1. Treatment Options for Severe Hip Pain

2. Anatomy of the hip Ball-and-socket joint Ball (femoral head) at the end of the leg bone (femur) Hip socket (or acetabulum) holds the ball How your hip works Leg bone (Femur) Hip socket (Acetabulum) Pelvis Ball (Femoral head)

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 Osteoporosis Bone thinning or bone loss, often in hips, spine and wrists Rheumatoid arthritis An autoimmune disease that attacks the lining of joints, causing swelling and possibly throbbing and deformity 1. Landers, S. Another reason to exercise for those with arthritis. American Medical Association website. 2005. Available at: http://www.ama-assn.org/amednews/2005/05/02/hlsc0502.htm. Accessed July 17, 2008.http://www.ama-assn.org/amednews/2005/05/02/hlsc0502.htm.

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

5. Assessing your pain Do you sometimes limp? Is it difficult to perform daily tasks— like walking, housework or tying shoes? Does pain limit your activities & lifestyle? Does one leg feel “shorter”? Do you have balance problems? Do you experience pain in the thigh, groin or buttocks? Does pain radiate to the knee?

6. 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 Assessing your pain Little or no pain Excruciating, debilitating pain

7. How can your pain be treated? Medications Analgesics, narcotics Injections Steroids, hyaluronic acid Water therapy Soaking, hot packs Exercise & physical therapy Good for weight loss

8. Implants replace damaged surfaces Helps relieve pain and restore mobility 260,000 each year in the U.S. 1 Hip replacement 1. Solucient, a Thompson Company, 2006.

9. Surgical procedure that removes and replaces diseased joint surfaces with implants What is hip replacement? Cup Liner Ball Stem

10. Diseased area in hip socket removed & reshaped New cup secured in socket Liner placed within cup Stem inserted in leg bone (femur) Ball placed in cup How does it work? Cup Liner Stem Ball Leg bone (Femur)

11. When choosing a bearing, your surgeon will consider: Range of motion Stability Wear characteristics Lifestyle Age, weight & gender Severity of disease Your surgeon will work with you to choose materials that are right for you Which bearing is right for you?

12. What is the bearing? The bearing is the union of the ball and the cup—where moving parts of the hip implant interact DePuy bearing options: Metal-on-plastic (polyethylene) Metal-on-metal Ceramic-on-plastic (polyethylene) Ceramic-on-ceramic* *Duraloc ® Option System DePuy Hips offer several bearing options Metal-on-plastic Metal-on-metal Ceramic-on-plastic Ceramic-on-ceramic*

13. Pinnacle ® Hip Solutions with TrueGlide ™ Technology Pinnacle Hips: Feature TrueGlide ™ technology, enabling the body to create natural lubrication between surfaces of the ball and cup Provide a more fluid range of natural motion More closely matches feeling and movement of a natural hip Use surgical procedures and advanced materials to help improve recovery and durability Lubricating Fluid Ball Cup TrueGlide ™ Technology

14. Assess your pain and ability to function –Do you have difficulty sleeping or performing basic functions (shopping or walking up the 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 Should you wait to replace your hip? 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.

15. The outcome of joint replacements depends on your 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 Only an orthopaedic surgeon can tell if hip replacement is right for you. But you should also know this important safety information...

16. In a recent study of 600 people who chose hip replacement: –More than 96% said hip replacement enabled them to move freely and without pain. 1 –90% said they were able to participate in their favorite activities. 1 1.DePuy Hip Pain: A&U/Segmentation. Final Report January 2008. Data on file. What other patients have to say

17. Summary 1.The leading cause of hip pain is osteoarthritis 2.Osteoarthritis is degenerative—it won’t get better and may get worse 3.Early diagnosis and treatment for hip replacement are important 4.Hip replacement helps relieve pain and restore mobility 5.Your surgeon will help choose the right implant for you

18. Questions?

19. Additional slides The following 6 slides are the minimally invasive hip surgery module. If desired, please include the slides with the Pinnacle Hip Solutions presentation. REMOVE THIS SLIDE

20. Minimally invasive hip surgery What is it? A less invasive approach to traditional surgery Involves about 75% smaller incision (or incisions) Uses traditional components (cup, ball and stem) May help speed up the recovery process

21. Traditional surgery Average 5-day hospital stay Average 3-month recovery time Approximately 12-inch incision Larger scar on thigh Performed for decades Surgeon can fully see hip joint More disruption of muscles and tissue How is it different?

22. Minimally invasive surgery May lead to shorter hospital stay May reduce recovery time 2- to 4-inch incision Smaller, less noticeable scar Long-term effects and success still being studied May lead to less blood loss Potentially less disruption of muscles and tissue Possibly less pain after surgery

23. Smaller incision Less trauma to the body Quicker recovery and healing With the Anterior Approach, there is also a lower risk of dislocation 1 Potential benefits of minimally invasive hip surgery 1.Data on file at DePuy Orthopaedics, Inc.

24. Success depends upon: Overall health and activity level of the patient Patient’s age and weight Presence of osteoporosis or other conditions Skill of the surgeon Patient’s compliance with instructions Success factors

25. Success depends upon: Your health & activity level Age and weight Presence of osteoporosis or other conditions Skill of the surgeon Your compliance with instructions Complications & risks include: Hematoma Fracture Infection Dislocation Blood clots But you should also know this important safety information...

26. Additional slides The following 5 slides are the Anterior Approach module. If desired, please include the slides with the Pinnacle Hip Solutions presentation. REMOVE THIS SLIDE

27. Anterior Approach What is it? Incision is made on the front (anterior) of the leg rather than the side (lateral) or back (posterior) Surgeon can work between muscles without detaching them from the hip or bones Uses a high-tech table for precise positioning of implant

28. How is it different? Traditional surgery Patients typically lie on side or front Incision on side or back of leg Surgeon detaches muscles, disrupts tissue Surgeon relies on post-operative X-ray to check component placement & leg length

29. How is it different? Anterior Approach Patients lie on back Incision on front of leg No detachment of muscles, minimal disruption of tissue Surgeon can check component placement & leg length during procedure

30. First performed in 1947 by Robert Judet in France Surgery performed on the “Judet” table, with the patient lying on back rather than on side In 2002, Dr. Joel Matta of California adopted the technique, helped develop a new table and began to teach the technique in the U.S. Today, more than 200 U.S. surgeons perform the technique on this table 1 Anterior Approach history 1.Data on file at DePuy Orthopaedics, Inc.

31. Less trauma to the body Smaller incision Potentially less pain (especially when sitting) Less need for medication Faster recovery (muscles are spared lengthy healing) Minimal physical rehabilitation Fewer restrictions on activity after surgery Potential benefits of the Anterior Approach