orthopace Noninvasive Regenerative Medicine for Musculoskeletal Conditions

Transcription

1 orthopace Noninvasive Regenerative Medicine for Musculoskeletal Conditions

2 SANUWAVE Health, Inc. is a regenerative medicine company focused on the development and commercialization of noninvasive, biological response activating devices for the repair and regeneration of tissue, musculoskeletal and vascular structures.

3 SANUWAVE s U.S. Markets Exceed $10 Billion in Total Estimated addressable U.S. market sizes Source: PACE market potential based on estimates from AdvaMed; MEDACorp Analysis, BioMet and Integra LifeSciences and Management

4 History of ESWT and PACE Technology 1980 First clinical use of ESW lithotripsy for renal calculi (Chaussy et al, 2:1265, 1980) 1984 First ESW lithotripter for renal calculi approved by FDA 1992 Development of the first ESWT device for orthopaedic applications, used in Europe initially, then Canada, South America and Asia First U.S. FDA approval of ESWT to treat chronic plantar fasciitis 2003 First U.S. FDA approval of ESWT to treat chronic lateral epicondylitis 2007 First RCT begins in the U.S. investigating PACE for chronic wound healing (DFU); dermapace receives European CE mark clearance for healing acute and chronic defects of skin and subcutaneous tissue 2010 orthopace receives European CE mark clearance for stimulation of osteogenesis to treat tendinopathies and fractures; dermapace receives Canadian device license approval 2011 dermapace RCT completed and submitted to FDA for approval; AMA released first two CPT CAT III codes for ESWT in wound healing

5 orthopace orthopace is a proprietary form of Extracorporeal Shock Wave Technology (ESWT) developed by SANUWAVE that is used to treat a variety of musculoskeletal indications involving bone, tendons and ligaments. orthopace consists of a console and treatment applicator.

6 PACE (Pulsed Acoustic Cellular Expression) Procedures Deliver Positive and Negative Pressure Shock Wave Pressure-Time Diagram Positive Pressure (382,531 mmhg) 4 Shock Waves per Second Note: KCI VAC Technology has only negative pressure (-125 mmhg). VAC requires up to 10,080 minutes of treatment per week for 4-6 weeks (or longer) vs. 40 minutes per week (energy delivery time = 4 min/week) for 2 weeks with dermapace. Negative Pressure (-67,506 mmhg) PACE Energy Causes Mechanical Stresses on Cells High pressure amplitude (510 bar), rapid rise time (<33ns) and short life cycle (2-8μs) Frequency spectrum ranging from the audible to the ultrasonic region (16Hz-20MHz)

7 Biological Mechanism of Musculoskeletal Shock Waves ESWT significantly induced the ingrowth of neovascularization associated with increased expressions of angiogenic growth indicators in tendon and bone, and at the tendon-bone interface. Healing induced by a single ESWT treatment (500 impulses, 0.18 mj/mm 2 ). Wang et al. Shock Wave Therapy Induces Neovascularization at the Tendon-Bone Junction. Journal of Orthopaedic Research, 21 (2003) pp Note: The orthopace device is currently not available or for sale in the United States ESWT resulted in higher bone strength and mass, and better tensile strength of the graft at the tendonbone interface.

8 12-Week Upregulation of Growth Factors Increases in cellular signaling were apparent during Dr. Ching-Jen Wang s (Chang Gung University School of Medicine, Kaohsiung, Taiwan) mechanism of action research study. Biological markers that would indicate healing, including enos (benefits oxygenation), VEGF (increases blood flow) and PCNA (increases cellular proliferation), increased after treatment. The effects lasted up to 12 weeks before declining to normal levels. In comparison, the control samples did not demonstrate any positive cellular changes during the study. Wang et al. Shock Wave Therapy Induces Neovascularization at the Tendon-Bone Junction. Journal of Orthopaedic Research, 21 (2003) pp Note: The orthopace device is currently not available or for sale in the United States

9 Musculoskeletal problems are common Chronic musculoskeletal conditions prevent many people from living the active lifestyle they desire. orthopace quickly initiates a cascade of healing events, helping to restore mobility, minimize pain and allow life to be lived to its fullest. One in seven people has a musculoskeletal impairment. Musculoskeletal symptoms were the #2 reason for physician visits. Visits to physicians offices in Europe: 19 million due to knee problems 14 million due to shoulder problems 11 million due to foot, toe and ankle problems

