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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 1

For year ended June 15, 2010

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The OrThOpaedic indusTry annual repOrT: 2009-2010

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Table of ConTenTs

exeCuTive summary

Overview...................................................................................................................................................... 1 Patient Demographics ................................................................................................................................ 3 The Market and Players ................................................................................................................ 4

JoinT replaCemenT

Overview.................................................................................................................................................... 11 Patient Demographics .............................................................................................................................. 11 The Market and Players ........................................................................................................................... 13 Technologies and Trends ......................................................................................................................... 15 Summary .................................................................................................................................................... 23

fraCTure repair

Overview.................................................................................................................................................... 27 Patient Demographics .............................................................................................................................. 27 The Market and Players ........................................................................................................................... 28 Technologies and Trends ......................................................................................................................... 29 Bone Growth Stimulation ........................................................................................................................ 32 Summary .................................................................................................................................................... 35

arThrosCopy and sofT Tissue repair

Overview.................................................................................................................................................... 39 Patient Demographics .............................................................................................................................. 39 The Market and Players ........................................................................................................................... 41 Technologies and Trends ......................................................................................................................... 42 Summary .................................................................................................................................................... 49

spinal implanTs and insTrumenTaTion

Overview.................................................................................................................................................... 53 Patient Demographics .............................................................................................................................. 53 The Market and Players ........................................................................................................................... 54 Technologies and Trends ......................................................................................................................... 55 Disc Replacement ..................................................................................................................................... 57 Facet Replacement .................................................................................................................................... 63 Nucleus Replacement .............................................................................................................................. 64 Dynamic Stabilization .............................................................................................................................. 67 Vertebroplasty/Kyphoplasty .................................................................................................................. 75 Summary .................................................................................................................................................... 79

CompuTer assisTed surgery and roboTiCs sysTems

Overview.................................................................................................................................................... 83 The Market and Players ........................................................................................................................... 83

orThobiologiCs

Overview.................................................................................................................................................... 91 Bone Graft Materials ................................................................................................................................ 91 Osteoinductive Materials ........................................................................................................................ 96 Orthobiologics for Soft Tissue Applications ....................................................................................... 102 Orthobiologics for Pain Relief and Adhesion Prevention .................................................................111 Summary .................................................................................................................................................. 117

Appendices ......................................................................................................................................................A-1 Directory of Companies .......................................................................................................................DOC-1 Index of Companies ...............................................................................................................................Index-1

lisT of exhibiTs

1. 2. 3. 4. 5. 6. 7. 8. 9. 2009 WorldWide orThopaediC produCT sales: by markeT segmenT .................................. 1 and geographiC region ($billions) orThopaediC markeT groWTh 1993 To 2009 ........................................................................... 2 musCuloskeleTal diagnoses delineaTed by age .................................................................... 3 The 2009 WorldWide orThopaediC markeT: sales for The Top Ten ..................................... 4 Companies and all oThers ($billions) Top Company groWTh over Time .............................................................................................. 5 orThopaediC Companies WiTh 2009 sales >$10mm: esTimaTed .......................................... 6 sales and breadTh/depTh of produCT line arThriTis and iTs healTh impaCT ............................................................................................ 11 JoinT replaCemenT proCedures by paTienT age ..................................................................... 12 The World's populaTion by age group: 2005 and 2020....................................................... 13

10. arThriTis, JoinT replaCemenT and obesiTy............................................................................. 13 11. global JoinT replaCemenT sales in 2009: revenues by segmenT ($billions) ..................... 14 12. global JoinT replaCemenT sales in 2009: Company markeT shares ................................. 15 13. hip replaCemenT TeChnology opTions by Company ............................................................. 17 14. parTial knee replaCemenTs as perCenT of primary knee ................................................... 20 replaCemenT in various geographies 15. knee replaCemenT TeChnology opTions by Company........................................................... 20 16. resurfaCing and reverse shoulder replaCemenT ............................................................... 21 TeChnologies by Company 17. revisions as a perCenT of all JoinT replaCemenTs............................................................... 23 18. The JoinT replaCemenT markeT: key markeT dynamiCs ...................................................... 24 19. fraCTures by paTienT age ........................................................................................................ 27 20. global fraCTure repair sales in 2009: revenues by segmenT ($billions) ......................... 28 21. global fraCTure repair sales in 2009: Company markeT shares ..................................... 28 22. bone groWTh sTimulaTion sysTems by Company .................................................................. 32 23. osTeoporosis and iTs healTh impaCT ..................................................................................... 33 24. The fraCTure repair markeT: key markeT dynamiCs .......................................................... 35 25. arThrosCopy/sofT Tissue repair proCedures by paTienT age ............................................. 40 26. global arThrosCopy/sofT Tissue repair sales in 2009: ..................................................... 41 Company markeT shares 27. sofT Tissue repair implanTs by Company ............................................................................... 47

28. arTifiCial ligamenT TeChnologies by Company ..................................................................... 49 29. The sporTs mediCine markeT: key markeT dynamiCs ......................................................... 50 30. spine proCedures by paTienT age ............................................................................................ 53 31. global spine sales in 2009: Company markeT shares ........................................................ 54 32. aCquisiTions and sTraTegiC allianCes in spine in 2009....................................................... 55 33. spine produCT launChes in 2009............................................................................................. 56 34. arTifiCial disC landsCape - CerviCal .................................................................................... 58 35. arTifiCial disC landsCape - lumbar....................................................................................... 60 36. full spinal segmenT TeChnologies landsCape ..................................................................... 63 37. faCeT arThroplasTy landsCape............................................................................................... 64 38. nuCleus replaCemenT landsCape ........................................................................................... 66 39. moTion preservaTion landsCape - dynamiC sTabilizaTion ................................................. 69 40. verTebroplasTy and kyphoplasTy landsCape ......................................................................... 78 41. The spine markeT: key markeT dynamiCs ............................................................................. 80 42. Cas sysTems for orThopaediC appliCaTions ........................................................................ 87 43. allografT and xenografT bone produCTs by Company ...................................................... 92 44. synTheTiC bone grafT subsTiTuTes by Company .................................................................... 93 45. auTologous plaTeleT/plasma sysTems by Company ............................................................ 97 46. Cell-based produCTs and serviCes for hard Tissue repair by Company .......................... 98 47. osTeoinduCTive orThobiologiC iniTiaTives by Company ...................................................... 99 48. oTher bone repair/regeneraTion TeChnologies ................................................................ 101 49. sofT Tissue repair/replaCemenT TeChnologies by Company .............................................. 103 50. sofT Tissue reinforCemenT produCTs by Company ............................................................. 107 51. anTi-adhesion TeChnologies by Company ........................................................................... 113 52. hyaluroniC aCid produCTs by Company ............................................................................. 116

appendiCes

appendix a: reConsTruCTive deviCe Companies .........................................................................a-1 appendix b: fraCTure repair Companies...................................................................................... b-1 appendix C: arThrosCopy/sofT Tissue/sporTsmed Companies ................................................C-1 appendix d: spinal implanTs/insTrumenTaTion Companies ..................................................... d-1 appendix e: biologiCs & CemenT Companies .............................................................................. e-1

execuTive summary

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 1

ExEcutivE Summary

Orthopaedics relates to the treatment of musculoskeletal disorders, injuries, diseases and deformities ­ arthritis, osteoporosis, fractures, back pain, scoliosis, soft tissue disorders, etc. Products used to treat these conditions include: · · · · Reconstructive Devices ­ implants used in replacing failed joints in the hip, knee, shoulder, elbow, wrist, ankle, fingers and toes Fracture Repair ­ products used to repair fractures both internally and externally: plates, screws, intramedullary nails, pins, wires, staples, external fixators Arthroscopy/Soft Tissue Repair ­ arthroscopes, cameras, monitors, handheld instruments and implants used to access and treat soft tissue injuries: scopes, cameras, instruments, soft tissue implants and repair kits Spinal Implants/Instrumentation ­ implants used to treat degenerative disc disease, herniated discs, scoliosis, vertebral fractures: pedicle screws, plates, rods, hooks, screws, artificial discs, motion preserving devices, discectomy tools and vertebroplasty/kyphoplasty products Orthobiologics ­ implantable substances typically used in conjunction with a variety of other orthopaedic implants: bone graft substitutes, structural and non-structural allograft, autogenous bone and soft tissue replacement products, growth factors and viscoelastics Other Products ­ power tools (large and small bone and high speed), casting materials, soft goods, bracing systems, bone growth stimulators, cement and cement mixing/delivery systems, infection control equipment, pulsed lavage/irrigation systems, image-guided surgery systems, etc.

·

·

OvErviEw In 2009, revenues generated by sales of orthopaedic products reached $37.8 billion worldwide, an increase of just over six percent from 2008. Sales in the U.S. accounted for 61 percent of all 2009 orthopaedic revenues. Exhibit 1 summarizes worldwide orthopaedic product sales by segment and geographic region.

Exhibit 1 2009 WorldWidE orthopaEdic product SalES: by MarkEt SEgMEnt and gEographic rEgion ($billionS) Change vs. 2008 5.6% 6.2% 6.5% 10.8% 5.8% 1.6% 6.2%

Product Segment Reconstructive Devices Fracture Repair Arthroscopy/Soft Tissue Repair Spinal Implants/Instrumentation Orthobiologics Other Products Total Market Change vs. 2008

U.S. $7.0 $2.8 $1.9 $5.1 $2.8 $3.2 $22.9 5.5%

Ex-U.S. $6.3 $2.4 $1.4 $2.0 $1.1 $1.7 $14.9 7.1%

Total $13.3 $5.2 $3.3 $7.1 $3.9 $4.9 $37.8 6.2%

Growth from 2008 to 2009 came in at the lowest rate since the early 1990s, largely as a result of a global economic downturn. Exhibit 2 illustrates growth in the global orthopaedic market from 1993 to 2009.

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2 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 2 OrthOpaEdic MarkEt GrOwth 1993 tO 2009

16% 16% 16%

14%

14% 13% 12% 11% 11% 11% 10% 13% 12%

10%

7% 6%

1993/1994

1994/1995

1995/1996

1996/1997

1997/1998

1998/1999

1999/2000

2000/2001

2001/2002

2002/2003

2003/2004

2004/2005

2005/2006

2006/2007

2007/2008

A variety of external "events" worked together to bring about the slowdown in growth for the orthopaedic market from 2008 to 2009. Hospitals worldwide faced significant losses in their investment portfolios and, as a result, tightened their spending on all products. Orthopaedics felt the brunt across all segments as hospitals placed more pressure on orthopaedic manufacturers to cut prices. In addition, hospitals slowed spending on capital equipment items like arthroscopes, cameras, power equipment, etc., which dramatically affected growth for many companies competing in these segments of the orthopaedic market. Finally, hospitals were slower to replenish inventories, which had a negative impact on the fracture repair business. The year also brought economic hardship to millions of people worldwide who got laid off, lost investments and experienced the backlash from the collapse of the housing markets. Many chose not to travel for vacation, hence reducing the incidence of fractures and soft tissue injuries incurred either in automobiles or on the ski slopes. Furthermore, people policed their own healthcare, opting to not undergo certain elective procedures (like joint replacement) due to lack of funds or fear of losing their jobs. A downturn in the housing market and construction overall also affected the fracture repair segment of the market, according to various manufacturers. Towards the end of 2009 and into 2010, capital equipment spending began to return in the U.S., although other parts of the world (e.g. Europe) still struggle with sluggish economic recovery. Similarly, procedure volumes began to pick up due to less fear and uncertainty among patients. At the same time, however, hospitals remain ever diligent in working

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2008/2009

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 3 to rein in prices, particularly with higher ticket, higher volume procedures like joint replacement and spinal fusion. In fact, the spine segment continues to experience intense price pressure as a result of a plethora of new companies entering the space and discounting prices to gain business. In addition, in the U.S., insurance companies that would ordinarily reimburse for the use of technologies that received FDA clearance are now more frequently questioning them and denying payment due to their perceived "experimental" nature. Even with 2009's slowdown and continued (albeit lighter) pressures on market growth, the fact remains that the orthopaedic market should always be one of the healthiest among medical devices due to undeniably perfect demographics. Patient Demographics In 2009, the U.S., Europe and Japan accounted for more than 80 percent of the global orthopaedic marketplace; however, less than 20 percent of the world's 6.7 billion people live in these geographic regions. Clearly orthopaedic opportunities exist outside the three major orthopaedic markets, as most of the people in underdeveloped nations will need musculoskeletal care throughout their lives. At this time, however, many do not have access to the care they may need, including orthopaedic intervention, as their countries' governments struggle to provide even the most basic of healthcare. Also, in many of these areas, health insurance is non-existent and patients must pay out of pocket for the products used in their surgical procedures. Since many people in the developing world live in poverty, the purchase of orthopaedic implants remains a financial impossibility. As infrastructures improve in developing nations and as standards of living rise along with them, the majority of the world's people will begin to gain access to orthopaedic technologies, with the end result being solid, steady growth in orthopaedic procedures over the next decade. In addition, musculoskeletal conditions are the most common cause of chronic disability, the most common medical cause of long-term absence, the second most common reason for consulting a doctor and, in the U.S., the greatest cause of lost work days and medical bed days. From arthritis to osteoporosis and fractures to dislocations, musculoskeletal conditions and diseases know no age bounds. Exhibit 3 illustrates the diversity of the patient population presenting with musculoskeletal problems.

Exhibit 3 MuSculoSkElEtal diagnoSES dElinEatEd by agE <45 4% 22% 31% 2% 21% 26% 43% 13% 45-64 40% 43% 35% 14% 20% 32% 34% 28% 65+ 56% 34% 35% 84% 59% 42% 24% 59%

Arthropathies and related disorders Dorsopathies Osteopathies, chondropathies and acquired deformities Osteoporosis Fractures Sprains/strains Dislocations All Musculoskeletal Diagnoses

As Exhibit 3 illustrates, people of all ages and all walks of life may find themselves "victim" of a musculoskeletal injury or disease at one point or another in their lives. The pain of arthritis finds relief in a variety of orthopaedic products, from injections of hyaluronic acid to unicompartmental knee replacements. Plates, screws, nails and

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4 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT external fixators put broken bones back together much like interference screws and suture anchors repair torn cruciate ligaments and rotator cuffs. A child with scoliosis can stand tall again thanks to rods and hooks that are part and parcel of spinal instrumentation systems worldwide. These solutions to orthopaedic problems come from the products and services offered by nearly 1,100 companies that compete in the global orthopaedic marketplace. The Market and Players In 2009, 76 percent of global orthopaedic revenues came from the efforts of the ten largest orthopaedic companies in the world. Exhibit 4 lists these companies and their estimated sales. Exhibit 4 thE 2009 WorldWidE orthopaEdic MarkEt: SalES for thE top tEn coMpaniES and all othErS ($billionS)

Others $8.89 Aesculap $0.54 DJO $0.59 Arthrex $0.80 Biomet $2.34 Stryker $5.75

Smith & Nephew $2.93

Johnson & Johnson $4.93

Synthes $3.40 Medtronic $3.74 Zimmer $3.99

Notes: Biomet and Zimmer revenues exclude sales for dental products. Johnson & Johnson sales do not include those for Codman. Smith & Nephew's sales include those for orthopaedics and arthroscopy (a portion of the company's endoscopy division), but exclude wound management product revenues. Stryker excludes sales for patient handling equipment, physiotherapy products and endoscopic equipment used in non-orthopaedic areas. Performance for the publicly-traded of the top ten mirrored that for the market over time. That is, growth for most of the top ten companies has fallen substantially since early in the century, from double digit to single digit increases, as Exhibit 5 illustrates.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 5 Exhibit 5 top coMpany groWth ovEr tiME

40 35 30

Percent (%) 2002/2003 2005/2006 2008/2009

25 20 15 10 5 0 -5

Biomet ConMed DePuy Medtronic Smith & Nephew Stryker Synthes Wright Zimmer

Not only did the top tier companies struggle in 2009, but so too did many smaller companies working to get products to market. Funds available to finance many endeavors all but dried up and Archus Orthopedics, Disc Dynamics and Innovative Spinal Technologies all closed their doors due to lack of resources. Nonetheless, startups continue to enter the market, as evidenced by TGS Knee Innovations in joint replacement; DGIMed and Skeletal Dynamix in fracture repair; Axis Surgical Technologies, Del Palma, Ion Surgical Technologies, NuOrtho, Olive Medical, OrthoDynamix and Parcus in arthroscopy/soft tissue repair; and Binder Biomedical, Clariance and Renova in spine. Merger/acquisition activity continued at a steady pace, as well, mostly in deals that brought incremental technology advantages to the acquiring company, as illustrated by DePuy's purchase of Finsbury and Biomet's acquisition of Cartilix. Anika, Baxter and TiGenix broadened their orthobiologics portfolios with purchases of Fidia Advanced Biopolymers (FAB), Apatech and Orthomimetics, respectively, while actual share shifting (albeit small) acquisitions came with the combinations of Summit and ESKA and Alphatec and Scient'x. Several companies shelved initial public offerings in 2008 and 2009 due to the global economic downturn. With the turn of a new decade, however, Tornier and Trauson announced their intent to go public and others are likely to join them, signaling perhaps a more friendly capital environment for orthopaedic entities. Of all the orthopaedic companies marketing products worldwide, most generate less than $5 million in sales. Those with 2009 sales in excess of $10 million are profiled in Exhibit 6, along with the breadth and depth of their product offerings.

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6 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 6 orthopaEdic coMpaniES With 2009 SalES >$10MM: EStiMatEd SalES and brEadth/dEpth of product linE Company aap Acumed Aesculap Alphatec Amplitude Anatomica Anika/Fidia Anspach Apatech Arthrex ArthroCare ArthroSurface Ascension Baumer Biocomposites Biomecanica Biomet Biotechni Bone Support Ceraver Citieffe CoLigne ConMed Corin Custom Spine Dedienne Sante DePuy DeSoutter DJO Erothitan ETEX Euros Exactech FH Fin-Ceramica Genzyme Globus GMReis Groupe Lepine Gruppo Bioimpianti Implantcast Implantes Fico Impol Instrumental Integra 2009 Sales 33.1MM $115-$125MM $525-550MM $177MM 30MM $10-$15MM $30-$35MM $100-110MM $60-70MM $800MM $230MM $15-$20MM $15-$20MM $50-$60MM $10-$20MM $30-40MM $2.5BB $10-$20MM $10-$20MM $10-$20MM $20-$30MM $20-$30MM $414MM £41MM $10-$20MM $20-$30MM $4.9BB $30-$40MM $550-$600MM $10-$20MM $10-$20MM $30-$40MM $177MM $30-$40MM $10-$20MM $350-$375MM $200-$225MM $30-$40MM $20-$30MM $10-$20MM $40-$50MM $20-$30MM $10-$20MM $164MM Recon FF AR/ST Spine Biol BGS Other

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 7 Exhibit 6 orthopaEdic coMpaniES With 2009 SalES >$10MM: EStiMatEd SalES and brEadth/dEpth of product linE

(Continued)

Company Interventional Spine ISTO Japan MDM Japan Medical Materials JRI K2M Karl Storz Kensey Nash Kyocera/Kobe Lanx LDR Life Spine Lima MAKO Mathys MDT Implantes Medacta Medartis Medicrea Medtronic Merete MicroAire MTF NuVasive Olympus Medical OMNIlife science Orthofix OrthoHelix Orthovita Ortosintese Össur OsteoMed Osteotech Paradigm Spine Peter Brehm PhyGen Pioneer Surgical Richard Wolf RTI Salient Surgical Samo Biomedica SBi SeaSpine Seikagaku

2009 Sales $10-$15MM $10-$15MM ¥10,394MM $100-$120MM £17MM $60-$70MM $75-$100MM $27MM $100-$120MM $70-$80MM $30-$40MM $15-$20MM $40-$50MM $34MM CHF103.7MM $10-$20MM $35-$40MM $40-$50MM $19MM $3.7BB $15-$20MM $50-$60MM $350-$400MM $370MM $40-$50MM $10-$20MM $507MM $10-$15MM $93MM $20-$30MM $162MM $60-$70MM $97MM $10-$15MM $10-$20MM $10-$20MM $60-$70MM $60-$70MM $104MM $50-$60MM $40-$50MM $20-$30MM $50-$60MM ¥20,405MM

Recon

FF

AR/ST

Spine

Biol

BGS

Other

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8 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 6 orthopaEdic coMpaniES With 2009 SalES >$10MM: EStiMatEd SalES and brEadth/dEpth of product linE

(Continued)

Company Showa Ika Signus Sintea Biotech Smith & Nephew Solco Biomedical SoPlus Spinal Elements Spinal USA Spine Wave SpineArt SpineSmith Stryker Summit/ESKA Surgicraft Synthes Synvasive Takiron Tecres Teknimed Tornier Townsend Traiber TranS1 Trauson U.S. Spine Ulrich United Orthopedic Waldemar Link Weigao Orthopedic World of Medicine Wright Medical X-Spine Zimmer

2009 Sales $30-$40MM $30-$40MM $10-$20MM $2.9BB $50-$60MM $10-$15MM $20-$30MM $10-$20MM $10-$20MM $10-$20MM $10-$20MM $5.7BB $40-$50MM $30-$40MM $3.4BB $10-$15MM $10-$20MM $40-$50MM $10-$20MM $202MM $15-20MM $20-$30MM $30MM ¥211MM $10-$20MM $50-$60MM $20-$30MM $110-$130MM $10-$20MM $10-$20MM $488MM $20-$30MM $3.9BB

Recon

FF

AR/ST

Spine

Biol

BGS

Other

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JOinT replacemenT

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 11

JOint rEplacEmEnt

Overview Through joint replacement, metal (titanium, cobalt chrome and stainless steel alloys) or ceramic and plastic (ultra high molecular weight polyethylene or UHMWPe) devices replace diseased or damaged bone and cartilage, restoring alignment and function. Fixation of the implants into the bone can be accomplished either with bone cement (typically polymethylmethacrylate or PMMA), which serves as a grout to "fix" implants into place, or through cementless means, which typically involve a roughened texture or coating. Bone either "adheres" to the implant coating or incorporates into the surface of the implant. Nearly 2.9 million joint replacement procedures took place worldwide in 2009 ­ more than 1.4 million hip, 1.1 million knee and more than 95,000 shoulder replacements. U.S. volumes of joint replacement procedures totaled 48 percent of the number performed, with Western Europe accounting for 30 percent and Japan an additional seven percent. Patient Demographics People suffering from arthritis pain remain the primary patient population undergoing joint replacement procedures. Worldwide, the number of arthritis sufferers approximates 355 million people, more than 151 million with osteoarthritis (OA) and 24 million with rheumatoid arthritis (RA). OA remains the predominant diagnosis leading to hip, knee and shoulder replacement, with RA more often appearing as an underlying diagnosis for replacement of digits. OA is the sixth leading cause of years lost to disability worldwide and 80 percent of people with OA report some form of limitation in movement or activities, with 25 percent noting that they cannot perform their major daily activities of life. Knee OA has been found to be as disabling as any cardiovascular disease. For those with RA, more than half find themselves unable to work at all within ten years of onset of the disease. RA affects women three times more often than men. Medical care of arthritis and joint pain in the U.S. is estimated to cost $282 billion annually. It is the leading cause of disability; a more frequent cause of activity limitation than heart disease, cancer or diabetes; the second most frequently reported chronic condition and the third leading cause of work limitation there. It is also Australia's major cause of disability and pain and accounts for more disability among the elderly in Europe than any other disease. More people in Europe are affected by arthritis than any other chronic medical condition. Exhibit 7 summarizes select arthritis statistics. Exhibit 7 arthritiS and itS hEalth iMpact People with Arthritis · · · · · · · Australia 3.85MM (18.5% of population) U.K. 1 in 5 adults; 8.5MM with OA, 387,000 people with RA Canada ~4MM (16% of those over the age of 15) China 100MM Europe >100MM (3MM with RA) Japan 6MM (5% of the population) South Africa 1 in 7 people

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12 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 7 arthritiS and itS hEalth iMpact

(Continued)

· · ·

Shenzhen (South China) 22% of residents over 16 U.S. 46MM (1 in 5 adults); to rise to 67MM by 2030 27MM with OA and 2MM with RA

Costs of Arthritis to the Economy · · · · Australia $23.9BB Canada $4.4BB U.K. £5.5BB U.S. $281.5BB

In terms of patient age, most joint replacement procedures remain the purview of the elderly, as shown in Exhibit 8.

Exhibit 8 Joint rEplacEMEnt procEdurES by patiEnt agE

45-64

65+

36%

61%

3%

<45

The world's elderly population is expected to increase by three percent per year through 2020, with a similar growth rate occurring among those aged 45 to 64. The younger population, on the other hand, will increase at less than one percent per year. Exhibit 9 illustrates the growth expected in the world's population by age group from 2005 to 2020.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 13 Exhibit 9 thE World'S population by agE group: 2005 and 2020 Population (MM) 2020 2,513 2,286 2,085 724 7,608 Average Annual Growth 0.3% 0.8% 2.4% 3.5% 1.2%

Age Group <20 20-39 40-64 65+ Total World Population

2005 2,410 2,033 1,536 473 6,451

With more than 90 percent of joint replacements performed on people over the age of 45, the robust growth in these age groups will certainly bode well for the continued health of the joint replacement market. At the same time, an increase in the incidence of old sports injuries and obesity could further spur growth in the market. For instance, one study found that most female soccer players who had old knee injuries developed OA in that same knee within a 12-year period. In addition, obesity has been identified as a contributor to increases in arthritis (and meniscal tears and back problems). In fact, in one study, being overweight was found to significantly increase the risk of developing knee OA. Exhibit 10 summarizes results from additional studies on obesity and its link to arthritis and joint replacement.

Exhibit 10 arthritiS, Joint rEplacEMEnt and obESity · Obese women ~4X and obese men ~5X risk of developing knee OA (vs. non-obese) · 11 pound weight gain over 10 years = 50 percent increase in the likelihood of developing OA · Highest quartile of body weight up to 10X risk of knee OA vs. lowest quartile · Percent of arthritis cases linked to obesity up 5-fold from 1971 to 2002 · Risk of knee OA up 35% for every 5kg of weight gain · Doctor-diagnosed arthritis in U.S.: 16% of under/normal weight people vs. 22% overweight and 31% obese · 99% TKR in nonobese deemed successful 6.5 years after surgery vs. 88% in obese Estimates place the number of overweight people worldwide at 1.6 billion, with an additional 400 million obese. By 2015, these numbers could swell to more than 2.3 billion overweight and more than 700 million obese. With the apparent link between obesity and wear and tear of joints, a heavier population may portend well for growth in joint replacement into the future. The Market and Players In 2009, global sales of joint replacement products (hips, knees, shoulders, elbows, wrists, digits) exceeded $13.3 billion, an increase of just under six percent over sales generated in 2008. Knees comprised the largest subsegment of the joint replacement market, as illustrated in Exhibit 11.

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14 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 11 global Joint rEplacEMEnt SalES in 2009: rEvEnuES by SEgMEnt ($billionS)

Other Joints $0.34 Shoulders $0.59 Hips $5.65

Knees $6.77

Total Market $13.3BB

Geographically, sales in the U.S. accounted for 53 percent of global joint replacement revenues. In 2009, growth in joint replacement procedures worldwide decelerated from mid single digit to low single digit levels, largely as a result of the global economic uncertainties that faced people and institutions worldwide. Single digit growth had not characterized the joint replacement market since the early 1990s. Volume restrictions coupled with price intensity served to slow the markets worldwide, with Europe suffering more rapidly and for longer than the U.S. Hip and knee sales actually decreased for some of the world's largest manufacturers in 2009, as patients delayed and hospitals cancelled surgeries. Negative or flat pricing in joint replacement products befell all of the major companies in all of their major markets. Even products targeted at a younger population did not fare as well as expected due to the overall weakened economy. With the new year, stability characterized the implant businesses for most joint replacement manufacturers, even in Europe. Procedure volume improvements were seen globally, although growth has not returned to "pre-turmoil" levels. While price pressures are expected to continue, companies should still be able to gain price benefit from new product introductions. The world's seven largest joint replacement companies (and the only ones with global joint replacement sales in excess of $200 million) ­ Zimmer, Johnson & Johnson, Stryker, Smith & Nephew, Biomet, Wright Medical and Aesculap ­ generated 91 percent of hip, knee, shoulder and other joint product sales in 2009, as shown in Exhibit 12.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 15 Exhibit 12 global Joint rEplacEMEnt SalES in 2009: coMpany MarkEt SharES

Others 10.0%

Aesculap 1.6% Wright Medical 2.5% Smith & Nephew 11.0%

Zimmer 23.4%

Biomet 11.3%

DePuy 22.0% Stryker 18.1%

Other companies that sell joint replacement products number more than 100 worldwide. Many focus predominantly on particular geographic areas, as exemplified by Asia Orthopaedics in the Philippines; Japan Medical Materials and Japan MDM in Japan; United Orthopedic and Tianjin Taishan Medical in Taiwan and China, respectively; Fournitures Hospitalieres (FH), Intelligent Orthopaedics (IO), JRI Orthopaedics, Lima-Lto, Mathys and Waldemar Link predominantly in Europe; Baumer, Implantes Fico and Ortosintese in South America; Protetim in Eastern Europe; Roth Medical in South Africa; Sushrut and Uma Surgicals in India; etc. Other companies have built respectable joint replacement franchises by focusing on specific types of products such as Link and Stanmore in salvage/revision implants and Symbios in customs, the latter manufactured for individual patients based on preoperative computed tomography (CT) scans and x-rays. Strategic alliances in joint replacement over the past year included Summit's acquisition of ESKA Implants and DePuy's purchase of Finsbury. Further, Amedica and Orthopaedic Synergy entered into a joint venture agreement to support development, regulatory clearance and global distribution of silicon nitride ceramic articulating hip and knee implants and OMNIlife science will distribute (exclusively) SERF-Dedienne Santé's NOVAE Dual Mobility Acetabular Cup in the U.S. A list of companies with reconstructive device franchises can be found in the Appendix A at the end of this annual report. Technologies and Trends Although most hip and knee replacement procedures are performed on people over the age of 65, younger patients are undergoing joint replacement more frequently. In 1997, people over the age of 65 comprised 70 percent of primary hip and knee replacement patients in the U.S. By 2007, they accounted for 57 percent. A similar trend appeared in Canada from 1997 to 2007, where a 30 percent increase in hip and knee procedures in the 45 to 64 age group occurred while the number of hip and knee procedures rose a mere seven percent annually during that timeframe.

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16 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT The movement towards performing joint replacement in a younger patient population has occurred in large part due to the development of technologies and procedures that are more amenable and applicable to the activity levels and life expectancies of younger people. In the 1980s, when joint replacement came into its own, ultra high molecular weight polyethylene served as the primary bearing surface in hip and knee replacement. Over time (and largely in more active patients), polyethylene was shown to wear. Its wear particles have been implicated in the creation of osteolysis or bone death, which subsequently contributes to implant failure. Historically, surgeons delayed joint replacement in younger patients due to the potential risk of osteolysis. Traditional hip replacement involves the use of a cobalt chrome or titanium femoral stem with a cobalt chrome femoral head that articulates with a polyethylene liner in an acetabular cup. While polyethylene remains the bearing material of choice in joint replacement procedures, traditional poly has been superseded by its "enhanced" form. Through radiation processes, these enhanced polyethylenes undergo a structural change (a.k.a. crosslinking) that more tightly bonds their molecules. The resultant material reportedly exhibits improved abrasion and wear characteristics over traditional UHMWPe, thereby extending its longevity. Although some concern exists about the long-term wear properties of some of these highly crosslinked polyethylenes, they are used in the majority of hip cases and an increasing number of knee cases. Biomet, Corin and Mathys have taken enhanced poly one step further by stabilizing it with vitamin E. Biomet's E1 Antioxidant infused bearings helped to drive the company's 2009 hip sales and, along with its metal-on-metal offerings, grew faster than Biomet's first generation enhanced polyethylene. Zimmer holds a license for a vitamin E technology, as well. Most key players in joint replacement also market alternate bearing constructs that center on metals and ceramics. For instance, ceramics and cobalt chrome alloys have replaced poly in acetabular cup liners, and ceramic femoral heads find use as well in hip replacement. As a result, various ceramic-on-ceramic and metal-on-metal options exist for today's orthopaedic surgeon, with the use of these hard bearing constructs accounting for an estimated 30 percent of bearing couples in use. Throughout the last year, Biomet and Stryker both noted strong performance from their alternative bearing systems, while Corin reported lower sales and narrowed patient indications for its comparable products in Europe. Corin will develop a new cup system with multiple bearing options. With no metal-on-metal offering, Stryker introduced the industry's first so-called mobile bearing hip to address dislocation issues without metal-on-metal bearings. The system features a dual mobility acetabular system with advanced bearing technology, which reportedly provides significant wear reduction vs. conventional polyethylene. The use of diamond-on-diamond remains a point of discussion between Dimicron and Exactech, although particular applications of the technology have not been identified. Ceramic-on-metal articulating combinations have also begun to emerge, as demonstrated by DePuy's CoMplete system, the first ceramic-on-metal acetabular system to complete clinical trials in the U.S. In 2009, FDA's Orthopaedic and Rehabilitation Devices Panel unanimously agreed to recommend for clearance of the system. While the use of alternate bearings serves to address a younger, more active patient, so too do larger diameter head systems, which allow for increased range of motion and a lower risk of postoperative dislocation. Today, larger diameter heads are part and parcel of companies' full lines of hip replacement products. In the U.K., large diameter metal-on-metal heads accounted for seven percent of acetabular constructs in 2008.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 17 Beyond alternative bearings and large diameter heads, companies market surface replacement hip systems targeted at a younger patient. With a surface replacement hip, the surgeon removes only the surface of the femoral head, replacing it with a hemispherical implant that fits within the acetabular shell. Because a minimal amount of bone is resected, surface replacement surgery is far more conservative and thus, may be more appropriate to the management of the often less advanced disease state of a younger patient. According to implant registries, resurfacing hip procedures accounted for approximately eight percent of primary hip procedures in Australia and the U.K., less than two percent in Sweden and less than one percent in Canada, although resurfacing is employed in approximately four percent of hip revisions in Canada. Interestingly, the use of resurfacing in Australia has declined over the past two years, as has been the case in the U.K., as well. Smith & Nephew's Birmingham resurfacing hip leads the resurfacing market globally and comprises 25 percent of the company's U.S. hip sales. Smith & Nephew seeks to expand its resurfacing lineup with a new acetabular cup system that is awaiting FDA clearance. Outside the U.S., the Birmingham has faced intense competition and its market share in both the U.K. and Australia has fallen from more than 70 percent share to around 50 percent in a five year timeframe. Key competition to the Birmingham has come from Biomet's Recap, Corin's Cormet (distributed in the U.S. by Stryker), DePuy's ASR, ESKA's Bionik, Finsbury's Adept and MITCH products, IO's ICON (distributed by Global Orthopaedic Technology in Australia), Wright Medical's CONSERVE and Zimmer's Durom. Of note, DePuy reportedly recalled the ASR from the Australian market at the end of 2009 due to high rates of failure with the device and the U.K.'s regulatory agency issued an alert on the ASR cup following reports of higher than anticipated revision rates. Active Implants' TriboFit pliable, medical-grade polycarbonate urethane acetabular implant represents another resurfacing option and is available in Europe for use in hip arthroplasty and hip resurfacing. JRI claims exclusive distribution rights to the system in the U.K. Other conservative joint replacement technologies can be found with DePuy's bone-preserving Proxima hip, Corin's "mini" stem, Zimmer's Fitmore bone preserving stem and Aesculap's Metha hip short shaft cementless prosthesis with ceramic surfaces. Of note, Zimmer and Corin both recorded strong performance from their bone preserving femoral stems in 2009. Other initiatives on the hip side include gender specific implants developed by Zimmer. Exhibit 13 summarizes the competitive landscape for hip replacement options available worldwide.

