Acquisitions Purchase Price Allocation (Details) - USD ($) $ in Thousands			3 Months Ended		9 Months Ended
	Sep. 30, 2018	Jun. 30, 2018	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2017	Dec. 31, 2017
Business Acquisition [Line Items]
Provision for income taxes on gain on disposal				$ (86,211)	$ (86,211)
Intangible assets subject to amortization	$ 171,817		$ 171,817
Goodwill	624,455		624,455			$ 454,612
Paragon Medical Inc
Business Acquisition [Line Items]
Cash and cash equivalents	13,552	$ 13,418	13,552
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Cash and Equivalents			134
Accounts receivable	22,132	22,853	22,132
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Current Assets, Receivable			(721)
Inventories	23,508	23,606	23,508
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Inventory			(98)
Other current assets	1,671	937	1,671
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Current Assets			734
Property, plant and equipment	63,697	69,322	63,697
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Property, Plant, and Equipment			(5,625)
Intangible assets subject to amortization	163,500	164,200	163,500
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Finite-lived Intangibles			(700)
Other non-current assets	3,175	3,304	3,175
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Other Noncurrent Assets			(129)
Goodwill	162,438	157,421	162,438
Goodwill, Purchase Accounting Adjustments			5,017
Total assets acquired	453,673	455,061	453,673
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Assets			(1,388)
Current liabilities	16,886	16,767	16,886
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Current Liabilities			119
Deferred tax liability	45,306	46,713	45,306
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Deferred Tax Liabilities			(1,407)
Other non-current liabilities	620	620	620
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Noncurrent Liabilities, Other			0
Total liabilities assumed	62,812	64,100	62,812
Business Combination, Provisional Information, Initial Accounting Incomplete, Adjustment, Liabilities			(1,288)
Net assets acquired	$ 390,861	$ 390,961
Cash received to settle working capital adjustments			$ (100)