Orthofix Medical (OFIX) 10-K6 Mar 232022 FY Annual reportFinancial data

Company Profile

Document and Entity Information

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
Document and Entity Information - USD ($) $ in Millions	Dec. 31, 2022	Mar. 01, 2023	Jun. 30, 2022
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2022
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX MEDICAL INC.
Entity Central Index Key	0000884624
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Interactive Data Current	Yes
Entity Common Stock, Shares Outstanding		36,455,564
Entity Public Float			$ 470.8
Entity File Number	0-19961
Entity Tax Identification Number	98-1340767
Entity Address, Address Line One	3451 Plano Parkway
Entity Address, City or Town	Lewisville
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75056
City Area Code	214
Local Phone Number	937-2000
Entity Incorporation, State or Country Code	DE
Title of 12(b) Security	Common Stock, $0.10 par value
Security Exchange Name	NASDAQ
Document Annual Report	true
ICFR Auditor Attestation Flag	true
Document Transition Report	false
Auditor Firm ID	42
Auditor Name	Ernst & Young LLP
Auditor Location	Dallas, Texas
Documents Incorporated by Reference	Certain sections of the registrant’s definitive proxy statement to be filed with the Commission in connection with the Orthofix Medical Inc. 2022 Annual Meeting of Shareholders are incorporated by reference in Part III of this Annual Report.

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current assets
Cash and cash equivalents	$ 50,700	$ 87,847
Accounts receivable, net of allowances of $6,419 and $4,944, respectively	82,857	78,560
Inventories	100,150	82,974
Prepaid expenses and other current assets	22,283	20,141
Total current assets	255,990	269,522
Property, plant and equipment net	58,229	59,252
Intangible assets, net	47,388	52,666
Goodwill	71,317	71,317
Other long-term assets	25,705	23,866
Total assets	458,629	476,623
Current liabilities
Accounts payable	27,598	26,459
Current portion of finance lease liability	652	2,590
Other current liabilities	55,374	76,781
Total current liabilities	83,624	105,830
Long-term portion of finance lease liability	19,239	19,890
Other long-term liabilities	18,906	13,969
Total liabilities	121,769	139,689
Contingencies (Note 13)
Shareholders’ equity
Common shares $0.10 par value; 50,000 shares authorized; 20,162 and 19,837 issued and outstanding as of December 31, 2022 and 2021, respectively	2,016	1,983
Additional paid-in capital	334,969	313,951
Retained earnings	1,251	21,000
Accumulated other comprehensive loss	(1,376)
Total shareholders’ equity	336,860	336,934
Total liabilities and shareholders’ equity	$ 458,629	$ 476,623

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 6,419	$ 4,944
Common shares, par value	$ 0.10	$ 0.10
Common shares, authorized	50,000,000	50,000,000
Common shares, issued	20,162,000	19,837,000
Common shares, outstanding	20,162,000	19,837,000

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Income (Loss) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Statement [Abstract]
Net sales	$ 460,713	$ 464,479	$ 406,562
Cost of sales	123,544	114,914	101,889
Gross profit	337,169	349,565	304,673
Sales and marketing	228,810	221,318	204,434
General and administrative	79,966	69,353	67,948
Research and development	49,065	49,621	39,056
Acquisition-related amortization and remeasurement	(7,404)	17,588	(499)
Operating (loss)	(13,268)	(8,315)	(6,266)
Interest expense, net	(1,288)	(1,837)	(2,483)
Other income (expense), net	(3,150)	(3,343)	8,381
Income (loss) before income taxes	(17,706)	(13,495)	(368)
Income tax benefit (expense)	(2,043)	(24,884)	2,885
Net income (loss)	$ (19,749)	$ (38,379)	$ 2,517
Net income (loss) per common share:
Basic	$ (0.98)	$ (1.95)	$ 0.13
Diluted	$ (0.98)	$ (1.95)	$ 0.13
Weighted average number of common shares:
Basic	20,053,548	19,690,593	19,267,920
Diluted	20,053,548	19,690,593	19,391,718
Other comprehensive income (loss), before tax
Unrealized gain (loss) on debt securities	$ 395	$ (942)	$ 1,881
Currency translation adjustment	(1,771)	(2,544)	4,872
Other comprehensive income (loss), before tax	(1,376)	(3,486)	6,753
Income tax benefit (expense) related to items of other comprehensive income (loss)		234	(462)
Other comprehensive income (loss), net of tax	(1,376)	(3,252)	6,291
Comprehensive income (loss)	$ (21,125)	$ (41,631)	$ 8,808

Consolidated Statements of Chan

Consolidated Statements of Changes in Shareholders' Equity - USD ($) $ in Thousands	Total	Common Shares [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Beginning Balance at Dec. 31, 2019	$ 327,631	$ 1,902	$ 271,019	$ 57,749	$ (3,039)
Balance, Shares at Dec. 31, 2019		19,023
Cumulative effect adjustment from adoption \| ASU 2016-13 [Member]	(887)			(887)
Net income (loss)	2,517			2,517
Other comprehensive income (loss), net of tax	6,291				6,291
Share-based compensation expense	16,207		16,207
Common shares issued, net	5,105	$ 40	5,065
Common shares issued, net, Shares		401
Ending Balance at Dec. 31, 2020	356,864	$ 1,942	292,291	59,379	3,252
Balance, Shares at Dec. 31, 2020		19,424
Net income (loss)	(38,379)			(38,379)
Other comprehensive income (loss), net of tax	(3,252)				(3,252)
Share-based compensation expense	15,432		15,432
Common shares issued, net	6,269	$ 41	6,228
Common shares issued, net, Shares		413
Ending Balance at Dec. 31, 2021	$ 336,934	$ 1,983	313,951	21,000
Balance, Shares at Dec. 31, 2021	19,837,000	19,837
Net income (loss)	$ (19,749)			(19,749)
Other comprehensive income (loss), net of tax	(1,376)				(1,376)
Share-based compensation expense	18,443		18,443
Common shares issued, net	2,608	$ 33	2,575
Common shares issued, net, Shares		325
Ending Balance at Dec. 31, 2022	$ 336,860	$ 2,016	$ 334,969	$ 1,251	$ (1,376)
Balance, Shares at Dec. 31, 2022	20,162,000	20,162

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities
Net income (loss)	$ (19,749)	$ (38,379)	$ 2,517
Adjustments to reconcile net income (loss) to net cash from operating activities
Depreciation and amortization	29,019	29,599	30,546
Impairment of goodwill		11,756
Amortization of operating lease assets, debt costs, and other assets	3,056	3,496	3,730
Provision for expected credit losses	2,095	444	199
Deferred income taxes	314	24,482	10,787
Share-based compensation expense	18,443	15,432	16,207
Interest and (gain) loss on the valuation of investment securities	(308)	(1,146)	116
Change in fair value of contingent consideration	(17,200)	(3,575)	(7,300)
Other	2,027	1,064	(2,228)
Changes in operating assets and liabilities, net of effects of acquisitions
Accounts receivable	(6,735)	(7,049)	13,283
Inventories	(18,133)	619	(873)
Prepaid expenses and other current assets	(874)	(2,834)	4,526
Accounts payable	2,282	4,253	2,532
Other current liabilities	627	1,013	5,975
Contract liability (Note [15])	(4,791)	(9,060)	13,851
Payment of contingent consideration		(6,595)
Other long-term assets and liabilities	(1,611)	(5,045)	(19,596)
Net cash from operating activities	(11,538)	18,475	74,272
Cash flows from investing activities
Acquisition of a business			(18,000)
Capital expenditures for property, plant and equipment	(21,364)	(17,785)	(15,485)
Capital expenditures for intangible assets	(1,796)	(1,807)	(1,609)
Purchase of investment securities		(2,171)	(10,000)
Asset acquisitions and other investments	(1,374)	(1,250)	(7,240)
Net cash from investing activities	(24,534)	(23,013)	(52,334)
Cash flows from financing activities
Proceeds from revolving credit facility			100,000
Repayment of revolving credit facility			(100,000)
Proceeds from issuance of common shares	4,337	8,824	7,598
Payments related to withholdings for share-based compensation	(1,729)	(2,555)	(2,493)
Payment of contingent consideration		(8,405)
Payments related to finance lease obligation	(2,594)	(537)	(323)
Payment of debt issuance costs and other financing activities	(92)	(948)	(1,537)
Net cash from financing activities	(78)	(3,621)	3,245
Effect of exchange rate changes on cash and restricted cash	(997)	(815)	1,235
Net change in cash, cash equivalents, and restricted cash	(37,147)	(8,974)	26,418
Cash, cash equivalents, and restricted cash at the beginning of the year	87,847	96,821	70,403
Cash, cash equivalents, and restricted cash at the end of the year	50,700	87,847	96,821
Components of cash, cash equivalents, and restricted cash at the end of the year
Cash and cash equivalents	50,700	87,847	96,291
Restricted cash			530
Cash, cash equivalents, and restricted cash at the end of the year	$ 50,700	$ 87,847	$ 96,821

Business, basis of presentation

Business, basis of presentation, COVID-19 update, and CARES Act	12 Months Ended
	Dec. 31, 2022
Organization Consolidation And Presentation Of Financial Statements And Unusual Or Infrequent Items Disclosure [Abstract]
Business, basis of presentation, COVID-19 update, and CARES Act	1. Business and basis of presentation Description of the Business Orthofix Medical Inc. and its subsidiaries (the “Company”), following its recent merger with SeaSpine Holdings Corporation ("SeaSpine"), is a leading global spine and orthopedics company with a comprehensive portfolio of biologics, innovative spinal hardware, bone growth therapies, specialized orthopedic solutions and a leading surgical navigation system. Its products are distributed in 68 countries worldwide. The Company is headquartered in Lewisville, Texas, and has primary offices in Carlsbad, CA, with a focus on spinal product innovation and surgeon education, and in Verona, Italy, with an emphasis on product innovation, production, and medical education for Orthopedics. The combined Company’s global R&D, commercial and manufacturing footprint also includes facilities and offices in Irvine, CA, Toronto, Canada, Sunnyvale, CA, Wayne, PA, Olive Branch, MS, Maidenhead, UK, Munich, Germany, Paris, France and Sao Paulo, Brazil. The merger with SeaSpine was completed on January 5, 2023, with SeaSpine continuing as a wholly-owned subsidiary of Orthofix following the transaction. For additional discussion of the merger with SeaSpine, see Note 22. Orthofix, as the corporate parent entity in the combined company structure, will continue to trade on NASDAQ under the symbol “OFIX.” The combined company will be renamed at a later date and until then will continue to be known as Orthofix Medical Inc. The financial statements of the Company for the period ended as of December 31, 2022, do not include the financial position or operations of SeaSpine since the merger occurred subsequent to the end of the reporting period. Basis of Presentation The consolidated financial statements include the financial statements of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions are eliminated in consolidation. Information on our accounting policies and methods used in the preparation of our consolidated financial statements are included, where applicable, in the respective footnotes that follow. Footnote Footnote Reference Business and basis of presentation 1 Significant accounting policies 2 Recently adopted accounting standards, recently issued accounting pronouncements, and recent law changes 3 Acquisitions 4 Inventories 5 Property, plant, and equipment 6 Intangible assets 7 Goodwill 8 Leases 9 Other current liabilities 10 Long-term debt 11 Fair value measurements and investments 12 Commitments and contingencies 13 Shareholders' equity 14 Revenue recognition and accounts receivable 15 Business segment information 16 Acquisition-related amortization and remeasurement 17 Share-based compensation 18 Defined contribution plans and deferred compensation 19 Income taxes 20 Earnings per share 21 Subsequent events 22

Significant accounting policies

Significant accounting policies	12 Months Ended
Significant accounting policies	Dec. 31, 2022
Accounting Policies [Abstract]
Significant accounting policies	2. Significant accounting policies The preparation of financial statements in conformity with United States generally accepted accounting principles (“U.S. GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. On an ongoing basis, we evaluate these estimates, including those related to contractual allowances, allowances for expected credit losses, inventories, valuation of intangible assets, goodwill, fair value measurements, litigation and contingent liabilities, income taxes, and share-based compensation. We base our estimates on historical experience, future expectations, and other relevant assumptions that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates. The following is a discussion of accounting policies and methods used in our consolidated financial statements that are not presented within other footnotes. Market risk In the ordinary course of business, the Company is exposed to the impact of changes in interest rates and foreign currency fluctuations. The Company’s objective is to limit the impact of such movements on earnings and cash flows. In order to achieve this objective, the Company seeks to balance its non-U.S. Dollar denominated income and expenditures. The financial statements for operations outside the U.S. are generally maintained in their local currency. All foreign currency denominated balance sheet accounts, except shareholders’ equity, are translated to U.S. Dollars at year end exchange rates, and revenue and expense items are translated at average rates of exchange prevailing during the year. Gains and losses resulting from the translation of foreign currency are recorded in the accumulated other comprehensive income (loss) component of shareholders’ equity. Transactional foreign currency gains and losses, including those generated from intercompany operations, are included in other expense, net and were a loss of $ 3.3 million, a loss of $ 4.0 million, and a gain of $ 3.9 million for the years ended December 31, 2022, 2021, and 2020 , respectively. Financial instruments and concentration of credit risk Financial instruments that could subject the Company to a concentration of credit risk consist primarily of cash, cash equivalents, and accounts receivable. Generally, cash is held at large financial institutions and cash equivalents consist of highly liquid money market funds. The Company performs ongoing credit evaluations of customers, generally does not require collateral, and maintains a reserve for expected credit losses. The Company believes that a concentration of credit risk related to accounts receivable is limited because customers are geographically dispersed and end users are diversified. Cash, cash equivalents, and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. In September 2019, approximately $ 0.5 million (based upon foreign exchange rates as of December 31, 2020) of the Company’s cash in Brazil was frozen upon request to satisfy a judgment related to an ongoing legal dispute with a former Brazilian distributor. In December 2021, the dispute was settled and the cash was disbursed to the former distributor. Investing activities that did not result in cash receipts or cash payments during the years ended December 31, 2022, 2021, and 2020 consisted of the following, which were not included within cash from investing activities in the Company’s consolidated statements of cash flows: (U.S. Dollars, in thousands) 2022 2021 2020 Supplemental disclosure of cash flow information: Noncash investing activities: Intangible assets acquired in asset acquisitions $ 2,000 $ — $ 1,575 Contingent consideration recognized at acquisition date — — 375 Advertising costs Advertising costs are expensed as incurred. Advertising costs are included within sales and marketing expense and totaled $ 0.5 million, $ 0.5 million, and $ 0.9 million for the years ended December 31, 2022, 2021, and 2020 , respectively. Research and development costs, including collaborative arrangements Expenditures for research and development are expensed as incurred. Expenditures related to the Company’s collaborative arrangement with MTF Biologics (“MTF”) are expensed based on the terms of the related agreement. The Company recognized $ 0.0 million, $ 0.8 million and $ 0.8 million in research and development expense for the years ended December 31, 2022, 2021, and 2020, respectively. In October 2020, the Company and Neo Medical SA, a privately held Swiss-based company developing a new generation of products for spinal surgery (“Neo Medical”), entered into a co-development agreement covering the parties’ joint development of single use instruments for cervical spine procedures. In connection with this agreement, the Company is responsible for the payment of variable costs associated with the development of the specified products. Research and development expenses incurred under this collaborative arrangement totaled $ 0.5 million, $ 0.6 million, and less than $ 0.1 million for the years ended December 31, 2022, 2021, and 2020 , respectively.

Recently adopted accounting sta

Recently adopted accounting standards and recently issued accounting pronouncements	12 Months Ended
	Dec. 31, 2022
Accounting Changes and Error Corrections [Abstract]
Recently adopted accounting standards and recently issued accounting pronouncements	3. Recently adopted accounting standards, recently issued accounting pronouncements, and recent law changes Recently Adopted Accounting Standards Adoption of Accounting Standards Update (“ASU”) 2021-10—Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance In November 2021, the Financial Accounting Standards Board (“FASB”) issued ASU 2021-10, which aims to increase the transparency of government assistance by requiring entities to provide information about the nature of the transaction, terms and conditions associated with the transaction, and financial statement line items affected by the transaction. The Company voluntarily elected to early adopt this standard for the year ended December 31, 2021, on a prospective basis. Adoption of this standard did not have a significant impact to the existing disclosures made in relation to government assistance received by the Company in 2020 as part of the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act"). Adoption of ASU 2019-12, Simplifying the accounting for income taxes In December 2019, the FASB issued ASU 2019-12, which reduces the complexity of accounting for income taxes by eliminating certain exceptions to the general principles in ASC 740, Income Taxes . Additionally, the ASU simplifies U.S. GAAP by amending the requirements related to the accounting for "hybrid" tax regimes and also adding the requirement to evaluate when a step up in the tax basis of goodwill should be considered part of the business combination and when it should be considered a separate transaction. The Company adopted this ASU effective January 1, 2021 , with certain provisions applied retrospectively and other provisions applied prospectively. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows. Adoption of ASU 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments and Subsequent Amendments In June 2016, the FASB issued ASU 2016-13 (which was then further clarified in subsequent ASUs), which required that credit losses for certain types of financial instruments, including accounts receivable, be estimated based on expected credit losses among other changes. The Company adopted this ASU effective as of January 1, 2020 , using a modified retrospective approach. See Note 15 for additional discussion of the Company’s adoption of Topic 326 and its resulting accounting policies. Adoption of ASU 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment In January 2017, the FASB issued ASU 2017-04, which eliminated Step 2 of the previous goodwill impairment test, which required a hypothetical purchase price allocation to measure goodwill impairment. Under ASU 2017-04, a goodwill impairment loss is now measured as the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the recorded amount of goodwill. The Company adopted this ASU effective January 1, 2020 , on a prospective basis and followed this guidance to measure the goodwill impairment of $ 11.8 million recorded in the year ended December 31, 2021. Adoption of ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement In August 2018, the FASB issued ASU 2018-13, which eliminated certain disclosures, such as the amount and reasons for transfers between Level 1 and Level 2 of the fair value hierarchy, and added new disclosure requirements for Level 3 measurements. The Company adopted this ASU effective January 1, 2020 , with certain provisions of the ASU applied retrospectively and other provisions provided prospectively. Adoption of this ASU did not impact the Company’s condensed consolidated balance sheet, statements of operations, or cash flows; however, adoption of the ASU did result in modified disclosures in Note 12. Adoption of ASU 2018-15, Intangibles—Goodwill and Other—Internal-Use Software (Subtopic 350-40): Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract In August 2018, the FASB issued ASU 2018-15, which aligned the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software. The accounting for the service element of a hosting arrangement that is a service contract was not affected by the amendments in this update. The Company adopted this ASU effective January 1, 2020 , on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows, but is expected to impact future cloud computing arrangements. Adoption of ASU 2020-04, Reference Rate Reform (Topic 848) In March 2020, the FASB issued ASU 2020-04, which provided temporary optional guidance to ease the potential financial reporting burden of the expected market transition away from the London Inter-Bank Offered Rate. The new guidance provided optional expedients and exceptions for applying U.S. GAAP to contract modifications, hedge accounting, and other transactions affected by reference rate reform if certain criteria are met through December 31, 2022. The Company adopted this ASU effective March 12, 2020 , the effective date of the ASU, on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows. Recently Issued Accounting Pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (ASU 2021-08) Requires that an acquirer recognize and measure contract assets and liabilities acquired in a business combination in accordance with Topic 606, which governs the accounting for revenue contracts with customers. The guidance is to be applied prospectively to acquisitions occurring on or after the effective date, with early adoption permitted. January 1, 2023 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions (ASU 2022-03) Clarifies the guidance in Topic 820, Fair Value Measurement, when measuring the fair value of an equity security subject to contractual restrictions that prohibit the sale of an equity security and introduces new disclosure requirements for equity securities subject to contractual sale restrictions. Certain of the provisions are to be applied retrospectively with other provisions applied prospectively. January 1, 2024 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Recent Law Changes COVID-19 and the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) In March 2020, the CARES Act entered into federal law, which was aimed at providing emergency assistance and health care for individuals, families, and businesses affected by the Coronavirus Disease 2019 ("COVID-19") pandemic and to provide general support to the U.S. economy. The CARES Act, among other things, included provisions relating to the deferment of employer side social security payments and technical corrections to tax depreciation methods for qualified improvement property. The CARES Act had no impact to the Company’s income tax expense/benefit reported within the consolidated statements of operations for each of the years ended December 31, 2021 and 2020. The CARES Act also provided financial relief to the Company through other various programs, each of which are described in further detail below. In April 2020, the Company received $ 13.9 million in funds from the Centers for Medicare & Medicaid Services (“CMS”) Accelerated and Advance Payment Program. For discussion of the Company’s accounting for these funds, see Note 15. In April 2020, the Company also automatically received $ 4.7 million in funds from the U.S. Department of Health and Human Services as part of the Provider Relief Fund. The Company recognized this in-substance grant within other income for the year ended December 31, 2020. In addition, as part of the CARES Act, the Company was permitted to defer all employer social security payroll tax payments for the remainder of the 2020 calendar year subsequent to the CARES Act being signed into federal law, such that 50 % of the taxes could be deferred until December 31, 2021, with the remaining 50 % deferred until December 31, 2022. As of December 31, 2020, the Company had deferred $ 0.6 million associated with this program, which was then voluntarily repaid, in full, in 2021. Consolidated Appropriations Act of 2021 (the “Consolidated Appropriations Act”) On December 27, 2020, the Consolidated Appropriations Act entered into federal law. The Consolidated Appropriations Act did not have a material impact to the Company’s income tax provision for the year ended December 31, 2021. American Rescue Plan Act of 2021 (“the American Rescue Plan”) On March 11, 2021, the American Rescue Plan entered into federal law. The American Rescue Plan, among other things, included provisions related to the deduction of executive compensation beginning in 2027. The American Rescue Plan had no impact to the Company’s condensed consolidated financial statement for the year ended December 31, 2021.

Acquisitions

Acquisitions	12 Months Ended
Acquisitions	Dec. 31, 2022
Business Combinations [Abstract]
Acquisitions	4. Acquisitions FITBONE Asset Purchase Agreement In March 2020 , the Company completed an Asset Purchase Agreement (the “Purchase Agreement”) with Wittenstein SE (“Wittenstein”), a privately-held German-based company, to acquire assets associated with the FITBONE intramedullary lengthening system for limb lengthening of the femur and tibia bones for $ 18.0 million in cash consideration. The Company also entered into a Contract Manufacturing and Supply Agreement (“CMSA”) with Wittenstein, which was accounted for as a finance lease. Distributor Acquisition In July 2020, the Company acquired certain assets of a medical device distributor for consideration of up to $ 7.6 million. Purchase Price Allocations for Completed Acquisitions Discussed Above (U.S. Dollars, in thousands) FITBONE Assigned Distributor Acquisition Assigned Assets acquired Inventories $ 528 $ — Other long-term assets — — Intangible assets Customer relationships 800 15 years 7,340 5 years Developed technology 4,500 8 years — N/A In-process research and development ("IPR&D") 300 Indefinite — N/A Trade name 600 15 years — N/A Assembled workforce — N/A 235 5 years Total identifiable assets acquired $ 6,728 $ 7,575 Liabilities assumed — — Goodwill 11,272 — Total fair value of consideration transferred $ 18,000 $ 7,575

Inventories

Inventories	12 Months Ended
Inventories	Dec. 31, 2022
Inventory Disclosure [Abstract]
Inventories	5. Inventories Inventories are valued at the lower of cost or estimated net realizable value, after provision for excess, obsolete or impaired items, which is reviewed and updated on a periodic basis by management. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facility in Italy, cost is determined on a weighted-average basis, which approximates the first-in, first-out (“FIFO”) method. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facilities in Texas and California, standard cost, which approximates actual cost on the FIFO method, is used to value inventory. Standard costs are reviewed by management, at least annually or more often, in the event circumstances indicate a change in cost has occurred. Work-in-process and finished products include material, labor, and production overhead costs. Field and consignment inventory, which represents immediately saleable finished products inventory that is in the possession of the Company’s independent sales representatives or located at third-party customers, such as distributors and hospitals, is included within finished products. Inventory previously reported as field/consignment inventory has been reclassified to finished products to conform with current period presentation. December 31, (U.S. Dollars, in thousands) 2022 2021 Raw materials $ 17,035 $ 9,589 Work-in-process 19,243 15,096 Finished products 63,872 58,289 Inventories $ 100,150 $ 82,974 The Company adjusts the value of its inventory to the extent management determines that the cost cannot be recovered due to obsolescence or other factors. In order to make these determinations, management uses estimates of future demand for each product to determine the appropriate inventory reserves and to make corresponding adjustments to the carrying value of these inventories to reflect the lower of cost or estimated net realizable value.

