0000816956-24-000003 | 10-K | XBRL Viewer

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Employee Benefit Plans (Employee Benefit Reconciliation) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Defined Benefit Plan, Change in Benefit Obligation [Roll Forward]
Service cost	$ 776	$ 1,077	$ 991
Interest cost	3,646	2,148	1,803
Defined Benefit Plan, Change in Fair Value of Plan Assets [Roll Forward]
Fair value of plan assets at beginning of year	62,356
Fair value of plan assets at end of year	65,896	62,356
Defined Benefit Plan, Benefit Obligation, Period Increase (Decrease)	(600)
Pension Plan
Defined Benefit Plan Disclosure [Line Items]
Accumulated Benefit Obligation	70,588	71,203
Defined Benefit Plan, Change in Benefit Obligation [Roll Forward]
Projected benefit obligation at beginning of year	71,203	95,508
Service cost	776	1,077
Interest cost	3,646	2,148
Actuarial gain	(806)	(23,607)
Defined Benefit Plan, Benefit Obligation, Benefits Paid	(3,018)	(2,805)
Settlement	(1,213)	(1,118)
Projected benefit obligation at end of year	70,588	71,203	95,508
Defined Benefit Plan, Change in Fair Value of Plan Assets [Roll Forward]
Fair value of plan assets at beginning of year	62,356	79,404
Actual gain (loss) on plan assets	7,771	(13,125)
Defined Benefit Plan, Plan Assets, Benefits Paid	(3,018)	(2,805)
Settlement	(1,213)	(1,118)
Fair value of plan assets at end of year	65,896	62,356	$ 79,404
Funded status	$ (4,692)	$ (8,847)

Leases Supplementary Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 8,178	$ 7,383	$ 7,791
Financing cash flows from finance leases	436	313	287
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	5,864	5,167	4,704
Finance leases	$ 2,523	$ 0	$ 305

Business Acquisitions	12 Months Ended
Business Acquisitions	Dec. 31, 2023
Business Combinations [Abstract]
Business Acquisition	Business Acquisitions On June 13, 2022, we acquired In2Bones Global, Inc. ("In2Bones") and all of its stock (the "In2Bones Acquisition") for an aggregate upfront payment of $145.2 million in cash. In addition, there are potential earn-out payments to In2Bones’ equity holders in an amount up to $110.0 million based on the achievement of certain revenue targets for In2Bones products during the sixteen (16) successive quarters commencing on July 1, 2022. In2Bones was a global developer, manufacturer and distributor of medical devices for the treatment of disorders and injuries of the lower (foot and ankle) extremities. The In2Bones Acquisition was funded through a combination of cash on hand and long-term borrowings as further described in Note 8. Proforma information for In2Bones is immaterial for disclosure for the years ended December 31, 2023 and 2022. Purchase accounting has been completed for the In2Bones Acquisition. On August 9, 2022, we acquired Biorez, Inc. ("Biorez") and all of its stock (the "Biorez Acquisition") for an aggregate upfront payment of $85.5 million in cash. We paid $84.2 million as of December 31, 2023, with a $1.3 million holdback, pursuant to the merger agreement for the Biorez Acquisition. In addition, there are potential earn-out payments to Biorez’ equity holders in an amount up to $165.0 million based on the achievement of certain revenue targets for Biorez products during the sixteen (16) successive quarters commencing on October 1, 2022. Biorez was a medical device start-up focused on advancing the healing of soft tissue using its proprietary BioBrace® implant technology. The Biorez Acquisition was funded through a combination of cash on hand and long-term borrowings. Proforma information for Biorez is immaterial for disclosure for the years ended December 31, 2023 and 2022. Purchase accounting has been completed for the Biorez Acquisition. We incurred costs for the amortization of inventory step-up to fair value of $8.6 million and $4.5 million during the years ended December 31, 2023 and 2022, respectively, related to the In2Bones acquisition, which are included in cost of sales. Inventory step-up to fair value for the In2Bones acquisition is fully amortized as of December 31, 2023. During 2023, we recognized $0.8 million in integration costs and professional fees related to the In2Bones and Biorez acquisitions that were included in selling and administrative expense. During 2022, we recognized $10.1 million in consulting fees, legal fees and other integration related costs associated with the acquisitions of In2Bones and Biorez, which were included in selling and administrative expense.

Inventories (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Raw materials	$ 107,262	$ 110,677
Work in process	29,463	26,166
Finished goods	181,599	195,477
Total inventory	$ 318,324	$ 332,320

Leases Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
Leases Lease Cost (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Total operating lease cost	$ 8,118	$ 7,685	$ 7,720
Depreciation	344	396	389
Interest on lease liabilities	55	17	30
Total finance lease cost	399	413	419
Total lease cost	$ 8,517	$ 8,098	$ 8,139

Fair Value Measurement (Foreign Currency Forward Contracts) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Derivative [Line Items]
Net loss on currency transaction exposures	$ (1,305)	$ (1,950)	$ (1,832)
Derivative Assets (Liabilities), at Fair Value, Net, by Balance Sheet Classification [Abstract]
Asset Fair Value	3,824	6,865
Liabilities Fair Value	(3,839)	(3,916)
Net Fair Value	(15)	2,949
Foreign Exchange Forward
Derivative [Line Items]
Net loss on currency forward contracts	(891)	(240)	$ (451)
Derivatives designated as hedging instruments: \| Foreign Exchange Forward
Derivative Assets (Liabilities), at Fair Value, Net, by Balance Sheet Classification [Abstract]
Asset Fair Value	3,785	6,817
Liabilities Fair Value	(3,630)	(3,521)
Net Fair Value	155	3,296
Derivatives designated as hedging instruments: \| Foreign Exchange Forward \| Prepaid expenses and other current assets
Derivative Assets (Liabilities), at Fair Value, Net, by Balance Sheet Classification [Abstract]
Asset Fair Value	3,761	6,757
Liabilities Fair Value	(3,197)	(3,121)
Net Fair Value	564	3,636
Derivatives designated as hedging instruments: \| Foreign Exchange Forward \| Other long-term liabilities
Derivative Assets (Liabilities), at Fair Value, Net, by Balance Sheet Classification [Abstract]
Asset Fair Value	24	60
Liabilities Fair Value	(433)	(400)
Net Fair Value	$ (409)	(340)
Not Designated as Hedging Instrument \| Foreign Exchange Forward
Derivative [Line Items]
Maximum Length of Time Hedged in Cash Flow Hedge	1 month
Derivative, Notional Amount	$ 55,789	81,929
Not Designated as Hedging Instrument \| Foreign Exchange Forward \| Other Current Liabilities
Derivative Assets (Liabilities), at Fair Value, Net, by Balance Sheet Classification [Abstract]
Asset Fair Value	39	48
Liabilities Fair Value	(209)	(395)
Net Fair Value	$ (170)	(347)
Cash Flow Hedging \| Foreign Exchange Forward
Derivative [Line Items]
Maximum Length of Time Hedged in Cash Flow Hedge	2 years
Derivative, Notional Amount	$ 223,839	$ 198,473
Unrealized gain (loss) on cash flow hedges in accumulated other comprehensive income (loss) expected to be recognized in next fiscal year	$ 400

Revenues Revenue from Contracts with Customers (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenue from Contract with Customer [Abstract]
Contract with Customer, Liability, Revenue Recognized	$ 12,500	$ 11,500	$ 10,300
Contract with Customer, Liability	$ 17,962	$ 19,114

Fair Value Measurement

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Fair Value Measurement

We enter into derivative instruments for risk management purposes only. We operate internationally and, in the normal course of business, are exposed to fluctuations in interest rates, foreign exchange rates and commodity prices. These fluctuations can increase the costs of financing, investing and operating the business. We use forward contracts, a type of derivative instrument, to manage certain foreign currency exposures.

By nature, all financial instruments involve market and credit risks. We enter into forward contracts with major investment grade financial institutions and have policies to monitor the credit risk of those counterparties. While there can be no assurance, we do not anticipate any material non-performance by any of these counterparties.

Foreign Currency Forward Contracts. We hedge forecasted intercompany sales denominated in foreign currencies through the use of forward contracts. We account for these forward contracts as cash flow hedges. To the extent these forward contracts meet hedge accounting criteria, changes in their fair value are not included in current earnings but are included in accumulated other comprehensive loss. These changes in fair value will be recognized into earnings as a component of sales or cost of sales when the forecasted transaction occurs.

We also enter into forward contracts to exchange foreign currencies for United States dollars in order to hedge our currency transaction exposures. These forward contracts settle each month at month-end, at which time we enter into new forward contracts. We have not designated these forward contracts as hedges and have not applied hedge accounting to them.

The following table presents the notional contract amounts for forward contracts outstanding:


		As of
	FASB ASC Topic 815 Designation	December 31, 2023		December 31, 2022
Forward exchange contracts	Cash flow hedge	$	223,839	$	198,473
Forward exchange contracts	Non-designated	55,789		81,929

The remaining time to maturity as of December 31, 2023 is within two years for hedge designated foreign exchange contracts and approximately one month for non-hedge designated forward exchange contracts.

Statement of comprehensive income (loss) presentation

Derivatives designated as cash flow hedges

Foreign exchange contracts designated as cash flow hedges had the following effects on accumulated other comprehensive income (loss) ("AOCI") and net earnings on our consolidated statements of comprehensive income (loss) and our consolidated balance sheets:


	Amount of Gain Recognized in AOCI						Consolidated Statements of Comprehensive Income (Loss)							Amount of Gain (Loss) Reclassified from AOCI
	Years Ended							Total Amount of Line Item Presented						Years Ended
Derivative Instrument	2023		2022		2021		Location of amount reclassified	2023		2022		2021		2023		2022		2021

Foreign exchange contracts	$	5,489	$	14,494	$	8,650	Net Sales	$	1,244,744	$	1,045,472	$	1,010,635	$	3,790	$	15,085	$	(5,421)
							Cost of Sales	568,499		474,227		442,599		4,840		939		1,411
Pre-tax gain (loss)	$	5,489	$	14,494	$	8,650								$	8,630	$	16,024	$	(4,010)
Tax expense (benefit)	1,331		3,513		2,090									2,092		3,884		(969)
Net gain (loss)	$	4,158	$	10,981	$	6,560								$	6,538	$	12,140	$	(3,041)

At December 31, 2023, $0.4 million of net unrealized gains on forward contracts accounted for as cash flow hedges, and included in accumulated other comprehensive loss, are expected to be recognized in earnings in the next twelve months.

Derivatives not designated as cash flow hedges

Net losses from derivative instruments not accounted for as hedges and losses on our intercompany receivables on our consolidated statements of comprehensive income (loss) were:


		Years Ended
Derivative Instrument	Location on Consolidated Statements of Comprehensive Income (Loss)	2023		2022		2021

Net loss on currency forward contracts	Selling and administrative expense	$	(891)	$	(240)	$	(451)
Net loss on currency transaction exposures	Selling and administrative expense	$	(1,305)	$	(1,950)	$	(1,832)

Balance sheet presentation

We record these forward foreign exchange contracts at fair value. The following tables summarize the fair value for forward foreign exchange contracts outstanding at December 31, 2023 and 2022:


December 31, 2023	Location on Consolidated Balance Sheet	Asset Fair Value		Liabilities Fair Value		Net Fair Value
Derivatives designated as hedging instruments:
Foreign exchange contracts	Prepaid expenses and other current assets	$	3,761	$	(3,197)	$	564
Foreign exchange contracts	Other long-term liabilities	24		(433)		(409)
		$	3,785	$	(3,630)	$	155

Derivatives not designated as hedging instruments:
Foreign exchange contracts	Other current liabilities	39		(209)		(170)

Total derivatives		$	3,824	$	(3,839)	$	(15)


December 31, 2022	Location on Consolidated Balance Sheet	Asset Fair Value		Liabilities Fair Value		Net Fair Value
Derivatives designated as hedging instruments:
Foreign exchange contracts	Prepaid expenses and other current assets	$	6,757	$	(3,121)	$	3,636
Foreign exchange contracts	Other long-term liabilities	60		(400)		(340)
		$	6,817	$	(3,521)	$	3,296

Derivatives not designated as hedging instruments:
Foreign exchange contracts	Other current liabilities	48		(395)		(347)

Total derivatives		$	6,865	$	(3,916)	$	2,949

Our forward foreign exchange contracts are subject to a master netting agreement and qualify for netting in the consolidated balance sheets.

Fair Value Disclosure. FASB guidance defines fair value and establishes a framework for measuring fair value and related disclosure requirements. This guidance applies when fair value measurements are required or permitted. The guidance indicates, among other things, that a fair value measurement assumes that the transaction to sell an asset or transfer a liability

occurs in the principal market for the asset or liability or, in the absence of a principal market, the most advantageous market for the asset or liability. Fair value is defined based upon an exit price model.

Valuation Hierarchy. A valuation hierarchy was established for disclosure of the inputs to the valuations used to measure fair value. This hierarchy prioritizes the inputs into three broad levels as follows. Level 1 inputs are quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets in markets that are not active, inputs other than quoted prices that are observable for the asset or liability, including interest rates, yield curves and credit risks, or inputs that are derived principally from or corroborated by observable market data through correlation. Level 3 inputs are unobservable inputs based on our own assumptions used to measure assets and liabilities at fair value. A financial asset or liability’s classification within the hierarchy is determined based on the lowest level input that is significant to the fair value measurement. There have been no significant changes in the assumptions.

Valuation Techniques. Assets and liabilities carried at fair value and measured on a recurring basis as of December 31, 2023 consist of forward foreign exchange contracts and contingent consideration. The Company values its forward foreign exchange contracts using quoted prices for similar assets. The most significant assumption is quoted currency rates. The value of the forward foreign exchange contract assets and liabilities were valued using Level 2 inputs and are listed in the table above.

The Company values contingent consideration from the In2Bones and Biorez acquisitions using Level 3 inputs. The contingent consideration was recorded at fair value at the date of acquisition based on the consideration expected to be transferred, estimated as the probability-weighted future cash flows, discounted back to present value. The fair value of contingent consideration is measured using projected payment dates, discount rates, revenue volatilities, and projected revenues. The recurring Level 3 fair value measurements of contingent consideration for which the liabilities are recorded include the following significant unobservable inputs as of December 31, 2023:


	Assumptions
Unobservable Input	In2Bones	Biorez

Discount rate	7.62%	12.25%
Revenue volatility	15.49%	21.39%
Projected year of payment	2024-2026	2024-2026

Adjustments to the fair value of contingent consideration relate to the passage of time and changes in market and business assumptions. Changes in the fair value of contingent consideration liabilities for years ended December 31, 2023 and December 31, 2022 are as follows:


	In2Bones		Biorez
Balance at January 1, 2022	$	—	$	—

Purchase price contingent consideration	69,402		114,512

Changes in fair value of contingent consideration	796		1,722

Balance at December 31, 2022	$	70,198	$	116,234

Payments	(13,867)		—

Changes in fair value of contingent consideration	(14,938)		12,517

Balance at December 31, 2023	$	41,393	$	128,751

Contingent consideration of $77.6 million and $92.5 million is included in other current liabilities and other long-term liabilities, respectively, in the consolidated balance sheet at December 31, 2023. Contingent consideration of $18.6 million and $167.8 million is included in other current liabilities and other long-term liabilities, respectively, in the consolidated balance sheet at December 31, 2022.

The carrying amounts reported in our balance sheets for cash and cash equivalents, accounts receivable, accounts payable and variable long-term debt approximate fair value.

Income Taxes (Effective Income Tax Rate Reconciliation) (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Effective Income Tax Rate, Continuing Operations, Tax Rate Reconciliation [Abstract]
Tax provision at statutory rate based on income before income taxes (percent)	21.00%	21.00%	21.00%
State income taxes, net of federal tax benefit (percent)	2.90%	(1.40%)	3.70%
Foreign income taxes (percent)	2.80%	(1.80%)	3.10%
Non deductible/non-taxable items (percent)	2.00%	(2.90%)	0.80%
US tax on worldwide earnings at different rates, (percent)	(3.10%)	(1.80%)	(0.40%)
Federal research credit (percent)	(3.00%)	2.40%	(2.30%)
Contingent consideration (percent)	(1.80%)	0.00%	0.00%
Valuation allowance (percent)	(0.50%)	2.50%	(2.20%)
Stock-based compensation (percent)	0.00%	1.50%	(9.40%)
Non-deductible premium on extinguishment and change in fair value of convertible notes (percent)	0.00%	(32.20%)	0.00%
Other, net (percent)	0.00%	(1.00%)	0.10%
Effective income tax rate, continuing operations (percent)	20.30%	(13.70%)	14.40%

Revenues (Details) - USD ($) $ in Thousands	12 Months Ended
Revenues (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Net Sales	$ 1,244,744	$ 1,045,472	$ 1,010,635
Transferred at Point in Time
Disaggregation of Revenue [Line Items]
Net Sales	1,198,043	1,000,273	966,207
Transferred over Time
Disaggregation of Revenue [Line Items]
Net Sales	46,701	45,199	44,428
Orthopedic Surgery
Disaggregation of Revenue [Line Items]
Net Sales	533,158	461,528	438,424
Orthopedic Surgery \| Transferred at Point in Time
Disaggregation of Revenue [Line Items]
Net Sales	494,002	422,648	398,963
Orthopedic Surgery \| Transferred over Time
Disaggregation of Revenue [Line Items]
Net Sales	39,156	38,880	39,461
General Surgery
Disaggregation of Revenue [Line Items]
Net Sales	711,586	583,944	572,211
General Surgery \| Transferred at Point in Time
Disaggregation of Revenue [Line Items]
Net Sales	704,041	577,625	567,244
General Surgery \| Transferred over Time
Disaggregation of Revenue [Line Items]
Net Sales	$ 7,545	$ 6,319	$ 4,967

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Goodwill and Other Intangible Assets (Goodwill) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Aug. 09, 2022	Jun. 13, 2022
Goodwill [Roll Forward]
Goodwill beginning balance	$ 815,429	$ 617,528
Goodwill resulting from business combinations	0	199,162
Foreign currency translation and other adjustments	(8,585)	(1,261)
Goodwill ending balance	806,844	815,429
Goodwill, Subsequent Recognition of Deferred Tax Asset	9,000
Accumulated goodwill impairment loss	107,000	107,000
Goodwill [Line Items]
Goodwill	$ 806,844	$ 815,429
In2Bones Global Inc
Goodwill [Line Items]
Goodwill				$ 138,500
Biorez Inc
Goodwill [Line Items]
Goodwill			$ 51,600

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-2

+ Details

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2023
Audit Information [Abstract]
Auditor Firm ID	238
Auditor Name	PricewaterhouseCoopers LLP
Auditor Location	Fairport, New York

Income Taxes (Income Before Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Undistributed Earnings of Foreign Subsidiaries	$ 26,900
Deferred Tax Liability Not Recognized, Amount of Unrecognized Deferred Tax Liability, Undistributed Earnings of Foreign Subsidiaries	1,000
Income (Loss) from Continuing Operations before Equity Method Investments, Income Taxes, Extraordinary Items, Noncontrolling Interest [Abstract]
U.S. income (loss)	51,568	$ (96,114)	$ 45,260
Foreign income	29,260	25,252	27,845
Income (loss) before income taxes	$ 80,828	$ (70,862)	$ 73,105

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(11))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483586/944-220-S99-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 30
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-30

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 5: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 31
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-31

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
-SubTopic 235
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
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-URI https://asc.fasb.org//1943274/2147479557/942-235-S99-1

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Section 25
-Paragraph 1
-SubTopic 20
-Topic 940
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481913/940-20-25-1

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(10))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483621/220-10-S99-2

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 942
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(15))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483589/942-220-S99-1

+ Details

Employee Benefit Plans (Tables)

12 Months Ended

Dec. 31, 2023

Retirement Benefits [Abstract]

Schedule of Reconciliation of the Projected Benefit Obligation, Plan Assets and Funded Status of the Pension Plan

The following table provides a reconciliation of the projected benefit obligation, plan assets and funded status of the pension plan at December 31:


	2023		2022
Accumulated benefit obligation	$	70,588	$	71,203

Change in benefit obligation
Projected benefit obligation at beginning of year	$	71,203	$	95,508
Service cost	776		1,077
Interest cost	3,646		2,148
Actuarial gain	(806)		(23,607)
Benefits paid	(3,018)		(2,805)
Settlements	(1,213)		(1,118)
Projected benefit obligation at end of year	$	70,588	$	71,203

Change in plan assets
Fair value of plan assets at beginning of year	$	62,356	$	79,404
Actual gain (loss) on plan assets	7,771		(13,125)
Benefits paid	(3,018)		(2,805)
Settlements	(1,213)		(1,118)
Fair value of plan assets at end of year	$	65,896	$	62,356

Funded status	$	(4,692)	$	(8,847)

Schedule of Amounts Recognized in the Consolidated Balance Sheets

Amounts recognized in the consolidated balance sheets consist of the following at December 31,:


	2023		2022
Other long-term liabilities	$	(4,692)	$	(8,847)
Accumulated other comprehensive loss	(24,770)		(31,346)

Schedule of Actuarial Assumptions Used

The following actuarial assumptions were used to determine our accumulated and projected benefit obligations as of December 31,:


	2023		2022
Discount rate	5.15	%	5.41	%

The following actuarial assumptions were used to determine our net periodic pension benefit cost for the years ended December 31,:


	2023		2022		2021
Discount rate on benefit obligation	5.41	%	2.81	%	2.44	%
Effective rate for interest on benefit obligation	5.34	%	2.33	%	1.83	%
Expected return on plan assets	7.00	%	7.00	%	7.00	%

Schedule of Plan Assets and Benefit Obligations Recognized in Other Comprehensive Income

Other changes in plan assets and benefit obligations recognized in other comprehensive income (loss) in 2023 and 2022 are as follows:


	2023		2022
Current year actuarial loss	$	4,447	$	5,228
Amortization of actuarial loss	2,129		2,589
Total recognized in other comprehensive income (loss)	$	6,576	$	7,817

Schedule of Net Benefit Cost

Net periodic pension cost for the years ended December 31, consists of the following:


	2023		2022		2021
Service cost	$	776	$	1,077	$	991
Interest cost on projected benefit obligation	3,646		2,148		1,803
Expected return on plan assets	(4,130)		(5,295)		(5,155)
Amortization of loss	2,129		2,589		3,327

Net periodic pension cost	$	2,421	$	519	$	966

Schedule of Allocation of Plan Assets

The allocation of plan assets by category is as follows at December 31,:


	Percentage of Pension Plan Assets				Target Allocation
	2023		2022		2024
Equity securities	72	%	72	%	75	%
Debt securities	28	%	28	%	25	%
Total	100	%	100	%	100	%

The following table sets forth the value of the pension plan's assets as of December 31, 2023 and December 31, 2022:


	2023		2022
Investments measured at fair value:
Level 1
Common Stock	$	7,926	$	6,628
Fixed Income Securities	16,735		15,963
Total Investments measured at fair value	24,661		22,591

Investments measured at NAV:
Money Market Fund	1,834		1,477
Mutual Funds	39,401		38,288
Total Investments measured at NAV	41,235		39,765

Total Investments	$	65,896	$	62,356

Schedule of Expected Benefit Payments

The following table summarizes the benefits and settlements expected to be paid by our pension plan in each of the next five years and in aggregate for the following five years. The expected payments are estimated based on the same assumptions used to measure the Company’s projected benefit obligation at December 31, 2023.


