Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Operating activities:
Consolidated net (loss) income	$ (64,086)	$ (37,153)	$ 65,234
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Depreciation and amortization	149,524	140,937	135,593
Purchase of in-process research and development		1,011
Deferred income taxes	(4,141)	(18,007)	5,844
Amortization of non-cash interest	8,629	48,986	21,288
Stock-based compensation	25,292	18,145	30,297
Net (gain) loss on strategic investments	(3,082)	268	4,767
Changes in fair value of contingent consideration	53,404	2,327	(6,297)
Net loss recognized on change in fair value of derivatives		12,301
Net loss from foreign currency adjustment	28,709	4,218	785
Reserves on current assets	26,218	53,902	18,382
Other non-cash adjustments	11,006	10,331	11,162
Changes in operating assets and liabilities, net of effects from acquisitions:
Accounts receivable	(11,694)	3,030	(16,407)
Inventory	(37,020)	(40,765)	(54,872)
Prepaid expenses and other current assets	(3,366)	(4,986)	(4,622)
Accounts payable and accrued liabilities	533	8,756	(3,924)
Accrued payroll and related expenses	4,132	(23,654)	24,256
Income taxes	(1,884)	6,264	3,804
Net cash provided by operating activities	182,174	185,911	235,290
Investing activities:
Acquisition of Simplify Medical, net of cash acquired	(149,463)
Payment of contingent consideration for Simplify Medical	(45,850)
Acquisitions and investments	(500)		(4,100)
Proceeds from other investments		1,143
Purchases of intangible assets	(1,344)	(3,860)	(7,501)
Purchases of property and equipment	(111,112)	(105,729)	(122,883)
Purchases of marketable securities		(233,488)
Proceeds from sales of marketable securities	127,023	60,000
Proceeds from maturities of marketable securities	46,000
Other investing activities	(819)
Net cash used in investing activities	(136,065)	(281,934)	(134,484)
Financing activities:
Proceeds from the issuance of common stock	6,218	6,170	6,415
Payment of contingent consideration	(3)	(7,053)	(809)
Purchase of treasury stock	(8,813)	(80,665)	(14,478)
Proceeds from issuance of convertible debt, net of issuance costs		873,848
Proceeds from sale of warrants		93,915
Purchases of convertible note hedges		(147,825)
Payments upon settlement of senior convertible notes	(649,426)
Other financing activities	(1,325)	(1,734)	2,228
Net cash (used in) provided by financing activities	(653,349)	736,656	(6,644)
Effect of exchange rate changes on cash	(3,538)	3,202	131
(Decrease) increase in cash, cash equivalents and restricted cash	(610,778)	643,835	94,293
Cash, cash equivalents and restricted cash at beginning of period	858,363	214,528	120,235
Cash, cash equivalents and restricted cash at end of period	247,585	858,363	214,528
Supplemental cash flow information:
Interest paid	16,294	19,914	16,145
Income taxes paid	$ 11,879	$ 1,873	$ 5,828