Orthofix Medical (OFIX) 10-Q7 May 242024 Q1 Quarterly reportFinancial data

Company Profile

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
Document and Entity Information - shares	Mar. 31, 2024	May 03, 2024
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q1
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX MEDICAL INC.
Entity Central Index Key	0000884624
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Current Reporting Status	Yes
Entity Common Stock, Shares Outstanding		37,529,256
Entity File Number	0-19961
Entity Tax Identification Number	98-1340767
Entity Address, Address Line One	3451 Plano Parkway
Entity Address, City or Town	Lewisville
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75056
City Area Code	214
Local Phone Number	937-2000
Entity Incorporation, State or Country Code	DE
Title of 12(b) Security	Common stock, $0.10 par value per share
Security Exchange Name	NASDAQ
Entity Interactive Data Current	Yes
Document Quarterly Report	true
Document Transition Report	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Current assets
Cash and cash equivalents	$ 26,964	$ 33,107
Restricted cash	2,500	4,650
Accounts receivable, net of allowances of $8,398 and $7,130, respectively	125,617	128,098
Inventories	219,076	222,166
Prepaid expenses and other current assets	24,821	32,422
Total current assets	398,978	420,443
Property, plant, and equipment, net	158,132	159,060
Intangible assets, net	112,761	117,490
Goodwill	194,934	194,934
Other long-term assets	41,245	33,388
Total assets	906,050	925,315
Current liabilities
Accounts payable	57,147	58,357
Current portion of long-term debt	3,125	1,250
Current portion of finance lease liability	724	708
Other current liabilities	89,625	104,908
Total current liabilities	150,621	165,223
Long-term debt	115,071	93,107
Long-term portion of finance lease liability	18,345	18,532
Other long-term liabilities	51,698	49,723
Total liabilities	335,735	326,585
Contingencies (Note 8)
Shareholders’ equity
Common shares $0.10 par value; 100,000 shares authorized; 37,410 and 37,165 issued and outstanding as of March 31, 2024 and December 31, 2023, respectively	3,741	3,717
Additional paid-in capital	753,398	746,450
Accumulated deficit	(186,164)	(150,144)
Accumulated other comprehensive loss	(660)	(1,293)
Total shareholders’ equity	570,315	598,730
Total liabilities and shareholders’ equity	$ 906,050	$ 925,315

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 8,398	$ 7,130
Common shares, par value	$ 0.1	$ 0.1
Common shares, authorized	100,000,000	100,000,000
Common shares, issued	37,410,000	37,165,000
Common shares, outstanding	37,410,000	37,165,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Income Statement [Abstract]
Net sales	$ 188,608	$ 175,204
Cost of sales	61,366	64,875
Gross profit	127,242	110,329
Sales and marketing	100,043	93,791
General and administrative	31,648	48,811
Research and development	19,492	23,307
Acquisition-related amortization and remeasurement (Note 12)	5,396	4,134
Operating loss	(29,337)	(59,714)
Interest expense, net	(4,558)	(1,289)
Other income (expense), net	(1,274)	676
Loss before income taxes	(35,169)	(60,327)
Income tax expense	(851)	(611)
Net loss	$ (36,020)	$ (60,938)
Net loss per common share:
Basic	$ (0.95)	$ (1.71)
Diluted	$ (0.95)	$ (1.71)
Weighted average number of common shares:
Basic	37,741	35,734
Diluted	37,741	35,734
Other comprehensive loss, before tax
Unrealized [gain (loss)] on debt securities	$ 1,671	$ (63)
Currency translation adjustment	(1,038)	493
Other comprehensive income, before tax	633	430
Other comprehensive income, net of tax	633	430
Comprehensive loss	$ (35,387)	$ (60,508)

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Changes in Shareholders' Equity - USD ($) $ in Thousands	Total	Common Shares [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Beginning Balance at Dec. 31, 2022	$ 336,860	$ 2,016	$ 334,969	$ 1,251	$ (1,376)
Balance, Shares at Dec. 31, 2022		20,162,000
Net loss	(60,938)			(60,938)
Other comprehensive income, net of tax	430				430
Share-based compensation expense	13,020		13,020
Common shares issued in connection with SeaSpine merger, Shares		16,047,000
Common shares issued in connection with SeaSpine merger	376,745	$ 1,605	375,140
Common shares issued, net	(1,958)	$ 26	(1,984)
Common shares issued, net, Shares		254,000
Ending Balance at Mar. 31, 2023	664,159	$ 3,647	721,145	(59,687)	(946)
Balance, Shares at Mar. 31, 2023		36,463,000
Beginning Balance at Dec. 31, 2023	$ 598,730	$ 3,717	746,450	(150,144)	(1,293)
Balance, Shares at Dec. 31, 2023	37,165,000	37,165,000
Net loss	$ (36,020)			(36,020)
Other comprehensive income, net of tax	633				633
Share-based compensation expense	8,800		8,800
Common shares issued, net	(1,828)	$ 24	(1,852)
Common shares issued, net, Shares		245
Ending Balance at Mar. 31, 2024	$ 570,315	$ 3,741	$ 753,398	$ (186,164)	$ (660)
Balance, Shares at Mar. 31, 2024	37,410,000	37,410,000

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Cash flows from operating activities
Net loss	$ (36,020)	$ (60,938)
Adjustments to reconcile net loss to net cash from operating activities
Depreciation and amortization	14,862	12,670
Inventory reserve expenses	6,350	7,412
Amortization of inventory fair value step up	3,047	11,636
Amortization of operating lease assets, debt costs, and other assets	1,478	1,696
Provision for expected credit losses	1,376	208
Deferred income taxes	408	379
Share-based compensation expense	8,800	13,020
Change in valuation of investment securities	314	(207)
Change in fair value of contingent consideration	1,170
Other	944	(383)
Changes in operating assets and liabilities, net of effects of acquisitions
Accounts receivable	813	4,792
Inventories	(6,936)	(16,781)
Prepaid expenses and other current assets	2,749	2,225
Accounts payable	(820)	(3,560)
Other current liabilities	(14,856)	(5,842)
Other long-term assets and liabilities	(2,274)	(347)
Net cash used in operating activities	(18,595)	(34,020)
Cash flows from investing activities
Capital expenditures for property, plant, and equipment	(10,543)	(11,472)
Capital expenditures for intangible assets	(274)	(363)
Cash acquired in the SeaSpine merger		29,419
Other investing activities	(50)	(500)
Net cash provided by (used in) investing activities	(10,867)	17,084
Cash flows from financing activities
Payments related to tax withholdings for share-based compensation	(1,828)	(1,958)
Payments related to finance lease obligation	(172)	(160)
Borrowings under credit facility	40,000	45,000
Repayment of borrowings from credit facility	(15,000)
Payment of debt acquired from SeaSpine merger		(26,899)
Payment of debt issuance costs and other financing activities	(1,547)
Net cash provided by financing activities	21,453	15,983
Effect of exchange rate changes on cash	(284)	221
Net change in cash and cash equivalents	(8,293)	(732)
Cash and cash equivalents at the beginning of period	37,757	50,700
Cash and cash equivalents at the end of period	29,464	49,968
Components of cash and cash equivalents at the end of period
Cash and cash equivalents	26,964	49,968
Restricted cash	2,500
Cash and cash equivalents at the end of period	29,464	$ 49,968
Noncash investing activities - Purchase of intangible assets	$ 50

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Mar. 31, 2024	Mar. 31, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (36,020)	$ (60,938)

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Mar. 31, 2024
Trading Arrangements, by Individual
Title	directors or officers
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Rule 10b5-1 Arrangement Modified	false
Non-Rule 10b5-1 Arrangement Modified	false

Business and basis of presentat

Business and basis of presentation	3 Months Ended
Business and basis of presentation	Mar. 31, 2024
Organization Consolidation And Presentation Of Financial Statements And Unusual Or Infrequent Items Disclosure [Abstract]
Business and basis of presentation	1. Business and basis of presentation Description of the Business Orthofix Medical Inc. (the “Company” or "Orthofix") 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 more than 60 countries worldwide. The Company is headquartered in Lewisville, Texas, where it conducts general business, product development, medical education and manufacturing, and has primary offices in Carlsbad, CA, with a focus on spine and biologics product innovation and surgeon education, and Verona, Italy, with an emphasis on product innovation, production, and medical education for orthopedics. The combined company’s global research and development, commercial, and manufacturing footprint also includes facilities and offices in Irvine, CA, Toronto, Canada, Sunnyvale, CA, Maidenhead, UK, Munich, Germany, Paris, France, and São Paulo, Brazil. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“U.S. GAAP”) for interim financial information and with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. Pursuant to these rules and regulations, certain information and note disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. In the opinion of management, all adjustments (consisting of normal recurring items) considered necessary for a fair statement have been included. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and related notes contained in the Company’s Form 10-K for the year ended December 31, 2023. Operating results for the three months ended March 31, 2024, are not necessarily indicative of the results that may be expected for other interim periods or the year ending December 31, 2024. The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. On an ongoing basis, the Company evaluates its estimates, including those related to revenue recognition; contractual allowances; allowances for expected credit losses; inventories; valuation of intangible assets; goodwill; fair value measurements, including contingent consideration; litigation and contingent liabilities; tax matters; and share-based compensation. Actual results could differ from these estimates.

