1. Treatment Options for your Knee Pain

2. WHAT DO YOU THINK? 1.How many people in the United States undergo knee replacement surgery each year? a)150,000 b)660,000 c)800,000 2.What disease is the leading cause of disability in the U.S.? a)Heart Disease b)Diabetes c)Arthritis

3. 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 )

4. 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.

5. 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

6. ARTHRITIS 1 in 5 adults in the US report having been diagnosed with arthritis 1 By 2030, it is projected that 67 million adults will have arthritis − 25 million will have arthritis- attributable activity limitation (AAAL) 2 Osteoarthritis is one of the most common types of arthritis 1 1.http://www.cdc.gov/nccdphp/publications/aaq/pdf/arthitis.pdf. Accessed February 14, 2013.http://www.cdc.gov/nccdphp/publications/aaq/pdf/arthitis.pdf 2.http://www.rheumatology.org/about/newsroom/prevalence/prevalence-one.pdf. Accessed February 14, 2013.http://www.rheumatology.org/about/newsroom/prevalence/prevalence-one.pdf

7. OSTEOARTHRITIS Osteoarthritis (OA) is caused by cartilage breakdown and subsequent bony changes to joints 1 Joint changes are irreversible 1 OA Often goes undiagnosed until the disease has progressed, which can reduce treatment opportunities 2 1.Srikulmontree, T. Osteoarthritis patient fact sheet. American College of Rheumatology. 2009. 2.Kotlarz H, et al. Osteoarthritis and absenteeism costs: evidence from US national survey data. J Occup Environ Med. 2010;52:263-268.

8. For OA patients requiring surgery, total joint replacement provides marked pain relief and functional improvement in the vast majority of patients 1 1.Srikulmontree, T. Osteoarthritis patient fact sheet. American College of Rheumatology. 2009. OSTEOARTHRITIS

9. Osteoarthritis has a Strong Correlation with Obesity and Diabetes The overall age and weight of the US population are both increasing 1,2 For adults with arthritis, on average, obesity prevalence was 54% higher than adults without arthritis. 3 52% of adults with diabetes have arthritis 4 1.Dobriansky PJ, et al. Why Population Aging Matters. NIA NIH Pub No. 07-6134 March 2007. 2.http://www.cdc.gov/nchs/data/databriefs/db82.pdf. Accessed February 4, 2013.http://www.cdc.gov/nchs/data/databriefs/db82.pdf 3.CDC. Prevalence of Obesity Among Adults with Arthritis --- United States, 2003—2009. Web site. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6016a4.htm. Accessed February 14, 2013. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6016a4.htm 4.http://diabetes.webmd.com/news/20080508/cdc-52-percent-with-diabetes-get-arthritis. Accessed February 4, 2013. Osteoarthritis AgeWeightDiabetes

10. Pharmacological Interventions Include OSTEOARTHRITIS Treatment Pathway 1 Non-Pharmacological Interventions Include Surgical Interventions Include Patient education Physical therapy Assistive devices Exercise (weight loss, if overweight) Debridement (removing debris and smoothing surfaces to delay arthritis progression) Osteotomy (removing wedge of bone near arthritic joint to shift body weight) Joint Replacement Pain Medication (e.g., Acetaminophen, Ibuprofen) Topical Pain Medication (e.g., creams, gels, rubs) Joint Injection (e.g., cortisone) 1.Zhang W, et al. Osteoarthritis Research Society International (OARSI ) recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008 Feb;16(2):137-62.

11. 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?

12. 12 Rate your pain on a scale of 1 to 10 For most people, the tipping point is about 7 or 8— that’s when the pain becomes too difficult and they turn to a surgeon for relief 1 Little or no pain Unbearable pain ASSESSING YOUR PAIN 1.2007 DePuy Orthopaedics, Inc. Knee Attitudes & Usage Study 15102346789

13. 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 WalkBend at the hips and knees Pretend to drive: push the gas/brake Pretend to golf: swing a club

14. KNEE REPLACEMENT Implants replace damaged surfaces Helps relieve pain and restore mobility In 2012, more than 660,000 total knee replacements were performed in the United States 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. 2013 Premier, Inc. 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.

15. WHAT IS KNEE REPLACEMENT? A surgical procedure that removes and replaces diseased joint surfaces with implants

16. WHAT IS KNEE REPLACEMENT? A surgical procedure that removes and replaces diseased joint surfaces with implants 16

17. 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)

18. Healthy kneeKnee replacement HOW DOES IT WORK? Diseased knee

19. DEPUY SYNTHES JOINT RECONSTRUCTION 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

20. 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

21. SIGMA ® FIXED BEARING KNEES

22. 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..

23. 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.

