Orthofix Medical (OFIX) 10-Q 30 Apr 21 2021 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2021	Apr. 26, 2021
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2021
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q1
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX MEDICAL INC.
Entity Central Index Key	0000884624
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Current Reporting Status	Yes
Entity Common Stock, Shares Outstanding		19,558,752
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	Mar. 31, 2021	Dec. 31, 2020
Current assets
Cash and cash equivalents	$ 94,569	$ 96,291
Restricted cash	488	530
Accounts receivable, net of allowances of $4,506 and $4,848, respectively	69,680	72,423
Inventories	84,180	84,635
Prepaid expenses and other current assets	14,434	16,500
Total current assets	263,351	270,379
Property, plant, and equipment, net	62,467	63,613
Intangible assets, net	57,634	60,517
Goodwill	83,513	84,018
Deferred income taxes	26,140	25,042
Other long-term assets	20,769	22,292
Total assets	513,874	525,861
Current liabilities
Accounts payable	21,056	23,118
Current portion of finance lease liability	2,514	510
Other current liabilities	75,491	80,271
Total current liabilities	99,061	103,899
Long-term portion of finance lease liability	20,283	22,338
Other long-term liabilities	39,712	42,760
Total liabilities	159,056	168,997
Contingencies (Note 8)
Shareholders’ equity
Common shares $0.10 par value; 50,000,000 shares authorized; 19,474,384 and 19,423,874 issued and outstanding as of March 31, 2021 and December 31, 2020, respectively	1,947	1,942
Additional paid-in capital	297,629	292,291
Retained earnings	53,563	59,379
Accumulated other comprehensive income	1,679	3,252
Total shareholders’ equity	354,818	356,864
Total liabilities and shareholders’ equity	$ 513,874	$ 525,861

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	$ 4,506	$ 4,848
Common shares, par value	$ 0.10	$ 0.10
Common shares, authorized	50,000,000	50,000,000
Common shares, issued	19,474,384	19,423,874
Common shares, outstanding	19,474,384	19,423,874

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income and Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Income Statement [Abstract]
Net sales	$ 105,593	$ 104,823
Cost of sales	25,914	23,409
Gross profit	79,679	81,414
Sales and marketing	50,785	54,313
General and administrative	16,444	17,865
Research and development	10,897	9,964
Acquisition-related amortization and remeasurement (Note 12)	4,469	(7,582)
Operating income (loss)	(2,916)	6,854
Interest expense, net	(417)	(423)
Other expense, net	(2,690)	(798)
Income (loss) before income taxes	(6,023)	5,633
Income tax benefit	207	20,032
Net income (loss)	$ (5,816)	$ 25,665
Net income (loss) per common share:
Basic	$ (0.30)	$ 1.33
Diluted	$ (0.30)	$ 1.32
Weighted average number of common shares:
Basic	19,526,872	19,143,934
Diluted	19,526,872	19,299,820
Other comprehensive loss, before tax
Unrealized loss on debt securities	$ (726)
Currency translation adjustment	(1,027)	$ (1,711)
Other comprehensive loss before tax	(1,753)	(1,711)
Income tax related to other comprehensive loss	180
Other comprehensive loss, net of tax	(1,573)	(1,711)
Comprehensive income (loss)	$ (7,389)	$ 23,954

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, 2019	$ 327,631	$ 1,902	$ 271,019	$ 57,749	$ (3,039)
Balance, Shares at Dec. 31, 2019	19,423,874	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, 2020	356,864	$ 1,942	292,291	59,379	3,252
Balance, Shares at Dec. 31, 2020		19,423,874
Net income (loss)	(5,816)			(5,816)
Other comprehensive income (loss), net of tax	(1,573)				(1,573)
Share-based compensation	3,721		3,721
Common shares issued, net	1,622	$ 5	1,617
Common shares issued, net, Shares		50,510
Ending Balance at Mar. 31, 2021	$ 354,818	$ 1,947	$ 297,629	$ 53,563	$ 1,679
Balance, Shares at Mar. 31, 2021		19,474,384

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Cash flows from operating activities
Net income (loss)	$ (5,816)	$ 25,665
Adjustments to reconcile net income (loss) to net cash from operating activities
Depreciation and amortization	7,443	6,327
Amortization of operating lease assets, debt costs, and other assets	889	1,005
Provision for expected credit losses	(182)	679
Deferred income taxes	(971)	(1,027)
Share-based compensation	3,721	3,859
Interest and loss on valuation of investment securities	(96)	219
Change in fair value of contingent consideration	1,500	(9,000)
Other	24	(744)
Changes in operating assets and liabilities, net of effects of acquisitions
Accounts receivable	2,748	6,712
Inventories	16	(848)
Prepaid expenses and other current assets	1,993	(496)
Accounts payable	(1,457)	28
Other current liabilities	(7,719)	(1,333)
Other long-term assets and liabilities	348	(18,582)
Net cash from operating activities	2,441	12,464
Cash flows from investing activities
Acquisition of a business		(18,000)
Capital expenditures for property, plant and equipment	(4,365)	(4,285)
Capital expenditures for intangible assets	(416)	(659)
Asset acquisitions and other investments		(1,240)
Net cash from investing activities	(4,781)	(24,184)
Cash flows from financing activities
Proceeds from issuance of common shares	1,717	948
Payments related to withholdings for share-based compensation	(95)	(136)
Payments related to finance lease obligation	(127)	(92)
Other financing activities	(385)	(405)
Net cash from financing activities	1,110	315
Effect of exchange rate changes on cash	(534)	(730)
Net change in cash, cash equivalents, and restricted cash	(1,764)	(12,135)
Cash, cash equivalents, and restricted cash at the beginning of period	96,821	70,403
Cash, cash equivalents, and restricted cash at the end of period	95,057	58,268
Components of cash, cash equivalents, and restricted cash at the end of period
Cash and cash equivalents	94,569	57,739
Restricted cash	488	529
Cash, cash equivalents, and restricted cash at the end of period	$ 95,057	$ 58,268