Recently adopted accounting sta

Recently adopted accounting standards, recently issued accounting pronouncements	3 Months Ended
	Mar. 31, 2024
Accounting Changes and Error Corrections [Abstract]
Recently adopted accounting standards, recently issued accounting pronouncements	2. Recently adopted accounting standards, recently issued accounting pronouncements Adoption of Accounting Standards Update ("ASU") 2022-03 - Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions In June 2022, the Financial Accounting Standards Board ("FASB") issued ASU 2022-03, which 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 and to introduce new disclosure requirements. The Company adopted this standard effective January 1, 2024, on a prospective basis. Adoption of this standard did not have a material impact to the Company's consolidated balance sheet, statements of operations, or cash flows, but did modify the Company's disclosures related to certain investments. Refer to Note 7 for the Company's updated disclosures on investments in equity securities subject to capital sale restrictions. Adoption of ASU 2023-07 - Improvements to Reportable Segment Disclosures In November 2023, the FASB issued ASU 2023-07, which enhances and improves disclosures about operating segment's revenues, measures of profit/loss, and expenses to enable investors to better understand an entity's overall performance and assess potential future cash flows. The amendment requires that an entity disclose (i) significant expenses that are regularly provided to the Chief Operating Decision Maker ("CODM"), (ii) other segment items by reportable segment including a description of its composition, (iii) all annual disclosures required by Topic 280 in interim periods, (iv) additional measures of a segment's profit or loss used by the CODM in assessing segment performance and allocation of resources, and (v) title and position of the CODM and an explanation of how the CODM uses the reported measure(s) of segment profit or loss. The Company adopted this standard effective January 1, 2024, on a prospective basis. Refer to Note 11 for the Company's updated business segment disclosures. Recently Issued Accounting Pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Disclosure Improvements - Codification Amendments in Response to the SEC's Disclosure Update and Simplification Initiative (ASU 2023-06) Adds interim and annual disclosure requirements to a variety of subtopics in the Accounting Standards Codification, including those focusing on accounting changes, earnings per share, debt and repurchase agreements. The guidance will be applied prospectively. The effective date will be the date when the SEC's removal of the related disclosure requirement becomes effective, with early adoption prohibited. Various The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Improvements to Income Tax Disclosures (ASU 2023-09) Enhance the transparency and decision usefulness of income tax disclosures to better assess how an entity’s operations and related tax risks and tax planning and operational opportunities affect its tax rate and January 1, 2025 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Other recently issued ASUs, excluding those ASUs which have already been disclosed as adopted or described above, were assessed and determined not applicable, or are expected to have minimal impact on the Company's condensed consolidated financial statements.

Merger and Acquisitions

Merger and Acquisitions	3 Months Ended
Merger and Acquisitions	Mar. 31, 2024
Business Combinations [Abstract]
Merger and Acquisitions	3. Mergers and acquisitions Merger with SeaSpine On January 5, 2023, the Company and SeaSpine completed an all-stock merger of equals (the "Merger") to create a leading global spine and orthopedics company with highly complementary portfolios of biologics, innovative spinal hardware, bone growth therapies, specialized orthopedic solutions, and a leading surgical navigation system. As a result of the Merger, each share of SeaSpine common stock issued and outstanding immediately prior to the closing of the Merger was converted into the right to receive 0.4163 shares of Orthofix common stock. During the fourth quarter of 2023, the Company finalized its valuation of assets acquired and liabilities assumed. The following table summarizes the fair value of assets acquired and liabilities assumed at the acquisition date: (U.S. Dollars, in thousands) Final Acquisition Date Fair Value Assigned Useful Life Assets acquired: Current assets Cash and cash equivalents $ 29,419 Accounts receivable, net 35,313 Inventories 132,636 Prepaid expenses and other current assets 4,590 Total current assets 201,958 Property, plant, and equipment, net 68,863 Customer relationships 33,100 13 years Developed technology 47,200 6 - 8 years In-process research and development ("IPR&D") 5,750 Indefinite Other long-term assets 20,501 Total identifiable assets acquired $ 377,372 Liabilities assumed : Current liabilities Accounts payable $ 21,602 Other current liabilities 43,521 Total current liabilities 65,123 Long-term borrowings under SeaSpine credit facility 26,298 Other long-term liabilities 32,823 Total liabilities assumed 124,244 Net identifiable assets acquired $ 253,128 Total fair value of consideration transferred 376,745 Residual goodwill $ 123,617 The Company recognized $ 0.1 million and $ 6.5 million in direct acquisition-related costs, which exclude integration-related activities, that were expensed during the three months ended March 31, 2024, and 2023 , respectively. These costs are included in the condensed consolidated statements of operations and comprehensive loss, primarily within general and administrative expenses. The Company's results of operations included $ 70.5 million of net sales and a net loss of $ 14.3 million from SeaSpine for the three months ended March 31, 2024 compared to $ 60.9 million of net sales and a net loss of $ 27.9 million for the three months ended March 31, 2023 in the condensed consolidated statements of operations and comprehensive loss. Due to the completion of the Merger on January 5, 2023, all SeaSpine financial results for fiscal year 2023, except for the first four days of January, were included in the Company's condensed consolidated statement of operations and comprehensive loss. Therefore, the Company did not prepare unaudited pro forma financial information for the three months ended March 31, 2024, and 2023 , on the basis that the Merger was completed on January 1, 2023.

Inventories

Inventories	3 Months Ended
Inventories	Mar. 31, 2024
Inventory Disclosure [Abstract]
Inventories	4. Inventories Inventories were as follows: (U.S. Dollars, in thousands) March 31, December 31, (Unaudited) Raw materials $ 30,903 $ 28,390 Work-in-process 56,193 53,510 Finished products 131,980 140,266 Inventories $ 219,076 $ 222,166

Leases

Leases	3 Months Ended
Leases	Mar. 31, 2024
Leases [Abstract]
Leases	5. Leases A summary of the Company's lease portfolio as of March 31, 2024, and December 31, 2023, is presented in the table below: (U.S. Dollars, in thousands) Classification March 31, December 31, (Unaudited) Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 19,116 $ 19,869 Finance leases Property, plant and equipment, net 16,092 16,345 Total ROU assets $ 35,208 $ 36,214 Lease Liabilities Current Operating leases Other current liabilities $ 3,534 $ 3,477 Finance leases Current portion of finance lease liability 724 708 Long-term Operating leases Other long-term liabilities 16,372 17,125 Finance leases Long-term portion of finance lease liability 18,345 18,532 Total lease liabilities $ 38,975 $ 39,842 Supplemental cash flow information related to leases was as follows: (Unaudited, U.S. Dollars, in thousands) Three Months Ended Three Months Ended Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 2,162 $ 1,674 Operating cash flows from finance leases 210 214 Financing cash flows from finance leases 172 160 ROU assets obtained in exchange for lease obligations Operating leases 462 15,316 Finance leases — —

Long-term debt

Long-term debt	3 Months Ended
Long-term debt	Mar. 31, 2024
Debt Disclosure [Abstract]
Long-term debt	6. Long-term debt The carrying values of the Company's outstanding debt obligations as of March 31, 2024, and December 31, 2023, were as follows: (U.S. Dollars, in thousands) March 31, December 31, (Unaudited) Initial Term Loan and Delayed Draw Term Loan Principal amount $ 125,000 $ 100,000 Unamortized original debt discount ( 4,050 ) ( 4,331 ) Unamortized debt issuance costs and lenders fees ( 2,754 ) ( 1,312 ) Total indebtedness from initial term loan and delayed draw term loan 118,196 94,357 Revolving Credit Facilities Principal amount outstanding — — Total indebtedness outstanding $ 118,196 $ 94,357 Current portion of long-term debt $ 3,125 $ 1,250 Long-term debt 115,071 93,107 Total indebtedness outstanding $ 118,196 $ 94,357 On January 10, 2024, the Company borrowed $ 15.0 million under its senior secured revolving credit facility (the "Revolving Credit Facility") as part of its Financing Agreement with Blue Torch Finance LLC. On March 22, 2024, the secured delayed draw term loan facility (the "Delayed Draw Term Loan") of $ 25.0 million was fully funded and the proceeds were used to repay the $ 15.0 million outstanding under the Revolving Credit Facility. The Financing Agreement contains financial covenants requiring the Company to maintain a minimum level of liquidity at all times, a maximum consolidated leverage ratio (measured on a quarterly basis), and a minimum asset coverage ratio (measured on a monthly basis). As of March 31, 2024, the Company was in compliance with all required financial covenants. On March 15, 2024, the Company entered into Amendment No.1 to the Financing Agreement with Blue Torch Finance LLC (the "First Amendment"). Under the terms of the First Amendment, the parties agreed to reduce the number of business days to submit a notice of borrowing for the Delayed Draw Term Loan, and redefine certain terms within the asset coverage financial covenant. The maturity date remains November 6, 2027, for each of the Initial Term Loan, Delayed Draw Term Loan, and Revolving Credit Facility. As of March 31, 2024 , the Company had no borrowings on its available lines of credit in Italy, which provide up to an aggregate amount of € 5.5 million ($ 5.9 million).