Property, plant and equipment

Property, plant and equipment	12 Months Ended
Property, plant and equipment	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Property, plant and equipment	6. Property, plant, and equipment Property, plant, and equipment is stated at cost or estimated fair value when acquired as part of a business combination, less accumulated depreciation . Costs include all expenditures necessary to place the asset in service, generally including freight and sales and use taxes. Property, plant, and equipment includes instrumentation held by customers, which is generally used to facilitate the implantation of the Company’s products. The useful lives of these assets are generally as follows: Years Buildings 25 to 33 Plant and equipment 1 to 10 Instrumentation 3 to 4 Computer software 3 to 7 Furniture and fixtures 4 to 8 The Company evaluates the useful lives of these assets on an annual basis. Depreciation is computed on a straight-line basis over the useful lives of the assets. Depreciation of leasehold improvements is computed over the shorter of the lease term or the useful life of the asset. Total depreciation expense was $ 19.6 million, $ 20.2 million, and $ 19.3 million for the years ended December 31, 2022, 2021, and 2020, respectively. Expenditures for maintenance and repairs and minor renewals and improvements, which do not extend the lives of the respective assets, are expensed as incurred. All other expenditures for renewals and improvements are capitalized. The assets and related accumulated depreciation are adjusted for property retirements and disposals, with the resulting gain or loss included in earnings. Fully depreciated assets remain in the accounts until retired from service. December 31, (U.S. Dollars, in thousands) 2022 2021 Cost Buildings $ 3,867 $ 3,925 Plant and equipment 48,358 50,275 Instrumentation 92,607 100,515 Computer software 40,685 53,200 Furniture and fixtures 7,917 8,307 Construction in progress 4,515 2,597 Finance lease assets 23,276 23,397 Property, plant, and equipment, gross 221,225 242,216 Accumulated depreciation ( 162,996 ) ( 182,964 ) Property, plant, and equipment, net $ 58,229 $ 59,252 The Company capitalizes system development costs related to internal-use software during the application development stage. Costs related to preliminary project activities and post-implementation activities are expensed as incurred. Internal-use software is amortized on a straight-line basis over its estimated useful life, which generally ranges from three to seven years . Long-lived assets are evaluated for impairment annually or whenever events or changes in circumstances have occurred that would indicate impairment. For purposes of the evaluation, the Company groups its long-lived assets with other assets and liabilities at the lowest level of identifiable cash flows if the asset does not generate cash flows independent of other assets and liabilities. If the carrying value of the asset or asset group exceeds the undiscounted cash flows expected to result from the use and eventual disposition of the asset group, the Company will write the carrying value down to fair value in the period identified. The Company generally determines fair value of long-lived assets as the present value of estimated future cash flows. In determining the estimated future cash flows associated with the assets, the Company uses estimates and assumptions about future revenue contributions, cost structures, and remaining useful lives of the asset group. The use of alternative assumptions, including estimated cash flows, discount rates, and alternative estimated remaining useful lives could result in different calculations of impairment.

Intangible assets

Intangible assets	12 Months Ended
Intangible assets	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible assets	7. Intangible assets Intangible assets are recorded at cost, or when acquired as a part of a business combination, at estimated fair value, less accumulated amortization. These assets are amortized on a straight-line basis over the useful lives of the assets, which the Company believes is materially consistent with the pattern of economic benefit provided by the assets. December 31, (U.S. Dollars, in thousands) Weighted Average Amortization Period 2022 2021 Cost Patents 10.0 years $ 40,108 $ 44,561 Developed technology 9.8 years 43,699 43,979 IPR&D Indefinite 300 300 Customer relationships 7.8 years 15,572 15,621 License and other 9.3 years 23,295 18,924 Trademarks—finite lived 10.0 years 1,875 1,839 9.3 years 124,849 125,224 Accumulated amortization Patents $ ( 37,506 ) $ ( 41,408 ) Developed technology ( 17,830 ) ( 13,409 ) Customer relationships ( 6,938 ) ( 4,520 ) License and other ( 14,386 ) ( 12,528 ) Trademarks—finite lived ( 801 ) ( 693 ) ( 77,461 ) ( 72,558 ) Intangible assets, net $ 47,388 $ 52,666 Acquired IPR&D represents the fair value assigned to acquired research and development assets that have not reached technological feasibility. In a business combination, the fair value assigned to acquired IPR&D is determined by estimating the remaining costs to develop the acquired technology into commercially viable products, estimating the resulting revenues from the projects, and discounting the net cash flows to present value. The revenue and cost projections used to value acquired IPR&D are, as applicable, reduced based on the probability of success of developing the asset. Additionally, estimated revenues consider the relevant market sizes and growth factors, expected trends in technology, and the nature and expected timing of new product introductions by the Company and its competitors. The rates utilized to discount the net cash flows to their present value are commensurate with the stage of development of the project and uncertainties in the economic estimates used in the projections. Any future costs to further develop the IPR&D subsequent to acquisition are recorded to research and development expense as incurred. IPR&D assets are considered to be indefinite-lived assets until the completion or abandonment of the associated research and development efforts. During the period the assets are considered indefinite-lived, they are not amortized but tested for impairment. Impairment testing is performed at least annually or when a triggering event occurs that could indicate a potential impairment. If and when development is complete, which generally occurs when regulatory approval to market a product is obtained, the associated assets are reclassified to developed technology and are amortized over an assigned useful life that best reflects the economic benefits provided by these assets. Amortization expense for intangible assets was $ 9.4 million, $ 9.4 million, and $ 11.2 million for the years ended December 31, 2022, December 31, 2021, and 2020, respectively. Future amortization expense for intangible assets is estimated as follows: (U.S. Dollars, in thousands) Amortization 2023 $ 9,250 2024 8,705 2025 7,692 2026 6,658 2027 6,470 Thereafter 8,313 Total finite-lived intangible assets, net $ 47,088 Indefinite-lived intangible assets, net 300 Intangible assets, net $ 47,388

Goodwill

Goodwill	12 Months Ended
Goodwill	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	8. Goodwill The Company tests goodwill at least annually for impairment. The Company tests more frequently if indicators are present or changes in circumstances suggest that impairment may exist. These indicators include, among others, declines in sales, earnings or cash flows, or the development of a material adverse change in the business climate. The Company assesses goodwill for impairment at the reporting unit level, which is defined as an operating segment or one level below an operating segment. The following table presents the net carrying value of goodwill as of December 31, 2022, and 2021, and a rollforward of such balances from December 31, 2021, by reportable segment: (U.S. Dollars, in thousands) December 31, 2021 Impairment Currency Translation Adjustment December 31, 2022 Global Spine $ 71,317 $ — $ — $ 71,317 Global Orthopedics 11,822 ( 692 ) 11,130 Goodwill, gross $ 83,139 $ — $ ( 692 ) $ 82,447 Accumulated impairment loss ( 11,822 ) — 692 ( 11,130 ) Goodwill, net of accumulated impairment losses $ 71,317 $ — $ — $ 71,317 In the fourth quarter of 2021, the Company performed a quantitative assessment of its goodwill. The Company estimated the fair value of each reporting unit using a weighted average of fair value derived from both an income approach and a market approach (all Level 3 fair value measurements). Upon estimating the fair value of each of its reporting units, the Company determined its Global Orthopedics reporting unit’s fair value was less than its carrying value of net assets. This resulted in recording a full impairment of the Global Orthopedics goodwill of $ 11.8 million, which was reflected within Acquisition-related amortization and remeasurement. This amount also represents the total of the Company’s accumulated goodwill impairment losses as of December 31, 2022, and 2021, respectively. The assessment concluded there were no indicators of impairment for the Global Spine goodwill. In the fourth quarter of 2022, the Company performed a qualitative assessment for its annual goodwill impairment analysis, which did not result in impairment. This qualitative analysis considered all relevant factors specific to the reporting units, including macroeconomic conditions, industry and market considerations, overall financial performance, and relevant entity-specific events.

Leases

Leases	12 Months Ended
Leases	Dec. 31, 2022
Leases [Abstract]
Leases	9. Leases The Company determines if a contractual arrangement qualifies as a lease at inception. The Company’s leases primarily relate to facilities, vehicles, equipment, and certain contract manufacturing agreements. Lease assets represent the Company’s right to use an underlying asset for the lease term, while lease liabilities represent the obligation to make lease payments arising from the lease. Lease assets and liabilities are recognized at the commencement date based on the present value of lease payments over the lease term. As the Company’s leases do not provide an implicit rate, the Company’s incremental borrowing rate is used as a discount rate, based on the information available at the commencement date, in determining the present value of lease payments. Lease assets also include the impact of any prepayments made and are reduced by the impact of any lease incentives. The Company does not recognize lease liabilities or lease assets on the balance sheet for short-term leases (leases with a lease term of twelve months or less as of the commencement date). Rather, any short-term lease payments are recognized as an expense on a straight-line basis over the lease term. The current period short-term lease expense reasonably reflects our short-term lease commitments. For all classifications of leases, the Company combines lease and non-lease components to account for them as a single lease component. Variable lease payments are excluded from the lease liability and recognized in the period in which the obligation is incurred. Additionally, lease terms may include options to extend or terminate the lease when it is reasonably certain that the Company will exercise the option. A summary of the Company’s lease portfolio as of December 31, 2022, and 2021, is presented in the table below: (U.S. Dollars, in thousands, except lease term and discount rate) Classification December 31, 2022 December 31, 2021 Assets Operating leases Other long-term assets $ 6,788 $ 3,155 Finance leases Property, plant and equipment, net 17,360 18,600 Total lease assets $ 24,148 $ 21,755 Liabilities Current Operating leases Other current liabilities $ 1,638 $ 1,834 Finance leases Current portion of finance lease liability 652 2,590 Long-term Operating leases Other long-term liabilities 5,376 1,443 Finance leases Long-term portion of finance lease liability 19,239 19,890 Total lease liabilities $ 26,905 $ 25,757 Weighted Average Remaining Lease Term Operating leases 4.5 years 3.3 years Finance leases 17.6 years 17.0 years Weighted Average Discount Rate Operating leases 4.0 % 2.6 % Finance leases 4.4 % 4.2 % The components of lease costs were as follows: (U.S. Dollars, in thousands) For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 For the Year Ended December 31, 2020 Finance lease costs: Amortization of right-of-use assets $ 1,238 $ 2,049 $ 1,766 Interest on finance lease liabilities 890 933 940 Operating lease costs 2,126 2,234 2,235 Short-term lease costs 152 213 230 Variable lease costs 932 815 673 Total lease costs $ 5,338 $ 6,244 $ 5,844 Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 For the Year Ended December 31, 2020 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 3,805 $ 4,627 $ 4,299 Operating cash flows from finance leases 885 907 689 Financing cash flows from finance leases 2,594 537 323 Right-of-use assets obtained in exchange for lease obligations Operating leases 5,603 589 959 Finance leases — 149 1,949 A summary of the Company’s remaining lease liabilities as of December 31, 2022, is included below: (U.S. Dollars, in thousands) Operating Finance 2023 $ 1,821 $ 1,508 2024 1,587 1,538 2025 1,497 1,543 2026 1,411 1,562 2027 1,211 1,593 Thereafter 129 21,021 Total undiscounted value of lease liabilities 7,656 28,765 Less: Interest ( 642 ) ( 8,874 ) Present value of lease liabilities $ 7,014 $ 19,891 Current portion of lease liabilities $ 1,638 $ 652 Long-term portion of lease liabilities 5,376 19,239 Total lease liabilities $ 7,014 $ 19,891

Other current liabilities

Other current liabilities	12 Months Ended
Other current liabilities	Dec. 31, 2021
Payables and Accruals [Abstract]
Other current liabilities	10. Other current liabilities December 31, (U.S. Dollars, in thousands) 2022 2021 Accrued expenses $ 9,611 $ 7,151 Salaries, bonuses, commissions, and related taxes payable 18,531 23,552 Accrued distributor commissions 10,483 10,787 Accrued legal and settlement expenses 3,891 3,794 Contingent consideration liability 1,000 17,200 Short-term operating lease liability 1,638 1,834 Non-income taxes payable 6,586 4,655 Accelerated and advance payment program — 4,791 Other payables 3,634 3,017 Other current liabilities $ 55,374 $ 76,781

Long-term debt

Long-term debt	12 Months Ended
Long-term debt	Dec. 31, 2022
Debt Disclosure [Abstract]
Long-term debt	11. Long-term debt On October 25, 2019, the Company, and certain of its wholly-owned subsidiaries (collectively with the Company, the “Borrowers”), as borrowers, and certain material subsidiaries of the Company as guarantors, entered into a Second Amended and Restated Credit Agreement (the “Amended Credit Agreement”) with JPMorgan Chase Bank, N.A. (“JPMorgan”), as Administrative Agent, and certain lender parties thereto. The Amended Credit Agreement provides for a $ 300.0 million secured revolving credit facility (the “Facility”) amending and restating the $ 125.0 million secured revolving credit facility that previously existed with such lenders. The Credit Agreement has a maturity date of October 25, 2024 . On March 1, 2023, the Amended Credit Agreement and the Facility were amended to replace London Inter-Bank Offered Rate ("LIBOR")-based pricing with Secured Overnight Financing Rate ("SOFR")-based pricing. In April 2020, as a precautionary measure to increase the Company’s cash position and to preserve financial flexibility during the initial uncertainty resulting from the COVID-19 pandemic, the Company completed a borrowing of $ 100.0 million under the Facility, which the Company then paid back in full later that year. The Company had no borrowings outstanding under the Facility at December 31, 2022, and 2021 , respectively. However, on January 3, 2023, the Company borrowed $ 30.0 million under the Facility for working capital purposes, including to fund certain merger-related expenses. Further, an additional $ 15.0 million was borrowed on March 3, 2023. Borrowings under the Amended Credit Agreement may be used for, among other things, working capital and other general corporate purposes of the Company and its subsidiaries (including permitted acquisitions and permitted payments of dividends and other distributions). The Facility is available in U.S. Dollars with up to $ 150.0 million of the Facility available to be borrowed in Euros or Pound Sterling (the “Agreed Currencies”). The Facility further permits up to $ 50.0 million of the Facility to be utilized for the issuance of letters of credit in the Agreed Currencies. The Borrowers have the ability to increase the amount of the Facility, which increases may take the form of increases to the revolving credit commitments or the issuance of new term A loans, by an aggregate amount of up to the greater of $ 150.0 million or an incremental amount such that the total amount of the Facility does not exceed 350 % of consolidated EBITDA of the Company (as determined for the four fiscal quarter period most recently ended for which financial statements are available), upon satisfaction of customary conditions precedent for such increases or incremental loans and receipt of additional commitments by one or more existing or new lenders. Borrowings under the Facility bear interest at a floating rate, which is, at the Borrowers’ option, either SOFR, plus an applicable margin ranging from 1.25 % to 2.25 % or a base rate plus an applicable margin ranging from 0.25 % to 1.25 % (in each case subject to adjustment based on the Company’s total leverage ratio). An unused fee ranging from 0.15 % to 0.25 % (subject to adjustment based on the Company’s total leverage ratio) is payable quarterly in arrears based on the daily amount of the undrawn portion of each lender’s revolving credit commitment under the Facility. Fees are payable on outstanding letters of credit at a rate equal to the applicable margin for SOFR loans, plus certain customary fees payable solely to the issuer of the letter of credit. Certain of the Company’s existing and future material subsidiaries (collectively, the “Guarantors”) are required to guarantee the repayment of the Borrowers’ obligations under the Amended Credit Agreement. The obligations of the Borrowers and each of the Guarantors with respect to the Amended Credit Agreement are secured by a pledge of substantially all of the personal property assets of the Borrowers and each of the Guarantors, including accounts receivables, deposit accounts, intellectual property, investment property, inventory, equipment, and equity interests in their respective subsidiaries. The Amended Credit Agreement contains customary affirmative and negative covenants, including limitations on the Company’s ability to incur additional debt, grant or permit additional liens, make investments and acquisitions, merge or consolidate with others, dispose of assets, pay dividends and distributions, pay subordinated indebtedness, and enter into affiliate transactions. In addition, the Amended Credit Agreement contains financial covenants requiring the Company on a consolidated basis to maintain, as of the last day of any fiscal quarter, a total net leverage ratio of not more than 3.5 to 1.0 (which ratio can be permitted to increase to 4.0 to 1.0 for no more than 4 fiscal quarters following a material acquisition) and an interest coverage ratio of at least 3.0 to 1.0. The Amended Credit Agreement also includes events of default customary for facilities of this type and upon the occurrence of such events of default, subject to customary cure rights, all outstanding loans under the Facility may be accelerated and/or the lenders’ commitments terminated. The Company is in compliance with all required financial covenants as of December 31, 2022. In conjunction with obtaining the Facility, the Company paid $ 1.5 million in debt issuance costs and capitalized a total of $ 1.8 million associated with the Facility (inclusive of certain capitalized costs prior to the most recent amendment). These costs are being amortized over the life of the Facility. Capitalized debt issuance costs are included in other long-term assets, net of accumulated amortization. As of December 31, 2022, and December 31, 2021 , debt issuance costs, net of accumulated amortization, were $ 0.7 million and $ 1.0 million, respectively. Debt issuance costs amortized or expensed totaled $ 0.4 million for each of the years ended December 31, 2022, 2021, and 2020, respectively. The Company has an unused available Italian line of credit of € 5.5 million ($ 5.9 million and $ 6.3 million) at December 31, 2022, and 2021, respectively. This unsecured line of credit provides the Company the option to borrow amounts in Italy at interest rates determined at the time of borrowing. The Company paid cash related to interest of $ 1.4 million, $ 1.5 million, and $ 1.9 million for the years ended December 31, 2022, 2021, and 2020 , respectively.

Fair value measurements and inv

Fair value measurements and investments	12 Months Ended
Fair value measurements and investments	Dec. 31, 2022
Fair Value Measurements And Investment Disclosure [Abstract]
Fair value measurements and investments	12. Fair value measurements and investments Fair value is defined as the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Non-financial assets and liabilities of the Company measured at fair value include any long-lived assets that are impaired in a currently reported period or equity securities measured at observable prices in orderly transactions. The authoritative guidance also describes three levels of inputs that may be used to measure fair value: Level 1: quoted prices in active markets for identical assets and liabilities Level 2: observable inputs other than quoted prices in active markets for identical assets and liabilities Level 3: unobservable inputs in which there is little or no market data available, which require the reporting entity to develop its own assumptions The Company’s financial instruments include cash equivalents, accounts receivable, accounts payable, long-term secured debt, available for sale debt securities, equity securities, contingent consideration, and deferred compensation plan liabilities. The carrying value of cash equivalents, accounts receivable, and accounts payable approximate fair value due to the short-term maturities of these instruments. The Company’s secured revolving credit facility carries a floating rate of interest; therefore, the carrying value of long-term debt is considered to approximate the fair value. The Company’s available for sale debt securities, equity securities, contingent consideration, and deferred compensation plan liabilities are the only financial instruments recorded at fair value on a recurring basis as follows: (U.S. Dollars, in thousands) Balance Level 1 Level 2 Level 3 Assets Neo Medical convertible loan agreement $ 7,140 $ — $ — $ 7,140 Neo Medical preferred equity securities 6,084 — 6,084 — Bone Biologics equity securities — — — — Other investments 1,726 — — 1,726 Total $ 14,950 $ — $ 6,084 $ 8,866 Liabilities Spinal Kinetics contingent consideration — $ — $ — $ — Deferred compensation plan ( 1,515 ) — ( 1,515 ) — Total $ ( 1,515 ) $ — $ ( 1,515 ) $ — (U.S. Dollars, in thousands) Balance Level 1 Level 2 Level 3 Assets Neo Medical convertible loan agreements $ 7,148 $ — $ — $ 7,148 Neo Medical preferred equity securities 5,413 — 5,413 — Bone Biologics equity securities 309 309 — — Other Investments 1,505 — — 1,505 Total $ 14,375 $ 309 $ 5,413 $ 7,148 Liabilities Spinal Kinetics contingent consideration $ ( 17,200 ) $ — $ — $ ( 17,200 ) Deferred compensation plan ( 1,314 ) — ( 1,314 ) — Total $ ( 18,514 ) $ — $ ( 1,314 ) $ ( 17,200 ) The fair value of the Company’s deferred compensation plan liabilities are determined based on inputs that are readily available in public markets or that can be derived from information available in publicly quoted markets; therefore, the Company has categorized this liability as a Level 2 financial instrument. Neo Medical Convertible Loan Agreements and Equity Investment On October 1, 2020, the Company purchased shares of Neo Medical’s preferred stock for consideration of $ 5.0 million and entered into a Convertible Loan Agreement pursuant to which Orthofix loaned Neo Medical CHF 4.6 million, or $ 5.0 million at the date of issuance (the “Convertible Loan”). The loan bears interest at 8.0 %, with interest due semi-annually. At each interest payment date, the borrower may elect to capitalize any interest due to the then outstanding principal balance of the loan. The Convertible Loan matures on October 1, 2024 . If a change in control of Neo Medical occurs prior to the maturity date, the Convertible Loan shall become immediately due upon such event. The Convertible Loan may be convertible by either party into shares of Neo Medical’s preferred stock. The Company may convert the loan at its own election at any time prior to the full repayment or settlement of the Convertible Loan. Neo Medical may elect to convert the loan only in the event of a qualified financing event, as defined within the agreement. The price per share at which the loan converts is dependent upon i) the party electing conversion and ii) Neo Medical’s price per share in its most recent fundraising activities at the time of conversion, as specified within the agreement. In October 2021, the Company entered into an additional Convertible Loan Agreement (the “Additional Convertible Loan”), pursuant to which the Company loaned Neo Medical an additional CHF 0.6 million ($ 0.7 million as of the issuance date). In January 2022, the Company elected to convert the Additional Convertible Loan into shares of Neo Medical’s preferred stock. The equity securities are recorded in other long-term assets and are considered an investment that does not have a readily determinable fair value. As such, the Company measures this investment at cost, less any impairment, plus or minus changes resulting from observable price changes in orderly transactions for identical or similar investments of the same issuer. The table below presents a reconciliation of the carrying value of the Company’s investment in Neo Medical preferred equity securities for the years ended December 31, 2022, and 2021: (U.S. Dollars, in thousands) 2022 2021 Fair value of Neo Medical preferred equity securities at January 1 $ 5,413 $ 5,000 Conversion of loan into preferred equity securities 671 — Foreign currency remeasurement recognized in other income, net — 77 Unrealized gain recognized in other income (expense), net — 336 Fair value of Neo Medical preferred equity securities at December 31 6,084 5,413 Cumulative unrealized gain on Neo Medical preferred equity securities 413 413 The remaining Convertible Loan is recorded in other long-term assets as an available for sale debt security as of December 31, 2022. The Convertible Loan is recorded at fair value, with applicable interest recorded in interest income. The fair value of the Convertible Loan is based upon significant unobservable inputs, including the use of option-pricing models, Monte Carlo simulations for certain periods, and a probability-weighted discounted cash flows model, requiring the Company to develop its own assumptions. Therefore, the Company has categorized this asset as a Level 3 financial asset. Some of the more significant unobservable inputs used in the fair value measurement of the Convertible Loan include applicable discount rates, implied volatility, the likelihood and projected timing of repayment or conversion, and projected cash flows in support of the estimated enterprise value of Neo Medical. Holding other inputs constant, changes in these assumptions could result in a significant change in the fair value of the Convertible Loan. If the amortized cost of the Convertible Loan exceeds its estimated fair value, the security is deemed to be impaired, and must be evaluated for the recognition of credit losses. Impairment resulting from credit losses is recognized within the statement of income, while impairment resulting from other factors is recognized within other comprehensive income (loss). As of December 31, 2022 , the Company has no t recognized any credit losses related to the Convertible Loan. The following table provides a reconciliation of the beginning and ending balances of the Convertible Loan(s), measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2022 2021 Fair value of Neo Medical Convertible Loans at January 1 $ 7,148 $ 7,160 Additions — 671 Interest recognized in interest income, net 436 421 Foreign currency remeasurement recognized in other income (expense), net ( 67 ) ( 162 ) Unrealized gain (loss) recognized in other comprehensive income (loss) 294 ( 942 ) Conversion of Additional Convertible Loan into preferred equity securities ( 671 ) — Fair value of Neo Medical Convertible Loan(s) at December 31 7,140 7,148 Amortized cost basis of Neo Medical Convertible Loan(s) at December 31 5,907 6,209 The following table provides quantitative information related to certain key assumptions utilized within the valuation of the Convertible Loan as of December 31, 2022: (U.S. Dollars, in thousands) Fair Value as of December 31, 2022 Unobservable inputs Estimate Neo Medical Convertible Loan $ 7,140 Cost of equity discount rate 18.0 % Implied volatility 73.9 % Bone Biologics Equity Securities Until August of 2022, the Company held an investment in common stock of Bone Biologics Inc. (“Bone Biologics”), a developer of orthobiologic products. Prior to 2021, the equity securities were considered an investment that did not have a readily determinable fair value as Bone Biologics had very limited trading volumes. As such, the Company measured the investments at cost, less any impairments, plus or minus changes resulting from observable price changes in orderly transactions for an identical or similar investment of the same issuer. In 2021, Bone Biologics completed a public offering of units, with each unit consisting of one share of common stock and one warrant to purchase common shares. As a result, Bone Biologics’ common stock became actively traded on the NASDAQ (ticker BBLG). The Company concluded the investment represented a Level 1 fair value measurement subsequent to the public offering as the common shares subsequently had quoted prices in active markets for identical assets. As such, the Company recorded the investment at fair value, with changes in fair value recorded within other income (expense), net, subsequent to the public offering. The following table presents the changes in fair value recognized for each of the years ended December 31, 2022, 2021, and 2020: (U.S. Dollars, in thousands) 2022 2021 2020 Bone Biologics equity securities at January 1 $ 309 $ — $ 219 Fair value adjustments and impairments recognized in other income (expense), net ( 183 ) 309 ( 219 ) Proceeds from the disposition of equity securities ( 126 ) — — Bone Biologics equity securities at December 31 $ — $ 309 — Other investments Other investments represent other assets and investments recorded at fair value that are not deemed to be material for disclosure on an individual basis. The fair value of these assets is based upon significant unobservable inputs, such as probability-weighted discounted cash flows models, requiring the Company to develop its own assumptions. Therefore, the Company has categorized these assets as Level 3 financial assets. As of December 31, 2022, this balance was classified within other current assets, while as of December 31, 2021, this balance was classified within other long-term assets. Contingent Consideration The Company recognized a contingent consideration obligation in connection with the acquisition of Spinal Kinetics in 2018. The Spinal Kinetics contingent consideration consists of potential future milestone payments of up to $ 60.0 million in cash. The milestone payments included (i) $ 15.0 million upon U.S. Food and Drug Administration (“FDA”) approval of the M6-C artificial cervical disc (the “FDA Milestone”) and (ii) revenue-based milestone payments of up to $ 45.0 million in connection with future sales of the acquired artificial discs. To trigger applicable payments, milestones must be achieved by April 30, 2023. The FDA Milestone was achieved and paid in 2019. A second milestone payment, totaling $ 15.0 million, was achieved and paid in 2021 upon meeting certain net sales targets. The estimated fair value of the remaining Spinal Kinetics contingent consideration, attributable to a revenue-based milestone, was concluded to be zero as of December 31, 2022, as the Company does not expect to achieve the milestone by April 30, 2023. The estimated fair value reflects assumptions made by management as of December 31, 2022, such as the expected timing and volume of elective procedures and the impact of these procedures on future revenues. Any changes in fair value are recorded as an operating expense within acquisition-related amortization and remeasurement. The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2022 2021 Spinal Kinetics contingent consideration at January 1 $ 17,200 $ 35,400 Decrease in fair value recognized in acquisition-related amortization and remeasurement ( 17,200 ) ( 3,200 ) Payment made — ( 15,000 ) Spinal Kinetics contingent consideration at December 31 — $ 17,200

