consolidated basis to maintain, as of the last day of any fiscal quarter, a total net leverage ratio of not more than 3.5 to 1.0 (which ratio can be permitted to increase to 4.0 to 1.0 for no more than 4 fiscal quarters following a material acquisition) and an interest coverage ratio of at least 3.0 to 1.0. The Amended Credit Agreement also includes events of default customary for facilities of this type and upon the occurrence of such events of default, subject to customary cure rights, all outstanding loans under the Facility may be accelerated and/or the lenders’ commitments terminated.

Fair value measurements and inv

Fair value measurements and investments	9 Months Ended
	Sep. 30, 2019
Fair Value Measurements And Investment Disclosure [Abstract]
Fair value measurements and investments	7. Fair value measurements and investments The fair value of the Company’s financial assets and liabilities measured on a recurring basis were as follows: September 30, 2019 December 31, 2018 (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Treasury securities $ 447 $ — $ — $ 447 $ 490 Bone Biologics equity warrants — — — — — Bone Biologics equity securities — 219 — 219 219 eNeura debt security — — — — 17,820 eNeura warrant — — — — — Total $ 447 $ 219 $ — $ 666 $ 18,529 Liabilities Contingent consideration $ — $ — $ (41,700 ) $ (41,700 ) $ (28,560 ) Deferred compensation plan — (1,242 ) — (1,242 ) (1,275 ) Total $ — $ (1,242 ) $ (41,700 ) $ (42,942 ) $ (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, Inc. (“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. Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Bone Biologics equity securities and warrants beginning balance $ 219 $ 4,668 $ 219 $ 2,768 Impact of adoption of ASU 2016-01 recognized in other income (expense), net — — — 1,629 Purchase of additional common stock — — — 500 Fair value adjustments, expirations, and impairments recognized in other income (expense), net — (4,449 ) — (4,678 ) Bone Biologics equity securities and warrants ending balance $ 219 $ 219 $ 219 $ 219 eNeura Debt Security and Warrant As of September 30, 2019, the Company held a debt security of eNeura, Inc. (“eNeura”), 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 Subsequent to the restructuring, the debt security was no longer classified as an available for sale debt security, but rather as a held to maturity debt security. The 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. unrealized gains included T he Warrant was recorded at fair value and included in other long-term assets. The fair value of the Warrant was 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 categorized this asset as a Level 3 financial asset. The Warrant was considered an investment that does not have a readily determinable fair value. As such, the Company measured the Warrant 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. During the quarter ended September 30, 2019, the Company engaged in negotiations with eNeura to settle the Restructured Debt Security and on October 25, 2019, the Company and eNeura settled the Restructured Debt Security for a $4.0 million cash payment and agreed to transfer the Warrant to eNeura. As such, at September 30, 2019, the Company determined the Restructured Debt Security and Warrant were impaired and adjusted the carrying value of the Restructured Debt Security to $4.0 million, its settlement value, by recording a net other-than-temporary impairment of $6.5 million in other expense, net, which includes a reclassification of the related unrealized gains included in accumulated other comprehensive income of $5.2 million. Further, the Company also reclassified the remaining balance of the Restructured Debt Security to other current assets as payment was received within the next twelve months. During the three and nine months ended September 30, 2019, the Company recognized $0.5 and $1.5 million in interest income related to the eNeura debt security. The Company did not recognize any interest income during the three and nine months ended September 30, 2018. 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) prior to the settlement discussed above: (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 ) 3,200 Change in classification of debt security to held to maturity (15,227 ) — Issuance of Warrant as consideration for extension 491 — Impairment of Warrant (491 ) — eNeura debt security and Warrant at September 30 $ — $ 19,250 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 estimated fair value of the remaining contingent consideration was $41.7 million as of September 30, 2019; however, the actual amount ultimately paid could be higher or lower than the fair value of the remaining contingent consideration. This resulted in the recognition of expense of $22.3 and $28.1 million during the three and nine months ended September 30, 2019, respectively, which was primarily attributable to a change in management’s forecast of future net sales of the artificial discs, including an acceleration of the expected timing of such future sales during the three months ended September 30, 2019, subsequent to the Company’s launch of the product in the U.S. At September 30, 2019, the Company has classified $14.5 million of the liability attributable to the revenue-based milestones within other current liabilities, as the Company expects to pay one of the revenue-based milestones in the next twelve months, and the remaining $27.2 million 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 2018 Contingent consideration at January 1 $ 28,560 $ — Acquisition date fair value — 25,491 Increase in fair value recognized in acquisition-related amortization and remeasurement 28,140 2,689 Payment made (15,000 ) — Contingent consideration at September 30 $ 41,700 $ 28,180

Contingencies

Contingencies	9 Months Ended
	Sep. 30, 2019
Commitments And Contingencies Disclosure [Abstract]
Contingencies	8. 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. This 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 and $0.2 million for the three months ended September 30, 2019 and 2018, respectively, and $1.0 million and $0.8 million for the nine months ended September 30, 2019 and 2018, respectively. As of September 30, 2019, the Company has accrued $4.5 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. As such, this balance was reclassified to cash and cash equivalents during the second quarter of 2019. In September 2019, in relation to an ongoing legal dispute with a former Brazilian distributor, approximately $0.7 million of the Company’s cash in Brazil was frozen upon request to satisfy a judgment. Although the Company is appealing the judgment, this cash has been reclassified to restricted cash. As of September 30, 2019, the Company has an accrual of $1.6 million related to this matter.