2024			$5,213
2025			5,670
2026			5,740
2027			5,314
2028			5,224
2029-2033			24,730

Guarantees (Details) - USD ($) $ in Thousands	12 Months Ended
Guarantees (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Guarantees [Abstract]
Standard warranty period (in years)	1 year
Movement in Standard Product Warranty Accrual [Roll Forward]
Beginning balance	$ 1,944	$ 2,344	$ 1,826
Provision for warranties	614	224	1,458
Claims made	(756)	(624)	(940)
Ending balance	1,802	1,944	2,344
Extended Product Warranty Disclosure [Abstract]
Product Warranty Expense	$ 4,800	$ 5,900	$ 6,800

Long Term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Financing leases	$ 2,365	$ 230
Long-term Debt and Lease Obligation, Including Current Maturities	973,848	1,054,822
Current portion of long-term debt	708	69,746
Long-term debt	973,140	985,076
Revolving Line of Credit
Debt Instrument [Line Items]
Long-term debt	2,000	70,000
Term Loan Facility
Debt Instrument [Line Items]
Long-term debt	114,064	133,858
Unamortized Debt Issuance Expense	524	729
2.625 Percent Convertible Notes Due 2024 \| Convertible Notes Payable
Debt Instrument [Line Items]
Convertible Debt	70,000	69,568
Unamortized Debt Issuance Expense		432
2.250 Percent Convertible Notes Due 2027 \| Convertible Notes Payable
Debt Instrument [Line Items]
Convertible Debt	785,419	781,166
Unamortized Debt Issuance Expense	$ 14,581	$ 18,834

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Schedule of Provision (Benefit) for Income Taxes

The provision for income taxes for the years ended December 31, 2023, 2022 and 2021 consists of the following:


	2023		2022		2021
Current tax expense (benefit):
Federal	$	2,066	$	98	$	(97)
State	3,826		1,582		609
Foreign	9,777		14,082		7,046
	15,669		15,762		7,558
Deferred income tax expense (benefit):
Federal	2,826		(4,096)		3,466
State	(893)		(1,636)		1,449
Foreign	(1,233)		(310)		(1,910)
	700		(6,042)		3,005

Provision for income taxes	$	16,369	$	9,720	$	10,563

Schedule of Effective Income Tax Rate Reconciliation

A reconciliation between income taxes computed at the statutory federal rate and the provision for income taxes for the years ended December 31, 2023, 2022 and 2021 follows:


	2023		2022		2021
Tax provision at statutory rate based on income before income taxes	21.0	%	21.0	%	21.0	%

State income taxes, net of federal tax benefit	2.9		(1.4)		3.7

Foreign income taxes	2.8		(1.8)		3.1

Non-deductible/non-taxable items	2.0		(2.9)		0.8

US tax on worldwide earnings at different rates	(3.1)		(1.8)		(0.4)

Federal research credit	(3.0)		2.4		(2.3)

Contingent consideration	(1.8)		—		—

Valuation allowance	(0.5)		2.5		(2.2)

Stock-based compensation	—		1.5		(9.4)

Non-deductible premium on extinguishment and change in fair value of convertible notes	—		(32.2)		—



Other, net	—		(1.0)		0.1

	20.3	%	(13.7)	%	14.4	%

Schedule of Deferred Tax Assets and Liabilities

The tax effects of the significant temporary differences which comprise the deferred income tax assets and liabilities at December 31, 2023 and 2022 are as follows:


	2023		2022
Assets:
Inventory	$	4,577	$	2,939
Net operating losses	2,809		12,721
Capitalized research and development	16,573		11,402
Deferred compensation	3,114		3,012
Accounts receivable	4,002		3,580
Compensation and benefits	18,234		8,723
Accrued pension	1,658		2,530
Research and development credit	13,090		16,785
Interest limitation	18,332		9,116
Convertible notes hedge	28,765		36,204
Lease liabilities	3,033		2,735
Other	6,290		4,134
Less: valuation allowances	—		(543)
	120,477		113,338

Liabilities:
Goodwill and intangible assets	153,692		152,155
Depreciation	2,248		2,373
State taxes	9,732		11,733
Unremitted foreign earnings	1,557		1,573
Lease right-of-use assets	2,939		2,579

	170,168		170,413

Net liability	$	(49,691)	$	(57,075)

Schedule of Income (Loss) before Income Tax

Income (loss) before income taxes consists of the following U.S. and foreign income (loss):


	2023		2022		2021
U.S. income (loss)	$	51,568	$	(96,114)	$	45,260
Foreign income	29,260		25,252		27,845
Total income (loss)	$	80,828	$	(70,862)	$	73,105

Schedule of Unrecognized Tax Benefits Rollforward

The following table summarizes the activity related to our unrecognized tax benefits for the years ending December 31,:


	2023		2022		2021
Balance as of January 1,	$	200	$	200	$	200



Increases for positions taken in prior periods	1,504		—		—

Decreases in unrecorded tax positions related to settlement with the taxing authorities	—		—		—

Decreases in unrecorded tax positions related to lapse of statute of limitations	—		—		—

Balance as of December 31,	$	1,704	$	200	$	200

Property, Plant and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	$ 412,884	$ 393,147
Less: Accumulated depreciation	(292,162)	(277,536)
Total property, plant and equipment	120,722	115,611
Capitalized Computer Software, Gross	50,000	49,400
Capitalized Computer Software, Accumulated Amortization	(47,100)	(45,700)
Capitalized Computer Software, Amortization	1,700	2,100	$ 3,300
Land
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	4,027	4,027
Building and improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	100,299	97,214
Machinery and equipment
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	283,470	269,745
Construction in progress
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	$ 25,088	$ 22,161

Consolidated Statements of Shareholder's Equity (Parenthetical) - $ / shares			12 Months Ended
	Oct. 28, 2013	Feb. 29, 2012	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Stockholders' Equity [Abstract]
Dividends per share of common stock (in dollars per share)	$ 0.20	$ 0.15	$ 0.80	$ 0.80	$ 0.80

Operations and Significant Accounting Policies (Accumulated Other Comprehensive Loss) (Details) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2023

Dec. 31, 2022

Dec. 31, 2021

Accumulated other comprehensive income (loss) [Roll Forward]

Accumulated other comprehensive income (loss), beginning of the period

$ (57,858)

Other comprehensive income (loss), net of income tax

7,688

$ (3,655)

$ 9,478

Accumulated other comprehensive income (loss), end of the period

(50,170)

(57,858)

Accumulated Other Comprehensive Loss

Accumulated other comprehensive income (loss) [Roll Forward]

Accumulated other comprehensive income (loss), beginning of the period

(57,858)

(54,203)

(63,681)

Other comprehensive income (loss) before reclassifications, net of tax

12,613

6,524

3,914

Amounts reclassified from accumulated other comprehensive income (loss) before tax

^[1]

(6,501)

(13,435)

7,337

Reclassification from AOCI, Current Period, Tax

1,576

3,256

(1,773)

Other comprehensive income (loss), net of income tax

7,688

(3,655)

9,478

Accumulated other comprehensive income (loss), end of the period

(50,170)

(57,858)

(54,203)

Cash Flow Hedging Gain (Loss)

Accumulated other comprehensive income (loss) [Roll Forward]

Accumulated other comprehensive income (loss), beginning of the period

2,497

3,656

(5,945)

Other comprehensive income (loss) before reclassifications, net of tax

4,158

10,981

6,560

Amounts reclassified from accumulated other comprehensive income (loss) before tax

^[1]

(8,630)

(16,024)

4,010

Reclassification from AOCI, Current Period, Tax

2,092

3,884

(969)

Other comprehensive income (loss), net of income tax

(2,380)

(1,159)

9,601

Accumulated other comprehensive income (loss), end of the period

117

2,497

3,656

Pension Liability

Accumulated other comprehensive income (loss) [Roll Forward]

Accumulated other comprehensive income (loss), beginning of the period

(23,749)

(29,671)

(36,620)

Other comprehensive income (loss) before reclassifications, net of tax

3,370

3,961

4,426

Amounts reclassified from accumulated other comprehensive income (loss) before tax

^[1]

2,129

2,589

3,327

Reclassification from AOCI, Current Period, Tax

(516)

(628)

(804)

Other comprehensive income (loss), net of income tax

4,983

5,922

6,949

Accumulated other comprehensive income (loss), end of the period

(18,766)

(23,749)

(29,671)

Cumulative Translation Adjustment

Accumulated other comprehensive income (loss) [Roll Forward]

Accumulated other comprehensive income (loss), beginning of the period

(36,606)

(28,188)

(21,116)

Other comprehensive income (loss) before reclassifications, net of tax

5,085

(8,418)

(7,072)

Amounts reclassified from accumulated other comprehensive income (loss) before tax

^[1]

Reclassification from AOCI, Current Period, Tax

Other comprehensive income (loss), net of income tax

5,085

(8,418)

(7,072)

Accumulated other comprehensive income (loss), end of the period

$ (31,521)

$ (36,606)

$ (28,188)

[1]	(a) The cash flow hedging gain (loss) and pension liability accumulated other comprehensive income (loss) components are included in sales or cost of sales and as a component of net periodic pension cost, respectively. Refer to Note 16 and Note 13, respectively, for further details.

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net income (loss)	$ 64,459	$ (80,582)	$ 62,542

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(g)(1)(ii))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 323
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481687/323-10-50-3

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
-Paragraph 28
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482907/825-10-50-28

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-SubTopic 10
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-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482765/220-10-50-6

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Publisher FASB
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147483443/250-10-50-11

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147483443/250-10-50-4

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-Name Accounting Standards Codification
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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Reference 20: http://www.xbrl.org/2009/role/commonPracticeRef
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+ Details

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities:
Net income (loss)	$ 64,459	$ (80,582)	$ 62,542
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation	16,200	16,055	16,494
Amortization of debt discount	0	0	10,217
Amortization of deferred debt issuance costs	6,058	4,910	3,726
Amortization	55,674	53,464	54,249
Stock-based compensation	24,257	21,729	16,335
Deferred income taxes	700	(6,042)	3,005
Non-cash adjustment to fair value of contingent consideration liability	(2,421)	2,518	0
Loss on early extinguishment of debt	0	3,426	899
Loss on convertible notes conversion premium	0	103,125	0
Loss on convertible notes hedge transactions settlement	0	5,460	0
Increase (decrease) in cash flows from changes in assets and liabilities, net of acquired assets
Accounts receivable	(47,068)	(5,203)	(9,159)
Inventories	14,071	(78,564)	(37,806)
Accounts payable	14,849	13,302	4,890
Income taxes	(3,921)	6,726	(1,675)
Accrued compensation and benefits	14,425	(8,968)	11,067
Other assets	(21,845)	(17,735)	(24,005)
Other liabilities	(10,090)	(256)	991
Net cash provided by operating activities	125,348	33,365	111,770
Cash flows from investing activities:
Purchases of property, plant and equipment	(19,032)	(21,785)	(14,866)
Payments related to business acquisitions, net of cash acquired	0	(227,744)	0
Other	(1,000)	0	0
Net cash used in investing activities	(20,032)	(249,529)	(14,866)
Cash flows from financing activities:
Payments on term loan	(20,000)	(92,981)	(66,654)
Proceeds from term loan	0	0	52,411
Payments on revolving line of credit	(760,000)	(530,000)	(393,753)
Proceeds from revolving line of credit	692,000	460,000	326,753
Payments to redeem convertible notes	0	(275,000)	0
Proceeds from convertible notes	0	800,000	0
Payments related to contingent consideration	(13,867)	(798)	(6,222)
Payments related to debt issuance costs	0	(21,830)	(2,000)
Dividends paid on common stock	(24,502)	(23,960)	(23,256)
Purchases of convertible notes hedges	0	(187,600)	0
Proceeds from issuance of warrants	0	72,000	0
Proceeds from settlement of convertible notes hedge transactions	0	86,228	0
Payment for settlement of warrants	0	(69,534)	0
Other, net	15,937	8,475	11,173
Net cash provided by (used in) financing activities	(110,432)	225,000	(101,548)
Effect of exchange rate changes on cash and cash equivalents	470	(741)	(1,865)
Net increase (decrease) in cash and cash equivalents	(4,646)	8,095	(6,509)
Cash and cash equivalents at beginning of year	28,942	20,847	27,356
Cash and cash equivalents at end of year	24,296	28,942	20,847
Non-cash investing and financing activities:
Contingent consideration	0	183,914	0
Dividends payable	6,153	6,098	5,874
Cash paid during the year for:
Interest	33,687	26,081	21,797
Income taxes	$ 19,879	$ 9,074	$ 8,559

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 6,034	$ 5,508
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	500,000	500,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares issued (in shares)	31,299,194	31,299,194
Treasury stock, common shares (in shares)	534,000	811,532

Legal Matters and Contingencies (Details) $ in Millions	Dec. 31, 2023 USD ($)
Loss Contingencies [Line Items]
Product liability insurance, amount per incident	$ 35
Product liability insurance, aggregate annual amount	$ 35

Operations and Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Principles of consolidation

The consolidated financial statements include the accounts of CONMED Corporation and its controlled subsidiaries. All significant intercompany accounts and transactions have been eliminated.

Use of estimates

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and judgments which affect the reported amounts of assets, liabilities, related disclosure of contingent assets and liabilities at the date of the financial statements and the reported amount of revenues and expenses during the reporting period. While there has been uncertainty and disruption in the global economy and financial markets, we are not aware of any specific event or circumstance that would require an update to our estimates or judgments or a revision of the carrying value of our assets or liabilities as of February 28, 2024, the date of issuance of this Annual Report on Form 10-K. These estimates may change, as new events occur and additional information is obtained. Actual results could differ materially from these estimates under different assumptions or conditions.

Cash and cash equivalents

We consider all highly liquid investments with an original maturity of three months or less to be cash equivalents.

Inventories

Inventories are valued at the lower of cost and net realizable value determined on the FIFO (first-in, first-out) cost method.

We write-off excess and obsolete inventory resulting from the inability to sell our products at prices in excess of current carrying costs. We make estimates regarding the future recoverability of the costs of our products and record a provision for excess and obsolete inventories based on historical experience and expected future trends.

Property, plant and equipment

Property, plant and equipment are stated at cost and depreciated using the straight-line method over the following estimated useful lives:


			Building and improvements			12 to 40 years
			Leasehold improvements			Shorter of life of asset or life of lease
			Machinery and equipment			2 to 15 years

Leases

The Company leases various manufacturing facilities, office facilities and equipment under operating and finance leases. We determine if an arrangement is a lease at inception. Right-of-use ("ROU") assets represent our right to use an underlying asset for the lease term and lease liabilities represent our obligation to make lease payments arising from the lease. Operating lease ROU assets and liabilities are recognized at the lease commencement date based on the present value of lease payments over the lease term. We use the implicit rate when readily determinable. As most of our leases do not provide an implicit rate, we use our incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. Our lease terms may include options to extend or terminate the lease when it is reasonably certain that we will exercise that option. Lease expense for lease payments is recognized on a straight-line basis over the lease term. Certain of our leases include variable lease payments, mainly when a lease is tied to an index rate. These variable lease payments are recorded as expense in the period incurred and are not material.

The Company has lease agreements with lease and non-lease components, which we account for separately. For certain equipment leases, we apply a portfolio approach to efficiently account for the operating lease ROU assets and lease liabilities. We also elected the short-term lease exemption and do not recognize leases with terms less than one year on the balance sheet. The related short-term lease expense is not material.

Our leases have remaining lease terms of one year to 13 years, some of which include options to extend the leases for up to five years, and some of which include options to terminate the leases within one year. We only account for such extensions or early terminations when it is reasonably certain we will exercise such options. Refer to Note 6 for further detail on leases.

Leases

The Company places certain of our capital equipment with customers on a loaned basis and at no charge in exchange for commitments to purchase related single-use products over time periods generally ranging from one to three years. Placed equipment is loaned and subject to return if minimum single-use purchases are not met. The Company accounts for these placements as operating leases but applies a practical expedient and does not separate the non-lease and lease components from the combined component. Accordingly, the Company accounts for the combined component as a single performance obligation with revenue recognized upon shipment of the related single-use products. The cost of the equipment is amortized over its estimated useful life which is generally five years.

Goodwill and other intangible assets

We have a history of growth through acquisitions. Assets and liabilities of acquired businesses are recorded at their estimated fair values as of the date of acquisition. Goodwill represents costs in excess of fair values assigned to the underlying net assets of acquired businesses. Factors that contribute to the recognition of goodwill include synergies expected to increase net sales and profits; acquisition of a talented workforce; cost savings opportunities; the strategic benefit of expanding our presence in core and adjacent markets; and diversifying our product portfolio. Customer and distributor relationships, trademarks, tradenames, developed technology, patents and other intangible assets primarily represent allocations of purchase price to identifiable intangible assets of acquired businesses. Sales representation, marketing and promotional rights represent intangible assets created under our agreement with Musculoskeletal Transplant Foundation (“MTF”).

Goodwill and intangible assets deemed to have indefinite lives are not amortized, but are subject to at least annual impairment testing. It is our policy to perform our annual impairment testing in the fourth quarter. The identification and measurement of goodwill impairment involves the estimation of the fair value of our business. Estimates of fair value are based on the best information available as of the date of the assessment. We completed our goodwill impairment testing of our single reporting unit during the fourth quarter of 2023. We performed our impairment test utilizing the market capitalization approach to determine whether the fair value of a reporting unit is less than its carrying amount. Based upon our assessment, the fair value of our reporting unit continues to exceed carrying value.

Intangible assets with a finite life are amortized over the estimated useful life of the asset and are evaluated each reporting period to determine whether events and circumstances warrant a revision to the remaining period of amortization. Intangible assets subject to amortization are reviewed for impairment whenever events or changes in circumstances indicate that its carrying amount may not be recoverable. The carrying amount of an intangible asset subject to amortization is not recoverable if it exceeds the sum of the undiscounted cash flows expected to result from the use of the asset. An impairment loss is recognized by reducing the carrying amount of the intangible asset to its current fair value.

For all other indefinite-lived intangible assets, we perform a qualitative impairment test. Based upon this assessment, we have determined that our indefinite-lived intangible assets are not impaired.

Other long-lived assets

We review other long-lived assets consisting of property, plant and equipment and field inventory for impairment whenever events or circumstances indicate that such carrying amounts may not be recoverable. If the sum of the expected future undiscounted cash flows is less than the carrying amount of the asset, an impairment loss is recognized by reducing the recorded value to its current fair value.

Contingent consideration

Certain acquisitions involve potential payments of future consideration that is contingent upon the acquired businesses reaching certain performance milestones. The Company records contingent consideration at fair value at the date of acquisition based on the consideration expected to be transferred, estimated as the probability-weighted future cash flows, discounted back to present value. The fair value of contingent consideration is measured using projected payment dates, discount rates, revenue volatilities and projected revenues. Projected revenues are based on the Company’s most recent internal operational budgets and long-range strategic plans. The discount rate used is determined at the time of measurement in accordance with accepted valuation methodologies. Changes in projected revenues, revenue volatilities, discount rates, and projected payment dates may result in adjustments to the fair value measurements. Contingent consideration is remeasured each reporting period using Level 3 inputs, and the change in fair value, including accretion for the passage of time, is recognized as income or expense within selling and administrative expense in the consolidated statements of comprehensive income (loss). Contingent consideration payments made soon after the acquisition date are classified as investing activities in the consolidated statements of cash flows. Contingent consideration payments not made soon after the acquisition date that are related to the acquisition date fair value are reported as financing activities in the consolidated statements of cash flows, and amounts paid in excess of the original acquisition date fair value are reported as operating activities in the consolidated statements of cash flows.

