1. Treatment Options for Your Severe Knee Pain 1

2. How your knee works Anatomy of the knee Largest joint in body Referred to as a hinge joint because it allows the knee to flex & extend; while hinges can only bend and straighten, the knee has the ability to rotate (turn) & translate (glide) 3 bones Shin bone (tibia) Thigh bone (femur) Kneecap (patella)

3. What’s causing your pain? It’s estimated 70 million people in the U.S. have some form of arthritis. 1 Osteoarthritis is one of the most common types. Osteoarthritis Wear and tear that deteriorates the “cushion” in your joints A degenerative condition—it won’t get better and may get worse Rheumatoid arthritis An autoimmune disease that attacks the lining of joints, causing swelling, possibly throbbing pain and deformity 1. Landers, S. Another reason to exercise for those with arthritis. American Medical Association website., 2005.

4. What’s causing your pain? Healthy knee The end of each bone in the joint is covered with cartilage, acting as a cushion so the joint functions without pain Diseased knee (osteoarthritis) Wear and tear deteriorates natural cushion, leading to bone-on-bone contact, soreness and swelling

5. Assessing your pain Does your knee hurt one or more days per week? Does the pain interfere with your sleep? Is it painful for you to walk more than a block? Are pain medications no longer working? Is knee pain limiting your participation in activities (e.g. family vacations or other functions)? Has inactivity from knee pain caused you to gain weight?

6. Little or no pain Excruciating, debilitating pain Assessing your pain Rate your pain on a scale of 1 to 5 For most people, the tipping point is about 4 or 5— that’s when the pain becomes too difficult and they turn to a surgeon for relief 1 1. 2007 DePuy Orthopaedics, Inc. Knee Attitudes & Usage Study.

7. Assessing your pain Check your mobility If you have difficulty performing any of the movements below, it may be time to talk to your doctor about next steps Walk Bend at the hips and knees Pretend to drive: push the gas/brake Pretend to golf: swing a club

8. How can your pain be treated? Water therapy Soaking, ice packs, hot packs Exercise & physical therapy Also good for weight loss Medications Analgesics Corticosteroids Injections Corticosteroids, hyaluronic acid (e.g., ORTHOVISC ® ) ORTHOVISC ® is a trademark of Anika Research, Inc.

9. Knee replacement Implants replace damaged surfaces Helps relieve pain and restore mobility Approximately 580,000 knee replacements are performed each year in the U.S. 1 One study has shown that ten years after surgery, 99.6% of patients still depend on their SIGMA ® Knees with fixed bearing option in their daily lives 2 1. American Association of Orthopaedic Surgeons. Total Knee Replacement – Your Orthopaedic Connection. http://orthoinfo.aaos.org/topic.cfm?topic=a00389 Accessed April, 2011. http://orthoinfo.aaos.org/topic.cfm?topic=a00389 2.Dalury et al. Midterm results with the P.F.C. SIGMA Total Knee Arthroplasty System. The Journal of Arthroplasty Vol.23, No.2, 2008: 175-181.

10. Femoral component Tibial component What is knee replacement? A surgical procedure that removes and replaces diseased joint surfaces with implants

11. Femoral component Tibial component Patellar component Polyethylene insert How does it work? Diseased areas at top of shin bone (tibia) and bottom of thigh bone (femur) are removed and reshaped Femoral component covers the thigh bone (femur) Tibial component covers the shin bone (tibia) Polyethylene insert placed between femoral and tibial components Patellar component replaces the kneecap (patella)

12. Healthy kneeKnee replacement How does it work?

13. DePuy SIGMA ® Knees SIGMA Knees come in a wide range of shapes, sizes and materials Your surgeon may be able to fit you with a SIGMA Knee designed to provide a natural feel and movement The SIGMA Knee is an example of a proven design that continues to evolve to meet the demands of today’s patients

14. SIGMA ® Fixed Bearing Knees Most widely used type of knee replacement in the U.S. today 1 Designed to enhance stability of the joint New designs and advanced materials - Helps reduce wear 1. IMS Health