Accumulated other comprehensive

Accumulated other comprehensive income (loss)	9 Months Ended
	Sep. 30, 2019
Equity [Abstract]
Accumulated other comprehensive income (loss)	9. 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 (Loss) 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 (2,195 ) (2,593 ) (4,788 ) Income taxes — 641 641 Reclassification adjustment to: Interest income (expense), net — (1,034 ) (1,034 ) Other expense, net — (5,193 ) (5,193 ) Income taxes — 1,559 1,559 Balance at September 30, 2019 $ (4,581 ) $ — $ (4,581 )

Revenue recognition and account

Revenue recognition and accounts receivable	9 Months Ended
	Sep. 30, 2019
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	10. Revenue recognition and accounts receivable Revenue Recognition The Company has two reporting segments, 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 September 30, (U.S. Dollars, in thousands) 2019 2018 Change Bone Growth Therapies $ 48,836 $ 48,059 1.6 % Spinal Implants 22,947 22,102 3.8 % Biologics 16,308 14,636 11.4 % Global Spine 88,091 84,797 3.9 % Global Extremities 25,408 26,911 -5.6 % Net sales $ 113,499 $ 111,708 1.6 % Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 Change Bone Growth Therapies $ 146,228 $ 142,433 2.7 % Spinal Implants 69,076 66,689 3.6 % Biologics 48,784 43,639 11.8 % Global Spine 264,088 252,761 4.5 % Global Extremities 74,373 79,203 -6.1 % Net sales $ 338,461 $ 331,964 2.0 % Product Sales and Marketing Service Fees The table below presents net sales, which includes product sales and marketing service fees, for the three and nine months ended September 30, 2019 and 2018. Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Product sales $ 97,833 $ 97,604 $ 291,632 $ 289,946 Marketing service fees 15,666 14,104 46,829 42,018 Net sales $ 113,499 $ 111,708 $ 338,461 $ 331,964 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. Puerto Rico Settlement In June 2019, the Company received a payment of $1.4 million from the Administration of Medical Services of Puerto Rico, a government-owned corporation, in settlement of approximately $2.5 million of outstanding accounts receivable. This $2.5 million of outstanding accounts receivable had previously been fully reserved between the Company’s allowances for doubtful accounts and contractual allowances. As a result of this settlement, and in accordance with the Company’s policy, the Company recorded the resulting adjustment to contractual allowances of $0.4 million within net sales and the recovery of the allowance for doubtful accounts as a credit to bad debt expense of $1.0 million. 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 $ 3.5 million and $ 1.9 million as of September 30, 2 019, and December 31, 2018, respectively.

Business segment information

Business segment information	9 Months Ended
	Sep. 30, 2019
Segment Reporting [Abstract]
Business segment information	11. 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 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. Corporate activities are comprised of the operating expenses and activities of the Company not necessarily identifiable within the two reporting segments, such as human resources, finance, legal, and information technology functions. 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 has been consolidated and is now included within the Global Spine reporting segment as of September 30, 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 September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Global Spine $ (6,033 ) $ 15,637 $ 21,065 $ 53,492 Global Extremities 1,229 3,357 3,806 7,173 Corporate (15,949 ) (15,403 ) (38,356 ) (35,097 ) Total EBITDA $ (20,753 ) $ 3,591 $ (13,485 ) $ 25,568 Depreciation and amortization (6,275 ) (4,738 ) (18,180 ) (13,661 ) Interest income (expense), net 186 (181 ) 386 (615 ) Income (loss) before income taxes $ (26,842 ) $ (1,328 ) $ (31,279 ) $ 11,292 Geographical information The table below presents net sales by geographic destination for each reporting unit and for the consolidated Company: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Global Spine U.S. $ 82,816 $ 79,502 $ 246,943 $ 239,262 International 5,275 5,295 17,145 $ 13,499 Total Global Spine 88,091 84,797 264,088 252,761 Global Extremities U.S. 6,636 7,254 20,078 21,193 International 18,772 19,657 54,295 58,010 Total Global Extremities 25,408 26,911 74,373 79,203 Consolidated U.S. 89,452 86,756 267,021 260,455 International 24,047 24,952 71,440 71,509 Net sales $ 113,499 $ 111,708 $ 338,461 $ 331,964

Acquisition-Related Amortizatio

Acquisition-Related Amortization and Remeasurement	9 Months Ended
	Sep. 30, 2019
Acquisition Related Amortization And Remeasurement [Abstract]
Acquisition-Related Amortization and Remeasurement	12. 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 and nine months ended September 30, 2019 and 2018, respectively, are as follows: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Changes in fair value of contingent consideration $ 22,270 $ 1,580 $ 28,140 $ 2,689 Amortization of acquired intangibles 1,338 429 3,733 802 Total $ 23,608 $ 2,009 $ 31,873 $ 3,491

