Orthofix Medical (OFIX) 10-Q 5 Nov 20 2020 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2020	Nov. 02, 2020
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2020
Document Fiscal Year Focus	2020
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		19,333,698
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, 2020	Dec. 31, 2019
Current assets
Cash and cash equivalents	$ 79,810	$ 69,719
Restricted cash	490	684
Accounts receivable, net of allowances of $5,524 and $3,987, respectively	73,053	86,805
Inventories	82,859	82,397
Prepaid expenses and other current assets	18,457	20,948
Total current assets	254,669	260,553
Property, plant, and equipment, net	63,689	62,727
Intangible assets, net	62,309	54,139
Goodwill	83,503	71,177
Deferred income taxes	38,047	35,117
Other long-term assets	14,915	11,907
Total assets	517,132	495,620
Current liabilities
Accounts payable	16,943	19,886
Current portion of finance lease liability	498	323
Other current liabilities	75,938	64,674
Total current liabilities	93,379	84,883
Long-term portion of finance lease liability	22,463	20,648
Other long-term liabilities	46,394	62,458
Total liabilities	162,236	167,989
Contingencies (Note 9)
Shareholders’ equity
Common shares $0.10 par value; 50,000,000 shares authorized; 19,267,420 and 19,022,619 issued and outstanding as of September 30, 2020 and December 31, 2019, respectively	1,927	1,902
Additional paid-in capital	285,203	271,019
Retained earnings	68,757	57,749
Accumulated other comprehensive loss	(991)	(3,039)
Total shareholders’ equity	354,896	327,631
Total liabilities and shareholders’ equity	$ 517,132	$ 495,620

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Statement Of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 5,524	$ 3,987
Common shares, par value	$ 0.10	$ 0.10
Common shares, authorized	50,000,000	50,000,000
Common shares, issued	19,267,420	19,022,619
Common shares, outstanding	19,267,420	19,022,619

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income and Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Statement [Abstract]
Net sales	$ 110,985	$ 113,499	$ 288,943	$ 338,461
Cost of sales	26,243	24,896	72,818	74,416
Gross profit	84,742	88,603	216,125	264,045
Sales and marketing	52,926	54,805	150,718	165,363
General and administrative	16,541	21,090	49,453	63,497
Research and development	9,962	7,982	28,691	26,191
Acquisition-related amortization and remeasurement (Note 13)	1,138	23,608	(2,766)	31,873
Operating income (loss)	4,175	(18,882)	(9,971)	(22,879)
Interest income (expense), net	(731)	186	(2,055)	386
Other income (expense), net	1,817	(8,146)	6,088	(8,786)
Income (loss) before income taxes	5,261	(26,842)	(5,938)	(31,279)
Income tax benefit (expense)	(607)	(13,656)	17,833	(8,869)
Net income (loss)	$ 4,654	$ (40,498)	$ 11,895	$ (40,148)
Net income (loss) per common share:
Basic	$ 0.24	$ (2.14)	$ 0.62	$ (2.13)
Diluted	$ 0.24	$ (2.14)	$ 0.61	$ (2.13)
Weighted average number of common shares:
Basic	19,335,718	18,957,876	19,217,057	18,847,728
Diluted	19,398,567	18,957,876	19,319,302	18,847,728
Other comprehensive income (loss), before tax
Unrealized loss on debt security				$ (2,593)
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	$ 2,275	(1,893)	$ 2,048	(2,195)
Other comprehensive income (loss) before tax	2,275	(7,431)	2,048	(11,015)
Income tax related to other comprehensive income (loss)		1,388		2,200
Other comprehensive income (loss), net of tax	2,275	(6,043)	2,048	(8,815)
Comprehensive income (loss)	$ 6,929	$ (46,541)	$ 13,943	$ (48,963)

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, 2018	$ 335,397	$ 1,858	$ 243,165	$ 87,078	$ 3,296
Balance, Shares at Dec. 31, 2018		18,579,688
Cumulative effect adjustment from adoption | ASU 2018-02 [Member]				(938)	938
Cumulative effect adjustment from adoption | ASU 2016-02 [Member]	71			71
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
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
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
Beginning Balance at Dec. 31, 2019	$ 327,631	$ 1,902	271,019	57,749	(3,039)
Balance, Shares at Dec. 31, 2019	19,022,619	19,022,619
Cumulative effect adjustment from adoption | ASU 2016-13 [Member]	$ (887)			(887)
Net income (loss)	25,665			25,665
Other comprehensive income (loss), net of tax	(1,711)				(1,711)
Share-based compensation	3,859		3,859
Common shares issued, net	812	$ 4	808
Common shares issued, net, Shares		33,559
Ending Balance at Mar. 31, 2020	355,369	$ 1,906	275,686	82,527	(4,750)
Balance, Shares at Mar. 31, 2020		19,056,178
Beginning Balance at Dec. 31, 2019	$ 327,631	$ 1,902	271,019	57,749	(3,039)
Balance, Shares at Dec. 31, 2019	19,022,619	19,022,619
Net income (loss)	$ 11,895
Other comprehensive income (loss), net of tax	2,048
Ending Balance at Sep. 30, 2020	$ 354,896	$ 1,927	285,203	68,757	(991)
Balance, Shares at Sep. 30, 2020	19,267,420	19,267,420
Beginning Balance at Mar. 31, 2020	$ 355,369	$ 1,906	275,686	82,527	(4,750)
Balance, Shares at Mar. 31, 2020		19,056,178
Net income (loss)	(18,424)			(18,424)
Other comprehensive income (loss), net of tax	1,484				1,484
Share-based compensation	4,699		4,699
Common shares issued, net	1,917	$ 15	1,902
Common shares issued, net, Shares		152,885
Ending Balance at Jun. 30, 2020	345,045	$ 1,921	282,287	64,103	(3,266)
Balance, Shares at Jun. 30, 2020		19,209,063
Net income (loss)	4,654			4,654
Other comprehensive income (loss), net of tax	2,275				2,275
Share-based compensation	3,841		3,841
Common shares issued, net	(919)	$ 6	(925)
Common shares issued, net, Shares		58,357
Ending Balance at Sep. 30, 2020	$ 354,896	$ 1,927	$ 285,203	$ 68,757	$ (991)
Balance, Shares at Sep. 30, 2020	19,267,420	19,267,420

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash flows from operating activities
Net income (loss)	$ 11,895	$ (40,148)
Adjustments to reconcile net income (loss) to net cash from operating activities
Depreciation and amortization	22,299	18,180
Amortization of operating lease assets, debt costs, and other assets	2,811	2,724
Provision for expected credit losses	945	861
Deferred income taxes	(2,471)	(3,309)
Share-based compensation	12,399	17,378
Interest and loss on valuation of investment securities	219	5,000
Change in fair value of contingent consideration	(7,600)	28,140
Other	(1,798)	1,307
Changes in operating assets and liabilities, net of effects of acquisitions
Accounts receivable	11,551	(3,298)
Inventories	246	(4,995)
Prepaid expenses and other current assets	2,453	1,637
Accounts payable	(3,106)	447
Other current liabilities	5,742	347
Contract liability (Note 11)	13,851
Payment of contingent consideration		(1,340)
Other long-term assets and liabilities	(17,455)	(2,841)
Net cash from operating activities	51,981	20,090
Cash flows from investing activities
Acquisition of a business	(18,000)
Capital expenditures for property, plant, and equipment	(11,625)	(13,737)
Capital expenditures for intangible assets	(1,079)	(1,144)
Purchase of investment securities	(5,000)
Asset acquisitions and other investments	(7,240)	(6,400)
Net cash from investing activities	(42,944)	(21,281)
Cash flows from financing activities
Proceeds from revolving credit facility	100,000
Repayment of revolving credit facility	(100,000)
Proceeds from issuance of common shares	3,839	6,821
Payments related to withholdings for share-based compensation	(2,029)	(4,271)
Payment of contingent consideration		(13,660)
Payments related to finance lease obligation	(204)	(276)
Other financing activities	(1,023)	(1,224)
Net cash from financing activities	583	(12,610)
Effect of exchange rate changes on cash	277	(885)
Net change in cash, cash equivalents, and restricted cash	9,897	(14,686)
Cash, cash equivalents, and restricted cash at the beginning of period	70,403	72,189
Cash, cash equivalents, and restricted cash at the end of period	80,300	57,503
Components of cash, cash equivalents and restricted cash at the end of period
Cash and cash equivalents	79,810	56,849
Restricted cash	490	654
Cash, cash equivalents, and restricted cash at the end of period	80,300	$ 57,503
Noncash investing activities - Purchase of intangible assets	$ 1,575