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	13. Commitments and Contingencies Contingencies policy The Company records accruals for certain outstanding legal proceedings, investigations, or claims when it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. The Company evaluates developments in legal proceedings, investigations, and claims that could affect the amount of any accrual, as well as any developments that would make a loss contingency both probable and reasonably estimable on a quarterly basis. When a loss contingency is not both probable and reasonably estimable, the Company does not accrue the loss. However, if the loss (or an additional loss in excess of the accrual) is at least a reasonable possibility and material, then the Company discloses a reasonable estimate of the possible loss or range of loss, if such reasonable estimate can be made. If the Company cannot make a reasonable estimate of the possible loss, or range of loss, then that is disclosed. In addition, legal fees and other directly related costs are expensed as incurred. In addition to the matters described in the paragraphs below, in the normal course of its business, the Company is involved in various lawsuits from time to time and may be subject to certain other contingencies. The Company believes any losses related to these matters are individually and collectively immaterial as to a possible loss and range of loss. Italian Medical Device Payback (“IMDP”) In 2015, the Italian Parliament introduced rules for entities that supply goods and services to the Italian National Healthcare System. A key provision of the law is a ‘payback’ measure, requiring medical device companies in Italy to make payments to the Italian government if medical device expenditures exceed regional maximum ceilings. Companies are required to make payments equal to a percentage of expenditures exceeding maximum regional caps. In the third quarter of 2022, the Italian Ministry of Health provided guidelines to the Italian regions and provinces on seeking payback of expenditure overruns relating to the years ended December 31, 2015, through December 31, 2018. Since receiving the guidelines, several regions and provinces have requested payment from affected medical device companies, including the Company. The Company has taken legal action to dispute the legality of such measures. The Company accounts for the estimated cost of the IMDP as sales and marketing expense and periodically reassesses the liability based upon current facts and circumstances. As a result, the Company recorded expense of $ 1.2 million for the year ended December 31, 2022, a benefit of $ 1.2 million for the year ended December 31, 2021, as a result of certain temporary relief provided by the Italian National Healthcare System in response to the COVID-19 pandemic, and expense of $ 1.5 million for the year ended December 31, 2020. As of December 31, 2022 , the Company has accrued $ 5.9 million related to the IMDP, which it has classified within other long-term liabilities; however, the actual liability could be higher or lower than the amount accrued once all legal proceedings are resolved and upon further clarification of the IMDP by the Italian authorities for more recent fiscal years.

Shareholder's equity

Shareholder's equity	12 Months Ended
Shareholder's equity	Dec. 31, 2022
Stockholders' Equity Note [Abstract]
Shareholders' equity	14. Shareholders’ equity Dividends The Company has not historically paid dividends to holders of its common stock. Certain subsidiaries of the Company have restrictions on their ability to pay dividends in certain circumstances pursuant to the Amended Credit Agreement. In the event that the Company decides to pay a dividend to holders of its common stock in the future with dividends received from its subsidiaries, the Company may, based on prevailing rates of taxation, be required to pay additional withholding and income tax on such amounts received from its subsidiaries. Accumulated Other Comprehensive Income (Loss) Accumulated other comprehensive income (loss) is comprised of foreign currency translation adjustments and unrealized gains (losses) on available for sale debt securities. The Company’s policy is to release income tax effects related to items recognized within accumulated other comprehensive income (loss) using a portfolio approach. The components of and changes in accumulated other comprehensive income (loss) are as follows: (U.S. Dollars, in thousands) Currency Neo Medical Convertible Loans Other Investments Accumulated Other Balance at December 31, 2019 $ ( 3,039 ) $ — $ — $ ( 3,039 ) Other comprehensive income 4,872 1,881 — 6,753 Income taxes — ( 462 ) — ( 462 ) Balance at December 31, 2020 $ 1,833 $ 1,419 $ — $ 3,252 Other comprehensive loss ( 2,544 ) ( 942 ) — ( 3,486 ) Income taxes — 234 — 234 Balance at December 31, 2021 $ ( 711 ) $ 711 $ — $ — Other comprehensive income (loss) ( 1,771 ) 294 101 ( 1,376 ) Income taxes — — — — Balance at December 31, 2022 $ ( 2,482 ) $ 1,005 $ 101 $ ( 1,376 )

Revenue recognition and account

Revenue recognition and accounts receivable	12 Months Ended
Revenue recognition and accounts receivable	Dec. 31, 2022
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	15. Revenue recognition and accounts receivable Revenue Recognition The Company accounts for a contract when there is (i) approval and commitment from both parties, (ii) the rights of the parties are identified, (iii) payment terms are identified, (iv) the contract has commercial substance, (v) and collectability of consideration is probable. The Company’s contracts may contain one or more performance obligations. If a contract contains more than one performance obligation, the Company allocates the total transaction price to each of the performance obligations based upon the observable standalone selling price of the promised goods or services underlying each performance obligation. The Company recognizes revenue when control of the promised goods or services is transferred to the customer, which typically occurs at a point in time upon shipment, delivery, or utilization, in an amount that reflects the consideration which the Company expects to be entitled to in exchange for the promised goods or services. The consideration for goods or services reflects any fixed amount stated per the contract and estimates for any variable consideration, such as discounts, to the extent that is it probable that a significant reversal of cumulative revenue recognized will not occur when the uncertainty associated with the variable consideration is resolved. The following sections discuss the Company’s revenue recognition policies by significant product category: Bone Growth Therapies Bone Growth Therapies revenue is largely attributable to the U.S. and is comprised of third-party payor transactions and wholesale revenue. The largest portion of Bone Growth Therapies revenue is derived from third-party payors. This includes commercial insurance carriers, health maintenance organizations, preferred provider organizations, and governmental payors, such as Medicare. Revenue is recognized when the product is fitted to and accepted by the patient and all applicable documents required by the third-party payor have been obtained. Amounts paid by third-party payors are generally based on fixed or allowable reimbursement rates. These revenues are recorded at the expected or preauthorized reimbursement rates, net of any contractual allowances or adjustments. Certain billings are subject to review by the third-party payors and may be subject to adjustment. Wholesale revenue is related to the sale of the Company’s bone growth stimulators directly to durable medical equipment suppliers. Wholesale revenues are typically recognized upon shipment and receipt of a confirming purchase order, which is when the customer obtains control of the promised goods. Biologics Biologics revenue is largely attributable to the U.S. and is primarily related to a collaborative arrangement with MTF, which extends through December 31, 2032. Under this arrangement, the Company markets tissue for bone repair and reconstruction under the brand names Trinity Evolution and Trinity ELITE. Per the terms of the agreement, MTF sources the tissue, processes it to create the allografts, packages, and delivers the tissue to the customer. The Company has exclusive global marketing rights for the Virtuos Lyograft and Trinity ELITE tissue forms, exclusive rights to market FiberFuse Advanced, FiberFuse Strip, and certain other tissues in the U.S., non-exclusive marketing rights for certain other products, and receives marketing fees from MTF based on total sales. MTF is considered the primary obligor in these arrangements; therefore, the Company recognizes marketing service fees on a net basis within net sales upon shipment of the product to the customer and receipt of a confirming purchase order. Spinal Implants and Global Orthopedics Spinal Implants and Global Orthopedics products are distributed world-wide, with U.S. sales largely comprised of commercial sales and international sales derived from both commercial sales and stocking distributor arrangements. Commercial revenue is largely related to the sale of the Company’s Spinal Implants and Global Orthopedics products to hospital customers. The customer obtains control and revenues are recognized when these products have been utilized and a confirming purchase order has been received from the hospital. Other revenues within the Spinal Implants and Global Orthopedics product categories are derived from stocking distributors, who purchase the Company’s products and then re-sell them directly to customers, such as hospitals. For stocking distributor arrangements, it is the Company’s policy to recognize revenue upon shipment and receipt of a confirming purchase order, which is when the distributor obtains control of the promised goods. The transaction price for revenue recognition is estimated based upon the Company’s historical collection experience with the stocking distributor. Product Sales and Marketing Service Fees The table below presents net sales, which includes product sales and marketing service fees, for each of the years ended December 31, 2022, 2021, and 2020. For the year ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Product sales $ 405,437 $ 409,554 $ 353,087 Marketing service fees 55,276 54,925 53,475 Net sales $ 460,713 $ 464,479 $ 406,562 Product sales primarily consists of the sale of Bone Growth Therapies, Spinal Implants, and Global Orthopedics products. Marketing service fees are received from MTF based on total sales of biologics tissues and relates solely to the Biologics product category within the Global Spine reporting segment. Marketing service fees received from MTF were $ 55.3 million, or approximately 98 % of total Biologics revenues, for the year ended December 31, 2022. As MTF is the single supplier for certain allografts in the Company’s Biologics portfolio, derived from deceased donors for their bone grafts and living donors for their amnion grafts, any event or circumstance that would impact MTF’s continued access to donors or the Company’s ability to market these tissues may adversely impact the Company’s financial results. Revenues exclude any value added or other local taxes, intercompany sales, and trade discounts. Shipping and handling costs for products shipped to customers are included in cost of sales, and were $ 4.2 million, $ 3.5 million, and $ 2.4 million for the years ended December 31, 2022, 2021, and 2020, respectively. Accounts receivable and related allowances Payment terms vary by the type and location of the Company’s customers and the products or services offered. The term between invoicing and when payment is due is not significant. T he Company’s allowance for expected credit losses represents the portion of the receivable’s amortized cost basis that an entity does not expect to collect over the receivable’s contractual life, considering past events, current conditions, and reasonable and supportable forecasts of future economic conditions. The process for estimating the ultimate collection of accounts receivable involves certain assumptions and judgments. The determination of the contractual life of accounts receivable, the aging of outstanding receivables, as well as the historical collections, write-offs, and payor reimbursement experience over the estimated contractual lives of such receivables, are integral parts of the estimation process related to reserves for expected credit losses and the establishment of contractual allowances. Accounts receivable are analyzed on a quarterly basis to assess the adequacy of both reserves for expected credit losses and contractual allowances. Revisions in allowances for expected credit loss estimates are recorded as an adjustment to bad debt expense within sales and marketing expenses. Revisions to contractual allowances are recorded as an adjustment to net sales. These estimates are periodically tested against actual collection experience. In addition, the Company analyzes its receivables by geography and by customer type, where appropriate, in developing estimates for expected credit losses. The following table provides a detail of changes in the Company’s allowance for expected credit losses for the years ended December 31, 2022, and 2021: For the year ended December 31, (U.S. Dollars, in thousands) 2022 2021 Allowance for expected credit losses beginning balance $ 4,944 $ 4,848 Current period provision for expected credit losses 2,095 444 Write-offs charged against the allowance and other ( 450 ) ( 126 ) Effect of changes in foreign exchange rates ( 170 ) ( 222 ) Allowance for expected credit losses ending balance $ 6,419 $ 4,944 The Company will generally sell receivables from certain Italian public hospitals each year to accelerate cash collections. During 2022, 2021, and 2020 , the Company sold € 9.2 million, € 8.4 million, and € 8.3 million ($ 9.6 million, $ 9.9 million, and $ 9.6 million) of receivables, respectively. The related fees for 2022, 2021, and 2020 , were $ 0.3 million, $ 0.2 million, and $ 0.3 million, respectively, which were recorded as interest expense. Accounts receivables sold without recourse are removed from the balance sheet at the time of sale. Contract Liabilities The Company’s contract liabilities largely relate to a prepayment of $ 13.9 million received in 2020 from the CMS as part of the Accelerated and Advance Payment Program of the CARES Act. On October 1, 2020, the President of the United States signed the “Continuing Appropriations Act, 2021 and Other Extensions Act,” which relaxed a number of the Medicare Accelerated and Advance Payment Program’s recoupment terms for providers and suppliers that received funds from the program. In April 2021, Medicare began to recoup 25 % of Medicare payments otherwise owed to the provider or supplier for submitted claims. Recoupment then increased to 50 % of Medicare payments in March 2022. Thus, during these time periods, rather than receiving the full amount of payment for newly submitted claims, the Company’s outstanding balance under the Accelerated and Advance Payment Program was reduced by the recoupment amount until the full balance had been repaid. The following table provides a detail of changes in the Company’s contract liability associated with the Accelerated and Advanced Payment Program for the years ended December 31, 2022, and 2021: For the Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 Contract liability beginning balance $ 4,791 $ 13,851 Recoupment recognized in net sales ( 4,791 ) ( 9,060 ) Contract liability ending balance $ — $ 4,791 Other Contract Assets The Company’s contract assets, excluding accounts receivable (“Other Contract Assets”), largely consist of payments made to certain distributors to obtain contracts, gain access to customers in certain territories, and to provide the benefit of the exclusive distribution of the Company’s products. Other Contract Assets are included in other long-term assets and totaled $ 1.1 million and $ 1.4 million as of December 31, 2022, and 2021, respectively. Other Contract Assets are amortized on a straight-line basis over the term of the related contract. No impairments were incurred for other contract assets in 2022 or 2021 . Further, the Company applies the practical expedient to expense sales commissions when incurred, as the applicable amortization period would be for one year or less.

Business segment information

Business segment information	12 Months Ended
Business segment information	Dec. 31, 2022
Segment Reporting [Abstract]
Business segment information	16. Business segment information As of December 31, 2022 , the Company's operations were managed through two reporting segments: Global Spine and Global Orthopedics. These reporting segments represent the operating segments for which the Chief Executive Officer, who is also Chief Operating Decision Maker (the “CODM”), reviews financial information and makes resource allocation decisions among businesses. As of December 31, 2022, the primary metric used by the CODM in managing the Company is earnings before interest, tax, depreciation, and amortization (“EBITDA”). The Company neither discretely allocates assets, other than goodwill, to its operating segments nor evaluates the operating segments using discrete asset information. Following the merger with SeaSpine, which was completed on January 5, 2023, the Company expects to reassess its reporting segments in the first quarter of 2023 based on how the operations of the newly combined company will be managed The Company will also reassess its identified segment profitability metric at that time. Accordingly, the reporting segment information below has been prepared based on the Company's two historical reporting segments, which were utilized in managing operations for the year ended December 31, 2022. Global Spine The Global Spine reporting segment offers three primary product categories: Bone Growth Therapies, Spinal Implants, and Biologics. The Bone Growth Therapies product category manufactures, distributes, and provides support services of market leading bone growth stimulator devices that enhance bone fusion. These Class III medical devices are indicated as an adjunctive, noninvasive treatment to improve fusion success rates in the cervical and lumbar spine as well as a therapeutic treatment for non-spine fractures that have not healed (non-unions). This product category uses distributors and sales representatives to sell its devices to hospitals, healthcare providers, and patients, primarily in the U.S. The Spinal Implants product category designs, develops, and markets a broad portfolio of motion preservation and fixation implant products used in surgical procedures of the spine. Spinal Implants distributes its products through a global network of distributors and sales representatives to sell spine products to hospitals and healthcare providers. The Biologics product category provides a portfolio of regenerative products and tissue forms that allow physicians to successfully treat a variety of spinal and orthopedic conditions. This product category specializes in the marketing of the Company’s regeneration tissue forms and distributes its tissues to hospitals and healthcare providers, primarily in the U.S., through a network of independent distributors and sales representatives. The partnership with MTF allows the Company to exclusively market the Virtuos Lyograph, Trinity Evolution, FiberFuse Advanced, FiberFuse Strip, and certain other tissue forms for musculoskeletal defects to enhance bony fusion. Global Orthopedics The Global Orthopedics reporting segment offers products and solutions that allow physicians to successfully treat a variety of orthopedic conditions unrelated to the spine. This reporting segment specializes in the design, development, and marketing of the Company’s orthopedic products used in fracture repair, deformity correction, and bone reconstruction procedures. Global Orthopedics distributes its products through a global network of distributors and sales representatives to sell orthopedic products to hospitals, and healthcare providers. Corporate Corporate activities are comprised of the operating expenses and activities of the Company not necessarily identifiable within the two reporting segments. The table below presents net sales by major product category by reporting segment: Year Ended December 31, 2022 2021 2020 (U.S. Dollars, in thousands) Net Sales Percent of Net Sales Percent of Net Sales Percent of Bone Growth Therapies $ 187,247 40.7 % $ 187,448 40.4 % $ 171,396 42.2 % Spinal Implants 109,546 23.8 % 115,094 24.8 % 94,857 23.3 % Biologics 56,381 12.2 % 56,421 12.1 % 55,482 13.6 % Global Spine 353,174 76.7 % 358,963 77.3 % 321,735 79.1 % Global Orthopedics 107,539 23.3 % 105,516 22.7 % 84,827 20.9 % Net sales $ 460,713 100.0 % $ 464,479 100.0 % $ 406,562 100.0 % The following table presents EBITDA, the primary metric used in managing the Company, by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Global Spine $ 60,649 $ 58,014 $ 63,036 Global Orthopedics ( 4,037 ) 3,374 ( 4,993 ) Corporate ( 44,011 ) ( 31,691 ) ( 25,382 ) Total EBITDA 12,601 29,697 32,661 Depreciation and amortization ( 29,019 ) ( 29,599 ) ( 30,546 ) Goodwill impairment — ( 11,756 ) — Interest expense, net ( 1,288 ) ( 1,837 ) ( 2,483 ) Loss before income taxes $ ( 17,706 ) $ ( 13,495 ) $ ( 368 ) The following table presents depreciation and amortization by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Global Spine $ 18,213 $ 17,548 $ 18,362 Global Orthopedics 6,696 8,233 7,896 Corporate 4,110 3,818 4,288 Total $ 29,019 $ 29,599 $ 30,546 Geographical information The following data includes net sales by geographic destination: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 U.S. $ 358,843 $ 361,945 $ 327,280 Italy 19,098 20,187 18,733 Germany 11,569 13,716 11,940 United Kingdom 10,171 10,552 7,147 France 10,377 10,475 8,354 Brazil 5,668 5,108 2,347 Others 44,987 42,496 30,761 Net sales $ 460,713 $ 464,479 $ 406,562 The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Global Spine U.S. $ 332,846 $ 337,455 $ 304,595 International 20,328 21,508 17,140 Total Global Spine 353,174 358,963 321,735 Global Orthopedics U.S. $ 25,997 24,490 22,685 International 81,542 81,026 62,142 Total Global Orthopedics 107,539 105,516 84,827 Consolidated U.S. 358,843 361,945 327,280 International 101,870 102,534 79,282 Net sales $ 460,713 $ 464,479 $ 406,562 The following data includes property, plant, and equipment by geographic area: (U.S. Dollars, in thousands) 2022 2021 U.S. $ 44,802 $ 45,090 Italy 8,535 9,412 Germany 3,115 2,544 United Kingdom 1,149 1,193 Brazil 85 91 Others 543 922 Total $ 58,229 $ 59,252

Acquisition-Related Amortizatio

Acquisition-Related Amortization and Remeasurement	12 Months Ended
Acquisition-Related Amortization and Remeasurement	Dec. 31, 2022
Acquisition Related Amortization And Remeasurement [Abstract]
Acquisition-Related Amortization and Remeasurement	17. Acquisition-related amortization and remeasurement Acquisition-related amortization and remeasurement consists of (i) amortization related to intangible assets acquired through business combinations or asset acquisitions, (ii) the remeasurement of any related contingent consideration arrangement, (iii) recognized costs associated with acquired IPR&D assets, which are recognized immediately upon acquisition, and (iv) impairments of goodwill related to previously recognized business combinations. Components of acquisition-related amortization and remeasurement for the years ended December 31, 2022, 2021, and 2020, respectively, are as follows: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Changes in fair value of contingent consideration $ ( 17,200 ) $ ( 3,575 ) $ ( 7,300 ) Amortization of acquired intangibles 8,196 7,907 6,801 Acquired IPR&D 1,600 1,500 — Impairment of Global Orthopedics goodwill — 11,756 — Total $ ( 7,404 ) $ 17,588 $ ( 499 ) CGBio Co. Ltd. License and Distribution Agreement On July 30, 2022, the Company entered into an exclusive License and Distribution Agreement (the "License Agreement") with CGBio Co., Ltd. (“CGBio”), a developer of innovative, synthetic bone grafts. The Agreement grants the Company the exclusive right to conduct pre-clinical and clinical studies, commercialize, promote, market, and sell the Novosis recombinant human bone morphogenetic protein-2 (rhBMP-2) bone growth materials and other future tissue regenerative solutions in the U.S. and Canada. As consideration, the Company agreed to pay CGBio an upfront payment of $ 1.4 million with additional payments contingent upon the achievement of specified development milestones. The Company accounted for this transaction as an asset acquisition. As the transaction was classified as an asset acquisition, the value of the consideration associated with the contingent milestones will be recognized at the time that applicable contingencies are resolved and consideration is paid or becomes payable. The $ 1.4 million upfront payment was paid in the third quarter of 2022 and was recognized as acquired IPR&D costs, which was then immediately expensed. Legion Innovations, LLC Asset Acquisition On December 29, 2022, the Company entered into a technology assignment and royalty agreement with Legion Innovations, LLC, a U.S.-based medical device technology company, whereby the Company acquired intellectual property rights to certain assets. As consideration, the Company agreed to pay $ 0.2 million in January 2023, with additional payments contingent upon reaching future commercialization and revenue-based milestones. The Company accounted for this transaction as an asset acquisition. As the transaction was classified as an asset acquisition, the value of the consideration associated with the contingent milestones will be recognized at the time that applicable contingencies are resolved and consideration is paid or becomes payable. The $ 0.2 million initial payment was accrued as of December 31, 2022, and was recognized as acquired IPR&D costs, which was then immediately expensed. IGEA S.p.A Asset Acquisition In April 2021, the Company entered into an Exclusive License and Distribution Agreement (the “License Agreement”) with IGEA S.p.A (“IGEA”), an Italian manufacturer and distributor of bone and cartilage stimulation systems. As consideration for the License Agreement, the Company agreed to pay up to $ 4.0 million, with certain payments contingent upon reaching an FDA milestone. Of this amount, $ 0.5 million was paid in 2021, which was recognized as acquired IPR&D costs within acquisition-related amortization and remeasurement. The Company accounted for this transaction as an asset acquisition. As the transaction was classified as an asset acquisition, the value of the consideration associated with the contingent milestones will be recognized at the time that applicable contingencies are resolved and consideration is paid or becomes payable. The License Agreement also includes certain minimum purchase requirements. In May 2022, the Company achieved FDA approval pertaining to the acquired technology, triggering a contingent consideration milestone obligation of $ 3.5 million. Of this amount, $ 1.5 million was paid in 2022, $ 1.0 million was accrued within other current liabilities, and $ 1.0 million was accrued within other long-term liabilities as of December 31, 2022. Related Party Asset Acquisition In February 2021, the Company entered into a technology assignment and royalty agreement with a medical device technology company partially owned and controlled by the wife of our Executive Chairman, and former President and Chief Executive Officer, Jon Serbousek, whereby the Company acquired the intellectual property rights to certain assets for consideration of up to $ 10.0 million. Consideration was comprised of $ 1.0 million due at signing, which was recognized immediately as acquired IPR&D expense within acquisition-related amortization and remeasurement, and $ 9.0 million in contingent consideration. The contingent consideration is dependent upon multiple milestones, such as receipt of 510(k) clearance and the attainment of certain net sales targets. The Company accounted for this transaction as an asset acquisition. As the transaction was classified as an asset acquisition, the value of the consideration associated with the contingent milestones will be recognized at the time that applicable contingencies are resolved and consideration is paid or becomes payable. In addition, the Company is obligated to pay a royalty of 2 % to 4 % on net sales, commencing upon commercialization of the assets. The transaction was approved by the Company’s Audit and Finance Committee, with the Audit and Finance Committee directly supervising the negotiations of the transaction. Mr. Serbousek was excluded from such discussions and did not participate in the negotiation or evaluation of the transaction. Mr. Serbousek also continues to be excluded from the oversight of the Company’s development and commercialization activities in relation to the acquired technology and all other matters relating to the relationship between the Company and the counterparty

