Alphatec (ATEC) 10-Q31 Jul 242024 Q2 Quarterly reportFinancial data

Company Profile

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
Document and Entity Information - shares	Jun. 30, 2024	Jul. 25, 2024
Cover [Abstract]
Entity Registrant Name	ALPHATEC HOLDINGS, INC.
Entity Central Index Key	0001350653
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Document Type	10-Q
Trading Symbol	ATEC
Document Period End Date	Jun. 30, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus (Q1,Q2,Q3,FY)	Q2
Entity Current Reporting Status	Yes
Amendment Flag	false
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		140,459,773
Entity Shell Company	false
Entity File Number	000-52024
Entity Tax Identification Number	20-2463898
Entity Address, Address Line One	1950 Camino Vida Roble
Entity Address, City or Town	Carlsbad
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92008
City Area Code	760
Local Phone Number	431-9286
Document Quarterly Report	true
Document Transition Report	false
Entity Incorporation, State or Country Code	DE
Entity Interactive Data Current	Yes
Title of 12(b) Security	Common stock, par value $0.0001 per share
Security Exchange Name	NASDAQ

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 99,828	$ 220,970
Accounts receivable, net of allowances of $4,760 and $910, respectively	83,985	72,613
Inventories	172,314	136,842
Prepaid expenses and other current assets	20,478	20,666
Total current assets	376,605	451,091
Property and equipment, net	180,614	149,835
Right-of-use assets	37,178	26,410
Goodwill	72,008	73,003
Intangible assets, net	99,152	102,451
Other assets	3,029	2,418
Total assets	768,586	805,208
Current liabilities:
Accounts payable	72,739	48,985
Accrued expenses and other current liabilities	75,925	87,712
Contract liabilities	11,775	13,910
Short-term debt	2,289	1,808
Current portion of operating lease liabilities	6,723	5,159
Total current liabilities	169,451	157,574
Long-term debt	516,881	511,035
Operating lease liabilities, less current portion	29,626	23,677
Other long-term liabilities	11,914	11,203
Commitments and contingencies (Note 9)
Redeemable preferred stock, $0.0001 par value; 20,000 shares authorized at June 30, 2024 and December 31, 2023; 3,319 shares issued and outstanding at June 30, 2024 and December 31, 2023	23,603	23,603
Stockholders' Deficit:
Common stock, $0.0001 par value; 200,000 authorized; 143,014 shares issued and outstanding at June 30, 2024; and 139,257 shares issued and 139,245 shares outstanding at December 31, 2023	14	14
Treasury stock, 1,808 shares, at cost	(25,097)	(25,097)
Additional paid-in capital	1,261,860	1,230,484
Accumulated other comprehensive loss	(11,529)	(8,323)
Accumulated deficit	(1,208,137)	(1,118,962)
Total stockholders' equity	17,111	78,116
Total liabilities and stockholders' deficit	$ 768,586	$ 805,208

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Accounts receivable, net of allowances	$ 4,760	$ 910
Redeemable preferred stock, shares authorized	20,000,000	20,000,000
Redeemable preferred stock, par value (dollars per share)	$ 0.0001	$ 0.0001
Redeemable preferred stock, shares issued	3,319,000	3,319,000
Redeemable preferred stock, shares outstanding	3,319,000	3,319,000
Common stock, par value (dollars per share)	$ 0.0001	$ 0.0001
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	143,014,000	139,257,000
Common stock, shares outstanding	143,014,000	139,245,000
Treasury stock, shares	1,808,000	1,808,000

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Revenue:
Revenue	$ 145,573	$ 116,920	$ 284,050	$ 226,030
Cost of sales	42,979	52,379	84,105	91,064
Gross profit	102,594	64,541	199,945	134,966
Operating expenses:
Research and development	19,105	14,571	37,117	27,831
Sales, general and administrative	112,731	87,287	226,458	178,549
Litigation-related expenses	2,090	6,908	6,518	10,100
Amortization of acquired intangible assets	3,836	3,705	7,690	6,588
Transaction-related expenses		1,900	(117)	1,900
Restructuring expenses	139	29	927	204
Total operating expenses	137,901	114,400	278,593	225,172
Operating loss	(35,307)	(49,859)	(78,648)	(90,206)
Interest expense and other expense, net:
Interest expense, net	(5,815)	(3,892)	(11,156)	(7,766)
Other income, net	156	2,324	274	3,030
Total other expense, net	(5,659)	(1,568)	(10,882)	(4,736)
Net loss before taxes	(40,966)	(51,427)	(89,530)	(94,942)
Income tax benefit	(286)	(50)	(355)	(36)
Net loss	$ (40,680)	$ (51,377)	$ (89,175)	$ (94,906)
Net loss per share, basic	$ (0.29)	$ (0.43)	$ (0.63)	$ (0.83)
Net loss per share, diluted	$ (0.29)	$ (0.43)	$ (0.63)	$ (0.83)
Weighted average shares outstanding, basic	142,687	118,719	141,845	114,260
Weighted average shares outstanding, diluted	142,687	118,719	141,845	114,260
Products and Services
Revenue:
Revenue	$ 145,573	$ 116,920	$ 284,050	$ 226,030

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Statement of Comprehensive Income [Abstract]
Net loss	$ (40,680)	$ (51,377)	$ (89,175)	$ (94,906)
Foreign currency translation adjustments	(742)	178	(3,206)	1,283
Comprehensive loss	$ (41,422)	$ (51,199)	$ (92,381)	$ (93,623)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (DEFICIT) (Unaudited) - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional paid-in capital	Treasury stock	Accumulated other comprehensive loss	Accumulated deficit
Balance at Dec. 31, 2022	$ (34,667)	$ 11	$ 933,537	$ (25,097)	$ (10,794)	$ (932,324)
Balance, shares at Dec. 31, 2022		106,640
Stock-based compensation	16,462		16,462
Common stock issued for warrant exercises	457	$ 1	456
Common stock issued for warrant exercises, shares		4,443
Common stock issued for stock option exercises	768		768
Common stock issued for stock option exercises, shares		349
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability	(2,331)		(2,331)
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability, shares		2,027
Reclassification of equity-based liability	3,373		3,373
Foreign currency translation adjustments	1,105				1,105
Net loss	(43,529)					(43,529)
Balance at Mar. 31, 2023	(58,362)	$ 12	952,265	(25,097)	(9,689)	(975,853)
Balance, shares at Mar. 31, 2023		113,459
Balance at Dec. 31, 2022	(34,667)	$ 11	933,537	(25,097)	(10,794)	(932,324)
Balance, shares at Dec. 31, 2022		106,640
Foreign currency translation adjustments	1,283
Net loss	(94,906)
Balance at Jun. 30, 2023	(28,153)	$ 12	1,033,673	(25,097)	(9,511)	(1,027,230)
Balance, shares at Jun. 30, 2023		121,851
Balance at Mar. 31, 2023	(58,362)	$ 12	952,265	(25,097)	(9,689)	(975,853)
Balance, shares at Mar. 31, 2023		113,459
Stock-based compensation	24,194		24,194
Common stock issued for warrant exercises	172		172
Common stock issued for warrant exercises, shares		1,121
Common stock issued for employee stock purchase plan and stock option exercises, shares		274
Common stock issued for employee stock purchase plan and stock option exercises	2,277		2,277
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability	(2,934)		(2,934)
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability, shares		2,711
Common stock offering, net of offering costs	57,511		57,511
Common stock offering, net of offering costs, shares		4,286
Reclassification of equity-based liability	188		188
Foreign currency translation adjustments	178				178
Net loss	(51,377)					(51,377)
Balance at Jun. 30, 2023	(28,153)	$ 12	1,033,673	(25,097)	(9,511)	(1,027,230)
Balance, shares at Jun. 30, 2023		121,851
Balance at Dec. 31, 2023	78,116	$ 14	1,230,484	(25,097)	(8,323)	(1,118,962)
Balance, shares at Dec. 31, 2023		139,245
Stock-based compensation	17,322		17,322
Common stock issued for warrant exercises	150		150
Common stock issued for warrant exercises, shares		30
Common stock issued for stock option exercises	156		156
Common stock issued for stock option exercises, shares		56
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability	(7,560)		(7,560)
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability, shares		3,079
Reclassification of equity-based liability	327		327
Foreign currency translation adjustments	(2,464)				(2,464)
Net loss	(48,495)					(48,495)
Balance at Mar. 31, 2024	37,552	$ 14	1,240,879	(25,097)	(10,787)	(1,167,457)
Balance, shares at Mar. 31, 2024		142,410
Balance at Dec. 31, 2023	78,116	$ 14	1,230,484	(25,097)	(8,323)	(1,118,962)
Balance, shares at Dec. 31, 2023		139,245
Foreign currency translation adjustments	(3,206)
Net loss	(89,175)
Balance at Jun. 30, 2024	17,111	$ 14	1,261,860	(25,097)	(11,529)	(1,208,137)
Balance, shares at Jun. 30, 2024		143,014
Balance at Mar. 31, 2024	37,552	$ 14	1,240,879	(25,097)	(10,787)	(1,167,457)
Balance, shares at Mar. 31, 2024		142,410
Stock-based compensation	16,960		16,960
Common stock issued for employee stock purchase plan and stock option exercises, shares		283
Common stock issued for employee stock purchase plan and stock option exercises	2,524		2,524
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability	(265)		(265)
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability, shares		303
Common stock issued for asset acquisition	250		250
Common stock issued for asset acquisition, shares		18
Reclassification of equity-based liability	1,512		1,512
Foreign currency translation adjustments	(742)				(742)
Net loss	(40,680)					(40,680)
Balance at Jun. 30, 2024	$ 17,111	$ 14	$ 1,261,860	$ (25,097)	$ (11,529)	$ (1,208,137)
Balance, shares at Jun. 30, 2024		143,014

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (DEFICIT) (Parenthetical) $ in Thousands	3 Months Ended
	Jun. 30, 2023 USD ($)
Common stock, offering costs	$ 2,489

CONDENSED CONSOLIDATED STATEM_5

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Operating activities:
Net loss	$ (89,175)	$ (94,906)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	37,762	25,375
Stock-based compensation	34,282	40,656
Amortization of debt discount and debt issuance costs	2,119	1,710
Amortization of right-of-use assets	2,225	1,689
Write-down for excess and obsolete inventories	6,857	6,734
Loss on disposal of assets	2,151	1,402
Other	4,988	860
Changes in operating assets and liabilities:
Accounts receivable	(15,293)	98
Inventories	(42,857)	(22,046)
Prepaid expenses and other current assets	(119)	(9,271)
Other assets	(785)	(45)
Accounts payable	22,162	10,324
Accrued expenses	(10,676)	4,361
Lease liabilities	(2,439)	(1,570)
Contract liabilities	(2,017)	1,839
Other long-term liabilities	983	(3,406)
Net cash used in operating activities	(49,832)	(36,196)
Investing activities:
Purchase of property and equipment	(65,412)	(35,417)
Purchase of intangible assets	(4,100)	(1,962)
Acquisition of business		(55,000)
Net cash used in investing activities	(69,512)	(92,379)
Financing activities:
Proceeds from revolving credit facility	88,400	55,000
Repayment of revolving credit facility	(84,000)	(47,500)
Net cash paid for common stock exercises	(5,023)	(1,551)
Proceeds from financed insurance	1,156	1,328
Proceeds from term loan, net of debt discount		98,473
Payment of debt issuance costs		(3,321)
Proceeds from common stock offering		57,511
Repayment of OCEANES		(13,315)
Other	(1,661)	(1,602)
Net cash (used in) provided by financing activities	(1,128)	145,023
Effect of exchange rate changes on cash	(670)	(124)
Net change in cash and cash equivalents	(121,142)	16,324
Cash and cash equivalents at beginning of period	220,970	84,696
Cash and cash equivalents at end of period	99,828	101,020
Supplemental disclosure of cash flow information:
Cash paid for interest	9,758	6,840
Cash paid for income taxes	275	206
Supplemental disclosure of noncash activities:
Financed insurance	1,156	1,328
Purchases of property and equipment in accounts payable and accrued expenses	3,310	$ 2,233
Recognition of lease liabilities	$ 11,517