Exhibit 13 hip rEplacEMEnt tEchnology optionS by coMpany Enhanced polyethylene: Biomet, Corentec, Corin, DePuy, DJO, Exactech, Lafitt, Smith & Nephew, Stryker, Wright Medical, Zimmer Vitamin E poly: Biomet, Corin, Mathys, Zimmer Metal-on-metal: Biomet, Corin, DePuy, DJO, ESKA, Implantcast, Implants International, Lima, Mathys, Permedica, Smith & Nephew, Wright, Zimmer Ceramic-on-ceramic: Aesculap, Asia Orthopaedics, Biomet, Citieffe, Corentec, Corin, Dedienne Sante, DePuy, DJO, ESKA, Euros, Exactech, Implanet, Implantcast, Implants International, Mathys, Permedica, Samo, Smith & Nephew, StelKast, Stryker, Tornier, United Orthopedic, Waldemar Link, Zimmer

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18 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 13 hip rEplacEMEnt tEchnology optionS by coMpany

(Continued)

Metal-on-ceramic: DePuy, ESKA Resurfacing: Active Implants, Biomet, BioPRO, Corin, DePuy, ESKA/Summit, IO, Implantcast, Implants International, Lima, Medacta, Permedica, Smith & Nephew, Van Straten Mini Stems/Bone Preserving: Aesculap, Biomet, Corin, DePuy, ESKA, Lima, Waldemar Link, Zimmer

As in hip replacement, enhanced polyethylene plays a role in reducing potential wear in knee replacement. So too do less-constrained mobile bearing knee (MBK) designs. Due to their design, MBKs reportedly reduce contact stress and subsequent potential wear of polyethylene. Numerous companies worldwide market mobile bearing knees, with U.S. clearances granted only to DePuy and Zimmer. Stryker had been conducting clinical studies in the U.S. for its mobile bearing knee. However, results revealed no statistical difference in clinical outcomes between its mobile bearing and traditional fixed bearing knees. In addition, the company's Triathlon Knee with X3 Advanced Bearing Technology exhibited a 97 percent reduction in total polyethylene volume loss vs. competitive mobile bearing knees. As a result of these findings, Stryker has chosen not to offer a mobile bearing knee system in the U.S. market. Other companies have reportedly postponed submissions for clinical trials of mobile bearing knees in the U.S., believing that FDA may downclassify the products. Ceramics also play a role in knee systems, as exemplified by Smith & Nephew's Oxinium oxidized zirconium material, a proprietary transformed metal alloy with a ceramic bearing surface. Invibio's MOTIS carbon fiber/PEEK material against a cobalt chrome counterface in a mobile bearing unicompartmental (uni) device demonstrated lower levels of wear than the same construct with UHMWPe. Kinamed and Kyocera partnered to develop a zirconia ceramic femoral knee component, which is part of the Gem knee system currently under investigation in the U.S., and Aesculap introduced its Alternative Surface technology zirconium nitride coating for knee implants (Columbus Knee System). The company reports that the material has been used in more than 1,200 procedures to date, and has been shown to almost eliminate metal ion release while reducing polyethylene wear by up to 60 percent. Materials aside, a key trend in knee replacement to emerge over the past year has been the use of customized instrumentation. OtisMed (acquired by Stryker) began the trend with its TRIOS, a custom disposable alignment cutting guide tailored to the anatomy of individual knee replacement surgery patients. Taking preoperative CT or magnetic resonance imaging (MRI) scans, OtisMed applies its proprietary preoperative planning software and rapid manufacturing technology to create a template and cutting "jig" that accurately fit the unique anatomy of each individual patient. Stryker is not alone in its ability to provide customized instrumentation for knee replacement procedures. All told, customized instrumentation systems are available from: · Biomet ­ Signature Personalized Patient Care System that uses 3D MRI to create personalized positioning guides that don't require instrumentation of the bone canal, thus allowing for a potentially less invasive procedure ConforMIS ­ iUni-G2 with implants, iView patient-specific imaging data and iJig patient-specific instrumentation

·

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 19 · DePuy ­ TruMatch Personalized Solutions with software customized to the patient's anatomy and the surgeon's surgical preferences along with integrated metal saw and pin captures for improving accuracy and minimizing osteolytic debris Medacta ­ MyKnee Cutting Blocks that use MRI and x-ray images to create customized instruments for use with the company's GMK Total Knee System Smith & Nephew ­ Visionaire Patient Matched instrumentation system that uses MRI and x-rays to create custom instrumentation for use with the company's knee implants Stryker ­ OtisMed's TRIOS featuring preoperative CT or MRI scans as well as rapid manufacturing technology Wright ­ Prophecy Pre-Operative Navigation Guides that work with MRI or CT scans to provide more accurate implant positioning Zimmer ­ Zimmer Patient Specific Instruments that use MRI imaging and pre-operative software planning to create disposable, patient matched, femur and tibia pin placement guides

· · · · ·

Biomet, Smith & Nephew, Wright Medical and Zimmer all have noted a favorable impact of personalized instrumentation on knee sales. In the most common knee replacement procedures, surgeons replace the three compartments of the knee ­ medial, lateral and patellofemoral. However, often a patient's disease state involves just one or two compartments and total replacement may not be necessary. In these cases, the surgeon may opt for a more conservative approach with the use of unicompartmental, patellofemoral or bicompartmental implants. A variety of companies offer these implants throughout the world, from Implantcast to MAKO Surgical. Most unis feature fixed bearings although several companies also market mobile bearing unis, including Amplitude, Biomet, Corin and DePuy. Biomet's Oxford Partial Knee remains the only free-floating mobile bearing partial knee cleared by FDA. ConforMIS offers the FDA-cleared and CE Mark approved iUni unicompartmental knee resurfacing device for medial and lateral use, as well as bicompartmental implants that resurface one side of the knee and a portion of the patellofemoral joint. Each of the company's products comes with corresponding cutting and placement guides designed from patients' CT scans using the company's proprietary iFit technology to eliminate manual sizing during surgery. Smith & Nephew's Journey Deuce Bi-Compartment Knee also replaces two of three compartments of the knee, while Stryker's Triathlon features a partial knee resurfacing component. DePuy also markets a partial knee that can replace medial, lateral or patellofemoral compartments. MAKO Surgical launched a Lateral Unicompartmental Knee Resurfacing Application for its Robotic Arm Interactive Orthopedic System. The company's RESTORIS Multicompartmental line of knee implants includes uni- and bicompartmental knee applications for the medial and patellofemoral compartments. VOT Arthroscopic Solutions has implanted its Solo Partial uni through a 2-inch incision, with the goal of decreasing the incision to one inch for a full resurfacing of the medial condyle. Advanced Bio-Surfaces offers a conservative option for moderate OA of the medial knee in its OrthoGlide Medial Knee, while Arthrosurface's HemiCAP (Contoured Articular Prosthesis) implants allow for the replacement of only damaged, irreparable articular cartilage. The technology incorporates 3D mapping technology, instruments to map and prepare the damaged area and a rounded cobalt chrome cap-like implant that sits flush with the joint surface. Arthrosurface's unicondylar implant received marketing clearance in the U.S. and Europe, while its patellofemoral and femoral condyle implants remain in clinicals. Cardo Medical's À La

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20 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Carte Knee Remodeling system features total, unicondylar and patellofemoral replacement implants, while newcomer TGS Knee Innovations has developed the TGS UKA System, designed to help restore natural movement by implanting devices in a way that accommodates the soft tissue. Finally, BioPoly RS, a subsidiary of Schwartz Biomedical, has developed a technology that features a hydrophilic polymer (UHMWPe + a naturally occurring polysaccharide molecule) with mechanical and biochemical properties similar to those of articular cartilage. One application under development includes use of BioPoly self-lubricating plastic as a synthetic cartilage for partial resurfacing of the knee. According to the most recent data, unicondylar procedures make up approximately eight percent of knee replacement procedures worldwide, declining as a percent of all procedures for the past two years in Australia and the U.K. Exhibit 14 shows the variance in penetration of non-tricompartmental knees in key geographies throughout the world. Exhibit 14 partial knEE rEplacEMEntS aS pErcEnt of priMary knEE rEplacEMEnt in variouS gEographiES Unicompartmental · Australia 13% · · · · · Canada 8% Norway 12% Sweden 7% U.K 8% U.S. 7% Bicompartmental · Australia 0.6% · U.K. 1%

Gender designs began on the knee side with Zimmer's introduction of its Gender Solutions Knee, an implant specifically designed to address the unique anatomy of a woman's knee. Smith & Nephew, DePuy and Wright Medical introduced products that also address anatomical issues; however, the marketing "excitement" surrounding gender as a differentiator has waned to a degree and DJO and Consensus Orthopedics claim that gender-related differences are not as crucial as size matching, which is already addressed in their component designs. Exhibit 15 summarizes the competitive landscape for knee replacement options available worldwide.

Exhibit 15 knEE rEplacEMEnt tEchnology optionS by coMpany Unicompartmental: Aesculap, Amplitude, Asia Orthopaedics, Biomet, BioPRO, Cardo Medical, ConforMIS, Corin, DePuy, DJO, Euros, Exactech, FH Orthopedics, Global Orthopaedic, Implantcast, MAKO, Permedica, Protetim, Smith & Nephew, StelKast, Stryker, TGS, Tornier, Waldemar Link, VOT, Whiteside, Wright Medical, Zimmer

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 21 Exhibit 15 knEE rEplacEMEnt tEchnology optionS by coMpany

(Continued)

Bicompartmental: ConforMIS, MAKO, Smith & Nephew Patellofemoral: Biomet, Cardo Medical, DePuy, Global Orthopaedic, Kinamed, MAKO, Smith & Nephew, Stryker, Zimmer Mobile bearing total and/or uni: Amplitude, Biomet, Citieffe, Corin, Serf Dedienne Sante, DePuy, Elite Surgical, Endotec, ESKA, Euros, Global Orthopaedic, Groupe Lepine, Mathys, Permedica, Privelop, Smith & Nephew, Stryker, Tornier, United Orthopedic, Waldemar Link, Wright Medical, Zimmer Customized instrumentation: Biomet, ConforMIS, DePuy, Medacta, Smith & Nephew, Stryker, Wright Medical, Zimmer Resurfacing: Advanced Bio-Surfaces, ArthroSurface, ConforMIS, DePuy, Permedica, Zimmer Ceramics: Japan Medical Materials, Kinamed

In shoulders, Biomet, DePuy, Exactech, Implantcast, Tornier and Zimmer, among others, have built solid franchises, complete with total, partial, revision and fracture stems, while Traiber is developing a shoulder. In addition, companies from Asia Orthopaedics to Zimmer have launched reverse shoulder implant systems for patients with severe rotator cuff pain. These prostheses reverse the anatomy of the shoulder to use the healthy deltoid muscle. Like resurfacing for hips, similar products have emerged in shoulder portfolios. For instance, Ascension launched a pyrocarbon humeral resurfacing device worldwide and filed an Investigated Device Exemption (IDE) for the device, as well. Tornier released a resurfacing head for its Aequalis line, with DePuy's resurfacing foray coming through the launch of its Global CAP CTA resurfacing prosthesis for cuff tear arthropathy. Ascension also intends to launch its pyrocarbon hemi shoulder outside the U.S. in 2010. Exhibit 16 displays companies that market resurfacing and reverse shoulders worldwide.

Exhibit 16 rESurfacing and rEvErSE ShouldEr rEplacEMEnt tEchnologiES by coMpany Resurfacing: Arthrosurface, Ascension, Biomet, DePuy, DJO, Endotec, Implantcast, Impol, Lima, Tornier, Zimmer Reverse: Biomet, Biotechni, DePuy, DJO, Endotec, Euros, Exactech, Lima, Mathys, Tornier, Zimmer

In small joint initiatives, DePuy, Integra, Tornier and Wright market total ankle systems in the U.S., with Memometal Technologies acquiring Advanced Bio-Surfaces' OrthoGlide Ankle, akin to a unicompartmental knee in its more conservative approach vs. total ankle replacement or ankle fusion. Outside the U.S., Baumer, Corin, ESKA, Euros, FH, Implantcast, Integra, JMM, Link, Protetim, Sovereign Medical and Tornier sell their ankle systems. Interestingly, outside the U.S., mobile bearing ankle designs prevail, with Corin, Dedienne Sante, ESKA, Integra, Tornier and Van Straten all marketing mobile bearing ankles. While Endotec continues to pursue FDA clearance of its mobile bearing ankle device, FDA cleared for marketing the Scandinavian Total Ankle Replacement system (the "S.T.A.R. ankle") in May 2009. Small Bone Innovations (SBi) obtained the product through its acquisition of Link America, and other assets from Waldemar Link.

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22 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Other small joint products include Artimplant's Artelon STT Spacer and CMC Spacer Arthro for treatment of OA in the scaphotrapezotrapezoidal joint and thumb base arthritis, respectively. The Artelon Resurfacing concept involves a minimal resection of the joint afflicted by OA, creating the preconditions for integration of tissue in the implant, thus creating a new joint surface. Long a leader in digit implants, Wright Medical also offers elbow, radial head, ulnar head, wrist, trapezium, lunate, scaphoid, finger, thumb, ceramic interpositional implants, Great Toe, hinge toe and subtalar and hammertoe implants. Focused on small bones, Ascension markets FDA cleared and CE Mark approved silicone and pyrocarbon digit implants, the first pyrocarbon trapeziometacarpal implant, resurfacing hemiarthroplasty for Great toe, a hemiarthroplasty device for treatment of thumb-based arthritis and an implant for treatment of arthritis in the fourth and fifth tarsometatarsal joints of the foot. Implantcast markets a trapeziometacarpal implant, Extremity Medical received clearance for its trapezium replacement and Arthrosurface, BioPRO, Orthosonics and OsteoMed market hemi and total metatarsophalangeal joints. Other small joint implants can be found in the portfolios of Aptis Medical (CE Mark approved and FDA cleared distal radioulnar joint), ESKA (proximal interphalangeal/PIP, MCP, ankle and Great toe), Merete Medical (FDA-cleared ToeMobile Anatomical Great Toe Resurfacing System) Finsbury (PIP and TMP), Mathys (finger), Metasurg (subtalar implant) and Tecres (MCP implant), etc. Minimally invasive surgical techniques in joint replacement typically center on the refinement of instruments and modification of surgical techniques such that they can be used with standard hip and knee implant components with minimal or no compromise to surrounding structures. MIS techniques allow for smaller incisions (e.g. two to five inches vs. standard eight or more inches), minimal disruption of key soft tissue integrity (e.g. quad-sparing in the knee) and reportedly more rapid rehabilitation and less pain. MIS approaches are intended to reduce surgical trauma, blood loss, scarring and length of hospital stay, while improving overall recovery. In Canada, 13 percent of total hip and 11 percent of total knee replacement surgeries are performed through MIS approaches. In Sweden, 61 percent of unicondylar knee replacements used MIS procedures, and in the U.K., MIS techniques found use in five percent of hip replacements, 50 percent of unicondylar knees and three percent of all other types of knee replacements in 2008. Of note, the use of MIS in unicondylar knee replacements rose from 37 percent of procedures in 2004 to 50 percent in 2008. Minimally invasive surgical procedures can be performed with standard implants, although implant makers have developed implants specially designed for small incision procedures. Most joint replacement companies have MIS instruments and techniques in their product portfolios. At the opposite end of the spectrum from minimally invasive surgery and conservative approaches lies revision surgery. In a revision joint replacement procedure, the surgeon removes and replaces one or more of the components. Revisions account for as little as five percent of knees to more than ten percent of hip replacement procedures, depending on the geographic region, as shown in Exhibit 17.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 23 Exhibit 17 rEviSionS aS a pErcEnt of all Joint rEplacEMEntS Hips · Australia 12% · Canada 14% · Sweden 10% · U.K. 9% · U.S. 13% Knees · Australia 8% · Canada 6% · Sweden 6% · U.K. 5% · U.S. 9%

All major reconstructive device companies have expanded their franchises into devices designed for revisions, to address the unique surgeon and patient needs of these challenging procedures. Bone cement also has application in joint replacement. Globally, approximately half of hip stems and acetabular components and most knee tibial components are cemented into place. In the U.S. cementless hip systems claim 60 percent of more of units sold, while their use outside the U.S. ranges from 71 percent in Canada to 45 percent in the U.K. (down from 77 percent in 2004). On the knee side, most replacements are performed with cement, as is exemplified by the U.K. and Canada where more than 80 percent of knee procedures use cement. Most of the major implant companies market bone cement mixers, bowls, guns/injectors (for introducing cement) and bone cement, the latter with and without antibiotics. The vast majority of cements used worldwide include antibiotics, and Stryker's Simplex bone cement continues to be the most widely used bone cement in the world. Of smaller companies, Advanced Biomaterial Systems (ABS), Amplitude, Baumer, Bidoia, Ceraver, Corin, Gruppo Bioimpianti, Lima, Summit Medical and Synimed also market bone cements and accessories for joint replacement applications in various geographic regions. A successful cementless joint replacement relies on stable initial fixation and tissue ingrowth into the implant for long-term fixation. Implant manufacturers strive to develop implant surfaces that will promote these two goals. With this in mind, all the major implant companies market porous metal construct technology aimed at promoting good fixation and tissue ingrowth. Products include Biomet's Regenerex Porous Titanium Construct, DePuy's Gription, Lima's Trabecular Titanium, Smith & Nephew's Stiktite, Stryker's Tritanium, Wright's BioFoam and Zimmer's Trabecular Metal. Other technologies include Biorthex's Actipore (porous nickel-titanium alloy) and Ortix from Tigran Technologies (commercially pure titanium granules). Summary As we move into a new decade, joint replacement technologies likely will not change dramatically. Nor will the overall market or the competitive standing of companies. Dynamics expected to positively affect the market include an aging, obese and active population, while mitigators to growth will include more price conscious environments, rationing of care, evidence-based medicine that challenges joint replacement as an option to treatment of OA, etc. Exhibit 18 provides a summary of the key dynamics of the joint replacement market.

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24 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 18 thE Joint rEplacEMEnt MarkEt: kEy MarkEt dynaMicS · · · · · $13.3 billion, growing at 6% from 2008 to 2009 More than 2.9 million procedures Highly competitive - 91% controlled by top 7 players; very little share shift in 10+ years Highly price sensitive and expected to become increasingly so Technologies driving growth: optimal bearing surfaces, MIS, customized/personalized instruments, small joint initiatives

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FracTure repair

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 27

FracturE rEpair

Overview Fracture repair entails the manipulation of a fractured bone such that it is returned to its proper position and alignment. Manipulation of the bone can occur either in a closed fashion (e.g. nonsurgically) or in an open fashion using surgical incision and correction, with or without the use of fixation devices to secure the fractured bone in its proper anatomical position. Devices used to repair fractures include those applied externally (e.g. external fixators) and those implanted through open or closed means such as plates, screws, pins, wires, staples and intramedullary (IM) nails. Initially, stainless steel comprised the material of choice in internal fixation products. Over time, however, titanium has come to be used in nearly as many cases globally, largely due to its higher strength to weight ratio and its more image friendly quality. More than 50 million fractures occur worldwide every year, most from accidents, falls and activity-related injuries and most in people under the age of 65. Further, more than eight million fracture repair procedures (open and closed reduction with and without fixation, internal fixation without reduction, application of external fixator, etc.) were performed globally in 2009, most often on the radius/ulna, wrist/hand, tibia/fibula and ankle/foot. These figures do not include the treatment of vertebral compression fractures, which are covered in the Spinal Implants and Instrumentation section of this report. Patient Demographics Fractures afflict all age groups. However, of the millions of fractures that occur each year worldwide, just over half afflict people under the age of 45, as shown in Exhibit 19.

Exhibit 19 fracturES by patiEnt agE

65+ <45 29% 51% 21%

45-64

Over the next decade, the incidence of fractures likely will not slow, based solely on population demographics. More than six billion people worldwide will continue to be active, grow old and, on average, incur two fractures each over their lifetimes. In addition, increased industrialization and improved standards of living may lead to the use of more automobiles in highly populated areas like China and India. Undoubtedly more accidents will ensue, and with them will undoubtedly come more fractures.

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28 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Access to healthcare in many of the more populous (and often poorer) parts of the world could lead to basic fracture repair treatment where none existed in the past. Groups like Surgical Implant Generation Network (SIGN) have already begun to provide IM technologies to these types of areas. The Market and Players In 2009, sales of fracture repair (internal and external along with craniomaxillofacial) fixation products worldwide neared $5.2 billion, an increase of 6 percent over 2008 sales. Exhibit 20 displays fracture repair sales in 2009 by segment.

Exhibit 20 global fracturE rEpair SalES in 2009: rEvEnuES by SEgMEnt ($billionS)

Internal Fixation $3.68

External Fixation $0.78

Craniomaxillofacial $0.72

Total Market $5.2BB

In 2009, Synthes remained the market's leader with 43 percent market share globally. Other key players, each with fracture repair sales in excess of $100 million, include Stryker, Smith & Nephew, Zimmer, DePuy, Biomet, Acumed and Orthofix. Together, these eight largest companies controlled 85 percent of the total market in 2009, as shown in Exhibit 21. Exhibit 21 global fracturE rEpair SalES in 2009: coMpany MarkEt SharES

Synthes 43.1%

Other 14.6%

Ortho x 1.9% Acumed 2.2% Biomet 3.7% DePuy 4.1% Zimmer 4.5% Smith & Nephew 8.0%

Stryker 17.8%

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 29 Furthermore, companies like Aesculap, Integra, Medartis, OsteoMed and Wright Medical also claim solid positions in the global market (>$40 million in sales). Integra and Wright Medical have developed strong small bone fixation portfolios, while focus for OsteoMed and Medartis centers on both small bone and craniomaxillofacial fixation. A comprehensive list of fracture repair companies and the products they market can be found in Appendix B at the end of this report. Technologies and Trends Over the past decade, a number of trends have emerged in fracture repair, with perhaps the most market-changing being the use of locking plates. Locking plate systems feature a screw that locks into the plate, thereby maintaining more rigid structure and generally preventing screw backout. More than 80 percent of all plate and screw systems today feature locking plate designs and companies from Synthes to Intrauma market these implants. In fact, Synthes continues to post solid growth in its locking implant lines, in particular those used in distal radius and clavicle applications. In addition, various companies ­ Biomet, Integra, Smith & Nephew, Stryker, Wright Medical ­ have recently introduced locking plate systems for smaller bone applications. Intramedullary nailing remains the preferred method for treatment of long bone fractures. The procedure involves the insertion of a metal nail into the intramedullary canal where it is locked in place with screws. However, the locking screws are not fit tightly and, thus, toggling of the nail can occur. To provide more stability in these cases, Synthes developed the Angular Stable Locking System (ASLS) for IM nails, which dovetails from the company's development of locking plate technology. ASLS features a sleeve that is inserted into the nail with the screw and expands during the insertion of the screw. This expansion prevents toggling of the nail. Synthes also developed the RIA (Reamer-Irrigator-Aspirator) for eliminating risk of embolization in IM reaming. The device's reaming feature may also provide autograft for trauma procedures. Antibiotic coatings also remain on Synthes' development horizon for IM nails. A longstanding issue with IM nails is the inability of surgeons to locate the distal screw holes for locking the nail in place. Fluoroscopy is typically used to "guide" surgeons into the distal screw holes; however, excess exposure to radiation remains a key concern with traditional nail designs. DGIMed's Distalock Drill System, implanted in more than 30 people, uses Nitinol (nickel titanium) wire with inside out technique to mark where screws should be placed. Smith & Nephew's Sureshot Distal Targeting System also addresses radiation exposure during IM nailing. Used with the Trigen nail, the Sureshot is a portable device that uses 3D imaging rather than fluoroscopic C-arms, which are the most common form of imaging used in nailing procedures. SIGN has created a nailing system that obviates the need for imaging assistance by allowing the surgeon to lock the nail distally through the use of an outrigger that is mechanically connected to the nail. The technology, hence, expands the use of nails into geographic regions where imaging may not be either affordable or practical (e.g. on the battlefield, in lesser developed nations, etc.). Of late, IM nails have also found more application in the treatment of intertrochanteric femoral fractures, where surgeon preference for their use rose from three to 67 percent from 1999 to 2006. Further, IM technologies have entered the small bone arena with Wright Medical's MIS Micronail, the first IM nail introduced for treatment of distal radius fractures. More recently, Integra and Ortho Solutions received clearances for IM nails used in small bone fusion applications, and Sonoma Orthopedic Products released the WavEon WRx and CRx devices for

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30 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT minimally invasive repair of unstable distal radius and mid-shaft clavicle fractures, respectively. Both products utilize Sonoma's WaviBody Technology, a design feature that allows the device to be flexible to facilitate insertion but to then be locked to provide fixation. Extremity Medical received FDA clearances for its IM fusion products for first metatarsophalangeal and midfoot fusion applications, while Skeletal Dynamics awaits clearance for its IMplate Wrist Arthrodesis Nail. External fixation products generally find use when internal fixation is contraindicated or when a temporary solution is required. Fixators also have application in limb lengthening procedures. While the market leading companies all sell external fixation devices, so too do some lesser known smaller, newer entities like Gexfix, which focuses on external fixation with its composite devices for small fixators for wrist and pediatric application, large fixators for leg, ankle and pelvic fixation, a hybrid system with carbon rings and the tension guide fixator for proximal humerus fractures. Other newer external fixation offerings come from: · · · · · · · · · · · · 3D Medical Concepts ­ cannulated pins with Angle Blocks for oblique insertion BK Meditec ­ DynaExtor full line of fixators ExtraOrtho ­ Extrafix External Fixation System Intelligent Orthopaedics ­ flexible IOS external fixators for the treatment of diaphyseal tibial fractures New Medical Technology ­ Micro Mandibular External Fixator/Distractor Normed ­ fixation and distraction systems Nutek Orthopaedics ­ non-bridging external wrist and shoulder fixators Ortho Select ­ large, small, ring and linear fixators Small Bone Innovations ­ Mini Rail for first metatarsophalangeal and subtalar fusion Surgicraft ­ S Quattro for displaced comminuted intra-articular fracture dislocations of the phalanges Wright Medical ­ CORETRAK Articulating External Fixator for foot surgery) etc.

Most of the action in fracture repair over the past five years has come from products introduced for treatment of the small bones, which account for just over 44 percent of all fractures incurred annually. Globally, more than 30 companies offer products for the distal radius, hand, ankle and foot, with leading positions held by DePuy, Wright Medical, Integra, Acumed, Medartis, Osteomed and Synthes. The last 18 months have witnessed numerous new product innovations in the small bone arena, including OsteoMed's hps hand plating system and Integra's HalluLock MTP Arthrodesis System. OsteoMed intends to release its FPS system of titanium implants, plates and screws for use in lower extremity trauma procedures, while clearance could come in the near future for Skeletal Dynamics' elbow internal joint stabilizer, radial head system and wrist plate. Recent small bone product clearances include Fusion Medical's subtalar implant, MetaSurg's mid- and forefoot fixation products, distal volar plating from SBi and distal radius and small fragment fixation products from TriMed. Intrauma also markets a full line of specialty plates and screws for malleolar, calcaneus, clavicle, radius/ulna, humerus and olecranon applications.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 31 Surgicraft's Bone Tie provides an alternative method of fixation of intra-articular or comminuted fractures, particularly those in the phalanges. A hole is drilled across the fracture site and a loop of stainless steel wire is introduced to entrap and secure a stainless steel, butterfly shaped plate at either end of the fracture. UPex Holdings, through its acquisition of the assets of LeveL Orthopedics, carries a range of plates and other devices for fracture fixation of the finger, wrist, arm and elbow, as well as implant designs for joint replacement of the carpometacarpal (CMC or thumb) joint and other extremity-bone and soft tissue repair products. Despite its intensely competitive nature, the global fracture repair marketplace has always attracted start-ups and continues to do so. Newcomers over the past 18 months include the following companies, listed along with the trauma products they have developed: · · · · · · · · · · · AngleFix ­ T Locking Plate Expanding Orthopedics ­ wide range of "simple to use" products FxDevices ­ Pogo Screw Internal Fixation Systems ­ less expensive implants Kens FineMedTech ­ internal fixation system OrthoMechanics ­ anchors for hip screw and IM applications OrthoMediTec ­ WaisFix 100i for intracapsular femoral fracture fixation OrthoNetx ­ distraction osteogenesis devices for treatment of craniofacial deformities, limb length discrepancies and small bone deformities Ortho Select ­ bone plates and screws Simplicity Orthopedic Solutions ­ expandable anchors Synergy Surgical ­ cannulated screws

Novelty in fracture repair came with the introduction of FxDevices' Pogo Screw and Lagwire. The Pogo Screw (which looks like a pogo stick) offers dynamically applied constant compressive fixation of fractures. While stainless steel and titanium remain the predominant materials used in fracture repair implants, resorbables have a place, as well. The devices need to only provide structural support for a sufficient period to allow bone healing, and then are either removed or are no longer functional. Most companies offer some resorbable products for fracture repair, in particular those used in craniomaxillofacial applications. Resorbable technologies remain the focus of bankrupt Inion, whose Optima polymer comprises a polylactic acid/trimethylenecarbonate copolymer for repair of a variety of traumatic fractures. Advanced Biomedical Technologies is using a biodegradable polyamide material to develop a line of internal fixation implants, including screws, wires and rods. The company's screw and wire are part of a clinical trial in China. Other resorbable trauma products (e.g. resorbable nails, plates and screws) exist in the portfolios of a variety of companies from sports medicine players like Arthrex, Biomet Sports Medicine, ConMed Linvatec and DePuy Mitek to SBi with its RingFIX line of external fixators; Synthes with its PolyMax fixation system, etc. Materials specialty company, Invibio, developed PEEK(polyetheretherketone)-Optima polymers for use in locking plates and its Endolign composite found application in plating and nailing systems (including an FDA cleared and

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32 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT CE Mark approved humeral nail from N.M.B.). Science for Bio Materials' Duosorb combines tricalcium phosphate (TCP) ceramic and Poly DL Lactic Acid (PLDLA) for use in locking plates and screws for high tibial osteotomy, and NovaPedix's highly purified alginates will be developed into load bearing and resorbable internal fixation devices. Other interesting materials for fracture repair include shape memory technologies which "remember" their original shapes. The most common shape memory alloy in use in orthopaedic applications is nickel-titanium or Nitinol. Shape memory products can be found in the Memodyn Compression Staple (Bio Research Innovations), AEON Shape Memory Implants (InteliFUSE and its U.S. distributor, Integra), Lima, MemoClip and MemoStep staples (Memometal), Reverto Shape Memory Staple (Core Essence) and Technologie Transysteme's IP FIX H-shaped memory devices. MedShape Solutions' expertise in both polymer and metal shape memory materials may be leveraged into the trauma space. The company has developed products that use the shape memory and pseudoelastic properties of Nitinol alloys to provide continuous reduction and compression across fractures while also adjusting for changes in the surrounding bone. Bone Growth Stimulation An estimated five percent of fractures that occur annually do not heal properly. Bone growth stimulation has been used for years to help spur these problematic fractures to better heal (and as an adjunct to spinal fusion). Global revenues for bone growth stimulation for all applications reached $524 million in 2009, with 70 percent of sales coming from just two companies ­ Biomet and Orthofix. Stimulation is spurred through various technologies (e.g. ultrasound, pulsed electromagnetic fields, etc.), all of which have demonstrated their ability to induce the growth of bone. Biomet, DJO, Orthofix and Smith & Nephew all sell bone growth stimulators for fracture or spinal applications. Exhibit 22 summarizes their technologies.

Exhibit 22 bonE groWth StiMulation SyStEMS by coMpany Company Biomet Product(s) EBI Bone Healing, OrthoPak2, OsteoGen, SpinalPAK and SpF CMF OL1000 and CMF SpinaLogic Physio-Stim, CervicalStim and Spinal-Stim Exogen Technology Implantable direct current and noninvasive capacitive coupling Noninvasive, magnetic field technology Noninvasive, pulsed electromagnetic field Noninvasive, ultrasonic Application(s) Nonunion and lumbar spinal fusion

DJO

Nonunion and lumbar spinal fusion Nonunion and cervical and lumbar spinal fusion Fresh fractures

Orthofix Smith & Nephew

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 33 Although more than 90 percent of bone growth stimulation sales occur in the U.S., DJO and Orthofix have expressed interest in expanding stimulator sales in Europe. While bone growth stimulators have not yet found a significant following outside the U.S., extracorporeal shock wave therapy (ESWT) has. ESWT is used in the treatment of pseudarthrosis, delayed unions and nonunions. Through ESWT, high-pressure shock waves are focused on an affected site. The waves purportedly induce trauma to the tissue, which then spurs a healing or repair response from the body. ESWT also has application in the treatment of chronic, painful soft tissue orthopaedic disorders like lateral epicondylitis, calcific tendonitis of the shoulder and plantar fasciitis. Companies carrying ESWT include Direx Medical (Orthima), Dornier (Epos Ultra), Medical Technologies & Services (OrthoWave), Medispec (Orthospec), Orthometrix (Orbasone), SanuWave (OssaTron), Siemens Medical Solutions (Sonocur), Sonorex (representing Siemens in certain countries) and Storz Medical (MiniLTH and Masterpuls). In the U.S., Dornier, Medispec, Orthometrix and SanuWave market systems for plantar fasciitis, with ESWT systems from SanuWave and Siemens/Sonorex available, as well, for treating lateral epicondylitis. Orthometrix acquired the perpetual exclusive license (from Minimally Invasive Products) to manufacture, market, sell and service the Orbasone ESWT pain management device in the U.S. and Canada. Sanuwave intends to apply its orthoPACE (Pulsed Acoustic Cellular Expression) technology to the treatment of orthopaedic and spinal conditions, replacing the Ossatron device. Future indications for ESWT in the soft tissue arena may include treatment of supraspinatus tendon syndrome, medial epicondylitis, patellar tendonitis and achillodynis. Despite some slowdown in growth in 2009 due to less construction, fewer people travelling by car, fewer people on the ski slopes and hospitals reining in inventory levels, all in all the market for fracture repair products is expected to remain healthy for the foreseeable future based solely on patient demographics, which includes not only the young and active, but also the old and osteoporotic. That is, further growth in fracture repair will come from an older population most often afflicted by osteoporosis, characterized by decreased bone mass that increases susceptibility to fracture. Worldwide, approximately nine million osteoporotic fractures occur each year. In Europe alone, one osteoporotic fracture occurs every 30 seconds. As Exhibit 23 illustrates, osteoporosis remains a critical health issue in many countries throughout the world, afflicting more than 200 million women worldwide, with costs of hundreds of billions of dollars. In fact, estimates indicate that the total annual medical costs related to osteoporosis could reach $200 billion by 2040.