Business, basis of presentation

Business, basis of presentation, COVID-19 update, and CARES Act	9 Months Ended
	Sep. 30, 2020
Organization Consolidation And Presentation Of Financial Statements And Unusual Or Infrequent Items Disclosure [Abstract]
Business, basis of presentation, COVID-19 update, and CARES Act	1. Business, basis of presentation, COVID-19 update, and CARES Act Description of the Business Orthofix Medical Inc., together with its subsidiaries (the “Company” or “Orthofix”), is a global medical device company focused on musculoskeletal products and therapies. The Company’s mission is to deliver innovative, quality-driven solutions while partnering with health care professionals on improving patients’ lives. Headquartered in Lewisville, Texas, Orthofix’s spine and orthopedic extremities products are distributed in more than 70 countries via the Company's sales representatives and distributors. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“U.S. GAAP”) for interim financial information and with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. Pursuant to these rules and regulations, certain information and note disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. In the opinion of management, all adjustments (consisting of normal recurring items) considered necessary for a fair statement have been included. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and related notes contained in the Company’s Form 10-K for the year ended December 31, 2019. 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 expected credit losses; inventories; valuation of intangible assets; goodwill; fair value measurements, including contingent consideration; litigation and contingent liabilities; tax matters; and share-based compensation. Actual results could differ from these estimates. COVID-19 Update The global Coronavirus Disease 2019 ("COVID-19") pandemic has significantly affected the Company’s patients, communities, employees and business operations. The pandemic has led to the cancellation or deferral of elective surgeries and procedures within certain hospitals, ambulatory surgery centers, and other medical facilities; restrictions on travel; the implementation of physical distancing measures; and the temporary or permanent closure of certain businesses. In addition, broad economic factors resulting from the pandemic, including increased unemployment rates and reduced consumer spending, are affecting the Company’s patients and partners . The Company's condensed consolidated financial statements reflect estimates and assumptions made by management that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and reported amounts of revenue and expenses during the reporting periods presented. At this time, the future trajectory of the COVID-19 pandemic remains uncertain, both in the U.S. and in other markets. Progress continues to be made on therapeutic treatments and vaccine candidates, though the efficacy and timing of various treatments and vaccines is uncertain. Given these various uncertainties, it is unclear the extent to which lingering slowdowns in elective procedures will affect the Company’s business during the remainder of 2020 and beyond. The expected effects of COVID-19 on the Company’s business will depend on various factors including (i) the magnitude and length of increased case waves during the fall and winter, (ii) the comfort level of patients in returning to clinics and hospitals, (iii) the extent to which localized elective surgery shutdowns occur, (iv) the unemployment rate’s effect on potential patients lacking medical insurance coverage, and (v) general hospital capacity constraints occurring because of the need to treat COVID-19 patients. In addition, while the Company has not seen such effects to date, risk remains that COVID-19 could have material negative effects on contractual counterparties, leading to supply chain disruptions or counterparty payment defaults and bankruptcies (including bankruptcies to hospital systems that significantly rely on revenue from elective surgeries). These matters are also described in Part II, Item 1A of this Form 10-Q under the heading Risk Factors Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) On March 27, 2020, the President of the United States signed the CARES Act into federal law, which is aimed at providing emergency assistance and health care for individuals, families, and businesses affected by the COVID-19 pandemic and generally supporting the U.S. economy. The CARES Act has provided financial relief to the Company through other various programs, which are each described in further detail below. In April 2020, the Company received $13.9 million in funds from the Centers for Medicare & Medicaid Services (“CMS”) Accelerated and Advance Payment Program. For discussion of the Company’s accounting for these funds, see Note 11. The Company also automatically received, as a durable medical equipment provider, without request, $4.7 million in funds from the U.S. Department of Health and Human Services in April 2020 as part of the Provider Relief Fund. Upon review of the qualifying criteria required to retain the funding, which primarily relate to lost revenues or the incurrence of expenses attributable to COVID-19, it was determined that the Company met the criteria to retain the funds received. During the quarter ended June 30, 2020, the Company recognized other income of $4.7 million related to this in-substance grant. In addition, as part of the CARES Act, the Company is permitted to defer all employer social security payroll tax payments for the remainder of the 2020 calendar year, such that 50% of the taxes is deferred until December 31, 2021, with the remaining 50% deferred until December 31, 2022. As of September 30, 2020, the Company has deferred $2.2 million associated with this program, all of which is classified within other long-term liabilities.

Recently adopted accounting sta

Recently adopted accounting standards and recently issued accounting pronouncements	9 Months Ended
	Sep. 30, 2020
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”) 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments and Subsequent Amendments In June 2016, the Financial Accounting Standards Board (“FASB”) issued ASU 2016-13 (which was then further clarified in subsequent ASUs), which requires that credit losses for certain types of financial instruments, including trade accounts receivable, be estimated based on expected credit losses among other changes. Effective January 1, 2020, the Company adopted ASU 2016-13 using a modified retrospective approach. Therefore, results for reporting periods after January 1, 2020 are presented under Topic 326, while prior period amounts are not adjusted and continue to be reported in accordance with the historical accounting guidance. See Note 11 for additional discussion of the Company’s adoption of Topic 326 and its resulting accounting policies. Adoption of ASU 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment In January 2017, the FASB issued ASU 2017-04, which eliminates Step 2 of the previous goodwill impairment test, which required a hypothetical purchase price allocation to measure goodwill impairment. Under ASU 2017-04, a goodwill impairment loss will now be measured as the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the recorded amount of goodwill. The Company adopted this ASU effective January 1, 2020 on a prospective basis. Adoption of this ASU did not impact the Company’s condensed consolidated balance sheet, statements of operations, or cash flows, but is expected to impact the measurement of any future goodwill impairment. Adoption of ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement In August 2018, the FASB issued ASU 2018-13, which eliminates certain disclosures, such as the amount and reasons for transfers between Level 1 and Level 2 of the fair value hierarchy, and adds new disclosure requirements for Level 3 measurements. The Company adopted this ASU effective January 1, 2020, with certain provisions of the ASU applied retrospectively and other provisions provided prospectively. Adoption of this ASU did not impact the Company’s condensed consolidated balance sheet, statements of operations, or cash flows; however, adoption of the ASU did result in modified disclosures in Note 8. Adoption of ASU 2018-15, Intangibles—Goodwill and Other—Internal-Use Software (Subtopic 350-40): Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract In August 2018, the FASB issued ASU 2018-15, which 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 was not affected by the amendments in this update. The Company adopted this ASU effective January 1, 2020 on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows, but is expected to impact future cloud computing arrangements. Adoption of ASU 2020-04, Reference Rate Reform (Topic 848) In March 2020, the FASB issued ASU 2020-04, which provides temporary optional guidance to ease the potential financial reporting burden of the expected market transition away from LIBOR. The new guidance provides optional expedients and exceptions for applying U.S. GAAP to contract modifications, hedge accounting, and other transactions affected by reference rate reform if certain criteria are met through December 31, 2022. The Company adopted this ASU effective March 12, 2020, the effective date of the ASU, on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows, but is expected to impact the future borrowing rate used for the Company’s secured revolving credit facility. Recently issued accounting pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Simplifying the accounting for income taxes (ASU 2019-12) Reduces the complexity of accounting for income taxes by eliminating certain exceptions to the general principles in ASC 740, Income Taxes January 1, 2021 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements.

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2020
Business Combinations [Abstract]
Acquisitions	3. Acquisitions FITBONE Asset Purchase Agreement On February 3, 2020, the Company, through a wholly owned subsidiary, entered into an Asset Purchase Agreement (the “Purchase Agreement”) with Wittenstein SE (“Wittenstein”), a privately-held German-based company, to acquire assets associated with the FITBONE intramedullary lengthening system for limb lengthening of the femur and tibia bones. Under the terms of the Purchase Agreement, as consideration for the acquired assets, the Company paid $18.0 million in cash consideration and entered into a Contract Manufacturing and Supply Agreement (“CMSA”) with Wittenstein. The Company has accounted for this acquisition as a business combination. The acquisition was completed on March 26, 2020. The following table summarizes the preliminary estimated fair values of assets acquired and liabilities assumed at the acquisition date. A final determination of the allocation of the purchase price to assets acquired and liabilities assumed has not been made and is subject to completion of the Company’s valuation of the assets acquired and liabilities assumed, which may take up to one year. (U.S. Dollars, in thousands) Preliminary Acquisition Date Fair Value Balance Sheet Classification Assigned Useful Life Assets acquired Inventories $ 528 Inventories Developed technology 4,500 Intangible assets, net 8 years Customer relationships 800 Intangible assets, net 15 years Trade name 600 Intangible assets, net 15 years In-process research and development ("IPR&D") 300 Intangible assets, net Indefinite Total identifiable assets acquired 6,728 Goodwill 11,272 Total fair value of consideration transferred $ 18,000 The Company recorded goodwill of $11.3 million in connection with the acquisition, of which $11.1 million was assigned to the Global Extremities reporting segment and $0.2 million was assigned to the Global Spine reporting segment. Specifically, goodwill includes synergies associated with the purchase of the acquired assets and is expected to be deductible for tax purposes. The IPR&D intangible asset is considered an indefinite-lived asset until the completion or abandonment of the associated research and development efforts. Accordingly, during the development period after the acquisition, this asset is not amortized but, instead, is subject to impairment review and testing provisions. Upon completion of the IPR&D project, the Company will determine the useful life of the asset and begin amortization. The Company also entered into a CMSA with Wittenstein for an initial term of up to two years to manufacture the FITBONE product line. The Company is accounting for the CMSA as a finance lease. See Note 5 for further discussion of the recognized finance lease. The Company did not recognize significant acquisition-related costs during the three months ended September 30, 2020 and 2019 and recorded $0.4 million and $0.3 million of acquisition related costs during the nine months ended September 30, 2020 and 2019, respectively. These costs are included in the condensed consolidated statements of operations within general and administrative expenses. Additionally, the Company recognized $0.8 million and $1.0 million in revenues related to the FITBONE product line during the three and nine months ended September 30, 2020. Distributor Acquisition In July 2020, the Company, through a wholly owned subsidiary, entered into an agreement to acquire certain assets of a medical device distributor. The Company agreed to pay consideration of up to $7.6 million in accordance with the parties’ agreement. The following table summarizes the fair values of assets acquired and of consideration paid: (U.S. Dollars, in thousands) Fair Value Balance Sheet Classification Assigned Useful Life Fair Value of Consideration Transferred Cash paid or payable $ 7,200 Contingent consideration 375 Total fair value of consideration transferred $ 7,575 Fair value of assets acquired Customer relationships $ 7,340 Intangible assets, net 5 years Assembled workforce 235 Intangible assets, net 5 years Total fair value of assets acquired $ 7,575

Inventories

Inventories	9 Months Ended
	Sep. 30, 2020
Inventory Disclosure [Abstract]
Inventories	4. Inventories Inventories were as follows: (U.S. Dollars, in thousands) September 30, 2020 December 31, 2019 Raw materials $ 7,779 $ 9,587 Work-in-process 12,050 14,027 Finished products 26,384 20,712 Field/consignment 36,646 38,071 Inventories $ 82,859 $ 82,397

Leases

Leases	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
Leases	5. Leases A summary of the Company’s lease portfolio as of September 30, 2020 and December 31, 2019 is presented in the table below: (U.S. Dollars, in thousands) Classification September 30, 2020 December 31, 2019 Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 4,972 $ 5,798 Finance leases Property, plant and equipment, net 21,001 20,207 Total ROU assets 25,973 26,005 Lease Liabilities Current Operating leases Other current liabilities 1,999 1,875 Finance leases Current portion of finance lease liability 498 323 Long-term Operating leases Other long-term liabilities 3,166 4,084 Finance leases Long-term portion of finance lease liability 22,463 20,648 Total lease liabilities $ 28,126 $ 26,930 Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) Nine Months Ended September 30, 2020 Nine Months Ended September 30, 2019 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 3,170 $ 3,037 Operating cash flows from finance leases 458 687 Financing cash flows from finance leases 204 276 ROU assets obtained in exchange for lease obligations Operating leases 619 598 Finance leases 1,949 21,179 Wittenstein Contract Manufacturing and Supply Agreement In March 2020, the Company entered into a CMSA with Wittenstein for an initial term of two years to manufacture the FITBONE product line. As consideration, the Company will pay $2.0 million to Wittenstein at the conclusion of the CMSA if certain conditions are met in relation to the prompt delivery of manufactured products. The Company is accounting for the CMSA as a finance lease as the Company has the right to direct the use of and to obtain substantially all of the economic benefits of the dedicated equipment used to manufacture the products and has the option to obtain title and possession of the equipment at the conclusion of the CMSA. As a result, the Company recognized both a finance lease liability and a related ROU asset of $1.9 million as of the commencement date of the CMSA.

