1. *** Remove this slide before presentation*** This presentation was created to assist you during local market educational seminars given to patients. Before each segment of information contained herein, you will see a title screen informing you of the section to follow. You should not include every slide in the presentation if you do not want to. Please review the presentation prior to the event and choose only the screens youd like to include when delivering the presentation itself. Dont forget to delete the screens you do not wish to include. The different buckets of information to choose from within this presentation include: General Osteoarthritis General Facts About Knee Replacement Knee Replacement Options: Rotating Platform Knees Consequences of Delaying Surgery Patient Testimonials Computer Assisted Surgery Womens Issues in Knee Replacement Minimally Invasive Surgery Additionally, there are scripts from which you can refer while the two animations are playing. If you have any questions or need help, contact Jessica Masuga at (574) 371-4830.

2. [Insert name] Emcee representing DePuy Orthopaedics, Inc.

3. Welcome! You should have with you several forms: –Event Questionnaire – an event feedback form Please return this to us at the end of the event –Personal Assessment Form – a self-test of your mobility –For More Information Form – please return this to us to request additional information about knee replacement

4. Agenda Discuss treatment options for severe knee pain Patient stories Questions & answers

5. Dr. [insert name] Orthopaedic Surgeon

6. General Osteoarthritis Remove this slide

7. Whats the Leading Cause of Knee Pain? Osteoarthritis

8. What is Osteoarthritis? Cartilage deteriorates and friction is created between bone surfaces. Symptoms include: –Chronic knee pain –Knee stiffness –Difficulty with everyday activities (walking, driving, stair climbing)

9. 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

10. Knee Osteoarthritis Treatments Early Intervention Non-surgical Treatments Knee Replacement Medication Weight control Prescription medications Physical therapy Injection therapy Orthovisc(R) 400,000 performed yearly in the U.S.

11. General Facts About Knee Replacement Remove this slide

12. Knee Replacement Knee replacement surgery is the replacement of the worn and arthritic surfaces of the knee joint

13. Script to Use During Animation This animation shows that very little bone is actually removed. The damaged cartilage, along with a very small amount of bone, is removed, and the knee replacement, which is made of metal and plastic, is then fitted to the bone to provide an artificial surface. The components of a knee replacement comprise the femoral component, the tibial tray, and the tibial component (Remove this slide)

14. Are You Ready for Knee Replacement? 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? Has inactivity from knee pain caused you to gain weight? Can you limit activities for a few months to recover from surgery? Are you willing to commit to work hard during rehabilitation for a successful recovery?

15. Knee Replacement Facts Based on a National Institute of Health (NIH) study, 85% of patients are satisfied with the results of their knee replacement surgery 1 1: NIH Consensus Development Conference on Total Knee Replacement, NIH Consensus Development Program (http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=5299)http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=5299

16. But You Should Also Know… Performance of joint replacements depends on age, weight, activity level and other factors. There are potential risks and recovery takes time. People with current infections or conditions limiting rehabilitation should not have this surgery. Potential complications which could result in pain, stiffness or dislocation of the joint include: –Loosening –Fracturing –Wearing of the components

17. Knee Replacement Options: Rotating Platform Knees Remove this slide

18. Knee Replacement Options Traditional: fixed-bearing Unique: mobile-bearing (also called Rotating Platform)

19. Unique Options in Knee Replacement Rotating Platform Knee –Designed to rotate as it bends, imitating natural knee movement The surfaces roll and glide against each other as the knee bends, just as your natural knee does Designed for patients who want to remain active since it minimizes implant wear, compared to fixed-bearing knees 1 A multi-center internal study shows 97% patient satisfaction at 5 years 2 1: McNulty, D. et al. In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2) (2003) 2: DePuy Multi-Center Study (2006)

20. Why is Rotation Important?

21. Script to Use During Animation What makes the Rotating Platform knee unique is that the part of the implant that replaces the worn cartilage actually rotates slightly as you move, imitating the natural movement of the knee. On traditional knee replacements, this piece stays locked in place. While these types of knee replacements are extremely successful, for more active patients, the rotation is beneficial because it helps minimize wear and tear on the implant. Comment during animation: –Note the white component is moving slightly side to side Your knee rotates slightly during normal movement: –Walking-5 degrees of rotation –Climbing stairs-8 degrees of rotation –Kneeling-15 degrees of rotation (Remove this slide)

