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Goodwill and Other Intangible Assets | 12 Months Ended
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Dec. 31, 2023
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:
| 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 |

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