Fair value measurements and inv

Fair value measurements and investments	3 Months Ended
Fair value measurements and investments	Mar. 31, 2024
Fair Value Measurements And Investment Disclosure [Abstract]
Fair value measurements and investments	7. Fair value measurements and investments The fair value measurements of the Company’s financial assets and liabilities measured on a recurring basis were as follows: March 31, December 31, (Unaudited, U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Neo Medical convertible loan agreements $ — $ 8,355 $ — $ 8,355 $ 6,760 Neo Medical preferred equity securities — 4,951 — 4,951 4,951 Other investments — — 1,331 1,331 1,309 Total $ — $ 13,306 $ 1,331 $ 14,637 $ 13,020 Liabilities Lattus contingent consideration $ — $ — ( 9,670 ) $ ( 9,670 ) $ ( 8,500 ) Deferred compensation plan — ( 1,604 ) — ( 1,604 ) ( 1,674 ) Total $ — $ ( 1,604 ) $ ( 9,670 ) $ ( 11,274 ) $ ( 10,174 ) Neo Medical Convertible Loan Agreements and Equity Investment Since October 2020, the Company has held preferred equity securities of Neo Medical SA, a privately held Swiss-based company developing a new generation of products for spinal surgery ("Neo Medical") and a Convertible Loan Agreement, pursuant to which the Company loaned Neo Medical CHF 4.6 million, or $ 5.0 million, at the date of issuance (the “Convertible Loan”). The preferred 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 Company's equity investment with Neo Medical is subject to certain sales restrictions, such as right of first refusal, tag-along provisions, and drag-along provisions. Permitted transfers include (i) sales of shares to an affiliate of such shareholder, (ii) transfer of shares as part of a compensation package offered to employees, or (iii) Neo Medical may repurchase shares at a price no greater than that originally paid by the shareholder. The table below presents a reconciliation of the beginning and ending balances of the Company’s investment in Neo Medical preferred equity securities: (Unaudited, U.S. Dollars, in thousands) 2024 2023 Fair value of Neo Medical preferred equity securities at January 1 $ 4,951 $ 6,084 Conversion of loan into preferred equity securities — — Foreign currency remeasurement recognized in other income (expense), net — — Unrealized loss recognized in other income (expense), net — — Fair value of Neo Medical preferred equity securities at March 31 $ 4,951 $ 6,084 Cumulative unrealized gain (loss) on Neo Medical preferred equity securities $ ( 720 ) $ 413 The Convertible Loan is recorded in other long-term assets as an available for sale debt security as of March 31, 2024. In April 2024, the Company and Neo Medical agreed to convert the Convertible Loan into shares of Neo Medical preferred equity securities, with such conversion occurring on April 19, 2024. As such, the Company estimated the fair value of the Convertible Loan based upon the estimated fair value of equivalent preferred shares as of March 31, 2024. Therefore, as this fair value estimate is based upon a valuation method using observable market inputs, the Company has now classified this investment as a Level 2 financial asset. The following table provides a reconciliation of the beginning and ending balances of the Convertible Loans, which was measured at fair value using significant unobservable inputs in 2023: (Unaudited, U.S. Dollars, in thousands) 2024 2023 Fair value of Neo Medical Convertible Loans at January 1 $ 6,760 $ 7,140 Interest recognized in interest income, net 135 116 Foreign currency remeasurement recognized in other income (expense), net ( 471 ) 61 Unrealized gain (loss) recognized in other comprehensive loss 1,671 ( 137 ) Reversal of expected credit loss recognized in other income (expense), net 260 — Fair value of Neo Medical Convertible Loans at March 31 $ 8,355 $ 7,180 Contractual value of Neo Medical Convertible Loans at January 1 $ 6,683 $ 6,084 Allowance for credit loss recognized in other income (expense), net — — Amortized cost basis of Neo Medical Convertible Loans at March 31 $ 6,683 $ 6,084 Other Investments Other investments represent 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 flow models, requiring the Company to develop its own assumptions. Therefore, the Company has categorized these assets as Level 3 financial assets. As of March 31, 2024, this balance was classified within other current assets. Lattus Contingent Consideration In connection with the Merger, the Company assumed a contingent consideration obligation under a purchase agreement between SeaSpine and Lattus Spine LLC ("Lattus") executed in December 2022. Under the terms of the agreement, the Company may be required to make installment payments at certain dates based on future net sales of certain products (the "Lateral Products"). The estimated fair value of the Lattus contingent consideration is determined using a Monte Carlo simulation and a discounted cash flow model requiring significant inputs which are not observable in the market. The significant inputs include assumptions related to the timing and probability of certain product launch dates, estimated future sales of the products, revenue risk-adjusted discount rate, revenue volatility, and discount rates matched to the timing of payments. The following table provides a reconciliation of the beginning and ending balances for the Lattus contingent consideration measured at estimated fair value using significant unobservable inputs (Level 3): (Unaudited, U.S. Dollars, in thousands) 2024 2023 Lattus contingent consideration estimated fair value at January 1 $ 8,500 $ — Contingent consideration assumed in Merger — 11,500 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement 1,170 — Lattus contingent consideration estimated fair value at March 31 $ 9,670 $ 11,500 The following table provides quantitative information related to certain key assumptions utilized within the valuation as of March 31, 2024: (Unaudited, U.S. Dollars, in thousands) Fair Value as of Unobservable inputs Estimate Lattus Contingent Consideration $ 9,670 Counterparty discount rate 15.0 % - 15.6 % Revenue risk-adjusted discount rate 7.10 % - 7.86 %

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
Commitments and Contingencies	Mar. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	8. Commitments and Contingencies Contingencies policies 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. Arbitration claims with former executives In September 2023, the Company’s Board of Directors terminated the employment of Keith Valentine, John Bostjancic, and Patrick Keran, who had served respectively as the Company’s President and Chief Executive Officer, Chief Financial Officer, and Chief Legal Officer. The Board’s decision followed an investigation conducted by independent outside legal counsel and directed and overseen by the Company’s independent directors. As a result of the investigation, the Board determined that each of these executives engaged in repeated inappropriate and offensive conduct that violated multiple code of conduct requirements and was inconsistent with the Company’s values and culture. The Company notified each of Messrs. Valentine, Bostjancic, and Keran that their respective terminations were being made for “Cause,” as defined in applicable employment-related agreements (including each executive’s respective Change in Control and Severance Agreement, dated June 19, 2023). The Company also notified each of Messrs. Valentine, Bostjancic, and Keran that it did not believe it was required to make any further payments to them, other than payment of salary through September 12, 2023. The Board also requested that Mr. Valentine resign as a director, which he did in October 2023. In January 2024, the Company received written notices of arbitration claims from counsel to Messrs. Valentine, Bostjancic, and Keran. Each of the arbitration claims asserts that the respective former executive was wrongfully terminated for “Cause” because the former executive’s conduct did not meet the contractually applicable definition of “Cause.” The claims seek relief for, among other things, alleged breach of contract, defamation, false light invasion of privacy, deceit, as well as indemnification and advancement for attorneys’ fees. The three former executives seek severance payments, as well as the value of forfeited equity grants, under applicable change in control and severance agreements and further damages as a result of purported defamatory statements. The Company disagrees with many of the assertions contained in the written notices of arbitration claims and intends to vigorously defend the asserted claims. Due in part to the preliminary nature of this matter, the Company currently cannot reasonably estimate a possible loss, or range of loss, that may arise from the arbitration claims. Commitments As a result of the Merger, the Company became party to agreements with certain distributor partners that provide the Company with an option to purchase, and an option for those partners to require the Company to purchase, the distribution business of those partners at specified future dates. At such time, the Company or distributor may (in certain cases, subject to satisfying certain conditions) submit written notice to the other of its intention to exercise its rights and initiate or require the purchase. Upon receipt of the written notice, the Company and the distributor will work in good faith to consummate the purchase. Under these agreements, the purchase price would be paid in shares of the Company's common stock. Based on the closing price of the Company's common stock as of March 31, 2024 , assuming the options under all the relevant agreements were exercised, the estimated total number of shares the Company would issue under these agreements was approximately 1.5 million shares for agreements that must be settled in shares of the Company's stock. The Company has received notification from one such distributor, who has notified the Company of its decision to exercise its buyout option. The Company is currently in negotiations with this distributor in regard to the consummation of the potential acquisition. 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 an expense of $ 0.3 million and $ 0.3 million for the three months ended March 31, 2024, and 2023, respectively. As of March 31, 2024 , the Company has accrued $ 7.7 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.