Exhibit 23 oStEoporoSiS and itS hEalth iMpact People with Osteoporosis · · · · · Australia 2.2MM Brazil 10MM Canada 1.4MM Europe, Japan and U.S. 75MM Germany 7.8MM

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34 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 23 oStEoporoSiS and itS hEalth iMpact

(Continued)

· · · · ·

India ~26MM; to increase to 36MM by 2013 Mexico 1/4 osteopenic or osteoporotic Spain 2MM women U.S. 10MM and ~34MM more at risk due to low bone mass; to reach 12MM and 40MM by 2012 The highest risk of hip fractures is seen in Denmark, Iceland, Norway, Sweden and the U.S.

Annual Incidence of Osteoporotic Fractures · · · · · · · · · Australia 20,000 osteoporotic hip fractures Canada 30,000 osteoporotic hip fractures, 70-90% caused by osteoporosis; could quadruple by 2030 Europe 3.79MM total osteoporotic fractures, 0.89MM in the hip (2000) Japan 153,000 hip fractures forecasted for 2010; 238,000 in 2030 New Zealand 84,000 osteoporotic fractures in 2007 U.S. >1.5MM total osteoporotic fractures (700,000 vertebral, 300,000 hip, 250,000 wrist) Venezuela 9.6 osteoporotic hip fractures/day (1995); could reach 67/day in 2030 Worldwide ~9MM osteoporotic fractures in 2000; 1.7MM forearm, ~1.6MM hip and 1.4MM vertebral (51% in Europe and the Americas) In 2050: worldwide incidence of 4.5MM-6.3MM (655,648 hip fractures in Latin America)

Also of Note · · · · · · · · Overall 61% of osteoporotic fractures occur in women. In women over 45 years of age, osteoporosis accounts for more days spent in hospital than many other diseases, including diabetes, myocardial infarction and breast cancer. In men over the age of 50, the lifetime risk of experiencing an osteoporotic fracture is 30 percent, similar to the lifetime risk of developing prostate cancer. The combined lifetime risk of hip, forearm and vertebral fractures coming to clinical attention is about 40 percent, equivalent to the risk of cardiovascular disease. In white women, the lifetime risk of hip fracture is 1 in 6, compared with a 1 in 9 risk for a diagnosis of breast cancer. In Sweden, osteoporotic fractures in men account for more hospital bed days than those due to prostate cancer. Thirty to 50 percent of women and 15 to 30 percent of men will suffer a fracture related to osteoporosis in their lifetimes. Thirty percent of hip fractures and 20 percent of vertebral fractures occur in men.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 35 Summary In summary, the market for fracture repair should continue steady, predictable single digit growth over the next decade driven largely by a potential patient population that spans all age groups with both healthy and osteoporotic bones. Exhibit 24 provides a summary of the key dynamics of the fracture repair market.

Exhibit 24 thE fracturE rEpair MarkEt: kEy MarkEt dynaMicS · · · · · $5.2 billion, growing at 6% from 2008 to 2009 More than 8 million procedures Highly competitive - 85% controlled by top 8 players Mostly non-elective and, hence, less price sensitive than other segments Technologies driving growth: locking plates, MIS, IM nails for small bone applications, small bone initiatives

© ORTHOWORLD Inc., 2010. All rights reserved.

arThrOscOpy

and

sOFT Tissue repair

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 39

arthrOScOpy and SOFt tiSSuE rEpair

Overview Arthroscopy refers to the use of keyhole techniques for visualization, diagnosis and treatment of disorders internal to the joint. Initially, arthroscopy served simply as a diagnostic method used by surgeons to plan more standard open surgeries. Over time, however, technique and product designs allowed surgeons to use arthroscopic methods in the treatment of soft tissue injuries and disorders. As of 2008, 34 percent of orthopaedic surgeons in the U.S. specialized in arthroscopy. In addition, sports medicine fellowships remain the most popular among orthopaedic surgeons. In 1970, fewer than 1,000 arthroscopic procedures were performed in the U.S. By 2009, more than 3.6 million occurred in the U.S., 2.1 million in the knee (including more than one million meniscectomies) and more than 980,000 in the shoulder (including about 415,000 subacromial decompressions). All told, more than ten million procedures performed in the U.S. in 2009 entailed the open or arthroscopic diagnosis or repair of soft tissue, including biopsies, excisions, divisions/repairs, carpal tunnel and tarsal tunnel release, sutures of capsule or ligament, tenotomy, reconstructions of soft tissue structures, etc. Similar procedures worldwide number more than five million, with an estimated one million arthroscopic procedures performed in Europe alone in a given year. Patient Demographics In the U.S. alone, dislocations, sprains and soft tissue disorders number more than 90 million annually, a figure that includes joint derangement, ligament tears, chondromalacia patella, joint contracture, enthesopathy (degenerative disorders of soft tissues), disorders of synovium, tendon, bursa, fascia, ligament, muscle, etc. Soft tissue injuries and disorders afflict people of all ages. For instance, meniscal, ligament, cartilage and other soft tissue problems in the knee typically befall those aged 45 to 64. Nearly half of sprains of the elbow, wrist and ankle occur in people under the age of 25, as do more than 80 percent of dislocations of the elbow. Knee sprains find targets more often among those 25 to 44 years of age, a group that also incurs one quarter of all dislocations. The elderly fall victim to more than one-third of hip/thigh dislocations, hip enthesopathy and shoulder enthesopathy. Study results have indicated that the incidence of rotator cuff tendon defects ranges from less than ten percent in patients under the age of 60 to as much as 80 percent or more in those older than 80. Further, the prevalence of partialor full-thickness tears was found to be more than 50 percent of people in their 70s and more than 80 percent in those over 80 years of age, with researchers concluding that "rotator-cuff lesions are a natural correlate of aging." While aging may contribute to some soft tissue degeneration and subsequent disorders, the market for arthroscopy and soft tissue repair centers largely on sports- and activity-related injuries although obesity, too, could have an impact on the area of meniscal repair. By one estimate, obesity accounts for more than half of meniscal repair procedures performed in the U.S. each year. Furthermore, overweight men and women are three times more likely to tear their menisci, while those considered obese are 15 and 20 times more likely to suffer a torn meniscus, respectively. Sports injuries alone should keep the market healthy for years to come. Approximately 41 million children and teens in the U.S. participate in some form of competitive sports along with 150 million adults. Musculoskeletal injuries comprise the largest portion of athletic injuries, with 25 percent of athletes expecting to incur a musculoskeletal injury in any 12-month period. Injuries to foot and ankles are the most common (25 percent of occurrences), followed

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40 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT by knee injuries (22 percent) and back injuries (11 percent). According to the National Collegiate Athletic Association, one major knee injury occurs per football team every year. Approximately one-third of skiing injuries and up to 40 percent of soccer injuries involve the knee. Of knee injuries among the 109 million worldwide who ski, those to the anterior cruciate ligament (ACL) are the most common, although some 60 percent of ski injuries involve the medial collateral ligament (MCL). Sixty percent or more of ACL injuries also include an attendant meniscal tear. Each year in the U.S., more than 300,000 ACL injuries occur and basketball has been listed as the sport responsible for most of these. Estimates place the number of ACL injuries worldwide at twice the number incurred in the U.S. Of note, studies have shown that a torn ACL leads to OA in more than half of affected knees five to 15 years after injury. More than 200 million people worldwide play soccer, and most soccer injuries (60 percent) involve the lower extremities, with nearly half being strains and sprains. One-third of joggers are injured at one time and their injuries most often involve torn cartilage, tendinitis, plantar fasciitis, neuromas and shinsplints. Swimmers experience shoulder pain, and bikers come down with ulnar nerve palsies. Epicondylitis afflicts those playing racquet sports, while rowers and curlers more often incur back and knee injuries. In Germany, some two million people (approximately 5.6 percent of the physically active population) incur sports injuries in a given year, ranking sports injuries as the second most common type of accident there. An estimated seven million Americans receive medical attention for sports and recreation-related injuries each year, while about 2.5 million sport or activity related injuries occur in the U.K. each year, making sports injuries one of the major causes of work absence in Great Britain. Most problems resulting from these injuries (60 percent) involve distortion, dislocation and/or rupture of ligaments, with fractures involved in 18 percent of incidents. A similar proportion of Australians (five percent) who participate in sports or recreational activities sustain injuries. Of these, 27 percent require treatment for their injuries, the most common (39 percent) of which are dislocations, sprains and strains. As no one age group escapes soft tissue injuries, disorders and diseases, population growth alone should bring with it a concomitant increase in conditions requiring treatment. Furthermore, as more people worldwide engage in physical activity, the market for arthroscopy/soft tissue repair products should remain robust. In terms of patient age, most arthroscopy and soft tissue repair procedures are performed on those aged 45 to 64 years old, as shown in Exhibit 25. Exhibit 25 arthroScopy/Soft tiSSuE rEpair procEdurES by patiEnt agE

65+ 45-64 17% 44%

39%

<45

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 41 The Market and Players Arthroscopes to access all joints, cameras/visualization systems, fluid management systems, powered shavers and drills, handheld instruments (for removal of bone and soft tissue), radiofrequency systems and metal and resorbable soft tissue repair implants (e.g. screws, anchors, tacks, etc.) comprise the products included in this segment of the market. Revenues from these products neared $3.3 billion, up six percent from 2008 sales, the first time in ten or more years that growth did not reach double digit levels. This slowdown in growth came as a direct result of the global economic crisis. That is, hospitals worldwide lost significant amounts of their investment portfolios when the financial markets "turned south." In order to protect their financial viability in the face of these losses, hospitals tightened their belts and quickly stopped spending on higher ticket items, including arthroscopy systems. Capital equipment comprises about 20 percent of the arthroscopy/soft tissue repair market, and its double digit negative growth served to slow the overall market. Companies selling products used in arthroscopy and soft tissue repair procedures run the gamut from those with full lines like Arthrex and Smith & Nephew, the world's largest competitors, to Neoligaments whose soft tissue repair products focus on synthetic materials used in ligament and tendon repair in upper and lower extremities. Arthrex and Smith & Nephew dominate the market, with less than a percentage point of share differentiating them. The six largest companies in the market segment (Smith & Nephew, Arthrex, DePuy, Stryker, ConMed and ArthroCare) captured 91 percent of global arthroscopy/soft tissue repair sales in 2009, as shown in Exhibit 26.

Exhibit 26 global arthroScopy/Soft tiSSuE rEpair SalES in 2009: coMpany MarkEt SharES

Others 8.8% ArthroCare 6.3% Conmed 8.1% Arthrex 23.9%

Stryker 14.3%

Smith & Nephew 23.6% DePuy Mitek 15.1%

Total Market $3.3BB Other companies marketing arthroscopy/soft tissue repair products include Karl Storz, Olympus and Richard Wolf, key players in the capital equipment side of the segment, along with Biomet Sports Medicine and an additional 50 or so companies, most with niche products, as exemplified by MedShape Solutions in shape memory materials and Arthrovision in pumps.

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42 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT A comprehensive list of arthroscopy/soft tissue repair (aka sports medicine) companies can be found in Appendix C at the end of this report. Technologies and Trends Among the larger contenders in the sports medicine market, all sell arthroscopes, visualization equipment, suturing devices and handheld instruments for minimally invasive joint repair. ArthroCare, ConMed, DePuy Mitek, Smith & Nephew and Stryker dominate the radiofrequency (RF) energy subsegment of the market, which includes thermal energy products used to manipulate (e.g. remove, cut/sculpt, coagulate, shrink, etc.) soft tissue structures. Unlike traditional electrosurgical systems, however, ArthroCare's Coblation, PEAK Surgical's PlasmaBlade and NuOrtho Surgical's Tissue Preservation technologies employ lower temperatures, which may minimize thermal damage to the soft tissues. Coblation wands exist for suction, ablation, removal, debridement, etc. of soft tissue in all joint areas. PEAK Surgical's PULSAR Generator supplies pulsed plasma-mediated electrical discharges through the PlasmaBlade, which reportedly cuts at a much lower average temperature than that of conventional electrosurgery. NuOrtho's platform technology (in development) includes not only low level RF energy probes to preserve healthy tissue, but also interfacing agents that effect treatment specific to the site. Tissue-specific interfacing agents have been designed for procedure-specific applications and, in the case of bone-to-bone fixation, they may obviate the need for other fixation devices (e.g. ligament screws in ACL repair). NuOrtho's initial product, however, is the Ceruleau probe, which uses lower temperatures and lower RF energy to allow surgeons to preserve the healthy articular cartilage tissue while repairing and contouring the damaged area. Alpha Orthopaedics markets the AT2 System, which incorporates RelF Technology, a platform technology that generates electrocoagulation percutaneously. That is, it uses RF energy and reverse thermal gradient technology to actively cool upper layers of tissue while delivering thermal energy to target structures. Although not used in the same types of procedures as other RF technologies in soft tissue repair, the technology does have application in soft tissue pathologies like tennis elbow, Achilles tendinosis and joint instability. In other RF developments, ArthroCare introduced Ambient technology, which allows surgeons to assess the temperature of joint fluids during arthroscopic surgery. Several of the company's products now feature the technology. Smith & Nephew Endoscopy launched the DYONICS Radiofrequency system with a compact generator and specialized probes for aggressively removing defects and smoothing soft tissue during arthroscopic procedures, while DePuy Mitek released its VAPR Premier90 small-diameter RF electrode for arthroscopic tissue removal in the knee, shoulder, ankle, etc. Although the sports medicine market is highly competitive, it continues to attract newcomers, including OrthoDynamix with its ArthroSteer Ablator, a monopolar device for use in shoulder, knee and hip procedures. The company also markets the ArthroSteer steerable instrument that provides punch, grasper and cautery capabilities with a flexible spine that bends 180 degrees and a jaw that rotates 360 degrees. Also newly formed (in 2009) is Olive Medical, which appears to be focused on disposability, as the company has developed the industry's first single-use high definition endoscopic camera system. Another newcomer is Axis Surgical Technologies, which, in early 2010, received FDA clearance for its C-MOR Visualization Device for use in diagnostic and operative arthroscopic procedures. The device is a self-contained portable direct-imaging tool that provides illumination and visualization of an interior cavity. It displays real-

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 43 time endoscopic images directly, thereby enabling surgeons to immediately diagnose injuries. The technology was evaluated in a spine procedure for the first time in early 2010. In imaging technology, Micro-Imaging has developed a technology that allows it to remote the video processing of CMOS cameras and place CMOS pixel arrays in very small packages (e.g. the distal tip of an arthroscope) without affecting resolution. On the implant side of the market, all major sports medicine franchises boast an array of metal and resorbable fixation products and, increasingly, those derived from PEEK and those that incorporate calcium in their structures. Of note, B1 Medical and Giltech will collaborate on the development of a suture anchor that features Giltech's CorGlaes Pure biodegradable glass. Furthermore, a trend towards knotless fixation has emerged over the past several years and typically entails encasing a sliding knot into the inside of an anchor, thus allowing the surgeon to place the anchor without worrying about positioning of the knot. Typical procedures performed within the arthroscopy/soft tissue repair segment of the market that would require fixation of soft tissue to bone using implants include: Shoulder: Rotator cuff repairs, Bankart repair, SLAP lesion repair, biceps tenodesis, acromioclavicular separation repair, deltoid repair, capsular shift, capsulolabral reconstruction Foot/Ankle: Lateral stabilization, medial stabilization, Achilles tendon repair, hallux valgus reconstruction, midfoot reconstruction, metatarsal ligament repair, tendon repair Knee: anterior cruciate ligament repair, posterior cruciate ligament repair, medial collateral ligament repair, lateral collateral ligament repair, patellar tendon repair Hand/Wrist: Scapholunate ligament reconstruction, ulnar collateral ligament reconstruction, radial collateral ligament reconstruction Elbow: Biceps tendon reattachment, tennis elbow repair, ulnar collateral ligament reconstruction, radial collateral ligament reconstruction, lateral epicondylitis repair Hip: Capsular repair, acetabular labral repair Product highlights (on the implant side) follow. Active Implants has developed the NUsurface implant, a synthetic meniscal replacement product manufactured from a proprietary polyurethane. The product gained regulatory clearance in the European Union via a CE Mark. The Arthrex catalog includes a broad range of products ­ anchors, screws, darts, staples, etc. ­ manufactured from numerous materials ­ PEEK, PLDLA, PLLA (poly-lactic acid), biocomposite (TCP and PLDLA) and titanium ­ for a variety of applications from cartilage repair to tenodesis and collateral ligament reconstruction. Over the past year, the company received regulatory clearances for a wider range of biocomposite implants and fluid management products. Sixty-six percent of ArthroCare's annual sales derive from sports medicine products, which include the eyeless, resorbable DoublePlay suture anchor for a variety of applications, SpeedScrew knotless PEEK screw-in anchors along with the AutoCuff System with the Opus TwinLock Knotless Fixation System for use in rotator cuff repair, Bankart repair and SLAP lesion procedures. The DoublePlay comprises a resorbable composite of 30 percent TCP

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44 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT and 70 percent PLLA material, designed and developed by Biocomposites, which also supplies ArthroCare with its resorbable BiLok ST composite screws for ACL reconstruction and transverse fixation in femoral hamstrings. Artimplant's products center on the Artelon resorbable polyurethane scaffold technology. Biomet Sports Medicine signed a global development, license and supply agreement with Artimplant and launched SportMesh, an Artelonbased rotator cuff reinforcement patch. The product received both FDA clearance and CE Mark certification, the latter for additional tendon repair surgery including reinforcement of patellar, Achilles, biceps, quadriceps or other tendons. Additional Artelon-based products with CE Mark approval include a bone scaffold, a soft tissue barrier/ bone graft containment membrane, an Augmentation Device ACL and a suture with application in tendon and ligament repair. BioMedical Enterprises' foray into sports medicine comes through the company's OSSAnchor Grip, a Nitinol metal staple to be used to anchor soft tissue to bone in such procedures as tendon repair and reattachment. Intelifuse also markets a shape memory alloy staple for soft tissue to bone fixation. Biomet Sports Medicine comprises less than five percent of Biomet's total sales but its product portfolio mirrors that of its larger competitors, i.e., it is a full line of products for a variety of indications in all joints of the body. Most recently, Biomet introduced its JuggerKnot Soft Anchor for use in shoulder repair. The device contains all suture, the first of its kind to make that claim. Smaller competitor, Bio Recherches Innovations, markets a memory staple, anchors, interference screws and an artificial ligament. Cayenne Medical's products include a few firsts ­ iFix, reportedly the first PEEK self-tapping interference screw, and CrossFix, reportedly the first all inside suture repair for meniscal applications. The company entered the sports medicine market with its PEEK AperFix System, which allows for ACL reconstruction (using hamstring and other soft tissue grafts) that provides active tension to the graft while simultaneously eliminating graft laxity. Cayenne expects to expand its portfolio beyond the knee into shoulder and other joints. As a key player in the sports medicine market, ConMed boasts a portfolio with a wide range of anchors, including those made from the company's proprietary Self-Reinforced (96L/4D PLA) copolymer technology. Over the past year, ConMed introduced smaller sizes of its Matryx Biocomposite Interference Screw (copolymer + beta TCP), Bullseye Anatomic Cruciate Reconstruction System, designed to aid in anatomic single- and double-bundle cruciate reconstruction and the Linvatec Shoulder Restoration System for rotator cuff repair, which allows the surgeon to intraoperatively choose his method of fixation. ConMed gained clearance for PEEK implants, as well. Approximately 39 percent of ConMed's total company sales come from its arthroscopy and soft tissue repair businesses. A relative newcomer, Core Essence Orthopaedics, has developed a line of products including traditional and knotless suture anchors, percutaneous and endotendonous repair products, shape memory staples and endoscopic guides. Covidien's Scandius Biomedical business focuses on arthroscopic ACL reconstruction and markets the Stratis ST ACL Reconstruction System and Femoral Fixation Implant and TriTis Tibial Fixation System for ACL reconstruction in resorbable (PLLA) and non-resorbable versions.

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 45 Del Palma emerged on the soft tissue repair market with a focus on devices and techniques for upper and lower extremities based on Advanced Monorail Technology, a proprietary platform for a series of anatomic instruments that enable the surgeon to release constricted or stenotic soft tissue through a percutaneous approach. The company launched its Advansor TF, an all-inclusive procedure kit that allows surgeons to provide point-of-service trigger finger release. Sales of sports medicine products by DePuy Mitek represent approximately ten percent of total DePuy sales. Mitek's solid position in the sports medicine market derives from its full line of products ­ interference screws and suture anchors fabricated from PEEK and resorbable Biocryl Rapide composite of TCP and Poly(lactide-co-glycolide), in addition to a wide array of metal or polymer screws and anchors, both resorbable and non-resorbable. The FH sports medicine franchise includes the CoLS Classic for one-graft ACL reconstruction, which comprises a titanium interference screw and a woven band made of polyethylene terephthalate. FH also markets CROSS lig interference screws, which are injected into the Duosorb composite material. Inion's resorbable sports medicine products incorporate the company's resorbable Optima family of technologies and include ACL and meniscus screws. Also focused on resorbables is Invibio, the sole worldwide manufacturer and distributor of implantable-grade PEEK-Optima polymer and ENDOLIGN composite. In sports medicine, Invibio's contributions include suture anchors, interference screws, washers, etc., featuring a PEEK-Optima shoulder soft tissue repair device that received regulatory clearance in Japan, the first clearance in that country for a PEEK implant. Ion Surgical Technologies is developing PassTech Rotator Cuff Repair and ACL Fixation kits, while Kensey Nash supplies a broad range of biomaterials-based sports medicine (and trauma) products for Arthrex and others. KFx Medical offers its FDA cleared SutureCross Knotless Anatomic Fixation System, which accommodates knotless repair in an all-in-one handpiece along with bone screws and suture anchors, that, combined, obviate the need for both knot tying and suture passing. The company also markets the PASTAFx system for Partial Articular-Sided Tendon Avulsion transtendon rotator cuff repair. Brazil's MDT markets the Ligfix system for ACL and PCL reconstruction, which features titanium interference screw, titanium transverse pin, toothed and flat titanium washers and titanium screws. MedShape Solutions focuses on shape memory materials and introduced FDA cleared devices manufactured from shape memory polymers based on PEEK and PMMA chemistries, deployable via thermal or mechanical activation. The company's MORPHIX Anchor uses PEEK Altera shape memory technology and can be deployed into different shapes with minimal force. FDA cleared MedShape's WedgeLoc anchors, which the company hopes to get CE Mark approved in 2010. Orthomed and Ortosintese both market interference screws for knee ligament repair, with Orthomed also offering a line of staples and titanium and resorbable anchors. Ortheon focuses its efforts on soft tissue repair in the hand with its stainless steel TenoFix system (anchor and suture) for repair of severed or lacerated digital flexor tendons. Through TenoFix, the surgeon inserts a small anchoring coil into each end of a severed tendon, turning the anchor to gather collagen fibers. The surgeon then inserts a suture through the anchor on one side, passes it through the other side and reattaches the severed tendon ends.

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46 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Parcus Medical markets titanium and PEEK carbon fiber interference screws and suture anchors along with instruments, while PRIMA Implantes provides interference screws, staples and anchors to its customers in South America. Smith & Nephew's soft tissue repair product portfolio brings in 21 percent of total company revenues and includes a variety of metal, PEEK, resorbable and non-resorbable polymeric fixation devices, some with knots, others knotless, for use in all joints in the body. The company's implants incorporate not only traditional metals, but also resorbable polymers with calcium carbonate and those featuring poly-lactic-acid and Hydroxyapatite (PLA-HA). In the past year, the company introduced its OsteoRaptor, a PLA-HA anchor for shoulder and hip applications, Twinfix Ultra PK Suture Anchor to address wide variations in bone density and tissue quality for rotator cuff repair, Bioraptor Knotless Suture Anchor for the repair of torn labrum in the hip and shoulder and the Fast-Fix 360 system for meniscal repair. Surgicraft's soft tissue repair product line centers on ligament reconstruction, including not only artificial ligaments but also hamstring support and fixation systems that serve as ligament substitutes in ACL reconstruction. Stryker Endoscopy's sports medicine line includes Biocomposites' Biosteon wedge interference screws, femoral and tibial screws for ACL reconstruction and crosspins, all of which Stryker distributes through an exclusive worldwide agreement. The devices comprise calcium HA and PLLA. All told, the endoscopy business contributed ten to 15 percent of Stryker's total sales in 2009. Stryker also offers the Neuro Mend Collagen Matrix (developed in conjunction with Collagen Matrix) for nerve repair and acquired BioDuct assets, which include an FDA cleared Meniscal Repair Device. The novel device transports blood from the "red" vascular zone of the meniscus to the "white" avascular zone, thus allowing that area a chance to heal following damage. The device may obviate the need for surgical removal of knee cartilage. Takiron's key strength in medical devices lies in its materials expertise, as demonstrated in its soft tissue offering, the Osteotrans system. The system encompasses HA/PLLA fixation devices including interference screws for ligament repair and reconstruction. While Takiron focuses on HA/PLLA, Toby Orthopaedics is developing resorbable polymer flexor tendon repair implants. Tornier recently ventured into the sports medicine market and now boasts a portfolio of metallic, resorbable and non-resorbable polymer suture anchors, sutures and tissue reinforcement matrices. In addition, through an exclusive agreement with T.A.G. Medical Products, Tornier gained the license to T.A.G.'s ArthroTunneler, a transosseous bone tunneler system for rotator cuff repair. Furthermore, Tornier and Tepha are evaluating TephaFLEX sutures based on Tepha's polyhydroxyalkanoate polymer, which allows the engineering of resorbable devices with mechanical and biologic properties that are matched to specific tissue repair applications. The companies are also developing a range of Tepha polymer-based devices to target soft tissue repair applications in the extremities. Wright Medical's soft tissue repair portfolio focuses on the foot and includes products for endoscopic decompression and soft tissue release, a PEEK-Optima interference screw and a soft tissue anchor. Like Wright, Zimmer has a limited sports medicine offering, comprised solely of a line of titanium and resorbable suture anchors. Others with soft tissue repair implants are included in Exhibit 27, which summarizes the types of soft tissue repair implants available worldwide.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 47 Exhibit 27 Soft tiSSuE rEpair iMplantS by coMpany Company Amplitude Arthrex Product(s) Interference screw Anchors, mini anchors, screws, interference screws, darts, posts, washers, tacks, buttons, cross pins, femoral fixation devices, ligament fasteners Anchors, mini anchors, screws, interference screws Staples Anchors, mini anchors, tacks, screws, interference screws, femoral fixation devices, suture buttons, cross pins Anchors, interference screws, staples, artificial ligament Screw, aperture femoral implant, screw w/ sheath Screws, interference screws, anchors Anchors, mini anchors, screws, interference screws Anchor, staples Artificial ligaments Graft block w/ pin, cleat + screw + washer Anchors, mini anchors, screws, screw w/ sheath, interference screws, ligament fasteners, femoral fixation devices, cross pins Screws, interference screws, bands, artificial ligament Anchors Staple Nail bone anchors, suture lock screws Interference screw system Anchors Technologies Resorbable Resorbable and non-resorbable polymers, metal, PEEK, composites

ArthroCare BioMedical Enterprises Biomet

Resorbable and non-resorbable polymers, metal, PEEK, composites Nitinol Resorbable and non-resorbable polymers, metal, PEEK, composites Memory metal, resorbable polymers PEEK Metal, resorbable polymers Resorbable and non-resorbable polymers, metal, PEEK, composites Non-resorbable polymers, metal, Nitinol Resorbable and non-resorbable polymers Resorbable and non-resorbable polymers Resorbable and non-resorbable polymers, metal, PEEK, composites Metal, resorbable polymers Metal Nitinol Metal Titanium PEEK Altera shape memory material

Bio Recherches Cayenne CHM ConMed Core Essence Cousin Biotech Covidien DePuy Mitek

FH Orthopedics GMReis InteliFUSE KFx MDT MedShape Solutions

© ORTHOWORLD Inc., 2010. All rights reserved.

48 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 27 Soft tiSSuE rEpair iMplantS by coMpany

(Continued)

Company Micromed

Product(s) Interference screws, anchors

Technologies Metal, resorbable and non-resorbable polymers, PEEK Metal, non-resorbable polymers Metal Metal, resorbable and non-resorbable polymers Metal, PEEK/carbon fiber Resorbable and non-resorbable polymers, metal, PEEK, composites

Neoligaments Ortheon Orthomed

Staple, artificial ligament Anchors Anchors, artificial ligament, interference screws, screws, staples Anchors, interference screws Anchors, mini anchors, screws, interference screws, darts, posts, washers, tacks, buttons, cross pins, femoral fixation devices, ligament fasteners Interference screws

Parcus Smith & Nephew

Stryker

Metal, resorbable polymers, composites, PEEK Composite Metal, resorbable and non-resorbable polymers, Nitinol Metal, PEEK Metal, resorbable polymer

Takiron Tornier

Interference screws Anchors

Wright Medical Zimmer

Anchors, screws Anchors, screws

In addition to fasteners, anchors, sutures and other devices for soft tissue repair, some devices are designed to protect or reinforce tissues. Among these are Artimplant's Artelon-based patch (licensed and supplied to Biomet Sports Medicine), Ascension's resorbable FlexiGuide, Integra's TenoGlide Tendon Protector Sheet, Kensey Nash's BioBlanket Surgical Mesh, MAST Biosurgery's OrthoWrap Bioresorbable Protective Sheet, Orthomed's RevolNerv, Wright's BIOTAPE XM Reinforcement Matrix and Xylos' Porous Surgical Mesh. (For more on these biologically-based rotator cuff repair products, please refer to the Orthobiologics section of this report.) Furthermore, Magen is developing the TendonShield, a removable adhesion barrier for use after tendon repair surgery. While tendon reinforcement technologies have been cleared in the U.S., the same cannot be said for synthetic ligaments. Synthetic reinforcement/repair ligaments are used in thousands of procedures in Europe, with none cleared for use in the U.S. Companies marketing synthetic ligaments outside the U.S. are shown in Exhibit 28.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 49 Exhibit 28 artificial ligaMEnt tEchnologiES by coMpany · · · · · · · · · · · · Arex ­ nonresorbable Ligarex polyethylene terephthalate for chronic instability of metacarpophalangeal joint Bio Recherches Innovations ­ L.A.C. for acromioclavicular ligamentoplasty Corin ­ Ligament Augmentation and Reconstruction System for PCL, ACL, ankle, elbow and shoulder repairs Cousin Biotech ­ resorbable Resorbaid reinforcement ligament and Tendor Resorbaid Achilles tendon reinforcement, and non-resorbable intra- and extra-articular Biolig ligaments Ellis Development ­ Nottingham Hood polyester soft tissue reinforcement device for rotator cuff repair FH ­ Tenolig for Achilles tendon LARS ­ polyethylene terephthalate Ligament Augmentation and Reconstruction devices for cruciate ligament, Achilles tendon and acromioclavicular repair Neoligaments (division of Xiros) ­ Leeds-Keio Connective Tissue Prosthesis for patellar ligament and quadriceps tendon repairs, Leeds-Keio ACL and AchilloCord Orthomed ­ Ligastic polyethylene terephthalate for medial collateral ligament reinforcement, acromioclavicular separation and trapeziectomy Surgicraft ­ Surgilig coracoclavicular ligament reconstruction, composite ACL ligament, other tendon/ ligament augmentation, ABC ligament and tendon repair system Teknimed ­ Ligadon Achilles tendon reinforcement Telos Medical ­ Trevira synthetic ACL ligament

Summary A highly competitive marketplace and a plethora of products characterize the sports medicine market worldwide. Into the future, growth in this segment will come through the introduction and penetration of products like improvements to visualization equipment (e.g. higher definition digital cameras, autoclavable cameras, disposable cameras, flat screen monitors, etc.), enhanced suturing techniques, improved materials (both natural and synthetic), procedure-specific technologies that solve a surgeon's intraoperative needs, new materials tailored to specific applications, etc. The use of computer-assisted surgery, too, could find an increased role in the repair of soft tissue injuries, with particular application in ACL repair. Technologies and techniques aside, the market should continue a healthy, steady state of growth into the future based largely on the activities of a certain portion of the world's population that believes in and lives an active lifestyle. Growth may be adversely affected, as it was in 2009, by a tightening of capital budgets in the world's hospitals. At the same time, healthcare systems will more readily embrace those technologies that aid in the rapid return of the working age population to productivity. As a result, the market for soft tissue repair, which addresses this patient demographic, should experience solid procedure growth moving into the next decade. Exhibit 29 provides a summary of the key dynamics of the arthroscopy/soft tissue repair market.

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50 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 29 thE SportS MEdicinE MarkEt: kEy MarkEt dynaMicS · · · · · · · $3.3 billion, growing at 6% from 2008 to 2009 More than 10 million procedures Mostly non-elective and hence, less price sensitive in the implant side Highly competitive - 90% controlled by top six players Highly price sensitive on the capital side (~20% of business) To be embraced by healthcare systems for helping an active, productive population return to work Technologies driving growth: knotless fixation, procedure-specific novel fixation methodologies

© ORTHOWORLD Inc., 2010. All rights reserved.

spinal ImplanTs and insTrumenTaTiOn

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 53

Spinal implantS and inStrumEntatiOn

Overview The area of spinal implants and instrumentation encompasses spinal fusion, dynamic stabilization of the spine, motion preservation discectomy and vertebroplasty/kyphoplasty. Traditional spinal fusion incorporates the use of metal (titanium or stainless steel) plate/screw systems for cervical applications and metal plate/screw, hook/rod/ screw or interbody fusion devices for lumbar applications. The vast majority of spinal fusion procedures performed today use these more standard products, although resorbable and PEEK materials have found increasing use among spine surgeons largely because their radiolucency allows the surgeon to visualize the status of the fusion. Worldwide, spine procedure volumes exceeded 2.8 million in 2009, including fusion, discectomy, disc replacement, vertebroplasty/kyphoplasty and fracture repair. Patient Demographics Back pain is the most prevalent medical disorder in industrialized societies and the second most common cause of sick leave after the common cold. It is one of Canada's three most common chronic conditions, and afflicts an estimated two-thirds of American adults. Half of all working Americans have back pain symptoms each year, while 25 percent of European workers complain of backache and 22.5 percent of Japanese report low back pain. The lifetime prevalence of back pain is reported to be more than 70 percent in "resource-rich" countries and between 60 percent and 85 percent in European countries. At any one time, an estimated 15 percent of adults will have back pain and 80 percent of the world's population will experience back pain at some time in their lives. All told, back pain afflicts primarily a younger patient population and most spinal procedures are performed on patients under the age of 65, as noted in Exhibit 30.