10 orthopace Applications Standard areas of application are painful soft-tissue diseases, tendinoses and other orthopaedic conditions: Bone healing deficiencies in the extremity bones, such as delayed fracture healing, and nonunion (pseudarthrosis) Patellar tip syndrome (jumper s knee) Calcified shoulder (tendinosis calcarea) Fasciitis plantaris with and without heel spur Achillodynia Tennis elbow (epicondylitis radialis) Golfer s elbow (epicondylitis ulnaris) Avascular Necrosis Osteoarthritis Adjunctive use

11 orthopace Contraindications Do not apply orthopace to patients with: Anatomical anomalies in the treatment area Acute inflammation in the treatment area Presence of a cuff rupture in the case of shoulder treatments Malignant changes in the treatment area Fracture gap >5mm in the case of delayed fracture healing or nonunion Coagulopathies Do not treat: The head area The area near the lungs The area near electronic implants The spinal column

12 orthopace Patient Selection Little or no experience is available in the case of orthopace treatment of: Skeletally immature patients Pregnant patients Patients with cardiac pacemakers Patients with anatomical anomalies in the treatment area Patients with coagulopathies Areas near the gonads Do not use on patients with unexplained calf pain.

13 Shock Wave Production Methods Electrohydraulic: Creation and collapse of plasma bubble in liquid medium Focal Zone Cross-section Peak Pressure: 70MPa Rise time: nanoseconds True shockwave at all settings Optimal tissue coverage due to large focal volume; permits efficient protocols with fewer treatments and impulses Electromagnetic: Like charged plate collision Peak Pressure: 20MPa Rise time: microseconds True shockwave at high energy settings only* Piezoelectric: Focused vibrating crystals Peak Pressure: 15MPa Rise time: microseconds True shockwave at high energy settings only* * Cleveland RO, Chitnis PV, McClure SR. Acoustic Field of a Ballistic Shock Wave Therapy Device. Ultrasound in Med & Biol. 2007;33:

14 orthopace PACE Applicator Penetration Depths Applicator Type Penetration Depth (mm) per Energy Level R001 Minimum (E1) 3 Shallow Tendinopathies Deep Tendinopathy & Bone Indications Deeper Bone Indications Maximum (E6) 21 R005 Minimum (E1) 50 Maximum (E6) 59 R020 Minimum (E1) 66 Maximum (E6) 75 R035 Minimum (E1) 82 Maximum (E6) 91

15 orthopace PACE Applicator Energies (Max. Energy Flux Density) Epicondylitis, Patellar Tendinosis & Osteoarthritis Achillodynia & Tendinosis Calcarea Plantar Fasciitis & Pseudarthrosis Energy Level R001 R005, R020, (mj/mm 2) R035 (mj/mm 2) E E E E E E

16 orthopace Applicator Types, 5MPa Penetration Depths and Max Energy Flux Densities

17 Tendonitis Plantar Fasciitis (PF) Inflammation of the thick tissue on the bottom of the foot called the plantar fascia that connects the heel bone to the toes and creates the arch of the foot. Caused when tissue is overstretched or overused. This can be painful and make walking difficult. Contributing factors: Stress on the tendon Tight muscles Misalignment of the joints Muscular imbalance Common treatments: Pharmacological Physical (rest, exercise therapy, stretching, etc.) Surgical (release of fascia) Alternative (ultrasound, laser, and electrical stimulation) PACE advantages: One time, short treatment session Noninvasive, earlier weight bearing, faster recovery No changes in the biomechanics of the joint which may happen with surgery

18 Plantar Fasciitis (U.S. Approval Study) This study evaluated the use of electrohydraulic high energy shock waves in patients who had failed at least six months of prior nonoperative treatment. A randomized, placebo-controlled, blinded, crossover study that included 289 patients treated with either one or two treatments of ESWT or placebo. Patients received 100 graded shock waves beginning at 0.12 mj/mm 2 and increasing to 0.22 mj/mm 2, at which time another 1,400 shock waves were delivered. Three months later, patients were given the opportunity to receive a second treatment or to crossover into the study group. Patients were followed at least one year after the final treatment. Ogden, Alvarez, Levitt, Johnson, Marlow et al. Electrohydraulic High-Energy Shock-Wave Treatment for Chronic Plantar Fasciitis, Journal of Bone & Joint Surgery, Vol. 86-A, Number 10, October 2004.

