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Pay vs Performance Disclosure U_pure in Thousands | 12 Months Ended
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Dec. 31, 2023 USD ($) | Dec. 31, 2022 USD ($) | Dec. 31, 2021 USD ($) | Dec. 31, 2020 USD ($)
Pay vs Performance Disclosure |  |  |  |
Pay vs Performance Disclosure, Table | Pay Versus Performance As described in greater detail in "Compensation Discussion and Analysis," our executive compensation program reflects a variable "pay-for-performance" philosophy. The performance measures that we use for both our long-term and short-term incentive awards are selected based on an objective of incentivizing our Named Executive Officers to increase the value of our enterprise for our stockholders. The following table sets forth information regarding the compensation provided to our principal executive officer (the "CEO/PEO") and our other Named Executive Officers (the "Non-PEO" Named Executive Officers") and our performance during the last four fiscal years.
Year(1) |  | Summary Compensation Table Total for CEO/PEO ($) |  | Compensation Actually Paid to CEO/PEO ($)(2) |  | Average Summary Compensation Table for Non-PEO NEOs ($) |  | Average Compensation Actually Paid to Non-PEO NEOs ($)(3) |  | Value of Initial Fixed $100 Investment Based On: |  | Net Loss ($ thousands) |  | Total Revenue ($ thousands)(6) |
|  |  |  |  |  |  |  |  |  | Total Shareholder Return ($)(4) |  | Peer Group Total Shareholder Return ($)(5) |  |  |  |  |
| 2023 |  |  | 9,477,979 |  |  | 23,339,656 |  |  | 3,432,342 |  |  | 5,474,297 |  |  | 212.97 |  |  | 140.46 |  |  | (186,638 | ) |  | 482,262 |
| 2022 |  |  | 5,948,299 |  |  | 7,374,460 |  |  | 2,283,006 |  |  | 3,044,347 |  |  | 173.94 |  |  | 121.80 |  |  | (151,293 | ) |  | 350,867 |
| 2021 |  |  | 5,266,839 |  |  | 8,273,363 |  |  | 2,844,858 |  |  | 3,144,984 |  |  | 160.99 |  |  | 151.64 |  |  | (143,032 | ) |  | 243,212 |
| 2020 |  |  | 4,683,936 |  |  | 23,639,741 |  |  | 1,477,059 |  |  | 5,761,467 |  |  | 204.51 |  |  | 122.39 |  |  | (78,994 | ) |  | 144,861 |
(1) The CEO/PEO and Non-PEO Named Executive Officers included in the above compensation columns reflect the following:
Year | CEO/PEO | Non-PEO/NEOs
2023 | Patrick S. Miles | J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Scott Lish
2022 | Patrick S. Miles | J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Eric Dasso
2021 | Patrick S. Miles | J. Todd Koning, Craig E. Hunsaker, David P. Sponsel
2020 | Patrick S. Miles | Craig E. Hunsaker, David P. Sponsel
(2) "Compensation Actually Paid" to the CEO/PEO reflects the following adjustments from Total Compensation reported in the Summary Compensation Table:
Adjustments to Determine Compensation "Actually Paid" for CEO/PEO | 2023 ($) |  | 2022 ($) |  | 2021 ($) |  | 2020 ($) |
Total Reported in Summary Compensation Table |  | 9,477,979 |  |  | 5,948,299 |  |  | 5,266,839 |  |  | 4,683,936 |
Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table |  | 7,687,586 |  |  | 4,356,657 |  |  | 3,696,750 |  |  | 3,224,266 |
Less Amounts Reported under the "Option Awards" Column in the Summary Compensation Table |  | - |  |  | — |  |  | — |  |  | — |
Plus the Fair Value of Awards Granted during covered year that Remain Unvested as of Year-end |  | 10,134,386 |  |  | 6,510,735 |  |  | 10,572,750 |  |  | 12,714,583 |
Plus the Fair Value of Awards Granted during covered year that Vested during covered year |  | - |  |  | — |  |  | — |  |  | 125,793 |
Plus the Change in Fair Value from prior Year-end to current Year-end of Awards Granted prior to covered year that were Outstanding and Unvested as of Year-end |  | 1,802,804 |  |  | 1,116,353 |  |  | (4,423,380 | ) |  | 10,733,420 |
Plus the Change in Fair Value from prior Year-end to Vesting Date of Awards Granted prior to covered year that Vested during covered year |  | 9,612,073 |  |  | (1,844,270 | ) |  | 553,904 |  |  | (1,393,725 | )