15. SIGMA ® Fixed Bearing Knees

16. SIGMA ® Rotating Platform Knees Designed to rotate as it bends, imitating your natural knee movement The surfaces of the knee joint roll and glide against each other as you bend. In other words, your knee naturally rotates as it bends Designed for patients who want to remain active since it minimizes implant wear, compared to traditional knee replacements 1 One study has shown after 20 years, 97% of patients still depend on their rotating platform knees in their daily lives 2 1. McNulty, D. et al. “In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2).” 2003. 2. Buechel F., et al. “Twenty Year Evaluation of Meniscal Bearing and Rotating Platform Knee Replacements.” Clinical Orthopaedics and Related Research July 2001: 41-50.

17. Should you wait to replace your knee? Assess your pain and ability to function Do you feel severe pain in your knee? Has the pain and loss of function affected your quality of life? Do you have difficulty sleeping or performing basic functions (walking, driving, climbing stairs)? Does medication no longer provide relief? Consult your physician Early diagnosis and treatment are important 1 Delaying may lower your quality of life 2 Osteoarthritis is degenerative—it won’t get better and may get worse 1. Fortin PR, et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism. 1999;42:1722-1728. 2. Fortin PR, et al. Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients With Osteoarthritis of the Hip or Knee. Arthritis & Rheumatism. 2002;46:3327-3330.

18. Important safety information As with any medical treatment, individual results may vary The performance of joint replacements depends on your age, weight, activity level and other factors There are potential risks, and recovery takes time People with conditions limiting rehabilitation should not have this surgery Only an orthopaedic surgeon can tell if knee replacement is right for you

19. Summary The leading cause of knee pain is osteoarthritis Osteoarthritis is degenerative – it won’t get better and may get worse Early diagnosis and treatment for total knee replacement are important 1 An Arthritis Foundation ® study shows knee replacement has a 90-95% rate of patient satisfaction 2 SIGMA Knees come in a wide range of shapes, sizes and materials, so your surgeon can recommend the implant that is right for you. Arthritis Foundation ® is a trademark of The Arthritis Foundation, Inc. 1. Fortin, Paul R., et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism 42 (1999): 1722-1728 2. The Arthritis Foundation., 2006.

20. Questions?

21. Thank you!

22. Additional slides The following 2 slides are the SIGMA ® Rotating Platform Flexion Knees and SIGMA ® High Performance Partial Knees module. If desired, please select the appropriate slides to include within this presentation. REMOVE THIS SLIDE

23. SIGMA ® Rotating Platform Flexion Knees Rotating Platform Flexion Knee High Flex implant that enables deep knee flexion May help with everyday activities like sitting cross-legged, kneeling and squatting Shown to reduce implant wear by 94% over traditional knee implants 1,2 1. McNulty, D. et al. “The effect of crosslinking UHMWPE on in vitro wear rates of fixed and mobile bearing knees. ASTM STO 1445.” 2. Gsell, R. et al. American Society for Testing and Materials, West Conshohocken, PA., 2004.

24. SIGMA ® High Performance Partial Knees High Performance Partial Knees Can replace any of the three areas of your knee; replacing only the damaged area maintains more of your natural knee May be an option for more active patients who require a high degree of flexion but not total knee replacement Accommodates deep knee flexion, the movement needed for kneeling, squatting or sitting cross-legged Less invasive with potential for faster recovery than total knee replacement

25. Additional slides The following 3 slides are the TRUMATCH ® Personalized Solutions module. If desired, please select the appropriate slides to include within this presentation. REMOVE THIS SLIDE

26. TRUMATCH ® Personalized Solutions What is TRUMATCH? Uses advancements in technology to provide surgeons with customized instruments designed specifically for your knee anatomy

27. Benefits of TRUMATCH Helps your surgeon achieve consistency in the placement and positioning of your knee replacement TRUMATCH instruments help your surgeon to obtain a precise fit of the implant. The implant helps reduce a patient’s pain and restore their mobility Reduces number of surgical steps and operating time