Business, basis of presentation

Business, basis of presentation, COVID-19 update, and CARES Act	3 Months Ended
	Mar. 31, 2021
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. and its subsidiaries (the “Company”) is a global medical device and biologics company with a spine and orthopedics focus. The Company’s mission is to deliver innovative, quality-driven solutions while partnering with health care professionals to improve patient mobility. Headquartered in Lewisville, Texas, the Company has two reporting segments: Global Spine and Global Orthopedics (formerly referred to as Global Extremities). The Company’s spine and orthopedic products are distributed in over 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, 2020. 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. Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) 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. On March 27, 2020, the CARES Act entered into federal law, which was aimed at providing emergency assistance and health care for individuals, families, and businesses affected by the COVID-19 pandemic and to provide general support to the U.S. economy. 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 10. In addition, as part of the CARES Act, the Company was permitted to defer all employer social security payroll tax payments through December 31, 2020, such that 50% of the taxes would be deferred until December 31, 2021, with the remaining 50% deferred until December 31, 2022. As of December 31, 2020, the Company had deferred $0.6 million in social security payroll tax payments under this program. All of these deferred tax payments were then repaid in January 2021. Therefore, as of March 31, 2021, the Company has no deferred balance associated with this program. Consolidated Appropriations Act of 2021 (the “Consolidated Appropriations Act”) On December 27, 2020, the Consolidated Appropriations Act entered into federal law. The Consolidated Appropriations Act, among other things, included provisions related to the deductibility of business meals in 2021 and 2022. The impact of this act was not material to the Company’s income tax provision for the three months ended March 31, 2021. American Rescue Plan Act of 2021 (the “American Rescue Plan”) On March 11, 2021, the American Rescue Plan entered into federal law. The American Rescue Plan, among other things, included provisions related to the deduction of executive compensation beginning in 2027. The American Rescue Plan had no impact to the Company’s condensed consolidated financial statements for the three months ended March 31, 2021.

Recently adopted accounting sta

Recently adopted accounting standards and recently issued accounting pronouncements	3 Months Ended
	Mar. 31, 2021
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”) 2019-12, Simplifying the accounting for income taxes In December 2019, the Financial Accounting Standards Board (“FASB”) issued ASU 2019-12, which reduces the complexity of accounting for income taxes by eliminating certain exceptions to the general principles in ASC 740, Income Taxes

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2021
Business Combinations [Abstract]
Acquisitions	3. Acquisitions On February 2, 2021, the Company entered into a technology assignment and royalty agreement with a medical device technology company partially owned and controlled by the wife of President and Chief Executive Officer, Jon Serbousek, whereby the Company acquired the intellectual property rights to certain assets for consideration of up to $10.0 million. Consideration was comprised of $1.0 million due at signing and $9.0 million in contingent consideration, dependent upon multiple milestones, such as receipt of 510(k) clearance and the attainment of certain net sales targets. The Company accounted for this transaction as an asset acquisition. As the transaction is classified as an asset acquisition, the value of the consideration associated with the contingent milestones will be recognized at the time that applicable contingencies are resolved and consideration is paid or becomes payable. The following table summarizes the estimated fair values of assets acquired and liabilities assumed at the acquisition date: (U.S. Dollars, in thousands) Fair Value Fair Value of Consideration Transferred Cash paid $ 1,000 Total fair value of consideration transferred $ 1,000 Fair value of assets acquired In-process research and development costs, recognized within Acquisition-related amortization and remeasurement $ 1,000 Total fair value of assets acquired $ 1,000 In addition, the Company is obligated to pay a royalty of 2% to 4% on net sales, commencing upon commercialization of the acquired assets. The transaction was approved by the Company’s Audit and Finance Committee, with the Audit and Finance Committee directly supervising and directing the negotiations of the transaction by Company employees who reported directly to the Audit and Finance Committee in connection with such negotiations. Mr. Serbousek was excluded from such discussions and did not participate in the negotiation or evaluation of the transaction. Mr. Serbousek is also being excluded from the administration and implementation of the agreements and the transactions contemplated thereby, all discussions or disputes with the counterparty in connection with the agreement, or the administration or implementation thereof, oversight of the Company’s development and commercialization activities in relation to the acquired technology, and all other matters relating to the relationship between the Company and the counterparty.

Inventories

Inventories	3 Months Ended
	Mar. 31, 2021
Inventory Disclosure [Abstract]
Inventories	4. Inventories Inventories were as follows: (U.S. Dollars, in thousands) March 31, 2021 December 31, 2020 Raw materials $ 9,816 $ 8,442 Work-in-process 15,219 12,149 Finished products 19,997 29,142 Field/consignment 39,148 34,902 Inventories $ 84,180 $ 84,635

Leases

Leases	3 Months Ended
	Mar. 31, 2021
Leases [Abstract]
Leases	5. Leases A summary of the Company’s lease portfolio as of March 31, 2021 and December 31, 2020 is presented in the table below: (U.S. Dollars, in thousands) Classification March 31, 2021 December 31, 2020 Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 4,498 $ 4,840 Finance leases Property, plant and equipment, net 20,071 20,552 Total ROU assets 24,569 25,392 Lease Liabilities Current Operating leases Other current liabilities 2,078 2,092 Finance leases Current portion of finance lease liability 2,514 510 Long-term Operating leases Other long-term liabilities 2,603 2,946 Finance leases Long-term portion of finance lease liability 20,283 22,338 Total lease liabilities $ 27,478 $ 27,886 Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) Three Months Ended March 31, 2021 Three Months Ended March 31, 2020 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 1,147 $ 1,059 Operating cash flows from finance leases 225 229 Financing cash flows from finance leases 127 92 ROU assets obtained in exchange for lease obligations Operating leases 248 275 Finance leases 76 1,949

Long-term debt

Long-term debt	3 Months Ended
	Mar. 31, 2021
Debt Disclosure [Abstract]
Long-term debt	6. Long-term debt As of March 31, 2021, 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 ($6.5 million) available lines of credit in Italy as of March 31, 2021.