Exhibit 30 SpinE procEdurES by patiEnt agE

65+ 26% 27%

<45

46%

45-64

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54 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT The Market and Players In 2009, sales of spine products (excluding biologics) exceeded $7.1 billion worldwide, an increase of 11 percent over 2008 revenues. The six largest companies in the global spine market (and the only ones with spine sales in excess of $200 million) ­ Medtronic, DePuy, Synthes, Stryker, NuVasive and Zimmer ­ controlled 79 percent of 2009 sales in this segment (down from 81 percent in 2008). Medtronic remains the market leading spine company, with 37 percent market share, as shown in Exhibit 31.

Exhibit 31 global SpinE SalES in 2009: coMpany MarkEt SharES

Other 21.0%

Medtronic 36.8% Zimmer 3.2% NuVasive 4.7%

Stryker 8.7%

Synthes 13.3%

DePuy 12.4%

total MarkEt $7.1bb Competition within the spine market has intensified over the past several years as evidenced by strong growth from smaller challengers like Alphatec, Globus Medical, K2M, Orthofix and SeaSpine. More than 20 other midtier spine companies (with sales between $20 million and $200 million in 2009) also compete and include Aesculap, ArthroCare, Biomet, Integra, LDR, Pioneer, Scient'x, Signus and TranS1. Relative newcomers to the space number more than 100 and their numbers increase every month. New names in the spine space with FDA clearances include Advanced Medical Technologies (Distractable WAVE Cage), Amendia (Spartan S3 Facet System), Binder Biomedical (Binder Intervertebral Body Fixation Device), Blazejewski Medi-Tech (Spinal Foraminoscope), Innvotec Surgical (SEC Vertebral Body Replacement), Medical Designs (Asfora Bullet Cage System), Meditech Advisors (Talos Intervertebral Body Fusion Device), Medyssey (Novel Spinal System), Nexxt Medical (Blade Anterior Cervical Plate System), Norm Spinal Products (Norm Spinal Fixation System), OTIS Biotech (ULC Pedicle Screw System), TiTaMED (TiTaMED Spinal System), etc. In addition, a number of strategic alliances occurred among spine companies, as detailed in Exhibit 32.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 55 Exhibit 32 acquiSitionS and StratEgic alliancES in SpinE in 2009 Acquisitions · · · · Alphatec Spine acquired Scient'x Cardo Medical acquired Vertebron Integra Spine acquired Innovative Spinal Technologies Loukas Medical acquired Orthopedic Screw from Launch Medical Strategic Alliances · · · · · · · · · Alphatec Spine and International Spinal Innovations: worldwide license rights to intellectual property related to a stand-alone anterior lumbar interbody fusion device K2M and Smith & Nephew: agreement for distribution of K2M's products in Germany Orthofix and Stout Medical: license and product development for a new expandable vertebral body replacement and corpectomy device RSB Spine and Paradigm BioDevices: exclusive U.S. master distribution agreement Showa Ika and Century: distribution of Showa Ika products in Japan Spineology and Captiva: non-exclusive agreement for distribution of capLOX Pedicle Screw System in the U.S. Stellartech and OrthoMEMS: development of OrthoChip, a commercial reader for wireless communication with a miniature implanted sensor in the spine to provide an objective measurement of spinal disc pressures TranS1 and Life Spine: agreement for distribution of Avatar minimally invasive pedicle screw system X-spine and Gamma Spine: exclusive license agreement for development and distribution of MIS fixation technology

A comprehensive list of spinal implants/instrumentation companies can be found in Appendix D at the end of this report. Technologies and Trends Along with their traditional metals, most spine companies, large and small, market PEEK or other polymer cages, vertebral body replacement devices and spacers. Within the last year, Icotec received CE Mark approval for its continuous carbon fiber PEEK lumbar fusion device and clearance for PEEK interbody devices in the U.S. came to Advanced Vertebral Solutions, Atlas Spine, Binder Biomedical, Biomet Spine, Captiva Spine, ChoiceSpine, Custom Spine, Globus, Incite Innovation, LDR, Medicrea, RSB Spine, R Tree Innovations, Sea Spine, Signus, Solco Biomedical, Spinal Devices, Spinal USA, Spine Wave, Spineart, SpineCraft, SpineFrontier and Stryker Spine. DePuy, NuVasive and Signus also offer devices manufactured from carbon-reinforced PEEK and other polymers. Spinal Simplicity is developing a line of threaded percutaneous interspinous process fusion cages with PEEK shells and titanium inner workings. The devices could gain market clearance in 2010. Other interesting materials for spinal applications take the form of Zimmer's trabecular metal, Amedica's MC2 (Micro-Composite Ceramic), Actipore porous Nitinol, Oxford Performance Materials' OXPEKK-IG (Implantable Grade) and ­MG (Medical Grade) proprietary polymer, coLigne's Ostapek proprietary biomaterial made of a highly-dense long-fiber carbon composite

© ORTHOWORLD Inc., 2010. All rights reserved.

56 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT used in spinal rods and Trinity Orthopedics' Transpedicular Interbody Fusion Device, which features shape memory Nitinol cages. The system is in prototype stages and could gain clearance in the U.S. in 2010. In early 2010, Westlake Plastics (through Modern Plastics) introduced its permanent implantable medical-grade PEEK, MediPEEK-IM, a high-performance semi-crystalline thermoplastic designed for long-term body contact as an implantable material. The material has application in numerous orthopaedic areas, including for spinal cages. Patents for composite spinal systems have been assigned to Stryker and K Spine, while a number of entities are developing resorbable polymer platforms. The first U.S. introduction of a resorbable plating system for spinal applications came with Medtronic's Mystique Resorbable Graft Containment Plating System for stabilization of bony tissue in cervical spine applications. Inion received CE Mark approval and FDA clearance for its line of resorbable spinal products ­ the S-1 Biodegradable Anterior Cervical System for use with adjunctive immobilization and the S-2 Anterior Lumbar Fusion system for use as a graft containment device in combination with rigid fixation. Outside of materials, the last year brought to the fore several milestones related to traditional spinal products. For instance, · · · · · · · Impliant: first two implantations of TOPS VersaLink titanium lumbar fusion system Integra Spine: first implantation of Paramount Pedicle Screw System for MIS surgery Interventional Spine: more than 7,000 Perpos Fuse System implants and more than 1,000 patients with PercuDyn since 2007 LDR: implantation of more than 3,000 devices using VerteBRIDGE plating technology SpineGuard: 10,000th procedure to use PediGuard pedicle screw placement device Vertebral Technologies: 500th implantation of InterFuse Interbody Fusion Device VG Innovations: More than 750 patients with VerteLoc MIS Stabilization system in the U.S.

Product launches that occurred throughout 2009 appear in Exhibit 33.

Exhibit 33 SpinE product launchES in 2009 Amedica: Valeo vertebral body replacement and cervical plate Custom Spine: Pathway AVID interbody device and Regent ACP cervical plate DePuy Spine: Uniplate Integra Spine: Paramount Pedicle Screw Fixation System K2M: Natural Bridge Low Profile Transverse Connectors and CASPIAN Spinal System LDR: ROI-C cage Medicrea: PASS LP De-Rotation connector Medtronic: VERTEX SELECT® Reconstruction System, T2 SCEPTOR Distractible End Cleats System, TSRH 3Dx Spinal System and SOVEREIGN interbody fusion device Scient'x: Isobar Evolution Dynamic Rod Signus Medical: DIALOG Sacroiliac Joint Fusion System Titan Spine: Endoskeleton TT transforaminal lumbar interbody fusion device US Spine: Facet Gun MAX facet fixation device, Preference 2 Complex Spine System and Phantom Plus Interbody Fusion System

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 57 While fusion remains the predominant procedure used to treat degenerative disc disease, it is not without its problems. For instance, fusion can lead to some loss of motion for some patients and it has been associated with the deterioration of adjacent vertebral levels. As a result, fusion may not be optimal for younger, more active patients. Of note, spinal fusion is largely a young person's procedure, with just 22 percent of all spinal fusions performed on people over the age of 65. Due to the potential issues with fusion and the large pool of patients who could benefit from non-fusion technologies, most established spine companies (and a number of early stage entities) have targeted motion preserving technologies like artificial discs, nucleus replacement, dynamic stabilization, etc. for their development initiatives. Disc Replacement Through total disc arthroplasty or replacement, a device is implanted between the vertebrae with the intent to retain motion in the disc. Disc replacement devices are available throughout the world; however, despite the benefits they might provide, their use has been limited to just 20 percent of potential procedures globally, with penetration even lower in the U.S. Penetration of discs in the U.S. has been stymied by a number of issues, not the least of which is an insurance environment that deems many of the artificial disc implants "experimental" despite their approval by FDA. To date, just two lumbar (DePuy's Charité and Synthes' ProDisc L) and three cervical (Medtronic's Prestige and Bryan and Synthes' ProDisc C) discs have received FDA approval. Furthermore, the Centers for Medicare and Medicaid Services recommended against insurance coverage for artificial lumbar discs in patients over the age of 60. While older patients are not the primary target for artificial discs, the ruling casts doubt on the devices nonetheless and has had an adverse effect on their widespread adoption in the U.S. Despite a less-than-encouraging reception for discs in the U.S., a number of companies continued to pursue artificial disc initiatives. For instance, with its acquisition of Scient'x, Alphatec added a ceramic-on-ceramic cervical disc to its product portfolio. The company expects 2010 regulatory clearance for the device in China and will continue to evaluate the U.S. market for artificial discs. AxioMed completed a pilot multicenter trial of 50 patients in Europe, received the CE Mark and launched its Freedom lumbar disc (with silicone polycarbonate urethane thermoplastic elastomer core) in the European Union through a market evaluation. In the U.S., the device remains in a pivotal IDE study with more than 136 patients enrolled, 50 at more than two years. AxioMed hopes to complete enrollment by year-end 2010. Further, the company will begin biomechanical testing on a cervical device, with a filing for CE Mark approval in 2010, and will also investigate multi-level disc treatments and a lateral approach. During the course of the year, Biomet suspended its IDE pilot study for the Regain Lumbar Artificial Disc and its development of the Min-T lumbar ceramic disc. The company intends to focus, instead, on non-anterior MIS approaches to total disc arthroplasty.

© ORTHOWORLD Inc., 2010. All rights reserved.

58 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT LDR completed single- and two-level enrollment in its Mobi-C cervical disc over the past 18 months. The company expects to submit its premarket approval (PMA) application by mid-2010, with potential approval to begin a trial by mid-2011. Since 2004, more than 10,000 LDR artificial discs have been implanted. Orthofix gained CE Mark approval for the Advent Cervical Disc and began a limited market release of the device in Europe. Further, the company expects to add ten sites to its ongoing U.S. study of the disc. In early 2010, Ranier began a multi-center clinical trial in Europe for its CAdisc. Spinal Kinetics completed a pilot study of its cervical M6 disc in 30 patients and submitted one year data at the end of 2009. The company received conditional approval to begin a pivotal trial with the cervical disc and is preparing for that trial. The M6 lumbar disc received CE Mark approval in 2009 and Spinal Kinetics launched the device in Germany. To date, more than 5,250 cervical and 300 lumbar M6 discs have been implanted. For SpinalMotion, 2009 marked submission of a PMA for its lumbar Kineflex disc, with a cervical PMA expected in 2010. To date, more than 3,500 patients have been treated with the company's devices. A total of 510 patients participated in the lumbar IDE trial, with results showing faster pain relief and lower repeat procedure rates and adverse events than the control (the Charité). In the cervical trial, 330 patients received the Kineflex disc, which was shown to be statistically superior to fusion. SpinalMotion anticipates clearance for both discs in 2011. The company is also working on a lower height cervical disc, an MRI imaging friendly disc (PEEK with thin titanium endplate), which may enter pilot trials in mid-2010, and has begun a clinical study of a lateral lumbar disc, which could receive CE Mark approval by mid-2010. In 2009, NuVasive began enrollment in the clinical trial of its extreme lateral disc (XLTDR). Key turning points for the company will come in 2010 with likely filing of a PMA for the PCM cervical disc, completion of two-year follow-up for the NeoDisc and completion of enrollment in the XLTDR clinical trial. For Synthes, 2009 brought continued steady growth in its ProDisc-C implant. Neither DePuy nor Medtronic commented on the progress or lack thereof of their commercialized disc replacement implants. Newcomers to the disc space include Bricon with its monoblock Elastic Spine Pad lumbar disc. RE Spine and Smart Disc have discs under development. A number of other companies remain in clinical trials in the U.S. and overseas with their disc replacement products. Exhibits 34 and 35 summarize the artificial disc landscape globally. Exhibit 34 artificial diSc landScapE ­ cErvical Company Aesculap ALCerAX Alphatec Product Activ-C ConCera DiscoCerv Description CoCr on poly, semi mobile bearing; anterior Ceramic-on-ceramic Ceramic on ceramic; anterior Regulatory Status/# Implanted In clinical studies In clinical trials CE Mark; IDE began 2008; ~3,000 implanted; expecting clearance in China 2010

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 59 Exhibit 34 artificial diSc landScapE ­ cErvical

(Continued)

Company Amedica ArthroVision Spine AxioMed Biomet Cousin Biotech DePuy Globus LDR Spine

Product Altia C-MAXX

Description Silicon nitride ceramic; anterior w/ titanium nitride or diamolit coating

Regulatory Status/# Implanted

>8,000 implantations Biomechanical testing to begin 2010

Rescue Art-Disc Discover Secure-C Mobi-C

Pyrocarbon on pyrocarbon; anterior

IDE began 2007; estimated release 2Q12

Ti on poly; anterior Metal on poly/semi mobile bearing; anterior Ti/HA coated CoCr on poly, mobile core, 6° of freedom; anterior

CE Mark; IDE began 2006 IDE enrollment complete (380 patients) CE Mark + approved in Asia and South America; one- and two-level studies at 2-year follow-up ­ expects PMA submission 2Q10 w/ approval 2011. Implanted in >8,000 patients to date CE Mark; FDA approved CE Mark; FDA approved CE Mark; FDA approved In pre-clinical study

Medtronic Medtronic Medtronic Nexgen Spine

Prestige ST Prestige LP Bryan Physio-C

Stainless steel metal on metal, ball and trough; anterior Ceramic on ceramic, ball and trough; anterior Ti on polyurethane, ball and socket; anterior CoCr with Ti porous coated endplates + polycarbonate polyurethane core; anterior PEEK-Optima mobile core CoCr or Ti on poly, broad radius, unconstrained; anterior Ti on polyurethane, ball and socket; anterior Ti endplates, titanium nitride coated core; metal on metal, ball and trough; anterior HA-coated PEEK on PEEK semi-constrained ball and trough hybrid; anterior

NovaSpine NuVasive

Almas PCM-V, PCM-TI, PCM-EF Advent

CE Mark CE Mark; >5,000 implanted in 20 countries

Orthofix

CE Mark; IDE began 2008; estimated enrollment 450; FDA approval expected 2012

Osteon

MCD (Mobile Cervical Disc) NuNec

Pioneer Surgical

CE Mark; approval in US anticipated 2012

© ORTHOWORLD Inc., 2010. All rights reserved.

60 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 34 artificial diSc landScapE ­ cErvical

(Continued)

Company Ranier SeaSpine Signus Spineart Spinal Kinetics

Product CAdisc-C Catalina Galileo Baguera C M6

Description Variable modulus elastomer; anterior CoCr w/ PEEK endplates; anterior Ball and socket Coated Ti; mobile nucleus Polymeric nucleus, poly fiber annulus, Ti endplates; anterior CoCr on CoCr with CoCr mobile core; anterior

Regulatory Status/# Implanted In development

In development

CE Mark; pilot study complete (30 patients) w/ conditional approval for pivotal; >6,000 implanted CE Mark; IDE enrollment complete (330 patients); PMA submission expected 2010; also developing lower height cervical device CE Mark; IDE began 2006 CE Mark; FDA approved In development

SpinalMotion

Kineflex C

Stryker Synthes Takiron

CerviCore ProDisc-C Fabricube

CoCr on CoCr saddle; anterior CoCr on poly, ball and socket; anterior Poly-L-lactide + polyethylene fibers

Exhibit 35 artificial diSc landScapE ­ luMbar Company Advanced Prosthetic Technologies Aesculap AxioMed Activ L Freedom Product Description Resorbable steps, elastomeric polymer, Ti plugs and bellows; compressible CoCr on poly, semi mobile bearing; anterior CarboSil polymer core (silicone polycarbonate urethane thermoplastic elastomer)/Ti endplates; anterior One Piece, elastomeric w/TI endplates Regulatory Status/# Implanted In development

CE Mark; IDE began 2007 CE Mark and market evaluation in Europe 2009; >136 enrolled in IDE ­ should complete by yearend 2010; lateral disc underway CE Mark

Bricon

LP-ESP (Lumbar Disc Prosthesis Elastic Spine Pad

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 61 Exhibit 35 artificial diSc landScapE ­ luMbar

(Continued)

Company DePuy Eden Spine Globus Globus Integra Spine

Product Charité Welldisc-L Alliance Triumph eDisc

Description CoCr on poly, ball and socket; anterior Stainless steel on poly; anterior CoCr on poly; posterior CoCr on poly; transforaminal Elastomer/Ti endplates, w/ electronics; anterior or anterolateral Ti/HA coated CoCr on poly, mobile core, 6° of freedom; anterior CoCr on CoCr, ball and socket; anterior CoCr on CoCr, ball and socket; anterior oblique CoCr with Ti porous coated endplates; polycarbonate polyurethane core; anterior or anterolateral CoCr on CoCr; eXtreme lateral Variable modulus elastomer; anterior

Regulatory Status/# Implanted CE Mark; FDA approved CE Mark; launched worldwide in 2009 In development In development In development

LDR Spine

Mobidisc

CE Mark; IDE enrollment complete (1- and 2-level) CE Mark; IDE enrollment complete CE Mark CE Mark

Medtronic Medtronic Nexgen Spine

A-Mav O-Mav Physio-L

NuVasive

XL-TDR

Began enrollment in clinical study w/ completion expected end 2010; commercialization by 2015 Began clinical trial in Europe; implanted in 2 centers In development

Ranier SeaSpine Signus Spineart Spinal Kinetics

CAdisc-L La Jolla Lyptic Baguera L M6

Metal on metal; anterior Nickel-free Ti coating; mobile or fixed nucleus Polymeric nucleus, poly fiber annulus, Ti endplates; anterior CoCr on CoCr with CoCr mobile core; anterior CoCr on CoCr with CoCr mobile core; lateral PEEK w/ thin Ti endplate

In development CE Mark; launched in Europe 2009 CE Mark and launch in Europe (Germany); U.S. feasibility enrollment complete; 300 implanted CE Mark; submitted PMA application 4Q09; expects approval 2011 Pilot underway w/ 20% enrolled; CE Mark expected mid-2010 Pilot to begin 2Q10

SpinalMotion SpinalMotion SpinalMotion

Kineflex L

© ORTHOWORLD Inc., 2010. All rights reserved.

62 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 35 artificial diSc landScapE ­ luMbar

(Continued)

Company Stryker Synthes Takiron TranS1 Zimmer

Product FlexiCore ProDisc-L Fabricube PDR Dynardi

Description CoCr on CoCr, constrained ball and socket; anterior CoCr on poly, ball and socket; anterior 3D fabric Crosslinking elastomer; transsacral CoCr on poly, mobile core; anterior

Regulatory Status/# Implanted CE Mark; IDE enrollment complete CE Mark; FDA approved In development with Medtronic Will design clinical trial following launch of PNR pivotal trial (on hold in U.S.) CE Mark; no IDE underway

Taking disc replacement one step further are full spinal segment replacement technologies as offered by Impliant, Flexuspine and Disc Motion Technologies. Disc Motion Technologies developed the InLign TMS (Total Motion Segment), which includes artificial disc, dynamic stabilizer and dynamic pedicle screw, all implanted posteriorly. Further, the company's InLign MLH (Multi-Level Hybrid) comprises a posteriorly-implanted artificial disc and a motion preserving rod that allows motion at the level that has received the artificial disc and provides rigid stabilization for an adjacent level that received a posteriorlyimplanted fusion device. Both devices have been implanted in patients outside the U.S. In early 2010, Flexuspine received conditional approval from FDA to begin the initial phase of an IDE feasibility study of its FSU device. The approval marks the first for a clinical study of a Total Spine Arthroplasty system in the U.S. Flexuspine's FSU Total Spinal Segment Replacement features an interbody disc component (Core) and posterior dynamic resistance component (Dampener), with the combination acting to restore the motion and natural kinematics of the affected spine segment. A first in-man clinical series was performed in South Africa, and Flexuspine plans to begin patient enrollment in the U.S. feasibility study and to establish clinical study sites in several countries outside the U.S. whose data may be used in support of a pivotal trial in the U.S. Impliant's technology centers on the TOPS System for treatment of facet arthrosis, spondylolisthesis and spinal stenosis. The system features a semi-constrained titanium construct with central articulating core based on Impliant's cushion bearing polyurethane technology. TOPS remains in U.S. and European trials. Exhibit 36 summarizes full spinal segment technologies and their regulatory status worldwide.

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 63 Exhibit 36 full Spinal SEgMEnt tEchnologiES landScapE Company Disc Motion Product InLign Total Spinal Motion Segment System FSU Description Posterior lumbar disc + dynamic stabilizer + dynamic screw Interbody disc + posterior dynamic resistance component Total posterior arthroplasty; pedicle screw-based, semiconstrained Ti construct w/ central articulating core Regulatory Status/# Implanted CE Mark; 1st human implantation May 2008; will develop IDE submission in 2010; >35 implanted Received conditional approval to begin IDE feasibility study (early 2010) CE Mark; IDE voluntarily suspended 2007 following a device failure; enrollment restarted 2008 (74 enrolled)

Flexuspine

Impliant

TOPS

Facet Replacement Facet replacement addresses isolated facet pain and/or facet pain that can arise following artificial disc replacement. Several companies have developed products for facet joint arthroplasty, replacement of the facets and excised elements of the posterior lumbar spine. Over the last 18 months, the facet replacement segment of the market witnessed the dissolution of a key competitor. That is, Archus closed its doors in August 2009. The company had developed the TFAS systems that had been used for treatment of cervical spinal stenosis and as lumbar facet joint replacement implants. Key competitor, Facet Solutions, acquired the assets of Archus. Clariance moved above the radar in the facet replacement space. The company's NeoFacet is a pedicle screw-based articulating device intended to restore normal range of motion, while providing stabilization to the spine, following facetectomy and neural decompressive procedures. The device remains under development. Facet Solutions' Acadia Anatomic Posterior Stabilization System (pedicle-screw based) was initially positioned as a facet arthroplasty technology, but has since found its primary indication as treatment of spinal stenosis. Over the last 18 months, the company has brought in two-year data for its U.S. lumbar stenosis pilot study of the Acadia with results indicating that Acadia patients experienced significant and substantial improvement in disability and pain scores with no re-operations. The device received CE Mark approval, but remains in U.S. IDE trials at 20 sites. More than 100 patients have been enrolled and data at one year revealed an 88 percent reduction in disability, 77 percent reduction in back pain and an 84 percent reduction in leg pain. Furthermore, narcotic use and reoperation rates were substantially lower than in the controls. Gerraspine launched its Fenix Facet Resurfacing System for resurfacing both the superior and inferior articulating surfaces of the facet joints, leaving the posterior elements intact. The CE Mark approved device can be used as a standalone device, or with any motion preservation implant. Gerraspine expects to be fully integrated in four of the largest markets for spinal implants in Europe by year's end.

© ORTHOWORLD Inc., 2010. All rights reserved.

64 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Osprey Biomedical will focus on biological solutions to spine problems, with facet and interspinous process devices under development. Spinal Elements' Zyre facet arthroplasty system features a malleable spacer placed between the facet joints. Use of the spacer does not violate the pedicle and, thus, maintains the option for fusion in the future. The Zyre device can be used either in conjunction with disc replacement or as a stand-alone implant. It remains in clinical trials outside the U.S. Exhibit 37 summarizes facet technologies.

Exhibit 37 facEt arthroplaSty landScapE Company Clariance Facet Solutions Product NeoFacet AFRS Description Pedicle screw based Pedicle screw based + anatomically designed implants Facet resurfacing system Malleable spacer between facets Regulatory Status/# Implanted Under development CE Mark; U.S. pilot trial completed; pivotal trial initiated (300-450 patients) CE Mark, with European launch underway First system implanted 2008; clinical trial underway ex-U.S.

Gerraspine Spinal Elements

Fenix Zyre

Nucleus Replacement With nucleus replacement, only the center of the disc (the nucleus) is removed and replaced with an implant. The outer part of the disc (the annulus) is not removed. In mid-2009, the National Institutes of Health provided a grant to Cambridge Polymer for development of an injectable hydrogel for nucleus pulposus replacement. Funding will support finalization of the formula and longterm fatigue studies of the technology. Clariance is working on the NucleoFil, which features a self-forming, radiopaque, biocompatible coil along with a viscoelastic biomaterial that fills the medial cavity left after nucleotomy and coil formation. The device will be implanted in a transosseous approach. During the last 18 months, CryoLife completed a ten-patient clinical feasibility evaluation with two-year follow-up of BioDisc, a protein-based hydrogel spinal disc nucleus repair system. The company also noted its belief that CE Mark approval for the BioDisc will require more human implants and clinical follow-up. CryoLife will seek a partner to help with development. Disc Dynamics, which had been in U.S. pilot clinical trials for its DASCOR Disc Arthroplasty System, closed its doors at the end of 2009, reportedly having been unable to gain FDA approval to enter pivotal trials. The company's catheter-based minimally invasive nucleus replacement device features a balloon that is inserted into the disc space followed by a two-part flowable polyurethane that is injected as a liquid, filling the balloon and the disc space. The

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 65 polymer cures to form a firm but pliable implant. Disc Dynamics had gained CE Mark approval and launched the product in Europe. Gentis announced in 2009 that it plans to file for initiation of a pivotal trial of its DiscCell in the U.S. in 2010. DiscCell is an injectable reverse emulsion polymer matrix product that polymerizes in situ. The first human implant of the DiscCell device occurred in mid-2007 and a pilot study in discectomy patients is ongoing. Interventional Spine expects to complete implant designs in 2010 for its percutaneous nucleus scaffolding system for use with Percudyn, while NuVasive expects 2010 to bring two-year data on its NeoDisc cervical nucleus replacement device. The implant features an elastomeric core encapsulated by polyester embroidery, which acts as a scaffold for tissue ingrowth. The device entered U.S. pivotal studies in 2006. In early 2009, Pioneer Surgical began an IDE pivotal study of the NuBac device. The CE Mark approved NuBac Intradiscal Arthroplasty System (for nucleus replacement) features PEEK-on-PEEK ball and socket components inserted through an MIS approach, which also serves to preserve most of the annular tissue. Replication Medical continues preclinical testing for its NeuDisc modified poly-acrylonitrile polymer implant. The device can be implanted minimally invasively and, once inserted, it expands anisotropically, restoring the hydration to the disc space by absorbing the body's natural fluids. Spine Wave's NuCore Injectable Nucleus incorporates an in situ, curing, injectable, 100 percent synthetic recombinantly-produced protein hydrogel. The device is being investigated for use in treating early degenerative disc disease and as an adjunct to microdiscectomy. Patient enrollment in clinical trials for the device continues in Australia, Germany, Switzerland and the U.S. for both indications. Although best known for its AxiaLIF technology, which uses a percutaneous, para coccygeal axial approach to lumbar fusion, TranS1 also developed the PDR implant, designed to provide trans-sacral access for disc reconstruction while preserving motion in the lumbar spine, and the Percutaneous Nucleus Replacement (PNR), a nucleus replacement technology that incorporates a rod with injectable, curable in situ crosslinking elastomer. The company commenced a pilot study in Europe for the PNR in 2008. In 2009, TranS1 re-prioritized its development efforts and now seeks to pursue products that have a shorter pathway to regulatory clearance and commercialization. As a result, the company put its PNR project on hold in the U.S., which will also impact its PDR project. Vertebral Technologies continues its development of the InterCushion Disc Nucleus Replacement System and remains on track to begin a feasibility trial outside the U.S. in 2010. The InterCushion features a PEEK inner core with a soft polyurethane outer core introduced through a posterior approach, and uses Intraoperative Assembly (implanting larger devices through an MIS approach) of interlocking implant modules. Other nucleus replacement technologies under investigation or development may come through the efforts of Dynamic Spine, NP Solutions, Stryker, Synthes, X-Spine and Zimmer. Exhibit 38 summarizes nucleus replacement technologies and their regulatory status.

© ORTHOWORLD Inc., 2010. All rights reserved.

66 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 38 nuclEuS rEplacEMEnt landScapE Company Arthro Kinetics Biomet Regain Product Description Collagen matrix One-piece pyrocarbon Regulatory Status/# Implanted Under development CE Mark; MHRA (Japan) study underway; IDE feasibility enrollment underway Under development Under development Submitted CE Mark 2007; more data required; likely to seek partner

Cambridge Polymer Clariance CryoLife NucleoFil BioDisc

Injectable hydrogel Biocompatible coil with viscoelastic biomaterial Curable, in situ polymerizing protein hydrogel (purified bovine albumin + glutaraldehyde) Curable liquid polymer Annular sparing Intervertebral Prosthetic Disc Injectable reverse emulsion polymer matrix Elastomeric core surrounded by embroidered jacket PEEK on PEEK intradiscal arthroplasty, two-piece articulating inner ball/socket Modified poly-acrylonitrile polymer Injectable, 100% synthetic recombinant protein hydrogel Polyvinyl alcohol hydrogel Gelifex injectable hydrogel In situ crosslinking elastomer

DePuy Spine Dynamic Spine

SINUX ANR IPD

CE Mark In development

Gentis NuVasive

DiscCell NeoDisc

CE Mark filing; to file for pivotal trial 2010 IDE began 2006; 2 year data available in 2010; estimated release 4Q10 CE Mark; IDE began early 2009

Pioneer Surgical

NuBac

Replication Medical SpineWave

NeuDisc NuCore

Pilot clinicals ongoing Pilot clinicals ongoing

Stryker Synthes TranS1

Aquarelle Hydrafil PNR

In development In preclinicals Pilot clinicals in Europe launched 2008. Project on hold in U.S. Feasibility trial outside U.S. 2010 Pilot clinicals in Europe ongoing

Vertebral Technologies Zimmer

InterCushion Newcleus

PEEK inner core with soft polyurethane outer core

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 67 Dynamic Stabilization Dynamic stabilization products ­ pedicle screw-based or interspinous ­ offer an alternative to spinal fusion by providing stability to affected spine segments but also motion and flexibility. Furthermore, numerous technologies within this category also offer relief from spinal stenosis. A key event in dynamic stabilization during 2009 came with FDA's requirement that manufacturers of dynamic stabilization systems or components already on the market for spinal fusion conduct postmarket surveillance studies to collect clinical data on a number of potential safety issues, including fusion rates and frequency of additional surgeries. In other news on the dynamic stabilization front, Applied Spine Technologies (AST) received permission from FDA to proceed with enrollment in its IDE trial of the Stabilimax NZ Dynamic Spine Stabilization System. The company had voluntarily suspended enrollment in the trial following three reports of screw fracture. AST changed its screw manufacturing process from grit blast to shot peening, which reportedly significantly strengthened the device. To date, 20 patients in its IDE have received the new screw. AST received CE Mark approval for the Stabilimax, and the company is exploring its options outside the U.S. Disc Motion Technologies has developed the InLign Anatomic Radius Component, which can be used either as a stand-alone dynamic stabilization system, as a fixation rod for fusion or in conjunction with total disc replacement. During the year, Eden Spine received CE Mark approval for the PERFX-2 posterior dynamic stabilization system. The company also markets its Wellex Interspinous Process Technology, which acts as an extension controller. Globus Medical announced that the first FLEXUS Interspinous Spacers were implanted under an IDE. The 340-patient, 20-site prospective, randomized study will seek to prove equivalence with the X STOP device over a twoyear period and will involve patients over age 50 who may benefit from decompression provided by the FLEXUS device. FLEXUS is a unitary radiolucent implant that is placed unilaterally between two spinous processes with minimal disruption to surrounding muscles and tissue. Interventional Spine launched a U.S. clinical trial of the PercuDyn (branded the PDS System in the U.S.) for the percutaneous treatment of lumbar degenerative disc disease, and marked successful completion of the first U.S. outpatient interventional procedure using the device. The CE Marked (for treatment of LSS) PercuDyn, a percutaneous dynamic stabilization system, features a transfacet device incorporating the company's CLASP (Compression Locking Anchor with Secondary Purchase) technology. More than 40 patients have been enrolled in the IDE randomized study, and the company boasts two-year follow-up on 25 patients. Approval of the device in the U.S. could come in 2012. Interventional Spine is also developing percutaneous nucleus scaffolding system for use with Percudyn and markets PERPOS PLS, a percutaneous transfacet-pedicular compression system for posterior stabilization during lumbar fusion. The company's proprietary compression technologies have been implanted in more than 7,000 patients since 2007. Medtronic markets the X STOP Interspinous Process Decompression System, the first FDA cleared interspinousbased dynamic stabilization device, which comprises a less invasive titanium implant designed to treat lumbar spinal stenosis (LSS). The company's dynamic stabilization portfolio also includes the Aperius PercLID System and DIAM

© ORTHOWORLD Inc., 2010. All rights reserved.

