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Fair value measurements and investments (Tables) | 12 Months Ended
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Dec. 31, 2020
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items] |
Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis | The Company’s available for sale debt securities, equity securities, contingent consideration, and deferred compensation plan liabilities are the only financial instruments recorded at fair value on a recurring basis as follows:
(U.S. Dollars, in thousands) |  | Balance December 31, 2020 |  |  | Level 1 |  |  | Level 2 |  |  | Level 3 |
Assets |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Neo Medical convertible loan agreement |  | $ | 7,160 |  |  | $ | — |  |  | $ | — |  |  | $ | 7,160 |
Neo Medical preferred equity securities |  |  | 5,000 |  |  |  | — |  |  |  | 5,000 |  |  |  | — |
Bone Biologics equity securities |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |
Total |  | $ | 12,160 |  |  | $ | — |  |  | $ | 5,000 |  |  | $ | 7,160 |
Liabilities |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Spinal Kinetics contingent consideration |  | $ | (35,400 | ) |  | $ | — |  |  | $ | — |  |  | $ | (35,400 | )
Other contingent consideration |  |  | (375 | ) |  |  | — |  |  |  | — |  |  |  | (375 | )
Deferred compensation plan |  |  | (1,441 | ) |  |  | — |  |  |  | (1,441 | ) |  |  | — |
Total |  | $ | (37,216 | ) |  | $ | — |  |  | $ | (1,441 | ) |  | $ | (35,775 | )
(U.S. Dollars, in thousands) |  | Balance December 31, 2019 |  |  | Level 1 |  |  | Level 2 |  |  | Level 3 |
Assets |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Bone Biologics equity securities |  | $ | 219 |  |  | $ | — |  |  | $ | 219 |  |  | $ | — |
Total |  | $ | 219 |  |  | $ | - |  |  | $ | 219 |  |  | $ | - |
Liabilities |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Spinal Kinetics contingent consideration |  | $ | (42,700 | ) |  | $ | — |  |  | $ | — |  |  | $ | (42,700 | )
Deferred compensation plan |  |  | (1,255 | ) |  |  | — |  |  |  | (1,255 | ) |  |  | — |
Total |  | $ | (43,955 | ) |  | $ | — |  |  | $ | (1,255 | ) |  | $ | (42,700 | )
Schedule of Valuation Methodology and Unobservable Inputs for Level 3 Assets and Liabilities Measured at Fair Value | The changes in valuation of these securities for the years ended December 31, 2020, 2019, and 2018 are shown below:
(U.S. Dollars, in thousands) |  | 2020 |  |  | 2019 |  |  | 2018 |
Bone Biologics equity securities at January 1 |  | $ | 219 |  |  | $ | 219 |  |  | $ | 2,768 |
Impact of adoption of ASU 2016-01 recognized in other income |  |  | — |  |  |  | — |  |  |  | 1,629 |
Purchase of additional common stock |  |  | — |  |  |  | — |  |  |  | 500 |
Fair value adjustments and impairments recognized in other expense |  |  | (219 | ) |  |  | — |  |  |  | (4,678 | )
Bone Biologics equity securities at December 31 |  | $ | — |  |  | $ | 219 |  |  | $ | 219 |
Schedule of Reconciliation For Contingent Consideration Measured At Fair Value Using Significant Unobservable Inputs | The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3):
(U.S. Dollars, in thousands) |  | 2020 |  |  | 2019 |
Spinal Kinetics contingent consideration at January 1 |  | $ | 42,700 |  |  | $ | 28,560 |
Increase (decrease) in fair value recognized in acquisition-related amortization and remeasurement |  |  | (7,300 | ) |  |  | 29,140 |
Payment made |  |  | — |  |  |  | (15,000 | )
Spinal Kinetics contingent consideration at December 31 |  | $ | 35,400 |  |  | $ | 42,700 |
Fair Value, Inputs, Level 3 [Member] |
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items] |
Schedule of Reconciliation For Convertible Loan Measured At Fair Value Using Significant Unobservable Inputs | The following table provides a reconciliation of the beginning and ending balances of the Convertible Loan, measured at fair value using significant unobservable inputs (Level 3):
(U.S. Dollars, in thousands) |  | 2020 |  |  | 2019 |
Fair value of Neo Medical Convertible Loan at January 1 |  | $ | — |  |  | $ | — |
Issuance date |  |  | 5,000 |  |  |  | — |
Interest recognized in interest income, net |  |  | 103 |  |  |  | — |
Foreign currency remeasurement recognized in other income (expense), net |  |  | 176 |  |  |  | — |
Unrealized gain (loss) recognized in other comprehensive income (loss) |  |  | 1,881 |  |  |  | — |
Fair value of Neo Medical Convertible Loan at December 31 |  |  | 7,160 |  |  |  | — |
Amortized cost basis of Neo Medical Convertible Loan at December 31 |  |  | 5,279 |  |  |  | — |
Schedule of Valuation Methodology and Unobservable Inputs for Level 3 Assets and Liabilities Measured at Fair Value | The following table provides quantitative information related to certain key assumptions utilized within the valuation as of December 31, 2020:
(U.S. Dollars, in thousands) |  | Fair Value as of December 31, 2020 |  |  | Unobservable inputs |  | Estimate |
Neo Medical Convertible Loan |  | $ | 7,160 |  |  | Cost of equity discount rate |  |  | 21.1 | %
|  |  |  |  |  | Implied volatility |  |  | 108.1 | %
The following table provides a range of key assumptions used within the valuation as of December 31, 2020:
(U.S. Dollars, in thousands) |  | Fair Value as of December 31, 2020 |  |  | Valuation Technique |  | Unobservable inputs |  | Range
Spinal Kinetics contingent consideration |  | $ | 35,400 |  |  | Discounted cash flow |  | Revenue discount rate |  | 8.09% - 8.12%
|  |  |  |  |  |  |  | Payment discount rate |  | 3.83% - 3.90%
|  |  |  |  |  |  |  | Projected year of payment |  | 2021 - 2022
Schedule of Reconciliation of Debt Securities | The following table provides a reconciliation of the beginning and ending balances for the eNeura debt security, when it was measured at fair value as an available for sale debt security (prior to its change in classification):
(U.S. Dollars, in thousands) |  | 2020 |  |  | 2019 |  |  | 2018 |
Balance at January 1 |  | $ | — |  |  | $ | 17,820 |  |  | $ | 16,050 |
Gains (losses) recorded for the period |  |  |  |  |  |  |  |  |  |  |  |
Recognized in other expense, net |  |  | — |  |  |  | — |  |  |  | — |
Recognized in other comprehensive income (loss) |  |  | — |  |  |  | (2,593 | ) |  |  | 1,770 |
Change in classification of debt security to held to maturity |  |  | — |  |  |  | (15,227 | ) |  |  | — |
Issuance of Warrant as consideration for extension |  |  | — |  |  |  | 491 |  |  |  | — |
Impairment of Warrant |  |  | — |  |  |  | (491 | ) |  |  | — |
Balance at December 31 |  | $ | — |  |  | $ | — |  |  | $ | 17,820 |

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