Fair value measurements and inv

Fair value measurements and investments	3 Months Ended
	Mar. 31, 2021
Fair Value Measurements And Investment Disclosure [Abstract]
Fair value measurements and investments	7. Fair value measurements and investments The fair value of the Company’s financial assets and liabilities measured on a recurring basis were as follows: March 31, 2021 December 31, 2020 (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Neo Medical preferred equity securities $ — $ 5,000 $ — $ 5,000 $ 5,000 Neo Medical convertible loan agreement — — 6,200 6,200 7,160 Bone Biologics equity securities — — — — — Total $ — $ 5,000 $ 6,200 $ 11,200 $ 12,160 Liabilities Spinal Kinetics contingent consideration $ — $ — $ (36,900 ) $ (36,900 ) $ (35,400 ) Other contingent consideration — — (375 ) (375 ) (375 ) Deferred compensation plan — (1,381 ) — (1,381 ) (1,441 ) Total $ — $ (1,381 ) $ (37,275 ) $ (38,656 ) $ (37,216 ) Neo Medical Equity Investment and Convertible Loan Agreement On October 1, 2020, the Company purchased preferred shares of Neo Medical SA, a privately held Swiss-based Medtech company (“Neo Medical”), 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 equity securities are recorded in other long-term assets and are considered an investment that does not have a readily determinable fair value. As such, the Company measures this investment at cost, less any impairment, plus or minus changes resulting from observable price changes in orderly transactions for identical or similar investments of the same issuer. As of March 31, 2021, the carrying value of this investment remained at $5.0 million. 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 is recorded in other long-term assets as an available for sale debt security at fair value, with applicable interest recorded in interest income. Some of the more significant unobservable inputs used in the fair value measurement of the Convertible Loan include applicable discount rates, implied volatility, the likelihood and projected timing of repayment or conversion, and projected cash flows in support of the estimated enterprise value of Neo Medical. Holding other inputs constant, changes in these assumptions could result in a significant change in the fair value of the Convertible Loan. If the amortized cost of the Convertible Loan exceeds its estimated fair value, the security is deemed to be impaired, and must be evaluated for the recognition of credit losses. Impairment resulting from credit losses is recognized within the statement of income, while impairment resulting from other factors is recognized within other comprehensive income. As of March 31, 2021, the Company has not recognized any credit losses related to the Convertible Loan. The following table provides a reconciliation of the beginning and ending balances of the Convertible Loan, measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2021 2020 Fair value of Neo Medical Convertible Loan at January 1 $ 7,160 $ — Interest recognized in interest income, net 96 — Foreign currency remeasurement recognized in other expense, net (330 ) — Unrealized loss recognized in other comprehensive loss (726 ) — Fair value of Neo Medical Convertible Loan at March 31 6,200 — Amortized cost basis of Neo Medical Convertible Loan at March 31 5,045 — The following table provides quantitative information related to certain key assumptions utilized within the valuation as of March 31, 2021: (U.S. Dollars, in thousands) Fair Value as of March 31, 2021 Unobservable inputs Estimate Neo Medical Convertible Loan $ 6,200 Cost of equity discount rate 21.9 % Implied volatility 92.7 % Contingent Consideration The Company recognized a contingent consideration obligation in connection with the acquisition of Spinal Kinetics in 2018. The Spinal Kinetics contingent consideration consisted 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. The FDA Milestone was achieved and paid in 2019. In the first quarter of 2021, the Company achieved trailing-twelve month artificial disc sales of over $30.0 million, triggering the obligation of a $15.0 million milestone payment. The Company expects to make this payment in the second quarter of 2021. The estimated fair value of the remaining Spinal Kinetics contingent consideration, inclusive of the $15.0 million milestone payment discussed above, was $36.9 million as of March 31, 2021. The estimated fair value reflects assumptions made by management as of March 31, 2021, such as the expected timing and volume of elective procedures and the impact of these procedures on future revenues. However, the actual amount ultimately paid could be higher or lower than the fair value of the remaining contingent consideration. As of March 31, 2021, the Company has classified $15.0 million of the liability within other current liabilities, and $21.9 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) 2021 2020 Spinal Kinetics contingent consideration estimated fair value at January 1 $ 35,400 $ 42,700 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement 1,500 (9,000 ) Spinal Kinetics contingent consideration estimated fair value at March 31 $ 36,900 $ 33,700 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 March 31, 2021. (U.S. Dollars, in thousands) Fair Value as of March 31, 2021 Valuation Technique Unobservable inputs Range Spinal Kinetics contingent consideration $ 36,900 Discounted cash flow Revenue discount rate 8.1% - 8.2% Payment discount rate 4.2% - 4.3% 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 was based upon meeting certain revenue-based targets. This contingent liability is measured using a probability-weighted cash flow analysis.

Contingencies

Contingencies	3 Months Ended
	Mar. 31, 2021
Commitments And Contingencies Disclosure [Abstract]
Contingencies	8. Contingencies In addition to the matters described below, in the normal course of its business, the Company is involved in various lawsuits from time to time and may be subject to certain other contingencies. The Company believes any losses related to these matters are individually and collectively immaterial as to a possible loss and range of loss. Italian Medical Device Payback (“IMDP”) In 2015, the Italian Parliament introduced rules for entities that supply goods and services to the Italian National Healthcare System. This healthcare law is expected to impact the business and financial reporting of companies operating in the medical technology sector that sell medical devices in Italy. A key provision of the law is a ‘payback’ measure, requiring 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 $0.4 million for the three months ended March 31, 2021 and 2020, respectively. As of March 31, 2021, the Company has accrued $7.1 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 2019, in relation to an ongoing legal dispute with a former Brazilian distributor, approximately $0.5 million (based upon foreign exchange rates as of March 31, 2021) 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 March 31, 2021, the Company has an accrual of $1.5 million related to this matter.

