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Summary of significant accounting policies (Details)
 12 Months Ended
Jan. 01, 2016
USD ($)
Dec. 31, 2014
state
Sep. 30, 2016
USD ($)
Dec. 31, 2015
USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]        
Minimum age of ambulatory patient   5 years    
Number of member states of the European Economic Area | state   31    
Capitalized inventory     $ 1,300,000  
Allowance for doubtful accounts receivable     400,000 $ 0
Accounting Standards Update 2015-03 | Deposits and other assets        
New Accounting Pronouncements or Change in Accounting Principle [Line Items]        
Debt issuance cost $ (2,800,000)      
Accounting Standards Update 2015-03 | Long-term debt.        
New Accounting Pronouncements or Change in Accounting Principle [Line Items]        
Debt issuance cost $ 2,800,000      
Unamortized debt issuance cost     $ 2,500,000  
Minimum        
New Accounting Pronouncements or Change in Accounting Principle [Line Items]        
Gross profit margin (as a percent)     90.00%