CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
OPERATING ACTIVITIES:
Net income	$ 169,075	$ 133,892	$ 50,201
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	119,836	116,031	109,462
Non-cash in-process research and development expense	0	519	64,916
Non-cash impairment charges	2,754	0	5,764
Deferred income tax (benefit) provision	(2,755)	(64,138)	(19,046)
Share-based compensation	36,210	19,590	21,255
Amortization of debt issuance costs and expenses associated with debt refinancing	7,030	12,076	5,390
Non-cash lease expense	3,834	2,955	5,060
Accretion of bond issuance discount	0	15,415	0
Loss on disposal of property and equipment and construction in-progress	2,240	7,855	1,821
Gain from the sale of business	(41,798)	0	0
Change in fair value of contingent consideration and others	(2,162)	951	1,119
Changes in assets and liabilities:
Accounts receivable	7,265	52,105	(9,428)
Inventories	5,374	(48,348)	(43,308)
Prepaid expenses and other current assets	(21,143)	1,632	13,071
Other non-current assets	7,875	13,735	13,156
Accounts payable, accrued expenses and other current liabilities	32,874	(57,512)	14,666
Contract liabilities	28	(37)	(607)
Other non-current liabilities	(14,110)	(2,889)	(2,059)
Net cash provided by operating activities	312,427	203,832	231,433
INVESTING ACTIVITIES:
Purchases of property and equipment	(48,022)	(38,890)	(69,537)
Proceeds from sale of Extremity Orthopedics Business	190,468	0	0
Acquired in-process research and development and intangibles	(58)	(25,000)	(64,995)
Proceeds from note receivable	0	0	752
Cash paid for business acquisitions, net of cash acquired	(303,910)	0	(30,509)
Proceeds from sales of property and equipment	3	3,657	37
Net proceeds (payments) on swaps designated as net investment hedges	76	(7,840)	1,584
Net cash used in investing activities	(161,443)	(68,073)	(162,668)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness	25,500	171,500	236,900
Payments on debt	(125,500)	(441,000)	(246,100)
Purchase of option hedge on convertible notes	0	(104,248)	0
Proceeds from convertible notes issuance	0	575,000	0
Proceeds from sale of stock purchase warrants	0	44,563	0
Payment of debt issuance costs	(249)	(24,347)	0
Purchase of treasury stock	0	(100,000)	0
Proceeds from exercised stock options	6,824	5,232	6,948
Cash taxes paid in net equity settlement	(4,801)	(5,075)	(6,514)
Net cash (used in) provided by financing activities	(98,226)	121,625	(8,766)
Effect of exchange rate changes on cash and cash equivalents	(9,476)	13,871	74
Net increase in cash and cash equivalents	43,282	271,255	60,073
Cash and cash equivalents at beginning of period	470,166	198,911	138,838
Cash and cash equivalents at end of period	$ 513,448	$ 470,166	$ 198,911