This patient education brochure is presented courtesy of Wright.

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2 This patient education brochure is presented courtesy of Wright. Patient results may vary. Please consult your physician to determine if these products are right for you. For more information about Wright s products or prescribing information, including warnings and contraindications, please consult the product labeling summary provided on the back inside cover of this brochure, or visit Introduction What Is Osteoarthritis?... 1 Anatomy Total Knee Replacement (TKR) Minimally-Invasive Knee Surgery (MIS)... 4 Why Your Surgeon Has Selected A Wright Knee Who Is Wright? Why Wright?... 5 ADVANCE Knee Systems... 5 ODYSSEY MIS Knee Instrumentation... 6 Patient Preferred Patient Data... 7 What Patients Are Saying Frequently Asked Questions... 12

3 Introduction Osteoarthritis of the knee affects an estimated 20 million Americans. Those with osteoarthritis may experience pain which may keep them from performing and enjoying simple daily activities. In order to treat this condition, your doctor may recommend that you have knee surgery with a knee implant manufactured by Wright Medical Technology, Inc. Facing surgery can be daunting. However, Wright has decades of experience producing revolutionary products which provide hope every day for patients, such as yourself, struggling with pain and unable to live the active lifestyle you once did. What Is Osteoarthritis? Osteoarthritis is a common degenerative condition in which the cartilage that normally cushions the bones of a joint begins to wear, causing the bones to rub together. Osteoarthritis of the knee is common because most of the body s weight is carried by the knee joint. This can make the knee wear out more quickly than other joints. Symptoms include pain, swelling, and deformity which can contribute to loss of motion. Anatomy The knee joint is where the end of the thigh bone (femur) meets the top of the shin bone (tibia) and the knee cap (patella). The femur and tibia are connected by a set of muscles and Facing surgery can be daunting. Wright has decades of experience producing revolutionary products which provide hope. 1

4 ligaments, of which our quadricep muscles are primarily responsible for straightening the knee. The knee joint is cushioned by cartilage that covers the ends of the femur and tibia, helping them to move smoothly against each other. On the tibia lie two crescent-shaped pieces of cartilage called menisci. The menisci act as shock absorbers for the knee. They also provide a pocket-like surface on the top of the tibia for the femur to sit in. This pocket increases the stability of the knee and prevents it from sliding around during activities. In a knee joint that has osteoarthritis (Arthritic Knee), the cartilage wears down and bone begins to rub on bone. This creates pain and reduces the function of the knee. Introduction to Total Knee Replacement (TKR) TKR (or also, commonly known as total knee arthroplasty) is one of the most successful 2

5 operations utilized to restore knee function and stop arthritic pain. The goal of the surgery is to replace the arthritic surfaces of the bones with metal caps that will closely mimic the normal knee function, while also preventing pain caused by the damaged ends of the bones rubbing together. Precision instruments are utilized to reshape the ends of the bones to accept the artificial knee implant. A metal tray is placed on top of the tibia. An implant-grade plastic (polyethylene) insert is locked into the top of this tray. The plastic now acts as the cushioning cartilage and menisci. Next, a highly polished, pure implant-grade metal is placed on the end of the prepared femur. Finally, the underside of the patella (kneecap) is removed and replaced with a plastic dome which will slide against the new joint. 3

6 Minimally-Invasive Knee Surgery (MIS) Ideally, a minimally-invasive surgical approach allows your surgeon to avoid having to move your patella or cut the quadriceps muscle or quadriceps tendon. This type of surgery is referred to as a tissuepreserving procedure and involves smaller skin incisions (on average 4-6 inches, as compared to the 8-12 inches of a traditional knee surgery.) Minimally-invasive surgeries (MIS) may be performed with various surgical approaches, but all necessitate smaller instruments due to smaller skin incisions. However, the length of the incision is not what is truly important. What matters is how the surgery affects the quadriceps muscles (the muscles that are responsible for straightening your knee). Preliminary results, using this less-invasive approach to surgery, show that patients experience faster recovery, earlier range of motion, and less postoperative pain. In general, MIS can shorten rehabilitation up to two months. 1,2 However, due to the variance in arthritic disease, not every patient is a candidate for MIS surgery. Your surgeon will be able to help you make that determination. Why Has Your Surgeon Selected A Wright Knee For You? With Wright, both you and your surgeon, have options. Wright s products are all designed specifically to replicate normal knee motion by bending, rotating, and twisting, all with a high degree of stability and range of motion. And, your surgeon is empowered to implant Wright products through minimally-invasive surgical techniques. In addition to five years of clinical data, we have patient data that tells us our products are preferred over alternate designs. 3 Who Is Wright? Wright is a 50-year-old orthopaedic company with 4