Other current liabilities

Other current liabilities	9 Months Ended
	Sep. 30, 2020
Payables And Accruals [Abstract]
Other current liabilities	In December 2019, the Company approved and initiated a targeted restructuring plan in the U.S. to streamline costs and to better align talent with the Company’s strategic initiatives. The plan consists primarily of the realignment of certain personnel, representing a limited number of positions, which require severance payments. As of December 31, 2019, the Company recorded a liability of $3.2 million in connection with this activity, all of which was recognized in 2019 within general and administrative expenses. During the three and nine months ended September 30, 2020, the Company recorded additional accruals of $1.1 million and $2.5 million, respectively, associated with these activities. Payments were made during the three and nine months ended September 30, 2020 totaling $1.1 million and $2.1 million, respectively. As of September 30, 2020, the Company had a liability of $3.7 million associated with the restructuring plan.

Long-term debt

Long-term debt	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Long-term debt	7. Long-term debt As a precautionary measure to increase the Company’s cash position and preserve financial flexibility during the uncertainty resulting from the COVID-19 pandemic, the Company completed a borrowing of $100.0 million under its five year $300 million secured revolving credit facility on April 16, 2020. The Company made payments of $100.0 million in the third quarter of 2020 to fully pay down the outstanding balance. As of September 30, 2020, the Company had no borrowings outstanding under the secured revolving credit facility and was in compliance with all required financial covenants. In addition, the Company had no borrowings on its €5.5 million ($6.4 million) available lines of credit in Italy as of September 30, 2020.

Fair value measurements and inv

Fair value measurements and investments	9 Months Ended
	Sep. 30, 2020
Fair Value Measurements And Investment Disclosure [Abstract]
Fair value measurements and investments	8. 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, 2020 December 31, 2019 (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Bone Biologics equity securities $ — $ — $ — $ — $ 219 Total $ — $ — $ — $ — $ 219 Liabilities Spinal Kinetics contingent consideration $ — $ — $ (35,100 ) $ (35,100 ) $ (42,700 ) Other contingent consideration $ — $ — $ (375 ) $ (375 ) $ — Deferred compensation plan — (1,366 ) — (1,366 ) (1,255 ) Total $ — $ (1,366 ) $ (35,475 ) $ (36,841 ) $ (43,955 ) Contingent Consideration The Company recognized a contingent consideration obligation in connection with the acquisition of Spinal Kinetics in 2018. The Spinal Kinetics contingent consideration consists of potential future milestone payments of up to $60.0 million in cash. The milestone payments included (i) $15.0 million upon U.S. Food and Drug Administration (“FDA”) approval of the M6-C artificial cervical disc (the “FDA Milestone”) and (ii) revenue-based milestone payments of up to $45.0 million in connection with future sales of the acquired artificial discs. Milestones must be achieved within five years of April 30, 2018 to trigger applicable payments. In February 2019, the FDA Milestone was achieved and paid. The estimated fair value of the remaining Spinal Kinetics contingent consideration was $35.1 million as of September 30, 2020. The estimated fair value reflects assumptions made by management as of September 30, 2020, including the impact of COVID-19 on significant unobservable assumptions, such as the expected timing and volume of elective procedures and the impact of these procedures on future revenues. However, the impact of COVID-19 on the Company’s business remains uncertain and difficult to predict. As information surrounding the pandemic is continuing to evolve, the actual amount ultimately paid could be higher or lower than the fair value of the remaining contingent consideration. At September 30, 2020, the Company has classified $14.7 million of the liability attributable to the revenue-based milestone within other current liabilities, as the Company currently expects to pay one of the revenue-based milestones in the next twelve months, and the remaining $20.4 million within other long-term liabilities. Any changes in fair value are recorded as an operating expense within acquisition-related amortization and remeasurement. The following table provides a reconciliation of the beginning and ending balances for the Spinal Kinetics contingent consideration measured at estimated fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2020 2019 Spinal Kinetics contingent consideration estimated fair value at January 1 $ 42,700 $ 28,560 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement (7,600 ) 28,140 Payment made — (15,000 ) Spinal Kinetics contingent consideration estimated fair value at September 30 $ 35,100 $ 41,700 The $7.6 million decrease in fair value in 2020 is primarily attributable to a change in management’s forecast of future net sales of artificial discs because of uncertainty in the market and the economy attributable to COVID-19. The Company estimated the fair value of the remaining potential future revenue-based milestone payments using a Monte Carlo simulation and a discounted cash flow model. This fair value measurement is based on significant inputs that are unobservable in the market and thus represents a Level 3 measurement. The key assumptions in applying the valuation model include the Company’s forecasted future revenues for Spinal Kinetics products, the expected timing of payment, applicable discount rates applied, and assumptions for potential volatility of the Company’s forecasted revenue. Significant changes in these assumptions could result in a significantly higher or lower fair value. The following table provides a range of key assumptions used within the valuation as of September 30, 2020. (U.S. Dollars, in thousands) Fair Value as of September 30, 2020 Valuation Technique Unobservable inputs Range Spinal Kinetics contingent consideration $ 35,100 Discounted cash flow Revenue discount rate 7.41% - 7.49% Payment discount rate 4.33% - 4.40% Projected year of payment 2021 - 2022 Other contingent consideration is attributable to an agreement closed in the third quarter of 2020 to acquire certain assets of a medical device distributor as a portion of the consideration is based upon meeting certain revenue-based targets. eNeura Debt Security and Warrant Until October of 2019, the Company held a debt security and a related warrant to purchase common stock of eNeura, Inc. (“eNeura”), a privately held medical technology company that is developing devices for the treatment of migraines. On October 25, 2019, the Company and eNeura settled the debt security for a $4.0 million cash payment and agreed to transfer the warrant to eNeura as part of such settlement. 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. 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) 2020 2019 eNeura debt security and Warrant at January 1 $ — $ 17,820 Gains or losses recorded for the period Recognized in other comprehensive income (loss) — (2,593 ) Change in classification of debt security to held to maturity — (15,227 ) Issuance of Warrant as consideration for prior extension of debt maturity date — 491 Impairment of warrant — (491 ) eNeura debt security and Warrant at September 30 $ — $ —

Contingencies

Contingencies	9 Months Ended
	Sep. 30, 2020
Commitments And Contingencies Disclosure [Abstract]
Contingencies	9. Contingencies In addition to the matters described below, in the normal course of its business, the Company is involved in various lawsuits from time to time and may be subject to certain other contingencies. The Company believes any losses related to these matters are individually and collectively immaterial as to a possible loss and range of loss. Italian Medical Device Payback (“IMDP”) In 2015, the Italian Parliament introduced rules for entities that supply goods and services to the Italian National Healthcare System. 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 medical device companies in Italy to make payments to the Italian government if medical device expenditures exceed regional maximum ceilings. Companies are required to make payments equal to a percentage of expenditures exceeding maximum regional caps. There is considerable uncertainty about how the law will operate and what the exact timeline is for finalization. The Company’s current assessment of the IMDP involves significant judgment regarding the expected scope and actual implementation terms of the measure as the latter have not been clarified to date by Italian authorities. The Company accounts for the estimated cost of the IMDP as sales and marketing expense and recorded expense of $0.4 million and $0.3 million for the three months ended September 30, 2020 and 2019, respectively, and $1.1 million and $1.0 million for the nine months ended September 30, 2020 and 2019, respectively. As of September 30, 2020, the Company has accrued $6.3 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 September 2019, in relation to an ongoing legal dispute with a former Brazilian distributor, approximately $0.5 million (based upon foreign exchange rates as of September 30, 2020) 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, 2020, the Company has an accrual of $1.3 million related to this matter.