Share-based compensation

Share-based compensation	9 Months Ended
	Sep. 30, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Share-based compensation	13. 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 September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Cost of sales $ 169 $ 151 $ 536 $ 408 Sales and marketing 583 514 1,885 1,436 General and administrative 4,760 4,194 13,888 11,488 Research and development 332 402 1,069 1,060 Total $ 5,844 $ 5,261 $ 17,378 $ 14,392 Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Stock options $ 599 $ 579 $ 3,637 $ 2,442 Time-based restricted stock awards and units 3,805 2,244 8,462 5,480 Performance-based restricted stock awards and units — 734 — 1,493 Market-based restricted stock units 1,092 1,298 4,015 3,855 Stock purchase plan 348 406 1,264 1,122 Total $ 5,844 $ 5,261 $ 17,378 $ 14,392 During the three months ended September 30, 2019 and 2018, the Company issued 43,603 and 50,928 shares, respectively, of common stock related to stock purchase plan issuances, stock option exercises and the vesting of restricted stock awards and units. During the nine months ended September 30, 2019 and 2018, the Company issued 295,496 and 257,833 shares, respectively, of common stock related to stock purchase plan issuances, stock option exercises and the vesting of restricted stock awards and units. On August 5, 2019 the Company entered into an employment agreement with its new President of Global Spine and awarded restricted stock units and stock options valued at approximately $1.5 million as inducement grants. 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 $2.2 million and $5.9 million in share-based compensation expense during the three and nine months ended September 30, 2019, related to the R etirement Agreement, which was charged to general and administrative expense in the condensed consolidated statements of operations and comprehensive income (loss ).

Income taxes

Income taxes	9 Months Ended
	Sep. 30, 2019
Income Tax Disclosure [Abstract]
Income taxes	14. 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 September 30, 2019 and 2018, the effective tax rate was (50.9%) and 8.8%, respectively. For the nine months ended September 30, 2019 and 2018, the effective tax rate was (28.4%) and 56.3%, respectively. The primary factors affecting the Company’s effective tax rate for the three and nine months ended September 30, 2019, were financial expenses not deductible for tax purposes, primarily related to acquisition-related items, which includes remeasurement of contingent consideration, increased limitation of the deductibility of executive compensation, 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")	9 Months Ended
	Sep. 30, 2019
Earnings Per Share [Abstract]
Earnings per share ("EPS")	15. 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 and nine months ended September 30, 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 September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Weighted average common shares-basic 18,957,876 18,562,204 18,847,728 18,460,848 Effect of dilutive securities Unexercised stock options and stock purchase plan — — — 312,320 Unvested restricted stock awards and units — — — 91,001 Weighted average common shares-diluted 18,957,876 18,562,204 18,847,728 18,864,169 There were 1,814,544 and 2,088,843 weighted average outstanding stock options and restricted stock awards and units not included in the diluted EPS computation for the three months ended September 30, 2019 and 2018, respectively, and 1,880,423 and 359,172 weighted average outstanding stock options and restricted stock awards and units not included in the diluted EPS computation for the nine months ended September 30, 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.

Recently adopted accounting s_2

Recently adopted accounting standards and recently issued accounting pronouncements (Policies)	9 Months Ended
	Sep. 30, 2019
Accounting Changes And Error Corrections [Abstract]
Recently adopted accounting standards and recently issued accounting pronouncements	Adoption of Accounting Standards Update (“ASU”) 2016-02, Leases (Topic 842) In February 2016 the Financial Accounting Standards Board (“FASB”) issued 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 Co mpany’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), and subsequent amendments 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 has formed an implementation team to evaluate the impact this ASU will have on its consolidated financial statements. Based on the Company's preliminary evaluation, the ASU is expected to primarily impact trade accounts receivable; however, the Company is continuing to evaluate 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. However, the Company does not expect this ASU to have a significant impact on its financial statements but may have significant impact on disclosures for any level 3 assets or liabilities. 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 plans to adopt this ASU prospectively to all implementation costs incurred after the date of adoption and 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 material impact to its consolidated financial statements.

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2019
Business Acquisition [Line Items]
Summary of Unaudited Pro forma Results	The following table presents the unaudited pro forma results for the three and nine months ended September 30, 2019 and 2018, Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 (unaudited) (unaudited) (unaudited) (unaudited) Net sales $ 113,499 $ 111,708 $ 338,461 $ 336,882 Net income (loss) (40,498 ) (923 ) (40,148 ) 5,276
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: (U.S. Dollars, in thousands) Final Acquisition Date Fair Value Assigned Useful Life Assets acquired 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 Developed technology 12,400 10 years In-process research and development ("IPR&D") 26,800 10 years Tradename 100 2 years Deferred income taxes 3,594 Total identifiable assets acquired $ 62,509 Liabilities assumed 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
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)	9 Months Ended
	Sep. 30, 2019
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories were as follows: (U.S. Dollars, in thousands) September 30, 2019 December 31, 2018 Raw materials $ 7,760 $ 8,463 Work-in-process 10,532 13,478 Finished products 62,701 54,906 Inventories $ 80,993 $ 76,847