22. Consequences of Delaying Surgery Remove this slide

23. 1: Fortin, Paul R., et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism 42 (1999): 1722-1728 2: Fortin, Paul R., et al. Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients with Osteoarthritis of the Hip or Knee. Arthritis & Rheumatism 46 (12) (2002): 3327-3330 3: www.jointreplacement.comwww.jointreplacement.com Early diagnosis and treatment for total knee replacement are important 1 –Delaying surgery can lower quality of life before the operation and up to two years after surgery 2 Pre-existing medical conditions may become more serious, delaying elective surgery 3 Osteoarthritis is degenerative – it wont get better and will likely get worse! Should You Delay Surgery?

24. What to Expect With or Without Knee Replacement Severe pain Inability to walk any distance Medications dont help Interrupted sleep Surgery is recommended 3-6 months+ Return to activities 3-6 months+ Continued or increased pain and reduced mobility 1-2 months Rehabilitation 1-2 months Continue to address symptoms Have Surgery Delay Surgery

25. Patient Testimonials Remove this slide

27. Patient Testimonial Received Rotating Platform Knee Date of Surgery Insert quote

28. Computer Assisted Surgery Remove this slide

29. Computer Assisted Surgery What is computer assisted surgery (CAS)? –A new approach to knee replacement –The patients anatomy is simulated and displayed on a computer –Computer provides information about where to place the components

30. Your anatomical information is entered into the computer through a process called registration This information is fed back to the camera and communicated to the computer Computer calculates the best position to place the components for accurate alignment Camera searches for arrays placed on the patient via infrared signals How Does CAS Work?

31. Potential Benefits of CAS Guides surgeon in areas that are difficult to visualize Relays specific measurements not previously available to surgeons Gives precise, accurate data on your specific anatomy Allows surgeons to make informed decisions about precise implant placement based on detailed data from the computer

32. Why Use Computer Assisted Knee Replacement Surgery? Advanced knee replacement technology combined with widely used, clinically successful implants Allows surgeons to be more precise when making decisions about placing knee components Provides the surgeon with extensive information to assist with surgical decisions

33. Womens Issues in Knee Replacement 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 Womens knees rotate more than mens, 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 There is no clinical support of the need for gender- specific implants It is too new for any clinical data; wont know results of the implant for 10-15 years All orthopaedic manufacturers have knee implant systems with sizes appropriate for both females and males 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 (http://www.aaos.org/wordhtml/research/stats/Hipkneefacts.htm) (2006)http://www.aaos.org/wordhtml/research/stats/Hipkneefacts.htm 2: The Arthritis Foundation (http://www.arthritis.org/research/Bulletin/vol51no11/Printable.htm) (2006)http://www.arthritis.org/research/Bulletin/vol51no11/Printable.htm

36. Gender Issues in Knee Replacement: The Bottom Line Rotation is important, especially for women Womens knees rotate more than mens –In deep flexion (deep knee bending) –Daily activity Only one knee, the Rotating Platform knee, is designed to accommodate your knees anatomical need for rotation

37. Minimally Invasive Surgery Remove this slide

38. Minimally Invasive Knee Replacement Surgery Minimally invasive surgery (MIS) is still very new Visibility of your knee during surgery to help ensure proper alignment is more important to the long-term success of your knee replacement than the length of your incision or even your recovery Alignment affects: –How long your knee replacement lasts –Long-term success

39. Benefits of MIS Some early studies of MIS have shown some benefits of the surgery (when compared to traditional, open surgery), such as: –Less blood loss –Shorter hospital stays –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 wont 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 (if applicable)

43. Event Questionnaires Please take a moment to complete the event questionnaires Please pick up additional information about knee replacement as you leave Dont forget your free gift!

44. Thank you for attending our event: Restoring the Joy of MotionQuestions? For more information: Include surgeon information here www.kneereplacement.com or visit www.aaos.orgwww.aaos.org TM

45. Potential Questions to Be Asked During Q&A Remove this slide

46. Q&A 1.What can I expect during recovery and rehabilitation from knee replacement? 2.Should I be concerned about anesthesia during surgery? 3.Will I recover at home or at a rehab facility? 4.How long will the implant last? 5.When can I drive, work, resume activities? 6.Ive heard there are knee replacements made just for women. Do I need one of these? 7.How can I prepare my family and myself before surgery? (Remove this slide)