68 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Spinal Stabilization System. Aperius PercLID features an implant that is placed percutaneously between the spinous processes and is then expanded in place. The company anticipates ex-U.S. launch of Aperius in its fiscal year 2010, with U.S. launch following in 2013. Paradigm Spine's portfolio includes the coflex, DSS and DCI systems. In early 2010, the company completed enrollment in the pivotal IDE trial for the interspinous coflex, a titanium dynamically functional implant. Paradigm's CE Mark approved pedicle screw-based DSS implantable dynamic spine stabilization system incorporates elements of fusion and motion preservation, while the one piece DCI (Dynamic Cervical Implant), an interbody device, has been used to treat cervical stenosis since 2002. Replication Medical received CE Mark approval for its GelFix Interspinous Spacer in early 2010. The spacer comprises a one piece posterior implant made from HPAN, a biocompatible hydrogel that acts as a dynamic spacer when implanted between the spinous processes. Scorpion Surgical Technologies is focusing on technology for anchoring dynamic and static spinal implants, while SpineLab is developing Elaspine, a pedicle screw-based dynamic stabilization system. In early 2010, VertiFlex completed the first human implantation of its Shockwave Dynamic Stabilization System, a dynamic rod. The company's other dynamic products include the CE Mark approved posterior, percutaneouslyapproached Superion titanium interspinous spacer and the Dynabolt dynamic stabilization device. Superion remains in U.S. clinical trials for treatment of LSS. Vertos Medical's MILD (Minimally Invasive Lumbar Decompression) devices accommodate a percutaneous, fluoroscopically guided MILD procedure that can be performed under local anesthesia for the treatment of LSS. In early 2010, the company completed enrollment in its post-market U.S. Institutional Review Board I Patient Outcomes Trial, a 75-patient study of its procedure. Further, results from a 12-center, 90-patient observational study of the MILD procedure demonstrated safety in the treatment of LSS, with no reports of patient complications related to the mild devices or technique. Zimmer's dynamic stabilization products include Wallis and Dynesys. The Wallis system features PEEK spacers and clips, combined with polyethylene braided "loops." Used for more than 15 years outside the U.S., the Wallis entered U.S. clinicals in 2005. The Dynesys combines pedicle screws with a polycarbonate urethane spacer and polyethylene terephthalate cord. The device received CE Mark approval in 1999 and, in 2009, FDA's Orthopaedic and Rehabilitation Devices Panel voted five to one against recommending the system for use as a standalone treatment. The panel questioned data, clinical trial design and the integrity of the device over time. Based on the panel's recommendation, Zimmer will explore its options for the product. Zimmer has also developed the DTO implant, a combination of Dynesys with the OPTIMA ZS rigid stabilization system for a segmental approach to treat different stages of degeneration at contiguous levels. The implant is not available in the U.S. Additional pedicle screw- or rod/plate-based systems for dynamic stabilization include Biomet's PEEK rods and pedicle screws, flexible rod technologies from BioSpine, Globus and Orthofix, DePuy PDS in Europe, Eden Spine's FX-1, GMReis' Dinamika, K2M's Potomac nickel titanium pedicle screw/rod system and Cayman Buttress and

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 69 Thoracolumbar plates, Life Spine's Prodigy, Medicrea's Granvia, and the Aladyn3 system of dynamic or rigid rods and plates from Scient'x. Additional interspinous devices include Biomet's CE Mark approved ISS system, GMReis' Dynafix (like coflex), NuVasive's FDA cleared ExtenSure allograft implant and the Spinos titanium spacer from Privelop (to be distributed in Europe by SpineVision). Medtronic, Nexgen, NuVasive and SeaSpine also have dynamic stabilization products under development. Exhibit 39 summarizes dynamic stabilization technologies and their regulatory status worldwide.

Exhibit 39 Motion prESErvation landScapE - dynaMic Stabilization Company Alphatec Alphatec Alphatec Product Aladyn Isobar Duo Isobar TTL Dynamic Rod Isolock Twinflex Stabilimax NZ ISS Bioflex Spring Rod ISSYS DC PDS InLign Anatomic Radius Component InLign MLH PerFx-2 Rod based, angled motion Disc + motion preserving rod Dynamic rod technology pedicle screw based Interspinous Description Rod and/or posterior plate based Pedicle screw based; Ti or stainless steel Pedicle screw based; Ti, shock absorber Posterior dynamic plate with washers Pedicle screw based; Ti or stainless steel Pedicle screw based Interspinous, titanium alloy Screw based with Nitinol rods Screw based, Nitinol springs/joints CE Mark Used in >40 patients ex-U.S. 1st implantation 2009 CE Mark Regulatory Status/# Implanted CE Mark; >3,000 implanted CE Mark; FDA cleared as fusion device; 120 implanted CE Mark; FDA cleared as fusion device; 14,000 implanted; 1st implant in Europe in 2009 CE Mark; FDA cleared as fusion device; 5,000 implanted CE Mark; 3,000 implanted IDE trial restarted in 2009; enrolled >100 patients CE Mark CE Mark, cleared in Korea

Alphatec Alphatec Applied Spine Technologies Biomet BioSpine Custom Spine DePuy Disc Motion Technologies Disc Motion Technologies Eden Spine

Eden Spine

Wellex

IDE expected 2010

© ORTHOWORLD Inc., 2010. All rights reserved.

70 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 39 Motion prESErvation landScapE - dynaMic Stabilization

(Continued)

Company Globus GM Reis GM Reis Integra Integra

Product Flexus Dinamika Dynafix Axient SC Axient Total

Description Interspinous; PEEK Pedicle screw based Interspinous; Ti Pedicle screw-based, adjunct to fusion Pedicle screw-based full motion posterior dynamic stabilization Percutaneous bilateral facet augmentation system, including L5-S1 Pedicle-screw based; shape memory alloy Interspinous; shape memory alloy Flexible rod; shape memory alloy Pedicle screw/rod based; nickel Ti Rod/plate based Percutaneous interspinous; Ti alloy Interspinous; silicon + polyethylene Interspinous; Ti alloy Pedicle screw based Interspinous Pedicle screw based; carbon fiber composite Interspinous; allograft U-shaped; interspinous; Ti alloy U-shaped interbody

Regulatory Status/# Implanted In IDE

At least 218 implanted

Interventional Spine

PercuDyn (PDS in the U.S.)

CE Mark; IDE ongoing

Jemo Spine Jemo Spine Jemo Spine K2M Life Spine Medtronic Medtronic

Omega, SpinoFix and SpinoFlex SmartU and S-Flex Niti Potomac Dyna-Link Aperius PercLID DIAM

Launched 2009 ex-U.S. FDA cleared as fusion device CE Mark; launch fiscal 2010 in Europe CE Mark; IDE began 2008; primary efficacy study completion estimated 2010 FDA cleared

Medtronic Medyssey Medyssey Mekanika NuVasive Paradigm Spine Paradigm Spine

X STOP Wave FleX Posterior Semi Rigid System OMEGA Modulus System ExtenSure coflex DCI (Dynamic Cervical Implant)

In development FDA cleared CE Mark; completed U.S. pivotal trial enrollment Used to treat cervical stenosis since 2002

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 71 Exhibit 39 Motion prESErvation landScapE - dynaMic Stabilization

(Continued)

Company Paradigm Spine Pioneer Surgical

Product DSS BacJac

Description Pedicle screw based Self deploying interspinous spacer; PEEK on PEEK Interspinous; Ti Interspinous; hydrogel IM nail system

Regulatory Status/# Implanted CE Mark; FDA cleared; IDE 2006 CE Mark

Privelop Replication Medical Scorpion SpineLab SpineVision Synthes Synthes

Spinos GelFix

CE Mark CE Mark In development In development CE Mark Completed enrollment in pilot US IDE in 2009 (500 patients) CE Mark; IDE began 2007; some systems recalled in 2009 due to dimensional spec issues CE Mark FDA cleared as fusion device 1st human implantation early 2010 CE Mark; in U.S. clinical trials FDA cleared

Elaspine FlexPLUS In-Space Nflex

Pedicle screw based Pedicle screw based; Ti and polymer Interspinous Pedicle screw based; Ti and elastomer Titanium hinged screw head Pedicle screw based, adjunct to fusion Dynamic rod Percutaneous interspinous; Ti Instrumentation Dynesys + OPTIMA ZS rigid stabilization system Screw based; polycarbonate urethane spacer + polyethylene terephthalate Interspinous; PEEK spacers and clips, polyethylene braided "loops"

Ulrich VertiFlex VertiFlex VertiFlex Vertos Zimmer

Cosmic Dynabolt Shockwave Superion MILD DTO

Zimmer Spine

Dynesys

CE Mark; FDA cleared as fusion device with Panel recommending against approval in the U.S. in 2009 CE Mark; IDE began 2005

Zimmer Spine

Wallis

© ORTHOWORLD Inc., 2010. All rights reserved.

72 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT In the MIS arena for spinal procedures, Spinal Elements announced the first lumbar surgery using its Axxion Minimally Invasive Surgery Retractor System. Aesculap Implant Systems launched the Spyder Minimally Invasive Spinal Retractor, indicated for use in the lumbar spine with the company's S4 Pedicle Screw and received clearance for its MILI (minimally invasive lumbar implant). Integra Spine's Paramount Pedicle Screw for MIS spine surgery found use in its first two-level surgery. The company initiated a limited launch of the system. The last year also marked the first clinical application of Integra's Coral Spinal System for minimally invasive spine surgery. Alphatec commenced limited market release of the ARC Portal Access System along with the GLIF technique in 2009. The company's MIS portfolio also includes the Illico line of products ­ retractors, cannulated polyaxial screws, precut and pre-bent rods. Baxano's iO-Flex System accommodates an "over the wire" inside out lumbar decompression using flexible instruments. The 510(k) cleared device allows for complete access to impinging tissue, with minimal disruption to the facet joints, and can be used in open or MIS procedures. Globus' MILDER (Minimally Invasive, Less Disruptive, Earlier Recovery) platform debuted several new products in early 2009, including the Patriot Signature TLIF Spacer, Independence Spacer, etc. The company marked the first use of its XPand expandable corpectomy cage in a totally minimally invasive procedure. Hoogland Spine Products received FDA clearance in 2009 for its MIS maxMorespine System and TOM Endoscope, endoscopic spine systems for discectomy and decompression through posterolateral transforaminal approach. Spine Now will serve as Hoogland's exclusive distribution arm in the U.S. Joimax's Thessys system accommodates transforaminal posterolateral removal of herniated discs and may be applied to any MIS disc procedure. The company has also launched the 360° TESSYS and the iLESSYS fully-endoscopic systems for use in the treatment of spinal canal stenosis. Both systems are based on the TESSYS Transforaminal Endoscopic Surgical System, a technique for the removal of lumbar disc herniations under direct endoscopic view through the vertebral foramen. The iLESSYS (interLaminar Endoscopic Surgical System) enables fully dorsal endoscopic access to the lamina and spinal canal. The treatment is performed under local anesthesia through a minimally invasive fingernail-like cut, and patients are able to leave the hospital within a few hours. K2M launched its TERRA NOVA Minimally Invasive Access System during 2009. The company also markets the screw-based, structure-sparing Serengeti MIS retractor system and the hinge-based NAPA MIS retractor systems. In mid-2009, Life Spine received FDA clearance for its FS3 Minimally Invasive Spinal System of facet screws. Late in 2009 the company launched its AVATAR Minimally Invasive Spinal System for the delivery of pedicle screws. TranS1 then conducted a limited market release of the Avatar Pedicle Screw through an agreement with Life Spine. Non Linear Technologies intends to further develop its minimally invasive products for spinal fusion and stabilization. NuVasive's minimally disruptive access (MAS) technologies for thoracic surgery include the MaXcess Access Systems and NeuroVision, a software-driven nerve avoidance system, as well as specialized implants (SpheRx, XLP Lateral Plate, CoRoent) and various biologic products.

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 73 OuroBoros received approval in Europe for its MIS OSS device, which is designed to circumferentially expand in the interbody disc space and contain graft materials to support fusion. Richard Wolf markets Vertebris endoscopic spinal access technologies for posterior, posterolateral and lateral percutaneous endoscopy and foraminotomy. Other interesting spine technologies run the gamut from annular repair to ozone injection therapeutics. Anulex's FDA cleared Inclose Surgical Mesh System provides a barrier and scaffold to facilitate the repair of soft tissue and could have application in repairing and sealing the annulus in herniated or otherwise damaged discs. The implant comprises polyethylene terephthalate monofilament braid material preloaded on a disposable delivery tool. Anulex's Xclose for soft tissue approximation in general and orthopaedic applications has found use in more than 7,300 patients in the U.S. Anulex completed enrollment in a post market study of the device in 750 patients. Furthermore, Anulex has developed FDA-cleared Rimclose for fixation of suture to bone. The company intends to discuss the product's application in spine with FDA. Articular Engineering has developed the novel Cationic Nucleus Therapy technology for contained herniated discs. The therapy delivers a charged polymer percutaneously into the disc nucleus where it renders certain components of the nucleus incapable of attracting and holding water, thereby reducing the volume that the nucleus occupies. The technology dramatically decreases the amount of space taken up by the disc, thus reducing compression on the nerve and subsequently decreasing pain. Articular has completed small preclinical animal studies of the technology. Axial Biotech released its ScoliScore saliva-based genetic prognostic test for Adolescent Idiopathic Scoliosis to the general spine surgeon population following its refinement by a group of U.S. spine surgeons from 40 medical centers throughout the U.S. DePuy Spine will market the test, which has been run more than 900 times. Axial Biotech continues its focus on the development and commercialization of DNA-based tests, including one for Degenerative Disc Disease (DDD). The DDD prognostic test will confirm not only the likelihood of developing DDD but also the level of severity of the condition to allow earlier surgical intervention and treatment. The test is currently in clinicals. Axial will also develop tests for spondylolisthesis, OA and osteoporosis. Bone Support's Sonothermal Disc Treatment with the use of Ultrazonix Spine Minimal-Invasive Disc System features a High Intensity Focused Ultrasound probe to coagulate and decompress disc material. The technology received FDA clearance and CE Mark approval to treat symptomatic patients with annular disruption of contained herniated lumbar discs. CoreSpine Technologies' Xtend-ST Nucleus Removal System offers the surgeon an instrument for removing the nucleus without harming the endplates through the use of an articulating and extendable tip that "gets around the corner." The company also developed the Xtend CR for removal of cartilage from bone. DePuy Spine and Johnson & Johnson Development will provide financing to Biomerix to support development of a new annulus repair implant for use following lumbar discectomy. The implant utilizes the Biomerix Reticulated Matrix, a biocompatible, biodurable polyurethane scaffold which has demonstrated the support of tissue growth in animals.

© ORTHOWORLD Inc., 2010. All rights reserved.

74 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Ellipse Technologies received CE Mark approval and announced the world's first human use of any medical device operated via remote control that can non-invasively expand or reverse its length to straighten a human spine. The company's MAGnetic Expansion Control (MAGEC) System features a technology that can adjust implants from outside the body via remote control. The MAGEC system for treatment of spinal deformity will first be applied to treatment of scoliosis in young children and teenagers. Intralink Spine's technology centers on the company's Nonsurgical Exogenous crosslink Therapy, which uses a tissue modifying reagent that can be injected into the intervertebral disc of the human spine to increase crosslinking in the native collagen matrix, which, in turn, should help to strengthen and stabilize spinal discs. Intralink is conducting human trials in Korea and Malaysia, and should be able to commercialize its technology in 2011 in Asia and Europe. The company expects to have clinical data for FDA in 2012. Annular repair for Intrinsic Therapeutics comes through its Barricaid annular repair device used for closing defects in the disc annulus. The device received approval under the CE Mark in 2009 for use in minimally invasive reconstruction of soft tissues in the spine in patients with lumbar disc herniation and sciatica. Intrinsic launched the product in Europe, where it will also conduct post-marketing studies. The company also filed an IDE for Barricaid in anular closure as part of discectomy. Magellan Spine Technologies completed enrollment in a 20-patient study of its Magellan DART Disc Annular Repair Technology system for annular repair following lumbar discectomy. The CE Marked device is intended to seal the access site in the annulus fibrosus following microdiscectomy in the lumbar spine. Magen Medical's CE Mark approved SpineShield acts as an anti-adhesion barrier that protects the spinal canal from penetrating scar tissue. The device features a flexible spiral foil, reinforced by a metal core wire. While in place, the spiral lies flat, with the coils partially overlapping, to form a surface that adapts to fit the surface area. Minimus Spine is developing ozone injection technology for spinal applications, such as disc herniation. Intradiscal ozone injections have been used to treat disc herniations in Europe for nearly 20 years and Minimus will work to improve standard techniques used outside the U.S. SpineForm seeks to enter clinical trials with its spine staple for use in non-surgical scoliosis correction, while SI-Bone has developed the IFuse Implant, a plasma sprayed intramedullary implant for fixation and fusion of sacroiliac joint. Spine21 has developed its Bionic Spacer, an interspinous process device that allows the surgeon (with patient feedback) to postoperatively adjust the implant through a built-in radio activated distraction. The device has been implanted in sheep, with the first in-human implantation expected in late 2011 when CE Mark approval and IDE clinical trials could occur as well. SpineView's enSpire provides an option for complete discectomy in open or MIS procedures. The 510(k) cleared device includes an expandable wire with cutter that simultaneously cuts and removes disc material including endplate cartilage. Spineview has also developed a needle-based interventional discectomy tool based on the enSpire technology.

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 75 Vertebroplasty/Kyphoplasty Estimates place the number of vertebral fractures worldwide at approximately 1.4 million, with some 700,000 in the U.S. alone. Nearly 400,000 surgical procedures were performed in 2009 to treat these vertebral compression fractures (VCFs), resulting in a worldwide market valued at more than $1 billion. Treatment of osteoporotic spine fractures consists primarily of conservative, non-operative modalities. However, vertebroplasty and kyphoplasty have become more commonplace in treating spine fractures. Through vertebroplasty, a physician uses image guidance to percutaneously inject a biomaterial (typically bone cement) into a fractured vertebra. The MIS technique stabilizes the collapsed vertebra, thereby preventing further vertebral collapse and providing pain relief and a return to activity. Through kyphoplasty, surgeons guide a balloon minimally-invasively into the fractured vertebral body and inflate the balloon, thereby reducing the fracture and raising the collapsed vertebra. Once the fracture has been reduced, the balloon is removed. Insertion and inflation of the balloon create a void into which bone cement is introduced. Other devices that create cavities in the bone compete with traditional balloon kyphoplasty. The market for products to treat vertebral compression fractures is crowded. A worldwide license agreement between Alphatec Spine and Stout Medical provides Alphatec with rights to develop and commercialize Stout's V-Stent minimally invasive expandable titanium cage, marketed under the brand name OsseoFix Spinal Fracture Reduction System. The system received CE Mark approval but remains in clinicals in the U.S. The company markets the device with its OsseoFix+ Cement. AscendX (formerly AOI Medical) is developing the AscendX Vertebral Compression Fracture Reduction System, which features a set of tools for use in restoring the anatomy of fractured bone. In 2009, the company completed enrollment for its 60 patient confirmatory clinical study for the system. For those VCFs caused by diseased or abnormal soft tissue, ArthroCare's Cavity SpineWand uses Coblation technology to remove affected soft tissue inside the vertebrae prior to introduction of osteoplastic materials. The company claims that its technology minimizes the potential for tumor cell embolization and movement of tissue into the spinal cord. ArthroCare's VCF franchise also includes Parallax Acrylic Resin bone cement and Integrated Delivery System. Vesselplasty, from A-Spine, uses a polyethylene terephthalate (PET) vessel, the Vessel-X, to restore the height of the vertebral body. The Vessel-X not only expands to fill the vertebral body, but also contains whatever bone void filler the surgeon wants to use. The void filler material penetrates through the device allowing for its interdigitation into surrounding bone. Both Vessel-X and bone void filler remain in situ. Benvenue Medical received CE Mark approval for its Kiva Vertebral Compression Fracture Treatment System, a PEEK-Optima polymer implant that is introduced using a percutaneous over-the-wire technique. BioCure's development efforts are focused on bone void fillers and bone cements based on its polyvinyl alcohol hydrogel technology platform. The company's load bearing bone cement will have application in the augmentation of VCFs.

© ORTHOWORLD Inc., 2010. All rights reserved.

76 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT CareFusion spun out of Cardinal Health and, with a recent addition of a balloon to its VCF line, it now offers a traditional vertebroplasty system that can also accommodate the balloon, allowing surgeons to perform either vertebroplasty or kyphoplasty with the same instruments. The company also markets Ava-Tex bone cement and accessories. DFine's VCF offering centers on its StabiliT Vertebral Augmentation System for use in what the company terms "RF Kyphoplasty." The StabiliT system features the VertecoR Midline Osteotome, which creates a cavity in the center of the vertebra and StabiliT ER2 (energy responsive) high viscosity bone cement. In vertebroplasty, DePuy Spine markets the Confidence Spinal Cement System, which features a highly viscous bone cement along with a novel hydraulic delivery system. Under development by Intelligent Implant Systems is the Spiron for VCF treatment. Kuros Biosurgery has developed KUR-021, a synthetic bone cement for use in the treatment of vertebral compression fractures. Medtronic leads in the VCF market with technology that centers on balloon-based kyphoplasty. Since 2000, the company has treated more than 700,000 fractures worldwide with its technology, with more than 14,000 surgeons trained on the procedure. In mid-2009, a study published in the New England Journal of Medicine found improvements in pain and pain-related disability with vertebroplasty in treatment of osteoporotic VCFs to be comparable to those in the control group. According to Medtronic, the article had a direct negative effect on its Kyphon sales, which declined in 2009. Orthovita launched its Cortoss Bone Augmentation material in the U.S. in 2009 for use in vertebral augmentation. Cortoss is an injectable, non-resorbable, bioactive polymer composite and is the first alternative to polymethylmethacrylate that has been clinically evaluated in a large-scale, multi-center randomized study for the treatment of vertebral compression fractures. Osseon Therapeutics received FDA clearance, CE Mark approval and medical device licenses in Canada for its Osseoflex steerable/curvable bone cement delivery needle and Osseoflex DR steerable/curvable bone drill for percutaneous vertebral augmentation. More than 700 patients have been treated with its technology. The company is also developing Osseoperm bone cement. Renova Orthopedics focuses on the A-FX (Advanced Fixation) Method, a minimally invasive platform for creating implants in situ, primarily targeting osteoporotic bone. After a bone cavity is created using the company's Flexblade, a pre-formed implant and biomaterial are combined to create an in situ formed implant. The technology has application in a variety of orthopaedic indications, from intramedullary nailing to pedicle screw augmentation. Sintea's CE Mark approved and FDA cleared Spider implant is an expandable shape memory alloy tamp designed to compress cancellous bone as it expands. The device creates a cavity into which bone cement is introduced.

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 77 Skeltex's development efforts in VCF center on its Integrated System for Vertebroplasty, which comprises a delivery system, sensors to measure pressure and cement properties and a monitoring unit that controls the instruments and provides feedback to the physician. The company has developed prototypes for some of the system's components. Soteira has developed a kyphoplasty technology that features braided Nitinol with PET mesh shield. Results from clinical studies showed the technology to be equal to control in pain and quality of life, with leak frequency and volume superior to those experienced in the control groups. Furthermore, loss of height was deemed better than that achieved with vertebroplasty. Reportedly, Soteira has begun to sell its system in Germany. In mid-2009, SpineAlign began an IDE feasibility study of its VerteLift system for treatment of VCFs. The system features an expandable Nitinol alloy implant that raises the endplates and supports them in a minimally invasive approach. The device can then be collapsed and repositioned or completely retrieved prior to the introduction of PMMA. SpineAlign received CE Mark approval for the Vertelift, which is in commercial distribution in Europe. Spineology's OptiMesh bone graft containment and reinforcement system received CE Mark approval and FDA clearance, the latter for use in containing bone graft material within vertebral defects and for use as a cement restrictor. Surgeons implant the PET thread mesh pouch into skeletal defects through a small tube and then deploy the device to its full size. Spineology coined the phrase "Spineoplasty" to describe its MIS (or even percutaneous) procedure using the OptiMesh Deployable Grafting System and bone graft. A novel approach to building up weakened osteoporotic vertebra comes through Spine Wave's StaXx FX Structural Kyphoplasty System, which obtained both CE Mark approval and FDA clearance for use in treatment of VCFs. StaXx comprises the percutaneous injection of interlocking PEEK wafers into the vertebral body, allowing the surgeon to build a structural, height restoring implant. In the U.S. StaXx is indicated for use in conjunction with Stryker's SpinePlex bone cement. In early 2010, Stryker Interventional Spine released the iVAS inflatable vertebral augmentation system and introduced to the U.S. market its VertaPlex HV, a high viscosity bone cement for use in the treatment of VCFs. As the world's largest bone cement company, Stryker's VCF portfolio includes mixer and delivery systems, bone cements and needles for both balloon kyphoplasty and vertebroplasty. For VCF repair, Synthes is developing Vertebral Body Stenting (VBS) technology, which involves the use of a small, expandable metal stent that can be inflated with a balloon from inside. VBS can be implanted laterally on both sides of the spine and expanded up to four-fold with the balloon inside the collapsed vertebral body. Vexim is pursuing human clinical studies of its CE-Marked SpineJack, a titanium intra-vertebral implant designed to counter limitations of available surgical options and restore vertebral height. Through an exclusive distribution agreement, Stryker EMEA will sell and market the implant in Austria, Germany, Ireland and the U.K. Vexim also received CE Mark approval for its Cohesion high viscosity bone cement. Others marketing more traditional bone cements and accessories (e.g. mixing and delivery systems) for use in spine osteoplasty (vertebroplasty and/or kyphoplasty) procedures range from aap to Teknimed. Exhibit 40 summarizes the competitive landscape for spine osteoplasty worldwide.

© ORTHOWORLD Inc., 2010. All rights reserved.

78 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT

Exhibit 40 vErtEbroplaSty and kyphoplaSty landScapE Company aap Alphatec Product BoneOs Inject OsseoFix Spinal Fracture Reduction System and OsseoFix+ Cement. Cavity SpineWand, Parallax Acrylic Resin bone cement and Integrated Delivery System AscendX Vertebral Compression Fracture Reduction System Vessel-X PET expandable device PEEK-OPTIMA Kiva VCF Treatment System Cobalt bone cement and CVD and LP2 delivery systems Spine Support injectable bone substitute and mixing and delivery systems AvaFlex injection needle, AvaMax augmentation systems, Ava-Tex bone cement Duro-Ject injector set, Minimix cement mixer, Osteo-Force vertebroplasty trays, needles and Vertefix bone cement StabiliT system w/ osteotome and bone cement Confidence bone cement and delivery system OsteoJect cement delivery Solver vertebroplasty cement and instruments Kyphon kyphoplasty system w/ bone cement Spine System CORTOSS bone augmentation material FDA cleared, CE Mark approved CE Mark approved FDA cleared, CE Mark approved FDA cleared, CE Mark approved Regulatory Status FDA cleared, CE Mark approved CE Mark approved

ArthroCare

FDA cleared, CE Mark approved

AscendX A-Spine Benvenue Medical Biomet BoneSupport

In clinicals

CareFusion

FDA cleared

Cook

FDA cleared, CE Mark approved

DFine DePuy Spine Integra Spine Lafitt Medtronic Norm Spinal Orthovita

FDA cleared, CE Mark approved FDA cleared, CE Mark approved FDA cleared CE Mark approved FDA cleared, CE Mark approved

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 79 Exhibit 40 vErtEbroplaSty and kyphoplaSty landScapE

(Continued)

Company Osseon Therapeutics

Product Osseoflex steerable/curvable bone cement delivery needle and Osseoflex DR steerable/curvable bone drill Flexblade cavity creator and A-FX in situ implants Vertebroplasty instruments Spider expandable tamp Integrated System for Vertebroplasty (delivery system, sensors and monitoring unit) Kyphoplasty technology VerteLift expandable implant OptiMesh bone graft containment and reinforcement system StaXx FX Structural Kyphoplasty System SpinePlex and VertaPlex cements, several mixer/delivery systems, iVAS vertebral augmentation and vertebroplasty systems Mendec cement and spine kit Spine Fix biomimetic cement and delivery system SpineJack height restoration implant and Cohesion bone cement

Regulatory Status FDA cleared, CE Mark approved, approved in Canada

Renova Orthopedics Signus Sintea Skeltex

In development

FDA cleared, CE Mark approved In development

Soteira SpineAlign Spineology Spine Wave Stryker

CE Mark approved CE Mark approved; in IDE study FDA cleared, CE Mark approved FDA cleared, CE Mark approved FDA cleared

Tecres Teknimed Vexim

FDA cleared, CE Mark approved FDA cleared, CE Mark approved CE Mark approved

Summary From pedicle screw fixation to microdiscectomy, the global spine market should continue to post upper single to lower double digit growth for at least the next five years. Future growth in the global spine market will come with the introduction of more cervical artificial discs and second-generation lumbar designs in the U.S., motion preservation devices, disc revision products, increased adoption of MIS access tools and increased penetration of more premium-priced interbody fusion technologies into the spinal arena. Exhibit 41 provides a summary of the key dynamics of the spine market.

© ORTHOWORLD Inc., 2010. All rights reserved.

80 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 41 thE SpinE MarkEt: kEy MarkEt dynaMicS · · · · · $7.1 billion, growing at 11% from 2008 to 2009 More than 3 million procedures Highly competitive - 79% controlled by top 6 players but serious competition from smaller players Intensely price sensitive; challenging reimbursement environment Technologies expected to drive growth: PEEK and composite implants, MIS, motion preservation (outside of discs)

© ORTHOWORLD Inc., 2010. All rights reserved.

cOmpuTer assisTed surgery rObOTics sysTems

and

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 83

cOmputEr aSSiStEd SurgEry and rObOticS SyStEmS

Overview Computer assisted surgery systems provide surgeons with interactive guidance to help them track instruments and implants in real time during surgical procedures. The systems are designed to optimize the intraoperative positioning of instruments and the placement of implants either with or without image guidance (IGS) provided through CT, MRI, fluoroscopy, etc. Typically, patient CT scans or MRIs are taken preoperatively and downloaded into a computer, which in turn creates 3D images of the anatomy. Using the 3D images, the surgeon can plan his approach, the type of implant to be used, etc. prior to surgery. At the time of surgery, the surgeon registers the patient's anatomy with instruments that communicate with a computer. With this registration, the surgeon can then intraoperatively mate his preoperative images with real-time intraoperative images, track instruments, place implants and verify their position, etc. CAS systems play a role in spinal fusion (to aid in the placement of pedicle screws), joint replacement (to minimize leg length discrepancy in hip arthroplasty, improve accuracy of cuts, optimize positioning of components, etc.), tibial osteotomy (to improve accuracy of cuts), fracture repair (to place screws in difficult-to-reach fractures and for entry point and distal locking for IM nails) and ACL repair (to optimize accuracy in tunnel and graft placement). Demand for MIS techniques has also helped to drive adoption of CAS. The smaller working areas that characterize MIS do not always provide visualization required to safely and accurately access pertinent anatomical structures. CAS, however, can provide needed "visualization" to the surgeon without compromise to the MIS nature of the procedure. The Market and Players In 2009, image guided surgery found use in an estimated ten percent of joint replacement procedures in Europe, with penetration highest in Germany. In the U.K., use of CAS systems reached only one percent of primary total hip replacement (THR) procedures and two percent of primary total knee replacement (TKR) procedures in 2008. In the U.S., CAS use in joint replacement has not yet reached three percent of applicable procedures. For all orthopaedic and spine procedures, estimates place penetration of CAS at less than ten percent worldwide. Acrobot's CAS products include preoperative surgical planning and visualization software, a navigation system and an Active Constraint Robot. Acrobot's Active Constraint technology applies control to motorized, programmable devices allowing for "hands-on" robotics. The navigation system utilizes CT scans which are then converted to 3D images. Acrobot's Sculptor, a hands-on robotic system, is in final clinical evaluation. Acrobot has signed agreements with Biomet, Corin, Finsbury, JRI and Stanmore Implants to further commercialize the Acrobot system for additional orthopaedic procedures. Aesculap pioneered CAS in joint replacement with the 1997 introduction of its OrthoPilot system. Since then, OrthoPilot has been used worldwide in more than 136,000 procedures. OrthoPilot features CT-free modules for wedge osteotomy and high tibial osteotomy, unicondylar, primary total and revision knee replacement, total hip replacement (both stem and acetabular cup placement) and ACL repair. Aesculap also lays claim to being the first company to introduce a knee implant specifically designed for use with CAS navigation systems. The Columbus combines OrthoPilot navigation with CAS implant planning and flexion and extension gap balancing techniques. Aesculap's MIOS (Minimally Invasive Orthopaedic Solution), also for use

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84 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT with the Columbus, incorporates small-scale total knee instrumentation, a streamlined MIS surgical technique (not divergent from what surgeons currently use), an implant and software specifically for knee replacement through MIS navigation techniques. Blue Belt Technologies has developed next generation "smart" instruments for orthopaedic and neurosurgery, including the Precision Freehand Sculptor, a handheld, computer-assisted bone cutting tool that features semi-active robotics and a surgical navigation interface that provides real-time 3D views of the surgical procedure. BrainLAB's primary CAS product ­ VectorVision ­ features computer, monitor and infrared camera technology for positioning of patient and instruments intraoperatively, with subsequent 3D representation of patient anatomy based on preoperative images. VectorVision includes planning software and a suite of image-based and imageless modules for joint replacement; a trauma module with real-time fluoroscopic images for placement of distal screws in IM nail applications, alignment of bone fragments, application of external fixation devices and guidance of drills or screws; and vertebroplasty, osteotomy and pedicle screw placement in scoliosis patients, through the use of CT scans, fluoroscopy or a combination of the two simultaneously. VectorVision applications also include ACL replacement, wedge osteotomy and pre-op planning for spine and hip replacement. BrainLAB also markets the Kolibri CAS platform, designed to provide a more economical, wireless navigation system that integrates analog and digital C-arm images and endoscope images for use in spine and sports medicine surgeries. Due to its open platform architecture, BrainLAB's CAS system can be used with implant systems from a variety of companies - Aesculap, Biomet, DePuy, Link, Smith & Nephew, Wright Medical and Zimmer. In addition, BrainLAB has collaborated on product development initiatives with Biomet, DePuy, Smith & Nephew, Waldemar Link and Wright for joint replacement, Ulrich Medical in spinal applications and the AO Foundation and Synthes for trauma, maxillofacial and spine products. Finally, BrainLAB and the Institute for Robotics and Mechatronics at the German Aerospace Center have developed surgical robots including the KineMedic (Vectorbot) device, a haptic system that will allow surgeons to align drills, needles, etc. into predefined trajectories with millimeter precision. The Center plans for its next generation of robot arms to be able to guide a laser unit for the precise separation of bone tissue in orthopaedics or set holes for bone screws. BrainLAB entered into a development and marketing partnership with Ziehm Imaging to integrate mobile 3D C-arms with CAS for 3D intraoperative imaging. The partnership resulted in the introduction of the Ziehm NaviPort 3D interface, which integrates 3D C-arm images and surgical navigation and is intended to assist in the intraoperative guidance of pedicle screw and hardware placement. Integra LifeScience's CAS offerings include a variety of neurosurgery CAS systems and the OmniSight EXcel 3D visualization system that features wireless NeuroSight and SpinalSight cranial and spinal modules. LRS Ortho is developing technology that includes the BonFixatore, which features a laser-based opto-mechanical aiming device and computerized image processing that aid surgeons in placing screws distally in IM nailing procedures. The company completed preliminary clinical tests on the device and results indicate that use of the device reduced the number of X-rays used and the time required to locate the exact point for putting in nails. MAKO Surgical focuses on MAKOplasty, an FDA cleared, haptic assisted therapy that provides the surgeon with a computerized, physician-interactive robotic system (the Tactile Guidance System or TGS) initially targeted at unicompartmental knee replacement. (Haptics refers to the science of applying tactile sensation and control

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 85 to interaction with computer applications.) The MAKOplasty technology allows the surgeon to not only plan preoperatively, but to also size and align components and then precisely sculpt bone according to virtual, volumetric templates of an implant system. The system's robotic arm houses the instruments and the haptic window controls the space in which the instruments will work. The preplanned implant size determines the incision size and the virtual 3D working space in which the surgeon will make his cuts for introduction of the implant. The technology provides continual tactile, visual and acoustic reference feedback. Mazor Surgical Technologies developed SpineAssist, featuring a miniature robotics guidance system that mounts above the patient's spine and a workstation with surgical planning software. SpineAssist allows surgeons to accurately place implants with reduced radiation exposure for such procedures as MIS, percutaneous procedures or 3+ level cases; open procedures and scoliosis/deformity cases; vertebroplasty, biopsy and single level approaches; and cervical and GO-LIF cases. The first use of SpineAssist in a cervical spine procedure occurred in mid-2009. Mazor also developed Guided Oblique Lumbar Interbody Fusion (GO-LIF), a percutaneous procedure enabled by SpineAssist. Mazor received CE Mark approval to use the SpineAssist robot in these procedures but the procedure has not been cleared in the U.S. Mazor did obtain FDA clearance to market C-InSight, an add-on software system for C-arms that converts two-dimensional x-rays taken during spine and orthopaedic surgeries to 3D images. Under development at Mazor are additional orthopaedic and neurosurgical applications for its SpineAssist technology, including an IM nailing guidance system (NailAssist), total knee replacement application (KneeAssist) and CranioAssist for tumor biopsy. Johnson & Johnson Development Corporation has invested in Mazor. Medtronic Navigation holds the honors for being first to introduce navigation and fluoroscopic guidance to spine applications. The company's StealthStation Treatment Guidance System remains the most widely used optical imageguidance surgery system, with more than 2,500 systems installed worldwide for a wide range of medical disciplines. Medtronic's line of CAS products today encompasses 2D and 3D fluoroscopy-, CT- and electromagnetics-based modules for use in a range of orthopaedic and spinal procedures, as well as multiple platforms and products designed to work in integrated operating rooms or via integration into computer workstations. OrthAlign received FDA clearance to market its KneeAlign, a palm-sized computer assisted navigation system used for tibial alignment in total knee arthroplasty. The disposable device attaches to total knee instrumentation to assist in orienting the cutting blocks in proper position in three dimensions. Praxim Medivision develops automated systems, software and instruments focused on total knee replacement. Its technologies include the open platform Surgetics Station (accommodates image-guided navigation), NanoBlock, a cutting block for total knee arthroplasty that allows for fine adjustments; and, under development, the iBlock automated cutting guide, a minimally invasive intelligent instrument that automatically positions a bone cutting guide exactly as planned by the surgeon. The company has signed non-exclusive collaboration agreements with 16 implant companies and supports more than 25 total knee implants including those from Biomet, Ceraver, Consensus Orthopedics, Dedienne Sante, DePuy, DJO Surgical, ESKA Implants, Exactech, FH, Finsbury Orthopaedics, Groupe Lepine, Implantcast, Mathys, Medacta, OMNIlife science, Smith & Nephew, Wright Medical and Zimmer. In mid-2010, Orthopaedic Synergy acquired Praxim.