Translation of foreign currency financial statements

Assets and liabilities of foreign subsidiaries have been translated into United States dollars at the applicable rates of exchange in effect at the end of the period reported. Revenues and expenses have been translated at the applicable weighted average rates of exchange in effect during the period reported. Translation adjustments are reflected in accumulated other comprehensive loss. Transaction gains and losses are included in net income (loss).

Foreign exchange and hedging activity

We manage our foreign currency transaction risks through the use of forward contracts to hedge forecasted cash flows associated with foreign currency transaction exposures. We account for these forward contracts as cash flow hedges. To the extent these forward contracts meet hedge accounting criteria, changes in their fair value are not included in current earnings but are included in accumulated other comprehensive loss. These changes in fair value will be reclassified into earnings as a component of sales or cost of sales when the forecasted transaction occurs. These cash flows are recorded in operating activities in the consolidated statements of cash flows.

We also enter into forward contracts to exchange foreign currencies for United States dollars in order to hedge our currency transaction exposures on intercompany receivables denominated in foreign currencies. These forward contracts settle each month at month-end, at which time we enter into new forward contracts. We have not designated these forward contracts as hedges and have not applied hedge accounting to them. We record these forward contracts at fair value with resulting gains and losses included in selling and administrative expense in the consolidated statements of comprehensive income (loss).

Income taxes

Deferred income tax assets and liabilities are based on the difference between the financial statement and tax basis of assets and liabilities and operating loss and tax credit carryforwards as measured by the enacted tax rates that are anticipated to be in effect in the respective jurisdictions when these differences reverse. The deferred income tax provision generally represents the net change in the assets and liabilities for deferred income taxes. A valuation allowance is established when it is necessary to reduce deferred income tax assets to amounts for which realization is likely. In assessing the need for a valuation

allowance, we estimate future taxable income, considering the feasibility of ongoing tax planning strategies and the realizability of tax loss carryforwards following tax law ordering rules. Valuation allowances related to deferred tax assets may be impacted by changes to tax laws, changes to statutory tax rates, reversal of temporary differences and ongoing and future taxable income levels.

Deferred income taxes are not provided on the unremitted earnings of certain subsidiaries outside of the United States earned after December 31, 2017 as it is expected that these earnings are permanently reinvested. Such earnings may become taxable upon a repatriation of assets from a subsidiary or the sale or liquidation of a subsidiary. Deferred income taxes are provided when the Company no longer considers subsidiary earnings to be permanently invested, such as in situations where the Company’s subsidiaries plan to make future dividend distributions.

Revenue recognition

The Company recognizes revenue when we have satisfied a performance obligation by transferring a promised good or service (that is an asset) to a customer. An asset is transferred when the customer obtains control of that asset. The following policies apply to our major categories of revenue transactions:

•Revenue is recognized when product is shipped at which point the performance obligation is satisfied and the customer obtains control of the product.

•We place certain of our capital equipment with customers on a loaned basis and at no charge in exchange for commitments to purchase related single-use products over time periods generally ranging from one to three years. In these circumstances, no revenue is recognized upon capital equipment shipment as the equipment is loaned and subject to return if certain minimum single-use purchases are not met. Revenue is recognized upon the sale and shipment of the related single-use products. The cost of the equipment is amortized over its estimated useful life which is generally five years.

•We recognize revenues in accordance with the terms of our agreement with MTF on a net basis as our role is that of an agent earning a commission or fee. MTF is responsible for the sourcing, processing and distribution of allograft tissue for sports medicine procedures while the Company represents, markets and promotes MTF’s sports medicine allograft tissues to customers. The Company is paid a fee by MTF which is calculated as a percentage of the net amounts invoiced by MTF to customers for sports medicine allograft tissues. The Company accounts for the services provided to MTF as a series of distinct performance obligations and each service is recognized over time as MTF simultaneously receives and consumes the benefit.

•Product returns are only accepted at the discretion of the Company and in accordance with our “Returned Goods Policy”. Historically, the level of product returns has not been significant. We accrue for sales returns, rebates and allowances based upon an analysis of historical customer returns and credits, rebates, discounts and current market conditions.

•Our terms of sale to customers generally do not include any obligations to perform future services. Limited warranties are provided for capital equipment sales and provisions for warranty are provided at the time of product sale based upon an analysis of historical data.

•Amounts billed to customers related to shipping and handling have been included in net sales. Shipping and handling costs included in selling and administrative expense were $26.3 million, $21.7 million and $17.0 million for 2023, 2022 and 2021, respectively.

•We sell to a diversified base of customers around the world and, therefore, believe there is no material concentration of credit risk.

•We assess the risk of loss on accounts receivable and adjust the allowance for doubtful accounts based on this risk assessment. We do so by applying historical loss rates to our accounts receivable aging schedule to estimate expected credit losses. We further adjusted expected credit losses for specifically identified and forecasted credit losses. Historically, losses on accounts receivable have not been material. Management believes that the allowance for doubtful accounts is adequate to provide for probable losses resulting from accounts receivable.

•We sell extended warranties to customers that are typically for a period of one to three years. The related revenue is recorded as a contract liability and recognized over the life of the contract on a straight-line basis, which is reflective of our obligation to stand ready to provide repair services.

Earnings (loss) per share

Basic earnings (loss) per share (“basic EPS”) is computed by dividing net income (loss) by the weighted average number of common shares outstanding for the reporting period. Diluted earnings (loss) per share (“diluted EPS”) gives effect to all dilutive potential shares. As the Company was in a net loss position for the year ended December 31, 2022, there were no dilutive potential shares included in the computation of diluted shares outstanding.

Stock-based compensation

All share-based payments to employees, including grants of employee stock options, restricted stock units, performance share units and stock appreciation rights are recognized in the financial statements at their fair values. Compensation expense is generally recognized using a straight-line method over the vesting period. Compensation expense for performance share units is recognized using the graded vesting method.

We issue shares under our stock based compensation plans out of treasury stock whereby treasury stock is reduced by the weighted average cost of such treasury stock. To the extent there is a difference between the cost of the treasury stock and the exercise price of shares issued under stock based compensation plans, we record gains to paid in capital; losses are recorded to paid in capital to the extent any gain was previously recorded, otherwise the loss is recorded to retained earnings.

Operations and Significant Accounting Policies

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Operations and Significant Accounting Policies

Organization and operations

CONMED Corporation (“CONMED”, the “Company”, “we” or “us”) is a medical technology company that provides devices and equipment for surgical procedures. The Company’s products are used by surgeons and other healthcare professionals in a variety of specialties including orthopedics, general surgery, gynecology, thoracic surgery and gastroenterology.

Principles of consolidation

The consolidated financial statements include the accounts of CONMED Corporation and its controlled subsidiaries. All significant intercompany accounts and transactions have been eliminated.

Use of estimates

Cash and cash equivalents

We consider all highly liquid investments with an original maturity of three months or less to be cash equivalents.

Inventories

Inventories are valued at the lower of cost and net realizable value determined on the FIFO (first-in, first-out) cost method.

Property, plant and equipment

Property, plant and equipment are stated at cost and depreciated using the straight-line method over the following estimated useful lives:


			Building and improvements			12 to 40 years
			Leasehold improvements			Shorter of life of asset or life of lease
			Machinery and equipment			2 to 15 years

Leases

Goodwill and other intangible assets

Other long-lived assets

The Company maintains field inventory consisting of capital equipment for customer demonstration and evaluation purposes. Field inventory is generally not sold to customers but rather continues to be used over its useful life for demonstration, evaluation and loaner purposes. An annual wear and tear provision has been recorded on field inventory. The net book value of such equipment at December 31, 2023 and 2022 is $43.4 million and $41.3 million, respectively.

Contingent consideration

Translation of foreign currency financial statements

Foreign exchange and hedging activity

Income taxes

Revenue recognition

•Revenue is recognized when product is shipped at which point the performance obligation is satisfied and the customer obtains control of the product.

•We sell to a diversified base of customers around the world and, therefore, believe there is no material concentration of credit risk.

Please refer to Note 11 for further detail on revenue.

Earnings (loss) per share


	2023		2022		2021

Net income (loss)	$	64,459	$	(80,582)	$	62,542

Basic-weighted average shares outstanding	30,668		30,040		29,162

Stock Compensation	727		—		1,275

Warrants	11		—		506

Convertible notes	142		—		1,273

Diluted-weighted average shares outstanding	31,548		30,040		32,216

Net income (loss) (per share)
Basic	$	2.10	$	(2.68)	$	2.14
Diluted	2.04		(2.68)		1.94

The shares used in the calculation of diluted EPS exclude stock options to purchase shares and stock appreciation rights where the exercise price was greater than the average market price of common shares for the year and the effect of the inclusion would be anti-dilutive. Such shares aggregated approximately 1.7 million and 0.6 million at December 31, 2023 and 2021, respectively. As the Company was in a net loss position for the year ended December 31, 2022, there were no anti-dilutive shares.

The 2.625% convertible notes due in 2024 (the "2.625% Notes") and 2.250% convertible notes due in 2027 (the "2.250% Notes"), more fully described in Note 8, are convertible under certain circumstances, as defined in the respective indentures for each series of notes, into a combination of cash and CONMED common stock. The following is intended to describe the impact of the 2.625% Notes and 2.250% Notes and related hedge transactions on the calculation of diluted EPS. Additional shares to be issued pursuant to the terms of the Notes and related hedge transactions, if any, would occur at settlement.

Effective with our adoption of Accounting Standard Update ("ASU") 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity ("ASU 2020-06") on January 1, 2022 (see Note 2), the Company began using the if-converted method to compute diluted EPS. Under the if-converted method, in the calculation of diluted EPS, the numerator is adjusted for interest expense applicable to the convertible notes (net of tax) and the denominator is adjusted to include additional common shares assuming the principal portion of the notes and the conversion premium are settled in common shares, when permitted or required. Under the if-converted method, when convertible notes require the principal to be paid in cash, then only the conversion premium affects the calculation of diluted EPS.

On June 6, 2022, the Company repurchased and extinguished $275.0 million principal value of 2.625% Notes as further discussed in Note 8. Concurrently, the Company entered into a Supplemental Indenture related to the remaining

$70.0 million in 2.625% Notes, pursuant to which the Company irrevocably elected to settle the principal value of the 2.625% Notes in cash. Similarly, the 2.250% Notes, issued on June 6, 2022, require the principal to be paid in cash. As a result, in periods in which the Company has net income, only the conversion premium will affect the dilutive share count. Accordingly, for periods prior to adoption of ASU 2020-06 on January 1, 2022 and after June 6, 2022, in periods in which the Company has net income, the calculation of diluted EPS includes potential diluted shares upon conversion of the 2.625% Notes and the 2.250% Notes, only when the average market price per share of our common stock for the period is greater than the conversion price and only for the conversion premium, with the principal portion required to be settled in cash.

We have entered into convertible note hedge transactions to increase the effective conversion price of the 2.625% Notes from $88.80 to $114.92. However, our convertible notes hedges are not included when calculating potential dilutive shares since their effect is always anti-dilutive. Concurrent with entering into the hedge transactions, we entered into warrant transactions under which we agreed to sell shares of our common stock at $114.92. In periods in which the company has net income, the calculation of diluted EPS includes potential diluted shares to be issued under the warrants when the average market price per share of our common stock for the period is greater than $114.92, calculated under the treasury stock method.

On June 6, 2022, we entered into convertible notes hedge transactions to increase the effective conversion price of the 2.250% Notes from $145.33 to $251.53. However, our convertible notes hedges are not included when calculating potential dilutive shares since their effect is always anti-dilutive. Concurrent with entering into the hedge transactions, we entered into warrant transactions under which we agreed to sell shares of our common stock at $251.53. In periods in which the Company has net income, the calculation of diluted EPS includes potential diluted shares to be issued under the warrants when the average market price per share of our common stock for the period is greater than $251.53, calculated under the treasury stock method.

Stock-based compensation

Accumulated other comprehensive loss

Accumulated other comprehensive loss consists of the following:


	Cash Flow Hedging Gain (Loss)		Pension Liability		Foreign Currency Translation Adjustments		Accumulated Other Comprehensive Loss

Balance, December 31, 2020	$	(5,945)	$	(36,620)	$	(21,116)	$	(63,681)

Other comprehensive income (loss) before reclassifications, net of tax	6,560		4,426		(7,072)		3,914
Amounts reclassified from accumulated other comprehensive income (loss) before tax(a)	4,010		3,327		—		7,337
Income tax	(969)		(804)		—		(1,773)

Net current-period other comprehensive income (loss)	9,601		6,949		(7,072)		9,478

Balance, December 31, 2021	$	3,656	$	(29,671)	$	(28,188)	$	(54,203)

Other comprehensive income (loss) before reclassifications, net of tax	10,981		3,961		(8,418)		6,524
Amounts reclassified from accumulated other comprehensive income (loss) before tax(a)	(16,024)		2,589		—		(13,435)
Income tax	3,884		(628)		—		3,256

Net current-period other comprehensive income (loss)	(1,159)		5,922		(8,418)		(3,655)

Balance, December 31, 2022	$	2,497	$	(23,749)	$	(36,606)	$	(57,858)

Other comprehensive income (loss) before reclassifications, net of tax	4,158		3,370		5,085		12,613
Amounts reclassified from accumulated other comprehensive income (loss) before tax(a)	(8,630)		2,129		—		(6,501)
Income tax	2,092		(516)		—		1,576

Net current-period other comprehensive income (loss)	(2,380)		4,983		5,085		7,688

Balance, December 31, 2023	$	117	$	(18,766)	$	(31,521)	$	(50,170)

(a) The cash flow hedging gain (loss) and pension liability accumulated other comprehensive income (loss) components are included in sales or cost of sales and as a component of net periodic pension cost, respectively. Refer to Note 16 and Note 13, respectively, for further details.

Income Taxes (Tax Credit Carryforwards) (Details) - Federal $ in Millions	Dec. 31, 2023 USD ($)
Tax Credit Carryforward [Line Items]
Operating Loss Carryforwards, After Tax Effects	$ 1.9
Research and Development Credit
Tax Credit Carryforward [Line Items]
Tax Credit Carryforwards, After Tax Effects, Amount	$ 13.1

Goodwill and Other Intangible Assets

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Other Intangible Assets

The changes in the net carrying amount of goodwill for the years ended December 31, are as follows:


	2023		2022
Balance as of January 1,	$	815,429	$	617,528



Goodwill resulting from business combinations	—		199,162

Foreign currency translation and other adjustments	(8,585)		(1,261)

Balance as of December 31,	$	806,844	$	815,429

During 2022, the Company acquired In2Bones Global, Inc. and Biorez, Inc. as further described in Note 3. Goodwill resulting from the In2Bones Acquisition amounted to $138.5 million and acquired intangible assets including distributor relationships and developed technology amounted to $64.9 million. Goodwill resulting from the Biorez Acquisition amounted to $51.6 million and acquired intangible assets including developed technology and trademarks and tradenames amounted to $177.9 million. The 2023 change in goodwill includes an immaterial correction of $9.0 million to record deferred tax assets associated with the deductibility of contingent consideration related to purchase accounting from 2022.

Total accumulated goodwill impairment losses aggregated $107.0 million at December 31, 2023 and 2022, respectively.

Other intangible assets consist of the following:


	December 31, 2023					December 31, 2022
	Weighted Average Amortization Period (Years)	Gross Carrying Amount		Accumulated Amortization		Gross Carrying Amount		Accumulated Amortization
Intangible assets with definite lives:	22

Customer and distributor relationships	24	$	369,930	$	(188,486)	$	369,854	$	(170,870)

Sales representation, marketing and promotional rights	25	149,376		(72,000)		149,376		(66,000)

Patents and other intangible assets	16	82,594		(54,120)		79,838		(52,472)

Developed technology	18	320,204		(44,558)		320,204		(34,675)

Intangible assets with indefinite lives:

Trademarks and tradenames		86,544		—		86,544		—

		$	1,008,648	$	(359,164)	$	1,005,816	$	(324,017)

Amortization expense related to intangible assets which are subject to amortization totaled $35.2 million, $33.7 million and $33.3 million for the years ending December 31, 2023, 2022 and 2021, respectively, and is included as a reduction of revenue (for amortization related to our sales representation, marketing and promotional rights) and in selling and administrative expense (for all other intangible assets) in the consolidated statements of comprehensive income (loss).

The estimated amortization expense related to intangible assets at December 31, 2023 for each of the five succeeding years is as follows:


	Amortization included in expense		Amortization recorded as a reduction of revenue		Total
2024	$	28,755	$	6,000	$	34,755
2025	29,626		6,000		35,626
2026	29,360		6,000		35,360
2027	30,396		6,000		36,396
2028	33,528		6,000		39,528

New Accounting Pronouncements (Policies)	12 Months Ended
New Accounting Pronouncements (Policies)	Dec. 31, 2023
Accounting Standards Update and Change in Accounting Principle [Abstract]
New Accounting Pronouncements	New Accounting Pronouncements Recently Adopted Accounting Standards In August 2020, the Financial Accounting Standards Board ("FASB") issued Accounting Standard Update ("ASU") 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity ("ASU 2020-06"), which simplifies the accounting for convertible instruments by removing certain separation models requiring separate accounting for embedded conversion features which will result in more convertible debt instruments accounted for as a single liability. The ASU eliminates certain settlement conditions that are required for equity classification to qualify for the derivative scope exception. The ASU addresses how convertible instruments are accounted for in the calculation of diluted earnings per share by using the if-converted method. The Company adopted this standard on January 1, 2022 using the modified retrospective method. Recently Issued Accounting Standards, Not Yet Adopted In December 2023, the FASB issued ASU 2023-09 - Income Taxes (Topic 740): Improvements to Income Tax Disclosures. The standard requires disaggregated information about a reporting entity’s effective tax rate reconciliation in specified categories as well as information on income taxes paid. This ASU is effective for annual periods beginning after December 15, 2024 and early adoption is permitted. This ASU should be applied on a prospective basis with retrospective application permitted. We expect this ASU to only impact our disclosures with no impact to the consolidated financial statements. In November 2023, the FASB issued ASU 2023-07 - Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which requires public entities to disclose significant segment expenses and other segment items on an annual and interim basis, and provide in interim periods all disclosures about a reportable segment's profit or loss and assets that are currently required annually. The ASU does not change how a public entity identifies its operating segments, aggregates them or applies the quantitative threshold to determine its reportable segments. The new disclosure requirements are also applicable to entities that account and report as a single operating segment entity. This ASU is effective for fiscal years beginning after December 15, 2023 and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted and the guidance is to be applied retrospectively to all prior periods presented. We expect this ASU to only impact our disclosures with no impact to the consolidated financial statements. In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional guidance if certain criteria are met for entities that have contracts, hedging relationships, and other transactions that reference LIBOR or other reference rates expected to be discontinued as a result of reference rate reform. This ASU was effective as of March 12, 2020 through December 31, 2022 and was extended through December 31, 2024 by ASU 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848. The Company has not adopted these ASUs as of December 31, 2023. Our seventh amended and restated senior credit agreement includes language to address the change from LIBOR to SOFR, an alternative base rate, therefore we do not believe reference rate reform will have a significant impact on our consolidated financial statements.

Employee Benefit Plans (Other Changes in Plan Assets and Benefit Obligations) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Retirement Benefits [Abstract]
Current year actuarial loss	$ 4,447	$ 5,228
Amortization of actuarial loss	2,129	2,589
Total recognized in other comprehensive loss	$ 6,576	$ 7,817

Long Term Debt (Tables)

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Schedule of Long-term Debt

Long-term debt consists of the following at December 31:


	2023		2022
Revolving line of credit	$	2,000	$	70,000
Term loan, net of deferred debt issuance costs of $524 and $729 in 2023 and 2022, respectively	114,064		133,858
2.625% convertible notes, net of deferred debt issuance costs of $432 in 2022	70,000		69,568
2.250% convertible notes, net of deferred debt issuance costs of $14,581 and $18,834 in 2023 and 2022, respectively	785,419		781,166
Finance leases	2,365		230
Total debt	973,848		1,054,822
Less: Current portion	708		69,746
Total long-term debt	$	973,140	$	985,076

Schedule of Maturities of Long-term Debt

The scheduled maturities of long-term debt outstanding at December 31, 2023 are as follows:


2024	$	—
2025	—
2026	186,588
2027	800,000
2028	—

The above amounts exclude deferred debt issuance costs and finance leases.

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

+ References

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+ Details

Employee Benefit Plans (Fair Value of Plan Assets) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Defined Benefit Plan Disclosure [Line Items]
Number of CONMED shares in Plan	27,562
Fair value of CONMED shares in Plan	$ 3,000
Fair value of plan assets	65,896	$ 62,356
Fair Value, Inputs, Level 1
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	24,661	22,591
Fair Value Measured at Net Asset Value Per Share
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	41,235	39,765
Common Stock \| Fair Value, Inputs, Level 1
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	7,926	6,628
Fixed Income Securities \| Fair Value, Inputs, Level 1
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	16,735	15,963
Money Market Funds \| Fair Value Measured at Net Asset Value Per Share
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	1,834	1,477
Mutual Funds \| Fair Value Measured at Net Asset Value Per Share
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	$ 39,401	$ 38,288

Shareholders' Equity

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Shareholders' Equity

Shareholders’ Equity

On February 29, 2012, the Board of Directors adopted a cash dividend policy and declared an initial quarterly dividend of $0.15 per share. On October 28, 2013, the Board of Directors increased the quarterly dividend to $0.20 per share. The total dividend per share was $0.80 for each of 2023, 2022 and 2021. The fourth quarter dividend for 2023 was paid on January 5, 2024 to shareholders of record as of December 18, 2023. The total dividend payable was $6.2 million and $6.1 million at December 31, 2023 and 2022, respectively, and is included in other current liabilities in the consolidated balance sheet.

