Leases (Narrative) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Jan. 01, 2019
Right of use asset	$ 90,280	$ 75,176
Lease liability	$ 90,316	$ 75,429
Option to extend operating lease	true
Option to terminate operating lease	true
Weighted average remaining lease term	9 years	6 years
Weighted average discount rate	3.84%	3.96%
Operating lease expenses	$ 21,300	$ 20,100
Short term lease expenses	19,100	20,000
Cash paid related to operating lease obligations	18,600	17,500
Right-of-use assets obtained in exchange for operating lease liabilities	33,300	$ 16,100
Payments for Rent			$ 21,100
Zimmer, S.A. de C.V.
Right-of-use assets obtained in exchange for operating lease liabilities	$ 19,700
Accounting Standards Update 2016-02 [Member] | Restatement Adjustment [Member]
Right of use asset				$ 76,300
Lease liability				$ 76,300