Total Adjustments |  | 13,861,677 |  |  | 1,426,161 |  |  | 3,006,524 |  |  | 18,955,805 |
Compensation Actually Paid |  | 23,339,656 |  |  | 7,374,460 |  |  | 8,273,363 |  |  | 23,639,741 |
(3) The average "Compensation Actually Paid" to the Non-PEO Named Executive Officers reflect the following adjustments from Total Compensation reported in the Summary Compensation Table:
Adjustments to Determine Average Compensation "Actually Paid" for Non-PEO NEOs | 2023 ($) |  | 2022 ($) |  | 2021 ($) |  | 2020 ($) |
Total Reported in Summary Compensation Table |  | 3,432,342 |  |  | 2,283,006 |  |  | 2,844,858 |  |  | 1,477,059 |
Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table |  | 2,489,639 |  |  | 1,389,695 |  |  | 2,067,800 |  |  | 723,996 |
Less Amounts Reported under the "Option Awards" Column in the Summary Compensation Table |  | — |  |  | — |  |  | — |  |  | — |
Plus the Fair Value of Awards Granted during covered year that Remain Unvested as of Year-end |  | 3,340,773 |  |  | 2,076,807 |  |  | 2,971,800 |  |  | 2,784,776 |
Plus the Fair Value of Awards Granted during covered year that Vested during covered year |  | — |  |  | — |  |  | — |  |  | 45,359 |
Plus the Change in Fair Value from prior Year-end to current Year-end of Awards Granted prior to covered year that were Outstanding and Unvested as of Year-end |  | 537,648 |  |  | 266,411 |  |  | (697,232 | ) |  | 2,408,807 |
Plus the Change in Fair Value from prior Year-end to Vesting Date of Awards Granted prior to covered year that Vested during covered year |  | 653,173 |  |  | (192,182 | ) |  | 93,358 |  |  | (230,538 | )
Total Adjustments |  | 2,041,955 |  |  | 761,341 |  |  | 300,126 |  |  | 4,284,408 |
Compensation Actually Paid |  | 5,474,297 |  |  | 3,044,347 |  |  | 3,144,984 |  |  | 5,761,467 |
(4) Reflects total shareholder return indexed to $100 invested on December 31, 2019. (5) Reflects total shareholder return indexed to $100 invested on December 31, 2019 for the Nasdaq Medical Equipment Index, which is an industry line peer group reported in the performance graph included in the Company’s 2023 Annual Report on Form 10-K, and assuming reinvestment of all dividends, where applicable. (6) Total Revenue, which is a GAAP measure, represents the most important financial performance measure (that is not otherwise required to be disclosed in the table) used by the Company to link compensation actually paid to our Named Executive Officers, including our CEO, for the most recently completed fiscal year to the Company’s performance. |  |  |
Company Selected Measure Name | Total Revenue |  |  |
Named Executive Officers, Footnote | (1) The CEO/PEO and Non-PEO Named Executive Officers included in the above compensation columns reflect the following:
Year | CEO/PEO | Non-PEO/NEOs
2023 | Patrick S. Miles | J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Scott Lish
2022 | Patrick S. Miles | J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Eric Dasso
2021 | Patrick S. Miles | J. Todd Koning, Craig E. Hunsaker, David P. Sponsel
2020 | Patrick S. Miles | Craig E. Hunsaker, David P. Sponsel
" |  |  |
Peer Group Issuers, Footnote | (5) Reflects total shareholder return indexed to $100 invested on December 31, 2019 for the Nasdaq Medical Equipment Index, which is an industry line peer group reported in the performance graph included in the Company’s 2023 Annual Report on Form 10-K, and assuming reinvestment of all dividends, where applicable. |  |  |
PEO Total Compensation Amount | $ 9,477,979 | $ 5,948,299 | $ 5,266,839 | $ 4,683,936
PEO Actually Paid Compensation Amount | $ 23,339,656 | 7,374,460 | 8,273,363 | 23,639,741
Adjustment To PEO Compensation, Footnote | (2) "Compensation Actually Paid" to the CEO/PEO reflects the following adjustments from Total Compensation reported in the Summary Compensation Table:
Adjustments to Determine Compensation "Actually Paid" for CEO/PEO | 2023 ($) |  | 2022 ($) |  | 2021 ($) |  | 2020 ($) |