Accumulated other comprehensive

Accumulated other comprehensive loss	3 Months Ended
	Mar. 31, 2021
Equity [Abstract]
Accumulated other comprehensive loss	9. Accumulated other comprehensive income (loss) The components of and changes in accumulated other comprehensive income (loss) were as follows: (U.S. Dollars, in thousands) Currency Translation Adjustments Neo Medical Convertible Loan Accumulated Other Comprehensive Income (Loss) Balance at December 31, 2020 $ 1,833 $ 1,419 $ 3,252 Other comprehensive loss (1,027 ) (726 ) (1,753 ) Income taxes — 180 180 Balance at March 31, 2021 $ 806 $ 873 $ 1,679

Revenue recognition and account

Revenue recognition and accounts receivable	3 Months Ended
	Mar. 31, 2021
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	10. Revenue recognition and accounts receivable Revenue Recognition The Company has two reporting segments, which consist of Global Spine and Global Orthopedics. Within the Global Spine reporting segment there are three product categories: Bone Growth Therapies, Spinal Implants, and Biologics. The table below presents net sales by major product category by reporting segment: Three Months Ended March 31, (U.S. Dollars, in thousands) 2021 2020 Change Bone Growth Therapies $ 42,947 $ 45,443 -5.5 % Spinal Implants 25,701 22,926 12.1 % Biologics 13,692 13,949 -1.8 % Global Spine 82,340 82,318 0.0 % Global Orthopedics 23,253 22,505 3.3 % Net sales $ 105,593 $ 104,823 0.7 % 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 March 31, (U.S. Dollars, in thousands) 2021 2020 Product sales $ 92,263 $ 91,421 Marketing service fees 13,330 13,402 Net sales $ 105,593 $ 104,823 Product sales primarily consist of the sale of bone growth therapies devices, motion preservation products, spine fixation products, and orthopedics 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. Accounts receivable and related allowances 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 following table provides a detail of changes in the Company’s allowance for expected credit losses for the three months ended March 31, 2021 and 2020: (U.S. Dollars, in thousands) Three Months Ended March 31, 2021 Three Months Ended March 31, 2020 Allowance for expected credit losses beginning balance $ 4,848 $ 3,987 Impact of adoption of ASU 2016-13 — 1,120 Current period provision (recovery) for expected credit losses (182 ) 679 Writeoffs charged against the allowance and other (46 ) (114 ) Effect of changes in foreign exchange rates (114 ) (81 ) Allowance for expected credit losses ending balance $ 4,506 $ 5,591 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. Medicare began to recoup these funds beginning in April 2021. As of March 31, 2021, the Company has classified $13.7 million of this contract liability within other current liabilities and $0.2 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 months ended March 31, 2021, 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 $1.8 million and $2.0 million as of March 31, 2021 and December 31, 2020, respectively.

Business segment information

Business segment information	3 Months Ended
	Mar. 31, 2021
Segment Reporting [Abstract]
Business segment information	11. Business segment information The Company has two reporting segments: Global Spine and Global Orthopedics. 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 March 31, (U.S. Dollars, in thousands) 2021 2020 Global Spine $ 11,895 $ 22,417 Global Orthopedics (2,229 ) (1,894 ) Corporate (7,829 ) (8,140 ) Total EBITDA $ 1,837 $ 12,383 Depreciation and amortization (7,443 ) (6,327 ) Interest expense, net (417 ) (423 ) Income (loss) before income taxes $ (6,023 ) $ 5,633 Geographical information The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Three Months Ended March 31, (U.S. Dollars, in thousands) 2021 2020 Global Spine U.S. $ 77,755 $ 77,106 International 4,585 5,212 Total Global Spine 82,340 82,318 Global Orthopedics U.S. 5,591 6,043 International 17,662 16,462 Total Global Orthopedics 23,253 22,505 Consolidated U.S. 83,346 83,149 International 22,247 21,674 Net sales $ 105,593 $ 104,823

Acquisition-Related Amortizatio

Acquisition-Related Amortization and Remeasurement	3 Months Ended
	Mar. 31, 2021
Acquisition Related Amortization And Remeasurement [Abstract]
Acquisition-Related Amortization and Remeasurement	12. Acquisition-related amortization and remeasurement Acquisition-related amortization and remeasurement consists of (i) amortization related to intangible assets acquired through business combinations or asset acquisitions, (ii) the remeasurement of any related contingent consideration arrangement, and (iii) recognized costs associated with acquired in-process research and development assets, which are recognized immediately upon acquisition. Components of acquisition-related amortization and remeasurement are as follows: Three Months Ended March 31, (U.S. Dollars, in thousands) 2021 2020 Changes in fair value of contingent consideration $ 1,500 $ (9,000 ) Amortization of acquired intangibles 1,969 1,418 Acquired in-process research and development 1,000 — Total $ 4,469 $ (7,582 )

Share-based compensation

Share-based compensation	3 Months Ended
	Mar. 31, 2021
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Share-based compensation	13. Share-based compensation Components of share-based compensation expense are as follows: Three Months Ended March 31, (U.S. Dollars, in thousands) 2021 2020 Cost of sales $ 178 $ 181 Sales and marketing 717 696 General and administrative 2,529 2,530 Research and development 297 452 Total $ 3,721 $ 3,859 Three Months Ended March 31, (U.S. Dollars, in thousands) 2021 2020 Stock options $ 661 $ 304 Time-based restricted stock awards and units 1,727 2,421 Market-based restricted stock units 897 670 Stock purchase plan 436 464 Total $ 3,721 $ 3,859 During the three months ended March 31, 2021 and 2020, the Company issued 50,510 and 33,559 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	3 Months Ended
	Mar. 31, 2021
Income Tax Disclosure [Abstract]
Income taxes	14. Income taxes Generally, income tax provisions for interim periods are based on an estimated annual income tax rate, adjusted for discrete tax items, with any changes affecting the estimated annual effective tax rate recorded in the interim period in which the change occurs, including discrete items. Due to the impact of losses not benefited by the Company’s European manufacturing subsidiary and certain non-deductible financial statement expenses, the Company determined the estimated annual effective tax rate method would not provide a reliable estimate of the Company’s overall annual effective tax rate. As such, the Company has calculated the tax provision using the actual effective rate for the three months ended March 31, 2021. For the three months ended March 31, 2021 and 2020, the effective tax rate was 3.4% and (355.6%), respectively. The primary factors affecting the Company’s effective tax rate for the three months ended March 31, 2021, were certain losses not benefited, remeasurement of contingent consideration predominantly not recognized for tax purposes, a favorable tax ruling related to certain previously unrecognized tax benefits, and limits on the deductibility of executive compensation. During the first quarter, the Company received a favorable ruling related to certain previously unrecognized tax benefits, which resulted in the recognition of a net benefit of $0.3 million. The Company believes it is reasonably possible that, in the next 12 months, the amount of unrecognized tax benefits related to the resolution of federal, state, and foreign matters could be reduced by $1.0 million to $1.5 million as audits close and statutes expire.