Our shareholders have authorized 500,000 shares of preferred stock, par value $.01 per share, which may be issued in one or more series by the Board of Directors without further action by the shareholders. As of December 31, 2023 and 2022, no preferred stock had been issued.

Our Board of Directors has authorized a $200.0 million share repurchase program. Through December 31, 2023, we have repurchased a total of 6.1 million shares of common stock aggregating $162.6 million under this authorization and have $37.4 million remaining available for share repurchases. The repurchase program calls for shares to be purchased in the open market or in private transactions from time to time. We may suspend or discontinue the share repurchase program at any time. During 2023, 2022, and 2021 we did not repurchase any shares.

We have reserved 6.3 million shares of common stock for issuance to employees and directors under two shareholder approved share-based compensation plans (the "Plans") of which approximately 2.4 million shares remain available for grant at December 31, 2023. The exercise price on all outstanding stock options and stock appreciation rights (“SARs”) is equal to the quoted fair market value of the stock at the date of grant. Restricted stock units (“RSUs”) are valued at the market value of the underlying stock on the date of grant. Performance stock units (“PSUs”) are valued using a Monte Carlo valuation model at the date of grant. Stock options, SARs and RSUs are generally non-transferable other than on death and generally become exercisable over a 4 to 5 year period from date of grant. PSUs are generally non-transferable other than on death and cliff vest after 3 years from date of grant. Stock options and SARs expire 10 years from date of grant. SARs are only settled in shares of the Company’s stock. The issuance of shares pursuant to the exercise of stock options and SARs and vesting of RSUs and PSUs are from the Company’s treasury stock.

Total pre-tax stock-based compensation expense recognized in the consolidated statements of comprehensive income (loss) was $24.3 million, $21.7 million and $16.3 million for the years ended December 31, 2023, 2022 and 2021, respectively. These amounts are included in selling and administrative expense. Tax related benefits of $4.0 million, $3.8 million and $3.9 million were also recognized for the years ended December 31, 2023, 2022 and 2021, respectively. Cash received from the exercise of stock options was $16.2 million, $8.9 million and $19.6 million for the years ended December 31, 2023, 2022 and 2021, respectively, and is reflected in cash flows from financing activities in the consolidated statements of cash flows.

The Company uses the Black-Scholes option pricing model to estimate the fair value of stock options and SARs at the date of grant. Use of a valuation model requires management to make certain assumptions with respect to select model inputs. Expected volatilities are based upon historical volatility of the Company’s stock over a period equal to the expected life of each stock option and SAR grant. The risk-free interest rate is based on the stock option and SAR grant date for a traded U.S. Treasury bond with a maturity date closest to the expected life. The expected annual dividend yield is based on the Company's anticipated cash dividend payouts. The expected life represents the period of time that the stock options and SARs are expected to be outstanding based on a study of historical data of option holder exercise and termination behavior. Forfeitures are recognized as incurred.

The following table illustrates the assumptions used in estimating fair value in the years ended December 31, 2023, 2022 and 2021:


	2023			2022			2021
Grant date fair value of stock options and SARs	$	40.18		$	49.88		$	42.47
Expected stock price volatility	41.84		%	38.45		%	39.27		%
Risk-free interest rate	4.14		%	1.68		%	0.81		%
Expected annual dividend yield	0.82		%	0.56		%	0.64		%
Expected life of options & SARs (years)	5.4			5.4			5.5

The following table illustrates the stock option and SAR activity for the year ended December 31, 2023:


	Number of Shares (in 000’s)	Weighted- Average Exercise Price
Outstanding at December 31, 2022	3,701	$	92.98

Granted	564	$	97.77
Forfeited	(241)	$	118.06
Exercised	(260)	$	67.30

Outstanding at December 31, 2023	3,764	$	93.82
Exercisable at December 31, 2023	2,097	$	77.53
Stock options & SARs expected to vest	1,667	$	114.32

The weighted average remaining contractual term for SARs and stock options outstanding and exercisable at December 31, 2023 was 6.1 years and 4.7 years, respectively. The aggregate intrinsic value of SARs and stock options outstanding and exercisable at December 31, 2023 was $87.2 million and $74.3 million, respectively. The aggregate intrinsic value of stock options and SARs exercised during the years ended December 31, 2023, 2022 and 2021 was $12.9 million, $13.6 million and $49.2 million, respectively.

The following table illustrates the RSU and PSU activity for the year ended December 31, 2023:


	Number of Shares (in 000’s)	Weighted- Average Grant-Date Fair Value
Outstanding at December 31, 2022	46	$	117.91

Granted	53	$	127.59
Vested	(22)	$	108.69
Forfeited	(10)	$	113.87

Outstanding at December 31, 2023	67	$	129.32

The weighted average fair value of RSU and PSU awards granted in the years ended December 31, 2023, 2022 and 2021 was $127.59, $136.35 and $129.94, respectively.

The total fair value of RSUs vested was $2.4 million, $2.6 million and $2.2 million for the years ended December 31, 2023, 2022 and 2021, respectively.

As of December 31, 2023, there was $54.6 million of total unrecognized compensation cost related to nonvested stock options, SARs, PSUs and RSUs granted under the Plans which is expected to be recognized over a weighted average period of 3.2 years.

We offer to our employees a shareholder-approved Employee Stock Purchase Plan (the “Employee Plan”), under which we reserved 1.0 million shares of common stock for issuance to our employees. The Employee Plan provides employees with the opportunity to invest from 1% to 10% of their annual salary to purchase shares of CONMED common stock at a purchase price equal to 95% of the fair market value of the common stock on the exercise date. During 2023, we issued approximately 19,005 shares of common stock under the Employee Plan. No stock-based compensation expense has been recognized in the accompanying consolidated financial statements as a result of common stock issuances under the Employee Plan.

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Dec. 31, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Fair Value Measurement Contingent Consideration (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Reconciliation of Beginning and Ending Balances of Contingent Consideration [Abstract]
Non-cash adjustment to fair value of contingent consideration liability	$ (2,421)	$ 2,518	$ 0
Business Combination, Contingent Consideration, Liability, Current	77,600	18,600
Business Combination, Contingent Consideration, Liability, Noncurrent	92,500	167,800
In2Bones Global Inc
Reconciliation of Beginning and Ending Balances of Contingent Consideration [Abstract]
Business Combination, Contingent Consideration, Liability Beginning of Year	70,198	0
Purchase price contingent consideration		69,402
Payments	(13,867)
Non-cash adjustment to fair value of contingent consideration liability	(14,938)	796
Business Combination, Contingent Consideration, Liability End of Year	$ 41,393	70,198	0
In2Bones Global Inc \| Fair Value, Inputs, Level 3 \| Fair Value, Recurring \| Measurement Input, Discount Rate
Reconciliation of Beginning and Ending Balances of Contingent Consideration [Abstract]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.0762
In2Bones Global Inc \| Fair Value, Inputs, Level 3 \| Fair Value, Recurring \| Measurement Input, Revenue Volatility
Reconciliation of Beginning and Ending Balances of Contingent Consideration [Abstract]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.1549
Biorez Inc
Reconciliation of Beginning and Ending Balances of Contingent Consideration [Abstract]
Business Combination, Contingent Consideration, Liability Beginning of Year	$ 116,234	0
Purchase price contingent consideration		114,512
Payments	0
Non-cash adjustment to fair value of contingent consideration liability	12,517	1,722
Business Combination, Contingent Consideration, Liability End of Year	$ 128,751	$ 116,234	$ 0
Biorez Inc \| Fair Value, Inputs, Level 3 \| Fair Value, Recurring \| Measurement Input, Discount Rate
Reconciliation of Beginning and Ending Balances of Contingent Consideration [Abstract]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.1225
Biorez Inc \| Fair Value, Inputs, Level 3 \| Fair Value, Recurring \| Measurement Input, Revenue Volatility
Reconciliation of Beginning and Ending Balances of Contingent Consideration [Abstract]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.2139

Shareholders' Equity (Awards) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 54.6
Weighted average period costs expected to be recognized (in years)	3 years 2 months 12 days
Stock Options and Stock Appreciation Rights (SARs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Grant date fair value of Stock options & SARs (in dollars per share)	$ 40.18	$ 49.88	$ 42.47
Expected stock price volatility (percent)	41.84%	38.45%	39.27%
Risk-free interest rate (percent)	4.14%	1.68%	0.81%
Expected annual dividend yield (percent)	0.82%	0.56%	0.64%
Expected term of option & SARs (in years)	5 years 4 months 24 days	5 years 4 months 24 days	5 years 6 months
Share-based Compensation Arrangement by Share-based Payment Award, Options and SARs, Outstanding [Roll Forward]
Number of shares outstanding, Beginning Balance	3,701
Number of shares, Granted	564
Number of shares, Forfeited	(241)
Number of shares, Exercised	(260)
Number of shares outstanding, Ending Balance	3,764	3,701
Number of shares, Exercisable	2,097
Number of shares, Stock options & SARs expected to vest	1,667
Share-based Compensation Arrangement by Share-based Payment Award, Options and SARs, Outstanding, Weighted Average Exercise Price [Roll Forward]
Weighted average exercise price, Beginning Balance (in dollars per share)	$ 92.98
Weighted average exercise price, Granted (in dollars per share)	97.77
Weighted average exercise price, Forfeited (in dollars per share)	118.06
Weighted average exercise price, Exercised (in dollars per share)	67.30
Weighted average exercise price, Ending Balance (in dollars per share)	93.82	$ 92.98
Exercisable, Weighted Average Exercise Price (in dollars per share)	77.53
Stock options & SARs expected to vest, Weighted Average Exercise Price (in dollars per share)	$ 114.32
Weighted average remaining contractual term, options outstanding (in years)	6 years 1 month 6 days
Weighted average remaining contractual term, options exercisable (in years)	4 years 8 months 12 days
Aggregate intrinsic value, options outstanding	$ 87.2
Aggregate intrinsic value, options exercisable	74.3
Aggregate intrinsic value	$ 12.9	$ 13.6	$ 49.2
Restricted Stock Units (RSUs) and Performance Share Units (PSUs)
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Number of shares outstanding, Beginning Balance	46
Number of shares, Granted	53
Number of shares, Vested	(22)
Number of shares, Forfeited	(10)
Number of shares outstanding, Ending Balance	67	46
Share-based Compensation Arrangement by Share-based Payment Award, Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]
Weighted average grant date fair value, Beginning Balance (in dollars per share)	$ 117.91
Weighted average grant date fair value, Granted (in dollars per share)	127.59	$ 136.35	$ 129.94
Weighted average grant date fair value, Vested (in dollars per share)	108.69
Weighted average grant date fair value, Forfeited (in dollars per share)	113.87
Weighted average grant date fair value, Ending Balance (in dollars per share)	$ 129.32	$ 117.91
Total fair value of shares vested	$ 2.4	$ 2.6	$ 2.2

Guarantees

12 Months Ended

Dec. 31, 2023

Guarantees [Abstract]

Guarantees

We provide warranties on certain of our products at the time of sale and sell extended warranties. The standard warranty period for our capital equipment is generally one year and our extended warranties typically vary from one to three years. Liability under service and warranty policies is based upon a review of historical warranty and service claim experience. Adjustments are made to accruals as claim data and historical experience warrant.

Changes in the carrying amount of standard warranties for the years ended December 31, are as follows:


	2023		2022		2021
Balance as of January 1,	$	1,944	$	2,344	$	1,826

Provision for warranties	614		224		1,458
Claims made	(756)		(624)		(940)

Balance as of December 31,	$	1,802	$	1,944	$	2,344

Costs associated with extended warranty repairs are recorded as incurred and amounted to $4.8 million, $5.9 million and $6.8 million for the years ended December 31, 2023, 2022 and 2021 respectively.

- Definition

The entire disclosure for each guarantee obligation, or each group of similar guarantee obligations, including (a) the nature of the guarantee, including its term, how it arose, and the events or circumstances that would require the guarantor to perform under the guarantee; (b) the maximum potential amount of future payments (undiscounted) the guarantor could be required to make under the guarantee; (c) the current carrying amount of the liability, if any, for the guarantor's obligations under the guarantee; and (d) the nature of any recourse provisions under the guarantee, and any assets held either as collateral or by third parties, and any relevant related party disclosure. Excludes disclosures about product warranties.

+ References + Details

Employee Benefit Plans (Actuarial Assumptions) (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Discount rate (percent)	5.15%	5.41%
Discount rate on benefit obligation (percent)	5.41%	2.81%	2.44%
Effective rate for interest on benefit obligation (percent)	5.34%	2.33%	1.83%
Expected return on plan assets (percent)	7.00%	7.00%	7.00%
Cumulative Gains and Losses Amortization Period Limit	11 years 1 month 17 days	11 years 4 months 17 days

Long Term Debt

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Long Term Debt

Long-term debt consists of the following at December 31:


	2023		2022
Revolving line of credit	$	2,000	$	70,000
Term loan, net of deferred debt issuance costs of $524 and $729 in 2023 and 2022, respectively	114,064		133,858
2.625% convertible notes, net of deferred debt issuance costs of $432 in 2022	70,000		69,568
2.250% convertible notes, net of deferred debt issuance costs of $14,581 and $18,834 in 2023 and 2022, respectively	785,419		781,166
Finance leases	2,365		230
Total debt	973,848		1,054,822
Less: Current portion	708		69,746
Total long-term debt	$	973,140	$	985,076

Seventh Amended and Restated Senior Credit Agreement

On July 16, 2021, we entered into a seventh amended and restated senior credit agreement consisting of: (a) a $233.5 million term loan facility and (b) a $585.0 million revolving credit facility. The revolving credit facility will terminate and the loans outstanding under the term loan facility will expire on July 16, 2026. The term loan was payable in quarterly installments increasing over the term of the facility. During 2022, we made a $90.0 million prepayment on the term loan facility resulting in the elimination of such quarterly payments with the remaining balance due upon the expiration of the term loan facility. The $90.0 million prepayment was accounted for as an extinguishment and resulted in a write-off to other expense of unamortized debt issuance costs of $0.5 million. Proceeds from the term loan facility and borrowings under the revolving credit facility were used to repay the then existing senior credit agreement. During 2021, we recorded $1.1 million to other expense related to the loss on the early extinguishment and third-party fees associated with the seventh amended and restated credit agreement. Interest rates are at the Term Secured Overnight Financing Rate plus 0.114% ("Adjusted Term SOFR") (5.489% at December 31, 2023) plus an interest rate margin of 1.125% (6.614% at December 31, 2023). For borrowings where we elect to use the alternate base rate, the initial base rate is the greatest of (i) the Prime Rate, (ii) the Federal Funds Rate plus 0.50% or (iii) the one-month Adjusted Term SOFR plus 1.00%, plus, in each case, an interest rate margin.

There were $114.6 million in borrowings outstanding on the term loan facility as of December 31, 2023. There were $2.0 million in borrowings outstanding under the revolving credit facility as of December 31, 2023. Our available borrowings on the revolving credit facility at December 31, 2023 were $581.4 million with approximately $1.6 million of the facility set aside for outstanding letters of credit. The carrying amounts of the term loan and revolving credit facility approximate fair value.

The seventh amended and restated senior credit agreement is collateralized by substantially all of our personal property and assets. The seventh amended and restated senior credit agreement contains covenants and restrictions which, among other things, require the maintenance of certain financial ratios and restrict dividend payments and the incurrence of certain indebtedness and other activities, including acquisitions and dispositions. We were in full compliance with these covenants and restrictions as of December 31, 2023. We are also required, under certain circumstances, to make mandatory prepayments from net cash proceeds from any issuance of equity and asset sales.

2.625% Convertible Notes

On January 29, 2019, we issued $345.0 million aggregate principal amount of 2.625% convertible notes due in 2024. Interest was payable semi-annually in arrears on February 1 and August 1 of each year, commencing August 1, 2019. The 2.625% Notes were scheduled to mature on February 1, 2024, unless earlier repurchased or converted. In February 2024, the Company repaid the $70.0 million then outstanding of the 2.625% Notes through borrowings on our revolving credit facility. Accordingly, we have classified the 2.625% Notes as long-term obligations as of the December 31, 2023 balance sheet date in accordance with the repayment terms of the revolving credit facility with which we refinanced the obligation.

The 2.625% Notes represented subordinated unsecured obligations and were convertible under certain circumstances, as defined in the indenture, into a combination of cash and CONMED common stock. The 2.625% Notes were converted at an initial conversion rate of 11.2608 shares of our common stock per $1,000 principal amount of 2.625% Notes (equivalent to an initial conversion price of approximately $88.80 per share of common stock). Holders of the 2.625% Notes could have converted the 2.625% Notes at their option at any time on or after November 1, 2023 through the second scheduled trading day preceding the maturity date. Holders of the 2.625% Notes also had the right to convert the 2.625% Notes prior to November 1, 2023, but only upon the occurrence of specified events. The conversion rate was subject to anti-dilution adjustments if certain

events occurred. A portion of the net proceeds from the offering of the 2.625% Notes was used as part of the financing for the Buffalo Filter acquisition and $21.0 million was used to pay the cost of certain convertible notes hedge transactions as further described below.

On June 6, 2022, the Company repurchased and extinguished $275.0 million principal amount of the 2.625% Notes for aggregate consideration consisting of $275.0 million in cash and approximately 0.9 million shares of the Company's common stock. During the year ended December 31, 2022, the Company recorded a loss on extinguishment of $103.1 million to other expense based on the fair value of the shares of the Company’s common stock issued in connection with the extinguishment. This loss was not deductible for tax purposes. We also recorded a write-off to other expense of unamortized debt issuance costs related to the 2.625% Notes of $2.9 million. Concurrently, the Company entered into a Supplemental Indenture related to the remaining $70.0 million in 2.625% Notes, in which the Company irrevocably elected to settle the principal value of those 2.625% Notes in cash.

Our effective borrowing rate for nonconvertible debt at the time of issuance of the 2.625% Notes was estimated to be 6.14%, which resulted in $51.6 million of the $345.0 million aggregate principal amount of 2.625% Notes issued, or $39.1 million after taxes, being attributable to equity. For the year ended December 31, 2021, we have recorded interest expense related to the amortization of debt discount on the 2.625% Notes of $10.2 million at the effective interest rate of 6.14%. On January 1, 2022, we adopted ASU 2020-06 using the modified retrospective approach as further described in Note 2. This ASU eliminated the equity component separately recorded for the conversion features associated with the convertible notes and related debt discount. For the years ended December 31, 2023, 2022 and 2021, we recorded interest expense on the 2.625% Notes of $1.8 million, $4.8 million and $9.1 million, respectively, at the contractual coupon rate of 2.625%.

The estimated fair value of the 2.625% Notes was approximately $86.1 million as of December 31, 2023 based on a market approach which represents a Level 2 valuation in the fair value hierarchy. The estimated fair value was determined based on the estimated or actual bids and offers of the 2.625% Notes in an over-the-counter market transaction on the last business day of the period.

2.250% Convertible Notes

On June 6, 2022, we issued $800.0 million aggregate principal amount of 2.250% Notes. Interest is payable semi-annually in arrears on June 15 and December 15 of each year, commencing December 15, 2022. The 2.250% Notes will mature on June 15, 2027, unless earlier repurchased or converted. The 2.250% Notes represent subordinated unsecured obligations and are convertible under certain circumstances, as defined in the indenture, into a combination of cash and CONMED common stock, with the principal required to be paid in cash. The 2.250% Notes may be converted at an initial conversion rate of 6.8810 shares of our common stock per $1,000 principal amount of the 2.250% Notes (equivalent to an initial conversion price of approximately $145.33 per share of common stock). Holders of the 2.250% Notes may convert the 2.250% Notes at their option at any time on or after March 15, 2027 through the second scheduled trading day preceding the maturity date. Holders of the 2.250% Notes will also have the right to convert the 2.250% Notes prior to March 15, 2027, but only upon the occurrence of specified events. The conversion rate is subject to anti-dilution adjustments if certain events occur. A portion of these proceeds were used to repurchase and extinguish a portion of the 2.625% Notes, pay off our then outstanding balance on our revolving line of credit, pay down $90.0 million of our term loan and partially pay for the In2Bones Acquisition. In addition, approximately $115.6 million of the proceeds were used to pay the cost of certain convertible notes hedge transactions related to the 2.250% Notes.

For the year ended December 31, 2023 and 2022, we have recorded interest expense on the 2.250% Notes of $18.0 million and $10.3 million, respectively, at the contractual coupon rate of 2.250%.

The estimated fair value of the 2.250% Notes was approximately $802.4 million as of December 31, 2023 based on a market approach which represents a Level 2 valuation in the fair value hierarchy. The estimated fair value was determined based on the estimated or actual bids and offers of the 2.250% Notes in an over-the-counter market transaction on the last business day of the year.

Convertible Notes Hedge Transactions

In connection with the offerings of the 2.625% and 2.250% Notes, we entered into convertible notes hedge transactions with a number of financial institutions (each, an “option counterparty”). The convertible notes hedge transactions cover, subject to anti-dilution adjustments substantially similar to those applicable to the respective Notes, the number of shares of our common stock underlying the 2.625% and 2.250% Notes. Concurrent with entering into the convertible notes hedge transactions, we also entered into separate warrant transactions with each option counterparty whereby we sold to such option counterparty warrants to purchase, subject to customary anti-dilution adjustments, the same number of shares of our common stock.