Accumulated other comprehensive

Accumulated other comprehensive loss	3 Months Ended
Accumulated other comprehensive loss	Mar. 31, 2024
Equity [Abstract]
Accumulated other comprehensive loss	9. Accumulated other comprehensive loss The components of and changes in accumulated other comprehensive loss were as follows: (Unaudited, U.S. Dollars, in thousands) Currency Neo Medical Convertible Loans Other Investments Accumulated Other Balance at December 31, 2023 $ ( 1,065 ) $ ( 228 ) $ — $ ( 1,293 ) Other comprehensive income (loss) ( 1,038 ) 1,671 — 633 Income taxes — — — — Balance at March 31, 2024 $ ( 2,103 ) $ 1,443 $ — $ ( 660 )

Revenue recognition and account

Revenue recognition and accounts receivable	3 Months Ended
Revenue recognition and accounts receivable	Mar. 31, 2024
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	10. Revenue recognition and accounts receivable Revenue Recognition The Company has two reporting segments: Global Spine and Global Orthopedics. Within the Global Spine reporting segment, there are two product categories: (i) Bone Growth Therapies, and (ii) Spinal Implants, Biologics, and Enabling Technologies. The table below presents net sales by major product category by reporting segment: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 52,477 $ 47,714 10.0 % Spinal Implants, Biologics, and Enabling Technologies 108,816 101,492 7.2 % Global Spine 161,293 149,206 8.1 % Global Orthopedics 27,315 25,998 5.1 % Net sales $ 188,608 $ 175,204 7.7 % Product Sales and Marketing Service Fees The table below presents product sales and marketing service fees, which are both components of net sales: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Product sales $ 175,831 $ 162,248 Marketing service fees 12,777 12,956 Net sales $ 188,608 $ 175,204 Product sales primarily consist of the sale of bone growth therapies devices, spinal implants, certain biologics, enabling technologies, and orthopedics products. Marketing service fees are received from MTF Biologics based on total sales of biologics tissues sourced from MTF Biologics and relate solely to the Global Spine reporting segment. The Company partners with MTF Biologics to provide certain allograft solutions (HCT/Ps) for various spine, orthopedic and other bone repair needs, with this partnership allowing us to exclusively market certain biologic offerings. Accounts receivable and related allowances The following table provides a detail of changes in the Company’s allowance for expected credit losses for the three months ended March 31, 2024 and 2023: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Allowance for expected credit losses beginning balance $ 7,130 $ 6,419 Addition resulting from the Merger with SeaSpine — 137 Current period provision for expected credit losses 1,376 208 Write-offs charged against the allowance and other ( 19 ) ( 126 ) Effect of changes in foreign exchange rates ( 89 ) 53 Allowance for expected credit losses ending balance $ 8,398 $ 6,691

Business segment information

Business segment information	3 Months Ended
Business segment information	Mar. 31, 2024
Segment Reporting [Abstract]
Business segment information	11. Business segment information The Company's operations are 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 the CODM, reviews financial information and makes resource allocation decisions among businesses. The primary metric used by the CODM in managing the Company is adjusted earnings before interest, tax, depreciation, and amortization (“adjusted EBITDA”, a non-GAAP financial measure). Adjusted EBITDA represents earnings before interest income (expense), income taxes, depreciation, and amortization, and excludes the impact of share-based compensation, gains and losses related to changes in foreign exchange rates, charges related to the SeaSpine merger and other strategic investments, acquisition-related fair value adjustments, gains and/or losses on investments, litigation and investigation charges, charges related to initial compliance with regulations set forth by the European Union Medical Device Regulation, and succession charges. Corporate activities are comprised of operating expenses not directly identifiable within the two reporting segments, such as human resources, finance, legal, and information technology functions. The Company neither discretely allocates assets, other than goodwill, to its operating segments nor evaluates the operating segments using discrete asset information. Global Spine The Global Spine reporting segment offers two primary product categories: (i) Bone Growth Therapies and (ii) Spinal Implants, Biologics, and Enabling Technologies. The Bone Growth Therapies product category manufactures, distributes, sells, and provides support services for market leading devices used adjunctively in high-risk spinal fusion procedures and to treat both nonunion and acute fractures in the orthopedic space. 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 acute and nonunion fractures. This product category uses distributors and a direct sales channel to sell its devices to hospitals, healthcare providers, and patients, in the U.S. Spinal Implants, Biologics, and Enabling Technologies is comprised of (i) a broad portfolio of spine fixation and motion preservation implant products used in surgical procedures of the spine, (ii) one of the most comprehensive biologics portfolios in both the demineralized bone matrix and cellular allograft market segments, and (iii) image-guided surgical solutions to facilitate degenerative, minimally invasive, and complex surgical procedures. Spinal Implants, Biologics, and Enabling Technologies products are sold through a network of distributors and sales representatives to hospitals and healthcare providers on a global basis for Spinal Implants and Enabling Technologies, and primarily within the U.S. for Biologics. Global Orthopedics The Global Orthopedics reporting segment offers products and solutions for limb deformity correction and complex limb reconstruction with a focus on use in trauma, adult and pediatric limb reconstruction, and foot and ankle procedures. This reporting segment specializes in the design, development, and marketing of external and internal fixation orthopedic products that are coupled with enabling digital technologies to serve the complete patient treatment pathway. We sell these products through a global network of distributors and sales representatives to hospitals, healthcare organizations, 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: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 52,477 $ 47,714 10.0 % Spinal Implants, Biologics, and Enabling Technologies 108,816 101,492 7.2 % Global Spine 161,293 149,206 8.1 % Global Orthopedics 27,315 25,998 5.1 % Net sales $ 188,608 $ 175,204 7.7 % The following table presents adjusted EBITDA, the primary metric used in managing the Company, by reporting segment: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Adjusted EBITDA by reporting segment Global Spine $ 19,890 $ 14,981 Global Orthopedics ( 1,492 ) 44 Corporate ( 10,733 ) ( 11,821 ) Consolidated adjusted EBITDA $ 7,665 $ 3,204 Reconciling items: Interest expense, net $ 4,558 $ 1,289 Depreciation and amortization 14,862 12,670 Share-based compensation expense 8,800 13,020 Foreign exchange impact 1,588 ( 583 ) SeaSpine merger-related costs 4,520 20,740 Strategic investments 120 661 Acquisition-related fair value adjustments 4,217 11,636 Interest and loss on investments ( 260 ) — Litigation and investigation costs 2,260 469 Succession charges 2,210 — Medical device regulation — 3,629 All other ( 41 ) — Loss before income taxes $ ( 35,169 ) $ ( 60,327 ) The following table presents depreciation and amortization by reporting segment: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Global Spine $ 11,929 $ 9,599 Global Orthopedics 2,207 1,629 Corporate 726 1,442 Total $ 14,862 $ 12,670 Geographical information The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Three Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 Global Spine U.S. $ 151,865 $ 139,457 International 9,428 9,749 Total Global Spine 161,293 149,206 Global Orthopedics U.S. 8,154 6,636 International 19,161 19,362 Total Global Orthopedics 27,315 25,998 Consolidated U.S. 160,019 146,093 International 28,589 29,111 Net sales $ 188,608 $ 175,204 The following data includes property, plant, and equipment by geographic area: (U.S. Dollars, in thousands) March 31, December 31, (Unaudited) U.S. $ 142,355 $ 142,727 Italy 10,033 10,187 Germany 2,620 3,030 Others 3,124 3,116 Total $ 158,132 $ 159,060

Acquisition-Related Amortizatio

Acquisition-Related Amortization and Remeasurement	3 Months Ended
Acquisition-Related Amortization and Remeasurement	Mar. 31, 2024
Acquisition Related Amortization And Remeasurement [Abstract]
Acquisition-Related Amortization and Remeasurement	12. Acquisition-related amortization and remeasurement Acquisition-related amortization and remeasurement consists of (i) amortization related to intangible assets acquired through business combinations or asset acquisitions and (ii) remeasurement of any related contingent consideration arrangements, which are recognized immediately upon acquisition. Components of acquisition-related amortization and remeasurement are as follows: Three Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 Amortization of acquired intangibles $ 4,226 $ 4,134 Changes in fair value of contingent consideration 1,170 — Total $ 5,396 $ 4,134