Earnings per share ("EPS")

Earnings per share ("EPS")	3 Months Ended
	Mar. 31, 2021
Earnings Per Share [Abstract]
Earnings per share ("EPS")	15. Earnings per share (“EPS”) The Company uses the two-class method of computing basic EPS due to the existence of non-vested restricted stock awards with nonforfeitable rights to dividends or dividend equivalents (referred to as participating securities). For the three months ended March 31, 2021, no significant adjustments were made to net income for purposes of calculating basic and diluted EPS. The following is a reconciliation of the weighted average shares used in diluted EPS computations. Three Months Ended March 31, 2021 2020 Weighted average common shares-basic 19,526,872 19,143,934 Effect of dilutive securities Unexercised stock options and stock purchase plan — 95,594 Unvested restricted stock awards and units — 60,292 Weighted average common shares-diluted 19,526,872 19,299,820 There were 2,037,663 and 1,168,410 weighted average outstanding stock options and restricted stock awards and units not included in the diluted EPS computation for the three months ended March 31, 2021 and 2020, respectively, because inclusion of these awards was anti-dilutive or, for performance-based and market-based restricted stock awards and units, all necessary conditions had not been satisfied by the end of the respective period.

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2021
Subsequent Events [Abstract]
Subsequent Events	16. Subsequent Events On April 7, 2021, the Company entered into an Exclusive License and Distribution Agreement (the “License Agreement”) with IGEA S.p.A (“IGEA”), an Italian manufacturer and distributor of bone and cartilage stimulation systems. Per the terms of the License Agreement, the Company will have the exclusive right to sell IGEA products in the U.S. and Canada. As consideration for the License Agreement, the Company has agreed to pay up to $4.0 million, with certain payments contingent upon reaching an FDA milestone. The License Agreement also includes certain minimum purchase requirements.

Recently adopted accounting s_2

Recently adopted accounting standards and recently issued accounting pronouncements (Policies)	3 Months Ended
	Mar. 31, 2021
Accounting Changes And Error Corrections [Abstract]
Recently adopted accounting standards and recently issued accounting pronouncements	Adoption of Accounting Standards Update (“ASU”) 2019-12, Simplifying the accounting for income taxes Income Taxes

Acquisitions (Tables)

Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2021
Business Combinations [Abstract]
Summary of Estimated Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the estimated fair values of assets acquired and liabilities assumed at the acquisition date: (U.S. Dollars, in thousands) Fair Value Fair Value of Consideration Transferred Cash paid $ 1,000 Total fair value of consideration transferred $ 1,000 Fair value of assets acquired In-process research and development costs, recognized within Acquisition-related amortization and remeasurement $ 1,000 Total fair value of assets acquired $ 1,000

Inventories (Tables)

Inventories (Tables)	3 Months Ended
	Mar. 31, 2021
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories were as follows: (U.S. Dollars, in thousands) March 31, 2021 December 31, 2020 Raw materials $ 9,816 $ 8,442 Work-in-process 15,219 12,149 Finished products 19,997 29,142 Field/consignment 39,148 34,902 Inventories $ 84,180 $ 84,635

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2021
Leases [Abstract]
Summary of Lease Portfolio	A summary of the Company’s lease portfolio as of March 31, 2021 and December 31, 2020 is presented in the table below: (U.S. Dollars, in thousands) Classification March 31, 2021 December 31, 2020 Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 4,498 $ 4,840 Finance leases Property, plant and equipment, net 20,071 20,552 Total ROU assets 24,569 25,392 Lease Liabilities Current Operating leases Other current liabilities 2,078 2,092 Finance leases Current portion of finance lease liability 2,514 510 Long-term Operating leases Other long-term liabilities 2,603 2,946 Finance leases Long-term portion of finance lease liability 20,283 22,338 Total lease liabilities $ 27,478 $ 27,886
Summary of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) Three Months Ended March 31, 2021 Three Months Ended March 31, 2020 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 1,147 $ 1,059 Operating cash flows from finance leases 225 229 Financing cash flows from finance leases 127 92 ROU assets obtained in exchange for lease obligations Operating leases 248 275 Finance leases 76 1,949

Fair value measurements and i_2

Fair value measurements and investments (Tables)	3 Months Ended
	Mar. 31, 2021
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: March 31, 2021 December 31, 2020 (U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Neo Medical preferred equity securities $ — $ 5,000 $ — $ 5,000 $ 5,000 Neo Medical convertible loan agreement — — 6,200 6,200 7,160 Bone Biologics equity securities — — — — — Total $ — $ 5,000 $ 6,200 $ 11,200 $ 12,160 Liabilities Spinal Kinetics contingent consideration $ — $ — $ (36,900 ) $ (36,900 ) $ (35,400 ) Other contingent consideration — — (375 ) (375 ) (375 ) Deferred compensation plan — (1,381 ) — (1,381 ) (1,441 ) Total $ — $ (1,381 ) $ (37,275 ) $ (38,656 ) $ (37,216 )
Schedule of Reconciliation For Convertible Loan Measured At Fair Value Using Significant Unobservable Inputs	The following table provides a reconciliation of the beginning and ending balances of the Convertible Loan, measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2021 2020 Fair value of Neo Medical Convertible Loan at January 1 $ 7,160 $ — Interest recognized in interest income, net 96 — Foreign currency remeasurement recognized in other expense, net (330 ) — Unrealized loss recognized in other comprehensive loss (726 ) — Fair value of Neo Medical Convertible Loan at March 31 6,200 — Amortized cost basis of Neo Medical Convertible Loan at March 31 5,045 —
Schedule of Changes in Valuation of Securities	The following table provides quantitative information related to certain key assumptions utilized within the valuation as of March 31, 2021: (U.S. Dollars, in thousands) Fair Value as of March 31, 2021 Unobservable inputs Estimate Neo Medical Convertible Loan $ 6,200 Cost of equity discount rate 21.9 % Implied volatility 92.7 % The following table provides a range of key assumptions used within the valuation as of March 31, 2021. (U.S. Dollars, in thousands) Fair Value as of March 31, 2021 Valuation Technique Unobservable inputs Range Spinal Kinetics contingent consideration $ 36,900 Discounted cash flow Revenue discount rate 8.1% - 8.2% Payment discount rate 4.2% - 4.3% Projected year of payment 2021 - 2022
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) 2021 2020 Spinal Kinetics contingent consideration estimated fair value at January 1 $ 35,400 $ 42,700 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement 1,500 (9,000 ) Spinal Kinetics contingent consideration estimated fair value at March 31 $ 36,900 $ 33,700