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86 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT ROBODOC offers ORTHODOC, a computerized preoperative planning system for orthopaedic procedures, and ROBODOC, a computer-controlled surgical robot equipped with specialized drill bits and other hardware (e.g. the ORTHODOC workstation) for preparing bones for implantation of joint replacement implants. Since 1992, ROBODOC has been used in more than 24,000 hip and knee procedures outside the U.S. Siemens navigation technologies include CAPPA (Computer-Assisted Planning and Positioning Applications) C-Nav, which incorporates preoperative 3D planning with an open-interfaced, modular navigation system for use in spinal and trauma surgery. Siemens also offers the SIREMOBIL Iso-C3D, a mobile C-arm with 3D imaging that comes equipped with NaviLink, a 3D navigation interface. The technology allows for real-time CT scans to be transferred directly to navigation systems, obviating the need for any registration of anatomy. Smith & Nephew markets the AchieveCAS computer aided surgery platform and PiGalileo system. Achieve features dual infrared cameras to assist with positioning of the cutting instruments and implants for hip and knee replacement procedures, allowing minimally invasive surgical approaches. PiGalileo provides open and MIS, imageless CAS and navigation modules for hip and knee replacement applications along with mini-robotic instrument positioning technologies. Stryker's CAS line combines real-time navigation/visualization, active wireless instrument tracking via the company's Smart Instruments, infrared cameras, etc. to provide navigation through a variety of fluoroscopy-based and CT-based spine (pedicle screw placement) and CT-free systems for standard and MIS total hip, total knee and uni knee replacement; internal fixation of pelvic, femoral and tibial fractures, placement of lag screws, entry point navigation and distal locking for IM nails. Surgix began clinical trials of its computer-assisted surgical system, primarily for use in orthopaedic trauma applications. To date the system has found use in more than 150 procedures. TrueVision Systems has developed a real-time 3D high definition vision system that replaces the eyepiece module of a surgical microscope with a 3DHD image capture module, which allows the surgeon to save and retrieve images and integrate them with other image sources. Further, it converts the view from the microscope to a 3DHD image, called TrueView, which it then displays on a monitor. Although targeted at microsurgery, the technology also has applications in orthopaedics and spine. Zimmer's CAS portfolio centers on the ORTHOsoft product line of Navitrack systems, which features hardware, software, instruments, cameras, etc. with CT-based, CT-free and fluoroscopy-based modules for total and resurfacing hip replacement, total and unicondylar knee replacement and pedicle screw placement procedures. Zimmer also markets the ORTHOsoft Sesamoid system, reportedly the smallest fully functional CAS suite available on the market. ORTHOsoft's Navitrack technology has supported more than 45,000 surgeries in Europe and North America over the past decade. Other entities with navigation systems are displayed in Exhibit 42 along with those mentioned above.

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 87 Exhibit 42 caS SyStEMS for orthopaEdic applicationS Company Acrobot Aesculap Amplitude Blue Belt Technologies BrainLAB Technology CT-based + robotics OrthoPilot CT-free Amplivision image-based Precision Freehand Sculptor bone cutting tool VectorVision CT-based, CT-free, fluoroscopybased Ceravision (Praxim technology) 3D visualization systems NaviPro open platform, image-free BonFixatore laser-based opto-mechanical aiming device and computerized image processing MAKOPlasty haptic assisted therapy SpineAssist robotics guidance and C-arm software Fluoroscopy-, CT- and electromagnetic-based KneeAlign imageless, cutting block guide Surgetics image-based, NanoBlock and iBlock cutting blocks Orthodoc preop planning and Robodoc robot Preop 3D planning, open-interfaced CT-based navigation systems, C-arm with 3D imaging Achieve CAS, CT-free Fluoroscopy-based, CT-based and CT-free Image-based PLEOS image-free 3DHD image capture and transfer Navitrack CT-based, CT-free and fluoroscopybased Application(s) THR, hip resurfacing and unis THR (stem and cup), TKR, unis, revisions, osteotomies and ACL repair THR and TKR THR and TKR THR, hip resurfacing, TKR, unis, trauma, osteotomies, spine, vertebroplasty and ACL replacement THR and TKR Cranial and spine THR, TKR and shoulder IM nailing

Ceraver Integra Kinamed LRS Ortho

MAKO Mazor Medtronic OrthAlign Praxim ROBODOC Siemens Smith & Nephew Stryker Surgix Tornier TrueVision Zimmer

Unis Spine Orthopaedics and spine TKR TKR THR and TKR Trauma and spine THR and TKR THR, TKR, unis, trauma and spine Trauma TKR Orthopaedics and spine THR, hip resurfacing, TKR, unis and spine

© ORTHOWORLD Inc., 2010. All rights reserved.

OrThObiOlOgics

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 91

OrthObiOlOgicS

Overview "Orthobiologics" refers to products that incorporate biology and/or biochemistry for the repair, replacement or regeneration of musculoskeletal structures. Products considered "orthobiologic" include bone and soft tissue substitutes, allograft bone/tissue, tissue-engineered substances, growth factors/bone proteins, stem cells, hyaluronic acid, etc. In 2009, revenues generated by the sale or distribution of orthobiologics neared $3.9 billion, an increase of six percent from 2008. Hundreds of companies market orthobiologic products around the globe, ranging from bone graft substitutesfocused ETEX, to Medtronic with its $866 million orthobiologics franchise. A comprehensive list of companies marketing orthobiologic products can be found in Appendix E at the end of this overview. Bone Graft Materials Bone graft substitutes find application in augmenting/enhancing the healing of fractures and fusions and in filling defects or voids resulting from bone loss due to trauma or deformity. They are used in most spinal fusion and revision joint replacement procedures and in many oncology, fracture repair and malunion/nonunion applications, as well. Currently, orthopaedic surgeons have several technology options available for their bone grafting needs ­ autograft, allograft, xenograft and synthetics. In procedures that require a bone graft, autograft (typically harvested from the patient's iliac crest) or allograft tissue (from cadavers) is most often used. The gold standard in bone grafting remains autograft due to its osteoconductive (serves as a scaffold), osteoinductive (capable of inducing new bone formation) and osteogenic (capable of producing new bone) characteristics. However, autograft harvesting is not without its problems, not the least of which is the need for an additional surgery to obtain the graft material, which often brings with it donor site morbidity and pain. Allograft bone, which is osteoconductive and weakly osteoinductive, serves as an alternative to autograft but it, too, has drawbacks including limited supply and potential risk of disease transmission. Allograft finds use in orthopaedics not just as base tissue, but also in structural allografts for spinal fusion and as demineralized bone matrix (DBM), which is also widely used in spinal fusion procedures. DBM is prepared by acid extraction of most of the mineralized component of the bone, with retention of the collagen and noncollagenous proteins, including growth factors. DBM has been shown to contain bone morphogenetic proteins (BMPs), which are osteoinductive. Most companies that market spinal products also offer DBMs and structural allografts. Additional grafting options for orthopaedic application can be found in xenografts, which are tissues from another species, in this case non-human sources. Geographically, allografts are most popular in the U.S., with xenograft usage more pronounced in Europe. In Japan and other parts of Asia, ceramics and synthetics remain the mainstay in bone grafting due to cultural tenets that work counter to the use of human- or animal-derived tissue products. Exhibit 43 summarizes the landscape for allograft products by company.

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92 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 43 allograft and xEnograft bonE productS by coMpany Company Aesculap AlloSource Product(s) CeSpace and ProSpace allograft spacers Wide variety of bone, skin and soft tissue allografts, including tendons, ligaments and entire joints, as well as customized allograft solutions; supplies allograft for Globus, Integra LifeSciences, Lanx, Medtronic, Nanotherapeutics, NuVasive, Orthofix, Stryker, Wright Medical and Zimmer Spine AlphaGRAFT DBM, structural allografts and ProFUSE 100 OsteoSelect DBM putty, OsteoSponge, OsteoSpongeSC and OsteoWrap allografts OsteoStim traditional allografts, sports medicine allografts and DBMs like injectable InterGro, flexible Biomet PlatFORM and freeze-dried Bonus II, which includes platelet-rich components from the patient's blood Structural allografts VertiGraft structural allografts and Optium DBM EquivaBone with DBM Optecure DBM + resorbable polymer carrier, Optecure CCC Optefil and Opteform NuBone DBM in a cortical bone gelatin carrier Accell, DynaGraft II, OrthoBlast II, OsteoSparx, OsteoSurge and Trel-X DBMs and Trel-XC, a DBM premixed with cancellous bone MatriGraft and VertiGraft structural allografts; FlexiGraft soft tissues; ReadiGraft cancellous, corticocancellous and demineralized bone; and Cellect, Optium and the I/C Graft Chamber DBMs Progenix DBM putty, structural and non-structural allografts, Osteofil injectable DBM/gel bone paste (sourced from RTI Biologics) Wide variety of allograft tissue including base tissue, structural grafts, osteochondral and meniscal allografts, bone-tendon-bone constructs, allograft tendons, DBX DBM and AFT (demineralized bone + an aseptic solution containing hyaluronan) Triad cervical allograft Origen DBM with Bioactive Glass (from Nanotherapeutics) and AlloQuent cortical bone cervical allograft Structural and non-structural allografts FacetLinx structural spinal allograft, Grafton DBM, Graftech cancellous bone spacers, Lubboc and Laddec bovine bone tissues, MagniFuse allograft bone + polymer mesh, Orthoblend DBM fibers + chips, OsteoPure femoral head bone tissue, Plexur M mineralized cortical fibers + resorbable polymer, Plexur P bone/polymer biocomposite resorbable scaffold and Xpanse Bone Insert that incorporates demineralized bone fiber and cancellous chips

Alphatec Bacterin Biomet

Clearant DePuy ETEX Exactech Globus Medical Integra LifeSciences LifeNet Health

Medtronic MTF

NuVasive Orthofix Osprey Biomedical Osteotech

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 93 Exhibit 43 allograft and xEnograft bonE productS by coMpany

(Continued)

Company Performance Grafts Pioneer RTI Biologics

Product(s) Variety of bone tissue and allograft formats BioSet DBM with and without bone chips BioSet, BioSet IC, Optefil, Optefil RT, Osteofil, Osteofil RT, Regenafil and Regenafil RT DBMs, RTI Allograft Paste, Xenograft Sterling Interference Screw ST and Cancellous Chips and Cubes, fresh-stored osteochondral talus allograft, BTB Select allograft for ACL reconstruction and BioCAP Select composite allograft plug Viagraf DBM AlloCraft (from LifeCell) DBX and structural allografts Allomatrix (DBM + OsteoSet calcium sulfate), Allomatrix C (Allomatrix with cancellous bone granules), Allomatrix Custom Biocomposite, Allomatrix DR Graft and IGNITE ICS (Injectable Cellular Scaffold) calcium sulfate + DBM + autologous bone marrow aspirate Structural and non-structural allografts

Smith & Nephew Stryker Synthes Wright Medical

Zimmer

Research initiatives centered on allograft include Kuros' development of KUR-411, a fibrin matrix with DBM, and technologies that will result from AlloSource's relationship with Keratec. The two companies will co-develop a DBM putty using Keragraft carrier technology, which extracts natural keratin from wool and reportedly preserves its biological function of promoting cell strength and recovery. To address the downsides of autograft and allograft, companies worldwide have developed synthetic materials, the most widely used being calcium phosphates, calcium sulfates and hydroxylapatites (HAs). These materials provide osteoconductive scaffolding onto which new bone may grow and can also serve as delivery vehicles for osteoinductive and osteogenic substances. More than 50 companies market synthetic bone graft materials worldwide. Exhibit 44 provides a review of companies with synthetic bone graft products.

Exhibit 44 SynthEtic bonE graft SubStitutES by coMpany Company aap Implantate Product(s) Cerabone HA-based bovine, Jason G collagen fleece antibiotics carrier, Ostim HA and PerOssal calcium phosphate + antibiotic Calcium phosphate-based Callos Inject and Callos Impact Caltrix and A-Grix Resorbable Bone Void Fillers Availability EU

Acumed AG Digital

US US

© ORTHOWORLD Inc., 2010. All rights reserved.

94 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 44 SynthEtic bonE graft SubStitutES by coMpany

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Company Baxter Berkeley Advanced (BAB) Biocomposites Biocomposites Biocomposites Biocoral

Product(s) Actifuse silica-based, Actifuse Shape (co-developed with Ceremed and ApaPore porous HA Bi-Ostetic HA, Cem-Ostetic HA, GenerOs TCP Stimulan calcium sulfate Allogran-R TCP matrix and Allogran-N HA Genex calcium sulfate Biocoral coral-based

Availability EU, US EU, US EU, US EU China, EU, US Australia, Canada, EU, Korea and South Africa EU EU, US US EU, US EU US EU, US EU EU EU, US EU EU, US EU EU, US Phase III clinicals, US EU and South America US US

Biomatlante Biomet Bone Solutions BoneSupport BoneSupport Calcitec Cam Bioceramics Ceramisys Ceraver Osteal Collagen Matrix Covision curasan curasan DePuy DePuy Doctors Research Group ETEX Exactech

Hydros and Matrice calcium phosphate ProOsteon 200R and ProOsteon 500R HA and calcium carbonate-based OsteoCrete potassium phosphate, magnesium oxide and TCP Cerament calcium sulfate w/ HA Spine Support injectable ceramic Osteofix calcium phosphate CAMCERAM HA/TCP PermaBone HA and ReproBone HA/TCP Cerapatite HA, CalciresorbTCP, Calciresorb 35 HA/ TCP and Ceraplast calcium sulfate OssiGuide bovine based ORceram HA and HA/TCP Cerasorb TCP Osbone HA alpha-BSM calcium phosphate, Conduit TCP, Healos HA-coated collagen fiber matrix (bovine derived) Healos + bone marrow aspirate and fibular allograft in spinal fusion Kryptonite calcified resorbable polyurethane Calcium phosphate-based alpha-BSM, CarriGen, EquivaBone with DBM, Beta-bsm, Gamma-bsm putty OpteMx TCP/HA (through Biomatlante)

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 95 Exhibit 44 SynthEtic bonE graft SubStitutES by coMpany

(Continued)

Company Geistlich Biomaterials Globus Medical GMReis Graftys Graftys Integra LifeSciences

Product(s) Orthoss HA MicroFuse ST Granule resorbable polymer bone void filler Sponjosa TCP, Osteo calcium sulfate HBS calcium phosphate and BCP biphasic HA/TCP Quickset calcium phosphate Mozaik TCP, OsSatura TCP, OsteoStrux collagen ceramic matrix, FormPutty, TrueForm CP and LP/LT and xLink TCPs InQu PLGA + hyaluronic acid jectOs calcium phosphate, TCH biphasic ceramic Kasios TCP OrthoFill collagen + polymer Porous Tissue Matrix, OsseoFit collagen + polymer + ceramic Cerapaste BF+ biphasic Synthacer HA and Syntricer TCP Osteotrans HA and PLLA (from Takiron) Osmosys MasterGraft HA/TCP NovaBone Porous Morsel, NovaBone C/M calcium phosphosilicate granules derived from Bioglass Formagraft HA/TCP + collagen OsteoMax HA/TCP/calcium sulfate (from BAB) TriPore HA Gran TCP OSferion TCP Sobio Biphasic HA/TCP Vitoss TCP Colloss E bovine extracellular matrix Targobone (Colloss + antibiotic) Osteovation calcium phosphate

Availability EU, US

Asia, EU, South America EU, US EU, US pending US

ISTO Technologies Kasios Kasios Kensey Nash Kobayashi Pharmaceutical LDR Spine MedArtis MedArtis Medicrea Medtronic NovaBone NuVasive Orthofix Orthogem Orthos Olympus Terumo Orthomed Orthovita Ossacur Ossacur OsteoMed

US EU EU, US US Japan EU, US EU, US EU US US EU, US EU, US US EU, US EU, US Japan EU EU, US EU, US EU EU, US

© ORTHOWORLD Inc., 2010. All rights reserved.

96 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 44 SynthEtic bonE graft SubStitutES by coMpany

(Continued)

Company Pioneer Surgical Produits Dentaires PROMED Science for Bio Materials Science for Bio Materials Smith & Nephew Stryker Synthes

Product(s) nanOss Bioactive calcium phosphate VitalOs calcium phosphate Osteo-Link calcium sulfate Biosorb TCP Bio-Tecma and Tecma-FX HA + TCP + PLDLA Jax calcium sulfate BoneSource calcium phosphate, BoneSave TCP/HA, HydroSet HA ChronOs TCP, Norian Skeletal Repair System calcium phosphate, Craniofacial Repair System carbonated apatite Biphasic Ceraform HA/TCP, Cementek TCP, TriHA OsteoScaf polymer-based, three-phase scaffold with calcium phosphate coating HA/bovine collagen BonAlive bioactive glass OsteoSet and MIIG calcium sulfate, CellPlex TCP andPro-Dense calcium sulfate + calcium phosphate CopiOs calcium phosphate

Availability EU, US EU (for CMF) Taiwan, US EU, US EU US US Globally

Teknimed Tissue Regeneration Therapeutics Unilab Surgibone Vivoxid Wright Medical Zimmer

EU, US Status? OUS EU, US Globally US

Osteoinductive Materials Often, when using bone grafts, surgeons may wish to boost the osteoinductive and osteogenic properties of the graft material. A variety of technologies exist for just this purpose. One such technology entails obtaining a sample of the patient's blood, spinning it to separate the platelet rich plasma (PRP) from the red blood cells and then mixing the PRP concentrate with the bone graft material. The PRP provides a "dose" of the body's own natural bone growth factors to supplement the action of the bone graft. Exhibit 45 lists autologous platelet/plasma systems currently on the market.

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 97 Exhibit 45 autologouS platElEt/plaSMa SyStEMS by coMpany Company Arteriocyte Medical Biomet Product(s) Magellan Autologous Platelet Separator BMA Kit, Clotalyst Autologous Serum Collection System; BioCUE Platelet Concentration System, GPS III System, Recover Platelet Separation, MarrowStim and Plasmax Plasma Concentrate Autologous fluid concentrator, plasma concentrator and fluid transfer device for tissue regeneration AutoloGel system for producing PRP gel Celution point-of-care adipose tissue extraction system Symphony II PRP point of care, Symphony Graft Delivery System and Symphony I/C Graft Chambers (prefilled with allograft cancellous chips and DBM) Accelerate platelet concentration system Retrieve Bone Marrow Aspiration Kit and Bone Graft Harvest System Kit Osteogenica, a separator and ultraconcentrator of growth factors SmartPReP 2, APC+ (autologous platelet concentrate system) and BMAC (Bone Marrow Aspirate Concentrate) OsteoBoost-BMA kit Cellpaker collection system Imbibe Bone Marrow Aspirate Syringe CryoSeal Fibrin Sealant System (to prepare autologous hemostatic and adhesive surgical sealants from patient blood) 510(k) to be submitted EU, US US Availability US US

Circle Biologics Cytomedix Cytori Therapeutics DePuy Spine

Exactech Globus Medical GMReis Harvest Technologies

US US Asia, EU, South America US

Orthos Orthovita Orthovita ThermoGenesis

EU US US US

Stem cells may also help to improve healing and fusion in bone grafting. Stem cells are simple, undifferentiated human cells that have potential to give rise to many different cell types in the body. When stem cells divide they create progenitor cells, which can become cells with more specialized functions, such as cartilage and bone cells. Mesenchymal stem cells (MSCs) give rise to specialized cells in the body (bone, cartilage, fibrous tissue and muscle) that make up the musculoskeletal system. In the bone graft segment of the market, only NuVasive and Orthofix currently market MSC-based products in the U.S. Other companies have commercialized stem cell services, with several still in development, as shown in Exhibit 46.

© ORTHOWORLD Inc., 2010. All rights reserved.

98 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 46 cEll-baSEd productS and SErvicES for hard tiSSuE rEpair by coMpany Company Aastrom Bioscience BioTissue Technologies Celling Technologies (SpineSmith) co.don co.don Mesoblast Mesoblast NuVasive NuVasive Product(s) Tissue Repair Cells BioSeed-Oral Bone autologous bone technology Point of care adipose tissuederived adult stem cells (from Tissue Genesis) chondrotransplant autologous bone cell transplant osteotransplantBONE RepliCart adult stem cells NeoFuse off-the-shelf (OTS) adult stem cells Osteocel MSCs Progentix bioreactor system for expanding bone marrow derived adult MSCs Trinity Evolution Orthokine-Therapy autologous blood-derived XC Osteopore PCL scaffold autologous cells + 3D polymer Lab grown bone tissue CartiMate Scaffold (FGF reagent) Regenexx autologous SCs therapy GelrinBone GelrinSpine autologous cell matrix + TGF- Ossron cultured autologous osteoblasts Stem cell based treatments Allostrome bone marrowderived MSC technology Application(s) Had targeted fusion and nonunion Jaw replacement Spine, orthopaedics, other medical areas Fractures, tumors, pseudoarthrosis, etc. Bone loss/nonunions Knee OA after ACL reconstruction Fracture repair Spinal fusion Bone regeneration Availability Focused on cardiovascular EU Research

EU EU Phase II clinicals, Australia Submitted for approval, Australia US Approval anticipated 2011 US Australia, EU Development US Research

Orthofix Orthogen Osiris Osteopore Osteosphere Prochon Biotech Regenerative Sciences Regentis Biomaterials Regentis Biomaterials Sewon Cellontech Smith & Nephew Stematix

Spine, general orthopaedics Treatment of OA pain General orthopaedics CMF Osteoporosis Microfracture/small defect repair Variety of orthopaedic applications CMF, general orthopaedics Spinal fusion Autologous Bone Cell Implantation Treatment of OA pain Joint and cartilage repair

US Research Research Korea Prototype Research

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 99 Exhibit 46 cEll-baSEd productS and SErvicES for hard tiSSuE rEpair by coMpany

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Company Stematix TheraCell Tissue Regeneration Therapeutics

Product(s) Adult stem cell therapy and services (also Regenexx) Autologous stem cells + scaffold + oxygenated gel Stem cell therapy and storage

Application(s) Variety of orthopaedic applications Spinal fusion General

Availability Argentina, Mexico Research Canada

Beyond stem cells, osteoinductive substances to enhance healing and fusion include growth factors, peptides, etc. Bone growth factors are proteins responsible for signaling the fracture healing cascade, which, in turn, triggers the repair of bone. BMPs belong to the superfamily of proteins known as Transforming Growth Factor (TGF)-beta, a protein that controls proliferation, differentiation and other cellular functions. In the world of orthopaedics, its importance rests in the role it plays in the growth and repair of tissue. TGF-beta causes undifferentiated MSCs to rapidly multiply, grow into osteoblasts and chondroblasts and differentiate into Type I collagen cells, thereby forming bone matrix. A wide variety of biotechnology and orthopaedic startups and established companies are working on growth factors and other osteoinductive substances. Just four growth factor/peptide technologies have been approved for marketing worldwide ­ BioMimetic's Augment in Australia and Canada; Cerapedics' iFACTOR in the European Union; Medtronic's InFuse/InductOs in the EU and U.S. and Stryker's OP-1 in Australia, Canada, EU and U.S. Exhibit 47 provides an overview of initiatives being undertaken in the realm of osteoinductive orthobiologics.

Exhibit 47 oStEoinductivE orthobiologic initiativES by coMpany Company 3DM Acologix Affinergy BioMimetic Product(s) PuraMatrix peptide hydrogels AC-100 synthetic peptide Peptide-based coatings Augment Bone Graft rhPDGF + TCP Application(s) Periodontal bone regeneration Bone and cartilage repair Broad orthopaedic Hindfoot/ankle fusion Status Orthopaedic applications to be determined Clinicals expected 2010 Research Clearance in Australia, commercialized in Canada, registered for CE Mark and FDA approval Enrollment complete in pivotal trial; final decision on IDE expected 2010

BioMimetic

Augment Injectable Bone Graft rhPDGF-BB + TCP/ collagen matrix

Hindfoot/ankle fusion and distal radius fractures

© ORTHOWORLD Inc., 2010. All rights reserved.

100 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 47 oStEoinductivE orthobiologic initiativES by coMpany

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Company BioMimetic BioSET

Product(s) rhPDGF-BB + tissuespecific matrices AMPLEX B2A peptide modeled on BMP2 + HA/TCP AMPLEX B2A peptide BMP2 + HA/TCP F2A peptide synthetic growth factor coating (with Tornier) UCB-1 skeletal specific growth factor Osteorate DNA-based injectable bone graft gel i-FACTOR anorganic bone mineral + small peptide Nurture peptides + small molecule therapeutics + osteostimulating matrices rhGDF-5 and derivatives (from Biopharm) Optima biodegradable polymer + BMPs + pyrollidones KUR-111 fibrin matrix + variant Parathyroid Hormone (vPTH) + HA/ TCP KUR-112 fibrin matrix + vPTH KUR-113 fibrin matrix + vPTH InFuse Bone Graft rhBMP-2 Collagen scaffolds + proprietary growth factor LIM Mineralization Protein-1 (from Emory University)

Application(s) Tendon-tendon and tendon-bone injuries Lumbar fusion

Status Preclinicals Pilot clinicals

BioSET BioSET

Cervical, foot/ankle fusion Ligament/tendon repair

Research Research

Bone Biologics Cardium Therapeutics CeraPedics

Spinal fusion Nonunions and spinal fusion Anterior cervical discectomy and fusion Broad bone/cartilage

Preclinicals Research CE Mark, in IDE

Curative Biosciences

Research

DePuy Inion

Lumbar DDD Research

Phase II clinicals, US

Kuros

Tibial plateau fractures

Research

Kuros (with Baxter) Kuros (with Baxter) Medtronic Medtronic (with TEI Biosciences) Medtronic

Solitary bone cysts Tibial shaft fractures Spinal fusion, open tibial shaft fractures Spinal fusion and disc repair Spinal fusion

Research Phase IIb clinicals Commercialized EU, US Research Research

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 101 Exhibit 47 oStEoinductivE orthobiologic initiativES by coMpany

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Company Nanovis

Product(s) Nanostructured biomaterials + proprietary bone growth factors ST01 TCP coated + rhBMP variant ST03 cartilage growth factor rhCD-RAP + carrier matrix ST04 an injectable ST03 ST05 rhCD-RAP SI-6603 formulation of chondroitinase ABC HA + poly-lactacid polymer + BMP OP-1 Implant BMP-7 OP-1 Implant BMP-7

Application(s) Fractures

Status In testing

Scil Technology Scil Technology

Spinal fusion Cartilage

Preclinicals Preclinicals

Scil Technology Scil Technology Seikagaku Sintea Biotech Stryker Biotech Stryker

OA DDD Herniated lumbar discs Research Nonunion fractures Recalcitrant long bone nonunions and in revision spine surgery

Preclinicals Early research Research

Commercialized Australia, Canada, EU Humanitarian Device in US

Technologies for bone repair/regeneration that do not fall within previously-described categories and remain in early research/preclinical phases are displayed in Exhibit 48.

Exhibit 48 othEr bonE rEpair/rEgEnEration tEchnologiES Company Accelalox Technologies Arachidonic acid metabolites, which play a significant role in regulating the bone formation process in fracture healing and spinal fusion Hyaloss hyaluronic acid fibers used to mix blood/bone grafts to form a paste for bone regeneration PlastiBone, a porous calcium phosphate-coated polymer ArteBone, reindeer bone extract, comprising BMPs, cytokines and growth factors, for trauma applications

Anika/Fidia BAE Bioactive Bone Substitutes

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102 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 48 othEr bonE rEpair/rEgEnEration tEchnologiES

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Company Cardium Therapeutics Competitive Technologies curasan

Technologies Osteorate, a DNA-based injectable bone graft gel (collagen-based with a biologic encoding PDGF-B InstaBone calcium phosphate-based nanotechnology Cerasorb with collagen (in conjunction with Matricel), Cerasorb with enhanced platelet rich plasma and bone adhesive and Cerasorb with a 3D printing technology for rapid prototyping of custom patient-specific implants Protein matrix plus carrier for use in a range of bone regeneration materials (through an agreement with Ben-Gurion University) Nurture bone- and cartilage-forming peptides + small molecule therapeutics with osteostimulating matrices Broad BMP technology portfolio (including rhGDF-5 and its derivatives) for musculoskeletal indications like bone grafting, cartilage regeneration and meniscal repair, with further collaboration to combine the rhGDF-5 growth factor or derivatives with proprietary bio-engineered scaffolds Composite calcium phosphate with bioceramics Bone graft substitutes derived from collagen, synthetic polymers, ceramics and composite biomaterials KUR-024 injectable synthetic matrix technology as a bone graft substitute for certain orthopaedic indications Bone anabolic agent Nanostructured biomaterials and proprietary bone growth factors for bone regeneration Time-release calcium sulfate-based composite NovoSorb degradable polymer technology for fracture fixation and bone void fillers (in conjunction with Smith & Nephew) Osteoinductive synthetic material for regeneration, reconstruction or augmentation of skeletal defects Bioactive ceramics or biomimetic fibrous polymer scaffolds Matrix III and R-Gel resorbable drug delivery matrices Porous biodegradable polymer implants w/ integrated biologically active components

curasan Curative Biosciences (with MTF) DePuy (with Biopharm)

Innovative BioCeramix Kensey Nash Kuros Medtronic (with OsteoGenix) Nanovis Orthogen PolyNovo Biomaterials Progentix RepRegen Royer Biomedical Tissue Regeneration Systems

Orthobiologics for Soft Tissue Applications While PRP systems, MSCs, growth factors and other osteoinductive substances enhance bone healing and repair, orthobiologics for soft tissue repair typically center around cartilage repair and regeneration, one of the first

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 103 successful applications of tissue engineering in orthopaedics. Already companies have successfully combined chondroinductive substances or cell transplantation technologies with resorbable scaffolds for use in treatment of cartilage defects in joints and spine. Cartilage repair and replacement can involve a variety of substances including acellular, collagen and polymeric matrices; growth factor variants; genetically modified cells; etc. One of the more popular technologies, Autologous Chondrocyte Implantation (ACI) (also known as Autologous Chondrocyte Transplantation/ACT), involves the isolation of a patient's chondrocytes, expanding them in a culture and reimplanting them into the patient's defect. Exhibit 49 displays the variety of tissue engineered cartilage repair and replacement products either on the market or in development.