Total Reported in Summary Compensation Table |  | 9,477,979 |  |  | 5,948,299 |  |  | 5,266,839 |  |  | 4,683,936 |
Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table |  | 7,687,586 |  |  | 4,356,657 |  |  | 3,696,750 |  |  | 3,224,266 |
Less Amounts Reported under the "Option Awards" Column in the Summary Compensation Table |  | - |  |  | — |  |  | — |  |  | — |
Plus the Fair Value of Awards Granted during covered year that Remain Unvested as of Year-end |  | 10,134,386 |  |  | 6,510,735 |  |  | 10,572,750 |  |  | 12,714,583 |
Plus the Fair Value of Awards Granted during covered year that Vested during covered year |  | - |  |  | — |  |  | — |  |  | 125,793 |
Plus the Change in Fair Value from prior Year-end to current Year-end of Awards Granted prior to covered year that were Outstanding and Unvested as of Year-end |  | 1,802,804 |  |  | 1,116,353 |  |  | (4,423,380 | ) |  | 10,733,420 |
Plus the Change in Fair Value from prior Year-end to Vesting Date of Awards Granted prior to covered year that Vested during covered year |  | 9,612,073 |  |  | (1,844,270 | ) |  | 553,904 |  |  | (1,393,725 | )
Total Adjustments |  | 13,861,677 |  |  | 1,426,161 |  |  | 3,006,524 |  |  | 18,955,805 |
Compensation Actually Paid |  | 23,339,656 |  |  | 7,374,460 |  |  | 8,273,363 |  |  | 23,639,741 |
Non-PEO NEO Average Total Compensation Amount | $ 3,432,342 | 2,283,006 | 2,844,858 | 1,477,059
Non-PEO NEO Average Compensation Actually Paid Amount | $ 5,474,297 | 3,044,347 | 3,144,984 | 5,761,467
Adjustment to Non-PEO NEO Compensation Footnote | (3) The average "Compensation Actually Paid" to the Non-PEO Named Executive Officers reflect the following adjustments from Total Compensation reported in the Summary Compensation Table:
Adjustments to Determine Average Compensation "Actually Paid" for Non-PEO NEOs | 2023 ($) |  | 2022 ($) |  | 2021 ($) |  | 2020 ($) |
Total Reported in Summary Compensation Table |  | 3,432,342 |  |  | 2,283,006 |  |  | 2,844,858 |  |  | 1,477,059 |
Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table |  | 2,489,639 |  |  | 1,389,695 |  |  | 2,067,800 |  |  | 723,996 |
Less Amounts Reported under the "Option Awards" Column in the Summary Compensation Table |  | — |  |  | — |  |  | — |  |  | — |
Plus the Fair Value of Awards Granted during covered year that Remain Unvested as of Year-end |  | 3,340,773 |  |  | 2,076,807 |  |  | 2,971,800 |  |  | 2,784,776 |
Plus the Fair Value of Awards Granted during covered year that Vested during covered year |  | — |  |  | — |  |  | — |  |  | 45,359 |
Plus the Change in Fair Value from prior Year-end to current Year-end of Awards Granted prior to covered year that were Outstanding and Unvested as of Year-end |  | 537,648 |  |  | 266,411 |  |  | (697,232 | ) |  | 2,408,807 |
Plus the Change in Fair Value from prior Year-end to Vesting Date of Awards Granted prior to covered year that Vested during covered year |  | 653,173 |  |  | (192,182 | ) |  | 93,358 |  |  | (230,538 | )
Total Adjustments |  | 2,041,955 |  |  | 761,341 |  |  | 300,126 |  |  | 4,284,408 |
Compensation Actually Paid |  | 5,474,297 |  |  | 3,044,347 |  |  | 3,144,984 |  |  | 5,761,467 |
(4) Reflects total shareholder return indexed to $100 invested on December 31, 2019. |  |  |
Compensation Actually Paid vs. Total Shareholder Return | PEO and Average Non-PEO Named Executive Officer Compensation Actually Paid Versus TSR (in thousands except for TSR, assuming $100 invested on December 31, 2019) |  |  |
Compensation Actually Paid vs. Net Income | PEO and Average Non-PEO Named Executive Officer Compensation Actually Paid Versus Net Loss (in thousands) |  |  |
