Anterior Approach Hip Replacement Presenter Name | Presenter Title Presenter Contact Information 71-10-2910 2.16 Rev A

Surgical approach matters For hip replacement patients, the anterior approach is minimally invasive and avoids cutting muscle fibers, which allows the soft tissue in the joint to heal quickly.

A minimally invasive approach Requires 3-4 inch incision vs 8-12 inches with traditional hip replacement Hip accessed through a natural interval between muscles vs cutting muscle tissue Anterior Approach Traditional Approach

Advantages over other approaches Preserves muscle tissue Fewer post-operative hip precautions1 Potentially lower dislocation risk2-4 Restrepo C, Mortazavi SJM, Brothers J, Parvizi J and Rothman RH. Hip dislocation: Are hip precautions necessary in anterior approaches? Clin Ortho Rel Research. 2011;469:417-422. Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. Jrnl Bone Jnt Surg. 2011;93:1392-1398. Rodriguez JA, Deshmuk AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Ortho Rel Research. 2014;472:455-463. Zawadsky MW, Paulus MC, Murray PJ and Johansen MA. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. Jrnl Arthro. 2014;29(6):1256-1260.

Less tissue damage means faster recovery for patients1 On their feet and discharged from the hospital in 2-3 days Discharge to home vs rehab more likely Reduced pain scores and pain medication use at two weeks post-op More rapid progression from walker to cane to no use of walking aid After full physical rehabilitation, most patients can return to regular activity and exercise without any pain. They will regain full range of motion with no 90-degree angle restriction. Zawadsky MW, Paulus MC, Murray PJ and Johansen MA. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. Jrnl Arthro. 2014;29(6):1256-1260..

2003: used by less than 1% of surgeons 2012: used by 19% of surgeons Accelerated adoption1 2003: used by less than 1% of surgeons 2012: used by 19% of surgeons 1. Based on results received from surveys presented at the annual meeting of American Association of Hip and Knee Surgeons (AAHKS). 71-10-2910 2.16 REV A

Supportive clinical data Hip Dislocation: Are Hip Precautions Necessary in Anterior Approaches?1 AA and anterolateral approach performed in 2764 THA’s over 3 years Patients given no traditional functional post-op restrictions (elevated seats, driving restrictions, etc.) Low incidence of post-operative dislocation (15%); no-restriction protocol does not increase dislocation after primary THA Comparison of Minimally Invasive Direct Anterior Versus Posterior Total Hip Arthroplasty Based on Inflammation and Muscle Damage Markers2 Prospective analysis of 29 AA hip patients vs. 28 posterior approach AA associated with significantly less creatinine kinase (CK) post-op, indicating less muscle damage than the posterior approach Does the Direct Anterior Approach in THA Offer Faster Rehabilitation and Comparable Safety to the Posterior Approach?3 Prospective, comparative, nonrandomized study of 120 patients (60 AA, 60 posterior) Functional recovery assessed via a variety of methods (pain score, patient diary, timed up and go (TUG), etc.) Functional recovery faster at two weeks in AA patients based on two of the seven metrics No differences observed with other metrics or beyond six weeks Early Outcome Comparison Between the Direct Anterior Approach and the Mini-Incision Posterior Approach for Primary Total Hip Arthroplasty4 150 consecutive primary THA’s from a single surgeon evaluated – 50 from posterior approach, 50 during AA learning curve, 50 when AA was routine AA groups had reduced LOS (2.9 and 2.7 days vs. 3.9 days for posterior; p<0.0001) and discharge to home vs rehab was more likely (80% and 84% vs. 56% in posterior group; p=0.00285) AA groups resulted in less use of assistive devices (88% and 80% vs. 32% in posterior group; p<0.0001) and narcotics at 6 weeks (8% and 2% vs. 33% in posterior group; p=0.0026) Restrepo C, Mortazavi SJM, Brothers J, Parvizi J and Rothman RH. Hip dislocation: Are hip precautions necessary in anterior approaches? Clin Ortho Rel Research. 2011;469:417-422. Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. Jrnl Bone Jnt Surg. 2011;93:1392-1398. Rodriguez JA, Deshmuk AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Ortho Rel Research. 2014;472:455-463. Zawadsky MW, Paulus MC, Murray PJ and Johansen MA. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. Jrnl Arthro. 2014;29(6):1256-1260. 71-10-2910 2.16 REV A

Eligible patient for anterior hip Content here purposely left blank Surgeon to provide information or delete slide

Enabling technology for anterior approach hip replacement Aquamantys® Bipolar Sealers for Hemostasis CLICK HERE TO VIEW VIDEO 71-10-2910 2.16 REV A

Aquamantys bipolar sealers ® Hemostatic Sealing of Soft Tissue and Bone Radiofrequency (RF) energy + saline = Transcollation® technology Step 1 RF energy and saline is applied to tissue Step 2 Heat-induced tissue shrinkage occurs Step 3 Vessels up to 1 mm may be occluded

Aquamantys clinical data ® Broad plane hemostasis and more control over intraoperative coagulation Reduction in intraoperative blood loss has been associated with a statistically significant reduction in transfusions (21.2% vs 23.5%, p=0.0457) and hematomas (0.2% vs 0.8%, p=0.00024) 1 Has been associated with a statistically significant reduction in length of stay for patients (2.86 vs. 3.26 days, p<0.0001)1 As part of a comprehensive blood management program, may be more effective at reducing blood transfusions and the cost and complications associated with intraoperative blood loss2,3 Ackerman SJ, Tapia CI, Baik R, Pivec R, Mont MA. Use of a bipolar sealer in total hip arthroplasty: medical resource use and costs using a hospital administrative database. Orthopedics 2014;37(5):e472-481. Marulanda GA, Ulrich SD, Seyler TM et al. Reductions in blood loss with a bipolar sealer in total hip arthroplasty. Expert Rev Med Devices 2008; 5(2):125-131. Shander A, Hofmann A, Ozawa S et al. Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion Practice 2010; 50:753-65.

Aquamantys clinical data ® Compared to traditional electrosurgery Bipolar tip design with saline coverage allows broad hemostatic control in oozing tissue and active bleeding while penetrating deep to reach hidden bleeders, resulting in reduced blood loss and potentially lower transfusion rates1,2 Offers a definitive hemostatic solution by uniformly sealing bleeding tissues Marulanda GA, Ulrich SD, Seyler TM et al. Reductions in blood loss with a bipolar sealer in total hip arthroplasty. Expert Rev Med Devices 2008; 5(2):125-131. Ackerman SJ, Tapia CI, Baik R, Pivec R, Mont MA. Use of a bipolar sealer in total hip arthroplasty: medical resource use and costs using a hospital administrative database. Orthopedics 2014;37(5):e472-481.

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