In connection with the repurchase and extinguishment of $275.0 million principal amount of the 2.625% Notes, the Company entered into agreements with the option counterparties to terminate a corresponding portion of the hedges on the 2.625% Notes. The transactions had a net fair value due the Company on execution date of $22.2 million which was recorded as

an adjustment to Paid-in Capital. The Company recorded a $5.5 million charge to other expense as a result of a subsequent decline in fair value between execution date and settlement date with the Company receiving net cash of $16.7 million. The termination of the convertible notes hedge resulted in the release of the related deferred tax asset. In connection with the issuance of 2.250% Notes, the Company purchased hedges for $187.6 million ($142.1 million net of tax) and received proceeds from the issuance of warrants totaling $72.0 million, recorded to paid-in capital.

The convertible notes hedge transactions are expected generally to reduce the potential dilution upon conversion of the Notes and/or offset any cash payments we are required to make in excess of the principal amount of converted Notes, as the case may be, in the event that the market price per share of our common stock, as measured under the terms of the convertible notes hedge transactions, is greater than the strike price of the convertible notes hedge transactions, which initially corresponds to the conversion price of the Notes and is subject to anti-dilution adjustments substantially similar to those applicable to the conversion rate of the Notes. If, however, the market price per share of our common stock, as measured under the terms of the warrant transactions, exceeds the strike price ($114.92 for the 2.625% Notes and $251.53 for the 2.250% Notes) of the warrants, there would nevertheless be dilution to the extent that such market price exceeds the strike price of the warrants as noted in Note 1, unless we elect to settle the warrants in cash.

The scheduled maturities of long-term debt outstanding at December 31, 2023 are as follows:


2024	$	—
2025	—
2026	186,588
2027	800,000
2028	—

The above amounts exclude deferred debt issuance costs and finance leases.

Guarantees (Tables)

12 Months Ended

Dec. 31, 2023

Guarantees [Abstract]

Changes in the Carrying Amount of Service and Product Warranties

Changes in the carrying amount of standard warranties for the years ended December 31, are as follows:


	2023		2022		2021
Balance as of January 1,	$	1,944	$	2,344	$	1,826

Provision for warranties	614		224		1,458
Claims made	(756)		(624)		(940)

Balance as of December 31,	$	1,802	$	1,944	$	2,344

Consolidated Statements of Shareholders' Equity - USD ($)
shares in Thousands, $ in Thousands

Total

Common Stock

Paid-in Capital

Retained Earnings

Accumulated Other Comprehensive Loss

Treasury Stock, Common

Balance at period start (shares) at Dec. 31, 2020

31,299

Balance at period start at Dec. 31, 2020

$ 709,038

$ 313

$ 382,628

$ 457,417

$ (63,681)

$ (67,639)

Increase (Decrease) in Stockholders' Equity [Roll Forward]

Common stock issued under employee plans

11,396

(2,192)

13,588

Stock-based compensation

16,335

Dividends on common stock ($.80 per share)

(23,354)

Comprehensive income (loss):

Cash flow hedging loss, net

9,601

Pension liability, net

6,949

Foreign currency translation adjustments

(7,072)

Net income (loss)

62,542

Comprehensive income (loss)

72,020

Balance at period end (shares) at Dec. 31, 2021

31,299

Balance at period end at Dec. 31, 2021

785,435

$ 313

396,771

496,605

(54,203)

(54,051)

Increase (Decrease) in Stockholders' Equity [Roll Forward]

Common stock issued under employee plans

8,770

3,385

5,385

Stock-based compensation

21,729

Dividends on common stock ($.80 per share)

(24,183)

Shares issued for the settlement of convertible notes

(25,890)

25,890

Convertible notes premium on extinguishment

103,125

Settlement of convertible notes hedge transactions

118,912

Settlement of warrants

(96,758)

Issuance of convertible notes hedge transactions, net of tax

(142,128)

Issuance of warrants

72,000

Comprehensive income (loss):

Cash flow hedging loss, net

(1,159)

Pension liability, net

5,922

Foreign currency translation adjustments

(8,418)

Net income (loss)

(80,582)

Comprehensive income (loss)

$ (84,237)

Accounting Standards Update [Extensible Enumeration]

^[1]

Accounting Standards Update 2020-06

Balance at period end (shares) at Dec. 31, 2022

31,299

Balance at period end at Dec. 31, 2022

$ 745,545

$ 313

413,235

412,631

(57,858)

(22,776)

Balance at period end (Accounting Standards Update 2020-06) at Dec. 31, 2022

^[1]

(17,120)

(37,911)

20,791

Increase (Decrease) in Stockholders' Equity [Roll Forward]

Common stock issued under employee plans

16,832

9,043

7,789

Stock-based compensation

24,257

Dividends on common stock ($.80 per share)

(24,559)

Comprehensive income (loss):

Cash flow hedging loss, net

(2,380)

Pension liability, net

4,983

Foreign currency translation adjustments

5,085

Net income (loss)

64,459

Comprehensive income (loss)

72,147

Balance at period end (shares) at Dec. 31, 2023

31,299

Balance at period end at Dec. 31, 2023

$ 834,222

$ 313

$ 446,535

$ 452,531

$ (50,170)

$ (14,987)

[1]	(1)We recorded the cumulative impact of adopting ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity in 2022.

Consolidated Statements of Comprehensive Income (Loss) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income [Abstract]
Net sales	$ 1,244,744	$ 1,045,472	$ 1,010,635
Cost of sales	568,499	474,227	442,599
Gross profit	676,245	571,245	568,036
Selling and administrative expense	503,040	454,039	414,754
Research and development expense	52,602	47,152	43,565
Operating expenses	555,642	501,191	458,319
Income from operations	120,603	70,054	109,717
Interest expense	39,775	28,905	35,485
Other expense	0	112,011	1,127
Income (loss) before income taxes	80,828	(70,862)	73,105
Provision for income taxes	16,369	9,720	10,563
Net income (loss)	$ 64,459	$ (80,582)	$ 62,542
Earnings per share:
Basic (in dollars per share)	$ 2.10	$ (2.68)	$ 2.14
Diluted (in dollars per share)	$ 2.04	$ (2.68)	$ 1.94
Other comprehensive income (loss), before income tax:
Cash flow hedging	$ (3,141)	$ (1,530)	$ 12,660
Pension liability	6,576	7,817	9,163
Foreign currency translation adjustments	5,085	(8,418)	(7,072)
Other comprehensive income (loss), before income tax	8,520	(2,131)	14,751
Provision for income taxes related to items in other comprehensive income (loss)	832	1,524	5,273
Other comprehensive income (loss), net of income tax	7,688	(3,655)	9,478
Comprehensive income (loss)	$ 72,147	$ (84,237)	$ 72,020

Leases Maturities of Operating and Financing Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Operating Lease
2024	$ 7,509
2025	4,329
2026	2,313
2027	1,722
2028	973
Thereafter	4,221
Total lease payments	21,067
Less imputed interest	(3,661)
Total lease liabilities	17,406	$ 18,678
Finance Lease
2024	708
2025	682
2026	680
2027	436
2028	79
Thereafter	0
Total lease payments	2,585
Less imputed interest	(220)
Total lease liabilities	$ 2,365	$ 230

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
ASSETS
Cash and cash equivalents	$ 24,296	$ 28,942
Accounts receivable, less allowance for doubtful accounts of $6,034 in 2023 and $5,508 in 2022	242,279	191,345
Inventories	318,324	332,320
Prepaid expenses and other current assets	30,750	28,619
Total current assets	615,649	581,226
Property, plant and equipment, net	120,722	115,611
Deferred income taxes	11,211	9,650
Goodwill	806,844	815,429
Other intangible assets, net	649,484	681,799
Other assets	96,111	93,877
Total assets	2,300,021	2,297,592
LIABILITIES AND SHAREHOLDERS' EQUITY
Current portion of long-term debt	708	69,746
Accounts payable	88,224	73,393
Accrued compensation and benefits	70,069	54,733
Other current liabilities	151,728	98,680
Total current liabilities	310,729	296,552
Long-term debt	973,140	985,076
Deferred income taxes	60,902	66,725
Other long-term liabilities	121,028	203,694
Total liabilities	1,465,799	1,552,047
Commitments and contingencies (Note 14)
Preferred stock, par value $.01 per share; authorized 500,000 shares, none issued or outstanding	0	0
Common stock, par value $.01 per share; 100,000,000 authorized; 31,299,194 issued in 2023 and 2022, respectively	313	313
Paid-in capital	446,535	413,235
Retained earnings	452,531	412,631
Accumulated other comprehensive loss	(50,170)	(57,858)
Less: Treasury stock, at cost; 534,000 and 811,532 shares in 2023 and 2022, respectively	(14,987)	(22,776)
Total shareholders' equity	834,222	745,545
Total liabilities and shareholders' equity	$ 2,300,021	$ 2,297,592

Property, Plant and Equipment

12 Months Ended

Dec. 31, 2023

Property, Plant and Equipment [Abstract]

Property, Plant and Equipment

Property, plant and equipment consist of the following at December 31:


	2023		2022
Land	$	4,027	$	4,027
Building and improvements	100,299		97,214
Machinery and equipment	283,470		269,745
Construction in progress	25,088		22,161
	412,884		393,147
Less: Accumulated depreciation	(292,162)		(277,536)
	$	120,722	$	115,611

Internal-use software, included in gross machinery and equipment at December 31, 2023 and 2022 was $50.0 million and $49.4 million, respectively, with related accumulated depreciation of $47.1 million and $45.7 million, respectively. Internal use software depreciation expense was $1.7 million, $2.1 million and $3.3 million for the years ended December 31, 2023, 2022 and 2021, respectively.

Employee Benefit Plans

12 Months Ended

Dec. 31, 2023

Retirement Benefits [Abstract]

Employee Benefit Plans

We sponsor an employee savings plan (“401(k) plan”) covering substantially all of our United States based employees. We also sponsor a defined benefit pension plan (the “pension plan”) that was frozen in 2009. It covered substantially all our United States based employees at the time it was frozen.

Total employer contributions to the 401(k) plan were $8.2 million, $9.9 million and $9.2 million during the years ended December 31, 2023, 2022 and 2021, respectively.

We use a December 31, measurement date for our pension plan. Cumulative gains and losses in excess of 10% of the greater of the benefit obligation or the market-related value of assets are amortized on a straight-line basis over the lesser of the expected average remaining life expectancy of the plan's participants or 11.13 and 11.38 years at December 31, 2023 and 2022, respectively. The limits of 11.13 and 11.38 years, respectively, are adjusted to reflect the percentage change in the average remaining service period for the plan's active membership.

The following table provides a reconciliation of the projected benefit obligation, plan assets and funded status of the pension plan at December 31:


	2023		2022
Accumulated benefit obligation	$	70,588	$	71,203

Change in benefit obligation
Projected benefit obligation at beginning of year	$	71,203	$	95,508
Service cost	776		1,077
Interest cost	3,646		2,148
Actuarial gain	(806)		(23,607)
Benefits paid	(3,018)		(2,805)
Settlements	(1,213)		(1,118)
Projected benefit obligation at end of year	$	70,588	$	71,203

Change in plan assets
Fair value of plan assets at beginning of year	$	62,356	$	79,404
Actual gain (loss) on plan assets	7,771		(13,125)
Benefits paid	(3,018)		(2,805)
Settlements	(1,213)		(1,118)
Fair value of plan assets at end of year	$	65,896	$	62,356

Funded status	$	(4,692)	$	(8,847)

The projected benefit obligation decreased $0.6 million from December 31, 2022 to December 31, 2023. This reduction was mainly due to demographic changes and participants delaying benefit commencement, which decreased the obligation, offset by the decrease in the discount rate from 5.41% at December 31, 2022 to 5.15% at December 31, 2023, which increased the obligation.

Amounts recognized in the consolidated balance sheets consist of the following at December 31,:


	2023		2022
Other long-term liabilities	$	(4,692)	$	(8,847)
Accumulated other comprehensive loss	(24,770)		(31,346)

Accumulated other comprehensive loss for the years ended December 31, 2023 and 2022 consists of net actuarial losses not yet recognized in net periodic pension cost (before income taxes).

The following actuarial assumptions were used to determine our accumulated and projected benefit obligations as of December 31,:


	2023		2022
Discount rate	5.15	%	5.41	%

Other changes in plan assets and benefit obligations recognized in other comprehensive income (loss) in 2023 and 2022 are as follows:


	2023		2022
Current year actuarial loss	$	4,447	$	5,228
Amortization of actuarial loss	2,129		2,589
Total recognized in other comprehensive income (loss)	$	6,576	$	7,817

Net periodic pension cost for the years ended December 31, consists of the following:


	2023		2022		2021
Service cost	$	776	$	1,077	$	991
Interest cost on projected benefit obligation	3,646		2,148		1,803
Expected return on plan assets	(4,130)		(5,295)		(5,155)
Amortization of loss	2,129		2,589		3,327

Net periodic pension cost	$	2,421	$	519	$	966

Non-service pension cost/(benefit) was immaterial for the years ended 2023, 2022 and 2021.

The following actuarial assumptions were used to determine our net periodic pension benefit cost for the years ended December 31,:


	2023		2022		2021
Discount rate on benefit obligation	5.41	%	2.81	%	2.44	%
Effective rate for interest on benefit obligation	5.34	%	2.33	%	1.83	%
Expected return on plan assets	7.00	%	7.00	%	7.00	%

The Company’s discount rate and mortality assumptions are the significant assumptions in determining the projected benefit obligation of the Company’s pension plan.

The discount rate represents the interest rate used in estimating the present value of projected cash flows to settle the Company’s pension obligations. The discount rate assumption is determined by management using a full yield curve approach, which involves applying the specific spot rates along the yield curve used in the determination of the benefit obligation that correlates to the relevant projected cash flows.

Mortality assumptions are based on published mortality studies developed primarily based on past experience of the broad population and modified for projected longevity trends. The mortality assumptions used for 2023 and 2022 are based on the Pri-2012 Mortality Tables using the MP-2021 mortality improvement scale.

In determining the expected return on pension plan assets, we consider the relative weighting of plan assets, the historical performance of total plan assets and individual asset classes and economic and other indicators of future performance.

Asset management objectives include maintaining an adequate level of diversification to reduce interest rate and market risk and providing adequate liquidity to meet immediate and future benefit payment requirements.

The allocation of plan assets by category is as follows at December 31,:


	Percentage of Pension Plan Assets				Target Allocation
	2023		2022		2024
Equity securities	72	%	72	%	75	%
Debt securities	28	%	28	%	25	%
Total	100	%	100	%	100	%

As of December 31, 2023, the pension plan held 27,562 shares of our common stock, which had a fair value of $3.0 million. We believe that our long-term asset allocation on average will approximate the targeted allocation. We regularly review our actual asset allocation and periodically rebalance the pension plan’s investments to our targeted allocation when deemed appropriate.

FASB guidance defines fair value and establishes a framework for measuring fair value and related disclosure requirements as described in Note 16. Following is a description of the valuation methodologies used for our pension assets. There have been no changes in the methodologies used at December 31, 2023 and 2022:


Common Stock:			Common stock is valued at the closing price reported on the common stock’s respective stock exchange and is classified within level 1 of the valuation hierarchy.

Fixed Income Securities:			Valued at the closing price reported on the active market on which the individual securities are traded and are classified within level 1 of the valuation hierarchy.

Money Market Fund:			These investments are public investment vehicles valued using the Net Asset Value (NAV).

Mutual Funds:			These investments are public investment vehicles valued using the Net Asset Value (NAV) provided by the administrator of the fund. The NAV is based on the value of the underlying assets owned by the fund, minus its liabilities, and then divided by the number of shares outstanding.

The methods described above may produce a fair value calculation that may not be indicative of net realizable value or reflective of future fair values. Furthermore, while the pension plan believes its valuation methods are appropriate and consistent with other market participants, the use of different methodologies or assumptions to determine the fair value of certain financial instruments could result in a different fair value measurement at the reporting date.

The following table sets forth the value of the pension plan's assets as of December 31, 2023 and December 31, 2022:


	2023		2022
Investments measured at fair value:
Level 1
Common Stock	$	7,926	$	6,628
Fixed Income Securities	16,735		15,963
Total Investments measured at fair value	24,661		22,591

Investments measured at NAV:
Money Market Fund	1,834		1,477
Mutual Funds	39,401		38,288
Total Investments measured at NAV	41,235		39,765

Total Investments	$	65,896	$	62,356

We do not expect to make any contributions to our pension plan for 2024.


2024			$5,213
2025			5,670
2026			5,740
2027			5,314
2028			5,224
2029-2033			24,730

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 70
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480794/715-70-50-1

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 17
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480482/715-20-55-17

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(iv)(03)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
-Paragraph 1
-Subparagraph (q)
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-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

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-Subparagraph (l)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
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-URI https://asc.fasb.org//715/tableOfContent

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
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-Name Accounting Standards Codification
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-Paragraph 2
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-URI https://asc.fasb.org//1943274/2147480126/715-20-S99-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480266/715-60-50-3

+ Details

Shareholders' Equity (Details)			12 Months Ended
Shareholders' Equity (Details)	Oct. 28, 2013 $ / shares	Feb. 29, 2012 $ / shares	Dec. 31, 2023 USD ($) plans $ / shares shares	Dec. 31, 2022 USD ($) $ / shares shares	Dec. 31, 2021 USD ($) $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Dividends per share of common stock (in dollars per share) \| $ / shares	$ 0.20	$ 0.15	$ 0.80	$ 0.80	$ 0.80
Dividends payable			$ 6,153,000	$ 6,098,000	$ 5,874,000
Preferred stock, shares authorized (in shares) \| shares			500,000	500,000
Preferred stock, par value (in dollars per share) \| $ / shares			$ 0.01	$ 0.01
Preferred stock, shares issued (in shares) \| shares			0	0
Shares authorized under repurchase program			$ 200,000,000
Total stock repurchased under plan, shares \| shares			6,100,000
Total stock repurchased under plan, value			$ 162,600,000
Remaining authorized repurchase amount			$ 37,400,000
Number of shares reserved for share-based compensation plans \| shares			6,300,000
Number of share-based compensation plans \| plans			2
Number of shares available for grant \| shares			2,400,000
Stock-based compensation			$ 24,257,000	$ 21,729,000	16,335,000
Tax benefit from stock-based compensation			4,000,000	3,800,000	3,900,000
Proceeds from stock options exercised			$ 16,200,000	$ 8,900,000	$ 19,600,000
Stock Options and Stock Appreciation Rights (SARs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period from date of grant (in years)			10 years
Performance Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting term (in years)			3 years
Minimum \| Stock Options, Stock Appreciation Rights, and Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting term (in years)			4 years
Maximum \| Stock Options, Stock Appreciation Rights, and Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting term (in years)			5 years

Cover Page - USD ($) $ in Billions	12 Months Ended
Cover Page - USD ($) $ in Billions	Dec. 31, 2023	Feb. 21, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Transition Report	false
Current Fiscal Year End Date	--12-31
Document Period End Date	Dec. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Entity File Number	001-39218
Entity Registrant Name	CONMED CORPORATION
Entity Central Index Key	0000816956
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	16-0977505
Entity Address, Address Line One	11311 Concept Boulevard
Entity Address, City or Town	Largo,
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33773
City Area Code	727
Local Phone Number	392-6464
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	CNMD
Security Exchange Name	NYSE
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction [Flag]	false
Entity Shell Company	false
Entity Public Float			$ 3.1
Entity Common Stock, Shares Outstanding		30,780,567
Documents Incorporated by Reference [Text Block]	Portions of the Definitive Proxy Statement and any other informational filings for the 2024 Annual Meeting of Shareholders are incorporated by reference into Part III of this report.
Amendment Flag	false

Income Taxes (Deferred Tax Assets and Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Components of Deferred Tax Assets [Abstract]
Inventory	$ 4,577	$ 2,939
Net operating losses	2,809	12,721
Capitalized research and development	16,573	11,402
Deferred compensation	3,114	3,012
Accounts receivable	4,002	3,580
Compensation and benefits	18,234	8,723
Accrued pension	1,658	2,530
Research and development credit	13,090	16,785
Interest limitation	18,332	9,116
Convertible notes hedge	28,765	36,204
Lease liabilities	3,033	2,735
Other	6,290	4,134
Less: valuation allowances	0	(543)
Deferred tax assets, net of valuation allowance	120,477	113,338
Components of Deferred Tax Liabilities [Abstract]
Goodwill and intangible assets	153,692	152,155
Depreciation	2,248	2,373
State taxes	9,732	11,733
Unremitted foreign earnings	1,557	1,573
Lease right-of-use assets	2,939	2,579
Deferred tax liabilities	170,168	170,413
Net liability	$ (49,691)	$ (57,075)

Shareholders' Equity (Employee Plan) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares reserved for share-based compensation plans	6,300,000
Stock-based compensation	$ 24,257	$ 21,729	$ 16,335
Employee Plan \| Employee Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares reserved for share-based compensation plans	1,000,000
Minimum percent of salary employees can invest	1.00%
Maximum percent of salary employees can invest	10.00%
Purchase prices percent of fair market value	95.00%
Number of shares issued under Plan	19,005
Stock-based compensation	$ 0

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 35
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-URI https://asc.fasb.org//1943274/2147480483/718-10-35-1D

