HIPGRID BY ORTHOGRID. Advanced, real-time fluoroscopic grid technology designed to enhance intra-operative decision making in Total Hip Arthroplasty.

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1 HIPGRID BY ORTHOGRID Advanced, real-time fluoroscopic grid technology designed to enhance intra-operative decision making in Total Hip Arthroplasty.

2 UNLOCK THE VALUE OF FLUOROSCOPY WITH HIPGRID C-arm image that contains hidden distortion Fluoroscopy, utilizing a mobile c-arm, is the most widely used technology for placement and alignment in orthopedics. It s cost effective and provides real-time, intraoperative x-ray imagery allowing surgeons to directly visualize pelvic position, facilitate improvements to acetabular cup placement, and reduce mean limb length discrepancy. 7,8 While fluoroscopy has shown to have a positive impact on patient outcomes when utilized during total hip arthroplasty, there is one aspect of this technology that is greatly misunderstood: image distortion. S-DISTORTION is the most prevalent type of distortion and is caused by unseen continuously variable electromagnetic forces (EMF). Distortion can cause up to 19 mm in variation from one side of field of view to the other. 9 Fluoroscopic image distortion cannot be detected with the naked eye and could potentially influence surgeons to make incorrect adjustments affecting outcomes negatively. When utilized for total hip arthroplasty, one study found that grid overlay technology contributed to increased accuracy and precision of implant component placement. 6 HipGrid in the field of view revealing distortion Intended Path EMF Influenced Path C-ARM HIPGRID Post-op film confirms intraoperative accuracy + = SUCCESS

3 DISCOVER AND REVEAL HIDDEN DISTORTION IN REALTIME A typical C-arm image of the pelvis shows what appears to be a highly precise view of the anatomy. However, fluoroscopic distortion is revealed using the HipGrid technology. It is readily apparent that the image is highly imprecise and the effects of the distortion, if not recognized and addressed, could lead to suboptimal intraoperative decision making. Often, physicians will invest a significant amount of time and effort and order up to a dozen or more intraoperative fluoroscopic images as a method of comparing and contrasting images taken from different angles. This requires an excessive amount of time and yet still will not yield an image that is distortion-free. LEG LENGTH CUP POSITIONING HIP OFFSET HIPGRID IN ACTION LEG LENGTH CUP POSITIONING HIP OFFSET HipGrid empowers surgeons to more fully evaluate component positioning and anatomical alignment intra-operatively, aiding in the determination of: Pelvic Pitch Pelvic Obliquity Acetabular Cup Position Hip Offset Leg Length Restoration Visualizing the Difference HipGrid incorporates seamlessly into the current work flow and has shown to decrease surgical time up to 15 min. 6

4 70% of readmissions are attributed to STABILITY & ALIGNMENT ISSUES in primary total hip arthroplasty (THA) surgeries 1 FLUOROSCOPIC GRID STUDY RESULTS average READMISSION RATE 10.5% at 90 DAYS after Primary THA 1 LEG LENGTH +/- 10mm A fluoroscopic grid in supine total hip arthroplasty 6 average COST OF A READMISSION $36,068 due to a surgical complication 2 DISLOCATION is the main indication for revision for a THA surgery at 17.3% 3 average total charge for REVISION THA SURGERY $77, % of arthroplasty surgeons have been named in at least 1 MALPRACTICE LAWSUIT 4 average INDEMNITY PAYMENT $386,153 5 for negligent THA 100% WITH GRID CUP ABDUCTION % WITH GRID HIP OFFSET +/- 10mm 88% without 83% without OVERCOMING CLINICAL COMPLICATIONS -15 MIN Increased efficiency with a DECREASE IN PROCEDURE TIME 85% WITH GRID 67% without

