v3.25.4
Segments
 12 Months Ended
Dec. 31, 2025
Segment Reporting [Abstract]  
Segments Segments
The Company operates in two reportable segments: U.S. and International. These segments align with the Company’s operating structure and are based on the geographic markets in which the Company sells its products. Both segments sell the Company’s portfolio of products to healthcare institutions, physicians, patients, distributors and dealers.
The Company identifies a business as an operating segment if (i) it engages in business activities from which it may earn revenues and incur expenses; (ii) its operating results are regularly reviewed by the CODM and (iii) it has available discrete financial information. The Company’s CODM is its President and Chief Executive Officer, who uses segment Adjusted EBITDA to make decisions regarding the allocation of resources, assess performance and to develop annual budgets and forecasts. The Company does not disclose segment information by asset, as the CODM does not review or use such information to allocate resources or to assess the operating results and financial performance.
The following table presents segment Adjusted EBITDA reconciled to income (loss) before income taxes for the years ended December 31:
2025
U.S.InternationalConsolidated
Revenue$502,097 $65,990 $568,087 
Adjusted cost of sales(a)
113,824 24,855 
Adjusted selling expense(b)
152,075 12,687 
Adjusted marketing expense(b)
24,922 3,588 
Adjusted general and administrative expense(b)
97,497 9,329 
Adjusted research and development expense(c)
11,266 41 
Adjusted other segment expense(d)
1,546 180 
Adjusted EBITDA100,967 15,310 116,277 
Reconciliation to income before income taxes
Interest expense, net(26,486)
Depreciation and amortization(47,011)
Shareholder litigation costs(51)
Restructuring costs(2,235)
Equity-based compensation(12,673)
Debt refinancing(902)
Loss on extinguishment(326)
Loss on disposal of a business(81)
Other items(e)
(803)
Income before income taxes$25,709 

2024
U.S.InternationalConsolidated
Revenue$506,809 $66,471 $573,280 
Adjusted cost of sales(a)
118,985 24,188 
Adjusted selling expense(b)
157,789 11,233 
Adjusted marketing expense(b)
24,235 3,004 
Adjusted general and administrative expense(b)
97,592 14,949 
Adjusted research and development expense(c)
13,139 41 
Adjusted other segment income(d)
(352)(405)
Adjusted EBITDA95,421 13,461 108,882 
Reconciliation to loss before income taxes
Interest expense, net(38,792)
Depreciation and amortization(49,555)
Acquisition and related costs(1,339)
Shareholder litigation costs(13,802)
Restructuring costs57 
Equity-based compensation(13,274)
Debt refinancing(351)
Impairments of assets(36,357)
Loss on disposal of a business(292)
Other items(e)
(7,519)
Loss before income taxes$(52,342)
2023
U.S.InternationalConsolidated
Revenue$449,860 $62,485 $512,345 
Adjusted cost of sales(a)
109,889 25,760 
Adjusted selling expense(b)
140,278 11,908 
Adjusted marketing expense(b)
24,401 2,655 
Adjusted general and administrative expense(b)
86,108 12,285 
Adjusted research and development expense(c)
11,458 31 
Adjusted other segment income(d)
(942)(348)
Adjusted EBITDA78,668 10,194 88,862 
Reconciliation to loss before income taxes
Interest expense, net(40,676)
Depreciation and amortization(57,365)
Acquisition and related costs(5,694)
Restructuring and succession charges(2,331)
Equity-based compensation(2,722)
Debt refinancing(7,291)
Impairment of assets(78,615)
Loss on disposal of a business(1,539)
Other items(e)
(13,740)
Loss before income taxes$(121,111)
(a)Adjusted cost of sales used in calculating segment Adjusted EBITDA excludes depreciation and amortization.
(b)Adjusted selling, general and administrative expense used in the calculation of segment Adjusted EBITDA excludes certain acquisition and related costs, shareholder litigation costs, certain restructuring and succession charges, asset impairments, debt refinancing, equity-based compensation expense and other segment items—charges associated with strategic transactions, such as potential divestitures and a transformative project to redesign systems and information processing.
(c)Adjusted research and development expense used in calculating segment Adjusted EBITDA excludes depreciation and amortization, equity-based compensation expense.
(d)Adjusted other segment expense (income) primarily consists of foreign currency transaction and remeasurement gains and losses and other certain nonrecurring items.
(e)During the year ended December 31, 2025, other items primarily consisted of expenses related to the divestiture of the Advanced Rehabilitation Business, which was completed on December 31, 2024.
During the year ended December 31, 2024, other items primarily consisted of divestiture costs related to the Advanced Rehabilitation Business, strategic transaction costs and transformative project costs.
During the year ended December 31, 2023, other items mostly consisted of strategic transaction costs, transformative project costs, transition and severance costs and expenses related to the discontinuance of MOTYS.