19 Plantar Fasciitis (U.S. Approval Study) Results: Three months after treatment, 67 (47%) of the 144 actively treated patients had a completely successful result compared with 42 (30%) of the 141 placebo-treated patients (p=0.008). At one year, 65 of the 67 actively treated, randomized patients maintained a successful result (97%). For all 289 patients who had one or more actual treatments, 222 (76.8%) had a good or excellent result. No patient was made worse by the procedure. Authors Conclusion: There is ample evidence that electrohydraulically generated high-energy transcutaneous shock wave treatment is an effective treatment of heel pain due to chronic plantar fasciitis when compared with placebo. Ogden, Alvarez, Levitt, Johnson, Marlow et al. Electrohydraulic High-Energy Shock-Wave Treatment for Chronic Plantar Fasciitis, Journal of Bone & Joint Surgery, Vol. 86-A, Number 10, October 2004.

20 Plantar Fasciitis (U.S. Approval Study) Ossatron Success = 113 Control Success = 25

21 Plantar Fasciitis (U.S. Approval Study)

22 Plantar Fasciitis (U.S. Approval Study) 222 (77%)

23 Plantar Fasciitis Long-Term Results Long-term, prospective, randomized, controlled clinical study included 149 patients (168 heels), including 79 patients (85 heels) in the shock wave treatment group and 70 patients (83 heels) in the control group. Patients were evaluated at 60 to 72 months (shock wave group) or 34 to 64 months (control group) with a 100-point scoring system including 70 points for pain and 30 points for function. The clinical outcomes were rated as excellent, good, fair or poor. ESWT patients received a single procedure of 1,500 impulses. Anatomical picture of the foot (bottom view). Red circle indicates area of treatment. Wang et al. Long-term Results of Extracorporeal Shockwave Treatment for Plantar Fasciitis, The American Journal of Sports Medicine, Vol. 34, No. 4, 2006.

24 Plantar Fasciitis Long-Term Results

25 Plantar Fasciitis Long-Term Results

26 Plantar Fasciitis Long-Term Results Patients in the control group received conservative treatment consisting of nonsteroidal anti-inflammatory drugs, orthotics, physical therapy, an exercise program and/or a local cortisone injection. The overall results were (at p<0.001): Excellent Good Fair Poor ESWT 69.1% 13.6% 6.2% 11.1% Control 0% 55% 36% 9% 17.3% 45% The recurrence rate was 11% (9/81 heels) for the shockwave group versus 55% (43/78 heels) for the control group (P <.001). There were no systemic or local complications or device-related problems. Authors Conclusion: Extracorporeal shock wave treatment is effective and safe for patients with plantar fasciitis, with good long-term results. Wang et al. Long-term Results of Extracorporeal Shockwave Treatment for Plantar Fasciitis, The American Journal of Sports Medicine, Vol. 34, No. 4, 2006.

27 ESWT for Chronic Patellar Tendinopathy Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow and heel. This randomized, controlled trial investigating the use of ESWT for patellar tendinopathy included 50 patients (54 knees) that were divided into active (ESWT) (27 patients/30 knees) and control (SOC) (23 patients/24 knees) groups. ESWT treatment consisted of a single procedure of 1,500 impulses at 0.18 mj/mm 2. Patients in the control group received nonsteroidal anti-inflammatory drugs, physiotherapy, exercise and knee wraps. 2 to 3 years after treatment, patients were evaluated for pain, mobility and by ultrasound examination (1,3,6 and 12 months, and then once a year). Wang et al. Extracorporeal Shockwave for Chronic Patellar Tendinopathy, The American Journal of Sports Medicine, Vol. X, No. X, 2007.

28 ESWT for Chronic Patellar Tendinopathy Excellent Good Fair Poor ESWT 43% 47% 10% 0% Control 0% 50% 25% 25% 10% 50% Recurrence of symptoms occurred in 50% of the control group patients compared with 13% of ESWT patients (p=0.014). Ultrasonic examination showed a significant increase in vascularity of the patellar tendon after ESWT and a trend toward reduction in tendon thickness. Authors Conclusion: Surgery is the typical treatment for patellar tendinopathy that does not respond to conservative treatments; however, the results of surgical treatment are unpredictable and inconsistent. ESWT may provide superior results with the benefits of a noninvasive procedure that preserves the integrity of the knee joint. Wang et al. Extracorporeal Shockwave for Chronic Patellar Tendinopathy, The American Journal of Sports Medicine, Vol. X, No. X, 2007.