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2019
Summary of Lease Portfolio	A summary of the Company’s lease portfolio as of September 30, 2019 is presented in the table below: (U.S. Dollars, in thousands, except lease term and discount rate) Classification September 30, 2019 Assets Operating leases Other long-term assets $ 5,894 Finance leases Property, plant and equipment, net 20,451 Total lease assets 26,345 Liabilities Current Operating leases Other current liabilities 1,798 Finance leases Current portion of finance lease liability 293 Long-term Operating leases Other long-term liabilities 4,205 Finance leases Long-term portion of finance lease liability 20,767 Total lease liabilities $ 27,063 Weighted Average Remaining Lease Term Operating leases 4.3 years Finance leases 20.9 years Weighted Average Discount Rate Operating leases 2.45 % 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 September 30, 2019 Nine Months Ended September 30, 2019 Finance lease costs: Amortization of right-of-use assets $ 244 $ 728 Interest on finance lease liabilities 233 687 Operating lease costs 538 1,618 Short-term lease costs 61 195 Variable lease costs 173 501 Total lease costs $ 1,249 $ 3,729
Summary of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) Nine Months Ended September 30, 2019 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 3,037 Operating cash flows from finance leases 687 Financing cash flows from finance leases 276 Right-of-use assets obtained in exchange for lease obligations Operating leases 598 Finance leases 21,179
Summary of Remaining Lease Liabilities	A summary of the Company’s remaining lease liabilities as of September 30, 2019 is included below: (U.S. Dollars, in thousands) Operating Leases Finance Leases 2019 $ 505 $ 321 2020 $ 1,863 $ 1,013 2021 $ 1,654 $ 1,414 2022 $ 1,333 $ 1,442 2023 $ 250 $ 1,471 Thereafter $ 782 $ 27,207 Total undiscounted value of lease liabilities $ 6,387 $ 32,868 Less: Interest (384 ) (11,808 ) Present value of lease liabilities $ 6,003 $ 21,060 Current portion of lease liabilities 1,798 293 Long-term portion of lease liabilities 4,205 20,767 Total lease liabilities $ 6,003 $ 21,060
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 and i_2

Fair value measurements and investments (Tables)	9 Months Ended
	Sep. 30, 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: September 30, 2019 December 31, 2018 (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Treasury securities $ 447 $ — $ — $ 447 $ 490 Bone Biologics equity warrants — — — — — Bone Biologics equity securities — 219 — 219 219 eNeura debt security — — — — 17,820 eNeura warrant — — — — — Total $ 447 $ 219 $ — $ 666 $ 18,529 Liabilities Contingent consideration $ — $ — $ (41,700 ) $ (41,700 ) $ (28,560 ) Deferred compensation plan — (1,242 ) — (1,242 ) (1,275 ) Total $ — $ (1,242 ) $ (41,700 ) $ (42,942 ) $ (29,835 )
Schedule of Changes in Valuation of Securities	Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Bone Biologics equity securities and warrants beginning balance $ 219 $ 4,668 $ 219 $ 2,768 Impact of adoption of ASU 2016-01 recognized in other income (expense), net — — — 1,629 Purchase of additional common stock — — — 500 Fair value adjustments, expirations, and impairments recognized in other income (expense), net — (4,449 ) — (4,678 ) Bone Biologics equity securities and warrants ending balance $ 219 $ 219 $ 219 $ 219
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 2018 Contingent consideration at January 1 $ 28,560 $ — Acquisition date fair value — 25,491 Increase in fair value recognized in acquisition-related amortization and remeasurement 28,140 2,689 Payment made (15,000 ) — Contingent consideration at September 30 $ 41,700 $ 28,180
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) prior to the settlement discussed above: (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 ) 3,200 Change in classification of debt security to held to maturity (15,227 ) — Issuance of Warrant as consideration for extension 491 — Impairment of Warrant (491 ) — eNeura debt security and Warrant at September 30 $ — $ 19,250

Accumulated other comprehensi_2

Accumulated other comprehensive income (loss) (Tables)	9 Months Ended
	Sep. 30, 2019
Equity [Abstract]
Components of Changes in 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 (Loss) 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 (2,195 ) (2,593 ) (4,788 ) Income taxes — 641 641 Reclassification adjustment to: Interest income (expense), net — (1,034 ) (1,034 ) Other expense, net — (5,193 ) (5,193 ) Income taxes — 1,559 1,559 Balance at September 30, 2019 $ (4,581 ) $ — $ (4,581 )

Revenue recognition and accou_2

Revenue recognition and accounts receivable (Tables)	9 Months Ended
	Sep. 30, 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 September 30, (U.S. Dollars, in thousands) 2019 2018 Change Bone Growth Therapies $ 48,836 $ 48,059 1.6 % Spinal Implants 22,947 22,102 3.8 % Biologics 16,308 14,636 11.4 % Global Spine 88,091 84,797 3.9 % Global Extremities 25,408 26,911 -5.6 % Net sales $ 113,499 $ 111,708 1.6 % Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 Change Bone Growth Therapies $ 146,228 $ 142,433 2.7 % Spinal Implants 69,076 66,689 3.6 % Biologics 48,784 43,639 11.8 % Global Spine 264,088 252,761 4.5 % Global Extremities 74,373 79,203 -6.1 % Net sales $ 338,461 $ 331,964 2.0 %
Schedule of Net Sales	The table below presents net sales, which includes product sales and marketing service fees, for the three and nine months ended September 30, 2019 and 2018. Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Product sales $ 97,833 $ 97,604 $ 291,632 $ 289,946 Marketing service fees 15,666 14,104 46,829 42,018 Net sales $ 113,499 $ 111,708 $ 338,461 $ 331,964