Share-based compensation

Share-based compensation	3 Months Ended
Share-based compensation	Mar. 31, 2024
Share-Based Payment Arrangement [Abstract]
Share-based compensation	13. Share-based compensation Components of share-based compensation expense are as follows: Three Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 Cost of sales $ 576 $ 471 Sales and marketing 1,667 2,249 General and administrative 5,548 9,104 Research and development 1,009 1,196 Total $ 8,800 $ 13,020 Three Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 Stock options $ 1,118 $ 2,756 Market-based stock options 327 — Time-based restricted stock awards and units 5,873 9,846 Market-based / performance-based restricted stock units 838 — Stock purchase plan 644 418 Total $ 8,800 $ 13,020 Pursuant to the Merger Agreement, the equity awards of SeaSpine (including stock options and restricted stock units) outstanding as of immediately prior to the closing of the Merger were converted into equity awards denominated in shares of Orthofix common stock. The Company issued options to purchase 1.9 million shares of Orthofix common stock and 0.5 million shares of time-based vesting restricted stock in connection with the conversion of such awards. The estimated fair value of the portion of the SeaSpine equity awards for which the required service period had been completed at the time of the closing of the Merger was treated as purchase consideration. The remaining estimated fair value is recorded as compensation expense over the remainder of the service period associated with the awards. During the three months ended March 31, 2024, and 2023 , the Company issued 0.2 million and 0.3 million shares, respectively, of common stock related to stock purchase plan issuances, stock option exercises, and the vesting of restricted stock awards and units. Inducement plans During 2024, the Company appointed a new President and Chief Executive Officer, Chief Financial Officer, Chief People & Business Operations Officer, and Chief Legal Officer. As an inducement to accept employment with the Company, the individuals were awarded grants of (i) stock options, (ii) time-based restricted stock units, (iii) time-based cliff vesting restricted stock units, and (iv) performance stock units, valued in the aggregate across all award types at approximately $ 14.9 million.

Income taxes

Income taxes	3 Months Ended
Income taxes	Mar. 31, 2024
Income Tax Disclosure [Abstract]
Income taxes	14. Income taxes Generally, income tax provisions for interim periods are based on an estimated annual income tax rate, adjusted for discrete tax items, with any changes affecting the estimated annual effective tax rate recorded in the interim period in which the change occurs. Due to the impact of losses not benefited by the Company’s U.S. and Italian operations, the Company determined the estimated annual effective tax rate method would not provide a reliable estimate of the Company’s overall annual effective tax rate. As such, the Company has calculated the tax provision using the actual effective rate for the three months ended March 31, 2024. Due to the impact of temporary differences on the U.S. current tax liability without any deferred tax benefit, the actual effective rate may vary in future quarters. For the three months ended March 31, 2024, and 2023, the effective tax rate was ( 2.4 %) and ( 1.0 %) , respectively. The primary factors affecting the Company’s effective tax rate for the three months ended March 31, 2024 , were certain losses not benefited and tax amortization on certain acquired intangibles.

Earnings per share ("EPS")

Earnings per share ("EPS")	3 Months Ended
Earnings per share ("EPS")	Mar. 31, 2024
Earnings Per Share [Abstract]
Earnings per share ("EPS")	15. Earnings per share (“EPS”) For the three months ended March 31, 2024, and 2023 , no adjustments were made to net income for purposes of calculating basic and diluted EPS. The following is a reconciliation of the weighted average shares used in diluted EPS computations. Three Months Ended (Unaudited, In thousands) 2024 2023 Weighted average common shares-basic 37,741 35,734 Effect of dilutive securities Unexercised stock options and stock purchase plan — — Unvested restricted stock units — — Weighted average common shares-diluted 37,741 35,734 There were 6.7 million and 7 .2 million weighted average outstanding stock options and restricted stock units not included in the diluted EPS computation for the three months ended March 31, 2024, and 2023 , respectively, because inclusion of these awards was anti-dilutive.

Recently adopted accounting s_2

Recently adopted accounting standards, recently issued accounting pronouncements (Policies)	3 Months Ended
	Mar. 31, 2024
Accounting Changes and Error Corrections [Abstract]
Recently adopted accounting standards and recently issued accounting pronouncements	Recently Issued Accounting Pronouncements Topic Description of Guidance Effective Date Status of Company's Evaluation Disclosure Improvements - Codification Amendments in Response to the SEC's Disclosure Update and Simplification Initiative (ASU 2023-06) Adds interim and annual disclosure requirements to a variety of subtopics in the Accounting Standards Codification, including those focusing on accounting changes, earnings per share, debt and repurchase agreements. The guidance will be applied prospectively. The effective date will be the date when the SEC's removal of the related disclosure requirement becomes effective, with early adoption prohibited. Various The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Improvements to Income Tax Disclosures (ASU 2023-09) Enhance the transparency and decision usefulness of income tax disclosures to better assess how an entity’s operations and related tax risks and tax planning and operational opportunities affect its tax rate and January 1, 2025 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Other recently issued ASUs, excluding those ASUs which have already been disclosed as adopted or described above, were assessed and determined not applicable, or are expected to have minimal impact on the Company's condensed consolidated financial statements.

Merger and Acquisitions (Tables

Merger and Acquisitions (Tables)	3 Months Ended
Merger and Acquisitions (Tables)	Mar. 31, 2024
Business Combinations [Abstract]
Summary of Estimated Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the fair value of assets acquired and liabilities assumed at the acquisition date: (U.S. Dollars, in thousands) Final Acquisition Date Fair Value Assigned Useful Life Assets acquired: Current assets Cash and cash equivalents $ 29,419 Accounts receivable, net 35,313 Inventories 132,636 Prepaid expenses and other current assets 4,590 Total current assets 201,958 Property, plant, and equipment, net 68,863 Customer relationships 33,100 13 years Developed technology 47,200 6 - 8 years In-process research and development ("IPR&D") 5,750 Indefinite Other long-term assets 20,501 Total identifiable assets acquired $ 377,372 Liabilities assumed : Current liabilities Accounts payable $ 21,602 Other current liabilities 43,521 Total current liabilities 65,123 Long-term borrowings under SeaSpine credit facility 26,298 Other long-term liabilities 32,823 Total liabilities assumed 124,244 Net identifiable assets acquired $ 253,128 Total fair value of consideration transferred 376,745 Residual goodwill $ 123,617

Inventories (Tables)

Inventories (Tables)	3 Months Ended
Inventories (Tables)	Mar. 31, 2024
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories were as follows: (U.S. Dollars, in thousands) March 31, December 31, (Unaudited) Raw materials $ 30,903 $ 28,390 Work-in-process 56,193 53,510 Finished products 131,980 140,266 Inventories $ 219,076 $ 222,166

Leases (Tables)

Leases (Tables)	3 Months Ended
Leases (Tables)	Mar. 31, 2024
Leases [Abstract]
Summary of Lease Portfolio	A summary of the Company's lease portfolio as of March 31, 2024, and December 31, 2023, is presented in the table below: (U.S. Dollars, in thousands) Classification March 31, December 31, (Unaudited) Right-of-use assets ("ROU assets") Operating leases Other long-term assets $ 19,116 $ 19,869 Finance leases Property, plant and equipment, net 16,092 16,345 Total ROU assets $ 35,208 $ 36,214 Lease Liabilities Current Operating leases Other current liabilities $ 3,534 $ 3,477 Finance leases Current portion of finance lease liability 724 708 Long-term Operating leases Other long-term liabilities 16,372 17,125 Finance leases Long-term portion of finance lease liability 18,345 18,532 Total lease liabilities $ 38,975 $ 39,842
Summary of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases was as follows: (Unaudited, U.S. Dollars, in thousands) Three Months Ended Three Months Ended Cash paid for amounts included in the measurement of lease liabilities Operating cash flows from operating leases $ 2,162 $ 1,674 Operating cash flows from finance leases 210 214 Financing cash flows from finance leases 172 160 ROU assets obtained in exchange for lease obligations Operating leases 462 15,316 Finance leases — —

Long-term debt (Tables)

Long-term debt (Tables)	3 Months Ended
Long-term debt (Tables)	Mar. 31, 2024
Debt Disclosure [Abstract]
Summary of Carrying Values of Outstanding Debt Obligations	The carrying values of the Company's outstanding debt obligations as of March 31, 2024, and December 31, 2023, were as follows: (U.S. Dollars, in thousands) March 31, December 31, (Unaudited) Initial Term Loan and Delayed Draw Term Loan Principal amount $ 125,000 $ 100,000 Unamortized original debt discount ( 4,050 ) ( 4,331 ) Unamortized debt issuance costs and lenders fees ( 2,754 ) ( 1,312 ) Total indebtedness from initial term loan and delayed draw term loan 118,196 94,357 Revolving Credit Facilities Principal amount outstanding — — Total indebtedness outstanding $ 118,196 $ 94,357 Current portion of long-term debt $ 3,125 $ 1,250 Long-term debt 115,071 93,107 Total indebtedness outstanding $ 118,196 $ 94,357