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Operations and Significant Accounting Policies (Property, Plant and Equipment) (Details)	Dec. 31, 2023
Building and improvements \| Minimum
Property, Plant and Equipment [Line Items]
Estimated useful life, average (in years)	12 years
Building and improvements \| Maximum
Property, Plant and Equipment [Line Items]
Estimated useful life, average (in years)	40 years
Machinery and equipment \| Minimum
Property, Plant and Equipment [Line Items]
Estimated useful life, average (in years)	2 years
Machinery and equipment \| Maximum
Property, Plant and Equipment [Line Items]
Estimated useful life, average (in years)	15 years

Employee Benefit Plans (Allocation of Pension Plan Assets) (Details)	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Defined Benefit Plan Disclosure [Line Items]
Percentage of pension plan assets		100.00%	100.00%
Forecast
Defined Benefit Plan Disclosure [Line Items]
Target allocation (percent)	100.00%
Equity Securities
Defined Benefit Plan Disclosure [Line Items]
Percentage of pension plan assets		72.00%	72.00%
Equity Securities \| Forecast
Defined Benefit Plan Disclosure [Line Items]
Target allocation (percent)	75.00%
Debt Securities
Defined Benefit Plan Disclosure [Line Items]
Percentage of pension plan assets		28.00%	28.00%
Debt Securities \| Forecast
Defined Benefit Plan Disclosure [Line Items]
Target allocation (percent)	25.00%

Operations and Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Property Plant and Equipment Useful Life

Property, plant and equipment are stated at cost and depreciated using the straight-line method over the following estimated useful lives:


			Building and improvements			12 to 40 years
			Leasehold improvements			Shorter of life of asset or life of lease
			Machinery and equipment			2 to 15 years

Schedule of Calculation of Basic and Diluted Earnings (Loss) Per Share

The following table sets forth the computation of basic and diluted earnings (loss) per share at December 31, 2023, 2022 and 2021, respectively:


	2023		2022		2021

Net income (loss)	$	64,459	$	(80,582)	$	62,542

Basic-weighted average shares outstanding	30,668		30,040		29,162

Stock Compensation	727		—		1,275

Warrants	11		—		506

Convertible notes	142		—		1,273

Diluted-weighted average shares outstanding	31,548		30,040		32,216

Net income (loss) (per share)
Basic	$	2.10	$	(2.68)	$	2.14
Diluted	2.04		(2.68)		1.94

Schedule of Accumulated Other Comprehensive Loss

Accumulated other comprehensive loss consists of the following:


	Cash Flow Hedging Gain (Loss)		Pension Liability		Foreign Currency Translation Adjustments		Accumulated Other Comprehensive Loss

Balance, December 31, 2020	$	(5,945)	$	(36,620)	$	(21,116)	$	(63,681)

Other comprehensive income (loss) before reclassifications, net of tax	6,560		4,426		(7,072)		3,914
Amounts reclassified from accumulated other comprehensive income (loss) before tax(a)	4,010		3,327		—		7,337
Income tax	(969)		(804)		—		(1,773)

Net current-period other comprehensive income (loss)	9,601		6,949		(7,072)		9,478

Balance, December 31, 2021	$	3,656	$	(29,671)	$	(28,188)	$	(54,203)

Other comprehensive income (loss) before reclassifications, net of tax	10,981		3,961		(8,418)		6,524
Amounts reclassified from accumulated other comprehensive income (loss) before tax(a)	(16,024)		2,589		—		(13,435)
Income tax	3,884		(628)		—		3,256

Net current-period other comprehensive income (loss)	(1,159)		5,922		(8,418)		(3,655)

Balance, December 31, 2022	$	2,497	$	(23,749)	$	(36,606)	$	(57,858)

Other comprehensive income (loss) before reclassifications, net of tax	4,158		3,370		5,085		12,613
Amounts reclassified from accumulated other comprehensive income (loss) before tax(a)	(8,630)		2,129		—		(6,501)
Income tax	2,092		(516)		—		1,576

Net current-period other comprehensive income (loss)	(2,380)		4,983		5,085		7,688

Balance, December 31, 2023	$	117	$	(18,766)	$	(31,521)	$	(50,170)

Business Segments and Geographic Areas (Tables)

12 Months Ended

Dec. 31, 2023

Segment Reporting [Abstract]

Revenue from External Customers by Geographic Areas and Product Line

These product lines' net sales and primary geographic market where the products are sold, are as follows for the years ended December 31, 2023, 2022 and 2021:


	2023
	Orthopedic Surgery		General Surgery		Total
Primary Geographic Markets
United States	$	199,568	$	500,592	$	700,160
Europe, Middle East & Africa	127,637		98,616		226,253
Asia Pacific	123,043		74,358		197,401
Americas (excluding the United States)	82,910		38,020		120,930
Total sales from contracts with customers	$	533,158	$	711,586	$	1,244,744


	2022
	Orthopedic Surgery		General Surgery		Total
Primary Geographic Markets
United States	$	173,176	$	405,777	$	578,953
Europe, Middle East & Africa	113,649		84,288		197,937
Asia Pacific	103,353		59,124		162,477
Americas (excluding the United States)	71,350		34,755		106,105
Total sales from contracts with customers	$	461,528	$	583,944	$	1,045,472


	2021
	Orthopedic Surgery		General Surgery		Total
Primary Geographic Markets
United States	$	158,553	$	393,980	$	552,533
Europe, Middle East & Africa	108,457		81,238		189,695
Asia Pacific	107,590		63,628		171,218
Americas (excluding the United States)	63,824		33,365		97,189
Total sales from contracts with customers	$	438,424	$	572,211	$	1,010,635

Operations and Significant Accounting Policies (Earnings Per Share) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands			12 Months Ended
	Jun. 06, 2022	Jan. 29, 2019	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Earnings per share:
Net income (loss)			$ 64,459	$ (80,582)	$ 62,542
Basic-weighted average shares outstanding (in shares)			30,668	30,040	29,162
Stock Compensation			727	0	1,275
Warrants			11	0	506
Convertible notes			142	0	1,273
Diluted-weighted average shares outstanding (in shares)			31,548	30,040	32,216
Basic EPS (in dollars per share)			$ 2.10	$ (2.68)	$ 2.14
Diluted EPS (in dollars per share)			$ 2.04	$ (2.68)	$ 1.94
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount			1,700	0	600
Operations and Significant Accounting Policies [Line Items]
Payments to redeem convertible notes			$ 0	$ 275,000	$ 0
2.625 Percent Convertible Notes Due 2024 \| Convertible Notes Payable
Operations and Significant Accounting Policies [Line Items]
Debt Instrument, Interest Rate, Stated Percentage		2.625%
Payments to redeem convertible notes	$ 275,000
Debt Instrument, Face Amount	$ 70,000	$ 345,000
Debt Instrument, Convertible, Conversion Price		$ 88.80
2.250 Percent Convertible Notes Due 2027 \| Convertible Notes Payable
Operations and Significant Accounting Policies [Line Items]
Debt Instrument, Interest Rate, Stated Percentage	2.25%
Debt Instrument, Face Amount	$ 800,000
Debt Instrument, Convertible, Conversion Price	$ 145.33
Warrant \| 2.625 Percent Convertible Notes Due 2024 \| Convertible Notes Payable
Operations and Significant Accounting Policies [Line Items]
Option Indexed to Issuer's Equity, Strike Price		114.92
Warrant \| 2.250 Percent Convertible Notes Due 2027 \| Convertible Notes Payable
Operations and Significant Accounting Policies [Line Items]
Option Indexed to Issuer's Equity, Strike Price	251.53
Hedge Transaction \| 2.625 Percent Convertible Notes Due 2024 \| Convertible Notes Payable
Operations and Significant Accounting Policies [Line Items]
Option Indexed to Issuer's Equity, Strike Price		$ 114.92
Hedge Transaction \| 2.250 Percent Convertible Notes Due 2027 \| Convertible Notes Payable
Operations and Significant Accounting Policies [Line Items]
Option Indexed to Issuer's Equity, Strike Price	$ 251.53

Goodwill and Other Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Goodwill

The changes in the net carrying amount of goodwill for the years ended December 31, are as follows:


	2023		2022
Balance as of January 1,	$	815,429	$	617,528



Goodwill resulting from business combinations	—		199,162

Foreign currency translation and other adjustments	(8,585)		(1,261)

Balance as of December 31,	$	806,844	$	815,429

Schedule of Finite-Lived Intangible Assets

Other intangible assets consist of the following:


	December 31, 2023					December 31, 2022
	Weighted Average Amortization Period (Years)	Gross Carrying Amount		Accumulated Amortization		Gross Carrying Amount		Accumulated Amortization
Intangible assets with definite lives:	22

Customer and distributor relationships	24	$	369,930	$	(188,486)	$	369,854	$	(170,870)

Sales representation, marketing and promotional rights	25	149,376		(72,000)		149,376		(66,000)

Patents and other intangible assets	16	82,594		(54,120)		79,838		(52,472)

Developed technology	18	320,204		(44,558)		320,204		(34,675)

Intangible assets with indefinite lives:

Trademarks and tradenames		86,544		—		86,544		—

		$	1,008,648	$	(359,164)	$	1,005,816	$	(324,017)

Schedule of Indefinite-Lived Intangible Assets

Other intangible assets consist of the following:


	December 31, 2023					December 31, 2022
	Weighted Average Amortization Period (Years)	Gross Carrying Amount		Accumulated Amortization		Gross Carrying Amount		Accumulated Amortization
Intangible assets with definite lives:	22

Customer and distributor relationships	24	$	369,930	$	(188,486)	$	369,854	$	(170,870)

Sales representation, marketing and promotional rights	25	149,376		(72,000)		149,376		(66,000)

Patents and other intangible assets	16	82,594		(54,120)		79,838		(52,472)

Developed technology	18	320,204		(44,558)		320,204		(34,675)

Intangible assets with indefinite lives:

Trademarks and tradenames		86,544		—		86,544		—

		$	1,008,648	$	(359,164)	$	1,005,816	$	(324,017)

Schedule of Estimated Amortization Expense

The estimated amortization expense related to intangible assets at December 31, 2023 for each of the five succeeding years is as follows:


	Amortization included in expense		Amortization recorded as a reduction of revenue		Total
2024	$	28,755	$	6,000	$	34,755
2025	29,626		6,000		35,626
2026	29,360		6,000		35,360
2027	30,396		6,000		36,396
2028	33,528		6,000		39,528

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
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-URI https://asc.fasb.org//1943274/2147482548/350-20-55-24

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-2

+ Details

Business Acquisitions (Details) - USD ($) $ in Millions			12 Months Ended
Business Acquisitions (Details) - USD ($) $ in Millions	Aug. 09, 2022	Jun. 13, 2022	Dec. 31, 2023	Dec. 31, 2022
In2Bones Global Inc
Business Acquisition [Line Items]
Business combination, consideration transferred		$ 145.2
Business Combination, Contingent Consideration Arrangements, Range of Outcomes, Value, High		$ 110.0
Biorez Inc
Business Acquisition [Line Items]
Business combination, consideration transferred	$ 85.5
Payments to acquire business	84.2
Business Combination, Holdback	1.3
Business Combination, Contingent Consideration Arrangements, Range of Outcomes, Value, High	$ 165.0
Cost of Sales \| In2Bones Global Inc
Business Acquisition [Line Items]
Costs for inventory step-up adjustments			$ 8.6	$ 4.5
Selling and Administrative Expenses [Member] \| In2Bones Global Inc and Biorez Inc
Business Acquisition [Line Items]
Acquisition and integration costs			$ 0.8	$ 10.1

Long Term Debt (Maturities of Long-term Debt) (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Scheduled maturities of long-term debt outstanding [Abstract]
2024	$ 0
2025	0
2026	186,588
2027	800,000
2028	$ 0

Income Taxes

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Income Taxes

The provision for income taxes for the years ended December 31, 2023, 2022 and 2021 consists of the following:


	2023		2022		2021
Current tax expense (benefit):
Federal	$	2,066	$	98	$	(97)
State	3,826		1,582		609
Foreign	9,777		14,082		7,046
	15,669		15,762		7,558
Deferred income tax expense (benefit):
Federal	2,826		(4,096)		3,466
State	(893)		(1,636)		1,449
Foreign	(1,233)		(310)		(1,910)
	700		(6,042)		3,005

Provision for income taxes	$	16,369	$	9,720	$	10,563

A reconciliation between income taxes computed at the statutory federal rate and the provision for income taxes for the years ended December 31, 2023, 2022 and 2021 follows:


	2023		2022		2021
Tax provision at statutory rate based on income before income taxes	21.0	%	21.0	%	21.0	%

State income taxes, net of federal tax benefit	2.9		(1.4)		3.7

Foreign income taxes	2.8		(1.8)		3.1

Non-deductible/non-taxable items	2.0		(2.9)		0.8

US tax on worldwide earnings at different rates	(3.1)		(1.8)		(0.4)

Federal research credit	(3.0)		2.4		(2.3)

Contingent consideration	(1.8)		—		—

Valuation allowance	(0.5)		2.5		(2.2)

Stock-based compensation	—		1.5		(9.4)

Non-deductible premium on extinguishment and change in fair value of convertible notes	—		(32.2)		—



Other, net	—		(1.0)		0.1

	20.3	%	(13.7)	%	14.4	%

The Company has elected to account for Global Intangible Low Tax Income ("GILTI") using the period cost method. The net impact of GILTI including the allowable GILTI deduction is presented in the rate reconciliation as a component of “US tax on worldwide earnings at different rates”.

The tax effects of the significant temporary differences which comprise the deferred income tax assets and liabilities at December 31, 2023 and 2022 are as follows:


	2023		2022
Assets:
Inventory	$	4,577	$	2,939
Net operating losses	2,809		12,721
Capitalized research and development	16,573		11,402
Deferred compensation	3,114		3,012
Accounts receivable	4,002		3,580
Compensation and benefits	18,234		8,723
Accrued pension	1,658		2,530
Research and development credit	13,090		16,785
Interest limitation	18,332		9,116
Convertible notes hedge	28,765		36,204
Lease liabilities	3,033		2,735
Other	6,290		4,134
Less: valuation allowances	—		(543)
	120,477		113,338

Liabilities:
Goodwill and intangible assets	153,692		152,155
Depreciation	2,248		2,373
State taxes	9,732		11,733
Unremitted foreign earnings	1,557		1,573
Lease right-of-use assets	2,939		2,579

	170,168		170,413

Net liability	$	(49,691)	$	(57,075)

Income (loss) before income taxes consists of the following U.S. and foreign income (loss):


	2023		2022		2021
U.S. income (loss)	$	51,568	$	(96,114)	$	45,260
Foreign income	29,260		25,252		27,845
Total income (loss)	$	80,828	$	(70,862)	$	73,105

As of December 31, 2023, the amount of federal net operating loss carryforward was $1.9 million and begins to expire in 2027. As of December 31, 2023, the amount of federal research credit carryforward available was $13.1 million. These credits begin to expire in 2028.

We have accrued tax liabilities related to the amount of unremitted earnings at December 31, 2017 and certain subsequent unremitted earnings as these are not considered permanently reinvested. Deferred taxes have not been accrued on unremitted earnings subsequent to December 31, 2017 that are considered permanently reinvested. The amount of such untaxed foreign earnings for the periods occurring after December 2017 totaled $26.9 million. If we were to repatriate these funds, we would be required to accrue and pay taxes on such amounts. The Company has estimated foreign withholding taxes of $1.0 million would be due if these earnings were repatriated.

The Company is subject to taxation in the United States and various states and foreign jurisdictions. Taxing authority examinations can involve complex issues and may require an extended period of time to resolve. Our federal income tax returns have been examined by the Internal Revenue Service (“IRS”) for calendar years ending through 2019.

We recognize tax liabilities in accordance with the provisions for accounting for uncertainty in income taxes. Such guidance prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return.

The following table summarizes the activity related to our unrecognized tax benefits for the years ending December 31,:


	2023		2022		2021
Balance as of January 1,	$	200	$	200	$	200



Increases for positions taken in prior periods	1,504		—		—

Decreases in unrecorded tax positions related to settlement with the taxing authorities	—		—		—

Decreases in unrecorded tax positions related to lapse of statute of limitations	—		—		—

Balance as of December 31,	$	1,704	$	200	$	200

If the total unrecognized tax benefits of $1.7 million at December 31, 2023 were recognized, it would reduce our annual effective tax rate. The amount of interest accrued in 2021, 2022 and 2023 related to these unrecognized tax benefits was not material and is included in the provision for income taxes in the consolidated statements of comprehensive income (loss).

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
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-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Inventories (Tables)

12 Months Ended

Dec. 31, 2023

Inventory Disclosure [Abstract]

Schedule of inventory

Inventories consist of the following at December 31:


	2023		2022
Raw materials	$	107,262	$	110,677
Work in process	29,463		26,166
Finished goods	181,599		195,477
	$	318,324	$	332,320

Goodwill and Other Intangible Assets (Intangible Assets) (Details) - USD ($) $ in Thousands			12 Months Ended
	Aug. 09, 2022	Jun. 13, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Intangible assets, gross carrying amount			$ 1,008,648	$ 1,005,816
Intangible assets, accumulated amortization			(359,164)	(324,017)
Amortization of Intangible Assets			35,200	33,700	$ 33,300
Future amortization expense [Abstract]
2024			34,755
2025			35,626
2026			35,360
2027			36,396
2028			39,528
Expense
Future amortization expense [Abstract]
2024			28,755
2025			29,626
2026			29,360
2027			30,396
2028			33,528
Reduction of Revenue
Future amortization expense [Abstract]
2024			6,000
2025			6,000
2026			6,000
2027			6,000
2028			6,000
Trademarks and Trade Names
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Unamortized intangible assets, gross carrying amount			86,544	86,544
Customer and Distributor Relationships
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Amortized intangible assets, gross carrying amount			369,930	369,854
Intangible assets, accumulated amortization			(188,486)	(170,870)
Sales representation, marketing and promotional rights
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Amortized intangible assets, gross carrying amount			149,376	149,376
Intangible assets, accumulated amortization			(72,000)	(66,000)
Patents and Other Intangible Assets
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Amortized intangible assets, gross carrying amount			82,594	79,838
Intangible assets, accumulated amortization			(54,120)	(52,472)
Technology-Based Intangible Assets
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Amortized intangible assets, gross carrying amount			320,204	320,204
Intangible assets, accumulated amortization			$ (44,558)	$ (34,675)
Weighted Average
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life			22 years
Weighted Average \| Customer and Distributor Relationships
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life			24 years
Weighted Average \| Sales representation, marketing and promotional rights
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life			25 years
Weighted Average \| Patents and Other Intangible Assets
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life			16 years
Weighted Average \| Technology-Based Intangible Assets
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life			18 years
In2Bones Global Inc
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Finite-lived Intangible Assets Acquired		$ 64,900
Biorez Inc
Schedule of Finite-Lived and Indefinite-Lived Assets [Line Items]
Finite-lived Intangible Assets Acquired	$ 177,900

Employee Benefit Plans (Expected Future Payments) (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Retirement Benefits [Abstract]
2024	$ 5,213
2025	5,670
2026	5,740
2027	5,314
2028	5,224
2029-2033	$ 24,730

Leases

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Leases

Lease costs for the years ended December 31, consist of the following:


	2023		2022		2021
Operating lease cost:
Straight-line lease cost	$	8,118	$	7,685	$	7,720

Total operating lease cost	8,118		7,685		7,720
Finance lease cost:
Depreciation	344		396		389
Interest on lease liabilities	55		17		30
Total finance lease cost	399		413		419
Total lease cost	$	8,517	$	8,098	$	8,139

Supplemental balance sheet information related to leases as of December 31, is as follows:


	2023			2022
Operating leases
Other assets	$	16,606		$	17,710

Other current liabilities	$	7,509		$	6,919
Other long-term liabilities	9,897			11,759
Total operating lease liabilities	$	17,406		$	18,678

Finance leases
Property, plant and equipment, gross	$	3,901		$	1,924
Accumulated depreciation	(1,304)			(1,510)
Property, plant and equipment, net	$	2,597		$	414

Current portion of long-term debt	$	708		$	178
Long-term debt	1,657			52
Total finance lease liabilities	$	2,365		$	230


Weighted average remaining lease term (in years)
Operating leases	4.93 years			5.17 years
Finance leases	3.76 years			1.92 years

Weighted average discount rate
Operating leases	5.56		%	5.39		%
Finance leases	4.79		%	4.54		%

Supplemental cash flow information related to leases for the years ended December 31, was as follows:


	2023		2022		2021

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	8,178	$	7,383	$	7,791
Financing cash flows from finance leases	436		313		287

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	5,864		5,167		4,704
Finance leases	2,523		—		305

Maturities of lease liabilities as of December 31, 2023 are as follows:


	Finance Lease		Operating Lease

2024	$	708	$	7,509
2025	682		4,329
2026	680		2,313
2027	436		1,722
2028	79		973
Thereafter	—		4,221
Total lease payments	2,585		21,067

Less imputed interest	(220)		(3,661)

Total lease liabilities	$	2,365	$	17,406

As of December 31, 2023, we have not entered into any operating or finance leases that have not yet commenced.