5 COMPETITIVE MARKET ANALYSIS PRICED TO DELIVER THE INDUSTRY S BEST VALUE YES NO FEATURE Reveals fluoroscopic distortion Generates immediate image without delay Demonstrated to reduce OR time Integrates with virtually no learning curve Sales Rep/OR staff support not required Fully surgeon operated OVERLAY TECHNIQUE RADLINK JOINTPOINT ORTHALIGN INTELLIJOINT MAKO HipGrid is a patented technology ideal for hospitals seeking scalable, portable technology delivering proven clinical benefits. CLINICAL VALUE Enhances fluoroscopic visualization to assist in component positioning and anatomic alignment to maximize postoperative hip stability. ECONOMIC VALUE Designed to assist the surgeon in preventing common causes of complications and re-operations in Total Hip Arthroplasty as well as, the associated costs of readmissions, additional medical treatments, and potential legal fees. QUALITY Published clinical data (DAA) Reusable with no sterilization required Works with existing hospital equipment Eliminates disposable costs INSTITUTIONAL VALUE Integrates seamlessly with existing hospital equipment & surgical procedures to potentially save time and obviate the need for expensive medical navigation products. Non-invasive Eliminates risk of pin site infection RELATIVE COSTS $ $ $ $ $ $ PRICE

6 PLUS PROGRAM Advanced intraoperative alignment technology on your terms. CHOICE PLUS Subscribe to HipGrid via a technology licensing program. Eliminate surgeon scheduling and availability conflicts with multiple HipGrid devices. Access the most current HipGrid technologies at all times. Enjoy unlimited use with no per-case or user fees. Receive free full coverage warranty and comprehensive staff training & installation PURCHASE PLUS Acquire HipGrid devices via capital purchase. Enjoy attractive discounts for multi-unit purchases. Access extended warranty and replacement options. Receive comprehensive staff training and installation. Maintain upgrade trade-in value for future OrthoGrid technology enhancements.

7 REFERENCES 1. Kurtz SM, Lau EC, Ong KL, Adler EM, Kolisek FR, Manley MT. Hospital, Patient, and Clinical Factors Influence 30- and 90-day Readmission After Primary Total Hip Arthroplasty. The Journal of Arthroplasty, 2016 Oct 31;31(10): Clair AJ, Evangelista PJ, Lajam CM, Slover JD, Bosco JA, Iorio R. Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative. The Journal of Arthroplasty, 2016 Sep 30;31(9): Gwam CU, Mistry JB, Mohamed NS, Thomas M, Bigart KC, Mont MA, Delanois RE. Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to The Journal of Arthroplasty, 2017 Feb 27; 32(7): Upadhyay, Ashish, Sally York, William Macaulay, Brian McGrory, Jennifer Robbennolt, and B. Sonny Bal. Medical Malpractice in Hip and Knee Arthroplasty. The Journal of Arthroplasty, 22 no. 6 (2007): Patterson DC, Grelsamer RP, Bronson MJ, Moucha CS. Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis. The Journal of Arthroplasty May 3,32 (10): Gililland JM, Anderson LA, Boffeli SL, Pelt CE, Peters CL & Kubiak EN A Fluoroscopic Grid in Supine Total Hip Arthroplasty: Improving Cup Position, Limb Length and Hip Offset. J Arthroplasty, Sep 27 (8 Suppl): Jennings J, Lorio J, Kleiner M, Gaughan J, Star A. Intraoperative Fluoroscopy Improves Component Position During Anterior Hip Arthroplasty. ORTHOPEDICS. 2015; 38: e970-e Leucht P, Huddleston H, Bellino M, Huddleston J. Does Intraoperative Fluoroscopy Optimize Limb Length and the Precision of Acetabular Positioning in Primary THA? ORTHOPEDICS. 2015; 38: e380-e386. doi: / Data on file OrthoGrid Systems Inc, 2018 HIPGRID BY ORTHOGRID ORTHOGRID.COM 3216 S Highland Drive, Suite 202 Salt Lake City, UT OrthoGrid Systems, Inc. All rights reserved Cat No