Fair value measurements and i_2

Fair value measurements and investments (Tables)	3 Months Ended
Fair value measurements and investments (Tables)	Mar. 31, 2024
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis	The fair value measurements of the Company’s financial assets and liabilities measured on a recurring basis were as follows: March 31, December 31, (Unaudited, U.S. Dollars, in thousands) Level 1 Level 2 Level 3 Total Total Assets Neo Medical convertible loan agreements $ — $ 8,355 $ — $ 8,355 $ 6,760 Neo Medical preferred equity securities — 4,951 — 4,951 4,951 Other investments — — 1,331 1,331 1,309 Total $ — $ 13,306 $ 1,331 $ 14,637 $ 13,020 Liabilities Lattus contingent consideration $ — $ — ( 9,670 ) $ ( 9,670 ) $ ( 8,500 ) Deferred compensation plan — ( 1,604 ) — ( 1,604 ) ( 1,674 ) Total $ — $ ( 1,604 ) $ ( 9,670 ) $ ( 11,274 ) $ ( 10,174 )
Schedule of Reconciliation of Investments in Equity Securities	The table below presents a reconciliation of the beginning and ending balances of the Company’s investment in Neo Medical preferred equity securities: (Unaudited, U.S. Dollars, in thousands) 2024 2023 Fair value of Neo Medical preferred equity securities at January 1 $ 4,951 $ 6,084 Conversion of loan into preferred equity securities — — Foreign currency remeasurement recognized in other income (expense), net — — Unrealized loss recognized in other income (expense), net — — Fair value of Neo Medical preferred equity securities at March 31 $ 4,951 $ 6,084 Cumulative unrealized gain (loss) on Neo Medical preferred equity securities $ ( 720 ) $ 413
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 Lattus contingent consideration measured at estimated fair value using significant unobservable inputs (Level 3): (Unaudited, U.S. Dollars, in thousands) 2024 2023 Lattus contingent consideration estimated fair value at January 1 $ 8,500 $ — Contingent consideration assumed in Merger — 11,500 Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement 1,170 — Lattus contingent consideration estimated fair value at March 31 $ 9,670 $ 11,500
Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Schedule of Reconciliation For Convertible Loans Measured At Fair Value Using Significant Unobservable Inputs	(Unaudited, U.S. Dollars, in thousands) 2024 2023 Fair value of Neo Medical Convertible Loans at January 1 $ 6,760 $ 7,140 Interest recognized in interest income, net 135 116 Foreign currency remeasurement recognized in other income (expense), net ( 471 ) 61 Unrealized gain (loss) recognized in other comprehensive loss 1,671 ( 137 ) Reversal of expected credit loss recognized in other income (expense), net 260 — Fair value of Neo Medical Convertible Loans at March 31 $ 8,355 $ 7,180 Contractual value of Neo Medical Convertible Loans at January 1 $ 6,683 $ 6,084 Allowance for credit loss recognized in other income (expense), net — — Amortized cost basis of Neo Medical Convertible Loans at March 31 $ 6,683 $ 6,084
Schedule of Changes in Valuation of Securities	The following table provides quantitative information related to certain key assumptions utilized within the valuation as of March 31, 2024: (Unaudited, U.S. Dollars, in thousands) Fair Value as of Unobservable inputs Estimate Lattus Contingent Consideration $ 9,670 Counterparty discount rate 15.0 % - 15.6 % Revenue risk-adjusted discount rate 7.10 % - 7.86 %

Accumulated other comprehensi_2

Accumulated other comprehensive loss (Tables)	3 Months Ended
Accumulated other comprehensive loss (Tables)	Mar. 31, 2024
Equity [Abstract]
Components of Changes in Accumulated Other Comprehensive Loss	The components of and changes in accumulated other comprehensive loss were as follows: (Unaudited, U.S. Dollars, in thousands) Currency Neo Medical Convertible Loans Other Investments Accumulated Other Balance at December 31, 2023 $ ( 1,065 ) $ ( 228 ) $ — $ ( 1,293 ) Other comprehensive income (loss) ( 1,038 ) 1,671 — 633 Income taxes — — — — Balance at March 31, 2024 $ ( 2,103 ) $ 1,443 $ — $ ( 660 )

Revenue recognition and accou_2

Revenue recognition and accounts receivable (Tables)	3 Months Ended
Revenue recognition and accounts receivable (Tables)	Mar. 31, 2024
Revenue Recognition And Accounts Receivable [Abstract]
Schedule of Net Sales by Major Product Category by Reporting Segment	The table below presents net sales by major product category by reporting segment: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 52,477 $ 47,714 10.0 % Spinal Implants, Biologics, and Enabling Technologies 108,816 101,492 7.2 % Global Spine 161,293 149,206 8.1 % Global Orthopedics 27,315 25,998 5.1 % Net sales $ 188,608 $ 175,204 7.7 % The table below presents net sales by major product category by reporting segment: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 52,477 $ 47,714 10.0 % Spinal Implants, Biologics, and Enabling Technologies 108,816 101,492 7.2 % Global Spine 161,293 149,206 8.1 % Global Orthopedics 27,315 25,998 5.1 % Net sales $ 188,608 $ 175,204 7.7 %
Schedule of Components Net Sales	The table below presents product sales and marketing service fees, which are both components of net sales: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Product sales $ 175,831 $ 162,248 Marketing service fees 12,777 12,956 Net sales $ 188,608 $ 175,204
Allowances for Expected Credit Losses	The following table provides a detail of changes in the Company’s allowance for expected credit losses for the three months ended March 31, 2024 and 2023: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Allowance for expected credit losses beginning balance $ 7,130 $ 6,419 Addition resulting from the Merger with SeaSpine — 137 Current period provision for expected credit losses 1,376 208 Write-offs charged against the allowance and other ( 19 ) ( 126 ) Effect of changes in foreign exchange rates ( 89 ) 53 Allowance for expected credit losses ending balance $ 8,398 $ 6,691

Business segment information (T

Business segment information (Tables)	3 Months Ended
Business segment information (Tables)	Mar. 31, 2024
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: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 52,477 $ 47,714 10.0 % Spinal Implants, Biologics, and Enabling Technologies 108,816 101,492 7.2 % Global Spine 161,293 149,206 8.1 % Global Orthopedics 27,315 25,998 5.1 % Net sales $ 188,608 $ 175,204 7.7 % The table below presents net sales by major product category by reporting segment: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Change Bone Growth Therapies $ 52,477 $ 47,714 10.0 % Spinal Implants, Biologics, and Enabling Technologies 108,816 101,492 7.2 % Global Spine 161,293 149,206 8.1 % Global Orthopedics 27,315 25,998 5.1 % Net sales $ 188,608 $ 175,204 7.7 %
Summary of EBITDA by Reporting Segment	The following table presents adjusted EBITDA, the primary metric used in managing the Company, by reporting segment: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Adjusted EBITDA by reporting segment Global Spine $ 19,890 $ 14,981 Global Orthopedics ( 1,492 ) 44 Corporate ( 10,733 ) ( 11,821 ) Consolidated adjusted EBITDA $ 7,665 $ 3,204 Reconciling items: Interest expense, net $ 4,558 $ 1,289 Depreciation and amortization 14,862 12,670 Share-based compensation expense 8,800 13,020 Foreign exchange impact 1,588 ( 583 ) SeaSpine merger-related costs 4,520 20,740 Strategic investments 120 661 Acquisition-related fair value adjustments 4,217 11,636 Interest and loss on investments ( 260 ) — Litigation and investigation costs 2,260 469 Succession charges 2,210 — Medical device regulation — 3,629 All other ( 41 ) — Loss before income taxes $ ( 35,169 ) $ ( 60,327 )
Schedule of Depreciation and Amortization by Reporting Segment	The following table presents depreciation and amortization by reporting segment: Three Months Ended March 31, (Unaudited, U.S. Dollars, in thousands) 2024 2023 Global Spine $ 11,929 $ 9,599 Global Orthopedics 2,207 1,629 Corporate 726 1,442 Total $ 14,862 $ 12,670
Summary of Net Sales by Geographic Destination	The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company: Three Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 Global Spine U.S. $ 151,865 $ 139,457 International 9,428 9,749 Total Global Spine 161,293 149,206 Global Orthopedics U.S. 8,154 6,636 International 19,161 19,362 Total Global Orthopedics 27,315 25,998 Consolidated U.S. 160,019 146,093 International 28,589 29,111 Net sales $ 188,608 $ 175,204
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) March 31, December 31, (Unaudited) U.S. $ 142,355 $ 142,727 Italy 10,033 10,187 Germany 2,620 3,030 Others 3,124 3,116 Total $ 158,132 $ 159,060