Business segment information (T

Business segment information (Tables)	9 Months Ended
	Sep. 30, 2019
Segment Reporting [Abstract]
Summary of EBITDA 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 September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Global Spine $ (6,033 ) $ 15,637 $ 21,065 $ 53,492 Global Extremities 1,229 3,357 3,806 7,173 Corporate (15,949 ) (15,403 ) (38,356 ) (35,097 ) Total EBITDA $ (20,753 ) $ 3,591 $ (13,485 ) $ 25,568 Depreciation and amortization (6,275 ) (4,738 ) (18,180 ) (13,661 ) Interest income (expense), net 186 (181 ) 386 (615 ) Income (loss) before income taxes $ (26,842 ) $ (1,328 ) $ (31,279 ) $ 11,292
Summary of Net Sales by Geographic Destination for each Reporting Segment	Geographical information The table below presents net sales by geographic destination for each reporting unit and for the consolidated Company: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Global Spine U.S. $ 82,816 $ 79,502 $ 246,943 $ 239,262 International 5,275 5,295 17,145 $ 13,499 Total Global Spine 88,091 84,797 264,088 252,761 Global Extremities U.S. 6,636 7,254 20,078 21,193 International 18,772 19,657 54,295 58,010 Total Global Extremities 25,408 26,911 74,373 79,203 Consolidated U.S. 89,452 86,756 267,021 260,455 International 24,047 24,952 71,440 71,509 Net sales $ 113,499 $ 111,708 $ 338,461 $ 331,964

Acquisition-Related Amortizat_2

Acquisition-Related Amortization and Remeasurement (Tables)	9 Months Ended
	Sep. 30, 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 and nine months ended September 30, 2019 and 2018, respectively, are as follows: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Changes in fair value of contingent consideration $ 22,270 $ 1,580 $ 28,140 $ 2,689 Amortization of acquired intangibles 1,338 429 3,733 802 Total $ 23,608 $ 2,009 $ 31,873 $ 3,491

Share-based compensation (Table

Share-based compensation (Tables)	9 Months Ended
	Sep. 30, 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 September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Cost of sales $ 169 $ 151 $ 536 $ 408 Sales and marketing 583 514 1,885 1,436 General and administrative 4,760 4,194 13,888 11,488 Research and development 332 402 1,069 1,060 Total $ 5,844 $ 5,261 $ 17,378 $ 14,392 Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2019 2018 2019 2018 Stock options $ 599 $ 579 $ 3,637 $ 2,442 Time-based restricted stock awards and units 3,805 2,244 8,462 5,480 Performance-based restricted stock awards and units — 734 — 1,493 Market-based restricted stock units 1,092 1,298 4,015 3,855 Stock purchase plan 348 406 1,264 1,122 Total $ 5,844 $ 5,261 $ 17,378 $ 14,392

Earnings per share ("EPS") (Tab

Earnings per share ("EPS") (Tables)	9 Months Ended
	Sep. 30, 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 September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Weighted average common shares-basic 18,957,876 18,562,204 18,847,728 18,460,848 Effect of dilutive securities Unexercised stock options and stock purchase plan — — — 312,320 Unvested restricted stock awards and units — — — 91,001 Weighted average common shares-diluted 18,957,876 18,562,204 18,847,728 18,864,169

Business and Basis of Presentat

Business and Basis of Presentation - Additional Information (Detail) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2018USD ($)	Sep. 30, 2019Segment	Sep. 30, 2018USD ($)
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]
Decreases to general and administrative expenses	$ 0.4		$ 0.8
Acquisition Related Amortization and Remeasurement Expense [Member]
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Increases in acquisition related amortization and remeasurement expense	$ 0.4		$ 0.8

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	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Feb. 06, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Goodwill			$ 71,177,000		$ 71,177,000			$ 72,401,000
Consideration for the assets 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	$ 300,000	0	$ 3,300,000
Net sales from acquisition			4,200,000	2,900,000	10,500,000	5,200,000
Net loss from Acquisition			$ 2,900,000	$ 2,100,000	$ 10,300,000	$ 3,500,000
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	Sep. 30, 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
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
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
Tradename [Member] | Spinal Kinetics [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 100
Assigned Useful Life		2 years
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		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Business Acquisition [Line Items]
Net sales	$ 113,499	$ 111,708	$ 338,461	$ 336,882
Net income (loss)	$ (40,498)	$ (923)	$ (40,148)	$ 5,276

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Raw materials	$ 7,760	$ 8,463
Work-in-process	10,532	13,478
Finished products	62,701	54,906
Inventories	$ 80,993	$ 76,847

Leases - Additional Information

Leases - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Sep. 30, 2019	Jan. 01, 2019
Leases [Abstract]
Operating lease assets		$ 5,894	$ 20,200
Operating lease liabilities		$ 6,003	$ 20,500
Increase in finance lease liability	$ 8,000
Increase in finance lease asset	$ 8,000

