Business segment information (Tables)

12 Months Ended

Dec. 31, 2023

Segment Reporting [Abstract]

Schedule of Net Sales by Major Product Category by Reporting Segment

The table below presents net sales by major product category by reporting segment:

	Year Ended December 31,
	2023					2022					2021
(U.S. Dollars, in thousands)	Net Sales		Percent of Total Net Sales			Net Sales		Percent of Total Net Sales			Net Sales		Percent of Total Net Sales
Bone Growth Therapies	$	212,530		28.5	%	$	187,247		40.7	%	$	187,448		40.4	%
Spinal Implants, Biologics, and Enabling Technologies		418,789		56.1	%		165,927		36.0	%		171,515		36.9	%
Global Spine		631,319		84.6	%		353,174		76.7	%		358,963		77.3	%
Global Orthopedics		115,322		15.4	%		107,539		23.3	%		105,516		22.7	%
Net sales	$	746,641		100.0	%	$	460,713		100.0	%	$	464,479		100.0	%

Summary of EBITDA by Reporting Segment

The following table presents adjusted EBITDA, the primary metric used in managing the Company, by reporting segment:

	Year Ended December 31,
(U.S. Dollars, in thousands)	2023			2022			2021
Adjusted EBITDA by reporting segment
Global Spine	$	91,115		$	62,692		$	71,086
Global Orthopedics		442			5,267			9,260
Corporate		(45,272	)		(19,406	)		(19,084	)
Consolidated adjusted EBITDA	$	46,285		$	48,553		$	61,262
Reconciling items:
Interest expense, net	$	8,631		$	1,288		$	1,837
Depreciation and amortization		53,063			29,019			41,355
Share-based compensation expense		35,707			18,443			15,432
Foreign exchange impact		(1,581	)		3,291			3,981
SeaSpine merger-related costs		36,623			12,010			—
Strategic investments		2,272			4,018			5,700
Acquisition-related fair value adjustments		33,393			(15,595	)		(2,014	)
(Gain) loss on investments		1,781			187			(644	)
Litigation and investigation costs		14,453			803			33
Medical device regulation		9,446			10,261			8,018
Business interruption - COVID-19		—			2,387			320
Succession charges		1,176			147			739
Loss before income taxes	$	(148,679	)	$	(17,706	)	$	(13,495	)

Schedule of Depreciation and Amortization by Reporting Segment

The following table presents depreciation and amortization by reporting segment:

	Year Ended December 31,
(U.S. Dollars, in thousands)	2023		2022		2021
Global Spine	$	41,213	$	18,213	$	17,548
Global Orthopedics		7,158		6,696		8,233
Corporate		4,692		4,110		3,818
Total	$	53,063	$	29,019	$	29,599

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:

	Year Ended December 31,
(U.S. Dollars, in thousands)	2023		2022		2021
Global Spine
U.S.	$	591,937	$	332,846	$	337,455
International		39,382		20,328		21,508
Total Global Spine		631,319		353,174		358,963
Global Orthopedics
U.S.	$	28,892		25,997		24,490
International		86,430		81,542		81,026
Total Global Orthopedics		115,322		107,539		105,516
Consolidated
U.S.		620,829		358,843		361,945
International		125,812		101,870		102,534
Net sales	$	746,641	$	460,713	$	464,479

The following data includes net sales by geographic destination:

	Year Ended December 31,
(U.S. Dollars, in thousands)	2023		2022		2021
U.S.	$	620,829	$	358,843	$	361,945
Italy		20,060		19,098		20,187
Germany		11,467		11,569		13,716
United Kingdom		10,910		10,171		10,552
France		11,096		10,377		10,475
Brazil		6,452		5,668		5,108
Others		65,827		44,987		42,496
Net sales	$	746,641	$	460,713	$	464,479

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)	2023		2022
U.S.	$	142,727	$	44,802
Italy		10,187		8,535
Germany		3,030		3,115
Others		3,116		1,777
Total	$	159,060	$	58,229