Leases (Narrative) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Right of use asset	$ 100,124	$ 90,280
Lease liability	$ 100,074	$ 90,316
Option to extend operating lease	true
Option to terminate operating lease	true
Weighted average remaining lease term	9 years	9 years
Weighted average discount rate	3.60%	3.84%
Operating lease expenses	$ 22,500	$ 21,300	$ 20,100
Short term lease expenses	28,000	19,100	20,000
Cash paid related to operating lease obligations	19,000	18,600	17,500
Right-of-use assets obtained in exchange for operating lease liabilities	$ 28,600	33,300	$ 16,100
Zimmer, S.A. de C.V.
Right-of-use assets obtained in exchange for operating lease liabilities		$ 19,700