PATIENT EDUCATION SEMINAR

1. Reverse® Shoulder Prosthesis Patient Education REVERSE SHOULDER PROSTHESIS PATIENT EDUCATION SEMINAR

2. Reverse® Shoulder Prosthesis Patient Education JOHN DOE, M.D. • X Years of Private Practice in XXXXX • Doe Orthopedic Institute, a nationally recognized treatment center for musculoskeletal conditions • XYZ Hospital • Specializing in Sports Medicine, Shoulder and Knee Replacement • Member, American Board of Orthopaedic Surgeons and American Academy of Orthopaedic Surgeons

3. Reverse® Shoulder Prosthesis Patient Education AGENDA • Shoulder Anatomy • Shoulder Conditions • Rotator Cuff Deficiency • Reverse Ball & Socket Concept • Reverse® Shoulder Prosthesis • Recovery

4. Reverse® Shoulder Prosthesis Patient Education SHOULDER ANATOMY

5. Reverse® Shoulder Prosthesis Patient Education INTRODUCTION TO THE SHOULDER JOINT • Complex structure which consists of the humerus, scapula and clavicle. • The motion created by the shoulder is considered greater than any other joint in the body. • Supported and moved by 30+ muscles, ligaments and tendons.

6. Reverse® Shoulder Prosthesis Patient Education HUMERUS • Half circle-shaped portion ofhumerus for the shoulder joint • Points of attachment for therotator cuff • Surgical neck is a commonpoint of fracture • Mid-humeral shaft and also acommon fracture point

7. Reverse® Shoulder Prosthesis Patient Education SCAPULA • Shoulder blade - Attached to the axial skeleton by muscles,giving it mobility on upper back

8. Reverse® Shoulder Prosthesis Patient Education NORMAL SHOULDER BIOMECHANICS • Balance between the ascending forces of the deltoid and the descending forces of the rotator cuff muscles

9. Reverse® Shoulder Prosthesis Patient Education • SHOULDER CONDITIONS Tendonitis Impingement syndrome Rotator cuff deficiency Acromioclavicular joint arthritis Joint arthritis

10. Reverse® Shoulder Prosthesis Patient Education ROTATOR CUFF DEFICIENCY

11. Reverse® Shoulder Prosthesis Patient Education ROTATOR CUFFDEFICIENCY • Over 100,000 Americans undergo surgical rotator cuff repair annually (Praemer et al 1999) • Full thickness tears are present in up to 25% of all people over age 60 (Fuch et al 1999) • Cuff-tear arthropathy may develop in 4% of patients with a complete rotator cuff tear (Neer et al 1983)

12. Reverse® Shoulder Prosthesis Patient Education Kinematics of Shoulder Function L L C C Healthy Shoulder RC Deficient Shoulder

13. Reverse® Shoulder Prosthesis Patient Education Kinematics of Shoulder Function x x x Healthy Shoulder RC Deficient Shoulder

14. Reverse® Shoulder Prosthesis Patient Education • Rotator Cuff Repair • Space is increased between the acromiom and the rotator cuff tendon • The torn tendon is trimmedand a rough area is madeon the humerus • The tendon is securedto the humerus • sutures • anchors • tacks

15. Reverse® Shoulder Prosthesis Patient Education “Reverse Ball & Socket” Shoulder Concept

16. Reverse® Shoulder Prosthesis Patient Education • Why a Reverse Ball & Socket? • Delivers most mechanically efficient method to “neutralize” the vertical forces of the deltoid muscle and maintain joint stability • Provides enhanced stability of the glenohumeral joint • Optimizes the length-tension curve of deltoid muscle to provide a stable fulcrum for elevation

17. Reverse® Shoulder Prosthesis Patient Education • Clinical Solution • The Reverse® Shoulder Prosthesis is an exclusive semi-constrained design concept that reverses the shoulder anatomy by lateralizing the shoulder joint to effectively resist the superior pull of the deltoid muscle and optimize soft tissue balancing.

18. Reverse® Shoulder Prosthesis Patient Education • Reverse® Shoulder Prosthesis • This innovative surgical alternative is designated to provide patients with the potential for pain relief, restored function and improved stability.

19. Reverse® Shoulder Prosthesis Patient Education • Reverse® Shoulder Prosthesis • Cementless Glenoid • Encased Poly Humeral Socket • FDA Clearance in March 2005 • 2ndGeneration Reverse Ball & Socket Prosthesis

20. Reverse® Shoulder Prosthesis Patient Education • RECOVERY • Varies from patient to patient • Most perform light exercises the day after surgery • Your surgeon will prescribe the best recovery plan to fit your needs and lifestyle • Active and passive physical therapy are very helpful in aiding the recovery process

21. Reverse® Shoulder Prosthesis Patient Education Reaching higher by design... SO PATIENTS CAN, TOO. At DJO Surgical, our end goal is to help patients reach theirgreatest potential. We strive to achieve this through innovation,proven results, and clinical heritage. Our approach is to partnerwith surgeon experts in the field to design shoulder systems thatultimately provide shoulder solutions. Our aim is to reach newheights by providing clinicians solutions to help theirpatients reach higher.

22. Reverse® Shoulder Prosthesis Patient Education • QUESTIONS