Mako-Robotic Assisted Total Knee Arthroplasty Brian F. Moore MD 4/14/18

Joint replacement market 2017 US joint replacement procedural forecast1 Reference: 1. Millennium Research Group. 2015. Table 16: Large-Joint Reconstructive Knee Implant Procedures, by Product Type, US, 2013-2023, Table 20: Primary TKA Implant Procedures, by Approach, US, 2013-2023, and Table 33: Primary THA Implant Procedures, by Approach, US, 2013-2023. (Mako Total Knee Capital Deck)

1 in 5 patients are currently not satisfied with their total knee replacement outcomes13 This study was based on 1703 eligible patients who underwent primary TKA from June 2001 to December 2005. Ontario Joint Replacement Registry Did not specify but appears physcians practice is in canada MAKTKA-PRE-42_13895

Number of TKAs performed increasing exponentially Dilemma Number of TKAs performed increasing exponentially Revision rate increasing in conjunction Patient age decreasing yet expectations/demand increasing Failure mode changing Early revisions increasing MAKTKA-PRE-33_12288

Evolution of planning & execution Orthopaedic technology Static plan 1950s 1990s Navigated execution 2000s Navigated freehand power tools MKOSYM-PRE-2_11246 Over the last 50+ years there has been an evolution in orthopedics surgery. Started with static with x-rays which is currently still used. Moving forward into the 90s, Navigation which improved the accuracy of implant alignment, but still only represents 10% of procedures. Stryker investigated Navigated freedhand power tools that are similar to what some of our competitors are doing with navigated burrs and cutting guides. Based on this experience, Stryker decided to go down a different path and acquire Mako. Stryker believes Robotic Arm Assisted Surgery is the future. 2000s Robotic-arm assisted surgery

Stryker's knee continuum of care Early stage knee pain Knee arthroscopy Mid-stage OA Late-stage OA Total knee replacement Unicompartmental knee replacement Lateral Medial Patellofemoral knee replacement Medial Bicompartmental knee replacement Treatment Mako is a tool that can facilitate increased opportunity to treat the right patient with the right procedure

Enhanced Planning Mako Total Knee CT based 3D based model of the patient’s bony anatomy Ability to manipulate the implant based on key anatomic landmarks MAKTKA-PRE-33_12288

Dynamic joint balancing Mako Total Knee Dynamic joint balancing Real time/ dynamic assessment of the patient’s ligament tension, flexion/extension gaps, limb alignment Intra-operative adjustments can be made to the preoperative plan in both flexion and extension before bone preparation MAKTKA-PRE-33_12288

Mako Total Knee Robotic-arm assisted bone preparation Stereotactic boundaries are created that assist the surgeon in executing the femoral and tibial resections to plan These boundaries also help protect the essential anatomic structures of the knee MAKTKA-PRE-33_12288

Triathlon Total Knee System 18 19 9 MAKTKA-PRE-33_12288 16 10 17 20

Post Op Recovery PT/OT evaluation within 4 hours of surgery Multimodal pain control with either a Peri-articular Injection or an indwelling adductor canal block Majority of our TKA patients are discharged to home the following day after surgery Home Nursing and Home Physical Therapy for the first 1-2 weeks at home 4-6 weeks of outpatient Physical Therapy to reach/maintain goal ROM and quad strengthening