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024	Jun. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (40,680)	$ (48,495)	$ (51,377)	$ (43,529)	$ (89,175)	$ (94,906)

Insider Trading Arrangements

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

Organization and Significant Ac

Organization and Significant Accounting Policies	6 Months Ended
Organization and Significant Accounting Policies	Jun. 30, 2024
Accounting Policies [Abstract]
Organization and Significant Accounting Policies	1. Organization and Significant Accounting Policies The Company Alphatec Holdings, Inc. (the “Company”), through its wholly owned subsidiaries, Alphatec Spine, Inc. (“Alphatec Spine”), SafeOp Surgical, Inc. (“SafeOp”), and EOS imaging S.A.S. (“EOS”), is a medical technology company focused on the design, development, and advancement of technology for the better surgical treatment of spinal disorders. The Company, headquartered in Carlsbad, California, markets its products in the United States and internationally via a network of independent sales agents and direct sales representatives. Basis of Presentation and Principles of Consolidation The accompanying condensed consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries. The Company translates the financial statements of its foreign subsidiaries using end-of-period exchange rates for assets and liabilities and average exchange rates during each reporting period for results of operations. All intercompany balances and transactions have been eliminated during consolidation. The accompanying condensed consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”). Pursuant to these rules and regulations, the Company has condensed or omitted certain information and footnotes it normally includes in its annual consolidated financial statements prepared in accordance with generally accepted accounting principles in the United States of America (“U.S. GAAP”). The unaudited interim condensed consolidated financial statements reflect all adjustments, including normal recurring adjustments which, in the opinion of management, are necessary for a fair statement of the financial position and results of operations for the periods presented. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited consolidated financial statements for the year ended December 31, 2023, which are included in the Company’s Annual Report on Form 10-K that was filed with the SEC. Operating results for the six months ended June 30, 2024 are not necessarily indicative of the results that may be expected for the year ending December 31, 2024, or any other future periods. Use of Estimates The preparation of condensed consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities, and the reported amounts of revenues and expenses. Actual results could differ from those estimates. Significant items subject to such estimates and assumptions include the useful lives of property and equipment, goodwill, intangible assets, allowances for doubtful accounts, deferred tax assets, inventories, stock-based compensation, revenues, income tax uncertainties, and other contingencies. Fair Value Measurements The carrying amount of financial instruments consisting of cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, and short-term debt included in the Company’s condensed consolidated financial statements are reasonable estimates of fair value due to their short maturities. Authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Quoted prices in active markets for identical assets or liabilities. Level 2: Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active; or other inputs that can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3: Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities. Excess and Obsolete Inventory Most of the Company’s inventory is comprised of finished goods, which is primarily produced by third-party suppliers. Specialized implants, fixation products, and biologics are valued by utilizing a standard cost method that includes capitalized variances which together approximates the weighted average cost. Imaging equipment and related parts are valued at weighted average cost. Inventories are stated at the lower of cost or net realizable value. The Company reviews the components of its inventory on a periodic basis for excess and obsolescence and adjusts inventory to its net realizable value as necessary. The Company records a lower of cost or net realizable value (“LCNRV”) inventory reserve for estimated excess and obsolete inventory. In order to market its products effectively and meet the demands of interoperative product placement, the Company maintains and provides surgeons and hospitals with a variety of inventory products and sizes. For each surgery, fewer than all components will be consumed. The need to maintain and provide a wide variety of inventory causes inventory to be held that is not likely to be used. The Company’s estimates and assumptions for excess and obsolete inventory are reviewed and updated on a quarterly basis. The estimates and assumptions are determined primarily based on current usage of inventory and the age of inventory quantities on hand. Additionally, the Company considers recent sales experience to develop assumptions about future demand for its products, while considering product life cycles and new product launches. Increases in the LCNRV reserve for excess and obsolete inventory result in a corresponding charge to cost of sales. Revenue Recognition The Company recognizes revenue from product sales in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification Revenue from Contracts with Customers (“Topic 606”). This standard applies to all contracts with customers, except for contracts that are within the scope of other standards, such as leases, insurance, collaboration arrangements, and financial instruments. Under Topic 606, an entity recognizes revenue when its customer obtains control of promised goods or services, in an amount that reflects the consideration that the entity expects to receive in exchange for those goods or services. To determine revenue recognition for arrangements that an entity determines are within the scope of Topic 606, the entity performs the following five steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. The Company only applies the five-step model to contracts when it is probable that the entity will collect the consideration it is entitled to in exchange for the goods or services it transfers to the customer. Sales are derived primarily from the sale of spinal implant products, imaging equipment, and related services to hospitals and medical centers through direct sales representatives and independent sales agents. Revenue is recognized when obligations under the terms of a contract with customers are satisfied, which occurs with the transfer of control of products to customers, either upon shipment of the product or delivery of the product to the customer depending on the shipping terms, or when the products are used in a surgical procedure (implanted in a patient). Revenue from the sale of imaging equipment is recognized as each distinct performance obligation is fulfilled and control transfers to the customer, beginning with shipment or delivery, depending on the terms. Revenue from other distinct performance obligations, such as maintenance on imaging equipment and other imaging-related services, is recognized in the period the service is performed, and makes up less than 10 % of the Company’s total revenue. Revenue is measured based on the amount of consideration expected to be received in exchange for the transfer of the goods or services specified in the contract with each customer. In certain cases, the Company does offer the ability for customers to lease its imaging equipment primarily on a non-sales type basis, but such arrangements are immaterial to total revenue in the periods presented. The Company generally does not allow returns of products that have been delivered. Costs incurred by the Company associated with sales contracts with customers are deferred over the performance obligation period and recognized in the same period as the related revenue, except for contracts that complete within one year or less, in which case the associated costs are expensed as incurred. Payment terms for sales to customers may vary but are commensurate with the general business practices in the country of sale. To the extent that the transaction price includes variable consideration, such as discounts, rebates, and customer payment penalties, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing either the expected value method or the most likely amount method depending on the nature of the variable consideration. Variable consideration is included in the transaction price if, in the Company's judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information that is reasonably available, including historical, current, and forecasted information. The Company records a contract asset when one or more performance obligations have been completed by the Company and revenue has been recognized, but the customer's payment is contingent on the satisfaction of additional performance obligations. Contract assets are generally short-term in nature. The Company records a contract liability, or deferred revenue, when it has an obligation to provide a product or service to the customer and payment is received in advance of its performance. These amounts primarily relate to undelivered equipment and related services, or maintenance agreements. When the Company sells a product or service with a future performance obligation, revenue is deferred on the unfulfilled performance obligation and recognized over the related performance period. Generally, the Company does not have observable evidence of the standalone selling price related to its future service obligations; therefore, the Company estimates the selling price using an expected cost plus a margin approach. The transaction price is allocated using the relative standalone selling price method. The use of alternative estimates could result in a different amount of revenue deferral. Recently Issued Accounting Pronouncements In December 2023, the FASB issued Accounting Standard Update ("ASU") No. 2023-09, Income Taxes (Topic 740): Improvement to Income Tax Disclosures to enhance the transparency of income tax disclosures. The guidance in ASU No. 2023-09 allows for a prospective method of transition, with the option to apply the standard retrospectively. The standard is effective for fiscal years beginning after December 15, 2024, with early adoption permitted. The Company does not intend to early adopt the standard and is in the process of assessing the impact on its consolidated financial statements and related disclosures. In November 2023, the FASB issued ASU No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures that expands disclosure requirements for reportable segments, primarily through enhanced disclosure of significant segment expenses. The guidance in ASU No. 2023-07 allows for a retrospective method of transition. The standard is effective for fiscal years beginning after December 15, 2023, and interim periods in fiscal years beginning after December 15, 2024, with early adoption permitted. The Company does not intend to early adopt the standard and is in the process of assessing the impact on its consolidated financial statements and related disclosures.

Fair Value Measurements

Fair Value Measurements	6 Months Ended
Fair Value Measurements	Jun. 30, 2024
Fair Value Disclosures [Abstract]
Fair Value Measurements	2. Fair Value Measurements Assets and liabilities measured at fair value on a recurring basis include the following as of June 30, 2024, and December 31, 2023 (in thousands): June 30, 2024 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 40,471 — — $ 40,471 Total cash equivalents $ 40,471 — — $ 40,471 December 31, 2023 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 76,662 — — $ 76,662 Total cash equivalents $ 76,662 — — $ 76,662 The Company did not have any transfers of assets and liabilities between the levels of the fair value measurement hierarchy during the periods presented. Fair Value of Long-term Debt The fair value, based on a quoted market price (Level 1), of the Company’s outstanding Senior Convertible Notes due 2026 (the "2026 Notes") was approxim ately $ 305.8 million at June 30, 2024 , and approximately $ 335.4 million at December 31, 2023 .

Business Combination

Business Combination	6 Months Ended
Business Combination	Jun. 30, 2024
Business Combinations [Abstract]
Business Combination	3. Business Combination The Company recognizes assets acquired, liabilities assumed, and any noncontrolling interest at fair value at the date of acquisition. On April 19, 2023, the Company entered into an Asset Purchase Agreement with Integrity Implants Inc. and Fusion Robotics, LLC (collectively, the “Sellers”), whereby the Company acquired certain assets, liabilities, employees, and contracts in connection with the Sellers’ navigation-enabled robotics platform (the “Navigation-enabled Robotics Platform”). The Company paid the Sellers cash consideration of $ 55.0 million at closing, which represented the total purchase consideration. The acquisition was accounted for as a business combination in accordance with ASC 805 and the Company did not acquire any material assets or assume any material liabilities in connection with the acquisition, excluding intangible assets and goodwill. The acquisition is treated as an asset purchase for income tax purposes; therefore, the goodwill recorded is considered deductible for income tax purposes.