Share-based compensation

Share-based compensation	12 Months Ended
Share-based compensation	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Share-based compensation	18. Share-based compensation At December 31, 2022, and 2021, the Company had stock option and award plans, and a stock purchase plan. 2012 Long Term Incentive Plan The Board of Directors adopted the Amended and Restated 2012 Long-Term Incentive Plan (the “2012 LTIP”) on April 23, 2018, which was subsequently approved by shareholder ratification. The 2012 LTIP provides for the grant of options to purchase shares of the Company’s common stock, stock awards (including restricted stock, unrestricted stock, and stock units), stock appreciation rights, performance-based awards and other equity-based awards. All of the Company’s employees and the employees of the Company’s subsidiaries and affiliates are eligible and may receive awards under the 2012 LTIP. In addition, the Company’s non-employee directors, consultants, and advisors who perform services for the Company and its subsidiaries and affiliates may receive awards under the 2012 LTIP. Awards granted under the 2012 LTIP expire no later than ten years after the date of grant. At December 31, 2022 , the Company reserves a total of 8,375,000 shares of common stock for issuance pursuant to the 2012 LTIP, subject to certain adjustments set forth in the 2012 LTIP. At December 31, 2022 , there were 1,098,680 options outstanding under the 2012 LTIP, of which 852,490 were exercisable. In addition, there were 1,359,693 restricted stock units outstanding, some of which contain performance-based or market-based vesting conditions, under the 2012 LTIP as of December 31, 2022. Inducement Plans In 2013, the Company granted options to acquire up to 150,000 shares of common stock to a former Chief Executive Officer as an inducement to accept employment with the Company. As of December 31, 2022 , there were 150,000 options outstanding under this inducement, all of which were exercisable. In August 2019, the Company appointed a new President of Global Spine, who was then subsequently promoted to President and Chief Executive Officer. As an inducement to accept employment with the Company, the individual was awarded a grant of stock options to acquire up to 50,711 shares of common stock and an award of 14,743 restricted stock units. As of December 31, 2022 , there were 50,711 options outstanding under this inducement, 38,033 of which were exercisable, and 3,686 unvested restricted stock units outstanding. Stock Purchase Plan The Second Amended and Restated Stock Purchase Plan, as Amended (the “Stock Purchase Plan”) provides for the issuance of shares of the Company’s common stock to eligible employees and directors of the Company and its subsidiaries that elect to participate in the plan and acquire shares of common stock through payroll deductions (including executive officers). During each purchase period, eligible employees may designate between 1 % and 25 % of their compensation to be deducted for the purchase of common stock under the plan (or such other percentage in order to comply with regulations applicable to employees domiciled in or resident of a member state of the European Union). For eligible directors, the designated percentage will be applied to an amount equal to his or her director compensation paid in cash for the current plan period. The purchase price of the shares under the plan is equal to 85 % of the fair market value on the first day of the plan period or, if lower, on the last day of the plan period. Due to the compensatory nature of such plan, the Company records the related share-based compensation expense in the consolidated statement of operations. Compensation expense is estimated using the Black-Scholes valuation model, with such value recognized as expense over the plan period. As of December 31, 2022 , the aggregate number of shares reserved for issuance under the Stock Purchase Plan is 2,850,000 . As of December 31, 2022 , a total of 2,395,673 shares had been issued pursuant to the Stock Purchase Plan. Share-Based Compensation Expense Share-based compensation expense is recorded in the same line of the consolidated statements of operations as the employee’s cash compensation. The following tables present the detail of share-based compensation expense by line item in the consolidated statements of income as well as by award type, for the years ended December 31, 2022, 2021, and 2020: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Cost of sales $ 826 $ 779 $ 705 Sales and marketing 3,865 3,385 3,620 General and administrative 12,917 10,289 10,624 Research and development 835 979 1,258 Total $ 18,443 $ 15,432 $ 16,207 Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Stock options $ 1,114 $ 1,893 $ 2,571 Time-based restricted stock awards and stock units 9,452 7,437 8,485 Performance-based / Market-based restricted stock units 6,425 4,414 3,509 Stock purchase plan 1,452 1,688 1,642 Total $ 18,443 $ 15,432 $ 16,207 The income tax benefit related to this expense was $ 3.3 million, $ 3.1 million, and $ 3.2 million for the years ended December 31, 2022, 2021, and 2020, respectively. Stock Options The fair value of time-based stock options is determined using the Black-Scholes valuation model, with such value recognized as expense over the service period, which is typically four years, net of actual forfeitures. A summary of the Company’s assumptions used in determining the fair value of the stock options granted during each of the years ended December 31, 2022, 2021, and 2020, is shown in the following table. The Company did not grant any time-based stock options in 2022. Year Ended December 31, 2022 2021 2020 Assumptions: Expected term (in years) — 6.0 5.5 Expected volatility — 34.4 % – 34.8 % 30.2 % – 35.1 % Risk free interest rate — 0.83 % – 1.25 % 0.28 % – 1.65 % Dividend yield — — — Weighted average grant date fair value — $ 12.33 $ 8.74 The expected term of the options granted is estimated based on a number of factors, including the vesting and expiration terms of the award, historical employee exercise behavior for both options that are currently outstanding and options that have been exercised or are expired, and an employee’s average length of service. Expected volatility is based on the historical volatility of the Company’s common stock. The risk-free interest rate is determined based upon a constant U.S. Treasury security rate with a contractual life that approximates the expected term of the option. Summaries of the status of the Company’s stock option plans as of December 31, 2022, and 2021, and changes during the year ended December 31, 2022, are presented below: Options Weighted Weighted Outstanding at December 31, 2021 1,397,054 $ 39.20 Granted — $ - Exercised ( 575 ) $ 21.78 Forfeited or expired ( 97,088 ) $ 38.14 Outstanding at December 31, 2022 1,299,391 $ 39.29 3.77 Vested and expected to vest at December 31, 2022 1,299,391 $ 39.29 3.77 Exercisable at December 31, 2022 1,040,523 $ 40.70 3.13 As of December 31, 2022 , the unamortized compensation expense relating to options granted and expected to be recognized was $ 0.8 million. This amount is expected to be recognized through December 2025 over a weighted average period of approximately 1.0 years. The total intrinsic value of options exercised was $ 0.0 million, $ 0.6 million, and $ 0.9 million for the years ended December 31, 2022, 2021, and 2020, respectively. For the year ended December 31, 2022 , we received $ 0.0 million in cash from stock option exercises, with the tax benefit realized for the tax deductions from these exercises of $ 0.0 million. The aggregate intrinsic value of options outstanding and options exercisable as of December 31, 2022 , is calculated as the difference between the exercise price of the underlying options and the market price of the Company’s common stock for options that had exercise prices lower than $ 20.53 , the closing price of the Company’s stock on December 31, 2022 . The aggregate intrinsic value of options outstanding was $ 0.0 million as of December 31, 2022 . The aggregate intrinsic value of options exercisable was also $ 0.0 million as of that date. Time-based Restricted Stock Awards and Stock Units Compensation expense for time-based restricted stock awards and stock units, which represents the fair value of the stock measured at the market price at the date of grant, is recognized on a straight-line basis over the vesting period, which is typically four years , net of actual forfeitures. Since 2017, the annual grant to non-employee directors has been made in the form of one-year vesting restricted stock units with deferred delivery (“DSUs”), whereby shares are not settled until after the director ceases service as a director. As of December 31, 2022, there were 86,542 DSUs outstanding that are vested but not settled. The aggregate fair value of time-based restricted stock awards and stock units that vested during the years ended December 31, 2022, 2021, and 2020 , was $ 5.2 million, $ 9.0 million, and $ 6.5 million, respectively. Unamortized compensation expense related to time-based restricted stock awards and stock units amounted to $ 18.6 million at December 31, 2022 . This amount is expected to be recognized through October 2026 over a weighted average period of approximately 2.5 years. The aggregate intrinsic value of time-based restricted stock awards and stock units outstanding was $ 17.4 million as of December 31, 2022. Performance-based and Market-based Restricted Stock Units Certain of the Company's outstanding restricted stock units contain performance-based vested conditions or market-based vesting conditions. The fair value of performance-based restricted stock units is calculated based upon the closing stock price at the date of grant. Such value is recognized as expense over the requisite service period beginning in the period in which they are deemed probable to vest, net of actual forfeitures. Vesting probability is assessed based upon forecasted earnings and financial results. The fair value of market-based restricted stock units is determined at the date of the grant using the Monte Carlo valuation methodology, with any discounts for post-vesting restrictions estimated using the Chaffe Model. The Monte Carlo methodology incorporates into the valuation the possibility that the market condition may not be satisfied. Such value is recognized on a straight-line basis over the vesting period, net of actual forfeitures. The fair value of performance-based and/or market-based restricted stock units that vested and settled during the years ended December 31, 2022, 2021, and 2020, totaled $ 0.0 million, $ 0.0 million, and $ 1.4 million, respectively. Unamortized compensation expense for performance-based and/or market-based restricted stock units totaled $ 9.3 million at December 31, 2022 , and is expected to be recognized over a weighted average period of approximately 1.4 years. The aggregate intrinsic value of market-based restricted stock units outstanding was $ 10.6 million as of December 31, 2022. A summary of the status of our time-based and performance-based and/or market-based restricted stock units as of December 31, 2022, and 2021, and changes during the year ended December 31, 2022, are presented below: Time-based Restricted Stock Performance-based and/or Market-based Shares Weighted Shares Weighted Outstanding at December 31, 2021 559,368 $ 40.03 323,081 $ 48.56 Granted 500,222 $ 29.81 255,327 $ 33.57 Vested and settled ( 152,735 ) $ 41.03 — $ — Cancelled ( 59,708 ) $ 34.80 ( 62,176 ) $ 55.70 Outstanding at December 31, 2022 847,147 $ 34.18 516,232 $ 40.29

Defined Contribution Plans and

Defined Contribution Plans and deferred compensation	12 Months Ended
Defined Contribution Plans and deferred compensation	Dec. 31, 2022
Retirement Benefits [Abstract]
Defined contribution plans and deferred compensation	19. Defined contribution plans and deferred compensation Defined Contribution Plans Orthofix US LLC sponsors a defined contribution plan (the “401(k) Plan”) covering substantially all full-time U.S. employees. The 401(k) Plan allows participants to contribute up to 80 % of their pre-tax compensation, subject to certain limitations, with the Company matching 100 % of the first 2 % of the employee’s base compensation and 50 % of the next 4 % of the employee’s base compensation if contributed to the 401(k) Plan. During the years ended December 31, 2022, 2021, and 2020 , expenses incurred relating to the 401(k) Plan, including matching contributions, were approximately $ 3.3 million, $ 2.8 million, and $ 1.1 million, respectively. In April 2020, as a precautionary measure to increase the Company’s cash position and preserve financial flexibility in response to the initial uncertainty of the COVID-19 pandemic, the Company temporarily suspended the 401(k) match program through the remainder of fiscal year 2020. The 401(k) match program was reinstated in January 2021. The Company also operates defined contribution plans for its international employees meeting minimum service requirements. The Company’s expenses for such contributions during each of the years ended December 31, 2022, 2021, and 2020 , were $ 1.1 million, $ 1.2 million, and $ 1.1 million, respectively. Deferred Compensation Plans Under Italian Law, our Italian subsidiary accrues deferred compensation on behalf of its employees, which is paid on termination of employment. The accrual for deferred compensation is based on a percentage of the employee’s current annual remuneration plus an annual charge. Deferred compensation is also accrued for the leaving indemnity payable to agents in case of dismissal, which is regulated by a national contract and is equal to approximately 4 % of total commissions earned from the Company. The Company’s relations with its Italian employees, who represent 21 % of total employees at December 31, 2022, are governed by the provisions of a National Collective Labor Agreement setting forth mandatory minimum standards for labor relations in the metal mechanic workers industry. The Company is not a party to any other collective bargaining agreement. The balance in other long-term liabilities as of December 31, 2022, and 2021 was $ 1.5 million and $ 1.3 million, respectively, and represents the amount that would be payable if all the employees and agents had terminated employment at that date.

Income taxes

Income taxes	12 Months Ended
Income taxes	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Income taxes	20. Income taxes Income (loss) before provision for income taxes consisted of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 U.S. $ ( 22,318 ) $ ( 5,987 ) $ 5,556 Non-U.S. 4,612 ( 7,508 ) ( 5,924 ) Income (loss) before income taxes $ ( 17,706 ) $ ( 13,495 ) $ ( 368 ) The provision for income taxes consists of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 U.S. Current $ 1,151 $ ( 607 ) $ ( 15,054 ) Deferred 67 24,292 ( 29 ) 1,218 23,685 ( 15,083 ) Non-U.S. Current 578 1,009 1,382 Deferred 247 190 10,816 825 1,199 12,198 Income tax expense (benefit) $ 2,043 $ 24,884 $ ( 2,885 ) The differences between the income tax provision at the U.S. federal statutory tax rate and the Company’s effective tax rate for the years ended December 31, 2022, 2021, and 2020, consist of the following: 2022 2021 2020 (U.S. Dollars, in thousands, except percentages) Amount Percent Amount Percent Amount Percent Statutory U.S. federal income tax rate $ ( 3,718 ) 21.0 % $ ( 2,834 ) 21.0 % $ ( 77 ) 21.0 % State taxes, net of U.S. federal benefit ( 1,312 ) 7.4 ( 24 ) 0.2 1,151 ( 312.8 ) Foreign rate differential, including withholding taxes 475 ( 2.7 ) 480 ( 3.6 ) ( 147 ) 39.9 Valuation allowances, net 7,638 ( 43.1 ) 27,819 ( 206.1 ) 14,514 ( 3,944.0 ) Foreign income inclusions, net 1,018 ( 5.7 ) — — — — Research credits ( 750 ) 4.2 ( 537 ) 4.0 ( 982 ) 266.8 Unrecognized tax benefits, net of settlements ( 599 ) 3.4 ( 1,363 ) 10.1 ( 17,321 ) 4,706.8 Equity compensation 1,441 ( 8.1 ) 1,091 ( 8.1 ) 1,657 ( 450.3 ) Executive compensation 697 ( 3.9 ) 456 ( 3.4 ) 375 ( 101.9 ) Contingent consideration ( 3,316 ) 18.7 ( 640 ) 4.7 ( 1,460 ) 396.7 Other, net 469 ( 2.6 ) 436 ( 3.2 ) ( 595 ) 161.8 Income tax expense (benefit) /effective rate $ 2,043 ( 11.5 )% $ 24,884 ( 184.4 )% $ ( 2,885 ) 784.0 % The Company paid (received or was refunded) cash relating to taxes totaling ($0.9 ) million, $ 4.8 million, and $ 0.5 million for the years ended December 31, 2022, 2021, and 2020, respectively. The Company’s deferred tax assets and liabilities are as follows: December 31, (U.S. Dollars, in thousands) 2022 2021 Intangible assets and goodwill $ 5,807 $ 5,245 Inventories and related reserves 17,819 17,097 Deferred revenue and cost of goods sold 3,642 3,888 Other accruals and reserves 2,756 3,082 Accrued compensation 8,795 7,784 Provision for expected credit losses 1,253 1,217 Net operating loss and tax credit carryforwards 40,676 42,546 R&D capitalization 4,353 — Lease liabilities 6,440 5,691 Other, net 3,767 852 Total deferred tax assets 95,308 87,402 Valuation allowance ( 83,797 ) ( 76,725 ) Deferred tax asset, net of valuation allowance $ 11,511 $ 10,677 Withholding taxes ( 10 ) ( 10 ) Property, plant, and equipment ( 5,516 ) ( 4,809 ) Right-of-use lease assets ( 5,771 ) ( 5,165 ) Deferred tax liability ( 11,297 ) ( 9,984 ) Net deferred tax assets $ 214 $ 693 Reported as: Deferred income tax assets (classified within other long-term assets) 1,470 1,771 Deferred income tax liabilities (classified within other long-term liabilities) ( 1,256 ) ( 1,078 ) Net deferred tax assets $ 214 $ 693 The Company historically presented deferred income tax assets as a separate and discrete line item on its consolidated balance sheet; however, as the significance of the asset has decreased as a result of the recognition of valuation allowances, the Company has reclassified this balance to be included within other long-term assets. As such, the prior year balance has been reclassified to conform to current period presentation. The Company accounts for income taxes using the asset and liability method, under which deferred tax assets and liabilities are recognized for the expected future tax consequences of temporary differences between the financial reporting and income tax basis of assets and liabilities, and for operating losses and credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates in effect for the years in which those items are expected to be realized. Tax law and rate changes are recorded in the period such changes are enacted. The Company establishes a valuation allowance when it is more likely than not that certain deferred tax assets will not be realized in the foreseeable future. The valuation allowance is primarily attributable to net operating loss carryforwards and temporary differences in domestic and certain foreign jurisdictions. The net increase in the valuation allowance of $ 7.1 million during the year principally relates to recognizing a full valuation allowance against the net deferred tax asset within the Company’s U.S. operations as well as an increase in valuation allowance against deferred tax assets within the Company’s Italian manufacturing subsidiary. The Company considered many factors when assessing the likelihood of future realization of these deferred tax assets, including recent cumulative losses experienced by the subsidiary, expectations of future taxable income or loss, the carryforward periods available to the Company for tax reporting purposes, and other relevant factors. That increase was partially offset by a decrease of valuation allowances on net operating loss carryforwards in other foreign jurisdictions due to expiration, statutory rate changes, and changes regarding the realizability of net deferred tax assets. It is reasonably possible that the valuation allowance will increase in 2023 due to further losses in certain jurisdictions, offset by decreases related to the expiration of foreign net operating losses. The Company has federal net operating loss carryforwards of $ 13.3 million and research and development credits of $ 1.7 million, including amounts from the acquisition of Spinal Kinetics. These carryforwards are subject to limitation under the provisions of Section 382 and will begin to expire in 2026 . The Company has state net operating loss carryforwards of approximately $ 31.1 million, of which $ 20.6 million relates to Spinal Kinetics and begins to expire in 2027 . Additionally, the Company has net operating loss carryforwards in various foreign jurisdictions of approximately $ 120.4 million, the majority of which do not have an expiration, which mainly relate to the Company’s Italy, Netherlands, and Brazil operations. Unremitted foreign earnings were $ 27.0 million as of December 31, 2022. The Company’s investment in foreign subsidiaries continues to be indefinite in nature; however, the Company may periodically repatriate a portion of these earnings to the extent that it does not incur significant additional tax liability. Quantification of the deferred tax liability, if any, associated with indefinitely reinvested earnings of foreign subsidiaries is not practicable. The Company records a benefit for uncertain tax positions when the weight of available evidence indicates that it is more likely than not, based on an evaluation of the technical merits, that the tax position will be sustained on audit. The tax benefit is measured as the largest amount that is more than 50 % likely to be realized upon settlement. The Company re-evaluates income tax positions periodically to consider changes in facts or circumstances such as changes in or interpretations of tax law, effectively settled issues under audit, and new audit activity. The Company includes interest and any applicable penalties related to income tax issues as part of income tax expense in its consolidated financial statements. The Company’s unrecognized tax benefit was $1 .7 million and $3 .5 million for the years ended December 31, 2022, and 2021 , respectively. The Company recorded net interest and penalties expense (benefit) on unrecognized tax benefits of $ 0.1 million, $(0 .4 ) million, and $(5 .4 ) million for the years ended December 31, 2022, 2021, and 2020 , respectively, and had approximately $ 0.9 million and $0 .8 million accrued for payment of interest and penalties as of December 31, 2022, and 2021, respectively. The entire amount of unrecognized tax benefits, including interest, would favorably impact the Company’s effective tax rate if recognized. The Company believes it is reasonably possible that, in the next 12 months, no unrecognized tax benefits, exclusive of interest and penalties, will be resolved by the closure of an audit or statute release. A reconciliation of the gross unrecognized tax benefits (excluding interest and penalties) for the years ended December 31, 2022, and 2021, is shown below: (U.S. Dollars, in thousands) 2022 2021 Balance as of January 1, $ 3,462 $ 4,629 Additions for current year tax positions 46 45 Increases for prior year tax positions 16 110 Settlements of prior year tax positions ( 144 ) — Expiration of statutes ( 1,637 ) ( 1,322 ) Balance as of December 31, $ 1,743 $ 3,462 The Company and its subsidiaries file income tax returns in the U.S. federal jurisdiction and in certain state and foreign jurisdictions, including Italy, as well as other jurisdictions where the Company maintains operations. The statute of limitations with respect to federal and state tax filings is closed for years prior to 2019. The statute of limitations with respect to the major foreign tax filing jurisdictions is closed for years prior to 2018. The Company cannot reasonably determine if any state and local or foreign examinations will have a material impact on its financial statements and cannot predict the timing regarding the resolution of these tax examinations.

Earnings per share (EPS)

Earnings per share (EPS)	12 Months Ended
Earnings per share (EPS)	Dec. 31, 2022
Earnings Per Share [Abstract]
Earnings per share (EPS)	21. Earnings per share (EPS) The Company uses the two-class method of computing basic EPS due to the existence of non-vested restricted stock awards in certain periods with nonforfeitable rights to dividends or dividend equivalents (referred to as participating securities). Basic EPS is computed using the weighted average number of common shares outstanding during each of the respective years. Diluted EPS is computed using the weighted average number of common and common equivalent shares outstanding during each of the respective years using the more dilutive of either the treasury stock method or two-class method. The difference between basic and diluted shares, if any, largely results from common equivalent shares, which represents the dilutive effect of the assumed exercise of certain outstanding share options, the assumed vesting of restricted stock granted to employees and directors, or the satisfaction of certain necessary conditions for contingently issuable shares (see Note 18). For each of the three years ended December 31, 2022, 2021, and 2020 , no significant adjustments were made to net income for purposes of calculating basic and diluted EPS. The following is a reconciliation of the weighted average shares used in the diluted EPS computations: Year Ended December 31, 2022 2021 2020 Weighted average common shares-basic 20,053,548 19,690,593 19,267,920 Effect of diluted securities: Unexercised stock options and employee stock purchase plan — — 51,951 Unvested time-based restricted stock units — — 71,847 Weighted average common shares-diluted 20,053,548 19,690,593 19,391,718 There were 2,313,226 ; 1,711,323 ; and 1,499,630 weighted average outstanding options, restricted stock, and market-based units not included in the diluted earnings per share computation for the years ended December 31, 2022, 2021, and 2020 , respectively, because inclusion of these awards was anti-dilutive or, for market-based units, all necessary conditions had not been satisfied by the end of the respective period.