Leases - Summary of Net Impact

Leases - Summary of Net Impact of Adoption Balance Sheet (Detail) - USD ($) $ in Thousands	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Jan. 01, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017
Current assets
Cash, cash equivalents, and restricted cash	$ 57,503				$ 72,189	$ 56,242			$ 81,157
Accounts receivable, net	79,690				77,747
Inventories	80,993				76,847
Prepaid expenses and other current assets	19,617				17,856
Total current assets	237,803				244,639
Property, plant, and equipment, net	62,964				42,835
Intangible assets, net and goodwill					124,298
Deferred income taxes	39,626				33,228
Other long-term assets	10,420				21,641
Total assets	475,603				466,641
Current liabilities
Accounts payable	17,892				17,989
Other current liabilities	70,323				67,919
Total current liabilities	88,508				85,908
Other long-term liabilities	59,894				45,336
Total liabilities	169,169				131,244
Shareholders’ equity
Common shares	1,888				1,858
Additional paid-in capital	263,064				243,165
Retained earnings	46,063				87,078
Accumulated other comprehensive income	(4,581)				3,296
Total shareholders’ equity	306,434	$ 347,794	$ 343,682		335,397	$ 323,350	$ 319,846	$ 313,174	$ 296,608
Total liabilities and shareholders’ equity	$ 475,603				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				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) - USD ($) $ in Thousands	Sep. 30, 2019	Jan. 01, 2019
Assets
Operating leases	$ 5,894	$ 20,200
Operating lease, right-of-use asset, statement of financial position [Extensible List]	us-gaap:OtherAssetsNoncurrent
Finance leases	$ 20,451
Finance lease, right-of-use asset, statement of financial position [Extensible List]	us-gaap:PropertyPlantAndEquipmentNet
Total lease assets	$ 26,345
Current
Operating leases	$ 1,798
Operating lease, liability, current, statement of financial position [Extensible List]	us-gaap:OtherLiabilitiesCurrent
Finance leases	$ 293
Long-term
Operating leases	$ 4,205
Operating lease, liability, noncurrent, statement of financial position [Extensible List]	us-gaap:OtherLiabilitiesNoncurrent
Finance leases	$ 20,767
Total lease liabilities	$ 27,063
Weighted Average Remaining Lease Term
Operating leases	4 years 3 months 18 days
Finance leases	20 years 10 months 24 days
Weighted Average Discount Rate
Operating leases	2.45%
Finance leases	4.38%

Leases - Summary of Components

Leases - Summary of Components of Lease Costs (Detail) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2019
Finance lease costs:
Amortization of right-of-use assets	$ 244	$ 728
Interest on finance lease liabilities	233	687
Operating lease costs	538	1,618
Short-term lease costs	61	195
Variable lease costs	173	501
Total lease costs	$ 1,249	$ 3,729

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2019USD ($)
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 3,037
Operating cash flows from finance leases	687
Financing cash flows from finance leases	276
Right-of-use assets obtained in exchange for lease obligations
Operating leases	598
Finance leases	$ 21,179

Leases - Summary of Remaining L

Leases - Summary of Remaining Lease Liabilities (Detail) - USD ($) $ in Thousands	Sep. 30, 2019	Jan. 01, 2019
Operating Leases
2019	$ 505
2020	1,863
2021	1,654
2022	1,333
2023	250
Thereafter	782
Total undiscounted value of lease liabilities	6,387
Less: Interest	(384)
Present value of lease liabilities	6,003	$ 20,500
Current portion of lease liabilities	1,798
Long-term portion of lease liabilities	4,205
Total lease liabilities	6,003	$ 20,500
Finance Leases
2019	321
2020	1,013
2021	1,414
2022	1,442
2023	1,471
Thereafter	27,207
Total undiscounted value of lease liabilities	32,868
Less: Interest	(11,808)
Present value of lease liabilities	21,060
Current portion of lease liabilities	293
Long-term portion of lease liabilities	20,767
Total lease liabilities	$ 21,060

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail)	Oct. 25, 2019USD ($)	Sep. 30, 2019USD ($)	Oct. 28, 2019USD ($)	Sep. 30, 2019EUR (€)	Aug. 31, 2015USD ($)
Italy [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 6,000,000		€ 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
Amended Credit Agreement [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 300,000,000
Amount outstanding under lines of credit			$ 0
Credit agreement maturity date	Oct. 25, 2024
Maximum borrowing capacity available for issuance of letters of credit	$ 50,000,000
Maximum additional borrowing capacity	$ 150,000,000
Line of credit facility, percentage of maximum incremental amount on consolidated EBITDA	350.00%
Borrowers ability to increase amount of line of credit facility, Description	The Borrowers have the ability to increase the amount of the Facility, which increases may take the form of increases to the revolving credit commitments or the issuance of new term A loans, by an aggregate amount of up to the greater of $150 million or an incremental amount such that the total amount of the Facility does not exceed 350% of consolidated EBITDA of the Company (as determined for the four fiscal quarter period most recently ended for which financial statements are available), upon satisfaction of customary conditions precedent for such increases or incremental loans and receipt of additional commitments by one or more existing or new lenders.
Line of credit, net leverage ratio	3.5
Line of credit, interest coverage ratio	300.00%
Amended Credit Agreement [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Maximum [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity available for working capital and other general corporate purposes	$ 150,000,000
Line of credit facility, unused commitment fee percentage	0.25%
Line of credit, net leverage ratio	4
Amended Credit Agreement [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Maximum [Member] | LIBOR [Member]
Debt Instrument [Line Items]
Margin on variable rate	2.25%
Amended Credit Agreement [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Maximum [Member] | Base Rate [Member]
Debt Instrument [Line Items]
Margin on variable rate	1.25%
Amended Credit Agreement [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Minimum [Member]
Debt Instrument [Line Items]
Line of credit facility, unused commitment fee percentage	0.15%
Amended Credit Agreement [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Minimum [Member] | LIBOR [Member]
Debt Instrument [Line Items]
Margin on variable rate	1.25%
Amended Credit Agreement [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Minimum [Member] | Base Rate [Member]
Debt Instrument [Line Items]
Margin on variable rate	0.25%