Inventories

Inventories	6 Months Ended
Inventories	Jun. 30, 2024
Inventory Disclosure [Abstract]
Inventories	4. Inventories Inventories reported at the lower of cost or net realizable value consist of the following (in thousands): June 30, December 31, Raw materials $ 22,131 $ 23,394 Work-in-process 101 950 Finished goods 150,082 112,498 Inventories $ 172,314 $ 136,842

Property and Equipment, net

Property and Equipment, net	6 Months Ended
Property and Equipment, net	Jun. 30, 2024
Property, Plant and Equipment [Abstract]
Property and Equipment, net	5. Property and Equipment, net Property and equipment, net consist of the following (in thousands, except as indicated): Useful lives June 30, December 31, Surgical instruments 4 $ 280,261 $ 224,357 Machinery and equipment 7 12,115 11,633 Computer equipment 8 30,520 5,778 Office furniture and equipment 5 6,701 6,225 Leasehold improvements various 4,322 3,986 Construction in progress n/a 1,694 24,732 335,613 276,711 Less: accumulated depreciation ( 154,999 ) ( 126,876 ) Property and equipment, net $ 180,614 $ 149,835 Total depreciation expense was $ 15.7 million and $ 29.5 million for the three and six months ended June 30, 2024, respectively. Total depreciation expense was $ 9.8 million and $ 18.3 million for the three and six months ended June 30, 2023 , respectively. Construction in progress is not depreciated until placed in service. Property and equipment includes assets under financing leases and the related amortization of assets under financing leases is included in depreciation expense.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	6 Months Ended
Goodwill and Intangible Assets	Jun. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	6. Goodwill and Intangible Assets Goodwill The change in the carrying amount of goodwill during the period ended June 30, 2024, includes the following (in thousands): December 31, 2023 $ 73,003 Foreign currency fluctuation ( 995 ) June 30, 2024 $ 72,008 Intangible assets, net Intangible assets, net consist of the following (in thousands, except as indicated): Remaining Avg. Gross Accumulated Intangible June 30, 2024: (in years) Amount Amortization Assets, net Developed product technology 6 $ 105,461 $ ( 33,228 ) $ 72,233 Trademarks and trade names 7 5,431 ( 1,785 ) 3,646 Customer relationships 2 14,254 ( 9,442 ) 4,812 Distribution network - 2,413 ( 2,343 ) 70 Total amortized intangible assets 127,559 ( 46,798 ) 80,761 Software in development n/a 12,106 — 12,106 In-process research and development n/a 6,285 — 6,285 Total intangible assets $ 145,950 $ ( 46,798 ) $ 99,152 . Remaining Avg. Gross Accumulated Intangible December 31, 2023: (in years) Amount Amortization Assets, net Developed product technology 6 $ 106,782 $ ( 26,560 ) $ 80,222 Trademarks and trade names 7 5,588 ( 1,561 ) 4,027 Customer relationships 3 14,504 ( 8,692 ) 5,812 Distribution network 1 2,413 ( 2,242 ) 171 Total amortized intangible assets 129,287 ( 39,055 ) 90,232 Software in development n/a 7,934 — 7,934 In-process research and development n/a 4,285 — 4,285 Total intangible assets $ 141,506 $ ( 39,055 ) $ 102,451 Total amortization expense attributed to intangible assets was $ 4.1 million and $ 8.3 million for the three and six months ended June 30, 2024, respectively. Total amortization expense attributed to intangible assets was $ 3.9 million and $ 7.0 million for the three and six months ended June 30, 2023, respectively. Software in development is amortized when the projects are completed and the assets are ready for their intended use. In-process research and development assets begin amortizing when the relevant products reach full commercial launch. Future amortization expense related to intangible assets is as follows (in thousands): Remainder of 2024 $ 8,222 2025 15,061 2026 15,061 2027 12,839 2028 10,847 Thereafter 18,731 $ 80,761

Contract Assets and Contract Li

Contract Assets and Contract Liabilities	6 Months Ended
Contract Assets and Contract Liabilities	Jun. 30, 2024
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Abstract]
Contract Assets and Contract Liabilities	7. Contract Assets and Contract Liabilities Contract assets included within prepaid expenses and other current assets in the condensed consolidated balance sheets are as follows (in thousands): June 30, December 31, Contract assets $ 2,309 $ 3,865 The non-current contract liabilities balance is included in other long-term liabilities on the condensed consolidated balance sheets. The Company’s contract liabilities are as follows (in thousands): June 30, December 31, Contract liabilities $ 14,623 $ 16,474 Less: Non-current portion of contract liabilities 2,848 2,564 Current portion of contract liabilities $ 11,775 $ 13,910 The Company recognized $ 3.3 million and $ 6.4 million of revenue from the opening contract liabilities balance for the three and six months ended June 30, 2024 , respectively.

Debt

Debt	6 Months Ended
Debt	Jun. 30, 2024
Debt Disclosure [Abstract]
Debt	8. Debt Term Loan On January 6, 2023, the Company entered into a $ 150.0 million term loan credit facility with Braidwell Transaction Holdings, LLC (the “Braidwell Term Loan”). The Braidwell Term Loan provides for an initial term loan of $ 100.0 million which was funded on the closing date. On September 28, 2023, the Company drew an additional $ 50.0 million (the “delayed draw term loan(s)” or the “DDTL”). The Braidwell Term Loan matures on January 6, 2028 . As of June 30, 2024, the outstanding balance under the Braidwell Term Loan was $ 150.0 million. In conjunction with the issuance of the Braidwell Term Loan, the Company incurred $ 3.4 million in debt issuance costs and $ 1.5 million in commitment fees. Commitment fees paid to the lender were accounted for as a debt discount. The debt issuance costs and debt discount were recorded as a direct reduction of the carrying amount of the loan on the condensed consolidated balance sheets and are being amortized over the life of the loan. As of June 30, 2024, debt issuance costs and debt discount, net of accumulated amortization, associated with the Braidwell Term Loan were $ 2.7 million and $ 1.1 million, respectively. Borrowings under the Braidwell Term Loan bear interest at a rate per annum equal to the Term Secured Overnight Financing Rate for such SOFR business day ("SOFR") subject to a 3 % floor, plus 5.75 %. The applicable interest rate as of June 30, 2024 was 11.2 %. The loan agreement includes an undrawn commitment fee, which is calculated as 1 % per annum of the average daily undrawn portion of the DDTL. Interest a nd undrawn commitment fees incurred are due quarterly. The Company is also required to pay fees on any prepayment of the Braidwell Term Loan, ranging from 2.0 % to 1.0 % depending on the date of prepayment, and a final payment fee equal to 3.25 % of the principal amount of the loans drawn. The effective interest rate as of June 30, 2024 was 12.2 %. During the three months ended June 30, 2024, the Company reco gnized interest expense on the Braidwell Term Loan of $ 4.3 million, which includes $ 0.2 million for the amortization of debt issuance costs and $ 0.1 million for the debt discount. During the six months ended June 30, 2024, the Company recognized interest expense on the Braidwell Term Loan of $ 8.5 million, which includes $ 0.3 million for the amortization of debt issuance costs and $ 0.2 million for the debt discount. During the three months ended June 30, 2023 , the Company recognized interest expense on the Braidwell Term Loan of $ 2.9 million, which includes $ 0.1 million for the amortization of debt issuance costs and $ 0.1 million for the debt discount. During the six months ended June 30, 2023 , the Company recognized interest expense on the Braidwell Term Loan of $ 5.6 million, which includes $ 0.2 million for the amortization of debt issuance costs and $ 0.1 million for the debt discount. Upon the Braidwell Term Loan’s maturity, any outstanding principal balance, unpaid accrued interest, and all other obligations under the Braidwell Term Loan will be due and payable. The Braidwell Term Loan is secured by substantially all of the Company’s assets with the priority interest of the lenders in the Braidwell Term Loan and the Revolving Credit Facility, as defined below, subject to terms of a customary intercreditor agreement, which provides that the lenders under the Revolving Credit Facility have a priority with respect to the Company's accounts receivable, inventory, medical instruments, and items related to the foregoing, and the lenders under the Braidwell Term Loan have priority with respect to the remainder of the Company's assets. The loan agreement contains customary representations and warranties and affirmative and negative covenants. Under the loan agreement, the Company is required to maintain a minimum level of liquidity. The loan agreement also includes certain events of default, and upon the occurrence of such events of default, all outstanding loans under the Braidwell Term Loan may be accelerated and/or the lenders’ commitments terminated. The Company is in compliance with all required financial covenants as of June 30, 2024. Revolving Credit Facility In September 2022, the Company entered into a revolving credit facility (the “Revolving Credit Facility”) with entities affiliated with MidCap Financial Trust (“MidCap”). The Revolving Credit Facility provides up to $ 50.0 million in borrowing capacity to the Company based on a borrowing base. The borrowing base is calculated based on certain accounts receivable and inventory assets. The Company may request increases up to $ 25.0 million in the Revolving Credit Facility for a total commitment of up to $ 75.0 million. The Company subsequently increased the borrowing capacity by $ 5.0 million for a total borrowing capacity of $ 55.0 million. The Revolving Credit Facility matures on the earlier of September 29, 2027 , or 90 days prior to the final maturity date of the Company’s 2026 Notes. As of June 30, 2024 , the outstanding balance under the Revolving Credit Facility was $ 54.9 million. In conjunction with obtaining the Revolving Credit Facility, the Company incurred $ 1.4 million in debt issuance costs. These costs were capitalized to other assets on the condensed consolidated balance sheets and are being amortized over the life of the Revolving Credit Facility. As of June 30, 2024, debt issuance costs, net of accumulated amortization, associated with the Revolving Credit Fac ility were $ 0.9 million. The outstanding loans under the Revolving Credit Facility bear interest at the sum of Term SOFR plus 3.5 % per annum. The applicable interest rate as of June 30, 2024 was 8.9 %. Th e loan agreements include an unused line fee, which is calculated as 0.5 % per annum of either the unused Revolving Credit Facility or a minimum balance. Interest and unused line fees incurred are due and capitalized to the outstanding principal balance monthly. The Company recognized interest expense on the Revolving Credit Facility of $ 0.8 million and $ 1.1 million during the three and six months ended June 30, 2024, respectively , which includes approximately $ 0.1 million for the amortization of debt issuance costs for both periods . The Company recognized interest expense on the Revolving Credit Facility of $ 0.3 million and $ 0.8 million during the three and six months ended June 30, 2023, respectively , which includes approximately $ 0.1 million for the amortization of debt issuance costs for both periods . Upon the Revolving Credit Facility’s maturity, any outstanding principal balance, unpaid accrued interest, and all other obligations under the Revolving Credit Facility will be due and payable. The Revolving Credit Facility contains a lockbox arrangement clause requiring the Company to maintain a lockbox bank account. If the revolving loan availability is less than 30 % of the revolving loan limit for five consecutive business days, or the Company is in default, MidCap will apply funds collected from the Company's lockbox account to reduce the outstanding balance of the Revolving Credit Facility. As of June 30, 2024, the Company's loan availability level has not activated lockbox deductions, nor is it expected to for the next 12 months; therefore, the Company has determined that the outstanding balance under the Revolving Credit Facility is long-term debt on the condensed consolidated balance sheets. The Revolving Credit Facility is secured by substantially all of the Company’s assets with the priority interest of the lenders subject to terms of a customary intercreditor agreement in connection with the Braidwell Term Loan, as described above. The loan agreements and other ancillary documents contain customary representations and warranties and affirmative and negative covenants. Under the loan agreements, the Company is required to maintain a minimum level of liquidity. The loan agreements also include certain events of default, and upon the occurrence of such events of default, all outstanding loans under the Revolving Credit Facility may be accelerated and/or the lenders’ commitments terminated. The Company is in compliance with all required financial covenants as of June 30, 2024. 0.75% Convertible Senior Notes due 2026 In August 2021, the Company issued $ 316.3 million aggregate principal amount of unsecured 2026 Notes with a stated interest rate of 0.75 % and a maturity date of August 1, 2026 . Interest on the 2026 Notes is payable semi-annually in arrears on February 1 and August 1 of each year, beginning on February 1, 2022 . The net proceeds from the sale of the 2026 Notes were approximately $ 306.2 million after deducting the initial purchasers’ offering expenses. The 2026 Notes do not contain any financial covenants. The 2026 Notes are convertible into shares of the Company’s common stock based upon an initial conversion rate of 54.5316 shares of the Company’s common stock per $ 1,000 principal amount of 2026 Notes (equivalent to an initial conversion price of approximately $ 18.34 per share). The conversion rate will be subject to adjustment upon the occurrence of certain specified events, including certain distributions and dividends to all or substantially all of the holders of the Company’s common stock. Based on the terms of the 2026 Notes, when a conversion notice is received, the Company has the option to pay or deliver cash, shares of the Company’s common stock, or a combination thereof. Holders of the 2026 Notes have the right to convert their notes in certain circumstances and during specified periods. Prior to the close of business on the business day immediately preceding February 2, 2026, holders may convert all or a portion of their 2026 Notes only under the following circumstances: (1) during any calendar quarter (and only during such calendar quarter) if the last reported sale price of the Company’s common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding calendar quarter is greater than or equal to 130 % of the conversion price on each applicable trading day; (2) during the 5 consecutive business days immediately after any 10 consecutive trading day period (the “measurement period”) in which the trading price per $ 1,000 principal amount of 2026 Notes for each trading day of the measurement period was less than 98 % of the product of the last reported sale price of the Company’s common stock and the conversion rate on each such trading day; or (3) upon the occurrence of specified corporate events. From and after February 2, 2026 , holders of the 2026 Notes may convert their notes at any time at their election until the close of business on the second scheduled trading day immediately before the maturity date. As of June 30, 2024, none of the conditions permitting the holders of the 2026 Notes to convert have been met. The 2026 Notes are classified as long-term debt on the condensed consolidated balances sheet as of June 30, 2024. The 2026 Notes are redeemable, in whole or in part, at the Company’s option at any time, and from time to time, on or after August 6, 2024 and on or before the 40th scheduled trading day immediately before the maturity date, at a cash redemption price equal to the principal amount of the 2026 Notes to be redeemed, plus accrued and unpaid interest, if any, but only if the last reported sale price per share of the Company’s common stock exceeds 130 % of the conversion price for a specified period of time. In addition, calling any of the 2026 Notes for redemption will constitute a “make-whole fundamental change” with respect to the redeemable note, in which case the conversion rate applicable to the conversion of the redeemed note will be increased in certain circumstances if such note is converted after it is called for redemption. If a fundamental change occurs prior to the maturity date, holders may require the Company to repurchase all or a portion of their 2026 Notes for cash at a price equal to 100 % of the principal amount of the 2026 Notes plus accrued and unpaid interest. No principal payments are otherwise due on the 2026 Notes prior to maturity. The Company recorded the full principal amount of the 2026 Notes as a long-term liability net of deferred issuance costs. The annual effective interest rate for the 2026 No tes is 1.4 %. The Company recognized interest expense on the 202 6 Notes of $ 1.1 million and $ 2.2 million, respectively, during the three and six months ended June 30, 2024 , which includes $ 0.5 million and $ 1.0 million for the amortization of debt issuance costs, respectively. The Company recognized interest expense on the 2026 Note s of $ 1.1 million and $ 2.1 million, respectively, during the three and six months ended June 30, 2023, which includes $ 0.5 million and $ 1.0 million f or the amortization of debt issuance costs, respectively. The Company uses the if-converted method for assumed conversion of the 2026 Notes to compute the weighted-average shares of common stock outstanding for diluted earnings per share, if applicable. The outstanding principal amount and carrying value of the 2026 Notes consists of the following (in thousands): June 30, December 31, Principal $ 316,250 $ 316,250 Unamortized debt issuance costs ( 4,287 ) ( 5,293 ) Net carrying value $ 311,963 $ 310,957 Capped Call Transactions In connection with the offering of the 2026 Notes, the Company entered into privately negotiated capped call transactions (the “Capped Call Transactions”) with certain financial institutions. The Capped Call Transactions are expected generally to reduce the potential dilution and/or offset the cash payments the Company is required to make in excess of the principal amount of the 2026 Notes upon conversion of the 2026 Notes in the event that the market price per share of the Company’s common stock is greater than the strike price of the Capped Call Transactions with such reduction and/or offset subject to a cap. The Capped Call Transactions have an initial cap price of $ 27.68 per share of the Company’s common stock, which represents a premium of 100 % over the last reported sale price of the Company’s common stock on August 5, 2021, and is subject to certain adjustments under the terms of the Capped Call Transactions. Collectively, the Capped Call Transactions cover, initially, the number of shares of the Company’s common stock underlying the 2026 Notes, subject to anti-dilution adjustments substantially similar to those applicable to the 2026 Notes. The cost of the Capped Call Transactions was approximately $ 39.9 million. The Capped Call Transactions are separate transactions and are not part of the terms of the 2026 Notes and will not affect any holder’s rights under the 2026 Notes. Holders of the 2026 Notes will not have any rights with respect to the Capped Call Transactions. Other Debt Agreements The Company has two loan agreements under French government sponsored COVID-19 relief initiatives (“PGE” loans) which mature in 2027. Monthly and quarterly installments of principal and interest under each PGE loan agreement is due until the original principal amounts and applicable interest is fully repaid in 2027. The outstanding obligation under each PGE loan as of June 30, 2024 was $ 2.8 million and $ 1.2 million at weighted average interest rates of 0.98 % and 1.25 %, respectively, and weighted average costs of the state guaranty of 0.69 % and 1.00 %, respectively. Total Indebtedness Principal payments remaining on the Company's debt are as follows as of June 30, 2024 (in thousands): Remainder of 2024 $ 1,305 2025 1,695 2026 317,515 2027 55,515 2028 154,875 Total 530,905 Less: unamortized debt discount and debt issuance costs ( 11,735 ) Total 519,170 Less: current portion of long-term debt ( 2,289 ) Long-term debt $ 516,881