7 foundations in total knee surgery. Wright s philosophy has always been to design implants and procedures that preserve as much of the body s natural structures (bone) as possible. The research, development, engineering, and manufacturing that has resulted in our ADVANCE Knee Replacement Systems featuring Medial-Pivot designs is unique and complex. However, this design, developed in conjunction with top knee surgeons in the US and around the world, is really the result of some very simple questions: How can we design the best knee implant on the market? One that will most closely mimic the natural motion of the knee s anatomy? One we would want our family members to receive, if they were facing knee surgery? ADVANCE Medial-Pivot Knee Why Wright? ADVANCE Knee Systems Wright manufactures ADVANCE Medial-Pivot and Double-High Knees. Wright has designed these knees to closely replicate the rotating, twisting, bending, flexion, and stability of your natural knee, so it FEELS more like your natural knee. In contrast to competitive knee implants with a design philosophy that acts as if the knee moves like a hinge, Wright s Medial-Pivot Knee design is more stabile during knee motion. 3 A normal knee does not act as a hinge, but pivots on its medial (inner) side. And, when the knee flexes (bends), the lateral (outer) side rolls back, 5

8 while the medial side rotates in one place. This is precisely how the ADVANCE Medial-Pivot knee implant was designed and how it received its name. A picture (or animation, in this case) is worth a thousand words. Visit to learn more about this unique design. ODYSSEY MIS Knee Instrumentation ODYSSEY MIS Knee Instrumentation was designed specifically for surgeons performing minimally-invasive techniques within smaller incisions (usually 4-6 inches as opposed to the 8-12 inches of a traditional knee surgery). MIS incision Traditional incision While ODYSSEY MIS Knee Instrumentation is reduced in size, it features more accurate alignment options and more precise control than traditional systems. It is important to note, however, that minimally-invasive surgery is not only about the size of the incision, but also the amount of soft-tissue damage that takes place below that incision. Wright s instruments are designed to minimize soft tissue manipulation, which helps alleviate pain after the surgery and promotes faster rehabilitation. When combined with ADVANCE knee implants, ODYSSEY MIS Instrumentation may significantly improve the results of total knee arthroplasty. 6

9 Patient Preferred At Wright, our implants allow patients to receive an implant that closely mimics their natural knee s motion (i.e. bending, flexing, twisting and range of motion). We are proud of these unique, patented designs that are made in our high tech manufacturing plant right here in the USA. Additionally, our surgeons are empowered to implant our products through minimally-invasive surgical techniques that have been shown to get you back on your feet faster. But, don t just take our word for it... Patient Data In a survey of patients who experienced total knee surgery on both knees (one with an ADVANCE Medial-Pivot Knee, the other with a competitive product design), 80% of the recipients reported that they liked their ADVANCE Medial-Pivot Knee better. And, nearly 75% of those surveyed said it was easier to rehabilitate the knee that was replaced with an ADVANCE Medial-Pivot Knee. 4 Question Medial-Pivot Other No Difference Easier To Rehab? Like Better Easier To Bend? 74% 13% 13% 80% 19% 0% 55% 26% 19% Believe me, I put both knees to the test every day... I happen to prefer my ADVANCE Medial-Pivot knee. Virginia Sage, Bi-lateral TKA patient 7

