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Goodwill and Other Intangible Assets
 12 Months Ended
Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Other Intangible Assets Goodwill and Other Intangible Assets
The changes in the net carrying amount of goodwill for the years ended December 31, are as follows:
 
 20222021
Balance as of January 1,$617,528 $618,440 
Goodwill resulting from business combinations199,162 — 
Foreign currency translation(1,261)(912)
Balance as of December 31,$815,429 $617,528 

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 $139.1 million and acquired intangible assets including distributor relationships and developed technology amounted to $64.9 million. Goodwill resulting from the Biorez Acquisition amounted to $60.0 million and acquired intangible assets including developed technology and trademarks and tradenames amounted to $177.9 million.
Total accumulated goodwill impairment losses aggregated $107.0 million at December 31, 2022 and 2021, respectively.

Other intangible assets consist of the following:

 December 31, 2022December 31, 2021
Weighted Average Amortization Period (Years)Gross
Carrying
Amount		Accumulated
Amortization		Gross
Carrying
Amount		Accumulated
Amortization
Intangible assets with definite lives:22  
Customer and distributor relationships24$369,854 $(170,870)$342,452 $(152,934)
Sales representation, marketing and promotional rights25149,376 (66,000)149,376 (60,000)
Patents and other intangible assets1679,838 (52,472)76,392 (50,890)
Developed technology18320,204 (34,675)106,604 (26,495)
Intangible assets with indefinite lives:
  
Trademarks and tradenames86,544 — 86,544 — 
 $1,005,816 $(324,017)$761,368 $(290,319)

Amortization expense related to intangible assets which are subject to amortization totaled $33.7 million, $33.3 million and $34.2 million for the years ending December 31, 2022, 2021 and 2020, 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, 2022 and for each of the five succeeding years is as follows:

Amortization included in expenseAmortization recorded as a reduction of revenueTotal
2023$29,351 $6,000 $35,351 
202429,059 6,000 35,059 
202529,551 6,000 35,551 
202629,308 6,000 35,308 
202730,347 6,000 36,347