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
Commitments and Contingencies	Jun. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	9. Commitments and Contingencies Leases The Company determines if an arrangement is a lease at inception by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. If both criteria are met, the Company records the associated lease liability and corresponding right-of-use asset (“ROU asset”) upon commencement of the lease using a discount rate based on the incremental borrowing rate of interest that the Company would borrow on a collateralized basis for an amount equal to the lease payments in a similar economic environment. Any short-term leases defined as twelve months or less or month-to-month leases are excluded and are expensed each month. Total costs associated with these short-term leases are immaterial to all periods presented. The Company leases office and storage facilities and equipment under various operating and financing lease agreements. The initial terms of these leases range from 1 to 10 years and generally provide for periodic rent increases. The Company’s lease agreements do not contain any material variable lease payments, residual value guarantees or material restrictive covenants. The Company aggregates all lease and non-lease components for each class of underlying assets into a single lease component and variable charges for common area maintenance and other variable costs are recognized as expense as incurred. Total variable costs associated with leases for the three and six months ended June 30, 2024 were immaterial. The Company had an immaterial amount of financing leases as of June 30, 2024, which is included in property and equipment, net, accrued expenses and other current liabilities, and other long-term liabilities, on the condensed consolidated balance sheets. On December 1, 2023, the Company entered into a nine-year operating lease in Paris, France that commenced on April 1, 2024 , and will terminate on December 31, 2032 . Future minimum annual lease payments for all operating leases of the Company are as follows as of June 30, 2024 (in thousands): Remainder of 2024 $ 3,653 2025 6,866 2026 6,310 2027 6,258 2028 5,785 Thereafter 15,128 Total undiscounted lease payments 44,000 Less: imputed interest ( 7,651 ) Operating lease liabilities 36,349 Less: current portion of operating lease liabilities ( 6,723 ) Operating lease liabilities, less current portion $ 29,626 The Company’s weighted average remaining lease term and weighted average discount rate as of June 30, 2024 and December 31, 2023 are as follows: June 30, December 31, Weighted-average remaining lease term (years) 6.7 6.5 Weighted-average discount rate 6.6 % 5.5 % Information related to the Company’s operating leases is as follows (in thousands): Three Months Ended Six Months Ended 2024 2023 2024 2023 Rent expense $ 2,040 $ 1,315 $ 3,505 $ 2,559 Cash paid for amounts included in measurement of lease liabilities $ 1,763 $ 1,263 $ 3,186 $ 2,450 Purchase Commitments The Company is obligated to meet certain minimum purchase commitment requirements with a third-party supplier through December 2026. As of June 30, 2024, the remaining minimum purchase commitment required by the Company under the agreement is $ 9.8 million. Litigation The Company is and may become involved in various legal proceedings arising from its business activities. While management is not aware of any litigation matter that in and of itself would have a material adverse impact on the Company’s condensed consolidated results of operations, cash flows or financial position, litigation is inherently unpredictable, and depending on the nature and timing of a proceeding, an unfavorable resolution could materially affect the Company’s future consolidated results of operations, cash flows or financial position in a particular period. The Company assesses contingencies to determine the degree of probability and range of possible loss for potential accrual or disclosure in the Company’s condensed consolidated financial statements. An estimated loss contingency is accrued in the Company’s condensed consolidated financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Because litigation is inherently unpredictable and unfavorable resolutions could occur, assessing contingencies is highly subjective and requires judgments about future events. When evaluating contingencies, the Company may be unable to provide a meaningful estimate due to a number of factors, including the procedural status of the matter in question, the presence of complex or novel legal theories, and/or the ongoing discovery and development of information important to the matters. In addition, damage amounts claimed in litigation against the Company may be unsupported, exaggerated or unrelated to reasonably possible outcomes, and as such are not meaningful indicators of the Company’s potential liability. Indemnifications In the normal course of business, the Company enters into agreements under which it occasionally indemnifies third-parties for intellectual property infringement claims or claims arising from breaches of representations or warranties. In addition, from time to time, the Company provides indemnity protection to third-parties for claims relating to past performance arising from undisclosed liabilities, product liabilities, environmental obligations, representations and warranties, and other claims. In these agreements, the scope and amount of remedy, or the period in which claims can be made, may be limited. It is not possible to determine the maximum potential amount of future payments, if any, due under these indemnities due to the conditional nature of the obligations and the unique facts and circumstances involved in each agreement. In October 2017, NuVasive filed a lawsuit in Delaware Chancery Court against Mr. Miles, the Company’s Chairman and CEO, who was a former officer and board member of NuVasive. The Company itself was not initially a named defendant in this lawsuit; however, in June 2018, NuVasive amended its complaint to add the Company as a defendant. In October 2018, the Delaware Court ordered that NuVasive advance legal fees for Mr. Miles’ defense in the lawsuit, as well as Mr. Miles’ legal fees incurred in pursuing advancement of his fees, pursuant to an indemnification agreement between NuVasive and Mr. Miles. As of June 30, 2024, the Company has not recorded any liability on the condensed consolidated balance sheets related to this matter. Royalties The Company has entered into various intellectual property agreements requiring the payment of royalties based on the sale of products that utilize such intellectual property. These royalties primarily relate to products sold by Alphatec Spine and are based on fixed fees or calculated either as a percentage of net sales or on a per-unit sold basis. Royalties are included on the accompanying condensed consolidated statements of operations as a component of cost of sales.

