1. Treatment Options for Severe Knee Pain

2. What’s the Leading Cause of Knee Pain? Osteoarthritis (OA) is what happens when your knee cartilage deteriorates, and friction is created between the bone surfaces.

3. What Are the Signs of OA? Stages of OASymptoms Mild Moderate Severe Joints ache after walking, driving, climbing stairs Chronic knee pain and knee stiffness You may limp to accommodate the pain Begin to see a reduced range of motion of the joint Bones begin to rub together, causing more pain, swelling, loss of motion The joint may begin to change shape Small growths, called bone spurs, may grow on the edges of the joint

4. Knee Pain Treatment Options: Early Intervention Physical therapy Ice down achy joints Over-the-counter anti-inflammatory medications Acetaminophen Nutritional supplements –Those treatments may become less effective over time because OA is a progressive disease 75% of OA patients are interested in more aggressive treatments for their osteoarthritis 1 1. Harris Interactive, Inc., 2005

5. Knee Pain Treatment Options: Non-surgical Prescription medications Physical therapy Injection therapy such as Orthovisc®

6. 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 Golf

7. Questions to Consider  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 such as family vacations or other functions?  Has inactivity from knee pain caused you to gain weight? If you answered yes to these questions it might be time to speak with your doctor about knee replacement surgery

8. Knee Replacement Facts 1: 2005 (http://www.aaos.org/Research/stats/Knee%20Facts.pdf). 2: 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) More than 500,000 knee replacements are performed each year in the U.S. 1 A National Institute of Health (NIH) study shows that 85% of patients are satisfied with the results of their knee replacement surgery. 2

9. But You Should Also Know… 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 knee replacement is right for you.

10. 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 more natural feel and movement Sigma Knees can be implanted using minimally invasive surgery

11. Sigma ® Fixed Bearing Knee Most widely used type of knee replacement in the U.S. 1 Designed to provide stability of the knee New designs and materials - Helps reduce wear 1: IMS Health

12. 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) Sigma ® Rotating Platform Knees Rotating Platform Knee -Designed to rotate as it bends, imitating your 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 DePuy study shows 97% patient satisfaction at 5 years 2

13. 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 may lower your quality of life before the operation and for up to two years after surgery 2 Pre-existing medical conditions may become more serious, delaying elective surgery 3 Osteoarthritis is degenerative – it won’t get better and may get worse! Should You Delay Surgery?

14. What to Expect With or Without Knee Replacement

15. So to Summarize What You Learned Today…. 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 A National Institute of Health (NIH) study shows that 85% of patients are satisfied with the results of their knee replacement surgery Sigma Knees come in a wide range of shapes, sizes and materials, so your surgeon may be able to fit you with a knee designed to provide a more natural feel and movement 1: Fortin, Paul R., et al. “Outcomes of Total Hip and Knee Replacement.” Arthritis & Rheumatism 42 (1999): 1722-1728

16. Questions & Answers

17. Additional Slides If desired, please select the appropriate slides to include within the Sigma Knees presentation *Remove this slide*

18. A customized knee replacement solution Designed specifically for your anatomy Helps your surgeon achieve consistency in the placement and positioning of your knee replacement What is TruMatch Personalized Solutions? TruMatch TM Personalized Solutions

19. A CT scan of your leg is taken A 3-D model of your knee is developed Personalized guides are created Guides are removed by your surgeon prior to your new knee being implanted A CT scan of your leg is taken A 3-D model of your knee is developed Personalized guides are created Guides are removed by your surgeon prior to your new knee being implanted How does TruMatch TM Personalized Solutions work?

20. 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

21. Potential Benefits of CAS 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

22. 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.

23. 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

24. 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 (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

25. 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

26. 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

27. 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

28. 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