Accumulated other comprehensive

Accumulated other comprehensive loss	9 Months Ended
	Sep. 30, 2020
Equity [Abstract]
Accumulated other comprehensive loss	10. Accumulated other comprehensive loss The components of and changes in accumulated other comprehensive loss were as follows: (U.S. Dollars, in thousands) Currency Translation Adjustments Accumulated Other Comprehensive Loss Balance at December 31, 2019 $ (3,039 ) $ (3,039 ) Other comprehensive income 2,048 2,048 Income taxes — — Balance at September 30, 2020 $ (991 ) $ (991 )

Revenue recognition and account

Revenue recognition and accounts receivable	9 Months Ended
	Sep. 30, 2020
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	11. Revenue recognition and accounts receivable Revenue Recognition The Company has two reporting segments, which consist of Global Spine and Global Extremities. Within the Global Spine reporting segment there are three product categories: Bone Growth Therapies, Spinal Implants and Biologics. The tables below presents net sales by major product category by reporting segment: Three Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 Change Bone Growth Therapies $ 47,066 $ 48,836 -3.6 % Spinal Implants 25,505 22,947 11.1 % Biologics 15,245 16,308 -6.5 % Global Spine 87,816 88,091 -0.3 % Global Extremities 23,169 25,408 -8.8 % Net sales $ 110,985 $ 113,499 -2.2 % Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 Change Bone Growth Therapies $ 120,888 $ 146,228 -17.3 % Spinal Implants 67,025 69,076 -3.0 % Biologics 40,319 48,784 -17.4 % Global Spine 228,232 264,088 -13.6 % Global Extremities 60,711 74,373 -18.4 % Net sales $ 288,943 $ 338,461 -14.6 % Product Sales and Marketing Service Fees The table below presents product sales and marketing service fees, which are both components of net sales: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Product sales $ 96,305 $ 97,833 $ 250,161 $ 291,632 Marketing service fees 14,680 15,666 38,782 46,829 Net sales $ 110,985 $ 113,499 $ 288,943 $ 338,461 Product sales primarily consist of the sale of bone growth therapies devices, motion preservation products, 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. Adoption of ASU 2016-13 As discussed in Note 2, the Company adopted ASU No. 2016-13 - Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (U.S. Dollars, in thousands) December 31, 2019 Impact of Adoption of ASC 326 January 1, 2020 Assets Current assets Cash, cash equivalents, and restricted cash $ 70,403 $ — $ 70,403 Accounts receivable, net 86,805 (1,120 ) 85,685 Inventories 82,397 — 82,397 Prepaid expenses and other current assets 20,948 — 20,948 Total current assets 260,553 (1,120 ) 259,433 Deferred income taxes 35,117 233 35,350 Other long-term assets 199,950 — 199,950 Total assets $ 495,620 $ (887 ) $ 494,733 Liabilities and shareholders’ equity Total liabilities $ 167,989 $ — $ 167,989 Shareholders’ equity Common shares $ 1,902 $ — $ 1,902 Additional paid-in capital 271,019 — 271,019 Retained earnings 57,749 (887 ) 56,862 Accumulated other comprehensive loss (3,039 ) — (3,039 ) Total shareholders’ equity 327,631 (887 ) 326,744 Total liabilities and shareholders’ equity $ 495,620 $ (887 ) $ 494,733 Accounts receivable and related allowances Subsequent to the adoption of ASU 2016-13, the Company’s allowance for expected credit losses represents the portion of the receivable’s amortized cost basis that an entity does not expect to collect over the receivable’s contractual life, considering past events, current conditions, and reasonable and supportable forecasts of future economic conditions. The process for estimating the ultimate collection of accounts receivable involves significant assumptions and judgments. The determination of the contractual life of accounts receivable, the aging of outstanding receivables, as well as the historical collections, write-offs, and payor reimbursement experience over the estimated contractual lives of such receivables, are integral parts of the estimation process related to reserves for expected credit losses and the establishment of contractual allowances. Accounts receivable are analyzed on a quarterly basis to assess the adequacy of both reserves for expected credit losses and contractual allowances. Revisions in allowances for expected credit loss estimates are recorded as an adjustment to bad debt expense within sales and marketing expenses. Revisions to contractual allowances are recorded as an adjustment to net sales. These estimates are periodically tested against actual collection experience. In addition, the Company analyzes its receivables by geography and by customer type, where appropriate, in developing estimates for expected credit losses. The following table provides a detail of changes in the Company’s allowance for expected credit losses for the three and nine months ended September 30, 2020: (U.S. Dollars, in thousands) Three Months Ended September 30, 2020 Nine Months Ended September 30, 2020 Allowance for expected credit losses beginning balance $ 6,364 $ 3,987 Impact of adoption of ASU 2016-13 — 1,120 Current period provision (recovery) for expected credit losses (619 ) 945 Writeoffs charged against the allowance and other (309 ) (647 ) Effect of changes in foreign exchange rates 88 119 Allowance for expected credit losses ending balance $ 5,524 $ 5,524 Contract Liabilities The Company’s contract liabilities largely relate to a prepayment of $13.9 million received in April 2020 from the CMS as part of the Accelerated and Advance Payment Program of the CARES Act intended to increase cash flow to providers of services and suppliers impacted by the COVID-19 pandemic. On October 1, 2020, the President of the United States signed the “Continuing Appropriations Act, 2021 and Other Extensions Act,” which relaxed a number of the Medicare Accelerated and Advance Payment Programs recoupment terms for providers and suppliers that received funds from the program. Under these new terms, recoupment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25% of Medicare payments otherwise owed to the provider or supplier for 11 months. At the end of the 11-month period, recoupment will increase to 50% for another 6 months. Thus, during these time periods, rather than receiving the full amount of payment for newly submitted claims, the Company’s outstanding accelerated / advance payment balance will be reduced by the recoupment amount until the full balance has been repaid. As of September 30, 2020, the Company has classified $6.9 million of this contract liability within other current liabilities and $6.9 million within other long-term liabilities based upon the Company’s estimates of when such funds will be recouped. The Company did not recognize any net sales during the three and nine months ended September 30, 2020, respectively, attributable to the satisfaction of performance obligations related to the CMS prepayment. Other Contract Assets The Company’s contract assets, excluding trade accounts receivable (“Other Contract Assets”), largely consist of payments made to certain distributors to obtain contracts, gain access to customers in certain territories, and to provide the benefit of the exclusive distribution of Orthofix products. Other Contract Assets are included in other long-term assets or other current assets, dependent upon the original term of the related agreement, and totaled $2.3 million and $3.7 million as of September 30, 2020, and December 31, 2019, respectively.

Business segment information

Business segment information	9 Months Ended
	Sep. 30, 2020
Segment Reporting [Abstract]
Business segment information	12. Business segment information The Company has two reporting segments: Global Spine and Global Extremities. The primary metric used in managing the Company is earnings before interest, tax, depreciation, and amortization (“EBITDA”). 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. The table below presents EBITDA by reporting segment: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Global Spine $ 19,960 $ (6,033 ) $ 38,670 $ 21,065 Global Extremities 1,258 1,229 (3,995 ) 3,806 Corporate (6,196 ) (15,949 ) (16,259 ) (38,356 ) Total EBITDA $ 15,022 $ (20,753 ) $ 18,416 $ (13,485 ) Depreciation and amortization (9,030 ) (6,275 ) (22,299 ) (18,180 ) Interest income (expense), net (731 ) 186 (2,055 ) 386 Income (loss) before income taxes $ 5,261 $ (26,842 ) $ (5,938 ) $ (31,279 ) Geographical information The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Global Spine U.S. $ 83,477 $ 82,816 $ 215,819 $ 246,943 International 4,339 5,275 12,413 $ 17,145 Total Global Spine 87,816 88,091 228,232 264,088 Global Extremities U.S. 6,356 6,636 16,439 20,078 International 16,813 18,772 44,272 54,295 Total Global Extremities 23,169 25,408 60,711 74,373 Consolidated U.S. 89,833 89,452 232,258 267,021 International 21,152 24,047 56,685 71,440 Net sales $ 110,985 $ 113,499 $ 288,943 $ 338,461

Acquisition-Related Amortizatio

Acquisition-Related Amortization and Remeasurement	9 Months Ended
	Sep. 30, 2020
Acquisition Related Amortization And Remeasurement [Abstract]
Acquisition-Related Amortization and Remeasurement	13. Acquisition-related amortization and remeasurement Acquisition-related amortization and remeasurement consists of amortization related to intangible assets acquired through business combinations or asset acquisitions and the remeasurement of any related contingent consideration arrangement. Components of acquisition-related amortization and remeasurement are as follows: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Changes in fair value of contingent consideration $ (700 ) $ 22,270 $ (7,600 ) $ 28,140 Amortization of acquired intangibles 1,838 1,338 4,834 3,733 Total $ 1,138 $ 23,608 $ (2,766 ) $ 31,873

Share-based compensation

Share-based compensation	9 Months Ended
	Sep. 30, 2020
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Share-based compensation	14. Share-based compensation Components of share-based compensation expense are as follows: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Cost of sales $ 149 $ 169 $ 535 $ 536 Sales and marketing 668 583 2,897 1,885 General and administrative 2,770 4,760 7,939 13,888 Research and development 254 332 1,028 1,069 Total $ 3,841 $ 5,844 $ 12,399 $ 17,378 Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Stock options $ 786 $ 599 $ 1,840 $ 3,637 Time-based restricted stock awards and units 1,632 3,805 6,804 8,462 Market-based restricted stock units 1,049 1,092 2,529 4,015 Stock purchase plan 374 348 1,226 1,264 Total $ 3,841 $ 5,844 $ 12,399 $ 17,378 During the three months ended September 30, 2020 and 2019, the Company issued 58,357 and 43,603 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, 2020 and 2019, the Company issued 244,801 and 295,496 shares, respectively, of common stock related to stock purchase plan issuances, stock option exercises, and the vesting of restricted stock awards and units.

Income taxes

Income taxes	9 Months Ended
	Sep. 30, 2020
Income Tax Disclosure [Abstract]
Income taxes	15. Income taxes Income tax provisions for interim periods are based on an estimated annual income tax rate, adjusted for discrete tax items. As a result, the Company’s interim effective tax rates may vary significantly from the statutory tax rate and the annual effective tax rate. For the three months ended September 30, 2020 and 2019, the effective tax rate was 11.5% and (50.9)%, respectively. For the nine months ended September 30, 2020 and 2019, the effective tax rate was 300.3% and (28.4)%, respectively. The primary factors affecting the Company’s effective tax rate for the three and nine months ended September 30, 2020, were statute expirations related to unrecognized tax benefits, financial deductions not recognized for tax purposes, limits on executive compensation, and reversal of tax benefits related to certain performance stock units forfeited in the current year. The financial deductions not recognized for tax purposes are primarily related to the remeasurement of contingent consideration. The CARES Act, among other things, includes income tax provisions relating to net operating loss carryback periods, alternative minimum tax credit refunds, modifications to the net interest deduction limitations, and technical corrections to tax depreciation methods for qualified improvement property. As of September 30, 2020, the Company does not expect a significant impact to its income tax expense (benefit) for fiscal year 2020 as a result of the CARES Act. During the three and nine months ended September 30, 2020, the Company recognized a net benefit of less than $0.1 million and $17.8 million, respectively, related to uncertain tax benefits. The net benefit resulted from expired statute of limitations related to certain unrecognized tax benefits. 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 $0.1 million to $0.6 million as audits close and statutes expire.