29 ESWT for Chronic Patellar Tendinopathy

30 Calcifying Tendinitis of the Rotator Cuff Inflammation to tendons in the rotator cuff due to overuse or overload. It is common in athletes and people whose jobs or hobbies include heavy demands on their shoulders, such as construction trades. Contributing factors: Include heavy lifting Repetitive overhead movement of the arms Common treatments: Physical (rest, exercise therapy) Pharmacological (pain relievers, steroid injections) Surgical (to repair cuff tears, remove bone spurs) PACE advantages: One time, short treatment session Noninvasive, faster recovery No changes in the biomechanics of the joint which may happen with surgery Anatomical picture of the rotator cuff. Red circle indicates area of treatment.

31 Shock Wave Therapy for Calcific Tendinitis of the Shoulder The purpose of this study was to show the effectiveness of shock wave treatment for calcifying tendinitis in 31 shoulders in 29 patients of 52 years average age (15 men/14 women). Each shoulder was treated with 1,000 impulses of shock waves at 0.18 mj/mm 2. After a 12-week follow up of 20 patients (21 shoulders) there were no complaints in 23.8% and significant improvement in 38.1%. There was a considerable improvement observed between 6 and 12 weeks. Radiographs showed complete elimination of calcium deposits in 29% of patients. Long-Term Results A prospective, controlled study reported improvement (excellent or good) in 91% of patients after 2-3 years. Wang et al., Shock Wave Therapy for Calcific Tendinitis of the Shoulder, The American Journal of Sports Medicine, Vol. 31, No. 3, Before treatment 8 weeks after treatment Wang et al., Treatment of Calcifying Tendinitis of the Shoulder With Shock Wave Therapy, Clinical Orthopaedics and Related Research, No. 387, June 2001.

32 Shock Wave Therapy for Calcific Tendinitis of the Shoulder

33 Shock Wave Therapy for Calcific Tendinitis of the Shoulder

34 Shock Wave Therapy for Calcific Tendinitis of the Shoulder

35 Shock Wave Therapy for Calcific Tendinitis of the Shoulder

36 Achilles Tendinopathy Disorders of the Achilles tendon are a frustrating cause of posterior heel pain. Achilles tendon injuries occur frequently in running and jumping athletes, and in overweight people. 35 patients were treated with a single procedure of high energy ESWT (3,000 impulses at 0.21 mj/mm 2, and 33 were treated with nonoperative therapy. Patients had to fail 3 forms of nonoperative therapy over at least 6 months. 12 months after treatment, the number of patients with successful Roles and Maudsley scores (self assessment of pain with movement) was significantly greater in the ESWT group (p<0.0002), with 83% of ESWT patients having a successful result. Author s Conclusion: Extracorporeal shock wave therapy is an effective treatment for chronic insertional Achilles tendinopathy. Wang et al., Treatment of Calcifying Tendinitis of the Shoulder With Shock Wave Therapy, Clinical Orthopaedics and Related Research, No. 387, June 2001.

37 Lateral Epicondylitis (U.S. Approval Study) Tennis elbow is inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow. There may be a partial tear of the tendon fibers, which connect muscle to bone. The tear may be at or near where these fibers begin on the outside of the elbow. Multicenter, randomized, sham controlled clinical trial. 225 subjects were enrolled and treated (183 randomized subjects). Each subject had symptoms of chronic lateral epicondylitis for at least 6 months prior to enrollment and failed 3 forms of nonoperative therapy. Each subject assigned to active treatment then underwent a single ESWT procedure with a total of 1,500 shocks delivered at an energy setting of 0.22 mj/mm2. Patients were followed up at 4 weeks and 8 weeks after treatment. At the 8 week post-treatment follow-up, a success / fail assignment was made based on three criteria: investigator assessment of pain, subject self-assessment of pain and the use of pain medications.

38 Lateral Epicondylitis (U.S. Approval Study) Results: Of the 82 ESWT subjects followed to 8 weeks, 33 (40%) met all 3 success criteria, compared to 20 of 83 placebo treated subjects (24 %) who met all 3 criteria (p<0.043).