Accumulated other comprehensi_2

Accumulated other comprehensive loss (Tables)	3 Months Ended
	Mar. 31, 2021
Equity [Abstract]
Components of Changes in Accumulated Other Comprehensive Loss	The components of and changes in accumulated other comprehensive income (loss) were as follows: (U.S. Dollars, in thousands) Currency Translation Adjustments Neo Medical Convertible Loan Accumulated Other Comprehensive Income (Loss) Balance at December 31, 2020 $ 1,833 $ 1,419 $ 3,252 Other comprehensive loss (1,027 ) (726 ) (1,753 ) Income taxes — 180 180 Balance at March 31, 2021 $ 806 $ 873 $ 1,679

Revenue recognition and accou_2

Revenue recognition and accounts receivable (Tables)	3 Months Ended
	Mar. 31, 2021
Revenue Recognition And Accounts Receivable [Abstract]
Schedule of Net Sales by Major Product Category by Reporting Segment	The table below presents net sales by major product category by reporting segment: Three Months Ended March 31, (U.S. Dollars, in thousands) 2021 2020 Change Bone Growth Therapies $ 42,947 $ 45,443 -5.5 % Spinal Implants 25,701 22,926 12.1 % Biologics 13,692 13,949 -1.8 % Global Spine 82,340 82,318 0.0 % Global Orthopedics 23,253 22,505 3.3 % Net sales $ 105,593 $ 104,823 0.7 %
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 March 31, (U.S. Dollars, in thousands) 2021 2020 Product sales $ 92,263 $ 91,421 Marketing service fees 13,330 13,402 Net sales $ 105,593 $ 104,823
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 months ended March 31, 2021 and 2020: (U.S. Dollars, in thousands) Three Months Ended March 31, 2021 Three Months Ended March 31, 2020 Allowance for expected credit losses beginning balance $ 4,848 $ 3,987 Impact of adoption of ASU 2016-13 — 1,120 Current period provision (recovery) for expected credit losses (182 ) 679 Writeoffs charged against the allowance and other (46 ) (114 ) Effect of changes in foreign exchange rates (114 ) (81 ) Allowance for expected credit losses ending balance $ 4,506 $ 5,591

Business segment information (T

Business segment information (Tables)	3 Months Ended
	Mar. 31, 2021
Segment Reporting [Abstract]
Summary of EBITDA by Reporting Segment	The table below presents EBITDA by reporting segment: Three Months Ended March 31, (U.S. Dollars, in thousands) 2021 2020 Global Spine $ 11,895 $ 22,417 Global Orthopedics (2,229 ) (1,894 ) Corporate (7,829 ) (8,140 ) Total EBITDA $ 1,837 $ 12,383 Depreciation and amortization (7,443 ) (6,327 ) Interest expense, net (417 ) (423 ) Income (loss) before income taxes $ (6,023 ) $ 5,633
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 March 31, (U.S. Dollars, in thousands) 2021 2020 Global Spine U.S. $ 77,755 $ 77,106 International 4,585 5,212 Total Global Spine 82,340 82,318 Global Orthopedics U.S. 5,591 6,043 International 17,662 16,462 Total Global Orthopedics 23,253 22,505 Consolidated U.S. 83,346 83,149 International 22,247 21,674 Net sales $ 105,593 $ 104,823

Acquisition-Related Amortizat_2

Acquisition-Related Amortization and Remeasurement (Tables)	3 Months Ended
	Mar. 31, 2021
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 March 31, (U.S. Dollars, in thousands) 2021 2020 Changes in fair value of contingent consideration $ 1,500 $ (9,000 ) Amortization of acquired intangibles 1,969 1,418 Acquired in-process research and development 1,000 — Total $ 4,469 $ (7,582 )

Share-based compensation (Table

Share-based compensation (Tables)	3 Months Ended
	Mar. 31, 2021
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 March 31, (U.S. Dollars, in thousands) 2021 2020 Cost of sales $ 178 $ 181 Sales and marketing 717 696 General and administrative 2,529 2,530 Research and development 297 452 Total $ 3,721 $ 3,859 Three Months Ended March 31, (U.S. Dollars, in thousands) 2021 2020 Stock options $ 661 $ 304 Time-based restricted stock awards and units 1,727 2,421 Market-based restricted stock units 897 670 Stock purchase plan 436 464 Total $ 3,721 $ 3,859

Earnings per share ("EPS") (Tab

Earnings per share ("EPS") (Tables)	3 Months Ended
	Mar. 31, 2021
Earnings Per Share [Abstract]
Schedule of Reconciliation of Weighted Average Shares Used in Diluted EPS	The following is a reconciliation of the weighted average shares used in diluted EPS computations. Three Months Ended March 31, 2021 2020 Weighted average common shares-basic 19,526,872 19,143,934 Effect of dilutive securities Unexercised stock options and stock purchase plan — 95,594 Unvested restricted stock awards and units — 60,292 Weighted average common shares-diluted 19,526,872 19,299,820

Business, basis of presentati_2

Business, basis of presentation, COVID-19 update, and CARES Act - Additional information (Detail) $ in Millions	1 Months Ended	3 Months Ended
	Apr. 30, 2020USD ($)	Mar. 31, 2021USD ($)Segment	Dec. 31, 2022	Dec. 31, 2021
Business And Basis Of Presentation [Line Items]
Number of reporting units | Segment		2
CARES Act of 2020 funds received	$ 13.9
Deferred and other long-term liabilities		$ 0
Scenario Forecast [Member]
Business And Basis Of Presentation [Line Items]
CARES Act of 2020 deferred taxes percentage			50.00%	50.00%

Recently Adopted Accounting S_3

Recently Adopted Accounting Standards and Recently Issued Accounting Pronouncements - Additional Information (Detail) - ASU 2019-12 [Member]	Mar. 31, 2021
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, 2021