Stock-Benefit Plans and Equity

Stock-Benefit Plans and Equity Transactions	6 Months Ended
Stock-Benefit Plans and Equity Transactions	Jun. 30, 2024
Share-Based Payment Arrangement [Abstract]
Stock-Benefit Plans and Equity Transactions	10. Stock-Benefit Plans and Equity Transactions Stock-Based Compensation The Company has stock-based compensation plans under which it grants stock options, restricted stock units ("RSUs"), and performance restricted stock units ("PRSUs") to officers, directors and third parties. Total stock-based compensation for the periods presented are as follows (in thousands): Three Months Ended Six Months Ended June 30, June 30, 2024 2023 2024 2023 Cost of sales $ 554 $ 16,226 $ 1,037 $ 22,232 Research and development 5,614 1,480 9,929 2,797 Sales, general and administrative 10,792 6,488 23,316 15,627 Total $ 16,960 $ 24,194 $ 34,282 $ 40,656 As of June 30, 2024, there was $ 80.3 million of unrecognized compensation expense for RSUs and PRSUs to be recognized over a weighted average period of 1.80 years. The Company has entered into Development Service Agreements for the development of a wide variety of potential products and intellectual property. Under these agreements, future royalty payments for product and/or intellectual property rights may be paid in either cash or restricted shares of the Company’s common stock at the election of the developer, depending on the terms of the agreement. Certain of these agreements were amended to remove the cash royalty option and require settlement in restricted shares of the Company’s common stock. During the three and six months ended June 30, 2024 and 2023, the vesting conditions of certain of these awards were deemed probable. Stock-based compensation associated with these awards is included in cost of sales and research and development expense on the condensed consolidated statements of operations. Restricted Stock Units and Performance Based Restricted Stock Units Awards The Company issued approximately 309,000 and 3,473,000 shares of common stock, before net share settlement, upon vesting of RSUs and PRSUs during the three and six months ended June 30, 2024 , respectively. The Company issued approximately 2,921,000 and 4,889,000 shares of common stock, before net share settlement, upon vesting of RSUs and PRSUs during the three and six months ended June 30, 2023, respectively. Employee Stock Purchase Plan Employees are eligible to participate in the Employee Stock Purchase Plan ("ESPP") approved by its shareholders. During the three and six months ended June 30, 2024 , there were approximately 251,000 shares issued under the ESPP. During the three and six months ended June 30, 2023 , there were approximately 247,000 shares issued under the ESPP. The Company estimates the fair value of shares issued to employees under the ESPP using the Black-Scholes option-pricing model. The assumptions used to estimate the fair value of stock options granted and stock purchase rights under the ESPP are as follows: Three and Six Months Ended June 30, 2024 2023 Risk-free interest rate 5.40 % - 5.41 % 4.54 % - 5.41 % Expected dividend yield — — Expected term (years) 0.50 0.41 - 0.60 Volatility 54.47 % - 58.41 % 40.87 % - 62.77 % Warrants Outstanding Squadron Medical Warrants In connection with debt financing entered into with Squadron Medical Finance Solutions, LLC ("Squadron Medical") in 2018, and amended in 2019 and 2020, the Company issued common stock warrants to Squadron Medical and a participant lender (the “Squadron Medical Warrants”). The Squadron Medical Warrants expire in May 2027 and are exercisable by cash exercise. No Squadron Medical Warrants have been exercised as of June 30, 2024. Executive Warrants The Company issued warrants to its Chairman and Chief Executive Officer (the “Executive Warrants”). The Executive Warrants had a five-year term and are exercisable by cash or cashless exercise. In October 2022, the term was extended to seven years and in May 2024, the term was extended to nine years . No Executive Warrants have been exercised as of June 30, 2024. A summary of all outstanding warrants for common stock as of June 30, 2024, are as follows (in thousands, except for strike price data): Number of Strike Price Expiration 2018 Squadron Medical Warrants 845 $ 3.15 May 2027 2019 Squadron Medical Warrants 4,839 $ 2.17 May 2027 2020 Squadron Medical Warrants 1,076 $ 4.88 May 2027 Executive Warrants 1,327 $ 5.00 December 2026 Other (1) 129 $ 10.10 Various through June 2026 Total 8,216 (1) Weighted-average strike price. All outstanding warrants were deemed to qualify for equity classification under authoritative accounting guidance.

Business Segment and Geographic

Business Segment and Geographic Information	6 Months Ended
Business Segment and Geographic Information	Jun. 30, 2024
Segment Reporting [Abstract]
Business Segment and Geographic Information	11. Business Segment and Geographic Information The Company operates in one segment based upon the Company’s organizational structure, the way in which the operations and investments are managed and evaluated by the chief operating decision maker (“CODM”) as well as the lack of available discrete financial information at a level lower than the consolidated level. The Company shares common, centralized support functions which report directly to the CODM and decision-making regarding the Company’s overall operating performance and allocation of Company resources is assessed on a consolidated basis. Net revenue and property and equipment, net, by geographic region are as follows (in thousands): Revenue Property and equipment, net Three Months Ended Six Months Ended June 30, December 31, (in thousands) 2024 2023 2024 2023 2024 2023 United States $ 136,406 $ 107,664 $ 266,251 $ 207,633 $ 178,956 $ 147,705 International 9,167 9,256 17,799 18,397 1,658 2,130 Total $ 145,573 $ 116,920 $ 284,050 $ 226,030 $ 180,614 $ 149,835

Net Loss Per Share

Net Loss Per Share	6 Months Ended
Net Loss Per Share	Jun. 30, 2024
Earnings Per Share [Abstract]
Net Loss Per Share	12. Net Loss Per Share Basic net loss per share is calculated by dividing the net loss available to common stockholders by the weighted-average number of common shares outstanding for the period. If applicable, diluted net loss per share attributable to common stockholders is calculated by dividing net loss available to common stockholders by the diluted weighted-average number of common shares outstanding for the period, determined using the treasury-stock method and the if-converted method for convertible debt. For purposes of this calculation, common stock subject to repurchase by the Company, common stock issuable upon conversion or exercise of convertible notes, preferred shares, options, and warrants are considered to be common stock equivalents and are only included in the calculation of diluted earnings per share when their effect is dilutive. Due to the Company’s net loss position, the effect of including common stock equivalents in the earnings per share calculation is anti-dilutive, and therefore not included. The following table presents the computation of basic and diluted net loss per share (in thousands, except per share amounts): Three Months Ended Six Months Ended 2024 2023 2024 2023 Numerator: Net loss $ ( 40,680 ) $ ( 51,377 ) $ ( 89,175 ) $ ( 94,906 ) Denominator: Weighted average common shares outstanding 142,687 118,719 141,845 114,260 Net loss per share, basic and diluted: $ ( 0.29 ) $ ( 0.43 ) $ ( 0.63 ) $ ( 0.83 ) The following potentially dilutive shares of common stock were excluded from the calculation of diluted net loss per share because their effect would have been anti-dilutive for the periods presented (in thousands): As of 2024 2023 Options to purchase common stock and employee stock purchase plan 2,497 2,517 Unvested restricted stock unit awards 8,172 7,546 Warrants to purchase common stock 8,216 8,226 Senior convertible notes 17,246 17,246 Total 36,131 35,535

Income Taxes

Income Taxes	6 Months Ended
Income Taxes	Jun. 30, 2024
Income Tax Disclosure [Abstract]
Income Taxes	13. Income Taxes To calculate its interim tax provision, at the end of each interim period the Company estimates the annual effective tax rate, adjusted for discrete items arising in that quarter. The computation of the annual estimated effective tax rate at each interim period requires certain estimates and significant judgment including, but not limited to, the estimated annual taxable income or loss for the year and projections of the proportion of income earned and taxed in foreign jurisdictions. The accounting estimates used to compute the provision for income taxes may change as new events occur, additional information is obtained, or the tax environment changes. The Company’s effective tax rate from operations wa s 0.70 % and 0.40 % for the three and six months ended June 30, 2024, respectively. The Company’s effective tax rate from operations wa s 0.10 % and 0.04 % for the three and six months ended June 30, 2023 , respectively. The Company’s effective tax rate differs from the federal statutory rate of 21 % in each period primarily due to the Company’s net loss position and valuation allowance.

Related Party Transactions

Related Party Transactions	6 Months Ended
Related Party Transactions	Jun. 30, 2024
Related Party Transactions [Abstract]
Related Party Transactions	14. Related Party Transactions The Company purchases inventory from an affiliate of Squadron Capital, LLC (the “Squadron Supplier Affiliate”). David Pelizzon, President and Director of Squadron Capital, LLC, currently serves on the Company’s Board of Directors. For the three and six months ended June 30, 2024, the Company purchased inventory in the amounts of $ 3.2 million and $ 8.0 million, r espectively, from the Squadron Supplier Affiliate. For the three and six months ended June 30, 2023, the Company purchased inventory in the amounts of $ 4.7 million and $ 8.3 million, r espectively, from the Squadron Supplier Affiliate. As of June 30, 2024, and December 31, 2023, the Company had $ 7.8 million and $ 5.4 million, respectively, due to the Squadron Supplier Affiliate, for inventory purchases.