Acquisition-Related Amortizat_2

Acquisition-Related Amortization and Remeasurement (Tables)	3 Months Ended
Acquisition-Related Amortization and Remeasurement (Tables)	Mar. 31, 2024
Acquisition Related Amortization And Remeasurement [Abstract]
Components of Acquisition-Related Amortization and Remeasurement	Components of acquisition-related amortization and remeasurement are as follows: Three Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 Amortization of acquired intangibles $ 4,226 $ 4,134 Changes in fair value of contingent consideration 1,170 — Total $ 5,396 $ 4,134

Share-based compensation (Table

Share-based compensation (Tables)	3 Months Ended
Share-based compensation (Tables)	Mar. 31, 2024
Share-Based Payment Arrangement [Abstract]
Schedule of Components of Share-Based Compensation Expense	Components of share-based compensation expense are as follows: Three Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 Cost of sales $ 576 $ 471 Sales and marketing 1,667 2,249 General and administrative 5,548 9,104 Research and development 1,009 1,196 Total $ 8,800 $ 13,020 Three Months Ended (Unaudited, U.S. Dollars, in thousands) 2024 2023 Stock options $ 1,118 $ 2,756 Market-based stock options 327 — Time-based restricted stock awards and units 5,873 9,846 Market-based / performance-based restricted stock units 838 — Stock purchase plan 644 418 Total $ 8,800 $ 13,020

Earnings per share ("EPS") (Tab

Earnings per share ("EPS") (Tables)	3 Months Ended
Earnings per share ("EPS") (Tables)	Mar. 31, 2024
Earnings Per Share [Abstract]
Schedule of Reconciliation of Weighted Average Shares Used in Diluted EPS	The following is a reconciliation of the weighted average shares used in diluted EPS computations. Three Months Ended (Unaudited, In thousands) 2024 2023 Weighted average common shares-basic 37,741 35,734 Effect of dilutive securities Unexercised stock options and stock purchase plan — — Unvested restricted stock units — — Weighted average common shares-diluted 37,741 35,734

Merger and acquisitions - Addit

Merger and acquisitions - Additional Information (Detail) - USD ($) $ in Thousands		3 Months Ended
	Jan. 05, 2023	Mar. 31, 2024	Mar. 31, 2023
Business Acquisition [Line Items]
Conversion of stock, shares converted	0.4163
Net sales		$ 188,608	$ 175,204
Net loss		(36,020)	(60,938)
SeaSpine Holdings Corporation [Member]
Business Acquisition [Line Items]
Direct acquisition-related costs		100	6,500
Net sales		70,500	60,900
Net loss		14,300	27,900
Global Spine [Member]
Business Acquisition [Line Items]
Net sales		$ 161,293	$ 149,206

Merger and acquisitions - Summa

Merger and acquisitions - Summary of Fair Values of Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands	Jan. 05, 2023	Mar. 31, 2024	Dec. 31, 2023
Current liabilities
Residual goodwill		$ 194,934	$ 194,934
SeaSpine Holdings Corporation [Member]
Current assets
Cash and cash equivalents	$ 29,419
Accounts receivable, net	35,313
Inventories	132,636
Prepaid expenses and other current assets	4,590
Total current assets	201,958
Property, plant, and equipment, net	68,863
Other long-term assets	20,501
Total identifiable assets acquired	377,372
Current liabilities
Accounts payable	21,602
Other current liabilities	43,521
Total current liabilities	65,123
Long-term borrowings under SeaSpine credit facility	26,298
Other long-term liabilities	32,823
Total liabilities assumed	124,244
Net identifiable assets acquired	253,128
Total fair value of consideration transferred	376,745
Residual goodwill	123,617
SeaSpine Holdings Corporation [Member] \| Customer Relationships [Member]
Current assets
Finite lived intangible assets, net acquired	$ 33,100
Current liabilities
Assigned Useful Life	13 years
SeaSpine Holdings Corporation [Member] \| Developed Technology [Member]
Current assets
Finite lived intangible assets, net acquired	$ 47,200
SeaSpine Holdings Corporation [Member] \| Developed Technology [Member] \| Minimum [Member]
Current liabilities
Assigned Useful Life	6 years
SeaSpine Holdings Corporation [Member] \| Developed Technology [Member] \| Maximum [Member]
Current liabilities
Assigned Useful Life	8 years
SeaSpine Holdings Corporation [Member] \| In Process Research and Development [Member]
Current assets
Finite lived intangible assets, net acquired	$ 5,750
Current liabilities
Assigned Useful Life	Indefinite

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Inventory Disclosure [Abstract]
Raw materials	$ 30,903	$ 28,390
Work-in-process	56,193	53,510
Finished products	131,980	140,266
Inventories	$ 219,076	$ 222,166

Leases - Summary of Lease Portf

Leases - Summary of Lease Portfolio (Detail) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Right-of-use assets ("ROU assets")
Operating leases	$ 19,116	$ 19,869
Operating lease, right-of-use asset, statement of financial position [Extensible List]	Other long-term assets	Other long-term assets
Finance leases	$ 16,092	$ 16,345
Finance lease, right-of-use asset, statement of financial position [Extensible List]	Property, plant, and equipment, net	Property, plant, and equipment, net
Total ROU assets	$ 35,208	$ 36,214
Current
Operating leases	$ 3,534	$ 3,477
Operating lease, liability, current, statement of financial position [Extensible List]	Other current liabilities	Other current liabilities
Finance leases	$ 724	$ 708
Long-term
Operating leases	$ 16,372	$ 17,125
Operating lease, liability, noncurrent, statement of financial position [Extensible List]	Other long-term liabilities	Other long-term liabilities
Finance leases	$ 18,345	$ 18,532
Total lease liabilities	$ 38,975	$ 39,842

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 2,162	$ 1,674
Operating cash flows from finance leases	210	214
Financing cash flows from finance leases	172	160
ROU assets obtained in exchange for lease obligations
Operating leases	$ 462	$ 15,316

Long-Term Debt - Summary of Car

Long-Term Debt - Summary of Carrying Values of Outstanding Debt Obligations (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Current portion of long-term debt	$ 3,125	$ 1,250
Long-term debt	115,071	93,107
Total initial indebtedness outstanding	118,196	94,357
Initial Term Loan and Delayed Draw Term Loan
Debt Instrument [Line Items]
Principal amount outstanding	125,000	100,000
Unamortized original debt discount	(4,050)	(4,331)
Unamortized debt issuance costs and lenders fees	(2,754)	(1,312)
Total initial indebtedness outstanding	118,196	94,357
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Total initial indebtedness outstanding	$ 118,196	$ 94,357

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail)		3 Months Ended
Long-Term Debt - Additional Information (Detail)	Mar. 22, 2024 USD ($)	Mar. 31, 2024 USD ($)	Mar. 31, 2024 EUR (€)	Jan. 10, 2024 USD ($)
Debt Instrument [Line Items]
Repayments of lines of credit		$ 15,000,000
Revolving Credit Facility [Member] \| Financing Agreement [Member] \| Blue Torch Finance L L C [Member]
Debt Instrument [Line Items]
Borrowings				$ 15,000,000
Repayments of lines of credit	$ 15,000,000
Delayed Draw Term Loan [Member] \| Financing Agreement [Member] \| Blue Torch Finance L L C [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 25,000,000
Italy [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		5,900,000	€ 5,500,000
Borrowings		$ 0

Fair Value Measurements and I_3

Fair Value Measurements and Investments - Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 14,637	$ 13,020
Deferred compensation plan, Liabilities	(1,604)	(1,674)
Liabilities fair value, Total	(11,274)	(10,174)
Lattus [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(9,670)
Liabilities fair value, Total		(8,500)
Convertible Loan Agreements [Member] \| Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	8,355	6,760
Preferred Equity Securities [Member] \| Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	4,951	4,951
Other Investments [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,331	$ 1,309
Fair Value, Inputs, Level 2 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	13,306
Deferred compensation plan, Liabilities	(1,604)
Liabilities fair value, Total	(1,604)
Fair Value, Inputs, Level 2 [Member] \| Convertible Loan Agreements [Member] \| Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	8,355
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	4,951
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,331
Liabilities fair value, Total	(9,670)
Fair Value, Inputs, Level 3 [Member] \| Lattus [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration	(9,670)
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	$ 1,331

Fair Value Measurements and I_4

Fair Value Measurements and Investments - Additional Information (Detail) - Oct. 31, 2020 SFr in Millions, $ in Millions	USD ($)	CHF (SFr)
Neo Medical [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Convertible loans	$ 5	SFr 4.6

Fair Value Measurements and I_5

Fair Value Measurements and Investments - Schedule of Reconciliation of Investments in Equity Securities (Detail) - Preferred Stock [Member] - Neo Medical [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of equity securities beginning balance	$ 4,951	$ 6,084
Fair value of equity securities Ending balance	4,951	6,084
Cumulative unrealized gain (loss) on Neo Medical preferred equity securities	$ (720)	$ 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	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Fair value of convertible loans beginning balance	$ 6,760	$ 7,140
Interest recognized in interest income, net	135	116
Foreign currency remeasurement recognized in other income (expense), net	(471)	61
Unrealized gain (loss) recognized in other comprehensive loss	1,671	(137)
Reversal of expected credit loss recognized in other income (expense), net	260
Fair value of convertible loans ending balance	8,355	7,180
Contractual value of Neo Medical Convertible Loans at January 1			$ 6,683	$ 6,084
Amortized cost basis of Neo Medical Convertible Loans at March 31	$ 6,683	$ 6,084