24. #1 Arthritis pain is just a part of aging. It’s just something you learn to live with. #2 A knee replacement won’t feel natural #3 I’m too young for a knee replacement #4 I should wait as long as possible to get knee replacement surgery #5 All knee implants are the same 5 MYTHS OF KNEE JOINT REPLACEMENT

25. Osteoarthritis affects nearly 27 million Americans today and will affect potentially up to 67 million people by 2030. 1 If everyday activities are causing pain and interfering with your daily life, you may benefit from talking with your primary care physician or an orthopaedic surgeon, no matter what your age. In 2012, more than 660,000 total knee replacements were performed in the United States. 2 Reality 1. http://www.niams.nih.gov/Heath-Info/Osteoarthritis/default.asp 2. 2013 Premier, Inc. MYTH 1 Arthritis pain is just a part of aging. It’s just something you learn to live with.

26. There have been many advancements in implant materials for knee replacement DePuy Synthes Joint Reconstruction offers unique implants, Rotating Platform (RP) Knees, that closely mimic the feel and movement of a natural knee. 1 Reality MYTH 2 A knee replacement won’t feel natural 1. Rees JL, Beard DJ, Price AJ, et al. Real in vivo kinematic differences between mobile-bearing and fixed-bearing total knee arthroplasties. ClinicalOrthopaedics and Related Research 2005;204.

27. Knee replacement is not based on age, but on the person’s level of pain and immobility. As a result of advances in implant technology, patients may benefit from knee replacement options such as the Rotating Platform (RP) Knee which is designed to help patients move naturally. 1 Reality I am too young for a knee replacement MYTH 3 1.Rees JL, Beard DJ, Price AJ, et al. Real in vivo kinematic differences between mobile-bearing and fixed- bearing total knee arthroplasties. ClinicalOrthopaedics and Related Research 2005;204.

28. 28 Studies have shown that waiting for joint replacement surgery generally worsens the outcomes 1 Delaying surgery lowers quality of life, not only before the operation, but even for up to two years following surgery 2 Reality 1.Ackermann IN, et al. Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study. BMC Musculoskelet Disord. 2011; 12: 108. 2.Rees JL, et al. Real in vivo kinematic differences between mobile-bearing and fixed-bearing total knee arthroplasties. Clinical Orthopaedics and Related Research 2005;204. MYTH 4 I should wait as long as possible to undergo knee replacement surgery

29. Today, knee replacement patients have a choice of knee implant types as well as a variety of implant shapes and sizes designed to accommodate specific needs and different lifestyles. Talk to your orthopaedic surgeon about your individual needs and the clinical history of the implant your surgeon recommends for you. Reality MYTH 5 All knee implants are the same

30. REHAB AND RECOVERY Can usually bend the knee the same day of surgery Rehabilitation therapy normally begins within a few hours of surgery Rehabilitation therapy normally lasts at least 3 months Goals of rehab: – Improve your muscle strength – Increase the movement in your knee joint – Return to most of your normal activities LEAVING THE HOSPITAL Doctor will decide the best place for continued recovery

31. 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

32. 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.

33. QUESTIONS?

34. THANK YOU! © DePuy Synthes Joint Reconstruction, a division of DOI 2014

35. ADDITIONAL SLIDE? The following slide is the SIGMA ® High Performance Partial Knees module. If desired, please select the slide to include within this presentation. REMOVE THIS SLIDE WHEN PRESENTING

36. 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

37. 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 WHEN PRESENTING

38. TRUMATCH ® PERSONALIZED SOLUTIONS What is TRUMATCH? Uses advancements in technology to provide surgeons with customized surgical guides that are designed specifically for your knee anatomy

39. BENEFITS OF TRUMATCH SOLUTIONS 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

40. 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

41. 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 WHEN PRESENTING

42. THE PARTIAL KNEE ALTERNATIVE “Partial” “Total”

43. PARTIAL KNEE REPLACEMENT Removes only the damaged area of the knee Uses metal and plastic implants to replace the damaged area, helping to relieve pain and restore natural movement.

44. 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 Unicondylar Patellofemoral

45. ADDITIONAL SLIDE? The following slide is the minimally invasive knee surgery module. If desired, please select the slide to include within this presentation. REMOVE THIS SLIDE WHEN PRESENTING

46. MINIMALLY INVASIVE KNEE REPLACEMENT SURGERY SIGMA ® Knees can be implanted using minimally invasive surgery Alignment affects: −How long your knee replacement lasts −Long-term success

47. 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 WHEN PRESENTING

48. COMPUTER-ASSISTED SURGERY What is computer-assisted surgery (CAS)? − An approach to knee replacement − The patient’s anatomy is simulated and displayed on a computer − Computer provides information about where to place the components

49. 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