Goodwill and Intangible Assets - Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 221,095	$ 221,662
Accumulated Amortization	(101,399)	(89,317)
Net Carrying Amount	119,696	132,345
Definite-lived intangible asset impairment	$ 2,169	41,032	$ 0
License agreements (3)
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Lives (Years)	1 year 7 months 18 days
Gross Carrying Amount	$ 3,894	4,497
Accumulated Amortization	(3,716)	(3,623)
Net Carrying Amount	178	874
License agreements (3) | Denmark
Finite-Lived Intangible Assets [Line Items]
Definite-lived intangible asset impairment	$ 500
Leases
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Lives (Years)	2 years
Gross Carrying Amount	$ 864	796
Accumulated Amortization	(689)	(534)
Net Carrying Amount	$ 175	262
Trademarks
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Lives (Years)	9 years 7 months 88 days
Gross Carrying Amount	$ 15,751	15,464
Accumulated Amortization	(6,202)	(6,184)
Net Carrying Amount	9,549	9,280
Trademarks | Denmark
Finite-Lived Intangible Assets [Line Items]
Definite-lived intangible asset impairment	100
Trademarks | P2S
Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 300
Non-competes (1)(2)
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Lives (Years)	4 years 4 months 4 days
Gross Carrying Amount	$ 2,529	1,197
Accumulated Amortization	(1,229)	(1,048)
Net Carrying Amount	1,300	149
Non-competes (1)(2) | Hebna
Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	1,100
Non-competes (1)(2) | P2S
Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 200
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Lives (Years)	8 years 10 months 35 days
Gross Carrying Amount	$ 159,719	160,423
Accumulated Amortization	(66,753)	(56,907)
Net Carrying Amount	92,966	103,516
Customer relationships | Denmark
Finite-Lived Intangible Assets [Line Items]
Definite-lived intangible asset impairment	300
Customer relationships | Hebna
Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	1,300
Customer relationships | P2S
Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 700
Patents and acquired technology
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Lives (Years)	5 years 7 months 18 days
Gross Carrying Amount	$ 38,338	39,285
Accumulated Amortization	(22,810)	(21,021)
Net Carrying Amount	$ 15,528	$ 18,264