39 Nonunion and Delayed Union Fractures Wang et al. published an important study, investigating the effectiveness of shock waves in the treatment of nonunions of long bone fractures of 72 patients. 6,000 impulses at 28kV for the femur and tibia, 3,000 impulses at 28kV for the humerus, 2,000 impulses at 24Kv for the radius and ulna, and 1,000 impulses at 20kV for the metatarsal. Results: The rate of bony union was 40% at 3 months, 60.9% at 6 months, and 80% at 12 months follow-up. There were no systemic complications or device-related problems. Authors Conclusion: Shock wave treatment is a safe and effective alternative method in the treatment of chronic nonunions of long bones. A B Fig 1A-B. (A) Radiograph of the right femur of a 32-year-old man showing nonunion fracture 9 months after the initial open reduction and internal fixation. (B) Radiograph of the same femur taken 3 months after treatment with 6,000 shock wave impulses showing bony union. Wang et al., Treatment of Nonunions of Long Bone Fractures With Shock Waves, Clinical Orthopaedics and Related Research, No. 387, pp , June 2001.

40 Nonunion and Delayed Union Fractures

41 Stress Fractures The purpose of this study was to evaluate the effects of ESWT for stress fracture, especially in resistant cases. A stress fracture is a major problem for athletes. It is sometimes difficult to repair, resulting in delayed union or nonunion. 62 patients underwent ESWT for delayed union or nonunion with a mean of 12 months between symptoms and ESWT treatment. Five patients suffered from chronic stress fractures with a mean age of 19 years. Patients received 2,000 4,000 shock wave impulses at mj/mm 2 under spinal anesthesia. Results: Radiographic union developed in all cases. The average duration until observed development of bony union was 2.9 months. The time until complete return to sports averaged 4 months. No complications or recurrences were observed in any of the 5 cases. Author s Conclusion: ESWT is a noninvasive and effective method to treat intractable stress fracture in athletes. Taki et al, Extracorporeal Shock Wave Therapy for Resistant Stress Fracture in Athletes, AJSM Preview, February 9, 2007.

42 Stress Fractures Case 1 (22-year-old male basketball player). A, stress fracture of middle third tibia before extracorporeal shock wave therapy (ESWT); B, at 3.5 months after ESWT, consolidation is seen; C, at 1.5 years after ESWT, consolidation is fully developed. Case 4 (21-year-old male soccer player). A, stress fracture of the fifth metatarsal base before extracorporeal shock wave therapy (ESWT); B, at 2 months after ESWT, bony union already achieved; C, at 12 months after ESWT, fusion became more complete. Taki et al, Extracorporeal Shock Wave Therapy for Resistant Stress Fracture in Athletes, AJSM Preview, February 9, 2007.

43 Osteoarthritis Osteoarthritis (OA) is the most common joint disorder. It is caused by wear and tear on a joint. The cause is unknown, and it is mostly related to aging. Before age 55, OA occurs equally in men and women. After age 55, it is more common in women. This study investigated the effects of extracorporeal shockwave therapy (ESWT) on the subchondral bone and articular cartilage in the initiation of osteoarthritis of the knee in rats. The study utilized three groups of Sprague-Dawley rats, each containing 9 animals. The animals in the first group (control) did not have their anterior cruciate ligaments (ACL) surgically cut, whereas animals in the other two groups had surgical transection of their ACL (ACLT) in order to induce osteoarthritis. Of the two ACLT groups, one group received a single ESWT procedure immediately following ACLT (800 shock wave impulses at 0.18 mj/mm 2, while the other group received no treatment of any kind after ACLT. Wang et al., Extracorporeal Shockwave Therapy Shows Chondroprotective Effects in Osteoarthritic Rat Knee, Archives of Orthopedic Trauma Surgery, Vol. 131, No. 8, , DOI: /s

44 Osteoarthritis Summary of Key Study Findings: A single ESWT procedure prevented or significantly improved surgically induced osteoarthritis damage to the knee in an animal model. A single ESWT procedure significantly decreased articular cartilage degradation and improved subchondral bone remodeling. When treated with ESWT, surgically compromised knees displayed comparable data to the control group of normal, healthy knees at 12 weeks post-treatment. Multiple analyses of articular cartilage, subchondral bone, and blood and urine protein markers suggest that early application of ESWT provides a chondroprotective effect to prevent osteoarthritis onset. Author s Conclusion: ESWT treatment may offer an effective, low-cost treatment option in humans that carries little risk compared with other treatments. This study is clinically relevant because it validates our original theory that ESWT treatment has a chondroprotective effect that repairs and prevents osteoarthritic changes in the knee joint. Wang et al., Extracorporeal Shockwave Therapy Shows Chondroprotective Effects in Osteoarthritic Rat Knee, Archives of Orthopedic Trauma Surgery, Vol. 131, No. 8, , DOI: /s