Organization and Significant _2

Organization and Significant Accounting Policies (Policies)	6 Months Ended
Organization and Significant Accounting Policies (Policies)	Jun. 30, 2024
Accounting Policies [Abstract]
The Company	The Company Alphatec Holdings, Inc. (the “Company”), through its wholly owned subsidiaries, Alphatec Spine, Inc. (“Alphatec Spine”), SafeOp Surgical, Inc. (“SafeOp”), and EOS imaging S.A.S. (“EOS”), is a medical technology company focused on the design, development, and advancement of technology for the better surgical treatment of spinal disorders. The Company, headquartered in Carlsbad, California, markets its products in the United States and internationally via a network of independent sales agents and direct sales representatives.
Basis of Presentation and Principles of Consolidation	Basis of Presentation and Principles of Consolidation The accompanying condensed consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries. The Company translates the financial statements of its foreign subsidiaries using end-of-period exchange rates for assets and liabilities and average exchange rates during each reporting period for results of operations. All intercompany balances and transactions have been eliminated during consolidation. The accompanying condensed consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”). Pursuant to these rules and regulations, the Company has condensed or omitted certain information and footnotes it normally includes in its annual consolidated financial statements prepared in accordance with generally accepted accounting principles in the United States of America (“U.S. GAAP”). The unaudited interim condensed consolidated financial statements reflect all adjustments, including normal recurring adjustments which, in the opinion of management, are necessary for a fair statement of the financial position and results of operations for the periods presented. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited consolidated financial statements for the year ended December 31, 2023, which are included in the Company’s Annual Report on Form 10-K that was filed with the SEC. Operating results for the six months ended June 30, 2024 are not necessarily indicative of the results that may be expected for the year ending December 31, 2024, or any other future periods.
Use of Estimates	Use of Estimates The preparation of condensed consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities, and the reported amounts of revenues and expenses. Actual results could differ from those estimates. Significant items subject to such estimates and assumptions include the useful lives of property and equipment, goodwill, intangible assets, allowances for doubtful accounts, deferred tax assets, inventories, stock-based compensation, revenues, income tax uncertainties, and other contingencies.
Fair Value Measurements	Fair Value Measurements The carrying amount of financial instruments consisting of cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, and short-term debt included in the Company’s condensed consolidated financial statements are reasonable estimates of fair value due to their short maturities. Authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Quoted prices in active markets for identical assets or liabilities. Level 2: Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active; or other inputs that can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3: Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.
Excess and Obsolete Inventory	Excess and Obsolete Inventory Most of the Company’s inventory is comprised of finished goods, which is primarily produced by third-party suppliers. Specialized implants, fixation products, and biologics are valued by utilizing a standard cost method that includes capitalized variances which together approximates the weighted average cost. Imaging equipment and related parts are valued at weighted average cost. Inventories are stated at the lower of cost or net realizable value. The Company reviews the components of its inventory on a periodic basis for excess and obsolescence and adjusts inventory to its net realizable value as necessary. The Company records a lower of cost or net realizable value (“LCNRV”) inventory reserve for estimated excess and obsolete inventory. In order to market its products effectively and meet the demands of interoperative product placement, the Company maintains and provides surgeons and hospitals with a variety of inventory products and sizes. For each surgery, fewer than all components will be consumed. The need to maintain and provide a wide variety of inventory causes inventory to be held that is not likely to be used. The Company’s estimates and assumptions for excess and obsolete inventory are reviewed and updated on a quarterly basis. The estimates and assumptions are determined primarily based on current usage of inventory and the age of inventory quantities on hand. Additionally, the Company considers recent sales experience to develop assumptions about future demand for its products, while considering product life cycles and new product launches. Increases in the LCNRV reserve for excess and obsolete inventory result in a corresponding charge to cost of sales.
Revenue Recognition	Revenue Recognition The Company recognizes revenue from product sales in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification Revenue from Contracts with Customers (“Topic 606”). This standard applies to all contracts with customers, except for contracts that are within the scope of other standards, such as leases, insurance, collaboration arrangements, and financial instruments. Under Topic 606, an entity recognizes revenue when its customer obtains control of promised goods or services, in an amount that reflects the consideration that the entity expects to receive in exchange for those goods or services. To determine revenue recognition for arrangements that an entity determines are within the scope of Topic 606, the entity performs the following five steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. The Company only applies the five-step model to contracts when it is probable that the entity will collect the consideration it is entitled to in exchange for the goods or services it transfers to the customer. Sales are derived primarily from the sale of spinal implant products, imaging equipment, and related services to hospitals and medical centers through direct sales representatives and independent sales agents. Revenue is recognized when obligations under the terms of a contract with customers are satisfied, which occurs with the transfer of control of products to customers, either upon shipment of the product or delivery of the product to the customer depending on the shipping terms, or when the products are used in a surgical procedure (implanted in a patient). Revenue from the sale of imaging equipment is recognized as each distinct performance obligation is fulfilled and control transfers to the customer, beginning with shipment or delivery, depending on the terms. Revenue from other distinct performance obligations, such as maintenance on imaging equipment and other imaging-related services, is recognized in the period the service is performed, and makes up less than 10 % of the Company’s total revenue. Revenue is measured based on the amount of consideration expected to be received in exchange for the transfer of the goods or services specified in the contract with each customer. In certain cases, the Company does offer the ability for customers to lease its imaging equipment primarily on a non-sales type basis, but such arrangements are immaterial to total revenue in the periods presented. The Company generally does not allow returns of products that have been delivered. Costs incurred by the Company associated with sales contracts with customers are deferred over the performance obligation period and recognized in the same period as the related revenue, except for contracts that complete within one year or less, in which case the associated costs are expensed as incurred. Payment terms for sales to customers may vary but are commensurate with the general business practices in the country of sale. To the extent that the transaction price includes variable consideration, such as discounts, rebates, and customer payment penalties, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing either the expected value method or the most likely amount method depending on the nature of the variable consideration. Variable consideration is included in the transaction price if, in the Company's judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information that is reasonably available, including historical, current, and forecasted information. The Company records a contract asset when one or more performance obligations have been completed by the Company and revenue has been recognized, but the customer's payment is contingent on the satisfaction of additional performance obligations. Contract assets are generally short-term in nature. The Company records a contract liability, or deferred revenue, when it has an obligation to provide a product or service to the customer and payment is received in advance of its performance. These amounts primarily relate to undelivered equipment and related services, or maintenance agreements. When the Company sells a product or service with a future performance obligation, revenue is deferred on the unfulfilled performance obligation and recognized over the related performance period. Generally, the Company does not have observable evidence of the standalone selling price related to its future service obligations; therefore, the Company estimates the selling price using an expected cost plus a margin approach. The transaction price is allocated using the relative standalone selling price method. The use of alternative estimates could result in a different amount of revenue deferral.
Recently Issued Accounting Pronouncements	Recently Issued Accounting Pronouncements In December 2023, the FASB issued Accounting Standard Update ("ASU") No. 2023-09, Income Taxes (Topic 740): Improvement to Income Tax Disclosures to enhance the transparency of income tax disclosures. The guidance in ASU No. 2023-09 allows for a prospective method of transition, with the option to apply the standard retrospectively. The standard is effective for fiscal years beginning after December 15, 2024, with early adoption permitted. The Company does not intend to early adopt the standard and is in the process of assessing the impact on its consolidated financial statements and related disclosures. In November 2023, the FASB issued ASU No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures that expands disclosure requirements for reportable segments, primarily through enhanced disclosure of significant segment expenses. The guidance in ASU No. 2023-07 allows for a retrospective method of transition. The standard is effective for fiscal years beginning after December 15, 2023, and interim periods in fiscal years beginning after December 15, 2024, with early adoption permitted. The Company does not intend to early adopt the standard and is in the process of assessing the impact on its consolidated financial statements and related disclosures.

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
Fair Value Measurements (Tables)	Jun. 30, 2024
Fair Value Disclosures [Abstract]
Assets and Liabilities Measured at Fair Value on Recurring Basis	Assets and liabilities measured at fair value on a recurring basis include the following as of June 30, 2024, and December 31, 2023 (in thousands): June 30, 2024 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 40,471 — — $ 40,471 Total cash equivalents $ 40,471 — — $ 40,471 December 31, 2023 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 76,662 — — $ 76,662 Total cash equivalents $ 76,662 — — $ 76,662

Inventories (Tables)

Inventories (Tables)	6 Months Ended
Inventories (Tables)	Jun. 30, 2024
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories reported at the lower of cost or net realizable value consist of the following (in thousands): June 30, December 31, Raw materials $ 22,131 $ 23,394 Work-in-process 101 950 Finished goods 150,082 112,498 Inventories $ 172,314 $ 136,842

Property and Equipment, net (Ta

Property and Equipment, net (Tables)	6 Months Ended
Property and Equipment, net (Tables)	Jun. 30, 2024
Property, Plant and Equipment [Abstract]
Property and equipment, net	Property and equipment, net consist of the following (in thousands, except as indicated): Useful lives June 30, December 31, Surgical instruments 4 $ 280,261 $ 224,357 Machinery and equipment 7 12,115 11,633 Computer equipment 8 30,520 5,778 Office furniture and equipment 5 6,701 6,225 Leasehold improvements various 4,322 3,986 Construction in progress n/a 1,694 24,732 335,613 276,711 Less: accumulated depreciation ( 154,999 ) ( 126,876 ) Property and equipment, net $ 180,614 $ 149,835

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	6 Months Ended
Goodwill and Intangible Assets (Tables)	Jun. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The change in the carrying amount of goodwill during the period ended June 30, 2024, includes the following (in thousands): December 31, 2023 $ 73,003 Foreign currency fluctuation ( 995 ) June 30, 2024 $ 72,008
Intangible Assets, Net	Intangible assets, net consist of the following (in thousands, except as indicated): Remaining Avg. Gross Accumulated Intangible June 30, 2024: (in years) Amount Amortization Assets, net Developed product technology 6 $ 105,461 $ ( 33,228 ) $ 72,233 Trademarks and trade names 7 5,431 ( 1,785 ) 3,646 Customer relationships 2 14,254 ( 9,442 ) 4,812 Distribution network - 2,413 ( 2,343 ) 70 Total amortized intangible assets 127,559 ( 46,798 ) 80,761 Software in development n/a 12,106 — 12,106 In-process research and development n/a 6,285 — 6,285 Total intangible assets $ 145,950 $ ( 46,798 ) $ 99,152 . Remaining Avg. Gross Accumulated Intangible December 31, 2023: (in years) Amount Amortization Assets, net Developed product technology 6 $ 106,782 $ ( 26,560 ) $ 80,222 Trademarks and trade names 7 5,588 ( 1,561 ) 4,027 Customer relationships 3 14,504 ( 8,692 ) 5,812 Distribution network 1 2,413 ( 2,242 ) 171 Total amortized intangible assets 129,287 ( 39,055 ) 90,232 Software in development n/a 7,934 — 7,934 In-process research and development n/a 4,285 — 4,285 Total intangible assets $ 141,506 $ ( 39,055 ) $ 102,451
Schedule of Intangible Assets, Future Expected Amortization Expense	Future amortization expense related to intangible assets is as follows (in thousands): Remainder of 2024 $ 8,222 2025 15,061 2026 15,061 2027 12,839 2028 10,847 Thereafter 18,731 $ 80,761

Contract Assets and Contract _2

Contract Assets and Contract Liabilities (Tables)	6 Months Ended
Contract Assets and Contract Liabilities (Tables)	Jun. 30, 2024
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Abstract]
Summary of Contract Assets and Liabilities	Contract assets included within prepaid expenses and other current assets in the condensed consolidated balance sheets are as follows (in thousands): June 30, December 31, Contract assets $ 2,309 $ 3,865 The non-current contract liabilities balance is included in other long-term liabilities on the condensed consolidated balance sheets. The Company’s contract liabilities are as follows (in thousands): June 30, December 31, Contract liabilities $ 14,623 $ 16,474 Less: Non-current portion of contract liabilities 2,848 2,564 Current portion of contract liabilities $ 11,775 $ 13,910

Debt (Tables)

Debt (Tables)	6 Months Ended
Debt (Tables)	Jun. 30, 2024
Debt Disclosure [Abstract]
Outstanding Principal Amount and Carrying Value of Notes	The outstanding principal amount and carrying value of the 2026 Notes consists of the following (in thousands): June 30, December 31, Principal $ 316,250 $ 316,250 Unamortized debt issuance costs ( 4,287 ) ( 5,293 ) Net carrying value $ 311,963 $ 310,957
Principal Payments Remaining on Debt	Principal payments remaining on the Company's debt are as follows as of June 30, 2024 (in thousands): Remainder of 2024 $ 1,305 2025 1,695 2026 317,515 2027 55,515 2028 154,875 Total 530,905 Less: unamortized debt discount and debt issuance costs ( 11,735 ) Total 519,170 Less: current portion of long-term debt ( 2,289 ) Long-term debt $ 516,881

Commitments and Contingencies (

Commitments and Contingencies (Tables)	6 Months Ended
Commitments and Contingencies (Tables)	Jun. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Future minimum annual lease payments	Future minimum annual lease payments for all operating leases of the Company are as follows as of June 30, 2024 (in thousands): Remainder of 2024 $ 3,653 2025 6,866 2026 6,310 2027 6,258 2028 5,785 Thereafter 15,128 Total undiscounted lease payments 44,000 Less: imputed interest ( 7,651 ) Operating lease liabilities 36,349 Less: current portion of operating lease liabilities ( 6,723 ) Operating lease liabilities, less current portion $ 29,626
Summary of Weighted-Average Remaining Lease Term and Discount Rate	The Company’s weighted average remaining lease term and weighted average discount rate as of June 30, 2024 and December 31, 2023 are as follows: June 30, December 31, Weighted-average remaining lease term (years) 6.7 6.5 Weighted-average discount rate 6.6 % 5.5 %
Summary of Operating Leases	Information related to the Company’s operating leases is as follows (in thousands): Three Months Ended Six Months Ended 2024 2023 2024 2023 Rent expense $ 2,040 $ 1,315 $ 3,505 $ 2,559 Cash paid for amounts included in measurement of lease liabilities $ 1,763 $ 1,263 $ 3,186 $ 2,450

Stock-Benefit Plans and Equit_2

Stock-Benefit Plans and Equity Transactions (Tables)	6 Months Ended
Stock-Benefit Plans and Equity Transactions (Tables)	Jun. 30, 2024
Share-Based Payment Arrangement [Abstract]
Summary of Total Stock Based Compensation	The Company has stock-based compensation plans under which it grants stock options, restricted stock units ("RSUs"), and performance restricted stock units ("PRSUs") to officers, directors and third parties. Total stock-based compensation for the periods presented are as follows (in thousands): Three Months Ended Six Months Ended June 30, June 30, 2024 2023 2024 2023 Cost of sales $ 554 $ 16,226 $ 1,037 $ 22,232 Research and development 5,614 1,480 9,929 2,797 Sales, general and administrative 10,792 6,488 23,316 15,627 Total $ 16,960 $ 24,194 $ 34,282 $ 40,656
Schedule of Assumptions used to Estimate Fair Value of Stock Options Granted and Stock Purchase Rights under ESPP	The Company estimates the fair value of shares issued to employees under the ESPP using the Black-Scholes option-pricing model. The assumptions used to estimate the fair value of stock options granted and stock purchase rights under the ESPP are as follows: Three and Six Months Ended June 30, 2024 2023 Risk-free interest rate 5.40 % - 5.41 % 4.54 % - 5.41 % Expected dividend yield — — Expected term (years) 0.50 0.41 - 0.60 Volatility 54.47 % - 58.41 % 40.87 % - 62.77 %
Summary of All Outstanding Warrants for Common Stock	A summary of all outstanding warrants for common stock as of June 30, 2024, are as follows (in thousands, except for strike price data): Number of Strike Price Expiration 2018 Squadron Medical Warrants 845 $ 3.15 May 2027 2019 Squadron Medical Warrants 4,839 $ 2.17 May 2027 2020 Squadron Medical Warrants 1,076 $ 4.88 May 2027 Executive Warrants 1,327 $ 5.00 December 2026 Other (1) 129 $ 10.10 Various through June 2026 Total 8,216 (1) Weighted-average strike price.