Subsequent Events

Subsequent Events	12 Months Ended
Subsequent Events	Dec. 31, 2022
Subsequent Events [Abstract]
Subsequent Events	22. Subsequent Events Merger with SeaSpine Holdings Corporation On October 10, 2022, the Company and Orca Merger Sub Inc., a wholly-owned subsidiary of Orthofix (“Merger Sub”), entered into an Agreement and Plan of Merger (the “Merger Agreement”) with SeaSpine, a global medical technology company focused on surgical solutions for the treatment of spinal disorders. On January 5, 2023, the transaction was completed and Merger Sub was merged with and into SeaSpine (the “Merger”), with SeaSpine continuing as the surviving company and a wholly-owned subsidiary of Orthofix following the transaction. For the year ended December 31, 2022, the Company incurred approximately $ 9.3 million in acquisition-related costs, substantially all of which was classified as general and administrative expenses. As a result of the Merger, each share of common stock of SeaSpine issued and outstanding immediately prior to the closing date was converted into the right to receive 0.4163 shares of common stock of Orthofix. In addition, the Company assumed SeaSpine’s existing equity incentive plans in connection with the Merger, and outstanding SeaSpine equity awards were converted into Orthofix equity awards (on the same vesting schedule and other terms and conditions as existed prior to such conversion). The conversion of such equity awards occurred at the same exchange ratio as applied to SeaSpine common stock in the Merger, and the exercise price of converted SeaSpine stock options was also correspondingly adjusted. The Merger is being accounted for as an acquisition of SeaSpine by Orthofix under the acquisition method of accounting for business combinations in accordance with U.S. GAAP. Thus, Orthofix is treated as the acquirer for accounting purposes. In identifying the acquirer, Orthofix and SeaSpine considered the structure of the transaction and other actions contemplated by the Merger Agreement, relative outstanding share ownership, and market values, the composition of the combined company’s board of directors, and the relative size of Orthofix and SeaSpine. The total estimated fair value of consideration associated with the Merger as of the acquisition date was comprised of: (U.S. Dollars, in thousands, except shares and price per share) Share Consideration: Orthofix common shares to be issued in exchange for SeaSpine common shares 16,104,854 Orthofix closing price per share as of January 4, 2023 $ 22.76 Estimated fair value of shares issued in exchange for SeaSpine common shares $ 366,546 Estimated fair value of Orthofix stock options and RSUs issued in exchange for outstanding SeaSpine equity awards 11,508 Total estimated fair value of consideration $ 378,054 Pursuant to the Merger Agreement, the outstanding equity awards of SeaSpine (including stock options and restricted stock units) were exchanged for awards of Orthofix. The Company issued 1,889,812 options to purchase shares of Orthofix common stock and 490,338 shares of time-based vesting restricted stock in the conversion of such awards. The estimated fair value of the portion of the SeaSpine awards for which the required service period had been completed at the time of the acquisition was treated as purchase consideration. The remaining estimated fair value will be recorded as compensation expense over the remainder of the service period associated with the awards. As of the date the consolidated financial statements were available to be issued, the Company was in the process of determining a preliminary allocation of the total estimated fair value of consideration to the fair value of the net assets acquired and residual goodwill; however, such allocation has not yet been finalized. A preliminary allocation of the purchase price to assets acquired and liabilities assumed will be reported in the Company’s quarterly report on Form 10-Q for the quarter ended March 31, 2023; however, such allocation will be subject to completion of the Company’s valuation of the assets acquired and liabilities assumed, which the Company expects to complete within one year from the acquisition date. In connection with the Merger, immediately after the closing of the acquisition on January 5, 2023, Orthofix repaid on behalf of SeaSpine all of the outstanding obligations in respect of principal, interest and fees under an Amended and Restated Credit Agreement, dated July 27, 2018, among SeaSpine and Project Maple Leaf Holdings ULC, as guarantors, and SeaSpine Orthopedics Corporation, SeaSpine, Inc., ISOTIS, Inc., SeaSpine Sales LLC, ISOTIS Orthobiologics, Inc., Theken Spine, LLC, SeaSpine Orthopedics Intermediate Co, Inc., 7D Surgical USA Inc. and 7D Surgical ULC, as borrowers, the lenders party thereto and Wells Fargo Bank, National Association, as administrative agent, and terminated all applicable commitments under such agreement. In addition, on January 3, 2023, the Company borrowed $ 30.0 million under its $ 300.0 million secured revolving credit facility for working capital purposes, including to fund certain merger-related expenses. Further, an additional $ 15.0 million was borrowed on March 3, 2023.

Significant accounting polici_2

Significant accounting policies (Policies)	12 Months Ended
Significant accounting policies (Policies)	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Market risk	Market risk In the ordinary course of business, the Company is exposed to the impact of changes in interest rates and foreign currency fluctuations. The Company’s objective is to limit the impact of such movements on earnings and cash flows. In order to achieve this objective, the Company seeks to balance its non-U.S. Dollar denominated income and expenditures. The financial statements for operations outside the U.S. are generally maintained in their local currency. All foreign currency denominated balance sheet accounts, except shareholders’ equity, are translated to U.S. Dollars at year end exchange rates, and revenue and expense items are translated at average rates of exchange prevailing during the year. Gains and losses resulting from the translation of foreign currency are recorded in the accumulated other comprehensive income (loss) component of shareholders’ equity. Transactional foreign currency gains and losses, including those generated from intercompany operations, are included in other expense, net and were a loss of $ 3.3 million, a loss of $ 4.0 million, and a gain of $ 3.9 million for the years ended December 31, 2022, 2021, and 2020 , respectively.
Financial instruments and concentration of credit risk	Financial instruments and concentration of credit risk Financial instruments that could subject the Company to a concentration of credit risk consist primarily of cash, cash equivalents, and accounts receivable. Generally, cash is held at large financial institutions and cash equivalents consist of highly liquid money market funds. The Company performs ongoing credit evaluations of customers, generally does not require collateral, and maintains a reserve for expected credit losses. The Company believes that a concentration of credit risk related to accounts receivable is limited because customers are geographically dispersed and end users are diversified.
Cash, cash equivalents and restricted cash	Cash, cash equivalents, and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. In September 2019, approximately $ 0.5 million (based upon foreign exchange rates as of December 31, 2020) of the Company’s cash in Brazil was frozen upon request to satisfy a judgment related to an ongoing legal dispute with a former Brazilian distributor. In December 2021, the dispute was settled and the cash was disbursed to the former distributor. Investing activities that did not result in cash receipts or cash payments during the years ended December 31, 2022, 2021, and 2020 consisted of the following, which were not included within cash from investing activities in the Company’s consolidated statements of cash flows: (U.S. Dollars, in thousands) 2022 2021 2020 Supplemental disclosure of cash flow information: Noncash investing activities: Intangible assets acquired in asset acquisitions $ 2,000 $ — $ 1,575 Contingent consideration recognized at acquisition date — — 375
Advertising costs	Advertising costs Advertising costs are expensed as incurred. Advertising costs are included within sales and marketing expense and totaled $ 0.5 million, $ 0.5 million, and $ 0.9 million for the years ended December 31, 2022, 2021, and 2020 , respectively.
Research and development costs	Research and development costs, including collaborative arrangements Expenditures for research and development are expensed as incurred. Expenditures related to the Company’s collaborative arrangement with MTF Biologics (“MTF”) are expensed based on the terms of the related agreement. The Company recognized $ 0.0 million, $ 0.8 million and $ 0.8 million in research and development expense for the years ended December 31, 2022, 2021, and 2020, respectively. In October 2020, the Company and Neo Medical SA, a privately held Swiss-based company developing a new generation of products for spinal surgery (“Neo Medical”), entered into a co-development agreement covering the parties’ joint development of single use instruments for cervical spine procedures. In connection with this agreement, the Company is responsible for the payment of variable costs associated with the development of the specified products. Research and development expenses incurred under this collaborative arrangement totaled $ 0.5 million, $ 0.6 million, and less than $ 0.1 million for the years ended December 31, 2022, 2021, and 2020 , respectively.
Recently adopted accounting standards and recently issued accounting pronouncements	Adoption of Accounting Standards Update (“ASU”) 2021-10—Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance In November 2021, the Financial Accounting Standards Board (“FASB”) issued ASU 2021-10, which aims to increase the transparency of government assistance by requiring entities to provide information about the nature of the transaction, terms and conditions associated with the transaction, and financial statement line items affected by the transaction. The Company voluntarily elected to early adopt this standard for the year ended December 31, 2021, on a prospective basis. Adoption of this standard did not have a significant impact to the existing disclosures made in relation to government assistance received by the Company in 2020 as part of the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act"). Adoption of ASU 2019-12, Simplifying the accounting for income taxes In December 2019, the FASB issued ASU 2019-12, which reduces the complexity of accounting for income taxes by eliminating certain exceptions to the general principles in ASC 740, Income Taxes . Additionally, the ASU simplifies U.S. GAAP by amending the requirements related to the accounting for "hybrid" tax regimes and also adding the requirement to evaluate when a step up in the tax basis of goodwill should be considered part of the business combination and when it should be considered a separate transaction. The Company adopted this ASU effective January 1, 2021 , with certain provisions applied retrospectively and other provisions applied prospectively. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows. Adoption of ASU 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments and Subsequent Amendments In June 2016, the FASB issued ASU 2016-13 (which was then further clarified in subsequent ASUs), which required that credit losses for certain types of financial instruments, including accounts receivable, be estimated based on expected credit losses among other changes. The Company adopted this ASU effective as of January 1, 2020 , using a modified retrospective approach. See Note 15 for additional discussion of the Company’s adoption of Topic 326 and its resulting accounting policies. Adoption of ASU 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment In January 2017, the FASB issued ASU 2017-04, which eliminated Step 2 of the previous goodwill impairment test, which required a hypothetical purchase price allocation to measure goodwill impairment. Under ASU 2017-04, a goodwill impairment loss is now measured as the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the recorded amount of goodwill. The Company adopted this ASU effective January 1, 2020 , on a prospective basis and followed this guidance to measure the goodwill impairment of $ 11.8 million recorded in the year ended December 31, 2021. Adoption of ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement In August 2018, the FASB issued ASU 2018-13, which eliminated certain disclosures, such as the amount and reasons for transfers between Level 1 and Level 2 of the fair value hierarchy, and added new disclosure requirements for Level 3 measurements. The Company adopted this ASU effective January 1, 2020 , with certain provisions of the ASU applied retrospectively and other provisions provided prospectively. Adoption of this ASU did not impact the Company’s condensed consolidated balance sheet, statements of operations, or cash flows; however, adoption of the ASU did result in modified disclosures in Note 12. Adoption of ASU 2018-15, Intangibles—Goodwill and Other—Internal-Use Software (Subtopic 350-40): Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract In August 2018, the FASB issued ASU 2018-15, which aligned the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software. The accounting for the service element of a hosting arrangement that is a service contract was not affected by the amendments in this update. The Company adopted this ASU effective January 1, 2020 , on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows, but is expected to impact future cloud computing arrangements. Adoption of ASU 2020-04, Reference Rate Reform (Topic 848) In March 2020, the FASB issued ASU 2020-04, which provided temporary optional guidance to ease the potential financial reporting burden of the expected market transition away from the London Inter-Bank Offered Rate. The new guidance provided optional expedients and exceptions for applying U.S. GAAP to contract modifications, hedge accounting, and other transactions affected by reference rate reform if certain criteria are met through December 31, 2022. The Company adopted this ASU effective March 12, 2020 , the effective date of the ASU, on a prospective basis. Adoption of this ASU did not have a material impact to the Company’s condensed consolidated balance sheet, statements of operations, or cash flows. Recently Issued Accounting Pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (ASU 2021-08) Requires that an acquirer recognize and measure contract assets and liabilities acquired in a business combination in accordance with Topic 606, which governs the accounting for revenue contracts with customers. The guidance is to be applied prospectively to acquisitions occurring on or after the effective date, with early adoption permitted. January 1, 2023 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions (ASU 2022-03) Clarifies the guidance in Topic 820, Fair Value Measurement, when measuring the fair value of an equity security subject to contractual restrictions that prohibit the sale of an equity security and introduces new disclosure requirements for equity securities subject to contractual sale restrictions. Certain of the provisions are to be applied retrospectively with other provisions applied prospectively. January 1, 2024 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Recent Law Changes COVID-19 and the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) In March 2020, the CARES Act entered into federal law, which was aimed at providing emergency assistance and health care for individuals, families, and businesses affected by the Coronavirus Disease 2019 ("COVID-19") pandemic and to provide general support to the U.S. economy. The CARES Act, among other things, included provisions relating to the deferment of employer side social security payments and technical corrections to tax depreciation methods for qualified improvement property. The CARES Act had no impact to the Company’s income tax expense/benefit reported within the consolidated statements of operations for each of the years ended December 31, 2021 and 2020. The CARES Act also provided financial relief to the Company through other various programs, each of which are described in further detail below. In April 2020, the Company received $ 13.9 million in funds from the Centers for Medicare & Medicaid Services (“CMS”) Accelerated and Advance Payment Program. For discussion of the Company’s accounting for these funds, see Note 15. In April 2020, the Company also automatically received $ 4.7 million in funds from the U.S. Department of Health and Human Services as part of the Provider Relief Fund. The Company recognized this in-substance grant within other income for the year ended December 31, 2020. In addition, as part of the CARES Act, the Company was permitted to defer all employer social security payroll tax payments for the remainder of the 2020 calendar year subsequent to the CARES Act being signed into federal law, such that 50 % of the taxes could be deferred until December 31, 2021, with the remaining 50 % deferred until December 31, 2022. As of December 31, 2020, the Company had deferred $ 0.6 million associated with this program, which was then voluntarily repaid, in full, in 2021. Consolidated Appropriations Act of 2021 (the “Consolidated Appropriations Act”) On December 27, 2020, the Consolidated Appropriations Act entered into federal law. The Consolidated Appropriations Act did not have a material impact to the Company’s income tax provision for the year ended December 31, 2021. American Rescue Plan Act of 2021 (“the American Rescue Plan”) On March 11, 2021, the American Rescue Plan entered into federal law. The American Rescue Plan, among other things, included provisions related to the deduction of executive compensation beginning in 2027. The American Rescue Plan had no impact to the Company’s condensed consolidated financial statement for the year ended December 31, 2021.
Inventories		Inventories are valued at the lower of cost or estimated net realizable value, after provision for excess, obsolete or impaired items, which is reviewed and updated on a periodic basis by management. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facility in Italy, cost is determined on a weighted-average basis, which approximates the first-in, first-out (“FIFO”) method. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facilities in Texas and California, standard cost, which approximates actual cost on the FIFO method, is used to value inventory. Standard costs are reviewed by management, at least annually or more often, in the event circumstances indicate a change in cost has occurred.
Property, plant and equipment	. Costs include all expenditures necessary to place the asset in service, generally including freight and sales and use taxes. Property, plant, and equipment includes instrumentation held by customers, which is generally used to facilitate the implantation of the Company’s products. The Company evaluates the useful lives of these assets on an annual basis. Depreciation is computed on a straight-line basis over the useful lives of the assets. Depreciation of leasehold improvements is computed over the shorter of the lease term or the useful life of the asset. Total depreciation expense was $ 19.6 million, $ 20.2 million, and $ 19.3 million for the years ended December 31, 2022, 2021, and 2020, respectively. Expenditures for maintenance and repairs and minor renewals and improvements, which do not extend the lives of the respective assets, are expensed as incurred. All other expenditures for renewals and improvements are capitalized. The assets and related accumulated depreciation are adjusted for property retirements and disposals, with the resulting gain or loss included in earnings. Fully depreciated assets remain in the accounts until retired from service. The Company capitalizes system development costs related to internal-use software during the application development stage. Costs related to preliminary project activities and post-implementation activities are expensed as incurred. Internal-use software is amortized on a straight-line basis over its estimated useful life, which generally ranges from three to seven years . Long-lived assets are evaluated for impairment annually or whenever events or changes in circumstances have occurred that would indicate impairment. For purposes of the evaluation, the Company groups its long-lived assets with other assets and liabilities at the lowest level of identifiable cash flows if the asset does not generate cash flows independent of other assets and liabilities. If the carrying value of the asset or asset group exceeds the undiscounted cash flows expected to result from the use and eventual disposition of the asset group, the Company will write the carrying value down to fair value in the period identified. The Company generally determines fair value of long-lived assets as the present value of estimated future cash flows. In determining the estimated future cash flows associated with the assets, the Company uses estimates and assumptions about future revenue contributions, cost structures, and remaining useful lives of the asset group. The use of alternative assumptions, including estimated cash flows, discount rates, and alternative estimated remaining useful lives could result in different calculations of impairment.
Intangible assets		Intangible assets are recorded at cost, or when acquired as a part of a business combination, at estimated fair value, less accumulated amortization. These assets are amortized on a straight-line basis over the useful lives of the assets, which the Company believes is materially consistent with the pattern of economic benefit provided by the assets.
Goodwill	The Company tests goodwill at least annually for impairment. The Company tests more frequently if indicators are present or changes in circumstances suggest that impairment may exist. These indicators include, among others, declines in sales, earnings or cash flows, or the development of a material adverse change in the business climate. The Company assesses goodwill for impairment at the reporting unit level, which is defined as an operating segment or one level below an operating segment.
Leases	The Company determines if a contractual arrangement qualifies as a lease at inception. The Company’s leases primarily relate to facilities, vehicles, equipment, and certain contract manufacturing agreements. Lease assets represent the Company’s right to use an underlying asset for the lease term, while lease liabilities represent the obligation to make lease payments arising from the lease. Lease assets and liabilities are recognized at the commencement date based on the present value of lease payments over the lease term. As the Company’s leases do not provide an implicit rate, the Company’s incremental borrowing rate is used as a discount rate, based on the information available at the commencement date, in determining the present value of lease payments. Lease assets also include the impact of any prepayments made and are reduced by the impact of any lease incentives. The Company does not recognize lease liabilities or lease assets on the balance sheet for short-term leases (leases with a lease term of twelve months or less as of the commencement date). Rather, any short-term lease payments are recognized as an expense on a straight-line basis over the lease term. The current period short-term lease expense reasonably reflects our short-term lease commitments. For all classifications of leases, the Company combines lease and non-lease components to account for them as a single lease component. Variable lease payments are excluded from the lease liability and recognized in the period in which the obligation is incurred. Additionally, lease terms may include options to extend or terminate the lease when it is reasonably certain that the Company will exercise the option.
Commitments and contingencies	Contingencies policy The Company records accruals for certain outstanding legal proceedings, investigations, or claims when it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. The Company evaluates developments in legal proceedings, investigations, and claims that could affect the amount of any accrual, as well as any developments that would make a loss contingency both probable and reasonably estimable on a quarterly basis. When a loss contingency is not both probable and reasonably estimable, the Company does not accrue the loss. However, if the loss (or an additional loss in excess of the accrual) is at least a reasonable possibility and material, then the Company discloses a reasonable estimate of the possible loss or range of loss, if such reasonable estimate can be made. If the Company cannot make a reasonable estimate of the possible loss, or range of loss, then that is disclosed. In addition, legal fees and other directly related costs are expensed as incurred.
Revenue Recognition	Revenue Recognition The Company accounts for a contract when there is (i) approval and commitment from both parties, (ii) the rights of the parties are identified, (iii) payment terms are identified, (iv) the contract has commercial substance, (v) and collectability of consideration is probable. The Company’s contracts may contain one or more performance obligations. If a contract contains more than one performance obligation, the Company allocates the total transaction price to each of the performance obligations based upon the observable standalone selling price of the promised goods or services underlying each performance obligation. The Company recognizes revenue when control of the promised goods or services is transferred to the customer, which typically occurs at a point in time upon shipment, delivery, or utilization, in an amount that reflects the consideration which the Company expects to be entitled to in exchange for the promised goods or services. The consideration for goods or services reflects any fixed amount stated per the contract and estimates for any variable consideration, such as discounts, to the extent that is it probable that a significant reversal of cumulative revenue recognized will not occur when the uncertainty associated with the variable consideration is resolved. The following sections discuss the Company’s revenue recognition policies by significant product category: Bone Growth Therapies Bone Growth Therapies revenue is largely attributable to the U.S. and is comprised of third-party payor transactions and wholesale revenue. The largest portion of Bone Growth Therapies revenue is derived from third-party payors. This includes commercial insurance carriers, health maintenance organizations, preferred provider organizations, and governmental payors, such as Medicare. Revenue is recognized when the product is fitted to and accepted by the patient and all applicable documents required by the third-party payor have been obtained. Amounts paid by third-party payors are generally based on fixed or allowable reimbursement rates. These revenues are recorded at the expected or preauthorized reimbursement rates, net of any contractual allowances or adjustments. Certain billings are subject to review by the third-party payors and may be subject to adjustment. Wholesale revenue is related to the sale of the Company’s bone growth stimulators directly to durable medical equipment suppliers. Wholesale revenues are typically recognized upon shipment and receipt of a confirming purchase order, which is when the customer obtains control of the promised goods. Biologics Biologics revenue is largely attributable to the U.S. and is primarily related to a collaborative arrangement with MTF, which extends through December 31, 2032. Under this arrangement, the Company markets tissue for bone repair and reconstruction under the brand names Trinity Evolution and Trinity ELITE. Per the terms of the agreement, MTF sources the tissue, processes it to create the allografts, packages, and delivers the tissue to the customer. The Company has exclusive global marketing rights for the Virtuos Lyograft and Trinity ELITE tissue forms, exclusive rights to market FiberFuse Advanced, FiberFuse Strip, and certain other tissues in the U.S., non-exclusive marketing rights for certain other products, and receives marketing fees from MTF based on total sales. MTF is considered the primary obligor in these arrangements; therefore, the Company recognizes marketing service fees on a net basis within net sales upon shipment of the product to the customer and receipt of a confirming purchase order. Spinal Implants and Global Orthopedics Spinal Implants and Global Orthopedics products are distributed world-wide, with U.S. sales largely comprised of commercial sales and international sales derived from both commercial sales and stocking distributor arrangements. Commercial revenue is largely related to the sale of the Company’s Spinal Implants and Global Orthopedics products to hospital customers. The customer obtains control and revenues are recognized when these products have been utilized and a confirming purchase order has been received from the hospital. Other revenues within the Spinal Implants and Global Orthopedics product categories are derived from stocking distributors, who purchase the Company’s products and then re-sell them directly to customers, such as hospitals. For stocking distributor arrangements, it is the Company’s policy to recognize revenue upon shipment and receipt of a confirming purchase order, which is when the distributor obtains control of the promised goods. The transaction price for revenue recognition is estimated based upon the Company’s historical collection experience with the stocking distributor. Product Sales and Marketing Service Fees The table below presents net sales, which includes product sales and marketing service fees, for each of the years ended December 31, 2022, 2021, and 2020. For the year ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Product sales $ 405,437 $ 409,554 $ 353,087 Marketing service fees 55,276 54,925 53,475 Net sales $ 460,713 $ 464,479 $ 406,562 Product sales primarily consists of the sale of Bone Growth Therapies, Spinal Implants, and Global Orthopedics products. Marketing service fees are received from MTF based on total sales of biologics tissues and relates solely to the Biologics product category within the Global Spine reporting segment. Marketing service fees received from MTF were $ 55.3 million, or approximately 98 % of total Biologics revenues, for the year ended December 31, 2022. As MTF is the single supplier for certain allografts in the Company’s Biologics portfolio, derived from deceased donors for their bone grafts and living donors for their amnion grafts, any event or circumstance that would impact MTF’s continued access to donors or the Company’s ability to market these tissues may adversely impact the Company’s financial results. Revenues exclude any value added or other local taxes, intercompany sales, and trade discounts. Shipping and handling costs for products shipped to customers are included in cost of sales, and were $ 4.2 million, $ 3.5 million, and $ 2.4 million for the years ended December 31, 2022, 2021, and 2020, respectively. Accounts receivable and related allowances Payment terms vary by the type and location of the Company’s customers and the products or services offered. The term between invoicing and when payment is due is not significant. T he Company’s allowance for expected credit losses represents the portion of the receivable’s amortized cost basis that an entity does not expect to collect over the receivable’s contractual life, considering past events, current conditions, and reasonable and supportable forecasts of future economic conditions.
Earnings Per Share	The Company uses the two-class method of computing basic EPS due to the existence of non-vested restricted stock awards in certain periods with nonforfeitable rights to dividends or dividend equivalents (referred to as participating securities). Basic EPS is computed using the weighted average number of common shares outstanding during each of the respective years. Diluted EPS is computed using the weighted average number of common and common equivalent shares outstanding during each of the respective years using the more dilutive of either the treasury stock method or two-class method. The difference between basic and diluted shares, if any, largely results from common equivalent shares, which represents the dilutive effect of the assumed exercise of certain outstanding share options, the assumed vesting of restricted stock granted to employees and directors, or the satisfaction of certain necessary conditions for contingently issuable shares (see Note 18).