Fair Value Measurements and I_3

Fair Value Measurements and Investments - Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 666	$ 18,529
Contingent consideration	(41,700)	(28,560)
Deferred compensation plan, Liabilities	(1,242)	(1,275)
Liabilities fair value, Total	(42,942)	(29,835)
Fair Value, Inputs, Level 1 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	447
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	(1,242)
Liabilities fair value, Total	(1,242)
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(41,700)
Liabilities fair value, Total	(41,700)
Treasury Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	447	490
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	447
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
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
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 and I_4

Fair Value Measurements and Investments - Additional Information (Detail) - USD ($)	Mar. 01, 2019	Feb. 14, 2019	Apr. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Feb. 06, 2019
Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Milestone achievement period			5 years			12 months
Contingent consideration				$ 41,700,000		$ 41,700,000
Recognition of expense for contingent consideration				22,300,000		28,100,000
Spinal Kinetics [Member] | Other Current Liabilities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration				14,500,000		14,500,000
Spinal Kinetics [Member] | Other Long-term Liabilities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration				27,200,000		27,200,000
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 contingent 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
ENeura Restructured Debt Security [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Interest income				500,000	$ 0	1,500,000	$ 0
eNeura Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Payments of restructured debt security				4,000,000
Adjusted carrying value of restructured debt				4,000,000		4,000,000
Other-than-temporary impairment on restructured debt securities				6,500,000
eNeura Inc [Member] | Reclassification Out of Accumulated Other Comprehensive Income [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Unrealized gains on restructured debt securities				$ 5,200,000		$ 5,200,000
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
Equity Warrants [Member] | Bone Biologics Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value of warrants						$ 0

Fair Value Measurements and I_5

Fair Value Measurements and Investments - Schedule of Change in Valuation of Securities (Detail) - Bone Biologics Inc [Member] - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Equity securities and warrants beginning balance	$ 219	$ 4,668	$ 219	$ 2,768
Purchase of additional common stock	0	0	0	500
Fair value adjustments, expirations, and impairments recognized in other income (expense), net	0	(4,449)	0	(4,678)
Equity securities and warrants ending balance	219	219	219	219
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 (expense), net	$ 0	$ 0	$ 0	$ 1,629

Fair Value Measurements and I_6

Fair Value Measurements and Investments - 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	9 Months Ended
	Sep. 30, 2019	Sep. 30, 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)	3,200
Change in classification of debt security to held to maturity	(15,227)	0
Issuance of Warrant as consideration for extension	491	0
Impairment of Warrant	(491)	0
Ending balance	$ 0	$ 19,250

Fair Value Measurements and I_7

Fair Value Measurements and Investments - Schedule of Reconciliation For Contingent Consideration Measured At Fair Value Using Significant Unobservable Inputs (Level 3) (Detail) - Fair Value, Inputs, Level 3 [Member] - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Contingent consideration at January 1	$ 28,560
Acquisition date fair value		$ 25,491
Increase in fair value recognized in acquisition-related amortization and remeasurement	28,140	2,689
Payment made	(15,000)
Contingent consideration at September 30	$ 41,700	$ 28,180

Contingencies - Additional Info

Contingencies - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Jul. 31, 2018
Commitments And Contingencies Disclosure [Abstract]
Accrued other long-term liabilities	$ 4.5		$ 4.5
Estimated sales and marketing expense	0.3	$ 0.2	1	$ 0.8
Freezing amount in cash resulted from court pending legal action issued	0.7		0.7		$ 2.5
Accruals related court pending legal dispute	$ 1.6		$ 1.6

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Income (Loss) - Components of Changes in Accumulated Other Comprehensive Income (Detail) - USD ($) $ in Thousands	3 Months Ended				9 Months Ended
	Sep. 30, 2019	Mar. 31, 2019	Sep. 30, 2018	Mar. 31, 2018	Sep. 30, 2019	Sep. 30, 2018
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 347,794	$ 335,397	$ 319,846	$ 296,608	$ 335,397	$ 296,608
Other comprehensive loss					(4,788)
Income taxes					641
Interest income (expense), net	186		(181)		386	(615)
Other expense, net	(8,146)		(5,054)		(8,786)	(5,785)
Income taxes	13,656		(117)		8,869	6,352
Ending Balance	306,434	343,682	323,350	313,174	306,434	323,350
Reclassification Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Interest income (expense), net					(1,034)
Other expense, net					(5,193)
Income taxes					1,559
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)			(2,386)
Other comprehensive loss					(2,195)
Ending Balance	(4,581)				(4,581)
Debt Security [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance		5,682			5,682
Other comprehensive loss					(2,593)
Income taxes					641
Debt Security [Member] | Reclassification Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Interest income (expense), net					(1,034)
Other expense, net					(5,193)
Income taxes					1,559
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 (Loss) [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	1,462	3,296	4,837	3,787	3,296	3,787
Ending Balance	$ (4,581)	1,833	$ 4,867	$ 4,484	$ (4,581)	$ 4,867
Accumulated Other Comprehensive Income (Loss) [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		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 113,499	$ 111,708	$ 338,461	$ 331,964
Change	1.60%		2.00%
Bone Growth Therapies [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 48,836	48,059	$ 146,228	142,433
Change	1.60%		2.70%
Spinal Implants [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 22,947	22,102	$ 69,076	66,689
Change	3.80%		3.60%
Biologics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 16,308	14,636	$ 48,784	43,639
Change	11.40%		11.80%
Global Spine [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 88,091	84,797	$ 264,088	252,761
Change	3.90%		4.50%
Global Extremities [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 25,408	$ 26,911	$ 74,373	$ 79,203
Change	(5.60%)		(6.10%)

