Pay vs Performance Disclosure
U_pure in Thousands

12 Months Ended

Dec. 31, 2024

USD ($)

Dec. 31, 2023

USD ($)

Dec. 31, 2022

USD ($)

Dec. 31, 2021

USD ($)

Dec. 31, 2020

USD ($)

Pay vs Performance Disclosure

Pay vs Performance Disclosure, Table

Pay Versus Performance

As described in greater detail in "Compensation Discussion and Analysis," our executive compensation program reflects a variable "pay-for-performance" philosophy. The performance measures that we use for both our long-term and short-term incentive awards are selected based on an objective of incentivizing our Named Executive Officers to increase the value of our enterprise for our stockholders.

The following table sets forth information regarding the compensation provided to our principal executive officer (the "CEO/PEO") and our other Named Executive Officers (the "Non-PEO Named Executive Officers") and our performance during the last four fiscal years.

Year(1)		Summary Compensation Table Total for CEO/PEO ($)		Compensation Actually Paid to CEO/PEO ($)(2)		Average Summary Compensation Table for Non-PEO NEOs ($)		Average Compensation Actually Paid to Non-PEO NEOs ($)(3)		Value of Initial Fixed $100 Investment Based On:				Net Loss ($ thousands)			Total Revenue ($ thousands)(6)
										Total Shareholder Return ($)(4)		Peer Group Total Shareholder Return ($)(5)
	2024		6,221,699		4,059,404		2,853,274		2,750,657		129.39		102.00		(162,123	)		611,562
	2023		9,477,979		23,339,656		3,432,342		5,474,297		212.97		140.46		(186,638	)		482,262
	2022		5,948,299		7,374,460		2,283,006		3,044,347		173.94		121.80		(151,293	)		350,867
	2021		5,266,839		8,273,363		2,844,858		3,144,984		160.99		151.64		(143,032	)		243,212
	2020		4,683,936		23,639,741		1,477,059		5,761,467		204.51		122.39		(78,994	)		144,861

(1)The CEO/PEO and Non-PEO Named Executive Officers included in the above compensation columns reflect the following:

Year	CEO/PEO	Non-PEO/NEOs
2024	Patrick S. Miles	J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Scott Lish
2023	Patrick S. Miles	J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Scott Lish
2022	Patrick S. Miles	J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Eric Dasso
2021	Patrick S. Miles	J. Todd Koning, Craig E. Hunsaker, David P. Sponsel
2020	Patrick S. Miles	Craig E. Hunsaker, David P. Sponsel

(2)"Compensation Actually Paid" to the CEO/PEO reflects the following adjustments from Total Compensation reported in the applicable Summary Compensation Table:

Adjustments to Determine Compensation "Actually Paid" for CEO/PEO	2024 ($)			2023 ($)		2022 ($)			2021 ($)			2020 ($)
Total Reported in Summary Compensation Table		6,221,699			9,477,979		5,948,299			5,266,839			4,683,936
Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table		5,028,680			7,687,586		4,356,657			3,696,750			3,224,266
Less Amounts Reported under the "Option Awards" Column in the Summary Compensation Table		—			—		—			—			—
Plus the Fair Value of Awards Granted during covered year that Remain Unvested as of Year-end		5,256,064			10,134,386		6,510,735			10,572,750			12,714,583
Plus the Fair Value of Awards Granted during covered year that Vested during covered year		—			—		—			—			125,793
Plus the Change in Fair Value from prior Year-end to current Year-end of Awards Granted prior to covered year that were Outstanding and Unvested as of Year-end		(2,428,632	)		1,802,804		1,116,353			(4,423,380	)		10,733,420
Plus the Change in Fair Value from prior Year-end to Vesting Date of Awards Granted prior to covered year that Vested during covered year		38,953			9,612,073		(1,844,270	)		553,904			(1,393,725	)
Total Adjustments		(2,162,295	)		13,861,677		1,426,161			3,006,524			18,955,805
Compensation Actually Paid		4,059,404			23,339,656		7,374,460			8,273,363			23,639,741

(3)The average "Compensation Actually Paid" to the Non-PEO Named Executive Officers reflect the following adjustments from Total Compensation reported in the applicable Summary Compensation Table:

Adjustments to Determine Average Compensation "Actually Paid" for Non-PEO NEOs	2024 ($)			2023 ($)		2022 ($)			2021 ($)			2020 ($)
Total Reported in Summary Compensation Table		2,853,274			3,432,342		2,283,006			2,844,858			1,477,059
Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table		2,147,889			2,489,639		1,389,695			2,067,800			723,996
Less Amounts Reported under the "Option Awards" Column in the Summary Compensation Table		—			—		—			—			—
Plus the Fair Value of Awards Granted during covered year that Remain Unvested as of Year-end		2,672,975			3,340,773		2,076,807			2,971,800			2,784,776
Plus the Fair Value of Awards Granted during covered year that Vested during covered year		—			—		—			—			45,359
Plus the Change in Fair Value from prior Year-end to current Year-end of Awards Granted prior to covered year that were Outstanding and Unvested as of Year-end		(1,476,084	)		537,648		266,411			(697,232	)		2,408,807
Plus the Change in Fair Value from prior Year-end to Vesting Date of Awards Granted prior to covered year that Vested during covered year		848,381			653,173		(192,182	)		93,358			(230,538	)
Total Adjustments		(102,617	)		2,041,955		761,341			300,126			4,284,408
Compensation Actually Paid		2,750,657			5,474,297		3,044,347			3,144,984			5,761,467

(4)Reflects total shareholder return indexed to $100 invested on December 31, 2019.