Leases

Lease costs for the years ended December 31, consist of the following:


	2023		2022		2021
Operating lease cost:
Straight-line lease cost	$	8,118	$	7,685	$	7,720

Total operating lease cost	8,118		7,685		7,720
Finance lease cost:
Depreciation	344		396		389
Interest on lease liabilities	55		17		30
Total finance lease cost	399		413		419
Total lease cost	$	8,517	$	8,098	$	8,139

Supplemental balance sheet information related to leases as of December 31, is as follows:


	2023			2022
Operating leases
Other assets	$	16,606		$	17,710

Other current liabilities	$	7,509		$	6,919
Other long-term liabilities	9,897			11,759
Total operating lease liabilities	$	17,406		$	18,678

Finance leases
Property, plant and equipment, gross	$	3,901		$	1,924
Accumulated depreciation	(1,304)			(1,510)
Property, plant and equipment, net	$	2,597		$	414

Current portion of long-term debt	$	708		$	178
Long-term debt	1,657			52
Total finance lease liabilities	$	2,365		$	230


Weighted average remaining lease term (in years)
Operating leases	4.93 years			5.17 years
Finance leases	3.76 years			1.92 years

Weighted average discount rate
Operating leases	5.56		%	5.39		%
Finance leases	4.79		%	4.54		%

Supplemental cash flow information related to leases for the years ended December 31, was as follows:


	2023		2022		2021

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	8,178	$	7,383	$	7,791
Financing cash flows from finance leases	436		313		287

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	5,864		5,167		4,704
Finance leases	2,523		—		305

Maturities of lease liabilities as of December 31, 2023 are as follows:


	Finance Lease		Operating Lease

2024	$	708	$	7,509
2025	682		4,329
2026	680		2,313
2027	436		1,722
2028	79		973
Thereafter	—		4,221
Total lease payments	2,585		21,067

Less imputed interest	(220)		(3,661)

Total lease liabilities	$	2,365	$	17,406

As of December 31, 2023, we have not entered into any operating or finance leases that have not yet commenced.

Employee Benefit Plans (Defined Contribution Plan) (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Employee Savings Plan
Defined Contribution Plan Disclosure [Line Items]
Employer contributions	$ 8.2	$ 9.9	$ 9.2

Schedule II - Valuation and Qualifying Accounts

12 Months Ended

Dec. 31, 2023

SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]

Valuation and Qualifying Accounts

SCHEDULE II—Valuation and Qualifying Accounts

(In thousands)




			Additions
	Balance at Beginning of Period		Charged to Costs and Expenses		Charged to Other Accounts(1)
									Balance at End of Period
Description							Deductions
2023
Allowance for bad debts	$	5,508	$	1,525	$	—	$	(999)	$	6,034
Sales returns and
allowance	6,388		1,533		—		(1,275)		6,646
Deferred tax asset
valuation allowance	543		—		—		(543)		—


2022
Allowance for bad debts	$	4,528	$	1,400	$	230	$	(650)	$	5,508
Sales returns and
allowance	4,441		2,923		—		(976)		6,388
Deferred tax asset
valuation allowance	786		—		1,571		(1,814)		543


2021
Allowance for bad debts	$	3,876	$	2,305	$	—	$	(1,653)	$	4,528
Sales returns and
allowance	3,684		1,261		—		(504)		4,441
Deferred tax asset
valuation allowance	2,721		621		—		(2,556)		786

(1) During 2022, allowances were assumed as part of the In2Bones acquisition.

Long Term Debt (Narrative) (Details) $ / shares in Units, shares in Millions				12 Months Ended
	Feb. 07, 2024 USD ($)	Jun. 06, 2022 USD ($) $ / shares shares	Jan. 29, 2019 USD ($) $ / shares	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Jul. 16, 2021 USD ($)
Debt Instrument [Line Items]
Repayments of Senior Debt				$ 20,000,000	$ 92,981,000	$ 66,654,000
Loss on early extinguishment of debt				0	3,426,000	899,000
Payments to redeem convertible notes				0	275,000,000	0
Loss on convertible notes conversion premium				0	103,125,000	0
Amortization of debt discount				0	0	10,217,000
Fair Value of Convertible Notes Hedges and Warrants Net		$ 22,200,000
Loss on convertible notes hedge transactions settlement				0	5,460,000	0
Net Proceeds From the Settlement of Convertible Note Hedge Transactions and Warrants		16,700,000
Payments for Convertible Notes Hedges		187,600,000
Purchases of Convertible Notes Hedges, Net of Tax		142,100,000
Proceeds from issuance of warrants		72,000,000		0	72,000,000	0
Other Expense
Debt Instrument [Line Items]
Write off of Deferred Debt Issuance Cost and Third Party Fees						1,100,000
Loss on convertible notes hedge transactions settlement					5,500,000
Revolving Line of Credit
Debt Instrument [Line Items]
Long-term debt outstanding				2,000,000	70,000,000
Line of credit facility, available borrowing capacity				581,400,000
Revolving Line of Credit \| Amended and Restated Senior Credit Agreement
Debt Instrument [Line Items]
Line of Credit Facility, Maximum Borrowing Capacity							$ 585,000,000
Letters of Credit
Debt Instrument [Line Items]
Letters of credit outstanding				1,600,000
Convertible Notes Payable \| 2.625 Percent Convertible Notes Due 2024
Debt Instrument [Line Items]
Debt Instrument, Face Amount		70,000,000	$ 345,000,000
Loss on early extinguishment of debt					2,900,000
Effective Interest Rate (percent)			6.14%
Interest Expense, Debt				1,800,000	4,800,000	9,100,000
Debt Instrument, Fair Value Disclosure				86,100,000
Debt Instrument, Interest Rate, Stated Percentage			2.625%
Debt Instrument, Convertible, Conversion Ratio			11.2608
Debt Instrument, Convertible, Conversion Price \| $ / shares			$ 88.80
Payments to redeem convertible notes		$ 275,000,000
Debt Conversion, Converted Instrument, Shares Issued \| shares		0.9
Loss on convertible notes conversion premium					103,100,000
Convertible Debt				70,000,000	69,568,000
Debt Instrument, Convertible, Gross Amount of Equity Component			$ 51,600,000
Debt Instrument, Convertible, Carrying Amount of Equity Component			$ 39,100,000
Amortization of debt discount						$ 10,200,000
Convertible Notes Payable \| 2.625 Percent Convertible Notes Due 2024 \| Warrant
Debt Instrument [Line Items]
Option Indexed to Issuer's Equity, Strike Price \| $ / shares			$ 114.92
Convertible Notes Payable \| 2.250 Percent Convertible Notes Due 2027
Debt Instrument [Line Items]
Debt Instrument, Face Amount		$ 800,000,000
Interest Expense, Debt				18,000,000	10,300,000
Debt Instrument, Fair Value Disclosure				802,400,000
Debt Instrument, Interest Rate, Stated Percentage		2.25%
Debt Instrument, Convertible, Conversion Ratio		6.8810
Debt Instrument, Convertible, Conversion Price \| $ / shares		$ 145.33
Convertible Debt				$ 785,419,000	781,166,000
Convertible Notes Payable \| 2.250 Percent Convertible Notes Due 2027 \| Warrant
Debt Instrument [Line Items]
Option Indexed to Issuer's Equity, Strike Price \| $ / shares		$ 251.53
Long-term Debt \| Amended and Restated Senior Credit Agreement
Debt Instrument [Line Items]
Effective Interest Rate (percent)				6.614%
Term SOFR Interest Rate Spread Adjustment				0.114%
Adjusted Term SOFR Interest Rate				5.489%
Long-term Debt \| Amended and Restated Senior Credit Agreement \| Fed Funds Effective Rate Overnight Index Swap Rate
Debt Instrument [Line Items]
Basis spread on variable rate (percent)				0.50%
Long-term Debt \| Amended and Restated Senior Credit Agreement \| Adjusted Term SOFR Interest Rate
Debt Instrument [Line Items]
Basis spread on variable rate (percent)				1.125%
Long-term Debt \| Amended and Restated Senior Credit Agreement \| Adjusted Term SOFR
Debt Instrument [Line Items]
Basis spread on variable rate (percent)				1.00%
Term Loan Facility
Debt Instrument [Line Items]
Long-term Debt, Gross				$ 114,600,000
Long-term debt outstanding				$ 114,064,000	133,858,000
Term Loan Facility \| Amended and Restated Senior Credit Agreement
Debt Instrument [Line Items]
Debt Instrument, Face Amount							$ 233,500,000
Repayments of Senior Debt					90,000,000
Loss on early extinguishment of debt					$ 500,000
Call Option \| Convertible Notes Payable \| 2.625 Percent Convertible Notes Due 2024
Debt Instrument [Line Items]
Hedge and warrant transactions, net cash paid			$ 21,000,000
Call Option \| Convertible Notes Payable \| 2.250 Percent Convertible Notes Due 2027
Debt Instrument [Line Items]
Hedge and Warrant Transactions, Net Cash Paid		$ 115,600,000
Subsequent Event \| Convertible Notes Payable \| 2.625 Percent Convertible Notes Due 2024
Debt Instrument [Line Items]
Payments to redeem convertible notes	$ 70,000,000

Shareholders' Equity (Tables)

12 Months Ended

Dec. 31, 2023

Stock Options and Stock Appreciation Rights (SARs)

Share-based Compensation Arrangement by Share-based Payment Award [Line Items]

Valuation Assumptions

The following table illustrates the assumptions used in estimating fair value in the years ended December 31, 2023, 2022 and 2021:


	2023			2022			2021
Grant date fair value of stock options and SARs	$	40.18		$	49.88		$	42.47
Expected stock price volatility	41.84		%	38.45		%	39.27		%
Risk-free interest rate	4.14		%	1.68		%	0.81		%
Expected annual dividend yield	0.82		%	0.56		%	0.64		%
Expected life of options & SARs (years)	5.4			5.4			5.5

Schedule of Stock Option and SAR Activity

The following table illustrates the stock option and SAR activity for the year ended December 31, 2023:


	Number of Shares (in 000’s)	Weighted- Average Exercise Price
Outstanding at December 31, 2022	3,701	$	92.98

Granted	564	$	97.77
Forfeited	(241)	$	118.06
Exercised	(260)	$	67.30

Outstanding at December 31, 2023	3,764	$	93.82
Exercisable at December 31, 2023	2,097	$	77.53
Stock options & SARs expected to vest	1,667	$	114.32

Restricted Stock Units (RSUs) and Performance Share Units (PSUs)

Share-based Compensation Arrangement by Share-based Payment Award [Line Items]

Schedule of PSU and RSU Activity

The following table illustrates the RSU and PSU activity for the year ended December 31, 2023:


	Number of Shares (in 000’s)	Weighted- Average Grant-Date Fair Value
Outstanding at December 31, 2022	46	$	117.91

Granted	53	$	127.59
Vested	(22)	$	108.69
Forfeited	(10)	$	113.87

Outstanding at December 31, 2023	67	$	129.32

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Operations and Significant Accounting Policies (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Operations and Significant Accounting Policies [Line Items]
Options to terminate leases	1 year
Selling and administrative expense	$ 503,040	$ 454,039	$ 414,754
Other Noncurrent Assets
Other Assets, Noncurrent [Abstract]
Field inventory	43,400	41,300
Shipping and Handling
Operations and Significant Accounting Policies [Line Items]
Selling and administrative expense	$ 26,300	$ 21,700	$ 17,000
Minimum
Operations and Significant Accounting Policies [Line Items]
Remaining lease terms	1 year
Maximum
Operations and Significant Accounting Policies [Line Items]
Remaining lease terms	13 years
Options to extend leases	5 years

Revenues (Tables)

12 Months Ended

Dec. 31, 2023

Revenues [Abstract]

Disaggregation of Revenue

The following tables present revenue disaggregated by product line and timing of revenue recognition for the years ended December 31, 2023, 2022 and 2021:


	2023
	Orthopedic Surgery		General Surgery		Total
Timing of Revenue Recognition
Goods transferred at a point in time	$	494,002	$	704,041	$	1,198,043
Services transferred over time	39,156		7,545		46,701
Total sales from contracts with customers	$	533,158	$	711,586	$	1,244,744


	2022
	Orthopedic Surgery		General Surgery		Total
Timing of Revenue Recognition
Goods transferred at a point in time	$	422,648	$	577,625	$	1,000,273
Services transferred over time	38,880		6,319		45,199
Total sales from contracts with customers	$	461,528	$	583,944	$	1,045,472


	2021
	Orthopedic Surgery		General Surgery		Total
Timing of Revenue Recognition
Goods transferred at a point in time	$	398,963	$	567,244	$	966,207
Services transferred over time	39,461		4,967		44,428
Total sales from contracts with customers	$	438,424	$	572,211	$	1,010,635

Contract with Customer, Asset and Liability

Contract liability balances related to the sale of extended warranties to customers are as follows:


	December 31, 2023		December 31, 2022

Contract Liability	$	17,962	$	19,114

Employee Benefit Plans (Amounts Recognized in Balance Sheet) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Retirement Benefits [Abstract]
Liability, Defined Benefit Plan, Noncurrent	$ (4,692)	$ (8,847)
Accumulated other comprehensive loss	$ (24,770)	$ (31,346)

Fair Value Measurement Amounts Recorded In and Reclassified From AOCI (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Derivative Instruments, Gain (Loss) [Line Items]
Net sales	$ 1,244,744	$ 1,045,472	$ 1,010,635
Cost of sales	568,499	474,227	442,599
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), before Reclassification and Tax	5,489	14,494	8,650
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), before Reclassification, Tax	1,331	3,513	2,090
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), before Reclassification, after Tax	4,158	10,981	6,560
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), Reclassification, before Tax	8,630	16,024	(4,010)
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), Reclassification, Tax	2,092	3,884	(969)
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), Reclassification, after Tax	6,538	12,140	(3,041)
Revenues
Derivative Instruments, Gain (Loss) [Line Items]
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), Reclassification, before Tax	3,790	15,085	(5,421)
Cost of Sales
Derivative Instruments, Gain (Loss) [Line Items]
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), Reclassification, before Tax	$ 4,840	$ 939	$ 1,411

Income Taxes (Unrecognized Tax Benefits) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Unrecognized Tax Benefits [Roll Forward]
Balance as of January 1	$ 200	$ 200	$ 200
Increases for positions taken in prior periods	1,504	0	0
Decreases in unrecorded tax positions related to settlement with the taxing authorities	0	0	0
Decreases in unrecorded tax positions related to lapse of statute of limitations	0	0	0
Balance as of December 31	$ 1,704	$ 200	$ 200

Inventories

12 Months Ended

Dec. 31, 2023

Inventory Disclosure [Abstract]

Inventories

Inventories consist of the following at December 31:


	2023		2022
Raw materials	$	107,262	$	110,677
Work in process	29,463		26,166
Finished goods	181,599		195,477
	$	318,324	$	332,320

Business Segments and Geographic Areas

12 Months Ended

Dec. 31, 2023

Segment Reporting [Abstract]

Business Segments and Geographic Areas

We are accounting and reporting for our business as a single operating segment entity engaged in the development, manufacturing and sale on a global basis of surgical devices and related equipment. Our chief operating decision maker (the CEO) evaluates the various global product portfolios on a net sales basis and evaluates profitability, investment, cash flow metrics and allocates resources on a consolidated worldwide basis due to shared infrastructure and resources. Our product lines consist of orthopedic surgery and general surgery. Orthopedic surgery consists of sports medicine and lower extremities instrumentation and implants, small bone, large bone and specialty powered surgical instruments as well as imaging systems for use in minimally invasive surgical procedures and fees related to sales representation, promotion and marketing of sports medicine allograft tissue. General surgery consists of a complete line of endo-mechanical instrumentation for minimally invasive laparoscopic and gastrointestinal procedures, smoke evacuation devices, a line of cardiac monitoring products as well as electrosurgical generators and related instruments. These product lines' net sales and primary geographic market where the products are sold, are as follows for the years ended December 31, 2023, 2022 and 2021:


	2023
	Orthopedic Surgery		General Surgery		Total
Primary Geographic Markets
United States	$	199,568	$	500,592	$	700,160
Europe, Middle East & Africa	127,637		98,616		226,253
Asia Pacific	123,043		74,358		197,401
Americas (excluding the United States)	82,910		38,020		120,930
Total sales from contracts with customers	$	533,158	$	711,586	$	1,244,744


	2022
	Orthopedic Surgery		General Surgery		Total
Primary Geographic Markets
United States	$	173,176	$	405,777	$	578,953
Europe, Middle East & Africa	113,649		84,288		197,937
Asia Pacific	103,353		59,124		162,477
Americas (excluding the United States)	71,350		34,755		106,105
Total sales from contracts with customers	$	461,528	$	583,944	$	1,045,472


	2021
	Orthopedic Surgery		General Surgery		Total
Primary Geographic Markets
United States	$	158,553	$	393,980	$	552,533
Europe, Middle East & Africa	108,457		81,238		189,695
Asia Pacific	107,590		63,628		171,218
Americas (excluding the United States)	63,824		33,365		97,189
Total sales from contracts with customers	$	438,424	$	572,211	$	1,010,635

Sales are attributed to countries based on the location of the customer. There were no significant investments in long-lived assets located outside the United States at December 31, 2023 and 2022. No single customer represented over 10% of our consolidated net sales for the years ended December 31, 2023, 2022 and 2021.

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-15

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 31
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-31

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-42

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 40
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-40

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//280/tableOfContent

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 26
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-26

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 34
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-34

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-41

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

+ Details

Legal Matters and Contingencies	12 Months Ended
Legal Matters and Contingencies	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Legal Matters and Contingencies	Legal Matters and Contingencies From time to time, the Company may receive an information request, subpoena or warrant from a government agency such as the Securities and Exchange Commission, Department of Justice, Equal Employment Opportunity Commission, the Occupational Safety and Health Administration, the United States Food and Drug Administration, the Department of Labor, the Treasury Department or other federal and state agencies or foreign governments or government agencies. These information requests, subpoenas or warrants may or may not be routine inquiries, or may begin as routine inquiries and over time develop into enforcement actions of various types. Likewise, if we receive reports of alleged misconduct from employees or third parties, we investigate as appropriate. Manufacturers of medical devices have been the subject of various investigations and enforcement actions relating to interactions with health care providers domestically or internationally whereby companies are claimed to have provided health care providers with inappropriate incentives to purchase their products. Similarly, the Foreign Corrupt Practices Act ("FCPA") prohibits U.S. companies and their representatives from offering or making payments to foreign officials for the purpose of securing a business advantage; and in many countries, the healthcare professionals with whom we regularly interact may meet the definition of a foreign government official for purposes of this law. Similar anti-bribery laws are in effect in many of the countries in which we operate. The FCPA also imposes obligations on manufacturers listed on U.S. stock exchanges to maintain accurate books and records, and maintain internal accounting controls sufficient to provide assurance that transactions are accurately recorded, lawful and in accordance with management’s authorization. The FCPA can pose unique challenges for manufacturers that operate in foreign cultures where conduct prohibited by the FCPA may not be viewed as illegal in local jurisdictions, and because, in some cases, a United States manufacturer may face risks under the FCPA based on the conduct of third parties (e.g., distributors) over whom the manufacturer may not have complete control. While CONMED has not experienced any material enforcement action to date, there can be no assurance that the Company will not be subject to a material enforcement action in the future, or that the Company will not incur costs including, in the form of fees for lawyers and other consultants, that are material to the Company’s results of operations in the course of responding to a future inquiry or investigation. In addition, as a manufacturer of U.S. FDA-approved devices reimbursable by federal healthcare programs, we are subject to the Physician Payments Sunshine Act, which requires us to annually report certain payments and other transfers of value we make to U.S.-licensed physicians, U.S. teaching hospitals or other U.S. covered recipients. Any failure to comply with these laws and regulations could subject us or our officers and employees to criminal and civil financial penalties. Manufacturers of medical products may face exposure to significant product liability claims, as well as patent infringement and other claims incurred in the ordinary course of business. To date, we have not experienced any claims that have been material to our financial statements or financial condition, but any such claims arising in the future could have a material adverse effect on our business, results of operations or cash flows. We currently maintain commercial product liability insurance of $35 million per incident and $35 million in the aggregate annually, which we believe is adequate. This coverage is on a claims-made basis. There can be no assurance that claims will not exceed insurance coverage, that the carriers will be solvent or that such insurance will be available to us in the future at a reasonable cost. Our operations are subject, and in the past have been subject, to a number of environmental laws and regulations governing, among other things, air emissions; wastewater discharges; the use, handling and disposal of hazardous substances and wastes; soil and groundwater remediation and employee health and safety. Likewise, the operations of our suppliers and sterilizers are subject to similar environmental laws and regulations. In some jurisdictions, environmental requirements may be expected to become more stringent in the future. In the United States, certain environmental laws can impose liability for the entire cost of site restoration upon each of the parties that may have contributed to conditions at the site regardless of fault or the lawfulness of the party’s activities. While we do not believe that the present costs of environmental compliance and remediation are material, there can be no assurance that future compliance or remedial obligations would not have a material adverse effect on our financial condition, results of operations or cash flows. CONMED has been defending two Georgia State Court actions. The first action was filed in Cobb County by various employees, former employees, contract workers and others against CONMED and against a contract sterilizer (the "Cobb County Action"). Plaintiffs alleged personal injury and related claims purportedly arising from or relating to exposure to Ethylene Oxide, a chemical used to sterilize certain products. CONMED’s motion to dismiss action was heard on January 10, 2022, and the Court issued a ruling on June 15, 2022 dismissing 44 of the 51 plaintiffs' claims as precluded by the exclusive workers' compensation remedy, as well as one claim from a non-employee plaintiff. After discovery closed in November 2023, the plaintiffs filed a voluntary dismissal without prejudice for the remaining plaintiffs in the case. The remaining plaintiffs have until June 2024 to refile. The second action was filed in Douglas County against CONMED’s landlord and other allegedly related entities (the "Douglas County Action"). Plaintiff alleged the same injuries as the Cobb County Action. Discovery closed in November 2023. As with any litigation, there are risks, including the risk that CONMED may not prevail with respect to the defense of the underlying claims, or with respect to securing adequate insurance coverage for the indemnification claims. CONMED submitted the foregoing claims for insurance coverage. One insurer is providing coverage for certain of the claims asserted directly against the Company. CONMED litigated two lawsuits in the United States District Court for the Northern District of New York ("the Northern District") with Federal Insurance Company (“Chubb”): one involving CONMED’s claim for coverage for the indemnification claims arising from the Cobb County Action, and the other concerning CONMED’s claim for coverage for the indemnification claims arising from the Douglas County Action. On March 10, 2022, the Court ruled in favor of CONMED with respect to coverage for the indemnification claims arising from the Cobb County Action. Chubb's motion for reconsideration was denied, and Chubb filed a notice of appeal. On August 9, 2022, CONMED won a similar ruling finding in its favor and against Chubb as to the coverage case concerning the Douglas County Action. Chubb appealed that decision as well. Chubb subsequently withdrew its appeal in connection with a settlement between the parties. Chubb disputes the amount it owes in fees incurred by the Company's attorneys defending the Douglas County action going forward. Accordingly, CONMED has commenced a third action against Chubb in the Northern District to enforce the terms of the settlement agreement, although there can be no assurance that CONMED will prevail. In addition, one of CONMED’s contract sterilizers, which is defending toxic tort claims asserted by various residents in the areas around its processing facility, has placed CONMED on notice of a claim for indemnification relating to some of those claims. CONMED reviewed the notice and reached out to the contract sterilizer for more information. At this time, the contract sterilizer has not responded. The government of Italy passed a law in late 2015 to tax medical device companies on revenue derived from sales to public hospitals. The tax is calculated and based on provincial spending over and above certain thresholds. The Italy medical device tax represents variable consideration in the form of a retroactive discount potentially owed to the customer, which is ultimately the Italian government. Since the law was enacted through September 2022, the Italian government essentially made no effort to administer or collect the tax. A lack of interpretative guidance and the complexity of the law resulted in uncertainty as to the actual amount of liability. In September 2022, the Italian government passed a further decree which, amongst other provisions, delegated administration and collection to the provincial level for the years 2015 – 2018. The Company is challenging the imposition of the medical device tax in Italy, as have many other medical device companies, on the grounds that the law was never implemented properly with regulations. While the Company is informed that its position is well-grounded in the law, there can be no assurance that the Company will prevail. The Company has recorded reserves in accordance with the provisions of the law, although no amounts have been remitted to date. In December 2023, the Company voluntarily informed the U.S. Department of Justice (“DOJ”) of potential issues with certain royalty payments related to design surgeons. The Company is fully cooperating with the DOJ and their review of the matter. From time to time, we are also subject to negligence and other claims arising out of the ordinary conduct of our business, including, for example, automobile or other accidents our employees may experience within the course of their employment or otherwise and which may, on occasion, involve potentially significant personal injuries. We record reserves sufficient to cover probable and estimable losses associated with pending claims. With respect to the matters described above, except as noted related to the medical device tax in Italy, the Company is unable to estimate a range of possible loss at this time, nor does it believe any potential loss is probable, and as a result has not recorded any reserves related to the potential outcomes in connection with these matters. We do not expect that the resolution of any pending claims, investigations or reports of alleged misconduct will have a material adverse effect on our financial condition, results of operations or cash flows. There can be no assurance, however, that future claims, investigations or reports of alleged misconduct, or the costs associated with responding to such claims, investigations or reports of alleged misconduct, especially when not covered by insurance, will not have a material adverse effect on our financial condition, results of operations or cash flows.