Revenue Recognition and Accou_4

Revenue Recognition and Accounts Receivable - Schedule of Net Sales (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Revenue Recognition [Abstract]
Product sales	$ 97,833	$ 97,604	$ 291,632	$ 289,946
Marketing service fees	15,666	14,104	46,829	42,018
Net sales	$ 113,499	$ 111,708	$ 338,461	$ 331,964

Revenue Recognition and Accou_5

Revenue Recognition and Accounts Receivable - Additional Information (Detail) - USD ($) $ in Millions	1 Months Ended
	Jun. 30, 2019	Sep. 30, 2019	Dec. 31, 2018
Other Long-Term Assets or Other Current Assets [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Other contract assets		$ 3.5	$ 1.9
Puerto Rico [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Proceeds from settlement of trade accounts receivable	$ 1.4
Accounts receivable	2.5
Contractual allowances	0.4
Recovery of the allowance for doubtful accounts	$ 1

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		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Segment Reporting Information [Line Items]
Total EBITDA	$ (20,753)	$ 3,591	$ (13,485)	$ 25,568
Depreciation and amortization	(6,275)	(4,738)	(18,180)	(13,661)
Interest income (expense), net	186	(181)	386	(615)
Income (loss) before income taxes	(26,842)	(1,328)	(31,279)	11,292
Operating Segments [Member] | Global Spine [Member]
Segment Reporting Information [Line Items]
Total EBITDA	(6,033)	15,637	21,065	53,492
Operating Segments [Member] | Global Extremities [Member]
Segment Reporting Information [Line Items]
Total EBITDA	1,229	3,357	3,806	7,173
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Total EBITDA	$ (15,949)	$ (15,403)	$ (38,356)	$ (35,097)

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		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	$ 113,499	$ 111,708	$ 338,461	$ 331,964
Global Spine [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	88,091	84,797	264,088	252,761
Global Extremities [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	25,408	26,911	74,373	79,203
U.S. [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	89,452	86,756	267,021	260,455
U.S. [Member] | Global Spine [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	82,816	79,502	246,943	239,262
U.S. [Member] | Global Extremities [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	6,636	7,254	20,078	21,193
International [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	24,047	24,952	71,440	71,509
International [Member] | Global Spine [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	5,275	5,295	17,145	13,499
International [Member] | Global Extremities [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net sales	$ 18,772	$ 19,657	$ 54,295	$ 58,010

Acquisition-Related Amortizat_3

Acquisition-Related Amortization and Remeasurement - Components of Acquisition-Related Amortization and Remeasurement (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Acquisition Related Amortization And Remeasurement [Abstract]
Changes in fair value of contingent consideration	$ 22,270	$ 1,580	$ 28,140	$ 2,689
Amortization of acquired intangibles	1,338	429	3,733	802
Total	$ 23,608	$ 2,009	$ 31,873	$ 3,491

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		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 5,844	$ 5,261	$ 17,378	$ 14,392
Stock options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	599	579	3,637	2,442
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	3,805	2,244	8,462	5,480
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		734		1,493
Market-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,092	1,298	4,015	3,855
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	348	406	1,264	1,122
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	169	151	536	408
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	583	514	1,885	1,436
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	4,760	4,194	13,888	11,488
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 332	$ 402	$ 1,069	$ 1,060

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - USD ($) $ in Thousands	Aug. 05, 2019	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 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		43,603	50,928	295,496	257,833
Share-based compensation expense		$ 5,844	$ 5,261	$ 17,378	$ 14,392
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		$ 2,200		$ 5,900
Employment Agreement [Member] | Global Spine [Member] | Inducement Grants [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share issued under restricted stock units and stock options, value	$ 1,500

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2019	Mar. 31, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Components Of Income Tax Expense Benefit [Line Items]
Income tax effective rate	50.90%		8.80%	28.40%	56.30%
Income taxes	$ 13,656		$ (117)	$ 8,869	$ 6,352
Internal Revenue Service [Member]
Components Of Income Tax Expense Benefit [Line Items]
Income taxes		$ (1,800)
Minimum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	13,000			13,000
Maximum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	$ 13,400			$ 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		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Earnings Per Share [Line Items]
Weighted average common shares-basic	18,957,876	18,562,204	18,847,728	18,460,848
Effect of dilutive securities
Weighted average common shares-diluted	18,957,876	18,562,204	18,847,728	18,864,169
Stock Options And Stock Purchase Plan [Member]
Effect of dilutive securities
Effect of diluted securities				312,320
Restricted Stock Units [Member]
Effect of dilutive securities
Effect of diluted securities				91,001

Earnings Per Share ("EPS") - Ad

Earnings Per Share ("EPS") - Additional Information (Detail) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 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	1,814,544	2,088,843	1,880,423	359,172