Acquisitions - Additional Infor

Acquisitions - Additional Information (Detail) $ in Millions	Feb. 02, 2021USD ($)
Intellectual Property Rights [Member]
Business Acquisition [Line Items]
Consideration transferred	$ 1
Consideration transferred	$ 9
Maximum [Member]
Business Acquisition [Line Items]
Royalty percentage on net sales	4.00%
Maximum [Member] | Intellectual Property Rights [Member]
Business Acquisition [Line Items]
Consideration transferred	$ 10
Minimum [Member]
Business Acquisition [Line Items]
Royalty percentage on net sales	2.00%

Acquisitions - Summary of Fair

Acquisitions - Summary of Fair Values of Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Fair Value of Consideration Transferred
Cash paid		$ 18,000
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member]
Fair Value of Consideration Transferred
Cash paid	$ 1,000
Total fair value of consideration transferred	1,000
Total fair value of assets acquired	1,000
Wittenstein [Member] | FITBONE Asset Purchase Agreement [Member] | In-process Research and Development Costs("IPR&D") [Member]
Fair Value of Consideration Transferred
In-process research and development costs, recognized within Acquisition-related amortization and remeasurement	$ 1,000

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Raw materials	$ 9,816	$ 8,442
Work-in-process	15,219	12,149
Finished products	19,997	29,142
Field/consignment	39,148	34,902
Inventories	$ 84,180	$ 84,635

Leases - Summary of Lease Portf

Leases - Summary of Lease Portfolio (Detail) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Right-of-use assets ("ROU assets")
Operating leases	$ 4,498	$ 4,840
Operating lease, right-of-use asset, statement of financial position [Extensible List]	Other long-term assets	Other long-term assets
Finance leases	$ 20,071	$ 20,552
Finance lease, right-of-use asset, statement of financial position [Extensible List]	Property, plant, and equipment, net	Property, plant, and equipment, net
Total ROU assets	$ 24,569	$ 25,392
Current
Operating leases	$ 2,078	$ 2,092
Operating lease, liability, current, statement of financial position [Extensible List]	Other current liabilities	Other current liabilities
Finance leases	$ 2,514	$ 510
Long-term
Operating leases	$ 2,603	$ 2,946
Operating lease, liability, noncurrent, statement of financial position [Extensible List]	Other current liabilities	Other long-term liabilities
Finance leases	$ 20,283	$ 22,338
Total lease liabilities	$ 27,478	$ 27,886

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 1,147	$ 1,059
Operating cash flows from finance leases	225	229
Financing cash flows from finance leases	127	92
ROU assets obtained in exchange for lease obligations
Operating leases	248	275
Finance leases	$ 76	$ 1,949

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail) - Mar. 31, 2021 - Italy [Member]	USD ($)	EUR (€)
Debt Instrument [Line Items]
Amount outstanding under lines of credit	$ 0
Maximum borrowing capacity	$ 6,500,000	€ 5,500,000

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	Mar. 31, 2021	Dec. 31, 2020
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 11,200	$ 12,160
Deferred compensation plan, Liabilities	(1,381)	(1,441)
Liabilities fair value, Total	(38,656)	(37,216)
Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(36,900)	(35,400)
Other [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(375)	(375)
Fair Value, Inputs, Level 2 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	5,000
Deferred compensation plan, Liabilities	(1,381)
Liabilities fair value, Total	(1,381)
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,200
Liabilities fair value, Total	(37,275)
Fair Value, Inputs, Level 3 [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(36,900)
Fair Value, Inputs, Level 3 [Member] | Other [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(375)
Convertible Loan Agreement | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	5,000	5,000
Convertible Loan Agreement | Fair Value, Inputs, Level 2 [Member] | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	5,000
Preferred Equity Securities | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,200	$ 7,160
Preferred Equity Securities | Fair Value, Inputs, Level 3 [Member] | Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 6,200

Fair Value Measurements and I_4

Fair Value Measurements and Investments - Additional Information (Detail) - USD ($)	Oct. 01, 2020	Apr. 30, 2018	Mar. 31, 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments			$ 30,000
Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Milestone achievement period		5 years
Consideration transferred			36,900,000
Spinal Kinetics [Member] | Other Current Liabilities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Consideration transferred			15,000,000
Spinal Kinetics [Member] | Other Long-term Liabilities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Consideration transferred			21,900,000
Maximum [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments		$ 60,000,000
US Food And Drug Administration [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments		15,000,000
Revenue Milestone [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments			15,000
Revenue Milestone [Member] | Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments		$ 45,000,000
Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Convertible loans	$ 4,600,000
Convertible loans interest rate	8.00%
Maturity date	Oct. 1, 2024
Carrying value of investment			5,000,000
Convertible loan credit losses			$ 0
Neo Medical [Member] | Preferred Stock
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Amount of Preferred stock consideration	$ 5,000,000

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) - Neo Medical [Member] - Fair Value, Inputs, Level 3 [Member] $ in Thousands	3 Months Ended
	Mar. 31, 2021USD ($)
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of Convertible Loan at January 1	$ 7,160
Interest recognized in interest income, net	96
Foreign currency remeasurement recognized in other expense, net	(330)
Unrealized loss recognized in other comprehensive loss	(726)
Fair value of Convertible Loan at March 31	6,200
Amortized cost basis of Neo Medical Convertible Loan at March 31	$ 5,045

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) $ in Thousands	3 Months Ended
	Mar. 31, 2021USD ($)	Mar. 31, 2020USD ($)
Spinal Kinetics [Member] | Revenue Discount Rate
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Consideration transferred	$ 36,900
Spinal Kinetics [Member] | 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
Spinal Kinetics [Member] | 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
Spinal Kinetics [Member] | 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
Spinal Kinetics [Member] | 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
Spinal Kinetics [Member] | 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
Spinal Kinetics [Member] | 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
Spinal Kinetics [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Spinal Kinetics contingent consideration estimated fair value at January 1	$ 35,400	$ 42,700
Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement	1,500	(9,000)
Spinal Kinetics contingent consideration estimated fair value at March 31	36,900	$ 33,700
Neo Medical [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Neo Medical Convertible Loan	$ 6,200
Fair value implied volatility	21.90%
Fair value discount rate	92.70%

