1. Treatment Options for your Knee Pain

2. How your knee works Anatomy of the knee Largest joint in body
Referred to as a hinge joint because it allows the knee to flex & extend; while hinges can only bend and straighten, the knee has the ability to rotate (turn) & translate (glide)
3 bones
Shin bone (tibia)
Thigh bone (femur)
Kneecap (patella)

3. 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, possibly throbbing pain and deformity
1. Landers, S. Another reason to exercise for those with arthritis. American Medical Association website. <

4. What’s causing your pain?
Healthy knee
The end of each bone in the joint is covered with cartilage, acting as a cushion so the joint functions without pain
Diseased knee (osteoarthritis)
Wear and tear deteriorates natural cushion, leading to bone-on-bone contact, soreness and swelling

5. Assessing your pain 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 (e.g. family vacations or other functions)?
Has inactivity from knee pain caused you to gain weight?

6. Excruciating, debilitating pain
Assessing your pain
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 relief1
Little or no pain
Excruciating, debilitating pain
DePuy Orthopaedics, Inc. Knee Attitudes & Usage Study.

7. Assessing your pain 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
Walk
Bend at the
hips and knees
Pretend to drive: push the gas/brake
Pretend to golf: swing a club

8. How can your pain be treated?
Water therapy
Soaking, ice packs, hot packs
Exercise & physical therapy
Also good for weight loss
Medications
Analgesics
Corticosteroids
Injections
Corticosteroids, hyaluronic acid (e.g., ORTHOVISC®)
ORTHOVISC® is a trademark of Anika Research, Inc.

9. Knee replacement Implants replace damaged surfaces
Helps relieve pain and restore mobility
In 2011, more than 650,000 total knee replacements were performed in the United States1
One study has shown that ten years after surgery, 99.6% of patients still depend on their SIGMA® Knees with fixed bearing option in their daily lives2
Premier, Inc.
2. Dalury et al. Midterm results with the P.F.C. SIGMA Total Knee Arthroplasty System. The Journal of Arthroplasty Vol.23, No.2, 2008:

10. What is knee replacement?
A surgical procedure that removes and replaces diseased joint surfaces with implants
Femoral component
Tibial component

11. How does it work?
Diseased areas at top of shin bone (tibia) and bottom of thigh bone (femur) are removed and reshaped
Femoral component covers the thigh bone (femur)
Tibial component covers the shin bone (tibia)
Polyethylene insert placed between femoral and tibial components
Patellar component replaces the kneecap (patella)
Femoral component
Polyethylene insert
Patellar component
Tibial component

12. How does it work?
Healthy knee
Knee replacement

13. DePuy SYNTHES JOINT RECONSTRUCTION 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 natural feel and movement
The SIGMA Knee is an example of a proven design that continues to evolve to meet the demands of today’s patients

14. Fixed Bearing Knees
Most widely used type of knee replacement in the U.S. today1
Designed to enhance stability of the joint
New designs and advanced materials - Helps reduce wear
1. IMS Health

15. SIGMA® Fixed Bearing Knees

16. SIGMA® Rotating Platform Knees
Designed to rotate as it bends, imitating your natural knee movement
The surfaces of the knee joint roll and glide against each other as you bend. In other words, your knee naturally rotates as it bends
Designed for patients who want to remain active since it minimizes implant wear, compared to traditional knee replacements1
One study has shown after 20 years, 97% of patients still depend on their rotating platform knees in their daily lives2
1. McNulty, D. et al. “In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2).” 2003.
2. Buechel F., et al. “Twenty Year Evaluation of Meniscal Bearing and Rotating Platform Knee Replacements.”
Clinical Orthopaedics and Related Research July 2001: .

17. Should you wait to replace your knee?
Assess your pain and ability to function
Do you feel severe pain in your knee?
Has the pain and loss of function affected your quality of life?
Do you have difficulty sleeping or performing basic functions (walking, driving, climbing stairs)?
Does medication no longer provide relief?
Consult your physician
Early diagnosis and treatment are important1
Delaying may lower your quality of life2
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:
2. 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:

18. Important safety information
As with any medical treatment, individual results may vary
The performance of joint replacements depends on your age, weight, activity level and other factors
There are potential risks, and recovery takes time
People with conditions limiting rehabilitation should not have this surgery
Only an orthopaedic surgeon can tell if knee replacement is right for you