45 Orthopaedic Clinical Summary PACE Compelling Efficacy in Orthopedic Healing Clinical use of PACE on all types of orthopedic conditions has shown superior efficacies to alternative therapies used, decreased the need for surgical intervention and is more cost effective than other modalities. Summary of Efficacy Findings in Published Reports of Clinical Studies Related to the Use of ESWT in Orthopaedic Treatment Author Treatment (Device) Dose Orthopedic Indication Follow-Up Time Efficacy Variable Souza ( ) ESWT w/reflectron 1 Treatment (0.15 mj/mm 2 ) 8 Nonunion Factures NR Complete boney union 7/8 (88%) Incomplete union 1/8 (12%) Schaden ( ) ESWT w/ossatron 80% - 1 Treatment 15% - 2 Treatments 5% - 3 Treatments 1 patient 4 Treatments ( mj/mm 2 ) 172 Nonunion Fractures 4.8 +/- 4.0 months Complete boney union 138/172 (80.2%) Incomplete union 34/172 (19.8%) Wang (2001) ESWT w/ossatron 1 Treatment depending on bone type, (20kV-28kV) 72 Nonunion Fractures 12 months Excellent/Good 58/72 (80%) Santos ( ) ESWT w/reflectron 1 Treatment , 20mm depth (0.14 mj/mm 2 ) 297 Chronic Plantar fasciitis (heel pain) 180 days Excellent/Good 228/297 (76.8%) Acceptable 24/297 (8.1%) No change 45/297 (15.1%) Worsening 0/297 (0%) Lui (2009) ESWT w/reflectron 1 Treatment 1000, 5mm depth (0.13 mj/mm 2 ) 16 Chronic Patellar Tendinopathy 180 days Excellent/Good 12/16 (75%) Poor 4/16 (25%) Rocket ( ) ESWT w/reflectron 79% - 1 Treatment 15% 2 Treatments 6% - 3 Treatments 1000, 5mm depth (0.13 mj/mm 2 ) 156 Chronic Achilles Tendinopathy 180 days Excellent/Good 108/156 (69.2%) Acceptable 24/156 (15.4%) Poor 24/156 (15.4%) Cross ( ) ESWT w/ossatron 1500 (18kV) 165 Chronic Lateral Epicondylitis (tennis elbow) 56 days Excellent/Good/Fair 149/165 90% Poor 16/165 (10%) Santos ( ) ESWT w/reflectron 94% - 1 Treatment 6% - 2 Treatments 1200, 35mm depth (0.14 mj/mm 2 ) 32 Hip Bursitis 180 Excellent/Good 28/32 (87.5%) Acceptable 4/32 (12.5%) Poor 4/32 (12.5%) Wang (2008) ESWT w/ossatron 1 Treatment 6000 (0.62 mj/mm 2 ) 30 Avascular Necrosis (Hip) Improved 25/30 (83%) Unchanged 2/30 (7%) Worsened/hip replacement 3/30 (10%)

46 Benefits of orthopace Leading Edge Technology orthopace generates powerful electrohydraulic shock waves via spark gap technology characterized by an ultra-short rise time and high peak pressure A large focal area ensures consistent distribution of energy to the entire treatment area Multiple treatment applicators are available for different penetration depths New, superficial applicator can be less painful for soft tissue, tendon, joint and small extremity bones Sterile sleeve barriers and sterile gel are now available User Friendly Plug-and-play technology and intuitive user interfaces enable an efficient treatment The compact design is particularly suitable for the small practice setting or wherever limited space is an issue

47 Benefits of orthopace Cost Effective Only 1 or 2 treatments are required to treat a patient successfully Amortization time is short with just a few patients per month The treatment takes only minutes to complete Broad Range of Applications orthopace can be used for many different indications orthopace can be used as an adjunctive treatment to accelerate healing and improve clinical outcomes and healthcare economics orthopace can also be used to treat any painful bone near soft tissue diseases

48 orthopace Healing... at the Speed of Life. Chronic musculoskeletal conditions prevent many people from living the active lifestyle they desire. orthopace quickly initiates a cascade of healing events, helping to restore mobility, minimize pain and allow life to be lived to its fullest.