Earnings per share ("EPS")

Earnings per share ("EPS")	9 Months Ended
	Sep. 30, 2020
Earnings Per Share [Abstract]
Earnings per share ("EPS")	16. Earnings per share (“EPS”) The Company uses the two-class method of computing basic EPS due to the existence of non-vested restricted stock awards with nonforfeitable rights to dividends or dividend equivalents (referred to as participating securities). For the three and nine months ended September 30, 2020, 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, 2020 2019 2020 2019 Weighted average common shares-basic 19,335,718 18,957,876 19,217,057 18,847,728 Effect of dilutive securities Unexercised stock options and stock purchase plan 10,607 — 41,701 — Unvested restricted stock awards and units 52,242 — 60,544 — Weighted average common shares-diluted 19,398,567 18,957,876 19,319,302 18,847,728 There were 1,771,113 and 1,814,544 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, 2020 and 2019, respectively, and 1,527,735 and 1,880,423 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, 2020 and 2019, respectively, because inclusion of these awards was anti-dilutive or, for performance-based and market-based restricted stock awards and units, all necessary conditions had not been satisfied by the end of the respective period.

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2020
Subsequent Events [Abstract]
Subsequent Events	17. Subsequent Events Neo Medical SA On October 1, 2020, the Company and Neo Medical SA, a privately held Swiss-based company developing a new generation of products for spinal surgery (“Neo Medical”), entered into a partnership that includes a co-development agreement covering the parties’ joint development of single use instruments for cervical spine procedures, and a distribution agreement under which Orthofix will exclusively distribute Neo Medical’s thoracolumbar procedure solutions to certain U.S. customer accounts. Separately, the Company also purchased shares of Neo Medical’s preferred stock for consideration of $5.0 million and entered into a Convertible Loan Agreement pursuant to which Orthofix loaned Neo Medical CHF 4.6 million (the “Convertible Loan”). The loan bears interest at 8.0%, with interest due semi-annually. At each interest payment date, the borrower may elect to capitalize any interest due to the then outstanding principal balance of the loan. The Convertible Loan matures on October 1, 2024, provided that if a change in control of Neo Medical occurs prior to the maturity date, the Convertible Loan shall become immediately due upon such event. The Convertible Loan may be convertible by either party into shares of Neo Medical’s preferred stock. The price per share at which the loan converts is dependent upon i) the party electing conversion and ii) Neo Medical’s price per share in its most recent fundraising activities at the time of conversion, as specified within the agreement. In relation to the purchased equity shares, the Company was required to pay the requisite funds into a blocked capital increase account administered by a third party on September 30, 2020, prior to the closing of the transaction. This amount is classified within other long-term assets as of September 30, 2020.

Recently adopted accounting s_2

Recently adopted accounting standards and recently issued accounting pronouncements (Policies)	9 Months Ended
	Sep. 30, 2020
Accounting Changes And Error Corrections [Abstract]
Recently adopted accounting standards and recently issued accounting pronouncements	Adoption of Accounting Standards Update (“ASU”) 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments and Subsequent Amendments In June 2016, the Financial Accounting Standards Board (“FASB”) issued ASU 2016-13 (which was then further clarified in subsequent ASUs), which requires that credit losses for certain types of financial instruments, including trade accounts receivable, be estimated based on expected credit losses among other changes. Effective January 1, 2020, the Company adopted ASU 2016-13 using a modified retrospective approach. Therefore, results for reporting periods after January 1, 2020 are presented under Topic 326, while prior period amounts are not adjusted and continue to be reported in accordance with the historical accounting guidance. See Note 11 for additional discussion of the Company’s adoption of Topic 326 and its resulting accounting policies. Adoption of ASU 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment In January 2017, the FASB issued ASU 2017-04, which eliminates Step 2 of the previous goodwill impairment test, which required a hypothetical purchase price allocation to measure goodwill impairment. Under ASU 2017-04, a goodwill impairment loss will now be measured as the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the recorded amount of goodwill. The Company adopted this ASU effective January 1, 2020 on a prospective basis. Adoption of this ASU did not impact the Company’s condensed consolidated balance sheet, statements of operations, or cash flows, but is expected to impact the measurement of any future goodwill impairment. Adoption of ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement In August 2018, the FASB issued ASU 2018-13, which eliminates certain disclosures, such as the amount and reasons for transfers between Level 1 and Level 2 of the fair value hierarchy, and adds new disclosure requirements for Level 3 measurements. The Company adopted this ASU effective January 1, 2020, with certain provisions of the ASU applied retrospectively and other provisions provided prospectively. Adoption of this ASU did not impact the Company’s condensed consolidated balance sheet, statements of operations, or cash flows; however, adoption of the ASU did result in modified disclosures in Note 8. Adoption of ASU 2018-15, Intangibles—Goodwill and Other—Internal-Use Software (Subtopic 350-40): Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract In August 2018, the FASB issued ASU 2018-15, which 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 was not affected by the amendments in this update. The Company adopted this ASU effective January 1, 2020 on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows, but is expected to impact future cloud computing arrangements. Adoption of ASU 2020-04, Reference Rate Reform (Topic 848) In March 2020, the FASB issued ASU 2020-04, which provides temporary optional guidance to ease the potential financial reporting burden of the expected market transition away from LIBOR. The new guidance provides optional expedients and exceptions for applying U.S. GAAP to contract modifications, hedge accounting, and other transactions affected by reference rate reform if certain criteria are met through December 31, 2022. The Company adopted this ASU effective March 12, 2020, the effective date of the ASU, on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows, but is expected to impact the future borrowing rate used for the Company’s secured revolving credit facility. Recently issued accounting pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Simplifying the accounting for income taxes (ASU 2019-12) Reduces the complexity of accounting for income taxes by eliminating certain exceptions to the general principles in ASC 740, Income Taxes January 1, 2021 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements.

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2020
Business Acquisition [Line Items]
Summary of Fair Values of Assets Acquired and Consideration Paid	The following table summarizes the fair values of assets acquired and of consideration paid: (U.S. Dollars, in thousands) Fair Value Balance Sheet Classification Assigned Useful Life Fair Value of Consideration Transferred Cash paid or payable $ 7,200 Contingent consideration 375 Total fair value of consideration transferred $ 7,575 Fair value of assets acquired Customer relationships $ 7,340 Intangible assets, net 5 years Assembled workforce 235 Intangible assets, net 5 years Total fair value of assets acquired $ 7,575
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member]
Business Acquisition [Line Items]
Summary of Preliminary Estimated Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the preliminary estimated fair values of assets acquired and liabilities assumed at the acquisition date. A final determination of the allocation of the purchase price to assets acquired and liabilities assumed has not been made and is subject to completion of the Company’s valuation of the assets acquired and liabilities assumed, which may take up to one year. (U.S. Dollars, in thousands) Preliminary Acquisition Date Fair Value Balance Sheet Classification Assigned Useful Life Assets acquired Inventories $ 528 Inventories Developed technology 4,500 Intangible assets, net 8 years Customer relationships 800 Intangible assets, net 15 years Trade name 600 Intangible assets, net 15 years In-process research and development ("IPR&D") 300 Intangible assets, net Indefinite Total identifiable assets acquired 6,728 Goodwill 11,272 Total fair value of consideration transferred $ 18,000

Inventories (Tables)

Inventories (Tables)	9 Months Ended
	Sep. 30, 2020
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories were as follows: (U.S. Dollars, in thousands) September 30, 2020 December 31, 2019 Raw materials $ 7,779 $ 9,587 Work-in-process 12,050 14,027 Finished products 26,384 20,712 Field/consignment 36,646 38,071 Inventories $ 82,859 $ 82,397

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
Summary of Lease Portfolio	A summary of the Company’s lease portfolio as of September 30, 2020 and December 31, 2019 is presented in the table below: (U.S. Dollars, in thousands) Classification September 30, 2020 December 31, 2019 Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 4,972 $ 5,798 Finance leases Property, plant and equipment, net 21,001 20,207 Total ROU assets 25,973 26,005 Lease Liabilities Current Operating leases Other current liabilities 1,999 1,875 Finance leases Current portion of finance lease liability 498 323 Long-term Operating leases Other long-term liabilities 3,166 4,084 Finance leases Long-term portion of finance lease liability 22,463 20,648 Total lease liabilities $ 28,126 $ 26,930
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, 2020 Nine Months Ended September 30, 2019 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 3,170 $ 3,037 Operating cash flows from finance leases 458 687 Financing cash flows from finance leases 204 276 ROU assets obtained in exchange for lease obligations Operating leases 619 598 Finance leases 1,949 21,179