Business Segment and Geograph_2

Business Segment and Geographic Information (Tables)	6 Months Ended
Business Segment and Geographic Information (Tables)	Jun. 30, 2024
Segment Reporting [Abstract]
Schedule of Net Revenue and Property, and Equipment, Net, by Geographic Region	Net revenue and property and equipment, net, by geographic region are as follows (in thousands): Revenue Property and equipment, net Three Months Ended Six Months Ended June 30, December 31, (in thousands) 2024 2023 2024 2023 2024 2023 United States $ 136,406 $ 107,664 $ 266,251 $ 207,633 $ 178,956 $ 147,705 International 9,167 9,256 17,799 18,397 1,658 2,130 Total $ 145,573 $ 116,920 $ 284,050 $ 226,030 $ 180,614 $ 149,835

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	6 Months Ended
Net Loss Per Share (Tables)	Jun. 30, 2024
Earnings Per Share [Abstract]
Computation of Basic and Diluted Net Loss Per Share	The following table presents the computation of basic and diluted net loss per share (in thousands, except per share amounts): Three Months Ended Six Months Ended 2024 2023 2024 2023 Numerator: Net loss $ ( 40,680 ) $ ( 51,377 ) $ ( 89,175 ) $ ( 94,906 ) Denominator: Weighted average common shares outstanding 142,687 118,719 141,845 114,260 Net loss per share, basic and diluted: $ ( 0.29 ) $ ( 0.43 ) $ ( 0.63 ) $ ( 0.83 )
Anti-Dilutive Securities of Common Stock Excluded from Calculation of Diluted Net Loss Per Share	The following potentially dilutive shares of common stock were excluded from the calculation of diluted net loss per share because their effect would have been anti-dilutive for the periods presented (in thousands): As of 2024 2023 Options to purchase common stock and employee stock purchase plan 2,497 2,517 Unvested restricted stock unit awards 8,172 7,546 Warrants to purchase common stock 8,216 8,226 Senior convertible notes 17,246 17,246 Total 36,131 35,535

Organization and Significant _3

Organization and Significant Accounting Policies - Additional Information (Details)	6 Months Ended
	Jun. 30, 2024
Maximum
Significant Accounting Policies [Line Items]
Percentage of revenue from other distinct performance obligations of total revenue	10%

Fair Value Measurements - Asset

Fair Value Measurements - Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - Recurring - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	$ 40,471	$ 76,662
Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	40,471	76,662
Fair Value, Inputs, Level 1
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	40,471	76,662
Fair Value, Inputs, Level 1 \| Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	$ 40,471	$ 76,662

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Details) - Fair Value, Inputs, Level 1 - 2026 Notes - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2024	Dec. 31, 2023
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value of long-term debt	$ 305.8	$ 335.4
Debt maturity year	2026

Business Combination - Addition

Business Combination - Additional Information (Details) - USD ($) $ in Thousands		6 Months Ended
	Apr. 19, 2023	Jun. 30, 2023
Business Acquisition [Line Items]
Purchase price in cash		$ 55,000
Navigation-enabled Robotics Platform \| Asset Purchase Agreement
Business Acquisition [Line Items]
Purchase price in cash	$ 55,000

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Inventory Disclosure [Abstract]
Raw materials	$ 22,131	$ 23,394
Work-in-process	101	950
Finished goods	150,082	112,498
Inventories	$ 172,314	$ 136,842

Property and Equipment, net - P

Property and Equipment, net - Property and Equipment, Net (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Dec. 31, 2023
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 335,613	$ 276,711
Less: accumulated depreciation and amortization	(154,999)	(126,876)
Property and equipment, net	$ 180,614	149,835
Surgical instruments
Property, Plant and Equipment [Line Items]
Useful life (in years)	4 years
Property and equipment, gross	$ 280,261	224,357
Machinery and equipment
Property, Plant and Equipment [Line Items]
Useful life (in years)	7 years
Property and equipment, gross	$ 12,115	11,633
Computer equipment
Property, Plant and Equipment [Line Items]
Useful life (in years)	8 years
Property and equipment, gross	$ 30,520	5,778
Office furniture and equipment
Property, Plant and Equipment [Line Items]
Useful life (in years)	5 years
Property and equipment, gross	$ 6,701	6,225
Leasehold improvements
Property, Plant and Equipment [Line Items]
Useful lives	various
Property and equipment, gross	$ 4,322	3,986
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,694	$ 24,732

Property and Equipment, net - A

Property and Equipment, net - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Property, Plant and Equipment [Abstract]
Depreciation	$ 15.7	$ 9.8	$ 29.5	$ 18.3

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Schedule of Goodwill (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2024 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
December 31, 2023	$ 73,003
Foreign currency fluctuation	(995)
June 30, 2024	$ 72,008

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Intangible Assets, Net (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Intangible Assets [Line Items]
Total amortized intangible assets, Gross Amount	$ 127,559	$ 129,287
Total amortized intangible assets, Accumulated Amortization	(46,798)	(39,055)
Total amortized intangible assets, net	80,761	90,232
Total Intangible assets, Gross Amount	145,950	141,506
Total intangible assets, net	$ 99,152	$ 102,451
Developed product technology
Intangible Assets [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives	6 years	6 years
Total amortized intangible assets, Gross Amount	$ 105,461	$ 106,782
Total amortized intangible assets, Accumulated Amortization	(33,228)	(26,560)
Total amortized intangible assets, net	$ 72,233	$ 80,222
Trademarks and trade names
Intangible Assets [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives	7 years	7 years
Total amortized intangible assets, Gross Amount	$ 5,431	$ 5,588
Total amortized intangible assets, Accumulated Amortization	(1,785)	(1,561)
Total amortized intangible assets, net	$ 3,646	$ 4,027
Customer Relationships
Intangible Assets [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives	2 years	3 years
Total amortized intangible assets, Gross Amount	$ 14,254	$ 14,504
Total amortized intangible assets, Accumulated Amortization	(9,442)	(8,692)
Total amortized intangible assets, net	4,812	$ 5,812
Distribution network
Intangible Assets [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives		1 year
Total amortized intangible assets, Gross Amount	2,413	$ 2,413
Total amortized intangible assets, Accumulated Amortization	(2,343)	(2,242)
Total amortized intangible assets, net	70	171
Software in development
Intangible Assets [Line Items]
Indefinite-Lived Intangible Assets, Gross Amount	12,106	7,934
Indefinite-Lived Intangible Assets, net	12,106	7,934
In process research and development
Intangible Assets [Line Items]
Indefinite-Lived Intangible Assets, Gross Amount	6,285	4,285
Indefinite-Lived Intangible Assets, net	$ 6,285	$ 4,285

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 4.1	$ 3.9	$ 8.3	$ 7

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Schedule of Intangible Assets, Future Expected Amortization Expense (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2024	$ 8,222
2025	15,061
2026	15,061
2027	12,839
2028	10,847
Thereafter	18,731
Total amortized intangible assets, net	$ 80,761	$ 90,232

Contract Assets and Contract _3

Contract Assets and Contract Liabilities - Summary of Contract Assets (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Abstract]
Contract assets	$ 2,309	$ 3,865

Contract Assets and Contract _4

Contract Assets and Contract Liabilities - Summary of Contract Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Abstract]
Contract liabilities	$ 14,623	$ 16,474
Less: Non-current portion of contract liabilities	2,848	2,564
Current portion of contract liabilities	$ 11,775	$ 13,910

Contract Assets and Contract _5

Contract Assets and Contract Liabilities - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2024
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Abstract]
Revenue recognized from contract liabilities	$ 3.3	$ 6.4

Debt - Term Loan (Details)

Debt - Term Loan (Details) - USD ($) $ in Thousands		3 Months Ended		6 Months Ended
Debt - Term Loan (Details) - USD ($) $ in Thousands	Jan. 06, 2023	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Sep. 28, 2023
Debt Instrument [Line Items]
Initial term loan facility		$ 519,170		$ 519,170
Braidwell Term Loan \| Braidwell Transaction Holdings, LLC
Debt Instrument [Line Items]
Long term debt	$ 150,000
Initial term loan facility	$ 100,000
Debt instrument drew						$ 50,000
Credit facility outstanding balance		$ 150,000		$ 150,000
Effective interest rate		12.20%		12.20%
Debt instrument, maturity date	Jan. 06, 2028
Interest rate		11.20%		11.20%
Interest expenses		$ 4,300	$ 2,900	$ 8,500	$ 5,600
Amortization of debt issuance costs		200	100	300	200
Amortization of debt discount		100	$ 100	200	$ 100
Debt discount		1,100		1,100
Debt issuance costs incurred	$ 3,400	$ 2,700		$ 2,700
Commitment fees incurred	$ 1,500
Undrawn commitment fee	1%
Final payment fee percentage	3.25%
Interest rate terms	Borrowings under the Braidwell Term Loan bear interest at a rate per annum equal to the Term Secured Overnight Financing Rate for such SOFR business day ("SOFR") subject to a 3% floor, plus 5.75%.
Braidwell Term Loan \| Braidwell Transaction Holdings, LLC \| Minimum
Debt Instrument [Line Items]
Fee amount percentage	2%
Braidwell Term Loan \| Braidwell Transaction Holdings, LLC \| Maximum
Debt Instrument [Line Items]
Fee amount percentage	1%
Braidwell Term Loan \| Braidwell Transaction Holdings, LLC \| Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Interest rate per annum	5.75%
Braidwell Term Loan \| Braidwell Transaction Holdings, LLC \| Secured Overnight Financing Rate (SOFR) \| Minimum
Debt Instrument [Line Items]
Interest rate per annum	3%

Debt - Revolving Credit Facilit

Debt - Revolving Credit Facility (Details) - Revolving Credit Facility - USD ($) $ in Millions	1 Months Ended	3 Months Ended		6 Months Ended
	Sep. 30, 2022	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Line of Credit Facility [Line Items]
Maximum borrowing capacity	$ 50	$ 55		$ 55
Increase in borrowing capacity				5
Maximum commitment amount	$ 75
Credit facility matures date	Sep. 29, 2027
Credit facility, matures period prior to final maturity date of 2026 notes	90 days
Interest expenses		0.8	$ 0.3	1.1	$ 0.8
Amortization of debt issuance costs		0.1	$ 0.1	0.1	$ 0.1
Credit facility outstanding balance		54.9		54.9
Debt issuance costs incurred		1.4		1.4
Debt issuance costs, net of accumulated amortization		$ 0.9		$ 0.9
Interest rate		8.90%		8.90%
Unused line fee percentage per annum				0.50%
Lockbox arrangement, percentage of revolving loan limit maximum availability				30%
Lockbox arrangement, revolving loan limit number of consecutive business day				5 days
Secured Overnight Financing Rate (SOFR)
Line of Credit Facility [Line Items]
Interest rate per annum				3.50%
Maximum
Line of Credit Facility [Line Items]
Increase in borrowing capacity	$ 25

