1. Russell Meldrum, MD Indiana, University, School of Medicine, Department of orthopedics 550 North University Blvd., Room 1250 Indianapolis, IN 46202 317-274-7359

2. Overview Named for Birmingham, England, where the device’s creators practice medicine Used globally since 1997; More than 65,000 implanted Approved by the FDA in March 2006 In an international study of 1,626 hips, 99.5% of patients were “Pleased” or “Extremely Pleased” with the results of the BIRMINGHAM HIP Resurfacing (BHR) System.

3. Who is the typical candidate for BHR * System? Adults under age 60 for whom total hip replacement may not be appropriate due to an increased level of physical activity Active adults over age 60 may be candidates, depending on their bone quality

4. Anatomy Socket Ball Femoral neck Smooth weight- bearing surfaces Smooth cartilage Femur

5. Diseases of the hip

6. Osteoarthritis (OA) “Wear and tear” arthritis Joint becomes pitted, eroded, uneven…and painful Bone spurs, or osteophytes, often form The common activities of daily living become limited by extreme pain

7. Hip dysplasia Congenital disease that affects 1 in 1,000 people The hip doesn’t develop the normal wear patterns, which leads to early OA Chief risk factor: family history Women, first-born children and breech babies have higher rates of dysplasia

8. Avascular necrosis (AVN) Caused when there is a disruption of the blood supply to the hip In time, the bone will die and the femoral head will collapse Leading causes: Alcoholism, corticosteroids Other risk factors: blood vessel blockage due to sickle cell anemia or fat particles, or from dislocation of the hip due to trauma

9. Non-surgical alternatives

10. Lifestyle modification Exercise and physical therapy Anti-inflammatory medication

11. Risks

12. Thromboembolism Infection Pneumonia

13. The procedure

14. Conventional hip replacement Healthy hipCutsImplant componentsImplanted

15. The BHR * System Healthy hipCutsImplant componentsImplanted

16. Conventional vs. BHR * Resurfacing

17. Conventional vs. the BHR * System Total hip cutsBHR System cuts

18. Is it minimally invasive?

19. That depends on how you define “Minimally Invasive.” Soft Tissue – No. Incision length of 6 to 8 inches Bone – Yes. Preserves your body’s natural bone structure; It resurfaces rather than replaces Conserved bone

20. The implant

21. The key benefits Head size Advanced bearing surface Bone conservation

22. Head size Closely matches the size of your natural femoral head Larger than the head of a total hip replacement Larger head means a reduced chance of dislocation after surgery—a leading cause of revision surgery – 1-3% of total hips dislocate over the lifetime of the implant – 0.3% of BHR* implants dislocated in the first 5 years after surgery (in a study of 2,385 hips) Healthy headBHR headTotal hip head

23. Advanced bearing surface Metal-on-metal implant No plastic liner like most total hip replacements All-metal total hip replacements reduce joint wear by 97% versus metal on plastic total hips; BHR* implants were found to be in this range Metal Plastic

24. Hip with osteoarthritis Bone cuts for a traditional hip replacement Bone conservation Preserves your natural femoral neck – Neck length and angle determine accurate leg length – With the BHR* System, you retain your original equipment; with a total hip, your femoral neck is replaced by the implant Bone cuts for BHR System

25. Bone conservation (cont.) Revises to a primary – If you need “revision” surgery, you don’t get a revision implant – The follow-up procedure would be the same total hip replacement you would otherwise have received

26. After surgery

27. You will undergo a rehabilitation protocol similar to total hip replacement patients During year-one: Low- impact activities as your bone and muscles adjust to the new stresses (swimming, walking, bicycling) After year-one: Higher impact physical activity may be appropriate (singles tennis, jogging)

28. Q&A www.BirminghamHipResurfacing.com Doc Name Clinic Name Address Line 1 Address Line 2 City State Zip Phone