Significant accounting polici_3

Significant accounting policies (Tables)	12 Months Ended
Significant accounting policies (Tables)	Dec. 31, 2022
Accounting Policies [Abstract]
Schedule of Supplemental Disclosure of Cash Flow Information	Investing activities that did not result in cash receipts or cash payments during the years ended December 31, 2022, 2021, and 2020 consisted of the following, which were not included within cash from investing activities in the Company’s consolidated statements of cash flows: (U.S. Dollars, in thousands) 2022 2021 2020 Supplemental disclosure of cash flow information: Noncash investing activities: Intangible assets acquired in asset acquisitions $ 2,000 $ — $ 1,575 Contingent consideration recognized at acquisition date — — 375

Acquisitions (Tables)

Acquisitions (Tables)	12 Months Ended
Acquisitions (Tables)	Dec. 31, 2022
Business Combinations [Abstract]
Summary of Fair Values of Assets Acquired and Liabilities Assumed	Purchase Price Allocations for Completed Acquisitions Discussed Above (U.S. Dollars, in thousands) FITBONE Assigned Distributor Acquisition Assigned Assets acquired Inventories $ 528 $ — Other long-term assets — — Intangible assets Customer relationships 800 15 years 7,340 5 years Developed technology 4,500 8 years — N/A In-process research and development ("IPR&D") 300 Indefinite — N/A Trade name 600 15 years — N/A Assembled workforce — N/A 235 5 years Total identifiable assets acquired $ 6,728 $ 7,575 Liabilities assumed — — Goodwill 11,272 — Total fair value of consideration transferred $ 18,000 $ 7,575

Inventories (Tables)

Inventories (Tables)	12 Months Ended
Inventories (Tables)	Dec. 31, 2022
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories are valued at the lower of cost or estimated net realizable value, after provision for excess, obsolete or impaired items, which is reviewed and updated on a periodic basis by management. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facility in Italy, cost is determined on a weighted-average basis, which approximates the first-in, first-out (“FIFO”) method. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at the Company's manufacturing facilities in Texas and California, standard cost, which approximates actual cost on the FIFO method, is used to value inventory. Standard costs are reviewed by management, at least annually or more often, in the event circumstances indicate a change in cost has occurred. Work-in-process and finished products include material, labor, and production overhead costs. Field and consignment inventory, which represents immediately saleable finished products inventory that is in the possession of the Company’s independent sales representatives or located at third-party customers, such as distributors and hospitals, is included within finished products. Inventory previously reported as field/consignment inventory has been reclassified to finished products to conform with current period presentation. December 31, (U.S. Dollars, in thousands) 2022 2021 Raw materials $ 17,035 $ 9,589 Work-in-process 19,243 15,096 Finished products 63,872 58,289 Inventories $ 100,150 $ 82,974

Property, plant and equipment (

Property, plant and equipment (Tables)	12 Months Ended
Property, plant and equipment (Tables)	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Schedule of Useful Lives of Assets	The useful lives of these assets are generally as follows: Years Buildings 25 to 33 Plant and equipment 1 to 10 Instrumentation 3 to 4 Computer software 3 to 7 Furniture and fixtures 4 to 8
Schedule of Property, Plant and Equipment	The assets and related accumulated depreciation are adjusted for property retirements and disposals, with the resulting gain or loss included in earnings. Fully depreciated assets remain in the accounts until retired from service. December 31, (U.S. Dollars, in thousands) 2022 2021 Cost Buildings $ 3,867 $ 3,925 Plant and equipment 48,358 50,275 Instrumentation 92,607 100,515 Computer software 40,685 53,200 Furniture and fixtures 7,917 8,307 Construction in progress 4,515 2,597 Finance lease assets 23,276 23,397 Property, plant, and equipment, gross 221,225 242,216 Accumulated depreciation ( 162,996 ) ( 182,964 ) Property, plant, and equipment, net $ 58,229 $ 59,252

Intangible assets (Tables)

Intangible assets (Tables)	12 Months Ended
Intangible assets (Tables)	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	Intangible assets are recorded at cost, or when acquired as a part of a business combination, at estimated fair value, less accumulated amortization. These assets are amortized on a straight-line basis over the useful lives of the assets, which the Company believes is materially consistent with the pattern of economic benefit provided by the assets. December 31, (U.S. Dollars, in thousands) Weighted Average Amortization Period 2022 2021 Cost Patents 10.0 years $ 40,108 $ 44,561 Developed technology 9.8 years 43,699 43,979 IPR&D Indefinite 300 300 Customer relationships 7.8 years 15,572 15,621 License and other 9.3 years 23,295 18,924 Trademarks—finite lived 10.0 years 1,875 1,839 9.3 years 124,849 125,224 Accumulated amortization Patents $ ( 37,506 ) $ ( 41,408 ) Developed technology ( 17,830 ) ( 13,409 ) Customer relationships ( 6,938 ) ( 4,520 ) License and other ( 14,386 ) ( 12,528 ) Trademarks—finite lived ( 801 ) ( 693 ) ( 77,461 ) ( 72,558 ) Intangible assets, net $ 47,388 $ 52,666
Schedule of Future Amortization Expense	Future amortization expense for intangible assets is estimated as follows: (U.S. Dollars, in thousands) Amortization 2023 $ 9,250 2024 8,705 2025 7,692 2026 6,658 2027 6,470 Thereafter 8,313 Total finite-lived intangible assets, net $ 47,088 Indefinite-lived intangible assets, net 300 Intangible assets, net $ 47,388

Goodwill (Tables)

Goodwill (Tables)	12 Months Ended
Goodwill (Tables)	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Net Carrying Amount of Goodwill	The following table presents the net carrying value of goodwill as of December 31, 2022, and 2021, and a rollforward of such balances from December 31, 2021, by reportable segment: (U.S. Dollars, in thousands) December 31, 2021 Impairment Currency Translation Adjustment December 31, 2022 Global Spine $ 71,317 $ — $ — $ 71,317 Global Orthopedics 11,822 ( 692 ) 11,130 Goodwill, gross $ 83,139 $ — $ ( 692 ) $ 82,447 Accumulated impairment loss ( 11,822 ) — 692 ( 11,130 ) Goodwill, net of accumulated impairment losses $ 71,317 $ — $ — $ 71,317

Leases (Tables)

Leases (Tables)	12 Months Ended
Leases (Tables)	Dec. 31, 2022
Leases [Abstract]
Summary of Lease Portfolio	A summary of the Company’s lease portfolio as of December 31, 2022, and 2021, is presented in the table below: (U.S. Dollars, in thousands, except lease term and discount rate) Classification December 31, 2022 December 31, 2021 Assets Operating leases Other long-term assets $ 6,788 $ 3,155 Finance leases Property, plant and equipment, net 17,360 18,600 Total lease assets $ 24,148 $ 21,755 Liabilities Current Operating leases Other current liabilities $ 1,638 $ 1,834 Finance leases Current portion of finance lease liability 652 2,590 Long-term Operating leases Other long-term liabilities 5,376 1,443 Finance leases Long-term portion of finance lease liability 19,239 19,890 Total lease liabilities $ 26,905 $ 25,757 Weighted Average Remaining Lease Term Operating leases 4.5 years 3.3 years Finance leases 17.6 years 17.0 years Weighted Average Discount Rate Operating leases 4.0 % 2.6 % Finance leases 4.4 % 4.2 %
Summary of Components of Lease Costs	The components of lease costs were as follows: (U.S. Dollars, in thousands) For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 For the Year Ended December 31, 2020 Finance lease costs: Amortization of right-of-use assets $ 1,238 $ 2,049 $ 1,766 Interest on finance lease liabilities 890 933 940 Operating lease costs 2,126 2,234 2,235 Short-term lease costs 152 213 230 Variable lease costs 932 815 673 Total lease costs $ 5,338 $ 6,244 $ 5,844
Summary of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases was as follows: (U.S. Dollars, in thousands) For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 For the Year Ended December 31, 2020 Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 3,805 $ 4,627 $ 4,299 Operating cash flows from finance leases 885 907 689 Financing cash flows from finance leases 2,594 537 323 Right-of-use assets obtained in exchange for lease obligations Operating leases 5,603 589 959 Finance leases — 149 1,949
Summary of Remaining Lease Liabilities	A summary of the Company’s remaining lease liabilities as of December 31, 2022, is included below: (U.S. Dollars, in thousands) Operating Finance 2023 $ 1,821 $ 1,508 2024 1,587 1,538 2025 1,497 1,543 2026 1,411 1,562 2027 1,211 1,593 Thereafter 129 21,021 Total undiscounted value of lease liabilities 7,656 28,765 Less: Interest ( 642 ) ( 8,874 ) Present value of lease liabilities $ 7,014 $ 19,891 Current portion of lease liabilities $ 1,638 $ 652 Long-term portion of lease liabilities 5,376 19,239 Total lease liabilities $ 7,014 $ 19,891

Other current liabilities (Tabl

Other current liabilities (Tables)	12 Months Ended
Other current liabilities (Tables)	Dec. 31, 2022
Payables and Accruals [Abstract]
Summary of Other Current Liabilities	December 31, (U.S. Dollars, in thousands) 2022 2021 Accrued expenses $ 9,611 $ 7,151 Salaries, bonuses, commissions, and related taxes payable 18,531 23,552 Accrued distributor commissions 10,483 10,787 Accrued legal and settlement expenses 3,891 3,794 Contingent consideration liability 1,000 17,200 Short-term operating lease liability 1,638 1,834 Non-income taxes payable 6,586 4,655 Accelerated and advance payment program — 4,791 Other payables 3,634 3,017 Other current liabilities $ 55,374 $ 76,781

Fair value measurements and i_2

Fair value measurements and investments (Tables)	12 Months Ended
Fair value measurements and investments (Tables)	Dec. 31, 2022
Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis	The Company’s available for sale debt securities, equity securities, contingent consideration, and deferred compensation plan liabilities are the only financial instruments recorded at fair value on a recurring basis as follows: (U.S. Dollars, in thousands) Balance Level 1 Level 2 Level 3 Assets Neo Medical convertible loan agreement $ 7,140 $ — $ — $ 7,140 Neo Medical preferred equity securities 6,084 — 6,084 — Bone Biologics equity securities — — — — Other investments 1,726 — — 1,726 Total $ 14,950 $ — $ 6,084 $ 8,866 Liabilities Spinal Kinetics contingent consideration — $ — $ — $ — Deferred compensation plan ( 1,515 ) — ( 1,515 ) — Total $ ( 1,515 ) $ — $ ( 1,515 ) $ — (U.S. Dollars, in thousands) Balance Level 1 Level 2 Level 3 Assets Neo Medical convertible loan agreements $ 7,148 $ — $ — $ 7,148 Neo Medical preferred equity securities 5,413 — 5,413 — Bone Biologics equity securities 309 309 — — Other Investments 1,505 — — 1,505 Total $ 14,375 $ 309 $ 5,413 $ 7,148 Liabilities Spinal Kinetics contingent consideration $ ( 17,200 ) $ — $ — $ ( 17,200 ) Deferred compensation plan ( 1,314 ) — ( 1,314 ) — Total $ ( 18,514 ) $ — $ ( 1,314 ) $ ( 17,200 )
Schedule of Reconciliation of Carrying Value of Investments in Equity Securities	The table below presents a reconciliation of the carrying value of the Company’s investment in Neo Medical preferred equity securities for the years ended December 31, 2022, and 2021: (U.S. Dollars, in thousands) 2022 2021 Fair value of Neo Medical preferred equity securities at January 1 $ 5,413 $ 5,000 Conversion of loan into preferred equity securities 671 — Foreign currency remeasurement recognized in other income, net — 77 Unrealized gain recognized in other income (expense), net — 336 Fair value of Neo Medical preferred equity securities at December 31 6,084 5,413 Cumulative unrealized gain on Neo Medical preferred equity securities 413 413 The remaining
Schedule of Changes in Valuation of Securities	The following table presents the changes in fair value recognized for each of the years ended December 31, 2022, 2021, and 2020: (U.S. Dollars, in thousands) 2022 2021 2020 Bone Biologics equity securities at January 1 $ 309 $ — $ 219 Fair value adjustments and impairments recognized in other income (expense), net ( 183 ) 309 ( 219 ) Proceeds from the disposition of equity securities ( 126 ) — — Bone Biologics equity securities at December 31 $ — $ 309 —
Schedule of Reconciliation For Contingent Consideration Measured At Fair Value Using Significant Unobservable Inputs	The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2022 2021 Spinal Kinetics contingent consideration at January 1 $ 17,200 $ 35,400 Decrease in fair value recognized in acquisition-related amortization and remeasurement ( 17,200 ) ( 3,200 ) Payment made — ( 15,000 ) Spinal Kinetics contingent consideration at December 31 — $ 17,200
Fair Value, Inputs, Level 3 [Member]
Schedule of Reconciliation For Convertible Loan Measured At Fair Value Using Significant Unobservable Inputs	The following table provides a reconciliation of the beginning and ending balances of the Convertible Loan(s), measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2022 2021 Fair value of Neo Medical Convertible Loans at January 1 $ 7,148 $ 7,160 Additions — 671 Interest recognized in interest income, net 436 421 Foreign currency remeasurement recognized in other income (expense), net ( 67 ) ( 162 ) Unrealized gain (loss) recognized in other comprehensive income (loss) 294 ( 942 ) Conversion of Additional Convertible Loan into preferred equity securities ( 671 ) — Fair value of Neo Medical Convertible Loan(s) at December 31 7,140 7,148 Amortized cost basis of Neo Medical Convertible Loan(s) at December 31 5,907 6,209
Schedule of Changes in Valuation of Securities	The following table provides quantitative information related to certain key assumptions utilized within the valuation of the Convertible Loan as of December 31, 2022: (U.S. Dollars, in thousands) Fair Value as of December 31, 2022 Unobservable inputs Estimate Neo Medical Convertible Loan $ 7,140 Cost of equity discount rate 18.0 % Implied volatility 73.9 %

Shareholders' equity (Tables)

Shareholders' equity (Tables)	12 Months Ended
Shareholders' equity (Tables)	Dec. 31, 2022
Stockholders' Equity Note [Abstract]
Components of Changes in Accumulated Other Comprehensive Income (Loss)	The components of and changes in accumulated other comprehensive income (loss) are as follows: (U.S. Dollars, in thousands) Currency Neo Medical Convertible Loans Other Investments Accumulated Other Balance at December 31, 2019 $ ( 3,039 ) $ — $ — $ ( 3,039 ) Other comprehensive income 4,872 1,881 — 6,753 Income taxes — ( 462 ) — ( 462 ) Balance at December 31, 2020 $ 1,833 $ 1,419 $ — $ 3,252 Other comprehensive loss ( 2,544 ) ( 942 ) — ( 3,486 ) Income taxes — 234 — 234 Balance at December 31, 2021 $ ( 711 ) $ 711 $ — $ — Other comprehensive income (loss) ( 1,771 ) 294 101 ( 1,376 ) Income taxes — — — — Balance at December 31, 2022 $ ( 2,482 ) $ 1,005 $ 101 $ ( 1,376 )

Revenue recognition and accou_2

Revenue recognition and accounts receivable (Tables)	12 Months Ended
Revenue recognition and accounts receivable (Tables)	Dec. 31, 2022	Dec. 31, 2021
Revenue Recognition And Accounts Receivable [Abstract]
Schedule of Net Sales		The table below presents net sales, which includes product sales and marketing service fees, for each of the years ended December 31, 2022, 2021, and 2020. For the year ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Product sales $ 405,437 $ 409,554 $ 353,087 Marketing service fees 55,276 54,925 53,475 Net sales $ 460,713 $ 464,479 $ 406,562
Allowances for Expected Credit Losses	The following table provides a detail of changes in the Company’s allowance for expected credit losses for the years ended December 31, 2022, and 2021: For the year ended December 31, (U.S. Dollars, in thousands) 2022 2021 Allowance for expected credit losses beginning balance $ 4,944 $ 4,848 Current period provision for expected credit losses 2,095 444 Write-offs charged against the allowance and other ( 450 ) ( 126 ) Effect of changes in foreign exchange rates ( 170 ) ( 222 ) Allowance for expected credit losses ending balance $ 6,419 $ 4,944
Schedule of Changes in Contract Liability	The following table provides a detail of changes in the Company’s contract liability associated with the Accelerated and Advanced Payment Program for the years ended December 31, 2022, and 2021: For the Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 Contract liability beginning balance $ 4,791 $ 13,851 Recoupment recognized in net sales ( 4,791 ) ( 9,060 ) Contract liability ending balance $ — $ 4,791

Business segment information (T

Business segment information (Tables)	12 Months Ended
Business segment information (Tables)	Dec. 31, 2022
Segment Reporting [Abstract]
Schedule of Net Sales by Major Product Category by Reporting Segment	The table below presents net sales by major product category by reporting segment: Year Ended December 31, 2022 2021 2020 (U.S. Dollars, in thousands) Net Sales Percent of Net Sales Percent of Net Sales Percent of Bone Growth Therapies $ 187,247 40.7 % $ 187,448 40.4 % $ 171,396 42.2 % Spinal Implants 109,546 23.8 % 115,094 24.8 % 94,857 23.3 % Biologics 56,381 12.2 % 56,421 12.1 % 55,482 13.6 % Global Spine 353,174 76.7 % 358,963 77.3 % 321,735 79.1 % Global Orthopedics 107,539 23.3 % 105,516 22.7 % 84,827 20.9 % Net sales $ 460,713 100.0 % $ 464,479 100.0 % $ 406,562 100.0 %
Summary of EBITDA by Reporting Segment	The following table presents EBITDA, the primary metric used in managing the Company, by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Global Spine $ 60,649 $ 58,014 $ 63,036 Global Orthopedics ( 4,037 ) 3,374 ( 4,993 ) Corporate ( 44,011 ) ( 31,691 ) ( 25,382 ) Total EBITDA 12,601 29,697 32,661 Depreciation and amortization ( 29,019 ) ( 29,599 ) ( 30,546 ) Goodwill impairment — ( 11,756 ) — Interest expense, net ( 1,288 ) ( 1,837 ) ( 2,483 ) Loss before income taxes $ ( 17,706 ) $ ( 13,495 ) $ ( 368 )
Schedule of Depreciation and Amortization by Reporting Segment	The following table presents depreciation and amortization by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Global Spine $ 18,213 $ 17,548 $ 18,362 Global Orthopedics 6,696 8,233 7,896 Corporate 4,110 3,818 4,288 Total $ 29,019 $ 29,599 $ 30,546
Summary of Net Sales by Geographic Destination	The following data includes net sales by geographic destination: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 U.S. $ 358,843 $ 361,945 $ 327,280 Italy 19,098 20,187 18,733 Germany 11,569 13,716 11,940 United Kingdom 10,171 10,552 7,147 France 10,377 10,475 8,354 Brazil 5,668 5,108 2,347 Others 44,987 42,496 30,761 Net sales $ 460,713 $ 464,479 $ 406,562 The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Global Spine U.S. $ 332,846 $ 337,455 $ 304,595 International 20,328 21,508 17,140 Total Global Spine 353,174 358,963 321,735 Global Orthopedics U.S. $ 25,997 24,490 22,685 International 81,542 81,026 62,142 Total Global Orthopedics 107,539 105,516 84,827 Consolidated U.S. 358,843 361,945 327,280 International 101,870 102,534 79,282 Net sales $ 460,713 $ 464,479 $ 406,562
Summary of Property, Plant and Equipment of Reporting Segments by Geographic Area	The following data includes property, plant, and equipment by geographic area: (U.S. Dollars, in thousands) 2022 2021 U.S. $ 44,802 $ 45,090 Italy 8,535 9,412 Germany 3,115 2,544 United Kingdom 1,149 1,193 Brazil 85 91 Others 543 922 Total $ 58,229 $ 59,252

Acquisition-Related Amortizat_2

Acquisition-Related Amortization and Remeasurement (Tables)	12 Months Ended
Acquisition-Related Amortization and Remeasurement (Tables)	Dec. 31, 2022
Acquisition Related Amortization And Remeasurement [Abstract]
Components of Acquisition-Related Amortization and Remeasurement	Components of acquisition-related amortization and remeasurement for the years ended December 31, 2022, 2021, and 2020, respectively, are as follows: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Changes in fair value of contingent consideration $ ( 17,200 ) $ ( 3,575 ) $ ( 7,300 ) Amortization of acquired intangibles 8,196 7,907 6,801 Acquired IPR&D 1,600 1,500 — Impairment of Global Orthopedics goodwill — 11,756 — Total $ ( 7,404 ) $ 17,588 $ ( 499 )

Share-based compensation (Table

Share-based compensation (Tables)	12 Months Ended
Share-based compensation (Tables)	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Schedule of Share-Based Compensation by Line Item in Consolidated Statements of Income	The following tables present the detail of share-based compensation expense by line item in the consolidated statements of income as well as by award type, for the years ended December 31, 2022, 2021, and 2020: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Cost of sales $ 826 $ 779 $ 705 Sales and marketing 3,865 3,385 3,620 General and administrative 12,917 10,289 10,624 Research and development 835 979 1,258 Total $ 18,443 $ 15,432 $ 16,207 Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 Stock options $ 1,114 $ 1,893 $ 2,571 Time-based restricted stock awards and stock units 9,452 7,437 8,485 Performance-based / Market-based restricted stock units 6,425 4,414 3,509 Stock purchase plan 1,452 1,688 1,642 Total $ 18,443 $ 15,432 $ 16,207
Schedule of Assumptions Used in Determining Fair Value of Stock Options	The fair value of time-based stock options is determined using the Black-Scholes valuation model, with such value recognized as expense over the service period, which is typically four years, net of actual forfeitures. A summary of the Company’s assumptions used in determining the fair value of the stock options granted during each of the years ended December 31, 2022, 2021, and 2020, is shown in the following table. The Company did not grant any time-based stock options in 2022. Year Ended December 31, 2022 2021 2020 Assumptions: Expected term (in years) — 6.0 5.5 Expected volatility — 34.4 % – 34.8 % 30.2 % – 35.1 % Risk free interest rate — 0.83 % – 1.25 % 0.28 % – 1.65 % Dividend yield — — — Weighted average grant date fair value — $ 12.33 $ 8.74
Schedule of Stock Option Plans	Summaries of the status of the Company’s stock option plans as of December 31, 2022, and 2021, and changes during the year ended December 31, 2022, are presented below: Options Weighted Weighted Outstanding at December 31, 2021 1,397,054 $ 39.20 Granted — $ - Exercised ( 575 ) $ 21.78 Forfeited or expired ( 97,088 ) $ 38.14 Outstanding at December 31, 2022 1,299,391 $ 39.29 3.77 Vested and expected to vest at December 31, 2022 1,299,391 $ 39.29 3.77 Exercisable at December 31, 2022 1,040,523 $ 40.70 3.13
Schedule of Changes in Time-Based and Market-Based Restricted Stock Awards and Stock Units	A summary of the status of our time-based and performance-based and/or market-based restricted stock units as of December 31, 2022, and 2021, and changes during the year ended December 31, 2022, are presented below: Time-based Restricted Stock Performance-based and/or Market-based Shares Weighted Shares Weighted Outstanding at December 31, 2021 559,368 $ 40.03 323,081 $ 48.56 Granted 500,222 $ 29.81 255,327 $ 33.57 Vested and settled ( 152,735 ) $ 41.03 — $ — Cancelled ( 59,708 ) $ 34.80 ( 62,176 ) $ 55.70 Outstanding at December 31, 2022 847,147 $ 34.18 516,232 $ 40.29

Income taxes (Tables)