Debt - 0.75% Senior Convertible

Debt - 0.75% Senior Convertible Notes due 2026 (Details) - 0.75% Senior Convertible Notes due 2026	1 Months Ended	3 Months Ended		6 Months Ended
	Aug. 31, 2021 USD ($) $ / shares shares	Jun. 30, 2024 USD ($)	Jun. 30, 2023 USD ($)	Jun. 30, 2024 USD ($) Days	Jun. 30, 2023 USD ($)
Line Of Credit Facility [Line Items]
Aggregate principal amount of debt	$ 316,300,000
Interest rate	0.75%
Debt instrument, maturity date	Aug. 01, 2026
Debt instrument, frequency of periodic payment	semi-annually
Debt instrument, Date of first payment	Feb. 01, 2022
Net proceeds	$ 306,200,000
Payment terms				Interest on the 2026 Notes is payable semi-annually in arrears on February 1 and August 1 of each year, beginning on February 1, 2022.
Debt instrument covenant description				The 2026 Notes do not contain any financial covenants.
Initial conversion rate \| shares	54.5316
Debt instrument converted principal amount	$ 1,000
Conversion price per share \| $ / shares	$ 18.34
Consecutive trading days \| Days				30
Threshold percentage of par value trigger	130%			98%
Number of conversion price, consecutive business days \| Days				5
Number of conversion price, consecutive trading days \| Days				10
Debt instrument converted principal amount				$ 1,000,000
Debt conversion start date				Feb. 02, 2026
Convertible notes redemption start date	Aug. 06, 2024
Convertible notes, redemption price percentage	100%
Principal payments due	$ 0
Effective interest rate		1.40%		1.40%
Interest expenses		$ 1,100,000	$ 1,100,000	$ 2,200,000	$ 2,100,000
Amortization of debt issuance costs		$ 500,000	$ 500,000	$ 1,000,000	$ 1,000,000
Minimum [Member]
Line Of Credit Facility [Line Items]
Threshold trading days \| Days				20
Maximum
Line Of Credit Facility [Line Items]
Threshold percentage of par value trigger				130%

Debt - Outstanding Principal Am

Debt - Outstanding Principal Amount and Carrying Value of Notes (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Principal	$ 530,905
Net carrying value	519,170
2026 Notes
Debt Instrument [Line Items]
Principal	316,250	$ 316,250
Unamortized debt issuance costs	(4,287)	(5,293)
Net carrying value	$ 311,963	$ 310,957

Debt - Capped Call Transactions

Debt - Capped Call Transactions (Details) - 0.75% Senior Convertible Notes due 2026	Aug. 05, 2021 USD ($) $ / shares
Debt Instrument [Line Items]
Initial cap price \| $ / shares	27.68
Percentage of premium over last reported sale price of common stock	100%
Cost of capped call transactions \| $	$ 39,900

Debt - Other Debt Agreements (D

Debt - Other Debt Agreements (Details) - EOS Imaging S.A. $ in Millions	6 Months Ended
	Jun. 30, 2024 USD ($) Agreement
Line Of Credit Facility [Line Items]
Number of loan agreements \| Agreement	2
Loan One
Line Of Credit Facility [Line Items]
Outstanding loan obligation	$ 2.8
Weighted average interest rate on loan	0.98%
Percentage of weighted average cost of state guaranty	0.69%
Loan Two
Line Of Credit Facility [Line Items]
Outstanding loan obligation	$ 1.2
Weighted average interest rate on loan	1.25%
Percentage of weighted average cost of state guaranty	1%

Debt - Principal Payments Remai

Debt - Principal Payments Remaining on Debt (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Debt Disclosure [Abstract]
Remainder of 2024	$ 1,305
2025	1,695
2026	317,515
2027	55,515
2028	154,875
Total	530,905
Less: unamortized debt discount and debt issuance costs	(11,735)
Net carrying value	519,170
Less: current portion of long-term debt	(2,289)
Long-term debt	$ 516,881	$ 511,035

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) - USD ($) $ in Millions		6 Months Ended
	Dec. 01, 2023	Jun. 30, 2024
Loss Contingencies [Line Items]
Lessee operating lease, description		Any short-term leases defined as twelve months or less or month-to-month leases are excluded and are expensed each month. Total costs associated with these short-term leases are immaterial to all periods presented.
Remaining minimum purchase commitment required		$ 9.8
Paris, France
Loss Contingencies [Line Items]
Operating lease term	9 years
Lease agreement commencement date	Apr. 01, 2024
Lease agreement expiry date	Dec. 31, 2032
Minimum
Loss Contingencies [Line Items]
Operating lease term		1 year
Maximum
Loss Contingencies [Line Items]
Operating lease term		10 years

Commitments and Contingencies_2

Commitments and Contingencies - Future Minimum Annual Lease Payments (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Remainder of 2024	$ 3,653
2025	6,866
2026	6,310
2027	6,258
2028	5,785
Thereafter	15,128
Total undiscounted lease payments	44,000
Less: imputed interest	(7,651)
Operating lease liabilities	36,349
Less: current portion of operating lease liabilities	(6,723)	$ (5,159)
Operating lease liabilities, less current portion	$ 29,626	$ 23,677

Commitments and Contingencies_3

Commitments and Contingencies - Summary of Weighted-Average Remaining Lease Term and Discount Rate (Details)	Jun. 30, 2024	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Weighted-average remaining lease term (years)	6 years 8 months 12 days	6 years 6 months
Weighted-average discount rate	6.60%	5.50%

Commitments and Contingencies_4

Commitments and Contingencies - Summary of Operating Leases (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Rent expense	$ 2,040	$ 1,315	$ 3,505	$ 2,559
Cash paid for amounts included in measurement of lease liabilities	$ 1,763	$ 1,263	$ 3,186	$ 2,450

Stock-Benefit Plans and Equit_3

Stock-Benefit Plans and Equity Transactions - Summary of Total Stock Based Compensation (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation	$ 16,960	$ 24,194	$ 34,282	$ 40,656
Cost of Sales
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation	554	16,226	1,037	22,232
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation	5,614	1,480	9,929	2,797
Sales, general and administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation	$ 10,792	$ 6,488	$ 23,316	$ 15,627

Stock-Benefit Plans and Equit_4

Stock-Benefit Plans and Equity Transactions - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended		3 Months Ended		6 Months Ended
	May 31, 2024	Oct. 31, 2022	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Warrants outstanding			8,216,000		8,216,000
Common stock, par value			$ 0.0001		$ 0.0001		$ 0.0001
Proceeds from common stock offering						$ 57,511
Mr. Miles
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Warrant expiration period					5 years
Warrant extended term	9 years	7 years
Number of warrants exercised					0
Squadron Medical \| Participant Lender
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of warrants exercised					0
RSU's and PRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unamortized compensation expense			$ 80,300		$ 80,300
Unamortized compensation expense to be recognized over weighted average period					1 year 9 months 18 days
Shares of common stock issued before net settlement			309,000	2,921,000	3,473,000	4,889,000
ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued under ESPP			251,000	247,000	251,000	247,000

Stock-Benefit Plans and Equit_5

Stock-Benefit Plans and Equity Transactions - Schedule of Assumptions used to Estimate Fair Value of Stock Options Granted and Stock Purchase Rights under ESPP (Details) - ESPP	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate, minimum	5.40%	4.54%	5.40%	4.54%
Risk-free interest rate, maximum	5.41%	5.41%	5.41%	5.41%
Expected term (years)	6 months		6 months
Volatility, minimum	54.47%	40.87%	54.47%	40.87%
Volatility, maximum	58.41%	62.77%	58.41%	62.77%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (years)		4 months 28 days		4 months 28 days
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (years)		7 months 6 days		7 months 6 days

Stock-Benefit Plans and Equit_6

Stock-Benefit Plans and Equity Transactions - Summary of All Outstanding Warrants for Common Stock (Details) shares in Thousands	6 Months Ended
	Jun. 30, 2024 $ / shares shares
Class Of Warrant Or Right [Line Items]
Number of Warrants	8,216
2018 Squadron Medical Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	845
Strike Price \| $ / shares	$ 3.15
Expiration	May 2027
2019 Squadron Medical Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	4,839
Strike Price \| $ / shares	$ 2.17
Expiration	May 2027
2020 Squadron Medical Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	1,076
Strike Price \| $ / shares	$ 4.88
Expiration	May 2027
Executive Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	1,327
Strike Price \| $ / shares	$ 5
Expiration	December 2026
Other Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	129	[1]
Strike Price \| $ / shares	$ 10.1	[1]
Expiration	Various through June 2026	[1]

[1] Weighted-average strike price.

Business Segment and Geograph_3

Business Segment and Geographic Information - Additional Information (Details)	6 Months Ended
	Jun. 30, 2024 Segment
Segment Reporting [Abstract]
Number of operating segments	1

Business Segment and Geograph_4

Business Segment and Geographic Information - Schedule of Net Revenue and Property, and Equipment, Net, by Geographic Region (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023
Revenues From External Customers And Long Lived Assets [Line Items]
Revenue	$ 145,573	$ 116,920	$ 284,050	$ 226,030
Property and equipment, net	180,614		180,614		$ 149,835
United States
Revenues From External Customers And Long Lived Assets [Line Items]
Revenue	136,406	107,664	266,251	207,633
Property and equipment, net	178,956		178,956		147,705
International
Revenues From External Customers And Long Lived Assets [Line Items]
Revenue	9,167	$ 9,256	17,799	$ 18,397
Property and equipment, net	$ 1,658		$ 1,658		$ 2,130

Net Loss Per Share - Computatio

Net Loss Per Share - Computation of Basic and Diluted Net Loss Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Numerator:
Net loss	$ (40,680)	$ (51,377)	$ (89,175)	$ (94,906)
Denominator:
Weighted average shares outstanding, basic	142,687	118,719	141,845	114,260
Weighted average shares outstanding, diluted	142,687	118,719	141,845	114,260
Net loss per share, basic:	$ (0.29)	$ (0.43)	$ (0.63)	$ (0.83)
Net loss per share, diluted:	$ (0.29)	$ (0.43)	$ (0.63)	$ (0.83)

Net Loss Per Share - Anti-Dilut

Net Loss Per Share - Anti-Dilutive Securities of Common Stock Excluded from Calculation of Diluted Net Loss Per Share (Details) - shares shares in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	36,131	35,535
Options to purchase common stock and employee stock purchase plan
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	2,497	2,517
Unvested restricted stock unit awards
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	8,172	7,546
Warrants to purchase common stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	8,216	8,226
Senior Convertible Notes
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	17,246	17,246

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details)	3 Months Ended		6 Months Ended
Income Taxes - Additional Information (Details)	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Income Tax Disclosure [Abstract]
Effective income tax rate from operations	0.70%	0.10%	0.40%	0.04%
Federal statutory income tax rate			21%	21%

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - Squadron Supplier Affiliate - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023
Related Party Transaction [Line Items]
Purchased inventory from related party	$ 3.2	$ 4.7	$ 8	$ 8.3
Due to Affiliate	$ 7.8		$ 7.8		$ 5.4