Exhibit 49 Soft tiSSuE rEpair/rEplacEMEnt tEchnologiES by coMpany Company Aesculap Alacer Bioimedical Alacer Bioimedical Anika/FAB Product(s) Novocart ACT, 3D and Disc SeriACL silk-based SeriCuff silk-based Hyalofast hyaluronic acid-based Application(s) Knee and disc cartilage ACL repair Rotator cuff repair Support for human bone marrow MSCs Knee defects Tenolysis Cartilage regeneration Knee cartilage repair Large and small defects Meniscal tears Filling of cartilage lesions Treatment of focal cartilage lesions Knee cartilage repair Cartilage repair (OA of knee, first MTP joint and CMC) Status EU Clinicals, US Research Argentina, EU, Korea and Middle East EU Argentina, EU, Korea, Middle East Research China, Hong Kong, Taiwan Preclinicals Preclinicals Early clinicals, EU Clinicals Canada, South Korea and Spain EU Canada, EU and South America

Anika/FAB Anika/FAB Anika/FAB (with TiGenix) Arthro Kinetics Arthro Kinetics Azellon Biomet (through Cartilix acquisition) BioSyntech (Pirimal Healthcare) BioTissue Technologies Carticept Medical

Hyalograft C autologous chondrocytes + Hyaff 3D matrix Hyaloglide hyaluronan-derived gel ChondroCelect + Hyalograft C scaffold CaReS, CartiPlug, CaRes Plus collagen matrix-derived Cell Free Implant system "Cell bandage" adult autologous stem cell technology ChonDox (biological adhesive + hydrogel) BST-CarGel (in situ ionic polysaccharide gel) BioSeed-C Cartiva polyvinyl alcohol cryogel

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104 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 49 Soft tiSSuE rEpair/rEplacEMEnt tEchnologiES by coMpany

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Company CellCoTec

Product(s) INSTRUCT cell-based therapy + autologous bone marrow + polymer scaffold CartiGro CartiGro + Chondro-Gide collagen membrane (from Geistlich) chondrotransplant DISC autologous disc cell transplantation chondrosphere (ACI with damaged cartilage cells) Bio-artificial cartilage (3D scaffold woven seeded with biocompatible gel, adiposederived adult stem cells + growth factors) Remenisc resorbable meniscal repair device Cartilage Autograft Implantation System Cartilage repair implant Chondro-Gide membrane Carticel Carticel II ACC Matrix-induced Autologous Chondrocyte Implantation Adult stem cells + 3D matrices Adult stem cells/ tissue construction Tissue scaffolds and processing NeoCart VeriCart OTS scaffold Cartilink-3

Application(s) Knee cartilage repair

Status Pilot clinicals, EU

CellGenix CellGenix

Knee cartilage repair Cartilage repair

EU (through Stryker) Research

co.don

Disc repair

EU

co.don Cytex Therapeutics

Arthroscopic hip and ankle cartilage repair Knee, shoulder and other joint cartilage repair Research

DePuy DePuy Mitek Exactech Taiwan Geistlich Biomaterials Genzyme Biosurgery Genzyme Biosurgery Genzyme Biosurgery Graftys Healthcare of Today/ Regenetech Healthcare of Today/ Xenotis Histogenics Histogenics Interface Biotech

Meniscal repair Repair of articular cartilage lesions Knee cartilage repair Cartilage defects Knee cartilage repair Knee cartilage repair Knee cartilage repair Cartilage and bone grafts Cartilage repair Ligaments Knee cartilage repair Knee cartilage repair Knee cartilage repair

Clinicals, US Clinicals, US Clinicals potentially 2010 EU EU, US Preclinicals Australia and EU Research Research Research Enrolling Phase II clinicals, US Research Research

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 105 Exhibit 49 Soft tiSSuE rEpair/rEplacEMEnt tEchnologiES by coMpany

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Company Interface Biotech ISTO Technologies ISTO Technologies J-TEC Karocell Engineering Kensey Nash

Product(s) Autologous Disc Stem Cell Transplantation DeNovo ET juvenile chondrocytes (OTS, scaffold free) DeNovo NT juvenile chondrocytes (OTS, scaffold free) ACT ACI Cartilage Repair Device proprietary collagen technology + TCP + synthetic polymer Porous Tissue Matrix NeoFuse OTS adult stem cell products NeoFuse OTS adult stem cell products NeoFuse OTS adult stem cell products Chondroprotective technology (inhibitor of cartilage breakdown + agent that promotes cartilage synthesis) Actifit

Application(s) Disc cartilage repair Knee cartilage repair Knee cartilage repair Elbow or knee repair Knee cartilage repair Chondral lesions

Status Research Phase I/II clinicals, US Post-market clinicals, US Submitted for approval in Japan Research CE Mark approved, IDE submitted

Mesoblast

Disc and disc cartilage repair, posterolateral lumbar fusion Disc and disc cartilage repair, cervical fusion Disc and disc cartilage repair, MIS posterolateral lumbar fusion Knee cartilage repair

Enrollment complete, US To begin Phase II clinicals, US Enrolling Phase II clinicals, US Preclinicals

Mesoblast Mesoblast

Omeros

Orteq Bioengineering

Meniscal tears

Belgium, Germany, EU (Italy through Fin-Ceramica) Investigation Commercialized in Australia Preclinicals Development Enrolling Phase II clinicals, US

Orthogen Orthogen Osiris (with Genzyme) Orthox Prochon Biotech

Tissue from adult stem cells Chondrokin ACT Chondrogen injectable preparation of human MSCs Spidrex MRS (silk protein technology) BioCart Cartilage Regeneration System

Knee cartilage repair Knee cartilage repair Meniscal injury Meniscal repair Knee cartilage repair

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106 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 49 Soft tiSSuE rEpair/rEplacEMEnt tEchnologiES by coMpany

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Company Prochon Biotech

Product(s) FGF2V (variant) platform, CartiMate without cells for augment microfracture and FGF on CartiMate with stem cell Isolated articular cartilage cells Menaflex bovine cartilage/ collagen template GelrinCartilage matrix for autologous chondrogenic extract + hydrogel Soft tissue/tissue engineering scaffold fixation technologies Hyaluronic acid-based tissue engineering scaffold technologies L-C Ligament engineered matrix of polymeric fibers Hybrid cell matrix construct with living core component Cell matrix construct seeded in a scaffold OrthADAPT PR Bioimplant (collagen matrix with polymer mesh) ChondroCelect ACI

Application(s) Knee cartilage repair

Status Development

Progenteq ReGen Biologics Regentis Biomaterials

Cartilage replacement Meniscal repair Knee cartilage repair

Research EU, US Research

Schwartz Biomedical Schwartz Biomedical Soft Tissue Regeneration SpinalCyte SpinalCyte Synovis Orthopedic and Woundcare TiGenix

Repair of articular cartilage, meniscus and rotator cuff Cartilage and meniscus repair ACL regeneration Cartilage repair Disc cartilage repair ACL reconstruction

Research Research Animial studies Research Research Research

Knee Cartilage Repair

Launch Europe 2010, filed Biologic License Application US Phase I clinicals, EU

TiGenix (through acquisition of Orthomimetics) TiGenix

Chondromimetic implant

Repair of cartilage and bone

TGX002 (ChondroCelect + Hyaff-11 3D cell culture matrix from FAB) 3D tensile connective tissues + "Bio-Optimization System" to provide physiologic support system for optimal cell growth and maintenance Decellularized biological scaffolds (dCells)

Knee cartilage repair

Research

Tissue Genesis

Ligament and tendon repair

Research

Tissue Regenix

Meniscal repair

Preclinicals

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 107 Exhibit 49 Soft tiSSuE rEpair/rEplacEMEnt tEchnologiES by coMpany

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Company Tissue Regenix

Product(s) Decellularized biological scaffolds (dCells)

Application(s) ACL repair

Status Research

TiGenix is also investigating cell-based products for repair of meniscal tears, cell free scaffolds for repair after partial meniscectomy, combination products for meniscal repair and a platform of technologies based on adult mesenchymal stem cells isolated from the synovial membrane of the knee. Orthobiologic initiatives in soft tissue repair extend as well to biologic scaffolds for reinforcement of weak or compromised tissue. Most such products combine high-strength resorbable collagen scaffolds with fibroblasts to promote cell remodeling. Exhibit 50 summarizes the competitive landscape of tissue reinforcement technologies relative to orthopaedics.

Exhibit 50 Soft tiSSuE rEinforcEMEnt productS by coMpany Company ACell Product(s) MatriStem porcine-based extracellular matrix scaffolding Hyalonect woven gauze Porcine-derived FortaFlex-based CuffPatch (from Organogenesis) ProPatch Soft Tissue Repair Matrix decellularized bovine pericardium TenoMend Collagen Tendon Wrap OssiPatch Collagen Bone Healing Protective Sheet Restore porcine small intestine submucosa soft tissue attachment device Application(s) General wound (promise in tendon and ligament healing) Graft wrap Rotator cuff repair Availability US

Anika/FAB Biomet Sports Medicine

Argentina, EU, Korea, Middle East EU, US

CryoLife

Reinforcement of soft tissues repaired by sutures or suture anchors during tendon repair surgery Management and protection of tendon injuries Support of weak bony tissue Shoulder applications EU, US

Collagen Matrix

Collagen Matrix DePuy

EU, US US

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108 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT Exhibit 50 Soft tiSSuE rEinforcEMEnt productS by coMpany

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Company Integra LifeSciences

Product(s) Porcine-derived FortaFlex-based Inforce Reinforcement Matrix (from Organogenesis) BioBlanket patch

Application(s) Tendon reinforcement

Availability US

Kensey Nash

Reinforcement/repair of ruptured/damaged soft tissues, including rotator cuff Tissue support, adhesion barrier, nerve guide (through Ascension) Management and protection of tendon injuries Tissue/bone reinforcement

US

Polyganics

VivoSorb poly(DLlactide--caprolactone) sheet TissueMend Soft Tissue Repair Matrix bovinederived collagen scaffold (from TEI) OrthADAPT PR Bioimplant collagen matrix with polymer mesh SurgiMend acellular bovine-derived biologic matrix derived from the dermis of fetal calves Conexa porcine-derived reconstructive tissue matrix (from LifeCell) Biotape XM acellular porcine dermal matrix GraftJacket Periosteum Replacement Scaffold (through LifeCell) Rotator Cuff Tendon Reinforcement Scaffold (through LifeCell)

US

Stryker

US

Synovis Orthopedic and Woundcare

EU, US

TEI

Tendon augmentation

Tornier

Orthopaedic and podiatric applications (in clinicals for large rotator cuff tears) Reinforcement for foot and ankle repair Uncontained bone defects, hand surgery applications and tendon and ligament repair Rotator cuff repair

US

Wright Medical Wright Medical

US US

Wright Medical

US

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 109 Exhibit 50 Soft tiSSuE rEinforcEMEnt productS by coMpany

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Company Xylos

Product(s) Securian Tissue Reinforcement Matrix

Application(s) Reinforcement of soft tissues (e.g. rotator cuff, patellar, Achilles, biceps and quadriceps tendons, etc.) Rotator cuff repair

Availability

Zimmer

Collagen Repair Patch

EU, US

In xenograft technologies for soft tissue repair, Aperion Biologics has developed the Z-Lig porcine ligament for ACL replacement, which has demonstrated safety and performance in numerous preclinical studies. The company expects to complete clinicals in Europe in 2010 with CE Mark and commercialization there by year-end. Development in the U.S. continues under an IDE. bioMD's Celxcel subsidiary has developed the ADAPT Tissue Engineering Process (TEP) used for processing animal derived tissues to produce implantable biologic soft tissue repair materials that are biocompatible with the human body. Numerous pre-clinical studies confirm that ADAPT TEP works equally well with bovine, porcine and kangaroo derived tissues and the company continues to evaluate the technology in orthopaedic applications. Kensey Nash and Arthrex will develop porcine dermis-derived biologic surgical meshes for tendon repair and small joint surgeries, while Zimmer will develop Revivicor's genetically-engineered xenogeneic tissues for applications such as tendon, ligament, meniscus, cartilage, bone and spinal nucleus repair and replacement. The orthobiologic treatment of spinal discs remains an area of focus for ISTO, Kuros, Orthonics, Sintea, Spinal Restoration and Synthes. In early 2010, ISTO initiated Phase I clinicals (15 patients) for NuQu, a cell-based injectable composed of culture-expanded juvenile cartilage cells in a protein-based carrier developed for nucleus regeneration in the spine. Enrollment should be complete by year end. NuQu appears to restore both nucleus structure and disc height. Orthonics is developing novel biomaterials that could provide a non-fusion alternative in spinal disc repair. The company's core technology addresses ingrowth and adhesion of bone and cartilage tissues. Orthonics uses microelectromechanical systems fabrication to create micropatterns on the biomaterial's surface to help form a more natural attachment between the artificial material and bone or cartilage. Kuros Biosurgery continues its work on a number of products such as KUR-521 for DDD and KUR-115 and KUR116 for undisclosed spine indications. Sintea Biotech is investigating biomaterials for restoration and substitution of the nucleus, annulus and intervertebral disc, while Synthes is researching Gelifex hydrogels, which are designed to restore motion and alleviate pain in patients suffering from degenerative disc disease. Spinal Restoration is developing its proprietary Biostat Disc Augmentation System for treating discogenic chronic low back pain. The resorbable biologic disc augmentation technology involves occlusion of annular fissures to

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110 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT prevent leakage of the nucleus pulposus and further avoid degradation of the disc. Biostat combines human-derived BIOSTAT BIOLOGX Fibrin Sealant and a proprietary application system designed to deliver the biologic to the intervertebral disc. The biological solution could relieve pain by sealing off annular fissures from inflammatory substances contained in the disc nucleus. In early 2010, Spinal Restoration began enrollment in a 15-site Phase III study of the Biostat System. Companies developing orthobiologic technology platforms that could have a wide range of application in orthopaedics include Articular Engineering, Cardium Therapeutics, FzioMed, Histogen, LAGeT Musculoskeletal, Omeros, Orthocon, RepRegen and Tepha. Articular Engineering has been developing cell-based and tissue modifying core technologies targeting articular cartilage and intervertebral disc repair and regeneration. Cardium Therapeutics' Gene Activated Matrix technology provides a therapeutic level of protein synthesis at a particular site in the body and can be used in orthopaedic applications in ligaments, tendons and cartilage, as well as hard tissue such as bone. FzioMed has exclusive, worldwide rights to a broad portfolio of patents and intellectual property covering synthetic peptides for the regeneration of bone, cartilage and skeletal tissue. The company expects to study these peptides in combination with its gel Oxiplex technology with an eye toward creating carriers for drug delivery in spine and orthopaedic applications (e.g. bone growth and cartilage repair). Oxiplex's viscoelastic and bioabsorbable properties also suggest that the material may have application in coatings and wraps for tendon repair and wound healing, in addition to use of the gel as an injectable treatment for osteoarthritic joints. Histogen's product families include Exceltrix extracellular matrix and Regenica, a proprietary liquid formula created by infusing the soluble chemicals secreted by "newborn" fibroblasts with a liquid medium. A combination of the two may be used to fill critical defects and induce cell infiltration and tissue regeneration. Further, by coating a screen with Exceltrix and conditioning it with Regenica, the company has created a 3D porous matrix scaffold with uniform pore size that may be used to grow specific tissues for regeneration. LAGeT Musculoskeletal has developed LAGT (Light Activated Gene Therapy), a technology process for articular and meniscal cartilage repair, ligament and tendon healing and enhanced spinal fusion applications. LAGeT plans to conduct large animal experiments involving cartilage growth and spinal fusion to develop the evidence necessary for approval of human clinical trials. The pipeline at Omeros includes products for direct delivery to the site of tissue injury, preemptively inhibiting inflammation, pain and other problems associated with medical and surgical procedures in orthopaedics and other specialties. The company's lead product candidate, OMS103HP, is in a Phase III program evaluating its safety and ability to improve postoperative joint function and reduce pain following arthroscopic ACL reconstruction surgery. The company expects to complete these trials and submit a New Drug Application to FDA during the second half of 2010. OMS103HP is also in a Phase II program evaluating its safety and ability to reduce pain and improve postoperative joint function following arthroscopic meniscectomy surgery. Omeros also develops drug therapies to treat cartilage disorders, combining an inhibitor of cartilage breakdown with an agent that promotes cartilage synthesis. In vitro and in vivo preclinical studies to evaluate this chondroprotective technology are underway. Orthocon's development activities center on its proprietary Syntinate platform, comprising natural and synthetic orthobiologic compounds with specific absorption and release attributes for intraoperative drug delivery. Pioneer

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 111 is developing the E-Matrix extracellular scaffold, an injectable biopolymer that may be used to regenerate damaged tissue in a variety of therapeutic indications. Interaction between E-Matrix and effector cells important for chondrocyte and osteoblast repair has been demonstrated in vitro. RepRegen (formerly BioCeramic Therapeutics) focuses on "smart" materials comprised of bioactive ceramics or biomimetic fibrous polymer scaffolds for hard tissue (trauma, spine, craniomaxillofacial) and soft tissue (cartilage) repair and regeneration. A recent in vivo study showed that the company's StronBone material can generate bone quality in and around defects that appears by analytical tests to be significantly superior to a standard bone void filler in the control defect. RepRegen's product pipeline includes additional variations of StronBone as well as preclinical products for soft tissue regeneration. Tepha's patented technologies center on the use of genetic engineering to create naturally-synthesized biopolymers (e.g. polyhydroxyalkanoate copolymer) that the company can process with a variety of mechanical properties. Tepha intends to develop resorbable polymers for use in such orthopaedic products as internal fixation devices, articular cartilage and meniscus regeneration devices, ligament and tendon grafts, spinal cages and bone graft substitutes. Orthobiologics for Pain Relief and Adhesion Prevention Hyaluronic acid (hyaluronan) remains the most prominent non-pharmaceutical pain relief "agent" to have found application in orthopaedics. More than 20 million injections of hyaluronic acid occur each year worldwide, generating in excess of $1 billion in 2009 revenues. A biopolymer, hyaluronic acid is found naturally in connective tissue, most notably in the synovial fluid of articular joints. As a result, it is used primarily as an injection into the intra-articular space of various joints to restore joint fluid and ease the pain associated with OA. Other orthobiologic products, based either on hyaluronan or other materials, have found application in the prevention of surgical adhesions following spine or tendon surgery and in failed back surgery syndrome. In adhesion prevention, Aap markets Adcon anti-adhesion products indicated for the inhibition of post-surgical scarring and adhesions following lumbar surgery. Anika's INCERT-S demonstrated safety in reducing post-surgical fibrosis following spinal surgery. The company's INCERT family comprises a group of chemically modified, crosslinked forms of hyaluronic acid for use in preventing surgical adhesions. Anika currently markets INCERT in three European countries and the Middle East; however, the company continues to assess the market potential for the product, with no plans to distribute it in the U.S. ARC Pharmaceuticals' lead product candidate, ARCAD Instillate, has demonstrated prevention of surgical adhesions in preclinical efficacy and pilot safety studies. ARCAD derives from a naturally occurring polysaccharide that is extracted from seaweed or brown marine algae. Although ARCAD has not identified orthopaedics specifically for its technology, the company believes that opportunity exists for the technology in the management of arthritis. Covidien launched DuraSeal, a synthetic hydrogel sealant for intraoperative use on the dural membrane during spine procedures.

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112 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT FzioMed manufactures Oxiplex/SP Gel, a resorbable gel derived from a combination of polyethylene oxide, sodium carboxymethylcellulose and calcium chloride. Applied during surgery, the gel acts as a protective coating that forms a barrier to adhesion formation during the normal healing process. Oxiplex/SP Gel is available in 49 countries outside the U.S. for use in reducing pain and radiculopathy and in reducing surgical adhesions following such spine surgeries as laminectomy, laminotomy and discectomy. DePuy and Medtronic distribute the product outside the U.S. Since its introduction, Oxiplex has been used in nearly 100,000 spine surgeries. Integra LifeSciences' DuraGen Plus Adhesion Barrier Matrix (derived from bovine deep flexor tendon) is marketed in Europe as an adhesion barrier matrix for use after spine surgery. The company began enrollment in a multicenter clinical trial for DuraGen Plus for use in spinal surgery in the U.S. in 2006; however, it decided to suspend new patient enrollment as a significantly larger number of patients would be necessary to demonstrate a statistically significant difference between control and the study arm. Kensey Nash's Hydrosorb Shield is a resorbable surgical thin film technology that received CE Mark approval for, among other things, control of the formation of adhesions in specific spinal applications. Also commercializing anti-adhesion products is MiMedx Group, which has developed a patented and proprietary durable hydrogel technology called HydroFix. The company received FDA clearance for its Paradis Vaso Shield, based on the HydroFix technology, and launched the product as a cover for vessels following anterior spine surgeries. Further, MiMedx's HydroFix Spine Shield received CE Mark approval as an adhesion barrier for use after vertebral surgery. Neomend's ProGEL platform technology combines a large, totally biocompatible protein backbone crosslinked with polyethylene glycol. Although initially targeted at thoracic surgery, the technology may have application as a sealant in spine surgery and for prevention of post-surgical adhesions. Polyganics' VivoSorb surgical sheet comprises poly(DL-lactide--caprolactone), a synthetic biodegradable polyester. The flexible, transparent sheet provides support to soft tissues and acts as an anti-adhesive barrier. A number of orthopaedic applications for the company's technologies are in development. Of note, Polyganics manufactures the Neurolac, a lactide-caprolactone polymeric nerve guide distributed by Ascension. The company's Lacthane proprietary biodegradable polyurethanes may have application in tissue regeneration scaffolds. Replication Medical received FDA clearance and CE Mark approval for its EnGuard vessel guard. The layered sheet of hydrophilic polymer, water and fabric support serves to protect major spinal blood vessels following anterior spine surgery. SyntheMed focuses on development of its proprietary bioresorbable reverse thermal gel polymer technology. The company's SpineShield Adhesion Barrier Film could help to reduce the risk of adhesions following anterior cervical fusions and lumbar artificial disc procedures. In addition, SyntheMed's Relieve Adhesion Barrier Gel may be suited for use in surrounding and protecting the spinal cord to reduce the formation of peridural adhesions in lumbar fusion. Exhibit 51 summarizes anti-adhesion technologies with orthopaedic application.

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THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 113 Exhibit 51 anti-adhESion tEchnologiES by coMpany Company aap Anika ARC Pharmaceuticals Covidien FzioMed Product(s) Adcon INCERT-S ARCAD Instillate DuraSeal hydrogel Oxiplex/SP Gel - polyethylene oxide, sodium carboxymethylcellulose and calcium chloride DuraGen Plus Adhesion Barrier Matrix (derived from bovine deep flexor tendon) Hydrosorb Shield surgical thin film technology Paradis Vaso Shield hydrogel HydroFix Spine Shield hydrogel ProGEL protein backbone crosslinked with polyethylene glycol EnGuard vessel guard SpineShield reverse thermal gel polymer Application(s) Lumbar surgery Spinal surgery Arthritis management Dural seal during spine surgery Spinal surgery Availability EU 3 EU countries, Middle East Preclinicals EU, US EU

Integra LifeSciences

Spinal surgery

EU, US enrollment suspended

Kensey Nash

Spinal surgery

EU

MiMedx Group MiMedx Group Neomend

Vessel cover post anterior spine surgery Spinal surgery Potential in spine

US EU Research

Replication Medical SyntheMed

Anterior spine surgery Anterior cervical fusions, lumbar disc and fusion procedures

US Development

Hyaluronic acid formulations for use in treatment of OA include aap's Hynoval, a viscoelastic solution made of fermented sodium hyaluronic acid for use in treating OA in the knee and other synovial joints. Anika Therapeutics manufactures ORTHOVISC, an ultra-pure, medical grade, high molecular weight sodium hyaluronate extracted from rooster and hen combs for the U.S. market and in a non-animal based form for the European market. The product has been cleared in Canada, Turkey and the U.S. for use in treatment of knee OA,

© ORTHOWORLD Inc., 2010. All rights reserved.

114 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT which entails a series of three intra-articular injections one week apart. In Europe, ORTHOVISC is available for treatment of pain in all joints. Anika also launched ORTHOVISC mini, a small-dose treatment primarily used for knee OA, in the European Union and initiated a post-approval multi-center clinical study of ORTHOVISC mini targeting the carpometacarpal joint. The company has no plans for the product in the U.S. market. DePuy Mitek distributes ORTHOVISC in the U.S., Latin America and Mexico for treatment of knee OA pain, while a variety of distribution groups handle the product's sales and marketing in approximately 20 other countries. In the U.S., Anika and Mitek initiated clinical trials for the use of ORTHOVISC in the treatment of shoulder OA and have begun clinical trials to assess the efficacy of ORTHOVISC post arthroscopy and in treating patellofemoral pain. In the U.S., Anika filed a final module of its PMA for MONOVISC, its single injection hyaluronic acid, which has been launched in Canada and Europe for treatment of OA symptoms in all synovial joints. The company's second singleinjection osteoarthritis product is CINGAL, which is based on the same technology platform used in MONOVISC but features an active therapeutic molecule to provide pain relief for a long period of time. With its acquisition of Fidia Advanced Biopolymers, Anika broadened its hyaluronic acid-based product portfolio to include Hyalgan, the first sodium hyaluronate therapy cleared for use in the U.S. for treatment of knee OA as a fiveinjection treatment regimen. Outside the U.S., surgeons may use Hyalgan in three or five weekly injections to treat pain due to OA in shoulder, hip or knee. Anteis' Synolis device is based on LSM (Ligo Stabilized Matrix) technology, which combines hyaluronic acid and sorbitol. The company claims the technology offers an optimal balance between elasticity and viscosity Bioniche Pharma manufactures and markets Suplasyn, a sodium hyaluronate for treatment of pain due to OA (through three weekly injections). Suplasyn, available in more than 30 countries outside the U.S., comes in two sizes ­ Suplasyn for treatment of large joints (e.g. knees and shoulders) and Suplasyn m.d. (mini-dose) for use in small joints (e.g. fingers and toes). Although the product has not been cleared for use in the U.S., it has been used in millions of injections over the past ten years. Clinical trials of Carbylan BioSurgery's ActaVisc viscosupplement for intra-articular injection were concluded in mid-2009. The company believes that ActaVisc would need to be injected only two to three times per year. curasan sources its CE Mark approved, hyaluronan-derived Curavisc from Impfstoffwerk Dessau-Tornau. Manufactured by fermentation, the weekly three-to-five injection Curavisc treatment is indicated for use in the knee and other synovial joints. Study results demonstrated the long-term efficacy of Curavisc in the treatment of chronic facet syndrome. Ferring Pharmaceuticals markets Euflexxa, an injectable non-avian-derived biologic formulation of hyaluronic acid for use in treating knee pain due to OA. Euflexxa's treatment regimen comprises three injections given one per week. The product is cleared for use in the U.S., Israel and the European Union. Flex Biomedical has developed a slow-degrading, synthetic injectable polymer for the treatment of knee OA. The company believes the Flex Polymer will provide superior lubrication and cushioning ability to existing hyaluronic acid products. In vitro and in vivo tests confirmed the polymer's superior mechanical properties and its biocompatibility and additional preclinical tests are underway.

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 115 Genzyme Biosurgery manufactures Synvisc, a rooster comb-based hyaluronan used to treat OA pain in a series of three injections into the joint. Commercially available in more than 60 countries, Synvisc's usage extends to more than 13 million injections, more than five million in the U.S. over the past ten years. Synvisc has been cleared for use in treating knee OA in the U.S., with clearance in Canada for hip and knee applications and CE Mark approval for treatment of OA in hip, knee, shoulder and ankle. Genzyme filed for approval to market Synvisc in Japan for the treatment of OA pain and expects to receive approval for marketing there in 2010. Genzyme launched its singleinjection Synvisc-One in both the U.S. and Europe. It is intended to provide up to six months of relief from knee OA pain through one injection. In 2009, Genzyme generated $329 million in revenues from its Synvisc franchise. Genzyme has also developed Jonexa, a bacterially fermented product derived from hyaluronan that is indicated for the treatment of pain associated with OA of the knee and administered in one or two injections. The company received CE Mark approval for the product in 2009 and expects to launch it in select European Union markets and Hong Kong in 2010. Hyalose hopes to commercialize its recombinant technologies for producing hyaluronic acid and claims that its fermentation processes can produce hyaluronic acid less expensively than other technologies. The company seeks commercialization partners in the areas of wound healing, OA, device coatings, drug delivery, tissue engineering and anti-adhesion surgical devices. Hyaltech manufactures medical grade hyaluronan using a bacterial fermentation process. The company's injectable Fermathron is CE Mark approved for treatment of knee OA, and Fermathron Plus entered a clinical trial in the Netherlands to evaluate improvement in pain and function in knee OA compared to placebo. Completion of the trial is expected by year-end 2010. Some Biomet companies distribute Fermathron in Europe. Novozymes Biopolymer has created HyaCare, reportedly a purer form of HA based on bacillus subtilis, a grampositive micro-organism. The company claims that HyaCare is the only sodium hyaluronate that features low protein levels and no endotoxins from the host strain, with the same efficacy as traditional sodium hyaluronate. Q-Med and Smith & Nephew teamed to develop and commercialize Q-Med's proprietary technology for the production of non-animal stabilized hyaluronic acid (NASHA) for the management of OA in joints and other products for orthopaedic applications. Smith & Nephew obtained exclusive global rights to market Q-Med's NASHA products, which Q-Med will manufacture. Q-Med's products include CE Mark approved Durolane for single injection treatment of OA in both knee and hip. In August 2009, FDA's Orthopaedic and Rehabilitation Devices Panel voted against clearance for the product for the treatment of knee OA pain. Q-Med and Smith & Nephew will work together to provide FDA with additional information as part of the PMA. Rottapharm/Madaus has developed GO ON and GO ON mini, hyaluronic acid viscosupplementation products and is also working on small molecules and therapeutic proteins for treatment of OA. Seikagaku boasts development of Artz, the first hyaluronan joint fluid therapy commercially available for use in treating pain associated with knee OA in humans. Since its introduction in 1987, the product has been used in over

© ORTHOWORLD Inc., 2010. All rights reserved.

116 - THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT 200 million injections in 21 countries as Artz, Artzal, OsteoArtz and Supartz. Seikagaku has approval in Japan for Artz formulations for the treatment of shoulder periarthritis and chronic knee pain caused by RA. In Europe and the U.S., Smith & Nephew distributes Seikagaku's Artz as Supartz, cleared as a three- or five-injection therapy for treatment of knee OA pain. Seikagaku completed its Phase III clinical trial in the U.S. for highly viscous Gel-200, a single-injection "joint function improving agent" based on cross-linked hyaluronate hydrogel. The product demonstrated statistically significant efficacy vs. placebo in the treatment of knee OA pain. Seikagaku entered in an agreement granting Zimmer sole U.S. distribution rights for Gel-200 and filed a PMA application for the product. In early 2010, FDA informed Seikagaku that its PMA of Gel-200 was not approvable. Seikagaku also submitted a PMA with FDA in September 2009 for SI-602, an additional indication of SUPARTZ for shoulder osteoarthritis. Finally, the company entered Phase II/III clinical trials in Japan and Phase II trials in the U.S. for SI-6603, an injectable glycosaminoglycan suited to dissolution of the nucleus pulposus in lumbar disc herniation. Seikagaku generated approximately $80.5 million (7,463 million yen) in Artz sales worldwide for the year ended March 31, 2009. Stellar manufactures synthetic NeoVisc based on its core polysaccharide technology. The one percent solution of highly purified sodium hyaluronate is available in one-injection or three-injection formulations. NeoVisc is CE Marked as a three-injection product administered over a two-week period, while Stellar launched NeoVisc Single Dose in Canada. TRB Chemedica's orthopaedic products all derive from highly purified sodium hyaluronates produced via bacterial fermentation and include Ostenil, Ostenil mini, Viscoseal and Diacerein, the latter an oral agent for treatment of OA. Ostenil received CE Mark approval for treatment of OA pain primarily in the knee, while Ostenil mini addresses OA in small joints (e.g. facets, saddle joint in thumb, interphalangeal joints of the fingers and toes, the proximal joint of the big toe, etc.) and Viscoseal serves as a synovial fluid substitute for joint lavage or pain relief, improvement in mobility and promotion of joint recovery immediately after arthroscopic surgery. Exhibit 52 summarizes hyaluronic acid products available worldwide.

Exhibit 52 hyaluronic acid productS by coMpany Company Anika Anika Anika Anika Bioniche curasan Product(s) ORTHOVISC ORTHOVISC mini MONOVISC Hyalgan Suplasyn Curavisc Clearances Knee (Canada, Turkey, US); all joints (EU) Knee (EU) All joints (Canada, EU) Knee (US); shoulder, hip, knee (OUS) Large and small joints (OUS) Synovial joints (OUS) # Injections 3 3 1 5 3 3 to 5

© ORTHOWORLD Inc., 2010. All rights reserved.

THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT - 117 Exhibit 52 hyaluronic acid productS by coMpany

(Continued)

Company Ferring Genzyme Genzyme Genzyme Hyaltech Q-Med Seikagaku Stellar Stellar TRB Chemedica TRB Chemedica TRB Chemedica

Product(s) Euflexxa Synvisc Synvisc-One Jonexa Fermathron Durolane Artz, Artzal, OsteoArtz, Supartz NeoVisc NeoVisc Single Dose Ostenil Ostenil mini Viscoseal

Clearances Knee (EU, Israel, US) Knee (US); hip and knee (Canada); hip, knee and shoulder (EU) Knee (EU, US) Knee (EU, Hong Kong) Knee (EU) Knee and hip (EU) Knee (EU and US through Smith & Nephew); shoulder and knee (Japan) Synovial joints (EU, Canada) Synovial joints (Canada) Synovial joints (Canada, EU) Small joints (EU) Post-arthroscopy (EU)

# Injections 3 3 1 1 or 2 3 1 3 or 5 1 or 3 1 3 1 to 3

Summary From joint replacement to hyaluronic acid, orthopaedics should remain one of the healthiest segments of the worldwide medical device industry. Compelling demographics and emerging geographies, alone, should serve to drive solid, steady growth in the years to come. Source: ORTHOWORLD Inc., 8401 Chagrin Road, Suite 18, Chagrin Falls, Ohio, 44023. 440.543.2101 (phone); 440.543.2122 (fax); e-mail: [email protected]; web: www.orthoworld.com.

© ORTHOWORLD Inc., 2010. All rights reserved.

appendices

Appendix A-1 appEndix a rEconStructivE dEvicE coMpaniES Company Hip Knee Shoulder Hand/ Wrist Elbow/ Radial Head Digits Ankle

aap Active Implants Acumed Advanced Biosurfaces Aequos Aesculap Alphamed Altimed Amplitude Aptis ARGE Argomedical Arthrex ArthroSurface Articulinx Artimplant Ascension Asia Orthopaedics Australian Surgical Design & Manufacture Baumer Beznoska Bioimplant Scandinavia Biomecanica Ortopedicos Biomet BioPRO Biotech Biotechni Biotek Bonovo Orthopedics Cardo Medical Ceramconcept Ceraver ChM Citieffe

© ORTHOWORLD Inc., 2010. All rights reserved.

A-2 Appendix appEndix a rEconStructivE dEvicE coMpaniES

(Continued)

Company

Hip

Knee

Shoulder

Hand/ Wrist

Elbow/ Radial Head

Digits

Ankle

Comis Orthopaedics ConforMIS Consensus Orthopedics Corentec Corin Cousin Biotech Covision DePuy DJO Elite Surgical Endotec Erothitan Euros Exactech FH Orthopedics Fin Ceramica Fusion Medical Global Orthopaedic Technology GPC Medical Gramedica Groupe Lepine Gruppo Bioimpianti Hit Medica ( a Lima company) Implanet Implantcast Implantes Fico Implants Industrie Implants International Impol INOR Orthopaedics Integra LifeSciences International Orthopaedics Japan MDM/Ortho Development Japan Medical Materials JRI

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix A-3 appEndix a rEconStructivE dEvicE coMpaniES

(Continued)

Company

Hip

Knee

Shoulder

Hand/ Wrist

Elbow/ Radial Head

Digits

Ankle

Kapp Surgical Kinamed KLS Martin Knee Creations LLC Lafitt Lima MAKO Surgical Mathys Maxx Orthopedics MDT Implantes Ortopedicos Medacta Medicalex-Francemed Medicor Memometal Technologies Merete Metasurg New Splint NMB Medical OMNIlife science Ortho Select Orthodynamics Orthopaedic Innovation Orthopaedic International Orthopaedic Synergy OrthoPro Orthosurgical Ortosintese OsteoMed Permedica Peter Brehm Prima Implantes Privelop Protetim Roth Medical Samo Biomedica

© ORTHOWORLD Inc., 2010. All rights reserved.