Fair value measurements and i_2

Fair value measurements and investments (Tables)	9 Months Ended
	Sep. 30, 2020
Fair Value Measurements And Investment Disclosure [Abstract]
Schedule of Financial Assets and Liabilities Recorded 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, 2020 December 31, 2019 (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Bone Biologics equity securities $ — $ — $ — $ — $ 219 Total $ — $ — $ — $ — $ 219 Liabilities Spinal Kinetics contingent consideration $ — $ — $ (35,100 ) $ (35,100 ) $ (42,700 ) Other contingent consideration $ — $ — $ (375 ) $ (375 ) $ — Deferred compensation plan — (1,366 ) — (1,366 ) (1,255 ) Total $ — $ (1,366 ) $ (35,475 ) $ (36,841 ) $ (43,955 )
Schedule of Reconciliation For Contingent Consideration Measured At Fair Value Using Significant Unobservable Inputs	The following table provides a reconciliation of the beginning and ending balances for the Spinal Kinetics contingent consideration measured at estimated fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2020 2019 Spinal Kinetics contingent consideration estimated fair value at January 1 $ 42,700 $ 28,560 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement (7,600 ) 28,140 Payment made — (15,000 ) Spinal Kinetics contingent consideration estimated fair value at September 30 $ 35,100 $ 41,700
Schedule of Valuation Methodology and Unobservable Inputs for Level 3 Assets and Liabilities Measured at Fair Value	The following table provides a range of key assumptions used within the valuation as of September 30, 2020. (U.S. Dollars, in thousands) Fair Value as of September 30, 2020 Valuation Technique Unobservable inputs Range Spinal Kinetics contingent consideration $ 35,100 Discounted cash flow Revenue discount rate 7.41% - 7.49% Payment discount rate 4.33% - 4.40% Projected year of payment 2021 - 2022
Schedule of Held to Maturity Debt Securities and Warrant Reconciliation	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) 2020 2019 eNeura debt security and Warrant at January 1 $ — $ 17,820 Gains or losses recorded for the period Recognized in other comprehensive income (loss) — (2,593 ) Change in classification of debt security to held to maturity — (15,227 ) Issuance of Warrant as consideration for prior extension of debt maturity date — 491 Impairment of warrant — (491 ) eNeura debt security and Warrant at September 30 $ — $ —

Accumulated other comprehensi_2

Accumulated other comprehensive loss (Tables)	9 Months Ended
	Sep. 30, 2020
Equity [Abstract]
Components of Changes in Accumulated Other Comprehensive Loss	The components of and changes in accumulated other comprehensive loss were as follows: (U.S. Dollars, in thousands) Currency Translation Adjustments Accumulated Other Comprehensive Loss Balance at December 31, 2019 $ (3,039 ) $ (3,039 ) Other comprehensive income 2,048 2,048 Income taxes — — Balance at September 30, 2020 $ (991 ) $ (991 )

Revenue recognition and accou_2

Revenue recognition and accounts receivable (Tables)	9 Months Ended
	Sep. 30, 2020
Revenue Recognition And Accounts Receivable [Line Items]
Schedule of Net Sales by Major Product Category by Reporting Segment	The tables below presents net sales by major product category by reporting segment: Three Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 Change Bone Growth Therapies $ 47,066 $ 48,836 -3.6 % Spinal Implants 25,505 22,947 11.1 % Biologics 15,245 16,308 -6.5 % Global Spine 87,816 88,091 -0.3 % Global Extremities 23,169 25,408 -8.8 % Net sales $ 110,985 $ 113,499 -2.2 % Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 Change Bone Growth Therapies $ 120,888 $ 146,228 -17.3 % Spinal Implants 67,025 69,076 -3.0 % Biologics 40,319 48,784 -17.4 % Global Spine 228,232 264,088 -13.6 % Global Extremities 60,711 74,373 -18.4 % Net sales $ 288,943 $ 338,461 -14.6 %
Schedule of Components Net Sales	The table below presents product sales and marketing service fees, which are both components of net sales: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Product sales $ 96,305 $ 97,833 $ 250,161 $ 291,632 Marketing service fees 14,680 15,666 38,782 46,829 Net sales $ 110,985 $ 113,499 $ 288,943 $ 338,461
Allowances for Expected Credit Losses	The following table provides a detail of changes in the Company’s allowance for expected credit losses for the three and nine months ended September 30, 2020: (U.S. Dollars, in thousands) Three Months Ended September 30, 2020 Nine Months Ended September 30, 2020 Allowance for expected credit losses beginning balance $ 6,364 $ 3,987 Impact of adoption of ASU 2016-13 — 1,120 Current period provision (recovery) for expected credit losses (619 ) 945 Writeoffs charged against the allowance and other (309 ) (647 ) Effect of changes in foreign exchange rates 88 119 Allowance for expected credit losses ending balance $ 5,524 $ 5,524
ASU 2016-13 [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Schedule of Net Impact of Adoption to Balance Sheet	The net impact of adoption to the Company’s balance sheet as of January 1, 2020 is presented in the table below. The standard did not have a material impact to the Company’s condensed consolidated statements of operations or cash flows. (U.S. Dollars, in thousands) December 31, 2019 Impact of Adoption of ASC 326 January 1, 2020 Assets Current assets Cash, cash equivalents, and restricted cash $ 70,403 $ — $ 70,403 Accounts receivable, net 86,805 (1,120 ) 85,685 Inventories 82,397 — 82,397 Prepaid expenses and other current assets 20,948 — 20,948 Total current assets 260,553 (1,120 ) 259,433 Deferred income taxes 35,117 233 35,350 Other long-term assets 199,950 — 199,950 Total assets $ 495,620 $ (887 ) $ 494,733 Liabilities and shareholders’ equity Total liabilities $ 167,989 $ — $ 167,989 Shareholders’ equity Common shares $ 1,902 $ — $ 1,902 Additional paid-in capital 271,019 — 271,019 Retained earnings 57,749 (887 ) 56,862 Accumulated other comprehensive loss (3,039 ) — (3,039 ) Total shareholders’ equity 327,631 (887 ) 326,744 Total liabilities and shareholders’ equity $ 495,620 $ (887 ) $ 494,733

Business segment information (T

Business segment information (Tables)	9 Months Ended
	Sep. 30, 2020
Segment Reporting [Abstract]
Summary of EBITDA by Reporting Segment	The table below presents EBITDA by reporting segment: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Global Spine $ 19,960 $ (6,033 ) $ 38,670 $ 21,065 Global Extremities 1,258 1,229 (3,995 ) 3,806 Corporate (6,196 ) (15,949 ) (16,259 ) (38,356 ) Total EBITDA $ 15,022 $ (20,753 ) $ 18,416 $ (13,485 ) Depreciation and amortization (9,030 ) (6,275 ) (22,299 ) (18,180 ) Interest income (expense), net (731 ) 186 (2,055 ) 386 Income (loss) before income taxes $ 5,261 $ (26,842 ) $ (5,938 ) $ (31,279 )
Summary of Net Sales by Geographic Destination for each Reporting Segment	The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Global Spine U.S. $ 83,477 $ 82,816 $ 215,819 $ 246,943 International 4,339 5,275 12,413 $ 17,145 Total Global Spine 87,816 88,091 228,232 264,088 Global Extremities U.S. 6,356 6,636 16,439 20,078 International 16,813 18,772 44,272 54,295 Total Global Extremities 23,169 25,408 60,711 74,373 Consolidated U.S. 89,833 89,452 232,258 267,021 International 21,152 24,047 56,685 71,440 Net sales $ 110,985 $ 113,499 $ 288,943 $ 338,461

Acquisition-Related Amortizat_2

Acquisition-Related Amortization and Remeasurement (Tables)	9 Months Ended
	Sep. 30, 2020
Acquisition Related Amortization And Remeasurement [Abstract]
Components of Acquisition-Related Amortization and Remeasurement	Components of acquisition-related amortization and remeasurement are as follows: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Changes in fair value of contingent consideration $ (700 ) $ 22,270 $ (7,600 ) $ 28,140 Amortization of acquired intangibles 1,838 1,338 4,834 3,733 Total $ 1,138 $ 23,608 $ (2,766 ) $ 31,873

Share-based compensation (Table

Share-based compensation (Tables)	9 Months Ended
	Sep. 30, 2020
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Schedule of Components of Share-Based Compensation Expense	Components of share-based compensation expense are as follows: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Cost of sales $ 149 $ 169 $ 535 $ 536 Sales and marketing 668 583 2,897 1,885 General and administrative 2,770 4,760 7,939 13,888 Research and development 254 332 1,028 1,069 Total $ 3,841 $ 5,844 $ 12,399 $ 17,378 Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2020 2019 2020 2019 Stock options $ 786 $ 599 $ 1,840 $ 3,637 Time-based restricted stock awards and units 1,632 3,805 6,804 8,462 Market-based restricted stock units 1,049 1,092 2,529 4,015 Stock purchase plan 374 348 1,226 1,264 Total $ 3,841 $ 5,844 $ 12,399 $ 17,378

Earnings per share ("EPS") (Tab

Earnings per share ("EPS") (Tables)	9 Months Ended
	Sep. 30, 2020
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, 2020 2019 2020 2019 Weighted average common shares-basic 19,335,718 18,957,876 19,217,057 18,847,728 Effect of dilutive securities Unexercised stock options and stock purchase plan 10,607 — 41,701 — Unvested restricted stock awards and units 52,242 — 60,544 — Weighted average common shares-diluted 19,398,567 18,957,876 19,319,302 18,847,728

Business, basis of presentati_2

Business, basis of presentation, COVID-19 update, and CARES Act - Additional information (Detail) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended	9 Months Ended
	Apr. 30, 2020	Jun. 30, 2020	Sep. 30, 2020	Dec. 31, 2022	Dec. 31, 2021
Business And Basis Of Presentation [Line Items]
Contract liability (Note 11)	$ 13,900		$ 13,851
Deferred and other long-term liabilities			2,200
Scenario Forecast [Member]
Business And Basis Of Presentation [Line Items]
CARES Act of 2020 deferred taxes percentage				50.00%	50.00%
Other Current Liabilities [Member]
Business And Basis Of Presentation [Line Items]
Contract liability (Note 11)			6,900
U.S. Department of Health and Human Services [Member]
Business And Basis Of Presentation [Line Items]
Contract liability (Note 11)	$ 4,700
Proceeds from funding retained			$ 4,700
Deferred income liability recognized other income		$ 4,700

Recently Adopted Accounting S_3

Recently Adopted Accounting Standards and Recently Issued Accounting Pronouncements - Additional Information (Detail)	Sep. 30, 2020
ASU 2016-13 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 1, 2020
ASU 2017-04 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 1, 2020
ASU 2018-13 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 1, 2020
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]	true
ASU 2018-15 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 1, 2020
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]	true
ASU 2020-04 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Mar. 12, 2020
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]	true