Contingencies - Additional Info

Contingencies - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Accrued other long-term liabilities	$ 7.1
Estimated sales and marketing expense	0.4	$ 0.4
Freezing amount in cash resulted from court pending legal action issued	0.5
Accruals related court pending legal dispute	$ 1.5

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Loss - Components of Changes in Accumulated Other Comprehensive Loss (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2021USD ($)
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 356,864
Ending Balance	354,818
Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	1,833
Other comprehensive loss	(1,027)
Ending Balance	806
Neo Medical [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	1,419
Other comprehensive loss	(726)
Income taxes	180
Ending Balance	873
Accumulated Other Comprehensive Loss [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	3,252
Other comprehensive loss	(1,753)
Income taxes	180
Ending Balance	$ 1,679

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
	Mar. 31, 2021	Mar. 31, 2020
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 105,593	$ 104,823
Change	0.70%
Bone Growth Therapies [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 42,947	45,443
Change	(5.50%)
Spinal Implants [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 25,701	22,926
Change	12.10%
Biologics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 13,692	13,949
Change	(1.80%)
Global Spine [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 82,340	82,318
Change	0.00%
Global Orthopedics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 23,253	$ 22,505
Change	3.30%

Revenue Recognition and Accou_4

Revenue Recognition and Accounts Receivable - Schedule of Components of Net Sales (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Revenue Recognition [Abstract]
Product sales	$ 92,263	$ 91,421
Marketing service fees	13,330	13,402
Net sales	$ 105,593	$ 104,823

Revenue Recognition and Accou_5

Revenue Recognition and Accounts Receivable - Schedule of Allowance for Expected Credit Losses (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Revenue Recognition [Abstract]
Allowance for expected credit losses beginning balance	$ 4,848	$ 3,987
Impact of adoption of ASU 2016-13		1,120
Current period provision (recovery) for expected credit losses	(182)	679
Writeoffs charged against the allowance and other	(46)	(114)
Effect of changes in foreign exchange rates	(114)	(81)
Allowance for expected credit losses ending balance	$ 4,506	$ 5,591

Revenue Recognition and Accou_6

Revenue Recognition and Accounts Receivable - Additional Information (Detail) $ in Thousands	Sep. 30, 2022	Oct. 01, 2021	Apr. 30, 2020USD ($)	Mar. 31, 2021USD ($)	Mar. 31, 2020USD ($)	Dec. 31, 2020USD ($)
Revenue Recognition And Accounts Receivable [Line Items]
CARES Act of 2020 funds received			$ 13,900
Net sales				$ 105,593	$ 104,823
Other Current Liabilities [Member]
Revenue Recognition And Accounts Receivable [Line Items]
CARES Act of 2020 funds received				13,700
Other Noncurrent Liabilities [Member]
Revenue Recognition And Accounts Receivable [Line Items]
CARES Act of 2020 funds received				200
Other Long-Term Assets or Other Current Assets [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Other contract assets				1,800		$ 2,000
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

Business Segment Information -

Business Segment Information - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2021Segment
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
	Mar. 31, 2021	Mar. 31, 2020
Segment Reporting Information [Line Items]
Total EBITDA	$ 1,837	$ 12,383
Depreciation and amortization	(7,443)	(6,327)
Interest expense, net	(417)	(423)
Income (loss) before income taxes	(6,023)	5,633
Operating Segments [Member] | Global Spine [Member]
Segment Reporting Information [Line Items]
Total EBITDA	11,895	22,417
Operating Segments [Member] | Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Total EBITDA	(2,229)	(1,894)
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Total EBITDA	$ (7,829)	$ (8,140)

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
	Mar. 31, 2021	Mar. 31, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 105,593	$ 104,823
Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	82,340	82,318
Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	23,253	22,505
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	83,346	83,149
U.S. [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	77,755	77,106
U.S. [Member] | Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	5,591	6,043
International [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	22,247	21,674
International [Member] | Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	4,585	5,212
International [Member] | Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 17,662	$ 16,462

Acquisition-Related Amortizat_3

Acquisition-Related Amortization and Remeasurement - Components of Acquisition-Related Amortization and Remeasurement (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Acquisition Related Amortization And Remeasurement [Abstract]
Changes in fair value of contingent consideration	$ 1,500	$ (9,000)
Amortization of acquired intangibles	1,969	1,418
Acquired in-process research and development	1,000
Total	$ 4,469	$ (7,582)

Share-based Compensation - Sche

Share-based Compensation - Schedule of Components of Share-Based Compensation Expense (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 3,721	$ 3,859
Stock options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	661	304
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	1,727	2,421
Market-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	897	670
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	436	464
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	178	181
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	717	696
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	2,529	2,530
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 297	$ 452

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - shares	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Shares issued under stock purchase plan, stock option exercises and restricted stock awards and units	50,510	33,559

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Components Of Income Tax Expense Benefit [Line Items]
Income tax effective rate	3.40%	(355.60%)
Internal Revenue Service [Member]
Components Of Income Tax Expense Benefit [Line Items]
Income tax benefit	$ 0.3
Minimum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	1
Maximum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	$ 1.5

Earnings Per Share ("EPS") - Sc

Earnings Per Share ("EPS") - Schedule of Reconciliation of Weighted Average Shares Used in Diluted EPS (Detail) - shares	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Earnings Per Share [Line Items]
Weighted average common shares-basic	19,526,872	19,143,934
Effect of dilutive securities
Weighted average common shares-diluted	19,526,872	19,299,820
Stock Options And Stock Purchase Plan [Member]
Effect of dilutive securities
Effect of dilutive securities		95,594
Restricted Stock Units [Member]
Effect of dilutive securities
Effect of dilutive securities		60,292

Earnings Per Share ("EPS") - Ad

Earnings Per Share ("EPS") - Additional Information (Detail) - shares	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
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	2,037,663	1,168,410

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) $ in Millions	Apr. 07, 2021USD ($)
On Approval [Member] | Subsequent Event [Member] | IGEA [Member] | Maximum [Member]
Subsequent Event [Line Items]
Payment related to sale of IGEA products	$ 4