10 Patients Speak Out Of course, individual results vary and only your physician can determine what is the best course of treatment for you. However, here s what some recipients of Wright s knees are saying... Don s Experience I was overweight, out of shape, and my physical problems deprived me of things I enjoyed. Now, I m back. I ve got an active future again. Don Lambert, 48 years old, received an ADVANCE Medial-Pivot Knee replacement through a minimally-invasive surgical approach. Since then, he committed himself to physical therapy, lost 70 pounds that he had accumluated (due in no small part to lack of activity due to constant knee pain), got into shape, and set as well as accomplished a goal to climb Mt. Kilimanjaro. In his photo at the peak, Lambert is holding a sign that says Thank You Wright Medical. Your Knee Got Me To The Top. I was pleased at how well the knee performed, he said. I really tested it on the mountain and found I relied on it, especially during the descent. Lambert said having his knee replacement was one of the best decisions of his life, and he is a strong proponent of not waiting. If you have a bad knee, now is the time you need it. Why wait? Don, 48 8

11 Maggie s Experience Before getting my new knees, the only way I could go long distances was in a wheelchair. Now, I can walk without pain. The first time Maggie Bala, 60, underwent surgery to treat debilitating arthritis in her right knee, she suffered through a tough recovery with weeks of physical therapy and use of a walker and cane. Fortunately, advances in surgery made a world of difference in her recovery after having a second surgery, this time to replace her left knee. Maggie s physician, Dr. Louis Levy, suggested she receive Wright s ADVANCE Medial-Pivot Total Knee and was able to surgically implant the device while minimizing cutting of muscles in the area. He used a new minimally-invasive technique during the operation that provided great benefits for Maggie. She only needed about a week of physical therapy and was able to walk on her own within days of her surgery! Maggie is thrilled to have knees that are now well enough to allow her to shop, mow her lawn and garden without pain. Maggie, 60 Virginia s Experience I avoided surgery for fear that I would be disabled at 60. Then, I realized I was actually handicapped at 40. Virginia DelGaldo was diagnosed with osteoarthritis when she was 44 years old and her doctor advised 9

12 knee surgery as the bone was rubbing directly against bone causing her immense pain. She was scared of getting the operation at such a young age because of the revision surgeries she would potentially need later so she sought multiple medical options but all the physicians she visited came to the same conclusion, surgery. Virginia saw Dr. Stephen Stuchin and he recommended a total knee replacement with the ADVANCE Medial-Pivot Total Knee System. Since having the surgery, she is thrilled with the results. The pain is gone and her range of motion is 130, and the implant feels like her own knee. She can finally exercise again and, as a result, has lost 53 pounds. Pain no longer dictates what I can and cannot do. I have my life back. Virginia, 44 Judy s Experience I couldn t do anything before surgery. Now, I m back to normal. A fall at work prompted Judy Valentine to seek treatment for a painful knee injury. Unfortunately, she developed painful arthritis as a result of her injury. It seemed like every two steps Judy took, her knee would give way or lock up. She worried about falling. Going up and down stairs was hard as the pain was so intense. Her debilitating 10

13 condition forced Judy to depend on crutches and be out of work for almost 6 months. This worried Judy, as sole provider for her family. She had completely taken for granted, like most people, the ability to be mobile. She began to wonder if she had lost the ability to perform her job. And, she worried about how she would pay her bills. One day her knee locked again this time for hours and requiring two injections of antiinflammatory drugs. Judy and her orthopaedic surgeon, Dr. Richard Rosa, decided that it was time to try something different. As she was a young patient just 53 years old with only one compartment of her knee damaged, Dr. Rosa suggested that Judy would be a good candidate for a procedure called unicompartmental knee arthroplasty. In this minimally-invasive procedure, only the damaged portion of the knee is replaced, leaving all the healthy bone, ligaments, and cartilage in place. The unicompartmental knee would also allow her to recover faster with much less rehabilitation. The surgery took place with Dr. Rosa using the ADVANCE Unicompartmental Knee from Wright. According to Judy, Although having any surgery is potentially serious, I thought this procedure was a breeze. I had only one night s stay in the hospital, no narcotics, and no formal physical therapy. Dr. Rosa instructed me on what exercises to perform during my recovery, which I did to regain my flexibility. In just six weeks, I was back to work... pulling 13-hour shifts on my feet again. Judy, 53 11