(5)Reflects total shareholder return indexed to $100 invested on December 31, 2019 for the Nasdaq Medical Equipment Index, which is an industry line peer group reported in the performance graph included in the Company’s 2024 Annual Report on Form 10-K, and assuming reinvestment of all dividends, where applicable.

(6)Total Revenue, which is a GAAP measure, represents the most important financial performance measure (that is not otherwise required to be disclosed in the table) used by the Company to link compensation actually paid to our Named Executive Officers, including our CEO, for the most recently completed fiscal year to the Company’s performance.

Company Selected Measure Name

Total Revenue

Named Executive Officers, Footnote

(1)The CEO/PEO and Non-PEO Named Executive Officers included in the above compensation columns reflect the following:

Year	CEO/PEO	Non-PEO/NEOs
2024	Patrick S. Miles	J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Scott Lish
2023	Patrick S. Miles	J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Scott Lish
2022	Patrick S. Miles	J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Eric Dasso
2021	Patrick S. Miles	J. Todd Koning, Craig E. Hunsaker, David P. Sponsel
2020	Patrick S. Miles	Craig E. Hunsaker, David P. Sponsel

Peer Group Issuers, Footnote

(5)Reflects total shareholder return indexed to $100 invested on December 31, 2019 for the Nasdaq Medical Equipment Index, which is an industry line peer group reported in the performance graph included in the Company’s 2024 Annual Report on Form 10-K, and assuming reinvestment of all dividends, where applicable.

PEO Total Compensation Amount

$ 6,221,699

$ 9,477,979

$ 5,948,299

$ 5,266,839

$ 4,683,936

PEO Actually Paid Compensation Amount

$ 4,059,404

23,339,656

7,374,460

8,273,363

23,639,741

Adjustment To PEO Compensation, Footnote

(2)"Compensation Actually Paid" to the CEO/PEO reflects the following adjustments from Total Compensation reported in the applicable Summary Compensation Table:

Adjustments to Determine Compensation "Actually Paid" for CEO/PEO	2024 ($)			2023 ($)		2022 ($)			2021 ($)			2020 ($)
Total Reported in Summary Compensation Table		6,221,699			9,477,979		5,948,299			5,266,839			4,683,936
Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table		5,028,680			7,687,586		4,356,657			3,696,750			3,224,266
Less Amounts Reported under the "Option Awards" Column in the Summary Compensation Table		—			—		—			—			—
Plus the Fair Value of Awards Granted during covered year that Remain Unvested as of Year-end		5,256,064			10,134,386		6,510,735			10,572,750			12,714,583
Plus the Fair Value of Awards Granted during covered year that Vested during covered year		—			—		—			—			125,793
Plus the Change in Fair Value from prior Year-end to current Year-end of Awards Granted prior to covered year that were Outstanding and Unvested as of Year-end		(2,428,632	)		1,802,804		1,116,353			(4,423,380	)		10,733,420
Plus the Change in Fair Value from prior Year-end to Vesting Date of Awards Granted prior to covered year that Vested during covered year		38,953			9,612,073		(1,844,270	)		553,904			(1,393,725	)
Total Adjustments		(2,162,295	)		13,861,677		1,426,161			3,006,524			18,955,805
Compensation Actually Paid		4,059,404			23,339,656		7,374,460			8,273,363			23,639,741

Non-PEO NEO Average Total Compensation Amount

$ 2,853,274

3,432,342

2,283,006

2,844,858

1,477,059

Non-PEO NEO Average Compensation Actually Paid Amount

$ 2,750,657

5,474,297

3,044,347

3,144,984

5,761,467

Adjustment to Non-PEO NEO Compensation Footnote

(3)The average "Compensation Actually Paid" to the Non-PEO Named Executive Officers reflect the following adjustments from Total Compensation reported in the applicable Summary Compensation Table:

Adjustments to Determine Average Compensation "Actually Paid" for Non-PEO NEOs	2024 ($)			2023 ($)		2022 ($)			2021 ($)			2020 ($)
Total Reported in Summary Compensation Table		2,853,274			3,432,342		2,283,006			2,844,858			1,477,059
Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table		2,147,889			2,489,639		1,389,695			2,067,800			723,996
Less Amounts Reported under the "Option Awards" Column in the Summary Compensation Table		—			—		—			—			—
Plus the Fair Value of Awards Granted during covered year that Remain Unvested as of Year-end		2,672,975			3,340,773		2,076,807			2,971,800			2,784,776
Plus the Fair Value of Awards Granted during covered year that Vested during covered year		—			—		—			—			45,359
Plus the Change in Fair Value from prior Year-end to current Year-end of Awards Granted prior to covered year that were Outstanding and Unvested as of Year-end		(1,476,084	)		537,648		266,411			(697,232	)		2,408,807
Plus the Change in Fair Value from prior Year-end to Vesting Date of Awards Granted prior to covered year that Vested during covered year		848,381			653,173		(192,182	)		93,358			(230,538	)
Total Adjustments		(102,617	)		2,041,955		761,341			300,126			4,284,408
Compensation Actually Paid		2,750,657			5,474,297		3,044,347			3,144,984			5,761,467

(4)Reflects total shareholder return indexed to $100 invested on December 31, 2019.

Compensation Actually Paid vs. Total Shareholder Return

PEO and Average Non-PEO Named Executive Officer Compensation Actually Paid Versus TSR

(in thousands except for TSR, assuming $100 invested on December 31, 2019)

Compensation Actually Paid vs. Net Income

PEO and Average Non-PEO Named Executive Officer Compensation Actually Paid Versus Net Loss

(in thousands)

Compensation Actually Paid vs. Company Selected Measure

PEO and Average Non-PEO Named Executive Officer Compensation Actually Paid Versus Total Revenue

(in thousands)

Tabular List, Table

Pay Versus Performance Tabular List of Most Important Financial Performance Measures for All Named Executive Officers for 2024

As described in greater detail in the "Compensation Discussion and Analysis" included in this proxy statement, our executive compensation program reflects a "pay-for-performance" philosophy. The most important financial performance measures we use to link executive compensation actually paid to our Named Executive Officers, for the most recently completed fiscal year, to our performance are as follows:

•Total revenue

•Adjusted EBITDA

•Adjusted EBITDA margin.

Total Shareholder Return Amount

$ 129.39

212.97

173.94

160.99

204.51

Peer Group Total Shareholder Return Amount

102

140.46

121.8

151.64

122.39

Net Income (Loss)

$ (162,123,000)

$ (186,638,000)

$ (151,293,000)

$ (143,032,000)

$ (78,994,000)

Company Selected Measure Amount

611,562

482,262

350,867

243,212

144,861

PEO Name

Patrick S. Miles

Patrick S. Miles

Patrick S. Miles

Patrick S. Miles

Patrick S. Miles

Non Peo Name

J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Scott Lish

J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Scott Lish

J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Eric Dasso

J. Todd Koning, Craig E. Hunsaker, David P. Sponsel

Craig E. Hunsaker, David P. Sponsel

Measure:: 1

Pay vs Performance Disclosure

Name

Total revenue

Measure:: 2

Pay vs Performance Disclosure

Name

Adjusted EBITDA

Measure:: 3

Pay vs Performance Disclosure

Name

Adjusted EBITDA margin.

PEO

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

$ (2,162,295)

$ 13,861,677

$ 1,426,161

$ 3,006,524

$ 18,955,805

PEO | Aggregate Grant Date Fair Value of Equity Award Amounts Reported in Summary Compensation Table

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

(5,028,680)

(7,687,586)

(4,356,657)

(3,696,750)

(3,224,266)

PEO | Year-end Fair Value of Equity Awards Granted in Covered Year that are Outstanding and Unvested

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

5,256,064

10,134,386

6,510,735

10,572,750

12,714,583

PEO | Year-over-Year Change in Fair Value of Equity Awards Granted in Prior Years That are Outstanding and Unvested

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

(2,428,632)

1,802,804

1,116,353

(4,423,380)

10,733,420

PEO | Vesting Date Fair Value of Equity Awards Granted and Vested in Covered Year

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

125,793

PEO | Change in Fair Value as of Vesting Date of Prior Year Equity Awards Vested in Covered Year

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

38,953

9,612,073

(1,844,270)

553,904

(1,393,725)

Non-PEO NEO

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

(102,617)

2,041,955

761,341

300,126

4,284,408

Non-PEO NEO | Aggregate Grant Date Fair Value of Equity Award Amounts Reported in Summary Compensation Table

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

(2,147,889)

(2,489,639)

(1,389,695)

(2,067,800)

(723,996)

Non-PEO NEO | Year-end Fair Value of Equity Awards Granted in Covered Year that are Outstanding and Unvested

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

2,672,975

3,340,773

2,076,807

2,971,800

2,784,776

Non-PEO NEO | Year-over-Year Change in Fair Value of Equity Awards Granted in Prior Years That are Outstanding and Unvested

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

(1,476,084)

537,648

266,411

(697,232)

2,408,807

Non-PEO NEO | Vesting Date Fair Value of Equity Awards Granted and Vested in Covered Year

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

45,359

Non-PEO NEO | Change in Fair Value as of Vesting Date of Prior Year Equity Awards Vested in Covered Year

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

$ 848,381

$ 653,173

$ (192,182)

$ 93,358

$ (230,538)