Income taxes (Tables)	12 Months Ended
Income taxes (Tables)	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Schedule of Income (Loss) Before Provision for Income Taxes	Income (loss) before provision for income taxes consisted of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 U.S. $ ( 22,318 ) $ ( 5,987 ) $ 5,556 Non-U.S. 4,612 ( 7,508 ) ( 5,924 ) Income (loss) before income taxes $ ( 17,706 ) $ ( 13,495 ) $ ( 368 )
Schedule of Provision for Income Taxes	The provision for income taxes consists of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2022 2021 2020 U.S. Current $ 1,151 $ ( 607 ) $ ( 15,054 ) Deferred 67 24,292 ( 29 ) 1,218 23,685 ( 15,083 ) Non-U.S. Current 578 1,009 1,382 Deferred 247 190 10,816 825 1,199 12,198 Income tax expense (benefit) $ 2,043 $ 24,884 $ ( 2,885 )
Schedule of Effective Income Tax Rate Reconciliation for Continuing Operations	The differences between the income tax provision at the U.S. federal statutory tax rate and the Company’s effective tax rate for the years ended December 31, 2022, 2021, and 2020, consist of the following: 2022 2021 2020 (U.S. Dollars, in thousands, except percentages) Amount Percent Amount Percent Amount Percent Statutory U.S. federal income tax rate $ ( 3,718 ) 21.0 % $ ( 2,834 ) 21.0 % $ ( 77 ) 21.0 % State taxes, net of U.S. federal benefit ( 1,312 ) 7.4 ( 24 ) 0.2 1,151 ( 312.8 ) Foreign rate differential, including withholding taxes 475 ( 2.7 ) 480 ( 3.6 ) ( 147 ) 39.9 Valuation allowances, net 7,638 ( 43.1 ) 27,819 ( 206.1 ) 14,514 ( 3,944.0 ) Foreign income inclusions, net 1,018 ( 5.7 ) — — — — Research credits ( 750 ) 4.2 ( 537 ) 4.0 ( 982 ) 266.8 Unrecognized tax benefits, net of settlements ( 599 ) 3.4 ( 1,363 ) 10.1 ( 17,321 ) 4,706.8 Equity compensation 1,441 ( 8.1 ) 1,091 ( 8.1 ) 1,657 ( 450.3 ) Executive compensation 697 ( 3.9 ) 456 ( 3.4 ) 375 ( 101.9 ) Contingent consideration ( 3,316 ) 18.7 ( 640 ) 4.7 ( 1,460 ) 396.7 Other, net 469 ( 2.6 ) 436 ( 3.2 ) ( 595 ) 161.8 Income tax expense (benefit) /effective rate $ 2,043 ( 11.5 )% $ 24,884 ( 184.4 )% $ ( 2,885 ) 784.0 %
Schedule of Deferred Tax Assets and Liabilities	The Company’s deferred tax assets and liabilities are as follows: December 31, (U.S. Dollars, in thousands) 2022 2021 Intangible assets and goodwill $ 5,807 $ 5,245 Inventories and related reserves 17,819 17,097 Deferred revenue and cost of goods sold 3,642 3,888 Other accruals and reserves 2,756 3,082 Accrued compensation 8,795 7,784 Provision for expected credit losses 1,253 1,217 Net operating loss and tax credit carryforwards 40,676 42,546 R&D capitalization 4,353 — Lease liabilities 6,440 5,691 Other, net 3,767 852 Total deferred tax assets 95,308 87,402 Valuation allowance ( 83,797 ) ( 76,725 ) Deferred tax asset, net of valuation allowance $ 11,511 $ 10,677 Withholding taxes ( 10 ) ( 10 ) Property, plant, and equipment ( 5,516 ) ( 4,809 ) Right-of-use lease assets ( 5,771 ) ( 5,165 ) Deferred tax liability ( 11,297 ) ( 9,984 ) Net deferred tax assets $ 214 $ 693 Reported as: Deferred income tax assets (classified within other long-term assets) 1,470 1,771 Deferred income tax liabilities (classified within other long-term liabilities) ( 1,256 ) ( 1,078 ) Net deferred tax assets $ 214 $ 693 The Company historically presented deferred income tax assets as a separate and discrete line item on its consolidated balance sheet; however, as the significance of the asset has decreased as a result of the recognition of valuation allowances, the Company has reclassified this balance to be included within other long-term assets. As such, the prior year balance has been reclassified to conform to current period presentation.
Schedule of Gross Unrecognized Tax Benefits (Excluding Interest and Penalties)	A reconciliation of the gross unrecognized tax benefits (excluding interest and penalties) for the years ended December 31, 2022, and 2021, is shown below: (U.S. Dollars, in thousands) 2022 2021 Balance as of January 1, $ 3,462 $ 4,629 Additions for current year tax positions 46 45 Increases for prior year tax positions 16 110 Settlements of prior year tax positions ( 144 ) — Expiration of statutes ( 1,637 ) ( 1,322 ) Balance as of December 31, $ 1,743 $ 3,462

Earnings per share (EPS) (Table

Earnings per share (EPS) (Tables)	12 Months Ended
Earnings per share (EPS) (Tables)	Dec. 31, 2022
Earnings Per Share [Abstract]
Schedule of Reconciliation of Weighted Average Shares Used in the Diluted EPS	The following is a reconciliation of the weighted average shares used in the diluted EPS computations: Year Ended December 31, 2022 2021 2020 Weighted average common shares-basic 20,053,548 19,690,593 19,267,920 Effect of diluted securities: Unexercised stock options and employee stock purchase plan — — 51,951 Unvested time-based restricted stock units — — 71,847 Weighted average common shares-diluted 20,053,548 19,690,593 19,391,718

Subsequent Events (Tables)

Subsequent Events (Tables)	12 Months Ended
Subsequent Events (Tables)	Dec. 31, 2022
Subsequent Events [Abstract]
Schedule of Estimated Fair Value of Consideration Associated with Merger	The total estimated fair value of consideration associated with the Merger as of the acquisition date was comprised of: (U.S. Dollars, in thousands, except shares and price per share) Share Consideration: Orthofix common shares to be issued in exchange for SeaSpine common shares 16,104,854 Orthofix closing price per share as of January 4, 2023 $ 22.76 Estimated fair value of shares issued in exchange for SeaSpine common shares $ 366,546 Estimated fair value of Orthofix stock options and RSUs issued in exchange for outstanding SeaSpine equity awards 11,508 Total estimated fair value of consideration $ 378,054

Business, basis of presentati_2

Business, basis of presentation, COVID-19 update, and CARES Act - Additional Information (Detail) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
	Apr. 30, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Business And Basis Of Presentation [Line Items]
CARES Act of 2020 funds received	$ 13,900	$ (4,791)	$ (9,060)	$ 13,851
CARES Act of 2020 deferred taxes percentage		50%	50%
Deferred tax payments				$ 600
U.S. Department of Health and Human Services [Member]
Business And Basis Of Presentation [Line Items]
CARES Act of 2020 funds received	$ 4,700

Significant Accounting Polici_4

Significant Accounting Policies - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Sep. 30, 2019
Summary Of Significant Accounting Policies [Line Items]
Freezing amount in cash resulted from court pending legal action issued				$ 0.5
Advertising costs	$ 0.5	$ 0.5	$ 0.9
Musculoskeletal Transplant Foundation ("MTF") [Member]
Summary Of Significant Accounting Policies [Line Items]
Expenditures for other research and development	0	0.8	0.8
Neo Medical SA [Member]
Summary Of Significant Accounting Policies [Line Items]
Expenditures for other research and development	0.5	0.6
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Transactional foreign currency gains and (losses), including those generated from intercompany operations	$ (3.3)	$ (4)	3.9
Maximum [Member] \| Neo Medical SA [Member]
Summary Of Significant Accounting Policies [Line Items]
Expenditures for other research and development			$ 0.1

Significant accounting polici_5

Significant accounting policies - Schedule of Supplemental Disclosure of Cash Flow Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2020
Noncash investing activities:
Intangible assets acquired in asset acquisitions	$ 2,000	$ 1,575
Contingent consideration recognized at acquisition date		$ 375

Recently Adopted Accounting S_2

Recently Adopted Accounting Standards and Recently Issued Accounting Pronouncements - Additional Information (Detail) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
	Apr. 30, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Impairment of goodwill			$ 11,756
CARES Act of 2020 funds received	$ 13,900	$ (4,791)	$ (9,060)	$ 13,851
CARES Act of 2020 deferred taxes percentage		50%	50%
Deferred tax payments				$ 600
U.S. Department of Health and Human Services [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
CARES Act of 2020 funds received	$ 4,700
ASU 2017-04 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]		true
Change in Accounting Principle, Accounting Standards Update, Adoption Date		Jan. 01, 2020
Impairment of goodwill			$ 11,800
Accounting Standards Update 2018-13
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]		true
Change in Accounting Principle, Accounting Standards Update, Adoption Date		Jan. 01, 2020
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]		true
Accounting Standards Update 2018-15
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]		true
Change in Accounting Principle, Accounting Standards Update, Adoption Date		Jan. 01, 2020
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]		true
ASU 2020-04 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]		true
Change in Accounting Principle, Accounting Standards Update, Adoption Date		Mar. 12, 2020
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]		true
ASU 2016-13 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]		true
Change in Accounting Principle, Accounting Standards Update, Adoption Date		Jan. 01, 2020
ASU 2019-12 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]		true
Change in Accounting Principle, Accounting Standards Update, Adoption Date		Jan. 01, 2021
ASU 2016-02 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]		true
ASU 2018-02 [Member]
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]		true

Acquisitions - Additional Infor

Acquisitions - Additional Information (Detail) - USD ($) $ in Thousands	1 Months Ended		12 Months Ended
	Jul. 31, 2020	Mar. 31, 2020	Dec. 31, 2020
Business Acquisition [Line Items]
Cash consideration paid for assets acquired			$ 18,000
Wittenstein [Member] \| FITBONE Asset Purchase Agreement [Member]
Business Acquisition [Line Items]
Date of assets purchase agreement		Mar. 31, 2020
Cash consideration paid for assets acquired		$ 18,000
DR Medical, LLC and MedSelect Corporation [Member]
Business Acquisition [Line Items]
Consideration transferred	$ 7,600

Acquisitions - Summary of Fair

Acquisitions - Summary of Fair Values of Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands	1 Months Ended		12 Months Ended
	Jul. 31, 2020	Mar. 31, 2020	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Goodwill			$ 71,317	$ 71,317
Assigned Useful Life			9 years 3 months 18 days
In-Process Research and Development ("IPR&D") [Member]
Business Acquisition [Line Items]
Assigned Useful Life			Indefinite
DR Medical, LLC and MedSelect Corporation [Member]
Business Acquisition [Line Items]
Total identifiable assets acquired	$ 7,575
Total fair value of consideration transferred	7,575
FITBONE Asset Purchase Agreement [Member] \| Wittenstein [Member]
Business Acquisition [Line Items]
Inventories		$ 528
Total identifiable assets acquired		6,728
Goodwill		11,272
Total fair value of consideration transferred		18,000
FITBONE Asset Purchase Agreement [Member] \| Wittenstein [Member] \| In-Process Research and Development ("IPR&D") [Member]
Business Acquisition [Line Items]
Indefinite lived intangible assets, net acquired		$ 300
Assigned Useful Life		Indefinite
Developed Technology [Member]
Business Acquisition [Line Items]
Assigned Useful Life			9 years 9 months 18 days
Developed Technology [Member] \| FITBONE Asset Purchase Agreement [Member] \| Wittenstein [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 4,500
Assigned Useful Life		8 years
Customer Relationships [Member]
Business Acquisition [Line Items]
Assigned Useful Life			7 years 9 months 18 days
Customer Relationships [Member] \| DR Medical, LLC and MedSelect Corporation [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired	$ 7,340
Assigned Useful Life	5 years
Customer Relationships [Member] \| FITBONE Asset Purchase Agreement [Member] \| Wittenstein [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 800
Assigned Useful Life		15 years
Trade name [Member] \| FITBONE Asset Purchase Agreement [Member] \| Wittenstein [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired		$ 600
Assigned Useful Life		15 years
Assembled Workforce [Member] \| DR Medical, LLC and MedSelect Corporation [Member]
Business Acquisition [Line Items]
Finite lived intangible assets, net acquired	$ 235
Assigned Useful Life	5 years

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Inventory Disclosure [Abstract]
Raw materials	$ 17,035	$ 9,589
Work-in-process	19,243	15,096
Finished products	63,872	58,289
Inventories	$ 100,150	$ 82,974

Property, Plant and Equipment -

Property, Plant and Equipment - Schedule of Useful Lives of the Assets (Detail)	12 Months Ended
	Dec. 31, 2022
Minimum [Member] \| Buildings [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	25 years
Minimum [Member] \| Plant and equipment [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	1 year
Minimum [Member] \| Instrumentation [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	3 years
Minimum [Member] \| Computer software [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	3 years
Minimum [Member] \| Furniture and fixtures [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	4 years
Maximum [Member] \| Buildings [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	33 years
Maximum [Member] \| Plant and equipment [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	10 years
Maximum [Member] \| Instrumentation [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	4 years
Maximum [Member] \| Computer software [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	7 years
Maximum [Member] \| Furniture and fixtures [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	8 years

Property, Plant and Equipment_2

Property, Plant and Equipment - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Property Plant And Equipment [Line Items]
Depreciation expense	$ 19.6	$ 20.2	$ 19.3
Internal-use Software [Member] \| Minimum [Member]
Property Plant And Equipment [Line Items]
Estimated useful life	3 years
Internal-use Software [Member] \| Maximum [Member]
Property Plant And Equipment [Line Items]
Estimated useful life	7 years

Property, Plant and Equipment_3

Property, Plant and Equipment - Schedule of Property, Plant and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	$ 221,225	$ 242,216
Accumulated depreciation	(162,996)	(182,964)
Property, plant, and equipment, net	58,229	59,252
Buildings [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	3,867	3,925
Plant and equipment [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	48,358	50,275
Instrumentation [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	92,607	100,515
Computer software [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	40,685	53,200
Furniture and fixtures [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	7,917	8,307
Construction in progress [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	4,515	2,597
Finance lease assets [Member]
Property Plant And Equipment [Line Items]
Property, plant, and equipment, gross	$ 23,276	$ 23,397

Intangible Assets - Schedule of

Intangible Assets - Schedule of Intangible Assets (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 124,849	$ 125,224
Accumulated amortization	(77,461)	(72,558)
Intangible assets, net	$ 47,388	52,666
Weighted Average Amortization Period	9 years 3 months 18 days
Patents [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 40,108	44,561
Accumulated amortization	$ (37,506)	(41,408)
Weighted Average Amortization Period	10 years
Developed Technology [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 43,699	43,979
Accumulated amortization	$ (17,830)	(13,409)
Weighted Average Amortization Period	9 years 9 months 18 days
Customer Relationships [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 15,572	15,621
Accumulated amortization	$ (6,938)	(4,520)
Weighted Average Amortization Period	7 years 9 months 18 days
Licenses and Other [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 23,295	18,924
Accumulated amortization	$ (14,386)	(12,528)
Weighted Average Amortization Period	9 years 3 months 18 days
Trademarks-Finite Lived [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 1,875	1,839
Accumulated amortization	$ (801)	(693)
Weighted Average Amortization Period	10 years
In-Process Research and Development ("IPR&D") [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 300	$ 300
Weighted Average Amortization Period	Indefinite

Intangible Assets - Additional

Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Finite And Indefinite Lived Intangible Assets [Abstract]
Amortization of intangible assets	$ 9.4	$ 9.4	$ 11.2

Intangible Assets - Schedule _2

Intangible Assets - Schedule of Future Amortization Expense (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
2023	$ 9,250
2024	8,705
2025	7,692
2026	6,658
2027	6,470
Thereafter	8,313
Total finite-lived intangible assets, net	47,088
Indefinite-lived intangible assets, net	300
Intangible assets, net	$ 47,388	$ 52,666

Goodwill - Additional Informati

Goodwill - Additional Information (Detail) - USD ($)	12 Months Ended
Goodwill - Additional Information (Detail) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Goodwill [Line Items]
Impairment of goodwill		$ 11,756,000
Global Orthopedics [Member]
Goodwill [Line Items]
Impairment of goodwill		$ 11,756,000
Global Spine [Member]
Goodwill [Line Items]
Impairment of goodwill	$ 0

Goodwill - Schedule of Net Carr

Goodwill - Schedule of Net Carrying Amount of Goodwill (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Goodwill [Line Items]
Goodwill, gross Beginning balance	$ 83,139
Goodwill gross, Foreign Currency Translation Adjustment	(692)
Goodwill, gross Ending balance	82,447
Accumulated impairment loss Beginning balance	(11,822)
Accumulated Impairment loss, Currency Translation Adjustment	692
Accumulated impairment loss Ending balance	(11,130)
Goodwill, net Beginning balance	71,317
Goodwill, net Ending balance	71,317
Global Spine [Member]
Goodwill [Line Items]
Goodwill, gross Beginning balance	71,317
Goodwill, gross Ending balance	71,317
Global Orthopedics [Member]
Goodwill [Line Items]
Goodwill, gross Beginning balance	11,822
Goodwill gross, Foreign Currency Translation Adjustment	(692)
Goodwill, gross Ending balance	$ 11,130

Leases - Summary of Lease Portf

Leases - Summary of Lease Portfolio (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Assets
Operating leases	$ 6,788	$ 3,155
Operating lease, right-of-use asset, statement of financial position [Extensible List]	Other long-term assets	Other long-term assets
Finance leases	$ 17,360	$ 18,600
Finance lease, right-of-use asset, statement of financial position [Extensible List]	Property, plant and equipment net	Property, plant and equipment net
Total lease assets	$ 24,148	$ 21,755
Current
Operating leases	$ 1,638	$ 1,834
Operating lease, liability, current, statement of financial position [Extensible List]	Other current liabilities	Other current liabilities
Finance leases	$ 652	$ 2,590
Long-term
Operating leases	$ 5,376	$ 1,443
Operating lease, liability, noncurrent, statement of financial position [Extensible List]	Other long-term liabilities	Other long-term liabilities
Finance leases	$ 19,239	$ 19,890
Total lease liabilities	$ 26,905	$ 25,757
Weighted Average Remaining Lease Term
Operating leases	4 years 6 months	3 years 3 months 18 days
Finance leases	17 years 7 months 6 days	17 years
Weighted Average Discount Rate
Operating leases	4%	2.60%
Finance leases	4.40%	4.20%

Leases - Summary of Components

Leases - Summary of Components of Lease Costs (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Finance lease costs:
Amortization of right-of-use assets	$ 1,238	$ 2,049	$ 1,766
Interest on finance lease liabilities	890	933	940
Operating lease costs	2,126	2,234	2,235
Short-term lease costs	152	213	230
Variable lease costs	932	815	673
Total lease costs	$ 5,338	$ 6,244	$ 5,844

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 3,805	$ 4,627	$ 4,299
Operating cash flows from finance leases	885	907	689
Financing cash flows from finance leases	2,594	537	323
Right-of-use assets obtained in exchange for lease obligations
Operating leases	$ 5,603	589	959
Finance leases		$ 149	$ 1,949

Leases - Summary of Remaining L

Leases - Summary of Remaining Lease Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Operating Leases
2023	$ 1,821
2024	1,587
2025	1,497
2026	1,411
2027	1,211
Thereafter	129
Total undiscounted value of lease liabilities	7,656
Less: Interest	(642)
Present value of lease liabilities	7,014
Current portion of lease liabilities	1,638	$ 1,834
Long-term portion of lease liabilities	5,376	1,443
Total lease liabilities	7,014
Finance Leases
2022	1,508
2023	1,538
2024	1,543
2025	1,562
2026	1,593
Thereafter	21,021
Total undiscounted value of lease liabilities	28,765
Less: Interest	(8,874)
Present value of lease liabilities	19,891	19,891
Current portion of finance lease liability	652	2,590
Long-term portion of finance lease liability	19,239	19,890
Total lease liabilities	$ 19,891	$ 19,891

Other Current Liabilities - Sum

Other Current Liabilities - Summary of Other Current Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Accrued expenses	$ 9,611	$ 7,151
Salaries, bonuses, commissions and related taxes payable	18,531	23,552
Accrued distributor commissions	10,483	10,787
Accrued legal and settlement expenses	3,891	3,794
Contingent consideration liability	1,000	17,200
Short-term operating lease liability	1,638	1,834
Non-income taxes payable	6,586	4,655
Accelerated and advance payment program		4,791
Other payables	3,634	3,017
Other current liabilities	$ 55,374	$ 76,781

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail)		12 Months Ended
Long-Term Debt - Additional Information (Detail)	Oct. 25, 2019 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Mar. 03, 2023 USD ($)	Jan. 03, 2023 USD ($)	Dec. 31, 2022 EUR (€)	Apr. 30, 2020 USD ($)	Aug. 31, 2015 USD ($)
Debt Instrument [Line Items]
Repayment of borrowings				$ 100,000,000
Debt issuance costs paid		$ 92,000	$ 948,000	1,537,000
Cash paid to interest		1,400,000	1,500,000	1,900,000
Italy [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		5,900,000	6,300,000				€ 5,500,000
Subsequent Event [Member]
Debt Instrument [Line Items]
Amount outstanding under lines of credit					$ 15,000,000	$ 30,000,000
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Amount outstanding under lines of credit								$ 100,000,000
Revolving Credit Facility [Member] \| Subsequent Event [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity						$ 300,000,000
Amended Credit Agreement [Member] \| Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 300,000,000
Credit agreement maturity date	Oct. 25, 2024
Amount outstanding under lines of credit		0	0
Maximum borrowing capacity available for issuance of letters of credit	$ 50,000,000
Maximum additional borrowing capacity	$ 150,000,000
Line of credit facility, percentage of maximum incremental amount on consolidated EBITDA	350%
Borrowers ability to increase amount of line of credit facility, Description	The Borrowers have the ability to increase the amount of the Facility, which increases may take the form of increases to the revolving credit commitments or the issuance of new term A loans, by an aggregate amount of up to the greater of $150.0 million or an incremental amount such that the total amount of the Facility does not exceed 350% of consolidated EBITDA of the Company (as determined for the four fiscal quarter period most recently ended for which financial statements are available), upon satisfaction of customary conditions precedent for such increases or incremental loans and receipt of additional commitments by one or more existing or new lenders.
Line of credit, leverage ratio	3.5
Line of credit, interest coverage ratio	300%
Amended Credit Agreement [Member] \| Revolving Credit Facility [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity available for working capital and other general corporate purposes	$ 150,000,000
Line of credit facility, unused commitment fee percentage	0.25%
Line of credit, leverage ratio	4
Amended Credit Agreement [Member] \| Revolving Credit Facility [Member] \| Maximum [Member] \| LIBOR [Member]
Debt Instrument [Line Items]
Margin on variable rate	2.25%
Amended Credit Agreement [Member] \| Revolving Credit Facility [Member] \| Maximum [Member] \| Base Rate [Member]
Debt Instrument [Line Items]
Margin on variable rate	1.25%
Amended Credit Agreement [Member] \| Revolving Credit Facility [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Line of credit facility, unused commitment fee percentage	0.15%
Amended Credit Agreement [Member] \| Revolving Credit Facility [Member] \| Minimum [Member] \| LIBOR [Member]
Debt Instrument [Line Items]
Margin on variable rate	1.25%
Amended Credit Agreement [Member] \| Revolving Credit Facility [Member] \| Minimum [Member] \| Base Rate [Member]
Debt Instrument [Line Items]
Margin on variable rate	0.25%
2015 Credit Agreement [Member] \| Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity				125,000,000
Debt issuance costs paid		1,500,000
Debt issuance costs capitalized									$ 1,800,000
Debt issuance costs, net of accumulated amortization		700,000	1,000,000
Debt issuance costs amortized or expensed		$ 400,000	$ 400,000	$ 400,000

Fair Value Measurements and I_3

Fair Value Measurements and Investments- Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis (Detail) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 14,950	$ 14,375
Deferred compensation plan, Liabilities	(1,515)	(1,314)
Liabilities fair value, Total	(1,515)	(18,514)
Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration		(17,200)
Convertible Loan Agreements [Member] \| Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	7,140	7,148
Preferred Equity Securities [Member] \| Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,084	5,413
Equity Securities [Member] \| Bone Biologics Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value		309
Other Investments [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,726	1,505
Fair Value, Inputs, Level 1 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value		309
Fair Value, Inputs, Level 1 [Member] \| Equity Securities [Member] \| Bone Biologics Inc [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value		309
Fair Value, Inputs, Level 2 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,084	5,413
Deferred compensation plan, Liabilities	(1,515)	(1,314)
Liabilities fair value, Total	(1,515)	(1,314)
Fair Value, Inputs, Level 2 [Member] \| Preferred Equity Securities [Member] \| Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	6,084	5,413
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	8,866	7,148
Liabilities fair value, Total		(17,200)
Fair Value, Inputs, Level 3 [Member] \| Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration		(17,200)
Fair Value, Inputs, Level 3 [Member] \| Convertible Loan Agreements [Member] \| Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	7,140	7,148
Fair Value, Inputs, Level 3 [Member] \| Other Investments [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 1,726	$ 1,505

Fair Value Measurements and I_4

Fair Value Measurements and Investments - Additional Information (Detail) SFr in Millions		12 Months Ended
	Oct. 01, 2020 USD ($)	Dec. 31, 2021 USD ($)	Apr. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)	Oct. 10, 2021 USD ($)	Oct. 10, 2021 CHF (SFr)	Oct. 01, 2020 CHF (SFr)
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Convertible loans	$ 5,000,000
Maximum [Member] \| Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments			$ 60,000,000
US Food And Drug Administration [Member] \| Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments			15,000,000
Revenue Milestone [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments		$ 15,000,000
Revenue Milestone [Member] \| Spinal Kinetics [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Future milestone payments			$ 45,000,000
Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Convertible loans					$ 700,000	SFr 0.6	SFr 4.6
Convertible loans interest rate	8%						8%
Maturity date	Oct. 01, 2024
Convertible loan credit losses				$ 0
Preferred Stock [Member] \| Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Amount of Preferred stock consideration	$ 5,000,000
Unrealized gain (loss) on equity investments		$ 336,000

Fair Value Measurements and I_5

Fair Value Measurements and Investments - Schedule of Reconciliation of Carrying Value of Investments in Equity Securities (Detail) - Preferred Stock [Member] - Neo Medical [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of equity securities beginning balance	$ 5,413	$ 5,000
Conversion Of Loan Into Preferred Equity Shares	671
Foreign currency remeasurement recognized in other income, net		77
Unrealized gain recognized in other income (expense), net		336
Fair value of equity securities Ending balance	6,084	5,413
Cumulative unrealized gain on Neo Medical preferred equity securities	$ 413	$ 413