14 12 Frequently Asked Questions Q. When Is Knee Surgery Appropriate? A. Only you and your doctor can determine what is the correct course of treatment for you and your condition. Surgery should be the last step and should be considered when other alternatives have proven ineffective and, when knee pain significantly impacts the activity and quality of your life. Q. What Differentiates the Medial-Pivot Design From Other Implant Designs? A. Many total knee implants on the market are based on a philosophy that the knee moves like a hinge... swinging only back and forth. But, of course, the knee does not function simply as a door hinge. The knee bends and rotates. The ADVANCE knee was designed to bend and rotate like a normal knee. Q. What Are the Advantages to Minimally- Invasive Knee Surgery? A. Most minimally-invasive techniques are performed through smaller incisions, on average 4-6 inches as compared to the 8-12 inches of a traditional surgery. This enables the patient to rehabilitate more quickly with less pain and return to his or her active lifestyle more quickly. Q. What Is A Partial Knee Replacement? A. Partial knee replacement (commonly known as uni ), is performed when only one condyle of the knee is affected by arthritis. Surgeons generally use a small incision to remove the joint surface and a small amount of bone, replacing them with the implant. The recovery period is usually shorter than with a total knee replacement. Many people can return to walking in two to four weeks, although physical therapy may still be needed to restore knee strength and function. Q. How Long Does A Knee Implant Last? A. Unfortunately, there is no easy answer to this question, other than it depends. Implant lifespan varies based on the materials it is comprised of, as well as, how much wear and tear it receives after being implanted.

15 Prescribing Information & Precautions Advances in knee implant replacement have given surgeons the ability to assist patients in restoring mobility, correcting deformity and reducing pain. While the implants used are largely successful in attaining these goals, it must be recognized that they are manufactured from metal and plastic and that any knee replacement system cannot be expected to withstand activity levels and loads as would normal healthy bone. To determine if you are a candidate for knee replacement, discuss your condition with your surgeon. He may determine that a knee replacement is appropriate for you if you have severe pain or significant disability resulting from one or more of the following conditions: Indications Deterioration of the knee joint cartilage (osteoarthritis). Inflammation in the lining of the knee joint (rheumatoid arthritis). Physical injury to the knee joint resulting in arthritis (traumatic arthritis). Moderate valgus (bowlegged), varus (knock-kneed), or flexion (bending) deformities. Correct problems caused by previously failed surgeries. Contraindications During consultation your doctor may decide that knee replacement surgery is not appropriate if: You have an infection. You do not have enough bone or the bone is not strong enough to support the prosthesis. You have known metal/plastic allergies. Your knee is severely unstable, possibly due to unstable knee ligaments. You have one of several conditions known as neuromuscular disease. The indications and contraindications herein are not intended to be an exhaustive list. Additional considerations that impact the outcome include the patient s weight, occupation or level of activity, mental condition, and use of alcohol and tobacco products. Consult with your physician to determine the correct treatment for you.

16 References 1. Tria AJ Jr, Coon TM. Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res Nov;(416): Laskin RS, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC, Pavlov H, Petersen M. Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res Nov;(428): Pritchett JW. Patient preferences in knee prostheses. J Bone and Joint Surgery (BR) Sept;(86- B): Clinical Survey of Patient Satisfaction: A Study of Bilateral Knee Recipients, July 2001, Data on file with Wright Medical. Wright Medical Technology, Inc Airline Road Arlington, TN phone toll-free Wright Medical Europe, SA Commerce Parc Gebouw B, 6th Floor, Krijgsman II 1186 DM Amsterdam The Netherlands Tel +31 (0) Covered by one or more of the following US patents: 4,298,992; 4,718,413; 5,219,362; 5,662,656; 5,672,178; 5,702,458; 6,013,103 Additional patents pending. Stock images provided courtesy of Getty Images Wright Medical Technology, Inc. All Rights Reserved. MK Rev. 3.06