28. TRUMATCH ® Personalized Solutions How does it work? A CT scan of your leg is taken A 3-D model of your knee is developed Personalized guides are created based on your unique anatomy Your guides help your surgeon position and place your new knee implant Guides are removed by your surgeon prior to your new knee being implanted

29. Additional slides The following 3 slides are the SIGMA ® Partial Knee Alternative module. If desired, please select the appropriate slides to include within this presentation. REMOVE THIS SLIDE 29

30. The Partial Knee Alternative 30 “Partial” “Total”

31. Partial Knee Replacement Removes only the damaged area of the knee Uses technologically- advanced metal and plastic implants to replace the damaged area, helping to relieve pain and restore more natural movement. 31

32. Potential advantages of a Partial Knee Maintains more of the healthy ligaments and bone, helping to restore the natural movement during activities Potential for faster recovery Minimally invasive procedure to reduce blood loss Possible reduced scarring 32 UnicondylarPatellofemoral

33. Additional slides The following 3 slides are the gender-specific module. If desired, please select the appropriate slides to include within this presentation. REMOVE THIS SLIDE

34. Important considerations for women Osteoarthritis affects three times more women than men 1 Women are more likely than men to be disabled The pain is more severe for women 2 Women’s knees rotate more than men’s, especially during deep bending (kneeling) 3 Current knee replacements are designed to fit the anatomies of both women and men 1. Hawker, Gillian A., et al. "Differences Between Men and Women in the Rate of Use of Hip and Knee Arthroplasty.“ The New England Journal of Medicine 342 (2000): 1016-1022 2. Harris Interactive research survey, April 2005 3. Hsu, Wei-Hsiu, et al. “Difference in Torsional Joint Stiffness of the Knee Between Genders.” The American Journal of Sports Medicine Vol. 34, No. 5 (2006): 765-770.

35. Gender-specific implants All orthopaedic manufacturers have knee implant systems with sizes appropriate for both female and male patients Surgeons know which knee will fit each patient best, based on gender, age, size, activity levels and aspirations There is no clinical support of the need for gender-specific implants It is too early for any clinical data; won’t know results of gender-specific implant clinical studies for 10-15 years

36. Gender-specific implants More than 60% of knee replacements have been implanted in women 1 Current knee replacement patients have a 90 to 95% satisfaction rate with the results of their surgery 2 1. American Academy of Orthopaedic Surgeons, 2006. 2. The Arthritis Foundation, 2006.

37. Additional slides The following 4 slides are the minimally invasive knee surgery module. If desired, please select the appropriate slides to include within this presentation. REMOVE THIS SLIDE

38. Minimally invasive knee replacement surgery Minimally invasive surgery (MIS) is still very new SIGMA ® Knees can be implanted using minimally invasive surgery Alignment affects: – How long your knee replacement lasts – Long-term success

39. Benefits of MIS Some early studies of MIS have shown some potential benefits of the surgery (when compared to traditional, “open” surgery), such as: Less blood loss Potential for shorter hospital stays Potential for faster recovery

40. Complications of MIS Other studies, however, have shown several complications with the surgery, (when compared to traditional, “open” surgery), including: Increased number of surgical complications Poor implant positioning No difference in the length of recovery

41. What really matters when it comes to MIS MIS is still relatively new It won’t be known for 10 to 15 years if the new techniques affect the long-term function and durability of the implant You should discuss with your surgeon whether MIS is an appropriate surgical course of treatment for you

42. Additional slides The following 2 slides are the computer-assisted surgery module. If desired, please select the appropriate slides to include within this presentation. REMOVE THIS SLIDE

43. Computer-assisted surgery What is computer-assisted surgery (CAS)? A new approach to knee replacement The patient’s anatomy is simulated and displayed on a computer Computer provides information about where to place the components

44. Potential benefits of CAS CAS guides surgeon in areas that are difficult to visualize Relays specific measurements not previously available to surgeons, such as implant alignment and angle of cuts Gives precise, accurate data on your specific anatomy Allows surgeons to make decisions about implant placement based on detailed data from the computer