Tabular List, Table | Pay Versus Performance Tabular List of Most Important Financial Performance Measures for All Named Executive Officers for 2023 As described in greater detail in the "Compensation Discussion and Analysis" included in this proxy statement, our executive compensation program reflects a "pay-for-performance" philosophy. The most important financial performance measures we use to link executive compensation actually paid to our Named Executive Officers, for the most recently completed fiscal year, to our performance are as follows: • Total revenue • Adjusted EBITDA • Adjusted EBITDA margin. |  |  |
Total Shareholder Return Amount | $ 212.97 | 173.94 | 160.99 | 204.51
Peer Group Total Shareholder Return Amount | 140.46 | 121.8 | 151.64 | 122.39
Net Income (Loss) | $ (186,638,000) | $ (151,293,000) | $ (143,032,000) | $ (78,994,000)
Company Selected Measure Amount | 482,262 | 350,867 | 243,212 | 144,861
PEO Name | Patrick S. Miles | Patrick S. Miles | Patrick S. Miles | Patrick S. Miles
Compensation Actually Paid vs.Total Revenue [Text Block] | PEO and Average Non-PEO Named Executive Officer Compensation Actually Paid Versus Total Revenue (in thousands) |  |  |
Non Peo Name | J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Scott Lish | J. Todd Koning, Craig E. Hunsaker, David P. Sponsel, Eric Dasso | J. Todd Koning, Craig E. Hunsaker, David P. Sponsel | Craig E. Hunsaker, David P. Sponsel
Measure:: 1 |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Name | Total revenue |  |  |
Measure:: 2 |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Name | Adjusted EBITDA |  |  |
Measure:: 3 |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Name | Adjusted EBITDA margin. |  |  |
PEO |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | $ 13,861,677 | $ 1,426,161 | $ 3,006,524 | $ 18,955,805
PEO | Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | 7,687,586 | 4,356,657 | 3,696,750 | 3,224,266
PEO | Plus the Fair Value of Awards Granted During Covered Year That Remain Unvested as of Year-end |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | 10,134,386 | 6,510,735 | 10,572,750 | 12,714,583
PEO | Plus the Fair Value of Awards Granted During Covered Year That Vested During Covered Year |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount |  |  |  | 125,793
PEO | Plus the Change in Fair Value from Prior Year-end to Current Year-end of Awards Granted Prior to Covered Year That were Outstanding and Unvested as of Year-end |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | 1,802,804 | 1,116,353 | (4,423,380) | 10,733,420
PEO | Plus the Change in Fair Value from Prior Year-end to Vesting Date of Awards Granted Prior to Covered Year That Vested During Covered Year |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | 9,612,073 | (1,844,270) | 553,904 | (1,393,725)
Non-PEO NEO |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | 2,041,955 | 761,341 | 300,126 | 4,284,408
Non-PEO NEO | Less Amounts Reported under the "Stock Awards Column" in the Summary Compensation Table |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | 2,489,639 | 1,389,695 | 2,067,800 | 723,996
Non-PEO NEO | Plus the Fair Value of Awards Granted During Covered Year That Remain Unvested as of Year-end |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | 3,340,773 | 2,076,807 | 2,971,800 | 2,784,776
Non-PEO NEO | Plus the Fair Value of Awards Granted During Covered Year That Vested During Covered Year |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount |  |  |  | 45,359
Non-PEO NEO | Plus the Change in Fair Value from Prior Year-end to Current Year-end of Awards Granted Prior to Covered Year That were Outstanding and Unvested as of Year-end |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | 537,648 | 266,411 | (697,232) | 2,408,807
Non-PEO NEO | Plus the Change in Fair Value from Prior Year-end to Vesting Date of Awards Granted Prior to Covered Year That Vested During Covered Year |  |  |  |
Pay vs Performance Disclosure |  |  |  |
Adjustment to Compensation, Amount | $ 653,173 | $ (192,182) | $ 93,358 | $ (230,538)

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