Fair Value Measurements and I_6

Fair Value Measurements and Investments - Schedule of Reconciliation For Contingent Consideration Measured At Fair Value Using Significant Unobservable Inputs (Level 3) (Detail) - Neo Medical [Member] - Fair Value, Inputs, Level 3 [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of convertible loans beginning balance	$ 7,148	$ 7,160
Additions		671
Interest recognized in interest income, net	436	421
Foreign currency remeasurement recognized in other income (expense), net	(67)	(162)
Unrealized gain (loss) recognized in other comprehensive income (loss)	294	(942)
Conversion of Additional Convertible Loan into preferred equity securities	(671)
Fair value of convertible loans ending balance	7,140	7,148
Amortized cost basis of Neo Medical Convertible Loans at December 31	$ 5,907	$ 6,209

Fair Value Measurements and I_7

Fair Value Measurements and Investments - Schedule of Valuation Methodology and Unobservable Inputs for Level 3 Assets and Liabilities Measured at Fair Value (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Spinal Kinetics [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Spinal Kinetics contingent consideration at January 1	$ 17,200	$ 35,400
Decrease in fair value recognized in acquisition-related amortization and remeasurement	(17,200)	(3,200)
Payment made		(15,000)
Spinal Kinetics contingent consideration at December 31		$ 17,200
Neo Medical [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Neo Medical Convertible Loans	$ 7,140
Fair value discount rate	18%
Fair value implied volatility	73.90%

Fair Value Measurements and I_8

Fair Value Measurements and Investments - Schedule of Change in Valuation of Securities (Detail) - Bone Biologics Inc [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Equity securities beginning balance	$ 309		$ 219
Fair value adjustments and impairments recognized in other income (expense), net	(183)	$ 309	$ (219)
Proceeds from the disposition of equity securities	$ 126
Equity securities ending balance		$ 309

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
Accrued other long-term liabilities	$ 5.9
Estimated sales and marketing expense (benefit)	$ 1.2	$ 1.2	$ 1.5

Shareholders' Equity - Componen

Shareholders' Equity - Components of Changes in Accumulated Other Comprehensive Income (Loss) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 336,934	$ 356,864	$ 327,631
Ending Balance	336,860	336,934	356,864
Other Investments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Other comprehensive income (loss)	101
Ending Balance	101
Convertible Loan [Member] \| Neo Medical SA [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	711	1,419
Other comprehensive income (loss)	294	(942)	1,881
Income taxes		234	(462)
Ending Balance	1,005	711	1,419
Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(711)	1,833	(3,039)
Other comprehensive income (loss)	(1,771)	(2,544)	4,872
Ending Balance	(2,482)	(711)	1,833
Accumulated Other Comprehensive Income (Loss) [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance		3,252	(3,039)
Other comprehensive income (loss)	(1,376)	(3,486)	6,753
Income taxes		$ 234	(462)
Ending Balance	$ (1,376)		$ 3,252

Revenue Recognition and Accou_3

Revenue Recognition and Accounts Receivable - Schedule of Net Sales (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenue Recognition [Abstract]
Product sales	$ 405,437	$ 409,554	$ 353,087
Marketing service fees	55,276	54,925	53,475
Net sales	$ 460,713	$ 464,479	$ 406,562

Revenue Recognition and Accou_4

Revenue Recognition and Accounts Receivable - Additional Information (Detail) € in Millions	1 Months Ended			12 Months Ended
	Mar. 31, 2022	Apr. 30, 2021	Apr. 30, 2020 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2022 EUR (€)	Dec. 31, 2021 USD ($)	Dec. 31, 2021 EUR (€)	Dec. 31, 2020 USD ($)	Dec. 31, 2020 EUR (€)
Revenue Recognition And Accounts Receivable [Line Items]
Marketing service fees				$ 55,276,000		$ 54,925,000		$ 53,475,000
Cost of sales				123,544,000		114,914,000		101,889,000
Sale of receivables				9,600,000	€ 9.2	9,900,000	€ 8.4	9,600,000	€ 8.3
Related fees recorded as interest expense				300,000		200,000		300,000
CARES Act of 2020 funds received			$ 13,900,000	(4,791,000)		(9,060,000)		13,851,000
Medicare recoupment	0.50	0.25
Contract liability, total						4,791,000		13,851,000
Other Contract Assets [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Other contract assets impairment				0		0
Other Long-Term Assets [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Other contract assets				1,100,000		1,400,000
Shipping and Handling Costs [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Cost of sales				4,200,000		$ 3,500,000		$ 2,400,000
Biologics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Marketing service fees				$ 55,300,000
Marketing service fee as percentage of segment revenues				98%	98%

Revenue Recognition and Accou_5

Revenue Recognition and Accounts Receivable - Schedule of Allowance for Expected Credit Losses (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenue Recognition [Abstract]
Allowance for expected credit losses beginning balance	$ 4,944	$ 4,848
Current period provision for expected credit losses	2,095	444	$ 199
Write-offs charged against the allowance and other	(450)	(126)
Effect of changes in foreign exchange rates	(170)	(222)
Allowance for expected credit losses ending balance	$ 6,419	$ 4,944	$ 4,848

Revenue Recognition and Accou_6

Revenue Recognition and Accounts Receivable - Schedule of Changes In Contract Liability (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Revenue Recognition [Abstract]
Contract liability beginning balance	$ 4,791	$ 13,851
Recoupment recognized in net sales	$ (4,791)	(9,060)
Contract liability ending balance		$ 4,791

Business Segment Information -

Business Segment Information - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2022 Segment
Segment Reporting [Abstract]
Number of reporting segments	2

Business Segment Information _2

Business Segment Information - Schedule of Net Sales by Major Product Category by Reporting Segment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting Information [Line Items]
Net Sales	$ 460,713	$ 464,479	$ 406,562
Percent of Total Net Sales	100%	100%	100%
Bone Growth Therapies [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 187,247	$ 187,448	$ 171,396
Percent of Total Net Sales	40.70%	40.40%	42.20%
Spinal Implants [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 109,546	$ 115,094	$ 94,857
Percent of Total Net Sales	23.80%	24.80%	23.30%
Biologics [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 56,381	$ 56,421	$ 55,482
Percent of Total Net Sales	12.20%	12.10%	13.60%
Global Spine [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 353,174	$ 358,963	$ 321,735
Percent of Total Net Sales	76.70%	77.30%	79.10%
Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 107,539	$ 105,516	$ 84,827
Percent of Total Net Sales	23.30%	22.70%	20.90%

Business Segment Information _3

Business Segment Information - Summary of EBIDTA by Reporting Segment (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting Information [Line Items]
Total EBITDA	$ 12,601,000	$ 29,697,000	$ 32,661,000
Depreciation and amortization	(29,019,000)	(29,599,000)	(30,546,000)
Goodwill, Impairment		(11,756,000)
Interest expense, net	(1,288,000)	(1,837,000)	(2,483,000)
Income (loss) before income taxes	(17,706,000)	(13,495,000)	(368,000)
Global Spine [Member]
Segment Reporting Information [Line Items]
Goodwill, Impairment	0
Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Goodwill, Impairment		(11,756,000)
Operating Segments [Member] \| Global Spine [Member]
Segment Reporting Information [Line Items]
Total EBITDA	60,649,000	58,014,000	63,036,000
Operating Segments [Member] \| Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Total EBITDA	(4,037,000)	3,374,000	(4,993,000)
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Total EBITDA	$ (44,011,000)	$ (31,691,000)	$ (25,382,000)

Business Segment Information _4

Business Segment Information - Schedule of Depreciation and Amortization by Reporting Segment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 29,019	$ 29,599	$ 30,546
Operating Segments [Member] \| Global Spine [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	18,213	17,548	18,362
Operating Segments [Member] \| Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	6,696	8,233	7,896
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 4,110	$ 3,818	$ 4,288

Business Segment Information _5

Business Segment Information - Summary of Net Sales by Geographic Destination (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 460,713	$ 464,479	$ 406,562
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	358,843	361,945	327,280
Italy [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	19,098	20,187	18,733
Germany [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	11,569	13,716	11,940
United Kingdom [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	10,171	10,552	7,147
France [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	10,377	10,475	8,354
Brazil [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	5,668	5,108	2,347
Others [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 44,987	$ 42,496	$ 30,761

Business Segment Information _6

Business Segment Information - Summary of Net Sales by Geographic Destination for Each Reporting Segment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 460,713	$ 464,479	$ 406,562
Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	353,174	358,963	321,735
Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	107,539	105,516	84,827
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	358,843	361,945	327,280
U.S. [Member] \| Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	332,846	337,455	304,595
U.S. [Member] \| Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	25,997	24,490	22,685
International [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	101,870	102,534	79,282
International [Member] \| Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	20,328	21,508	17,140
International [Member] \| Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 81,542	$ 81,026	$ 62,142

Business Segment Information _7

Business Segment Information - Summary of Property, Plant and Equipment of Reporting Segments by Geographic Area (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	$ 58,229	$ 59,252
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	44,802	45,090
Italy [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	8,535	9,412
Germany [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	3,115	2,544
United Kingdom [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	1,149	1,193
Brazil [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	85	91
Others [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	$ 543	$ 922

Acquisition-Related Amortizat_3

Acquisition-Related Amortization and Remeasurement - Components of Acquisition-Related Amortization and Remeasurement (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Research And Development Arrangement Contract To Perform For Others [Line Items]
Changes in fair value of contingent consideration	$ (17,200)	$ (3,575)	$ (7,300)
Amortization of acquired intangibles	8,196	7,907	6,801
Acquired IPR&D	1,600	1,500
Impairment of goodwill		11,756
Total	$ (7,404)	17,588	$ (499)
Global Orthopedics [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Impairment of goodwill		$ 11,756

Acquisition-Related Amortizat_4

Acquisition-Related Amortization and Remeasurement - Additional Information (Details) - USD ($) $ in Millions		1 Months Ended			3 Months Ended
	Dec. 29, 2022	May 31, 2022	Apr. 30, 2021	Feb. 28, 2021	Sep. 30, 2022	Dec. 31, 2022	Jul. 30, 2022
License Agreement [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Upfront payment payable with additional payments							$ 1.4
Upfront payment					$ 1.4
Consideration agreed to pay with additional payments contingent upon reaching future commercialization and revenue-based milestones	$ 0.2
Initial payment accrued						$ 0.2
Contingent Payment Upon Reaching FDA Milestone			$ 4
Amount Received for the year		$ 1.5	$ 0.5
Contingent consideration milestone obligation		$ 3.5
License Agreement [Member] \| Other Current Liabilities [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Contingent consideration accrued						1
License Agreement [Member] \| Other Noncurrent Liabilities [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Contingent consideration accrued						$ 1
Intellectual Property Rights [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Consideration transferred				$ 1
Consideration transferred				$ 9
Maximum [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Royalty percentage on net sales				4%
Maximum [Member] \| Intellectual Property Rights [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Consideration transferred				$ 10
Minimum [Member]
Research And Development Arrangement Contract To Perform For Others [Line Items]
Royalty percentage on net sales				2%

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended	12 Months Ended
	Aug. 31, 2019	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2013
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Options outstanding		1,299,391	1,397,054
Options exercisable		1,040,523
Income tax benefit related to expense		$ 3,300	$ 3,100	$ 3,200
Exercised stock option amount		0
Realized tax benefit amount		$ 0
Closing stock price		$ 20.53
Share-based compensation		$ 18,443	15,432	16,207
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation		$ 12,917	10,289	10,624
Global Spine [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Options outstanding		50,711
Options exercisable		38,033
Share based compensation grants of restricted stock unit	14,743
Global Spine [Member] \| Maximum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Common stock acqure under stock option	50,711
Global Extremities [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Options outstanding		150,000
Global Extremities [Member] \| Maximum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Common stock acqure under stock option					150,000
2012 LTIP Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Award Contractual term		10 years
Amount of shares reserved for issuance		8,375,000
Options outstanding		1,098,680
Options exercisable		852,490
Stock Purchase Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Amount of shares reserved for issuance		2,850,000
Maximum percentage of compensation eligible employees to be deducted for purchase of common stock		25%
Purchase price of shares equivalent to fair market value		85%
Shares issued under stock purchase plan		2,395,673
Stock Purchase Plan [Member] \| Minimum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Percentage of compensation eligible employees to be deducted for purchase of common stock		1%
Restricted Stock Units [Member] \| Global Spine [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unvested restricted stock and stock units outstanding		3,686
Restricted Stock Units [Member] \| 2012 LTIP Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unvested restricted stock and stock units outstanding		1,359,693
Market-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unamortized compensation expense		$ 9,300
Weighted-average period for unamortized compensation cost expected to be recognized		1 year 4 months 24 days
Aggregate intrinsic value of restricted stock outstanding		$ 10,600
Share based compensation, fair market value of restricted stock units vested		0	0	1,400
Stock Option [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unamortized compensation expense		$ 800
Weighted-average period for unamortized compensation cost expected to be recognized		1 year
Total intrinsic value of options exercised		$ 0	600	900
Aggregate intrinsic value of options outstanding		0
Aggregate intrinsic value of options exercisable		0
Share-based compensation		$ 1,114	1,893	2,571
Time-based Restricted Stock Awards and Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share based compensation grants of restricted stock unit		500,222
Unamortized compensation expense		$ 18,600
Weighted-average period for unamortized compensation cost expected to be recognized		2 years 6 months
Vesting period		4 years
Non-vested shares, vested in period		$ 5,200	9,000	6,500
Aggregate intrinsic value of restricted stock outstanding		17,400
Share-based compensation		$ 9,452	$ 7,437	$ 8,485
Restricted Stock Unit with Deferred Delivery (DSUs) [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Vesting period		1 year
Awards vested but not settled			86,542

Share-based Compensation - Sche

Share-based Compensation - Schedule of Share-Based Compensation by Line Item in Consolidated Statements of Income (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 18,443	$ 15,432	$ 16,207
Stock options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,114	1,893	2,571
Time-based Restricted Stock Awards and Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	9,452	7,437	8,485
Performance-based / Market-based restricted stock units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	6,425	4,414	3,509
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,452	1,688	1,642
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	826	779	705
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	3,865	3,385	3,620
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	12,917	10,289	10,624
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 835	$ 979	$ 1,258

Share-based Compensation - Sc_2

Share-based Compensation - Schedule of Assumptions Used in Determining Fair Value of Stock Options Granted (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-Based Compensation Arrangement by Share-Based Payment Award, Fair Value Assumptions and Methodology [Abstract]
Expected term (in years)	6 years	5 years 6 months
Expected volatility, minimum	34.40%	30.20%
Expected volatility, maximum	34.80%	35.10%
Risk free interest rate, minimum	0.83%	0.28%
Risk free interest rate, maximum	1.25%	1.65%
Weighted average grant date fair value	$ 12.33	$ 8.74

Share-based Compensation - Sc_3

Share-based Compensation - Schedule of Stock Option Plans (Detail)	12 Months Ended
	Dec. 31, 2022 $ / shares shares
Share-Based Payment Arrangement [Abstract]
Outstanding at the beginning of the period (in shares) \| shares	1,397,054
Exercised \| shares	(575)
Forfeited or expired \| shares	(97,088)
Outstanding at the end of the period (in shares) \| shares	1,299,391
Vested and expected to vest \| shares	1,299,391
Exercisable (in shares) \| shares	1,040,523
Outstanding at the beginning of the period (in dollars per share) \| $ / shares	$ 39.20
Exercised \| $ / shares	21.78
Forfeited or expired \| $ / shares	38.14
Outstanding at the end of the period (in dollars per share) \| $ / shares	39.29
Vested and expected to vest \| $ / shares	39.29
Exercisable \| $ / shares	$ 40.70
Options outstanding, weighted average remaining contractual term	3 years 9 months 7 days
Options vested and expected, weighted average remaining contractual term	3 years 9 months 7 days
Options exercisable, weighted average remaining contractual term	3 years 1 month 17 days

Share-based Compensation - Sc_4

Share-based Compensation - Schedule of Changes in Time-Based and Market-Based Restricted Stock Awards and Stock Units (Detail)	12 Months Ended
	Dec. 31, 2022 $ / shares shares
Time-based Restricted Stock Awards and Stock Units [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Outstanding at December 31, 2021 \| shares	559,368
Granted (in shares) \| shares	500,222
Vested and settled (in shares) \| shares	(152,735)
Cancelled (in shares) \| shares	(59,708)
Outstanding at December 31, 2022 \| shares	847,147
Outstanding at December 31, 2021 \| $ / shares	$ 40.03
Granted (in dollars per share) \| $ / shares	29.81
Vested and settled (in dollars per share) \| $ / shares	41.03
Cancelled (in dollars per share) \| $ / shares	34.80
Outstanding at December 31, 2022 \| $ / shares	$ 34.18
Preformance based and Market Based Restricted Stock Unit [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Outstanding at December 31, 2021 \| shares	323,081
Granted (in shares) \| shares	255,327
Cancelled (in shares) \| shares	(62,176)
Outstanding at December 31, 2022 \| shares	516,232
Outstanding at December 31, 2021 \| $ / shares	$ 48.56
Granted (in dollars per share) \| $ / shares	33.57
Cancelled (in dollars per share) \| $ / shares	55.70
Outstanding at December 31, 2022 \| $ / shares	$ 40.29

Defined Contribution Plans an_2

Defined Contribution Plans and Deferred Compensation - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Defined Contribution Plan Disclosure [Line Items]
Amount of deferred compensation payable	$ 1.5	$ 1.3
U.S. [Member]
Defined Contribution Plan Disclosure [Line Items]
Employee contribution limit per calendar year (as a percent of compensation)	80%
Employer match of employee contributions of first level of eligible compensation (as a percent)	100%
Percentage of eligible compensation, matched by employer, level one	2%
Employer match of employee contributions of second level of eligible compensation (as a percent)	50%
Percentage of eligible compensation matched by employer, level two	4%
Expenses incurred for contribution plans	$ 3.3	2.8	$ 1.1
Foreign Plan [Member]
Defined Contribution Plan Disclosure [Line Items]
Expenses incurred for contribution plans	$ 1.1	$ 1.2	$ 1.1
Italy [Member]
Defined Contribution Plan Disclosure [Line Items]
Annual deferred compensation provision for leaving indemnity, as a percentage of total commissions earned	4%
Italy [Member] \| Labor Force Concentration Risk [Member] \| National Collective Labor Agreement [Member]
Defined Contribution Plan Disclosure [Line Items]
Number of employees, percentage	21%

Income Taxes - Schedule of Inco

Income Taxes - Schedule of Income (Loss) Before Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
U.S.	$ (22,318)	$ (5,987)	$ 5,556
Non-U.S.	4,612	(7,508)	(5,924)
Income (loss) before income taxes	$ (17,706)	$ (13,495)	$ (368)

Income Taxes - Schedule of Prov

Income Taxes - Schedule of Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
U.S.
Current	$ 1,151	$ (607)	$ (15,054)
Deferred	67	24,292	(29)
Total U.S	1,218	23,685	(15,083)
Non-U.S.
Current	578	1,009	1,382
Deferred	247	190	10,816
Total Non U.S	825	1,199	12,198
Income tax expense (benefit)	$ 2,043	$ 24,884	$ (2,885)

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Income Tax Rate Reconciliation for Continuing Operations (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Statutory U.S. federal income tax rate	$ (3,718)	$ (2,834)	$ (77)
State taxes, net of U.S. federal benefit	(1,312)	(24)	1,151
Foreign rate differential, including withholding taxes	475	480	(147)
Valuation allowances, net	7,638	27,819	14,514
Foreign income inclusions, net	1,018
Research credits	(750)	(537)	(982)
Unrecognized tax benefits, net of settlements	(599)	(1,363)	(17,321)
Equity compensation	1,441	1,091	1,657
Executive compensation	697	456	375
Contingent consideration	(3,316)	(640)	(1,460)
Other, net	469	436	(595)
Income tax expense (benefit)	$ 2,043	$ 24,884	$ (2,885)
Statutory U.S. federal income tax rate	21%	21%	21%
State taxes, net of U.S. federal benefit	7.40%	0.20%	(312.80%)
Foreign rate differential, including withholding taxes	(2.70%)	(3.60%)	39.90%
Valuation allowances, net	43.10%	(206.10%)	(3944.00%)
Foreign income inclusions, net	(5.70%)
Research credits	4.20%	4%	266.80%
Unrecognized tax benefits, net of settlements	3.40%	10.10%	4,706.80%
Equity compensation	(8.10%)	(8.10%)	(450.30%)
Executive compensation	(3.90%)	(3.40%)	(101.90%)
Contingent consideration	18.70%	4.70%	396.70%
Other, net	(2.60%)	(3.20%)	161.80%
Income tax expense (benefit) /effective rate	(11.50%)	(184.40%)	784%

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Components Of Income Tax Expense Benefit [Line Items]
Tax paid (received or refunded) cash	$ (0.9)	$ 4.8	$ 0.5
Net increase in valuation allowance	7.1
Unremitted foreign earnings	$ 27
Minimum percentage of income tax benefit	50%
Gross unrecognized tax benefit	$ 0.7	0.5
Net interest and penalties on unrecognized tax benefits	(0.1)	(0.4)	$ (0.4)
Accrued interest and penalties related to unrecognized tax benefits	0.9	$ 0.8
State [Member]
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	$ 31.1
Operating loss carryforwards, expiration year	2027
State [Member] \| Spinal Kinetics [Member]
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	$ 20.6
Federal [Member]
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	$ 13.3
Operating loss carryforwards, expiration year	2026
Research and development credits	$ 1.7
Foreign Tax Authority
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	$ 120.4

Income Taxes - Schedule of Defe

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Intangible assets and goodwill	$ 5,807	$ 5,245
Inventories and related reserves	17,819	17,097
Deferred revenue and cost of goods sold	3,642	3,888
Other accruals and reserves	2,756	3,082
Accrued compensation	8,795	7,784
Provision for expected credit losses	1,253	1,217
Net operating loss and tax credit carryforwards	40,676	42,546
R&D capitalization	4,353
Lease liabilities	6,440	5,691
Other, net	3,767	852
Total deferred tax assets	95,308	87,402
Valuation allowance	(83,797)	(76,725)
Deferred tax asset, net of valuation allowance	11,511	10,677
Withholding taxes	(10)	(10)
Property, plant, and equipment	(5,516)	(4,809)
Right-of-use lease assets	(5,771)	(5,165)
Deferred tax liability	(11,297)	(9,984)
Net deferred tax assets	214	693
Reported as:
Deferred income taxes (classified within other long-term assets)	1,470	1,771
Deferred income tax liabilities (classified within other long-term liabilities)	(1,256)	(1,078)
Net deferred tax assets	$ 214	$ 693

Income Taxes - Schedule of Gros

Income Taxes - Schedule of Gross Unrecognized Tax Benefits (Excluding Interest and Penalties) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Beginning Balance	$ 3,462	$ 4,629
Additions for current year tax positions	46	45
Increases for prior year tax positions	16	110
Settlements of prior year tax positions	(144)
Expiration of statutes	(1,637)	(1,322)
Ending Balance	$ 1,743	$ 3,462

Earnings Per Share (EPS) - Sche

Earnings Per Share (EPS) - Schedule of Reconciliation of Weighted Average Shares Used in the Diluted EPS (Detail) - shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Earnings Per Share [Line Items]
Weighted average common shares-basic	20,053,548	19,690,593	19,267,920
Effect of diluted securities:
Weighted average common shares-diluted	20,053,548	19,690,593	19,391,718
Stock Options And Employee Stock Purchase Plan [Member]
Effect of diluted securities:
Effect of diluted securities			51,951
Time-Based Restricted Stock Units [Member]
Effect of diluted securities:
Effect of diluted securities			71,847

Earnings Per Share (EPS) - Addi

Earnings Per Share (EPS) - Additional Information (Detail) - shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Restricted Stock and Market Based Equity Units [Member] \| Stock options [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Weighted average outstanding options, awards not included in diluted earnings per share	2,313,226	1,711,323	1,499,630

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) - USD ($)		12 Months Ended
	Oct. 10, 2022	Dec. 31, 2022	Jan. 04, 2023	Jan. 03, 2023
Subsequent Event [Line Items]
Conversion of Stock, Shares Converted	0.4163
Subsequent Event [Member] \| Revolving Credit Facility [Member]
Subsequent Event [Line Items]
Maximum borrowing capacity				$ 300,000,000
Line of credit			$ 15,000,000	$ 30,000,000
SeaSpine Holdings Corporation [Member]
Subsequent Event [Line Items]
Acquisition-related costs		$ 9,300,000
Number of options issued in conversion of awards	1,889,812
Number of time based RSU issued in exchange for equity awards	490,338

Subsequent Events - Schedule of

Subsequent Events - Schedule of Estimated Fair Value of Consideration Associated with Merger (Detail) - SeaSpine Holdings Corporation [Member] $ / shares in Units, $ in Thousands	Oct. 10, 2022 USD ($) $ / shares shares
Business Acquisition [Line Items]
Orthofix common shares to be issued in exchange for SeaSpine common shares \| shares	16,104,854
Orthofix closing price per share as of January 4, 2023 \| $ / shares	$ 22.76
Estimated fair value of shares issued in exchange for SeaSpine common shares	$ 366,546
Estimated fair Value of Stock Options and RSU issued InExchange for Equity Awards	11,508
Total estimated fair value of consideration	$ 378,054