Acquisitions - Additional Infor

Acquisitions - Additional Information (Detail) - USD ($)	Jul. 31, 2020	Mar. 26, 2020	Feb. 03, 2020	Jul. 31, 2020	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Mar. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Cash consideration paid for assets acquired	$ 7,200,000						$ 18,000,000
Goodwill					$ 83,503,000		$ 83,503,000			$ 71,177,000
Consideration transferred	$ 7,575,000
Purchase agreement of acquired business, description				The Company agreed to pay consideration of up to $7.6 million in accordance with the parties’ agreement
Wittenstein [Member] | Contract Manufacturing and Supply Agreement ("CMSA") [Member] | FITBONE [Member]
Business Acquisition [Line Items]
Finance lease, term of contract					2 years		2 years		2 years
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member]
Business Acquisition [Line Items]
Date of assets purchase agreement			Feb. 3, 2020
Cash consideration paid for assets acquired		$ 18,000,000
Acquisition completion date		Mar. 26, 2020
Goodwill		$ 11,300,000
Acquisition related costs					$ 0	$ 0	$ 400,000	$ 300,000
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | FITBONE [Member]
Business Acquisition [Line Items]
Revenues related to acquisitions					$ 800,000		$ 1,000,000
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | Global Extremities [Member]
Business Acquisition [Line Items]
Goodwill		11,100,000
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | Global Spine [Member]
Business Acquisition [Line Items]
Goodwill		$ 200,000
DR Medical, LLC and MedSelect Corporation [Member]
Business Acquisition [Line Items]
Consideration transferred				$ 7,600,000

Acquisitions - Summary of Fair

Acquisitions - Summary of Fair Values of Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands	Jul. 31, 2020	Mar. 26, 2020	Sep. 30, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Goodwill			$ 83,503	$ 71,177
Customer Relationships [Member]
Business Acquisition [Line Items]
Assigned Useful Life	5 years
Finite lived intangible assets, net acquired	$ 7,340
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member]
Business Acquisition [Line Items]
Goodwill		$ 11,300
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | Previously Reported [Member]
Business Acquisition [Line Items]
Inventories		528
Total identifiable assets acquired		6,728
Goodwill		11,272
Total fair value of consideration transferred		$ 18,000
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | Trade Name [Member]
Business Acquisition [Line Items]
Assigned Useful Life		15 years
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | Trade Name [Member] | Previously Reported [Member]
Business Acquisition [Line Items]
Indefinite lived intangible assets, net acquired		$ 600
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | In-process Research and Development ("IPR&D") [Member] | Previously Reported [Member]
Business Acquisition [Line Items]
Indefinite lived intangible assets, net acquired		$ 300
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | Customer Relationships [Member]
Business Acquisition [Line Items]
Assigned Useful Life		15 years
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | Customer Relationships [Member] | Previously Reported [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 800
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | Developed Technology [Member]
Business Acquisition [Line Items]
Assigned Useful Life		8 years
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | Developed Technology [Member] | Previously Reported [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 4,500

Acquisitions - Summary of Fai_2

Acquisitions - Summary of Fair Values of Assets Acquired and Consideration Paid (Detail) - USD ($) $ in Thousands	Jul. 31, 2020	Sep. 30, 2020
Fair Value of Consideration Transferred
Cash paid or payable	$ 7,200	$ 18,000
Contingent consideration	375
Total fair value of consideration transferred	7,575
Total fair value of assets acquired	7,575
Customer Relationships [Member]
Fair Value of Consideration Transferred
Finite lived intangible assets, net acquired	$ 7,340
Assigned Useful Life	5 years
Assembled Workforce [Member]
Fair Value of Consideration Transferred
Finite lived intangible assets, net acquired	$ 235
Assigned Useful Life	5 years

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Inventory Disclosure [Abstract]
Raw materials	$ 7,779	$ 9,587
Work-in-process	12,050	14,027
Finished products	26,384	20,712
Field/consignment	36,646	38,071
Inventories	$ 82,859	$ 82,397

Leases - Summary of Lease Portf

Leases - Summary of Lease Portfolio (Detail) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Right-of-use assets ("ROU assets")
Operating leases	$ 4,972	$ 5,798
Operating lease, right-of-use asset, statement of financial position [Extensible List]	us-gaap:OtherAssetsNoncurrent	us-gaap:OtherAssetsNoncurrent
Finance leases	$ 21,001	$ 20,207
Finance lease, right-of-use asset, statement of financial position [Extensible List]	us-gaap:PropertyPlantAndEquipmentNet	us-gaap:PropertyPlantAndEquipmentNet
Total ROU assets	$ 25,973	$ 26,005
Current
Operating leases	$ 1,999	$ 1,875
Operating lease, liability, current, statement of financial position [Extensible List]	us-gaap:OtherLiabilitiesCurrent	us-gaap:OtherLiabilitiesCurrent
Finance leases	$ 498	$ 323
Long-term
Operating leases	$ 3,166	$ 4,084
Operating lease, liability, noncurrent, statement of financial position [Extensible List]	us-gaap:OtherLiabilitiesCurrent	us-gaap:OtherLiabilitiesNoncurrent
Finance leases	$ 22,463	$ 20,648
Total lease liabilities	$ 28,126	$ 26,930

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 3,170	$ 3,037
Operating cash flows from finance leases	458	687
Financing cash flows from finance leases	204	276
ROU assets obtained in exchange for lease obligations
Operating leases	619	598
Finance leases	$ 1,949	$ 21,179

Leases - Additional Information

Leases - Additional Information (Detail) - USD ($) $ in Thousands	Sep. 30, 2020	Mar. 31, 2020	Dec. 31, 2019
Lessee Lease Description [Line Items]
Finance lease, ROU asset	$ 21,001		$ 20,207
Wittenstein [Member] | Contract Manufacturing and Supply Agreement ("CMSA") [Member] | FITBONE [Member]
Lessee Lease Description [Line Items]
Consideration to be paid upon conditions met in relation to prompt delivery of manufactured products		$ 2,000
Finance lease, term of contract	2 years	2 years
Finance lease, ROU asset		$ 1,900
Finance lease, liability		$ 1,900

Other Current Liabilities - Add

Other Current Liabilities - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2020	Dec. 31, 2019
Restructuring plan liability, current			$ 3.2
Restructuring reserve	$ 3.7	$ 3.7
Payments made on restructuring	1.1	2.1
Former Executive Officer [Member] | Severance Payments [Member]
Additional accruals, restructuring	$ 1.1	$ 2.5

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail)	3 Months Ended	9 Months Ended
	Sep. 30, 2020USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2020EUR (€)	Apr. 16, 2020USD ($)	Aug. 31, 2015USD ($)
Debt Instrument [Line Items]
Repayment of borrowings		$ 100,000,000
Italy [Member]
Debt Instrument [Line Items]
Amount outstanding under lines of credit	$ 0	0
Maximum borrowing capacity	6,400,000	6,400,000	€ 5,500,000
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Amount outstanding under lines of credit				$ 100,000,000
Repayment of borrowings	100,000,000
2015 Credit Agreement [Member] | Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Amount outstanding under lines of credit	$ 0	$ 0
Debt instrument term (in years)		5 years
Maximum borrowing capacity					$ 300,000,000

Fair Value Measurements and I_3

Fair Value Measurements and Investments - Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value		$ 219
Deferred compensation plan, Liabilities	$ (1,366)	(1,255)
Liabilities fair value, Total	(36,841)	(43,955)
Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(35,100)	(42,700)
Other [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(375)
Fair Value, Inputs, Level 2 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Deferred compensation plan, Liabilities	(1,366)
Liabilities fair value, Total	(1,366)
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities fair value, Total	(35,475)
Fair Value, Inputs, Level 3 [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(35,100)
Fair Value, Inputs, Level 3 [Member] | Other [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	$ (375)
Equity Securities [Member] | Bone Biologics Inc
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value		$ 219

Fair Value Measurements and I_4

Fair Value Measurements and Investments - Additional Information (Detail) - USD ($) $ in Millions	Oct. 25, 2019	Apr. 30, 2018	Sep. 30, 2020	Sep. 30, 2019
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Decrease in fair value of future net sales			$ 7.6
eNeura Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Payments of restructured debt security	$ 4
Maximum borrowing capacity				$ 4
Other than temporary impairment losses	6.5
Unrealized gains included in accumulated other comprehensive income	$ 5.2
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			$ 35.1
Spinal Kinetics [Member] | Other Current Liabilities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration			14.7
Spinal Kinetics [Member] | Other Long-term Liabilities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration			$ 20.4
Maximum [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments		$ 60
US Food And Drug Administration [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments		15
Revenue Milestone [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments		$ 45

Fair Value Measurements and I_5

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] - Spinal Kinetics [Member] - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Spinal Kinetics contingent consideration estimated fair value at January 1	$ 42,700	$ 28,560
Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement	(7,600)	28,140
Payment made		(15,000)
Spinal Kinetics contingent consideration estimated fair value at September 30	$ 35,100	$ 41,700

Fair Value Measurements and I_6

Fair Value Measurements and Investments - Schedule of Valuation Methodology and Unobservable Inputs for Level 3 Assets and Liabilities Measured at Fair Value (Detail) - Spinal Kinetics [Member] $ in Thousands	9 Months Ended
	Sep. 30, 2020USD ($)
Revenue Discount Rate
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Contingent consideration	$ 35,100
Revenue Discount Rate | Minimum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement input	7.41
Revenue Discount Rate | Maximum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement input	7.49
Payment Discount Rate | Minimum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement input	4.33
Payment Discount Rate | Maximum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement input	4.40
Projected Year of Payment | Minimum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement period	2021
Projected Year of Payment | Maximum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business combination contingent consideration liability measurement period	2022

Fair Value Measurements and I_7

Fair Value Measurements and Investments - Schedule of Reconciliation of Debt Security and Warrant (Detail) - eNeura Inc [Member] - Debt Security And Warrant - Fair Value, Inputs, Level 3 [Member] $ in Thousands	9 Months Ended
	Sep. 30, 2019USD ($)
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Beginning balance	$ 17,820
Gains or losses recorded for the period
Recognized in other comprehensive income (loss)	(2,593)
Change in classification of debt security to held to maturity	(15,227)
Issuance of Warrant as consideration for prior extension of debt maturity date	491
Impairment of warrant	$ (491)