19. Summary 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 important1
An Arthritis Foundation® study shows knee replacement has a % rate of patient satisfaction2
SIGMA Knees come in a wide range of shapes, sizes and materials, so your surgeon can recommend the implant that is right for you.
Arthritis Foundation® is a trademark of The Arthritis Foundation, Inc.
1. Fortin, Paul R., et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism 42 (1999):
2. The Arthritis Foundation. <

20. Questions?

21. © DePuy Synthes Joint Reconstruction, a division of DOI 2013
Thank you!
© DePuy Synthes Joint Reconstruction, a division of DOI 2013

22. REMOVE THIS SLIDE WHEN PRESENTING
Additional slides
The following slide is the SIGMA® High Performance Partial Knees module. If desired, please select the appropriate slides to include within this presentation.
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23. SIGMA® High Performance Partial Knees
Can replace any of the three areas of your knee; replacing only the damaged area maintains more of your natural knee
May be an option for more active patients who require a high degree of flexion but not total knee replacement
Accommodates deep knee flexion, the movement needed for kneeling, squatting or sitting cross-legged
Less invasive with potential for faster recovery than total knee replacement

24. REMOVE THIS SLIDE WHEN PRESENTING
Additional slides
The following 3 slides are the TRUMATCH® Personalized Solutions module. If desired, please select the appropriate slides to include within this presentation.
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25. TRUMATCH® Personalized Solutions
What is TRUMATCH?
Uses advancements in technology to provide surgeons with customized surgical guides that are designed specifically for your knee anatomy

26. Benefits of TRUMATCH solutions
Helps your surgeon achieve consistency in the placement and positioning of your knee replacement
TRUMATCH instruments help your surgeon to obtain a precise fit of the implant. The implant helps reduce a patient’s pain and restore their mobility
Reduces number of surgical steps

27. TRUMATCH® Personalized Solutions
How does it work?
A CT scan of your leg is taken
A 3-D model of your knee is developed
Personalized guides are created based on your unique anatomy
Your guides help your surgeon position and place your new knee implant
Guides are removed by your surgeon prior to your new knee being implanted

28. Additional slides
The following 3 slides are the SIGMA® Partial Knee Alternative module. If desired, please select the appropriate slides to include within this presentation. REMOVE THIS SLIDE WHEN PRESENTING

29. The Partial Knee Alternative
“Total”

30. Partial Knee Replacement
Removes only the damaged area of the knee
Uses metal and plastic implants to replace the damaged area, helping to relieve pain and restore natural movement.

31. Potential advantages of a Partial Knee
Maintains more of the healthy ligaments and bone, helping to restore the natural movement during activities
Potential for faster recovery
Minimally invasive procedure to reduce blood loss
Possible reduced scarring
Patellofemoral
Unicondylar

32. REMOVE THIS SLIDE WHEN PRESENTING
Additional slides
The following 3 slides are the gender-specific module. If desired, please select the appropriate slides to include within this presentation.
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33. Important considerations for women
Osteoarthritis affects three times more women than men1
Women are more likely than men to be disabled
The pain is more severe for women2
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):
2. Harris Interactive research survey, April 2005

34. 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

35. Gender-specific implants
More than 60% of knee replacements have been implanted in women1
Current knee replacement patients have a 90 to 95% satisfaction rate with the results of their surgery2
1. American Academy of Orthopaedic Surgeons <
2. The Arthritis Foundation <

36. Additional slides
The following slide is the minimally invasive knee surgery module. If desired, please select the appropriate slides to include within this presentation. REMOVE THIS SLIDE WHEN PRESENTING

37. Minimally invasive knee replacement surgery
SIGMA® Knees can be implanted using minimally invasive surgery
Alignment affects:
How long your knee replacement lasts
Long-term success

38. Additional slides
The following 2 slides are the computer-assisted surgery module. If desired, please select the appropriate slides to include within this presentation. REMOVE THIS SLIDE WHEN PRESENTING

39. Computer-assisted surgery
What is computer-assisted
surgery (CAS)?
An approach to knee replacement
The patient’s anatomy is simulated and displayed on a computer
Computer provides information about where to place the components

40. Potential benefits of CAS
CAS guides surgeon in areas that are difficult to visualize
Relays specific measurements not previously available to surgeons, such as implant alignment and angle of cuts
Gives precise, accurate data on your specific anatomy
Allows surgeons to make decisions about implant placement based on detailed data from the computer