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) - Lattus Spine [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Contingent consideration	$ 9,670
Minimum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Counterparty discount rate	15%
Revenue risk-adjusted discount rate	7.10%
Maximum [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Counterparty discount rate	15.60%
Revenue risk-adjusted discount rate	7.86%
Fair Value, Inputs, Level 3 [Member]
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Contingent consideration estimated fair value	$ 8,500
Contingent consideration		$ 11,500
Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement	1,170	0
Contingent consideration estimated fair value at March 31	$ 9,670	$ 11,500

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) shares in Millions, $ in Millions	3 Months Ended
	Mar. 31, 2024 USD ($) Executive shares	Mar. 31, 2023 USD ($)
Other Commitments [Line Items]
Number of former executives seeking severance payments \| Executive	3
Estimated sales and marketing expense (benefit)	$ 0.3	$ 0.3
Accrued other long-term liabilities	$ 7.7
SeaSpine [Member]
Other Commitments [Line Items]
Number of shares issued under acquisition \| shares	1.5

Accumulated other comprehensi_3

Accumulated other comprehensive loss - Components of Changes in Accumulated Other Comprehensive Loss (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($)
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 598,730
Ending Balance	570,315
Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(1,065)
Other comprehensive income (loss)	(1,038)
Ending Balance	(2,103)
Neo Medical [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(228)
Other comprehensive income (loss)	1,671
Ending Balance	1,443
Accumulated Other Comprehensive Loss [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(1,293)
Other comprehensive income (loss)	633
Ending Balance	(660)
Other Investments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 0

Revenue Recognition and Accou_3

Revenue Recognition and Accounts Receivable - Schedule of Net Sales by Major Product Category by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 188,608	$ 175,204
Change	7.70%
Bone Growth Therapies [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 52,477	47,714
Change	10%
Spinal Implants, Biologics, and Enabling Technologies [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 108,816	101,492
Change	7.20%
Global Spine [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 161,293	149,206
Change	8.10%
Global Orthopedics [Member]
Revenue Recognition And Accounts Receivable [Line Items]
Net sales	$ 27,315	$ 25,998
Change	5.10%

Revenue Recognition and Accou_4

Revenue Recognition and Accounts Receivable - Schedule of Components of Net Sales (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Revenue Recognition [Abstract]
Product sales	$ 175,831	$ 162,248
Marketing service fees	12,777	12,956
Net sales	$ 188,608	$ 175,204

Revenue Recognition and Accou_5

Revenue Recognition and Accounts Receivable - Schedule of Allowance for Expected Credit Losses (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Accounts, Notes, Loans and Financing Receivable [Line Items]
Allowance for expected credit losses beginning balance	$ 7,130	$ 6,419
Addition resulting from the Merger with SeaSpine		137
Current period provision for expected credit losses	1,376	208
Write-offs charged against the allowance and other	(19)	(126)
Effect of changes in foreign exchange rates	(89)	53
Allowance for expected credit losses ending balance	$ 8,398	$ 6,691

Business Segment Information -

Business Segment Information - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2024 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	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Segment Reporting Information [Line Items]
Net sales	$ 188,608	$ 175,204
Change	7.70%
Bone Growth Therapies [Member]
Segment Reporting Information [Line Items]
Net sales	$ 52,477	47,714
Change	10%
Spinal Implants, Biologics, and Enabling Technologies [Member]
Segment Reporting Information [Line Items]
Net sales	$ 108,816	101,492
Change	7.20%
Global Spine [Member]
Segment Reporting Information [Line Items]
Net sales	$ 161,293	149,206
Change	8.10%
Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Net sales	$ 27,315	$ 25,998
Change	5.10%

Business Segment Information _3

Business Segment Information - Summary of EBIDTA by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Segment Reporting Information [Line Items]
Consolidated adjusted EBITDA	$ 7,665	$ 3,204
Interest expense, net	4,558	1,289
Depreciation and amortization	14,862	12,670
Share-based compensation expense	8,800	13,020
Foreign exchange impact	1,588	(583)
SeaSpine merger-related costs	4,520	20,740
Strategic investments	120	661
Acquisition-related fair value adjustments	4,217	11,636
Interest and loss on investments	(260)
Litigation and investigation costs	2,260	469
Succession charges	2,210
Medical device regulation		3,629
All other	(41)
Loss before income taxes	(35,169)	(60,327)
Operating Segments [Member] \| Global Spine [Member]
Segment Reporting Information [Line Items]
Consolidated adjusted EBITDA	19,890	14,981
Operating Segments [Member] \| Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Consolidated adjusted EBITDA	(1,492)	44
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Consolidated adjusted EBITDA	$ (10,733)	$ (11,821)

Business Segment Information _4

Business Segment Information - Schedule of Depreciation and Amortization by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 14,862	$ 12,670
Operating Segments [Member] \| Global Spine [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	11,929	9,599
Operating Segments [Member] \| Global Orthopedics [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	2,207	1,629
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 726	$ 1,442

Business Segment Information _5

Business Segment Information - Summary of Net Sales by Geographic Destination for Each Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 188,608	$ 175,204
Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	161,293	149,206
Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	27,315	25,998
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	160,019	146,093
U.S. [Member] \| Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	151,865	139,457
U.S. [Member] \| Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	8,154	6,636
International [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	28,589	29,111
International [Member] \| Global Spine [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	9,428	9,749
International [Member] \| Global Orthopedics [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 19,161	$ 19,362

Business Segment Information _6

Business Segment Information - Summary of Property, Plant and Equipment of Reporting Segments by Geographic Area (Detail) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	$ 158,132	$ 159,060
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	142,355	142,727
Italy [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	10,033	10,187
Germany [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	2,620	3,030
Others [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property, plant and equipment net	$ 3,124	$ 3,116

Acquisition-Related Amortizat_3

Acquisition-Related Amortization and Remeasurement - Components of Acquisition-Related Amortization and Remeasurement (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Acquisition Related Amortization And Remeasurement [Abstract]
Amortization of acquired intangibles	$ 4,226	$ 4,134
Changes in fair value of contingent consideration	1,170
Total	$ 5,396	$ 4,134

Share-based Compensation - Sche

Share-based Compensation - Schedule of Components of Share-Based Compensation Expense (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 8,800	$ 13,020
Employee Stock Option
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,118	2,756
Market-based Stock Options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	327
Time-based Restricted Stock Awards and Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	5,873	9,846
Market-based / Performance-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	838
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	644	418
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	576	471
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,667	2,249
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	5,548	9,104
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 1,009	$ 1,196

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - USD ($) shares in Millions, $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Shares issued under stock purchase plan, stock option exercises and restricted stock awards and units	0.2	0.3
Shares granted, value	$ 14.9
SeaSpine [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Number of options issued in connection with conversion of awards	1.9
Number of time based RSU issued in exchange for equity awards	0.5

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail)	3 Months Ended
Income Taxes - Additional Information (Detail)	Mar. 31, 2024	Mar. 31, 2023
Components Of Income Tax Expense Benefit [Line Items]
Income tax effective rate	(2.40%)	(1.00%)

Earnings Per Share ("EPS") - Sc

Earnings Per Share ("EPS") - Schedule of Reconciliation of Weighted Average Shares Used in Diluted EPS (Detail) - shares	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Earnings Per Share [Line Items]
Weighted average common shares-basic	37,741	35,734
Effect of dilutive securities
Weighted average common shares-diluted	37,741	35,734

Earnings Per Share ("EPS") - Ad

Earnings Per Share ("EPS") - Additional Information (Detail) - shares shares in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Restricted Stock Units [Member] \| Outstanding Stock Options [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Weighted average outstanding options, awards and units not included in diluted earnings per share	6.7	0.2

Goodwill - Schedule of Net Carr

Goodwill - Schedule of Net Carrying Value of Goodwill and Activity Recognized (Detail) $ in Thousands	Mar. 31, 2024 USD ($)
Goodwill [Line Items]
Goodwill, net Beginning Balance	$ 194,934
Goodwill, net Ending Balance	$ 194,934

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) - Blue Torch Finance LLC [Member] - Financing Agreement [Member] - USD ($) $ in Millions	Mar. 22, 2024	Jan. 10, 2024
Delayed Draw Term Loan [Member]
Subsequent Event [Line Items]
Maximum borrowing capacity	$ 25
Revolving Credit Facility [Member]
Subsequent Event [Line Items]
Borrowings		$ 15