Contingencies - Additional Info

Contingencies - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Commitments And Contingencies Disclosure [Abstract]
Accrued other long-term liabilities	$ 6.3		$ 6.3
Estimated sales and marketing expense	0.4	$ 0.3	1.1	$ 1
Freezing amount in cash resulted from court pending legal action issued		$ 0.5		$ 0.5
Accruals related court pending legal dispute	$ 1.3		$ 1.3

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Loss - Components of Changes in Accumulated Other Comprehensive Loss (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2020USD ($)
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 327,631
Other comprehensive income	2,048
Ending Balance	354,896
Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(3,039)
Other comprehensive income	2,048
Ending Balance	(991)
Accumulated Other Comprehensive Loss [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(3,039)
Other comprehensive income	2,048
Ending Balance	$ (991)

Revenue Recognition and Accou_3

Revenue Recognition and Accounts Receivable - Schedule of Net Sales by Major Product Category by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 110,985	$ 113,499	$ 288,943	$ 338,461
Change	(2.20%)		(14.60%)
Bone Growth Therapies [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 47,066	48,836	$ 120,888	146,228
Change	(3.60%)		(17.30%)
Spinal Implants [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 25,505	22,947	$ 67,025	69,076
Change	11.10%		(3.00%)
Biologics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 15,245	16,308	$ 40,319	48,784
Change	(6.50%)		(17.40%)
Global Spine [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 87,816	88,091	$ 228,232	264,088
Change	(0.30%)		(13.60%)
Global Extremities [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 23,169	$ 25,408	$ 60,711	$ 74,373
Change	(8.80%)		(18.40%)

Revenue Recognition and Accou_4

Revenue Recognition and Accounts Receivable - Schedule of Components of Net Sales (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Revenue Recognition [Abstract]
Product sales	$ 96,305	$ 97,833	$ 250,161	$ 291,632
Marketing service fees	14,680	15,666	38,782	46,829
Net sales	$ 110,985	$ 113,499	$ 288,943	$ 338,461

Revenue Recognition and Accou_5

Revenue Recognition and Accounts Receivable - Additional Information (Detail) $ in Thousands	Sep. 01, 2022	Oct. 01, 2021	Jan. 01, 2020USD ($)	Apr. 30, 2020USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Dec. 31, 2019USD ($)
Revenue Recognition And Accounts Receivable [Line Items]
Contract liability (Note 11)				$ 13,900			$ 13,851
Net sales					$ 110,985	$ 113,499	288,943	$ 338,461
Other Current Liabilities [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Contract liability (Note 11)							6,900
Other Long-term Liabilities [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Contract liability (Note 11)							6,900
Other Long-Term Assets or Other Current Assets [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Other contract assets					2,300		2,300		$ 3,700
Scenario Forecast [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Medicare recoupment	0.50	0.25
Frequency of recoupment	6 months	11 months
Performance Obligations [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales					$ 0		$ 0
ASU 2016-13 [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Increase (decrease) to allowance for expected credit losses			$ 1,100
Increase (decrease) in deferred income taxes			200
Decrease in retained earnings			$ (900)

Revenue Recognition and Accou_6

Revenue Recognition and Accounts Receivable - Schedule of Net Impact of Adoption to Balance Sheet (Detail) - USD ($) $ in Thousands	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Jan. 01, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Current assets
Cash, cash equivalents, and restricted cash					$ 70,403
Accounts receivable, net	$ 73,053				86,805
Inventories	82,859				82,397
Prepaid expenses and other current assets	18,457				20,948
Total current assets	254,669				260,553
Deferred income taxes	38,047				35,117
Other long-term assets					199,950
Total assets	517,132				495,620
Liabilities and shareholders’ equity
Total liabilities	162,236				167,989
Shareholders’ equity
Common shares	1,927				1,902
Additional paid-in capital	285,203				271,019
Retained earnings	68,757				57,749
Accumulated other comprehensive loss	(991)				(3,039)
Total shareholders’ equity	354,896	$ 345,045	$ 355,369		327,631	$ 306,434	$ 347,794	$ 343,682	$ 335,397
Total liabilities and shareholders’ equity	$ 517,132				495,620
ASU 2016-13 [Member]
Current assets
Cash, cash equivalents, and restricted cash				$ 70,403
Accounts receivable, net				85,685
Inventories				82,397
Prepaid expenses and other current assets				20,948
Total current assets				259,433
Deferred income taxes				35,350
Other long-term assets				199,950
Total assets				494,733
Liabilities and shareholders’ equity
Total liabilities				167,989
Shareholders’ equity
Common shares				1,902
Additional paid-in capital				271,019
Retained earnings				56,862
Accumulated other comprehensive loss				(3,039)
Total shareholders’ equity				326,744
Total liabilities and shareholders’ equity				$ 494,733
ASU 2016-13 [Member] | Impact of Adoption of ASC 326 [Member]
Current assets
Accounts receivable, net					(1,120)
Total current assets					(1,120)
Deferred income taxes					233
Total assets					(887)
Shareholders’ equity
Retained earnings					(887)
Total shareholders’ equity					(887)
Total liabilities and shareholders’ equity					$ (887)

Revenue Recognition and Accou_7

Revenue Recognition and Accounts Receivable - Schedule of Allowance for Expected Credit Losses (Detail) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2020
Revenue Recognition [Abstract]
Allowance for expected credit losses beginning balance	$ 6,364	$ 3,987
Impact of adoption of ASU 2016-13		1,120
Current period provision (recovery) for expected credit losses	(619)	945
Writeoffs charged against the allowance and other	(309)	(647)
Effect of changes in foreign exchange rates	88	119
Allowance for expected credit losses ending balance	$ 5,524	$ 5,524

Business Segment Information -

Business Segment Information - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2020Segment
Segment Reporting [Abstract]
Number of reporting segments	2

Business Segment Information _2

Business Segment Information - Summary of EBIDTA by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Segment Reporting Information [Line Items]
Total EBITDA	$ 15,022	$ (20,753)	$ 18,416	$ (13,485)
Depreciation and amortization	(9,030)	(6,275)	(22,299)	(18,180)
Interest income (expense), net	(731)	186	(2,055)	386
Income (loss) before income taxes	5,261	(26,842)	(5,938)	(31,279)
Operating Segments [Member] | Global Spine [Member]
Segment Reporting Information [Line Items]
Total EBITDA	19,960	(6,033)	38,670	21,065
Operating Segments [Member] | Global Extremities [Member]
Segment Reporting Information [Line Items]
Total EBITDA	1,258	1,229	(3,995)	3,806
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Total EBITDA	$ (6,196)	$ (15,949)	$ (16,259)	$ (38,356)

Business Segment Information _3

Business Segment Information - Summary of Net Sales by Geographic Destination for Each Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 110,985	$ 113,499	$ 288,943	$ 338,461
Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	87,816	88,091	228,232	264,088
Global Extremities [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	23,169	25,408	60,711	74,373
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	89,833	89,452	232,258	267,021
U.S. [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	83,477	82,816	215,819	246,943
U.S. [Member] | Global Extremities [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	6,356	6,636	16,439	20,078
International [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	21,152	24,047	56,685	71,440
International [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	4,339	5,275	12,413	17,145
International [Member] | Global Extremities [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 16,813	$ 18,772	$ 44,272	$ 54,295

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, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Acquisition Related Amortization And Remeasurement [Abstract]
Changes in fair value of contingent consideration	$ (700)	$ 22,270	$ (7,600)	$ 28,140
Amortization of acquired intangibles	1,838	1,338	4,834	3,733
Total	$ 1,138	$ 23,608	$ (2,766)	$ 31,873

Share-based Compensation - Sche

Share-based Compensation - Schedule of Components of Share-Based Compensation Expense (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 3,841	$ 5,844	$ 12,399	$ 17,378
Stock options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	786	599	1,840	3,637
Time-based Restricted Stock Awards and Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,632	3,805	6,804	8,462
Market-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,049	1,092	2,529	4,015
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	374	348	1,226	1,264
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	149	169	535	536
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	668	583	2,897	1,885
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	2,770	4,760	7,939	13,888
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 254	$ 332	$ 1,028	$ 1,069

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Shares issued under stock purchase plan, stock option exercises and restricted stock awards and units	58,357	43,603	244,801	295,496

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Components Of Income Tax Expense Benefit [Line Items]
Income tax effective rate	11.50%	(50.90%)	300.30%	(28.40%)
CARES Act income tax expenses benefit			$ 0
Internal Revenue Service [Member]
Components Of Income Tax Expense Benefit [Line Items]
Income tax benefit	$ 0.1		17.8
Minimum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	0.1		0.1
Maximum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	$ 0.6		$ 0.6

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, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Earnings Per Share [Line Items]
Weighted average common shares-basic	19,335,718	18,957,876	19,217,057	18,847,728
Effect of dilutive securities
Weighted average common shares-diluted	19,398,567	18,957,876	19,319,302	18,847,728
Stock Options And Stock Purchase Plan [Member]
Effect of dilutive securities
Effect of dilutive securities	10,607		41,701
Restricted Stock Units [Member]
Effect of dilutive securities
Effect of dilutive securities	52,242		60,544

Earnings Per Share ("EPS") - Ad

Earnings Per Share ("EPS") - Additional Information (Detail) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
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	1,771,113	1,814,544	1,527,735	1,880,423

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) - Oct. 01, 2020 - Neo Medical SA [Member] - Subsequent Event [Member] SFr in Millions, $ in Millions	USD ($)	CHF (SFr)
Subsequent Event [Line Items]
Convertible loans | SFr		SFr 4.6
Convertible loans interest rate		8.00%
Maturity date	Oct. 1, 2024
Preferred Stock [Member]
Subsequent Event [Line Items]
Amount of Preferred stock consideration | $	$ 5