Business Segments and Geographic Areas (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($) Customers	Dec. 31, 2022 USD ($) Customers	Dec. 31, 2021 USD ($) Customers
Segment Reporting Information [Line Items]
Net Sales	$ 1,244,744	$ 1,045,472	$ 1,010,635
Number of customer representing over 10% of consolidated net sales \| Customers	0	0	0
United States
Segment Reporting Information [Line Items]
Net Sales	$ 700,160	$ 578,953	$ 552,533
EMEA
Segment Reporting Information [Line Items]
Net Sales	226,253	197,937	189,695
Asia Pacific
Segment Reporting Information [Line Items]
Net Sales	197,401	162,477	171,218
Americas (excluding the United States)
Segment Reporting Information [Line Items]
Net Sales	120,930	106,105	97,189
Orthopedic Surgery
Segment Reporting Information [Line Items]
Net Sales	533,158	461,528	438,424
Orthopedic Surgery \| United States
Segment Reporting Information [Line Items]
Net Sales	199,568	173,176	158,553
Orthopedic Surgery \| EMEA
Segment Reporting Information [Line Items]
Net Sales	127,637	113,649	108,457
Orthopedic Surgery \| Asia Pacific
Segment Reporting Information [Line Items]
Net Sales	123,043	103,353	107,590
Orthopedic Surgery \| Americas (excluding the United States)
Segment Reporting Information [Line Items]
Net Sales	82,910	71,350	63,824
General Surgery
Segment Reporting Information [Line Items]
Net Sales	711,586	583,944	572,211
General Surgery \| United States
Segment Reporting Information [Line Items]
Net Sales	500,592	405,777	393,980
General Surgery \| EMEA
Segment Reporting Information [Line Items]
Net Sales	98,616	84,288	81,238
General Surgery \| Asia Pacific
Segment Reporting Information [Line Items]
Net Sales	74,358	59,124	63,628
General Surgery \| Americas (excluding the United States)
Segment Reporting Information [Line Items]
Net Sales	$ 38,020	$ 34,755	$ 33,365

- Definition

+ References

+ Details

Employee Benefit Plans (Net Periodic Pension Cost) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Service cost	$ 776	$ 1,077	$ 991
Interest cost on projected benefit obligation	$ 3,646	2,148	1,803
Defined Benefit Plan Net Periodic Benefit Cost Credit Interest Cost Statement Of Income Or Comprehensive Income Extensible List Not Disclosed Flag	Interest cost on projected benefit obligation
Expected return on plan assets	$ (4,130)	(5,295)	(5,155)
Defined Benefit Plan Net Periodic Benefit Cost Credit Expected Return Loss Statement Of Income Or Comprehensive Income Extensible List Not Disclosed Flag	Expected return on plan assets
Amortization of loss	$ 2,129	2,589	3,327
Defined Benefit Plan Net Periodic Benefit Cost Credit Amortization Of Gain Loss Statement Of Income Or Comprehensive Income Extensible List Not Disclosed Flag	Amortization of loss
Net periodic pension cost	$ 2,421	$ 519	$ 966

Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Schedule of Notional Amounts of Outstanding Derivative Positions

The following table presents the notional contract amounts for forward contracts outstanding:


		As of
	FASB ASC Topic 815 Designation	December 31, 2023		December 31, 2022
Forward exchange contracts	Cash flow hedge	$	223,839	$	198,473
Forward exchange contracts	Non-designated	55,789		81,929

Schedule of Cash Flow Hedges Included in Accumulated Other Comprehensive Income (Loss)


	Amount of Gain Recognized in AOCI						Consolidated Statements of Comprehensive Income (Loss)							Amount of Gain (Loss) Reclassified from AOCI
	Years Ended							Total Amount of Line Item Presented						Years Ended
Derivative Instrument	2023		2022		2021		Location of amount reclassified	2023		2022		2021		2023		2022		2021

Foreign exchange contracts	$	5,489	$	14,494	$	8,650	Net Sales	$	1,244,744	$	1,045,472	$	1,010,635	$	3,790	$	15,085	$	(5,421)
							Cost of Sales	568,499		474,227		442,599		4,840		939		1,411
Pre-tax gain (loss)	$	5,489	$	14,494	$	8,650								$	8,630	$	16,024	$	(4,010)
Tax expense (benefit)	1,331		3,513		2,090									2,092		3,884		(969)
Net gain (loss)	$	4,158	$	10,981	$	6,560								$	6,538	$	12,140	$	(3,041)

Derivatives Not Designated as Hedging Instruments

Net losses from derivative instruments not accounted for as hedges and losses on our intercompany receivables on our consolidated statements of comprehensive income (loss) were:


		Years Ended
Derivative Instrument	Location on Consolidated Statements of Comprehensive Income (Loss)	2023		2022		2021

Net loss on currency forward contracts	Selling and administrative expense	$	(891)	$	(240)	$	(451)
Net loss on currency transaction exposures	Selling and administrative expense	$	(1,305)	$	(1,950)	$	(1,832)

Schedule of Fair Value for Forward Foreign Exchange Contracts

We record these forward foreign exchange contracts at fair value. The following tables summarize the fair value for forward foreign exchange contracts outstanding at December 31, 2023 and 2022:


December 31, 2023	Location on Consolidated Balance Sheet	Asset Fair Value		Liabilities Fair Value		Net Fair Value
Derivatives designated as hedging instruments:
Foreign exchange contracts	Prepaid expenses and other current assets	$	3,761	$	(3,197)	$	564
Foreign exchange contracts	Other long-term liabilities	24		(433)		(409)
		$	3,785	$	(3,630)	$	155

Derivatives not designated as hedging instruments:
Foreign exchange contracts	Other current liabilities	39		(209)		(170)

Total derivatives		$	3,824	$	(3,839)	$	(15)


December 31, 2022	Location on Consolidated Balance Sheet	Asset Fair Value		Liabilities Fair Value		Net Fair Value
Derivatives designated as hedging instruments:
Foreign exchange contracts	Prepaid expenses and other current assets	$	6,757	$	(3,121)	$	3,636
Foreign exchange contracts	Other long-term liabilities	60		(400)		(340)
		$	6,817	$	(3,521)	$	3,296

Derivatives not designated as hedging instruments:
Foreign exchange contracts	Other current liabilities	48		(395)		(347)

Total derivatives		$	6,865	$	(3,916)	$	2,949

Fair Value Measurement Inputs and Valuation Techniques

The recurring Level 3 fair value measurements of contingent consideration for which the liabilities are recorded include the following significant unobservable inputs as of December 31, 2023:


	Assumptions
Unobservable Input	In2Bones	Biorez

Discount rate	7.62%	12.25%
Revenue volatility	15.49%	21.39%
Projected year of payment	2024-2026	2024-2026

Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation

Changes in the fair value of contingent consideration liabilities for years ended December 31, 2023 and December 31, 2022 are as follows:


	In2Bones		Biorez
Balance at January 1, 2022	$	—	$	—

Purchase price contingent consideration	69,402		114,512

Changes in fair value of contingent consideration	796		1,722

Balance at December 31, 2022	$	70,198	$	116,234

Payments	(13,867)		—

Changes in fair value of contingent consideration	(14,938)		12,517

Balance at December 31, 2023	$	41,393	$	128,751

New Accounting Pronouncements	12 Months Ended
New Accounting Pronouncements	Dec. 31, 2023
Accounting Standards Update and Change in Accounting Principle [Abstract]
New Accounting Pronouncements	New Accounting Pronouncements Recently Adopted Accounting Standards In August 2020, the Financial Accounting Standards Board ("FASB") issued Accounting Standard Update ("ASU") 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity ("ASU 2020-06"), which simplifies the accounting for convertible instruments by removing certain separation models requiring separate accounting for embedded conversion features which will result in more convertible debt instruments accounted for as a single liability. The ASU eliminates certain settlement conditions that are required for equity classification to qualify for the derivative scope exception. The ASU addresses how convertible instruments are accounted for in the calculation of diluted earnings per share by using the if-converted method. The Company adopted this standard on January 1, 2022 using the modified retrospective method. Recently Issued Accounting Standards, Not Yet Adopted In December 2023, the FASB issued ASU 2023-09 - Income Taxes (Topic 740): Improvements to Income Tax Disclosures. The standard requires disaggregated information about a reporting entity’s effective tax rate reconciliation in specified categories as well as information on income taxes paid. This ASU is effective for annual periods beginning after December 15, 2024 and early adoption is permitted. This ASU should be applied on a prospective basis with retrospective application permitted. We expect this ASU to only impact our disclosures with no impact to the consolidated financial statements. In November 2023, the FASB issued ASU 2023-07 - Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which requires public entities to disclose significant segment expenses and other segment items on an annual and interim basis, and provide in interim periods all disclosures about a reportable segment's profit or loss and assets that are currently required annually. The ASU does not change how a public entity identifies its operating segments, aggregates them or applies the quantitative threshold to determine its reportable segments. The new disclosure requirements are also applicable to entities that account and report as a single operating segment entity. This ASU is effective for fiscal years beginning after December 15, 2023 and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted and the guidance is to be applied retrospectively to all prior periods presented. We expect this ASU to only impact our disclosures with no impact to the consolidated financial statements. In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional guidance if certain criteria are met for entities that have contracts, hedging relationships, and other transactions that reference LIBOR or other reference rates expected to be discontinued as a result of reference rate reform. This ASU was effective as of March 12, 2020 through December 31, 2022 and was extended through December 31, 2024 by ASU 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848. The Company has not adopted these ASUs as of December 31, 2023. Our seventh amended and restated senior credit agreement includes language to address the change from LIBOR to SOFR, an alternative base rate, therefore we do not believe reference rate reform will have a significant impact on our consolidated financial statements.

- Definition

The entire disclosure for change in accounting principle. Includes, but is not limited to, nature, reason, and method of adopting amendment to accounting standards or other change in accounting principle.

+ References

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-Section 50
-Paragraph 1
-Subparagraph (b)(1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483443/250-10-50-1

Reference 31: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Topic 250
-Publisher FASB
-URI https://asc.fasb.org//250/tableOfContent

Reference 32: http://www.xbrl.org/2003/role/disclosureRef
-Topic 815
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (e)(1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480175/815-40-65-1

Reference 33: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (d)(1)
-SubTopic 20
-Topic 310
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481925/310-20-65-2

Reference 34: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (d)(2)
-SubTopic 20
-Topic 310
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481925/310-20-65-2

+ Details

Leases Supplementary Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Other assets	$ 16,606	$ 17,710
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Other assets	Other assets
Other current liabilities	$ 7,509	$ 6,919
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Other current liabilities	Other current liabilities
Other long-term liabilities	$ 9,897	$ 11,759
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other long-term liabilities	Other long-term liabilities
Total operating lease liabilities	$ 17,406	$ 18,678
Property, plant and equipment, gross	3,901	1,924
Accumulated depreciation	(1,304)	(1,510)
Property, plant and equipment, net	$ 2,597	$ 414
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Property, plant and equipment, net	Property, plant and equipment, net
Current portion of long-term debt	$ 708	$ 178
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Current portion of long-term debt	Current portion of long-term debt
Long-term debt	$ 1,657	$ 52
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Long-term debt	Long-term debt
Total finance lease liabilities	$ 2,365	$ 230
Weighted Average Remaining Lease Term [Abstract]
Operating leases	4 years 11 months 4 days	5 years 2 months 1 day
Finance leases	3 years 9 months 3 days	1 year 11 months 1 day
Leases Weighted Average Discount Rate [Abstract]
Operating leases	5.56%	5.39%
Finance leases	4.79%	4.54%

Leases (Tables)

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Lease, Cost

Lease costs for the years ended December 31, consist of the following:


	2023		2022		2021
Operating lease cost:
Straight-line lease cost	$	8,118	$	7,685	$	7,720

Total operating lease cost	8,118		7,685		7,720
Finance lease cost:
Depreciation	344		396		389
Interest on lease liabilities	55		17		30
Total finance lease cost	399		413		419
Total lease cost	$	8,517	$	8,098	$	8,139

Supplemental Balance Sheet Information Related to Leases

Supplemental balance sheet information related to leases as of December 31, is as follows:


	2023			2022
Operating leases
Other assets	$	16,606		$	17,710

Other current liabilities	$	7,509		$	6,919
Other long-term liabilities	9,897			11,759
Total operating lease liabilities	$	17,406		$	18,678

Finance leases
Property, plant and equipment, gross	$	3,901		$	1,924
Accumulated depreciation	(1,304)			(1,510)
Property, plant and equipment, net	$	2,597		$	414

Current portion of long-term debt	$	708		$	178
Long-term debt	1,657			52
Total finance lease liabilities	$	2,365		$	230


Weighted average remaining lease term (in years)
Operating leases	4.93 years			5.17 years
Finance leases	3.76 years			1.92 years

Weighted average discount rate
Operating leases	5.56		%	5.39		%
Finance leases	4.79		%	4.54		%

Supplemental Cash Flow Information Related to Leases

Supplemental cash flow information related to leases for the years ended December 31, was as follows:


	2023		2022		2021

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	8,178	$	7,383	$	7,791
Financing cash flows from finance leases	436		313		287

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	5,864		5,167		4,704
Finance leases	2,523		—		305

Operating Lease, Liability, Maturity

Maturities of lease liabilities as of December 31, 2023 are as follows:


	Finance Lease		Operating Lease

2024	$	708	$	7,509
2025	682		4,329
2026	680		2,313
2027	436		1,722
2028	79		973
Thereafter	—		4,221
Total lease payments	2,585		21,067

Less imputed interest	(220)		(3,661)

Total lease liabilities	$	2,365	$	17,406

Finance Lease, Liability, Maturity

Maturities of lease liabilities as of December 31, 2023 are as follows:


	Finance Lease		Operating Lease

2024	$	708	$	7,509
2025	682		4,329
2026	680		2,313
2027	436		1,722
2028	79		973
Thereafter	—		4,221
Total lease payments	2,585		21,067

Less imputed interest	(220)		(3,661)

Total lease liabilities	$	2,365	$	17,406

Income Taxes (Provision for Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Current tax expense:
Current Federal Tax Expense (Benefit)	$ 2,066	$ 98	$ (97)
Current State and Local Tax Expense (Benefit)	3,826	1,582	609
Current Foreign Tax Expense (Benefit)	9,777	14,082	7,046
Current income tax expense (benefit)	15,669	15,762	7,558
Deferred Income Tax Expense (Benefit), Continuing Operations [Abstract]
Deferred Federal Income Tax Expense (Benefit)	2,826	(4,096)	3,466
Deferred State and Local Income Tax Expense (Benefit)	(893)	(1,636)	1,449
Deferred Foreign Income Tax Expense (Benefit)	(1,233)	(310)	(1,910)
Deferred income tax expense (benefit):	700	(6,042)	3,005
Provision (benefit) for income taxes	$ 16,369	$ 9,720	$ 10,563

Schedule II - Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Allowance for Bad Debts
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at beginning of period	$ 5,508	$ 4,528	$ 3,876
Charged to costs and expenses	1,525	1,400	2,305
Charged to other accounts	0	230	0
Deductions	(999)	(650)	(1,653)
Balance at end of period	6,034	5,508	4,528
Sales Returns and Allowances
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at beginning of period	6,388	4,441	3,684
Charged to costs and expenses	1,533	2,923	1,261
Charged to other accounts	0	0	0
Deductions	(1,275)	(976)	(504)
Balance at end of period	6,646	6,388	4,441
Deferred Tax Asset Valuation Allowance
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at beginning of period	543	786	2,721
Charged to costs and expenses	0	0	621
Charged to other accounts	0	1,571	0
Deductions	(543)	(1,814)	(2,556)
Balance at end of period	$ 0	$ 543	$ 786

Revenues

12 Months Ended

Dec. 31, 2023

Revenues [Abstract]

Revenues

The following tables present revenue disaggregated by product line and timing of revenue recognition for the years ended December 31, 2023, 2022 and 2021:


	2023
	Orthopedic Surgery		General Surgery		Total
Timing of Revenue Recognition
Goods transferred at a point in time	$	494,002	$	704,041	$	1,198,043
Services transferred over time	39,156		7,545		46,701
Total sales from contracts with customers	$	533,158	$	711,586	$	1,244,744


	2022
	Orthopedic Surgery		General Surgery		Total
Timing of Revenue Recognition
Goods transferred at a point in time	$	422,648	$	577,625	$	1,000,273
Services transferred over time	38,880		6,319		45,199
Total sales from contracts with customers	$	461,528	$	583,944	$	1,045,472


	2021
	Orthopedic Surgery		General Surgery		Total
Timing of Revenue Recognition
Goods transferred at a point in time	$	398,963	$	567,244	$	966,207
Services transferred over time	39,461		4,967		44,428
Total sales from contracts with customers	$	438,424	$	572,211	$	1,010,635

Revenue disaggregated by primary geographic market where the products are sold is included in Note 12.

Contract liability balances related to the sale of extended warranties to customers are as follows:


	December 31, 2023		December 31, 2022

Contract Liability	$	17,962	$	19,114

Revenue recognized during years ended December 31, 2023, 2022 and 2021 from amounts included in contract liabilities at the beginning of the period were $12.5 million, $11.5 million and $10.3 million, respectively. There were no material contract assets as of December 31, 2023 and December 31, 2022.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-9

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-10

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-15

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-13

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Topic 606
-Publisher FASB
-URI https://asc.fasb.org//606/tableOfContent

+ Details

Property, Plant and Equipment (Tables)

12 Months Ended

Dec. 31, 2023

Property, Plant and Equipment [Abstract]

Schedule of Property, Plant and Equipment

Property, plant and equipment consist of the following at December 31:


	2023		2022
Land	$	4,027	$	4,027
Building and improvements	100,299		97,214
Machinery and equipment	283,470		269,745
Construction in progress	25,088		22,161
	412,884		393,147
Less: Accumulated depreciation	(292,162)		(277,536)
	$	120,722	$	115,611