DePuy Community Education Seminar Thank you for joining us! We hope today’s information will help you on the path toward regaining your mobility and once again enjoying life to the fullest extent. This informational presentation about hip pain and treatment options will be followed by a question-and-answer session. Today’s presentation is sponsored by DePuy Orthopaedics, Inc. Welcome!

1.How your hip works & why it hurts 2.Hip replacement basics 3.What patients have to say 4.Your questions 2 Agenda

Dr. [insert name] [insert practice name] 3

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 4 Leg bone (Femur) Hip socket (Acetabulum) Pelvis Ball (Femoral head) How your hip works

5 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 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 Available at:

6 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 What’s causing 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? Assessing your pain 7

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 Little or no pain Excruciating, debilitating pain 8 Assessing your pain

9 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

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

A surgical procedure that removes and replaces diseased joint surfaces with implants Cup Liner Ball Stem 11 What is hip replacement?

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 Cup Liner Stem Ball Leg bone (Femur) 12 How does it work?

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. 13 Which bearing is right for you?

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 Metal-on-plastic Metal-on-meta l Ceramic-on-plastic Ceramic-on-ceramic* 14 DePuy Hips offer several bearing options

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 15 Pinnacle ® Hip with TrueGlide ™ Technology

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 1. Fortin PR, et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism. 1999;42: 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: Should you wait to replace your hip?

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. 17 Important safety information...

Insert patient name for testimonial here Please note: As with any medical treatment, individual results may vary. Only an orthopaedic surgeon can determine whether an orthopaedic implant is an appropriate course of treatment. There are potential risks, and recovery takes time. The performance of the new joint depends on weight, activity level, age and other factors. 18 What other patients have to say

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 Data on file. 19 What other patients have to say

The leading cause of hip pain is osteoarthritis Osteoarthritis is degenerative—it won’t get better and may get worse Early diagnosis and treatment of osteoarthritis are important Hip replacement helps relieve pain and restore mobility Your surgeon will help choose the right implant for you 20 Summary

Please fill out: Seminar Questionnaire Return at end of seminar “For More Information” Form Request additional information be sent to your home 21 Before we take questions...

22 Questions?

To find out more about hip pain and the treatment options available, visit: © 2009 DePuy Orthopaedics, Inc. The third-party trademarks used herein are trademarks of their respective owners. 23 Thank You!

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 24 Additional slides

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 25 Minimally invasive hip 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 26 Traditional 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 27 Minimally invasive surgery

Smaller incision Less trauma to the body Quicker recovery and healing 28 Benefits of minimally invasive hip surgery

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 29 Success factors

Complications & risks include: Hematoma Fracture Blood clots 30 But know this important safety information Infection Dislocation

The following 4 slides are the Anterior Approach module. If desired, please include the slides with the Pinnacle Hip Solutions presentation. REMOVE THIS SLIDE 31 Additional slides

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 32 Anterior Approach

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 33 Traditional surgery

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 34 Anterior Approach

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 1.Data on file at DePuy Orthopaedics, Inc. 35 Anterior Approach History

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 Data on file at DePuy Orthopaedics, Inc. 36 Potential benefits of the Anterior Approach