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Fair value measurements and investments (Tables) | 12 Months Ended
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Dec. 31, 2021
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, 2021 |  |  | Level 1 |  |  | Level 2 |  |  | Level 3 |
Assets |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Neo Medical convertible loan agreements |  | $ | 7,148 |  |  | $ | — |  |  | $ | — |  |  | $ | 7,148 |
Neo Medical preferred equity securities |  |  | 5,413 |  |  |  | — |  |  |  | 5,413 |  |  |  | — |
Bone Biologics equity securities |  |  | 309 |  |  |  | 309 |  |  |  | — |  |  |  | — |
Other investments |  |  | 1,505 |  |  |  | — |  |  |  | — |  |  |  | 1,505 |
Total |  | $ | 14,375 |  |  | $ | 309 |  |  | $ | 5,413 |  |  | $ | 8,653 |
Liabilities |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Spinal Kinetics contingent consideration |  | $ | (17,200 | ) |  | $ | — |  |  | $ | — |  |  | $ | (17,200 | )
Other contingent consideration |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |
Deferred compensation plan |  |  | (1,314 | ) |  |  | — |  |  |  | (1,314 | ) |  |  | — |
Total |  | $ | (18,514 | ) |  | $ | — |  |  | $ | (1,314 | ) |  | $ | (17,200 | )
(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 | )
Schedule of Reconciliation of Carrying Value of Investments in Equity Securities | The table below presents a reconciliation of the carrying value of the Company’s investment in Neo Medical preferred equity securities for the years ended December 31, 2021, and 2020:
(U.S. Dollars, in thousands) |  | 2021 |  |  | 2020 |
Fair value of Neo Medical preferred equity securities at January 1 |  | $ | 5,000 |  |  | $ | — |
Additions |  |  | — |  |  |  | 5,000 |
Foreign currency remeasurement recognized in other income, net |  |  | 77 |  |  |  | — |
Unrealized gain recognized in other income (expense), net |  |  | 336 |  |  |  | — |
Fair value of Neo Medical preferred equity securities at December 31 |  |  | 5,413 |  |  |  | 5,000 |
Schedule of Changes in Valuation of Securities | The following table presents the changes in fair value recognized for the equity securities for each of the years ended December 31, 2021, 2020, and 2019:
(U.S. Dollars, in thousands) |  | 2021 |  |  | 2020 |  |  | 2019 |
Bone Biologics equity securities at January 1 |  | $ | — |  |  | $ | 219 |  |  | $ | 219 |
Fair value adjustments and impairments recognized in other income (expense), net |  |  | 309 |  |  |  | (219 | ) |  |  | — |
Bone Biologics equity securities at December 31 |  | $ | 309 |  |  | $ | — |  |  | $ | 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) |  | 2021 |  |  | 2020 |
Spinal Kinetics contingent consideration at January 1 |  | $ | 35,400 |  |  | $ | 42,700 |
Decrease in fair value recognized in acquisition-related amortization and remeasurement |  |  | (3,200 | ) |  |  | (7,300 | )
Payment made |  |  | (15,000 | ) |  |  | — |
Spinal Kinetics contingent consideration at December 31 |  | $ | 17,200 |  |  | $ | 35,400 |
Fair Value, Inputs, Level 3 [Member] |
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 Loans, measured at fair value using significant unobservable inputs (Level 3):
(U.S. Dollars, in thousands) |  | 2021 |  |  | 2020 |
Fair value of Neo Medical Convertible Loans at January 1 |  | $ | 7,160 |  |  | $ | — |
Additions |  |  | 671 |  |  |  | 5,000 |
Interest recognized in interest income, net |  |  | 421 |  |  |  | 103 |
Foreign currency remeasurement recognized in other income (expense), net |  |  | (162 | ) |  |  | 176 |
Unrealized gain (loss) recognized in other comprehensive income (loss) |  |  | (942 | ) |  |  | 1,881 |
Fair value of Neo Medical Convertible Loans at December 31 |  |  | 7,148 |  |  |  | 7,160 |
Amortized cost basis of Neo Medical Convertible Loans at December 31 |  |  | 6,209 |  |  |  | 5,279 |
Schedule of Changes in Valuation of Securities | The following table provides quantitative information related to certain key assumptions utilized within the valuation of the Convertible Loans as of December 31, 2021:
(U.S. Dollars, in thousands) |  | Fair Value as of December 31, 2021 |  |  | Unobservable inputs |  | Estimate |
Neo Medical Convertible Loans |  | $ | 7,148 |  |  | Cost of equity discount rate |  |  | 16.1 | %
|  |  |  |  |  | Implied volatility |  |  | 67.8 | %
The following table provides a range of key assumptions used within the valuation as of December 31, 2021:
(U.S. Dollars, in thousands) |  | Fair Value as of December 31, 2021 |  |  | Valuation Technique |  | Unobservable inputs |  | Range
Spinal Kinetics contingent consideration |  | $ | 17,200 |  |  | Discounted cash flow |  | Revenue discount rate |  | 7.13% - 7.55%
|  |  |  |  |  |  |  | Payment discount rate |  | 3.38% - 3.81%
|  |  |  |  |  |  |  | Projected year of achievement |  | 2022

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