A-4 Appendix appEndix a rEconStructivE dEvicE coMpaniES

(Continued)

Company

Hip

Knee

Shoulder

Hand/ Wrist

Elbow/ Radial Head

Digits

Ankle

Seremm SERF Dedienne Santa Sgarlato Showa Ika Signal Medical Small Bone Innovations Smith & Nephew Solana Surgical Stanmore StelKast Stemcup Medical Stryker Summit Medical/ESKA Surgival Sushrut Symbios Tantum Tecres Tianjin Taishan Medical Tornier Total Joint Orthopedics Traiber Transysteme Treu Trilliant Surgical TTK Healthcare Uma Surgicals United Orthopedic Van Straten Vilex VOT Solutions Waldemar Link Whiteside Wright Medical Zimmer

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix B-1 appEndix b fracturE rEpair coMpaniES

Company

ExFix

IM Nail

Hip Fix

Other Internal Fixation*

Bone Growth Trauma

3D Medical Concepts aap Accelalox Acumed Acute Innovations Advanced BioMedical Advanced Orthopaedic Solutions Aesculap Agee ALBU Medical-Implanta American Medical Specialties Amplitude AngleFix Anthem Orthopaedics AOI Medical Appiades Meditech ARC Surgical AREX Argomedical Arthrex Ascension Orthopedics Austofix Australian Surgical Design & Manufacture Autogenesis B1 Medical Baumer Beznoska Bidoia Bio Research Innovations Biomecanica Ortopedicos Bio-Medical Devices BioMedical Enterprises Biomet Bioplate

© ORTHOWORLD Inc., 2010. All rights reserved.

B-2 Appendix appEndix b fracturE rEpair coMpaniES

(Continued)

Company

ExFix

IM Nail

Hip Fix

Other Internal Fixation*

Bone Growth Trauma

BioPRO Bioretec Biotech BioTech One Biotek BK Meditech Bonutti CH Medical ChM Citieffe Coapt Systems Cohera Medical ConMed Linvatec Core Essence Corin Covision Medical Creative Medical Designs CyberOrthology DePuy DGIMed Ortho Diverquin DJO DSS Syntec Efratgo Elite Surgical Erothitan Titanium Implante Expanding Orthopedics ExtraOrtho Extremity Innovations Extremity Medical FH Orthopedics Fusion Medical Corp FxDevices Gexfix

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix B-3 appEndix b fracturE rEpair coMpaniES

(Continued)

Company

ExFix

IM Nail

Hip Fix

Other Internal Fixation*

Bone Growth Trauma

GMReis Gold Standard Orthopaedics GPC Medical Groupe Lepine Gruppo Bioimpianti Hand Biomechanics Hit Medica Icotec IGEA IlluminOss Medical Implant Technology Implantat Technologie Implantcast Implantes Fico Implants Industrie Implants International Impol Inion INOR Orthopaedics Integra LifeSciences InteliFUSE Intelligent Orthopaedics Internal Fixation Systems Intrauma Japan MDM/Ortho Development Japan Medical Materials Jeil Medical JMEA Juvent Medical Kanghui Kapp Surgical Kens FineMedTech Kinamed Kiscomedica

© ORTHOWORLD Inc., 2010. All rights reserved.

B-4 Appendix appEndix b fracturE rEpair coMpaniES

(Continued)

Company

ExFix

IM Nail

Hip Fix

Other Internal Fixation*

Bone Growth Trauma

Koby Surgical Lafitt LAGeT Lima LITOS Lotus Medical MDT Implantes Ortopedicos Medartis Medicalex-Francemed Medicor Medimetal Medizintechnik Sattler MedShape Solutions MedXpert Memometal Technologies Merete Meridian Medical Merlot OrthopediX Metasurg Micromed Mikai Mondeal Medical Mylad Orthopaedic Newclip NewMedical Technology NMB Medical Normed NovaLign Orthopaedics NovaPedix Nutek Ortho Select Ortho Solutions Orthodynamics Orthofix OrthoHelix

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix B-5 appEndix b fracturE rEpair coMpaniES

(Continued)

Company

ExFix

IM Nail

Hip Fix

Other Internal Fixation*

Bone Growth Trauma

OrthoMed OrthoMediTec Orthometrix OrthoNetx Orthopaedic Innovation Orthopaedic International OrthoPediatrics Orthopedic Designs OrthoPro Orthosurgical Ortosintese OsteoMed Pega Medical Permedica Pioneer Surgical Technology Poly 5 Group PolyNovo Biomaterials Prima Implantes Protetim pSivida Quantum Medical Concepts Renova Orthopedics Rigid fx Roth Medical RS Medical Rush Pin Samo Biomedica Sanatmetal Science for Bio Materials Scyon Orthopaedics SERF Dedienne Sante SH Pitkar Sharma Surgical Shoulder Options SI Bone

© ORTHOWORLD Inc., 2010. All rights reserved.

B-6 Appendix appEndix b fracturE rEpair coMpaniES

(Continued)

Company

ExFix

IM Nail

Hip Fix

Other Internal Fixation*

Bone Growth Trauma

SIC Brevetti Simpex Medical Simplicity Orthopedic Sintea Plustek Skeletal Dynamics Small Bone Innovations Smit Medimed Smith & Nephew Solco Biomedical Sonoma Orthopedic SOTA Orthopaedics Stryker Stuckenbrock Surgical Implant Generation Surgival Sushrut Synthes Taeyeon Medical Takiron Tantum Tekka Tianjin Toby Orthopaedics Tornier Tradimedics Traiber Transysteme Trauson Medical Treu TriMed TTK Healthcare U&I Uma Surgicals Union Surgical United Orthopedic

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix B-7 appEndix b fracturE rEpair coMpaniES

(Continued)

Company

ExFix

IM Nail

Hip Fix

Other Internal Fixation*

Bone Growth Trauma

UPex Vilex VQ OrthoCare Waldemar Link Waston Medical Weigao Whiteside Biomechanics Woll BioOrthopedics Wright Medical Zimmer

*Includes plates, screws, staples, etc. for use in fracture repair, fusion, osteotomy, etc.

© ORTHOWORLD Inc., 2010. All rights reserved.

C-1 Appendix appEndix c arthroScopy/Soft tiSSuE/SportSMEd coMpaniES Company 3D-Matrix Advanced Endoscopy Devices Aesculap Alpha Orthopaedics Amplitude ARC Surgical AREX Arthrex ArthroCare Arthroscopic Innovations Arthrovision Artimplant Australian Surgical Design Bio Research Innovations Biocomposites bioMD BioMedical Enterprises Biomet Biomimedica Bonutti Bovie Medical Cannuflow Cayenne ChM ConMed Core Essence Corin Cousin Biotech Covidien DePuy Mitek Elliquence Ellis Development FH Orthopedics Formae GMReis Arthroscopy Equipment Soft Tissue Fixation Artificial Ligament/Tendon

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix C-2 appEndix c arthroScopy/Soft tiSSuE/SportSMEd coMpaniES

(Continued)

Company Gore Medical Gruppo Bioimpianti Implanet Incisive Surgical Inion Integra LifeSciences InteliFUSE Invuity JetGuide JG Medical Joimax Karl Storz Kensey Nash KFx Medical LARS MAST Biosurgery MDT Implantes Medimetal MedShape Solutions Micro-Imaging Solutions Micromed Neoligaments NuOrtho Surgical Olive Medical Olympus Ortheon Medical Ortho Select OrthoDynamix Orthofix Orthomed OrthoMimetics/TiGenix Orthox Ortosintese Parcus Medical PEAK Surgical Plasma Surgical

Arthroscopy Equipment

Soft Tissue Fixation

Artificial Ligament/Tendon

© ORTHOWORLD Inc., 2010. All rights reserved.

C-3 Appendix appEndix c arthroScopy/Soft tiSSuE/SportSMEd coMpaniES

(Continued)

Company Prima Implantes Revivicor Richard Wolf RTI Biologics Sapphire Medical Science for Bio Materials Serica Technologies SH Pitkar Sharma Surgical Simplicity Orthopedic Small Bone Innovations Smith & Nephew Soft Tissue Regeneration SpineView Stryker Surgicraft Surgin Takiron Teknimed Telos Medical Tepha Toby Orthopaedics Tornier United Endoscopy World of Medicine Wright Medical Xiros Zimmer

Arthroscopy Equipment

Soft Tissue Fixation

Artificial Ligament/Tendon

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix D-1 appEndix d Spinal iMplantS/inStruMEntation coMpaniES Company Fusion Motion Preservation/ Dynamic Stabilization Nucleus Replacement/ Annular Repair Facet Repair/ Replacement Bone Growth Spine Kyphoplasty /Vertebroplasty

3Cor Medical 4th Column aap Acme Spine Adaptive Specialty Advanced Biomaterial Systems Advanced Medical Technologies Advanced Prosthetic Advanced Spine Technology Aesculap ALCerAX Alphamed Alphatec Spine/ Scient' x Amedica Amendia Anatomica Anulex AOI Medical Apollo Spine Applied Spine Technologies ARCA MEDICA ArchiMed Arthro Kinetics ArthroCare Spine A-Spine Atlas Spine AxioMed Baumer Benvenue Medical Binder Biomedical BioCure

? ? ? ? ? ? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

D-2 Appendix appEndix d Spinal iMplantS/inStruMEntation coMpaniES

(Continued)

Company

Fusion

Motion Preservation/ Dynamic Stabilization

Nucleus Replacement/ Annular Repair

Facet Repair/ Replacement

Bone Growth Spine

Kyphoplasty /Vertebroplasty

Biomecanica Bio-Medical Devices BioMedical Enterprises Biomerix BioSpine Biotech Biotechni Biotek BK Meditech BoneSupport BonWrx Bricon Calvary Spine Captiva Spine Cardo Medical CareFusion Centinel Spine CG Surgical ChM ChoiceSpine Clariance coLigne Cook CoreLink Corentec Corin Cousin Biotech Covision Creaspine Crosstrees Medical CryoLife Custom Spine DePuy DFine

? ? ? ? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix D-3 appEndix d Spinal iMplantS/inStruMEntation coMpaniES

(Continued)

Company

Fusion

Motion Preservation/ Dynamic Stabilization

Nucleus Replacement/ Annular Repair

Facet Repair/ Replacement

Bone Growth Spine

Kyphoplasty /Vertebroplasty

Disc Motion DJO Dynamic Spine Eden Spine EgiFix Medical Elite Surgical Ellipse Technologies Eminent Spine ESM Technologies Euros EuroSpine Exactech Expanding Orthopedics Expandis Facet Solutions FH Orthopedics Flexuspine G Surgical Genesys Gentis Gerraspine Global Orthopaedic Technology Globus Medical GMReis Gold Standard Orthopaedics GS Medical Highgate Orthopedics Implantcast Implants International Impliant Impol Incite Innovation Innovasis

?

?

© ORTHOWORLD Inc., 2010. All rights reserved.

D-4 Appendix appEndix d Spinal iMplantS/inStruMEntation coMpaniES

(Continued)

Company

Fusion

Motion Preservation/ Dynamic Stabilization

Nucleus Replacement/ Annular Repair

Facet Repair/ Replacement

Bone Growth Spine

Kyphoplasty /Vertebroplasty

Innovation Medical Technologies Innovative Delta Technology Innvotec Surgical INOR Orthopaedics Integra Spine Intelligent Implant Systems Interventional Spine Intrinsic Therapeutics Ionics Medical Japan MDM/Ortho Development Japan Medical Materials Jemo Spine JMEA K2M Kapp Surgical Kiscomedica Korea Bone Bank Kyungwon Medical Lafitt Lanx LDR Life Spine Linares Medical Lucero Medical Magellan Spine MAXXSPINE MDT Implantes Ortopedicos Medicalex-Francemed Medicrea Medtronic Medyssey

? ? ? ? ? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix D-5 appEndix d Spinal iMplantS/inStruMEntation coMpaniES

(Continued)

Company

Fusion

Motion Preservation/ Dynamic Stabilization

Nucleus Replacement/ Annular Repair

Facet Repair/ Replacement

Bone Growth Spine

Kyphoplasty /Vertebroplasty

Merries International MI4 Spine Mikai Nanovis Neurospine Innovations and Solutions Nexgen Spine Nexxt Spine NMB Medical NonLinear Technologies Norm Spinal Products NovaSpine NP Solutions NuVasive OptiMed Ortho Devices Ortho Sol Orthofix Orthonics Orthopaedic Innovation Orthopaedic International OrthoPediatrics Orthopedic Sciences Orthopeutics OrthoTec Orthovita Ortosintese Osseon Osteon OTIS Biotech Ouroboros Paradigm BioDevices Paradigm Spine Permedica Peter Brehm

? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

?

? ?

D-6 Appendix appEndix d Spinal iMplantS/inStruMEntation coMpaniES

(Continued)

Company

Fusion

Motion Preservation/ Dynamic Stabilization

Nucleus Replacement/ Annular Repair

Facet Repair/ Replacement

Bone Growth Spine

Kyphoplasty /Vertebroplasty

Phygen PINA Medizintechnik Pioneer Surgical Pisharodi Surgicals Precision Surgery Prima Implantes Privelop R Tree Innovations Ranier Reduction Technologies Replication Medical Restorative Physiology Rhausler Spinal Implants Roth Medical RSB Spine S14 Implants Sanacor Sanatmetal Scorpion Surgical SeaSpine SH Pitkar Sharma Surgical Showa Ika Signus Medical Sintea Biotech Skeltex Smart Disc SmArt Spine Smit Medimed Solco Biomedical Soteira Southern Spine Spartek Medical Specialty Spine Products Spinal Devices

? ? ? ? ? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix D-7 appEndix d Spinal iMplantS/inStruMEntation coMpaniES

(Continued)

Company

Fusion

Motion Preservation/ Dynamic Stabilization

Nucleus Replacement/ Annular Repair

Facet Repair/ Replacement

Bone Growth Spine

Kyphoplasty /Vertebroplasty

Spinal Edge Spinal Elements Spinal Instrumentation Simplification Systems Spinal Kinetics Spinal Simplicity Spinal USA SpinalMotion Spine 360 Spine Select Spine Wave Spine21 SpineAlign Medical Spineart SpineCraft SpineFrontier SpineLab SpineNetwork Spineology SpineSmith SpineSource SpineVision Spineway SpineWorks Stryker Summit Medical/ESKA Surgicraft Surgival Sushrut Sync Medical Synthes Taeyeon Medical Takiron Tecres TekMed

? ? ? ? ? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

D-8 Appendix appEndix d Spinal iMplantS/inStruMEntation coMpaniES

(Continued)

Company

Fusion

Motion Preservation/ Dynamic Stabilization

Nucleus Replacement/ Annular Repair

Facet Repair/ Replacement

Bone Growth Spine

Kyphoplasty /Vertebroplasty

Teknimed Titan Spine Tradimedics Traiber TranS1 Treu Trinity Orthopedics U&I Ulrich Medical Uma Surgicals US Spine Vertebral Technologies Vertebration Verticor Vertiflex Vexim Vidacare VQ OrthoCare Waldemar Link Waston Medical Weigao Wenzel Spine X-Spine Zimmer ? ? ? ? ? ? ?

?

In development Commercialized or in human clinical studies

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix E-1 appEndix E biologicS & cEMEnt coMpaniES Company 3D-Matrix aap Aastrom ACell Acologix Acumed Advanced Biologics Advanced Ceramics Aesculap Affinergy AG Digital Allograft Innovations Allograft Tissue Systems AlloSource Alphatec Spine Amplitude Anika Apatech/Baxter ARC Pharmaceuticals ARCA MEDICA AREX Artecel Arthrex Arthro Kinetics Articular Engineering Asahi Ascension Orthopedics Bacterin BAE Systems Baumer Baxter Berkeley Binder Biomedical BioActive Bone BioAfix Biocomposites ? ? ? ? ? ? Synthetics Allograft/DBM Osteoinductives Tissue Repair/ Viscoelastics Regeneration

© ORTHOWORLD Inc., 2010. All rights reserved.

E-2 Appendix appEndix E biologicS & cEMEnt coMpaniES

(Continued)

Company Biocoral BioE BioGrafts Biomatlante bioMD Biomerix Biomet BioMimetic Therapeutics Bioniche Pharma Biopharm BioSET BioStructures Biosyntech BioTech One BioTissue Technologies Bone Bank Allografts Bone Biologics Bone Solutions BoneSupport BoneGrafix Calcitec Cam Bioceramics Carbylan BioSurgery Cardo Medical Carmell Therapeutics Carticept Medical Cartilix CellCoTec CellGenix CellTec Ceramisys CeraPedics Ceraver Citagenix Clearant co.don

Synthetics

Allograft/DBM Osteoinductives Tissue Repair/ Viscoelastics Regeneration ?

? ? ? ? ? ? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix E-3 appEndix E biologicS & cEMEnt coMpaniES

(Continued)

Company Collagen Matrix CollEngin Community Tissue Services Competitive Technologies Corin Cousin Biotech Covalent Covidien Covision CrossCart CryoLife curasan DePuy Doctors Research Group DyfucaMed Educell ETEX Euros Exactech FH Orthopedics Fin Ceramica Flex Biomedical FzioMed Geistlich GenOsteo Gentis Genzyme Biosurgery Global Orthopaedic Technology Globus Medical GMReis Graftys Groupe Lepine Hans Biomed Histogenics Hit Medica

Synthetics

Allograft/DBM Osteoinductives Tissue Repair/ Viscoelastics Regeneration

? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

E-4 Appendix appEndix E biologicS & cEMEnt coMpaniES

(Continued)

Company Hospital Innovations Hyalose Hyaltech Innovasis Innovative BioCeramix Inoteb Integra LifeSciences Interface Biotech Intralink Spine Ion Surgical Technologies ISTO Japan MDM/Ortho Development Japan Medical Materials Japan Tissue (J-TEC) Karocell Kasios Kensey Nash Kobayashi Kuros Kyungwon Medical Lanx LDR LifeCell/KCI LifeLink Foundation LifeNet Lubris MAST Biosurgery Mathys Medacta Medartis MedicalBiomat Medicrea Medtronic Merries International Mesoblast

Synthetics

Allograft/DBM Osteoinductives Tissue Repair/ Viscoelastics Regeneration ? ?

?

? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix E-5 appEndix E biologicS & cEMEnt coMpaniES

(Continued)

Company Meta Biomed MiMedx minSURG Mitsubishi Materials MTF Nanotherapeutics Nanovis NeoStem NGK Spark Plug Norm Spinal Products NovaBone Novozymes NuVasive Octane Olympus Omeros Organogenesis Orteq Ortheon Medical Ortho Devices Orthocon Orthofix Orthogem Orthogen Orthomed OrthoMimetics/TiGenix Orthonics Orthopeutics OrthoPro Orthos Orthovita Orthox Osiris Osprey Biomedical Ossacur Osteogenesis

Synthetics

Allograft/DBM Osteoinductives Tissue Repair/ Viscoelastics Regeneration

? ? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

E-6 Appendix appEndix E biologicS & cEMEnt coMpaniES

(Continued)

Company OsteoGenix OsteoMed Osteopore Osteotech Parametrics Medical Pentax Performance Grafts Pioneer Surgical Polyganics PolyNovo Biomaterials ProChon Produits Dentaires Progenteq Progentix PROMED pSivida Q-Med ReGen Biologics Regenerative Medical System Regenerative Sciences RegenTec Regentis Biomaterials RepRegen Rottapharm Royer Biomedical RTI Biologics SaluMedica Schwartz Biomedical Science for Bio Materials Scil Technology Seikagaku Serica Technologies Sewon Cellontech Showa Ika Signus Medizintechnik Sintea Biotech

Synthetics

Allograft/DBM Osteoinductives Tissue Repair/ Viscoelastics Regeneration

? ? ? ? ? ? ? ? ? ?

© ORTHOWORLD Inc., 2010. All rights reserved.

Appendix E-7 appEndix E biologicS & cEMEnt coMpaniES

(Continued)

Company Skeletal Kinetics Small Bone Innovations Smith & Nephew Spinal Restoration SpineCraft Spineology SpineSmith Spineway Stryker Synovis Orthopedic and Woundcare Synthasome SyntheMed Synthes Taisho TBF Tissue Engineering TEI Biosciences Teknimed Tepha TheraCell TiGenix Tissue Banks Intl Tissue Genesis Tissue Regeneration Systems Tissue Regeneration Therapeutics Tissue Regenix Tissue Science Laboratories TissueGene TissueNet Tornier Transysteme TRB Chemedica Unilab Surgibone US Spine USBiomaterials

Synthetics

Allograft/DBM Osteoinductives Tissue Repair/ Viscoelastics Regeneration

?

© ORTHOWORLD Inc., 2010. All rights reserved.

E-8 Appendix appEndix E biologicS & cEMEnt coMpaniES

(Continued)

Company Van Straten Velcura Therapeutics Vivoxid Wright Medical Zimmer ?

Synthetics

Allograft/DBM Osteoinductives Tissue Repair/ Viscoelastics Regeneration

In development Commercialized or in human clinical studies ?

© ORTHOWORLD Inc., 2010. All rights reserved.

direcTOry

OF

cOmpanies

Companies/Entities DOC-1 dirEctory of coMpaniES Company/Entity 3D-Matrix Ltd 3Cor Medical Inc 3D Medical Concepts 4th Column LLC aap Implantate AG Aastrom Biosciences Inc Accelalox Inc ACell Inc Acme Spine LLC Acologix Inc Acrobot Company Limited The Active Implants Corporation Acumed LLC Acute Innovations LLC Adaptive Specialty LLC Advanced Biologics LLC Advanced Biomaterial Systems Inc Advanced BioMedical Technologies Inc Advanced Bio-Surfaces Inc Advanced Ceramics Research Inc Advanced Medical Technologies Inc Advanced Orthopaedic Solutions Inc Advanced Prosthetic Technologies Inc Advanced Surgical Design and Manufacture Ltd Advanced Vertebral Solutions Aequos Endoprothetik GmbH Aesculap AG/B Braun Aesculap Implant Systems Affinergy Inc AG Digital Technology Corp ALBU Medical-Implanta Orthopaedics GmbH ALCeraX Medizintech GmbH Alexandria Research Technologies LLC Allograft Innovations Allograft Tissue Systems Inc AlloSource Alpha Orthopaedics Inc Alphamed Medizintechnik Fischer GmbH URL www.3d-matrixco.jp n/a www.3dmedicalconcepts.com n/a www.aap.de www.aastrom.com www.accelalox.com www.acell.com n/a www.acologix.com www.acrobot.co.uk www.activeimplants.com www.acumed.net www.acuteinnovations.com n/a www.advancedbiologicscorp.com www.advbiomat.com n/a www.advbiosurf.com www.acrtucson.com www.amt-ag.de www.aosortho.com www.apt-inc.org www.asdm.com.au n/a www.aequos.de www.aesculap.de www.aesculapimplantsystems.com www.affinergy.com www.ag-digital.com n/a www.alcerax.de www.art-orthopaedics.com www.allograftinnovations.com www.tissuesystems.com www.allosource.org www.alphaorthopaedics.com www.alphamed-fischer.at

© ORTHOWORLD Inc., 2010. All rights reserved.

DOC-2 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity Alphatec Spine Inc Altimed JSC Amedica Corporation Amendia Inc American Medical Specialties Inc Amplitude Neyron Anatomica Surgical Products AngleFix Tech LLC Anika Therapeutics Inc Anteis SA Anthem Orthopaedics LLC Anulex Technologies Inc AO Foundation AOI Medical Inc ApaTech Ltd (Baxter) Apollo Spine Inc Appiades Meditech Ltd Applied Spine Technologies Inc Aptis Medical ARC Pharmaceuticals Inc ARC Surgical LLC ARCA MEDICA Gmbh ArchiMed Inc AREX Corp ARGE Medizintechnik Argomedical AG Arteriocyte Medical Systems Inc Arthrex Inc Arthro Kinetics plc ArthroCare Corporation Arthroscopic Innovations LLC Arthrosurface Inc ArthroVision Spine Articular Engineering LLC Articulinx Inc Artimplant AB Asahi Kasei Pharma Corp Ascension Orthopedics Inc

URL www.alphatecspine.com www.altimed.by www.amedicacorp.com www.amendia.com www.ammeds.com www.amplitude-ortho.com www.anatomicaspine.com n/a www.anikatherapeutics.com www.anteis.com n/a www.anulex.com www.aofoundation.org www.aoimedical.net www.apatech.com www.apollospine.com n/a www.appliedspine.com www.aptismedical.com www.arcpharma.com n/a www.arca-medica.com www.archimedcorp.com www.arex.fr www.arge-med.de www.argomedical.com www.arteriocyte.com www.arthrex.com www.arthro-kinetics.com www.arthrocare.com www.arthroscopicinnovations.com www.arthrosurface.com www.av-spine.de www.articular.com www.articulinx.com www.artimplant.se www.asahi-kasei.co.jp www.ascensionortho.com

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-3 dirEctory of coMpaniES

(Continued)

Company/Entity Asia Orthopaedics A-Spine Asia Co Ltd A-Spine USA Inc Atlas Spine Inc Austofix (Australian Orthopaedic Fixations Pty Ltd) Australian Surgical Design & Manufacture Pty Ltd Autogenesis Inc Axial Biotech Inc AxioMed Spine Corporation Axis Surgical Technologies Inc Azellon Ltd B1 Medical Ltd Bacterin Intl Inc BAE Systems Baumer SA Baxano Inc Baxter International Inc Benvenue Medical Inc Berkeley Advanced Biomaterials Inc Beznoska sro Bidoia sas Biedermann Motech GmbH Binder Biomedical Inc BioAfix Bio Recherches Innovations/Bio Research Innovations BioActive Bone Substitutes LLC Biocomposites Limited Biocoral Inc BioCure Inc BioD LLC BioE Inc BioGrafts Inc Bioimplant Scandinavia AB Biomatlante bioMD Limited Biomecanica Ortopedicos Ltda Bio-Medical Devices Intl BioMedical Enterprises Inc

URL www.asia-orthopedics.com www.aspine.com.tw www.aspine.com www.atlasspine.com www.austofix.com.au www.asdm.com.au n/a www.axialbiotech.com www.axiomed.com n/a www.azellon-ltd.com www.b1medical.com www.bacterin.com www.acrtucson.com www.baumer.com.br www.baxano.com www.baxter.com www.benvenuemedical.com www.hydroxyapatite.com www.beznoska.cz www.bidoia.com www.biedermann.com www.bindermed.com n/a www.bri-fr.com www.bbs-artebone.fi www.bio.composites.com www.biocoral.com www.biocure.com www.biodlogics.com www.bioe.com www.biografts.com www.biospring.net www.biomatlante.com www.biomd.com.au www.biomecanica.com.br www.bmdi.com www.bme-tx.com

© ORTHOWORLD Inc., 2010. All rights reserved.

DOC-4 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity Biomerix Corporation Biomet Biologics Biomet Spine Biomet Sports Medicine Biomet Inc Biomimedica Inc BioMimetic Therapeutics Inc Bioniche Pharma USA LLC Bioniche Pharma/Bioniche Life Sciences Inc Biopharm GmbH Bioplate Inc BioPoly RS (subsidiary of Schwartz Biomedical) BioPRO Inc Bioretec Ltd BioSET Inc BioSpine Co Ltd BioStructures LLC BioSurface Engineering Technologies Inc (BioSET) BioSyntech Inc Biotech GmbH BioTech One Inc Biotechni Biotek BioTissue Technologies AB BK Meditech Co Blazejewski Medi-Tech Blue Belt Technologies Bone Bank Allografts Bone Biologics Inc Bone Solutions Inc BoneGrafix Inc BoneSupport AB Bonovo Orthopedics Inc Bonutti Research Inc BonWrx BrainLAB AG Bricon AG Calcitec Inc

URL www.biomerix.com www.biomet.com www.biomet.com www.biomet.com www.biomet.com www.biomimedica.com www.biomimetics.com www.bionichepharmausa.com www.bioniche.com www.biopharm.de www.bioplate.com www.schwartzbiomedical.com www.bioproimplants.com www.bioretec.com www.biosetinc.com www.biospineco.en.ec21.com www.biostructures.net www.biosetinc.com www.biosyntech.com www.biotech-medical.com www.biotech-one.com www.biotechni.com www.biotekortho.com www.biotissue-tec.com www.bkmeditech.com www.blazejewskide www.bluebelttech.com www.bonebank.com www.bonebiologics.com www.bonesolutionsinc.com www.bonegrafix.com www.bonesupport.com www.bonovo-ortho.com www.bonuttiresearch.com www.bonwrx.com www.brainlab.com www.bricon.ch n/a

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-5 dirEctory of coMpaniES

(Continued)

Company/Entity Calvary Spine LLC Cam Bioceramics bv Cambridge Polymer Group Inc Cannuflow Inc Captiva Spine Inc Carbylan Biosurgery Inc Cardo Medical CareFusion Corporation Carmell Therapeutics Corporation Carticept Medical Inc Cartilix Inc Cayenne Medical Inc CellCoTec BV CellGenix Technologie Transfer GmbH Celling Technologies CellTec GmbH Centinel Spine Inc Century Medical Inc Ceramconcept LLC Ceramisys Ltd CeraPedics Inc Ceraver Osteal CG Surgical Ltd CH Medical Ltd ChM Ltd ChoiceSpine LP Circle Biologics LLC Citagenix Inc Citieffe SrL Clariance SAS Clearant Inc co.don AG Coapt Systems Inc Cohera Medical Inc coLigne AG Collagen Matrix Inc CollEngin Inc Comis Orthopaedics Ltd

URL www.calvaryspine.com www.cambioceramics.com www.campoly.com www.cannuflow.com www.captivaspine.com www.carbylan.com www.cardomedical.com www.carefusion.com www.carmellrx.com www.carticept.com www.cartilix.com www.cayennemedical.com www.cellcotec.com www.cellgenix.com www.cellingtechnologies.com www.celltec.de www.centinelspine.com www.cmi.co.jp www.ceramconcept.com www.ceramisys.com www.cerapedics.com www.ceraver.fr n/a n/a www.chm.pl www.choicespine.net www.circlebiologics.com www.citagenix.com www.citieffe.com www.clariance-spine.com www.clearant.com www.codon.de www.coaptsystems.com www.coheramed.com www.coligne.com www.collagenmatrix.com www.collengin.com www.comisorthopaedics.com

© ORTHOWORLD Inc., 2010. All rights reserved.

DOC-6 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity Community Tissue Services Competitive Technologies Inc ConforMIS Inc ConMed Linvatec Consensus Orthopedics Inc Cook Surgical Core Essence Orthopaedics Inc CoreLink LLC Corentec Co Ltd CoreSpine Technologies LLC Corin Group PLC Cousin Biotech Covalent Materials Corporation Covalon Technologies Ltd Covidien AG Covision Medical Technologies Limited Creaspine SAS Creative Medical Designs Inc CrossCart Inc Crosstrees Medical Inc CryoLife Inc curasan AG Curative Biosciences Inc Custom Spine Inc CyberOrthology Inc Cytex Therapeutics Inc Cytomedix Inc Cytori Therapeutics Inc Del Palma Orthopedics LLC DePuy Mitek Inc DePuy Spine Inc DePuy Inc Dfine Inc DGIMed Ortho Inc Dimicron Inc Direx Medical Systems Disc Motion Technologies Diverquin SA

URL www.communitytissue.org www.competitivetech.net www.conformis.com www.conmed.com www.consensusortho.com www.cookmedical.com www.ceortho.com n/a www.corentec.com www.corespinetech.com www.corin.co.uk www.cousin-biotech.com www.covalent.co.jp www.covalon.com www.covidien.com www.covision-medical.co.uk www.creaspine.com www.rayhack.com www.crosscart.com www.xtreesmed.com www.cryolife.com www.curasan.com www.curativebiosciences.com www.customspine.com n/a www.cytextherapeutics.com www.cytomedix.com www.cytoritx.com www.delpalmaortho.com www.depuymitek.com www.depuyacromed.com www.depuy.com www.dfineinc.com www.dgimedortho.com www.diamicron-corp.com www.direx.co.il www.discmotion.com www.diverquin.com

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-7 dirEctory of coMpaniES

(Continued)

Company/Entity DJO Incorporated Doctors Research Group Dornier Medical Systems Inc DSS Syntec Scientific Corp DyfucaMed LLC Dynamic Spine LLC Eden Spine LLC Educell doo Efratgo ltd EgiFix Medical Elite Surgical Supplies Pty Ltd Ellipse Technologies Inc Ellis Development Eminent Spine Endotec Inc Erothitan Titanium Implants SA ESM Technologies LLC ETEX Corporation Euros Company EuroSpine Exactech Inc Expanding Orthopedics Inc Expandis Ltd ExtraOrtho Extremity Innovations Incorporated Extremity Medical LLC Facet Solutions Inc FH Orthopedics Fin Ceramica Faenza SpA Finsbury Orthopaedics Ltd Flex Biomedical Inc Flexuspine Formae Inc Fusion Medical Corp FxDevices LLC FzioMed Inc G Surgical Co Ltd Gamma Spine Ltd

URL www.djoglobal.com www.doctorsresearchgroup.com www.dornier.com www.diversesurgical.com www.dyfucamed.com www.dynamicspine.net www.edenspine.com www.educell.si www.efratgo.com www.egifix.com www.elitesurgical.com n/a n/a www.eminentspine.com www.endotec.com www.erothitan.com www.esmtech.com www.etexcorp.com www.euros.fr www.eurospine.com www.exac.com www.xortho.com n/a www.qfxtechnologies.com www.extremityinnovations.com www.extremitymedical.com www.facetsolutions.com www.fhorthopedics.fr www.finceramica.it www.finsbury.org www.flexbio.com www.flexuspine.com n/a n/a www.fxdevices.com www.fzio.com www.gsurgical.com n/a

© ORTHOWORLD Inc., 2010. All rights reserved.

DOC-8 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity Geistlich Biomaterials Genesys Orthopedics Systems LLC GenOsteo Inc Gentis Inc Genzyme Biosurgery Gerraspine AG Gexfix S A Giltech Limited Global Orthopaedic Technology Globus Medical Inc GMReis Gold Standard Orthopaedics LLC Gore Medical Products GPC Medical Ltd Graftys Gramedica LLC Groupe Lepine Gruppo Bioimpianti srl GS Medical Co Ltd Hand Biomechanics Lab Inc Hans Biomed Corp Harvest Technologies Corp Highgate Orthopedics Histogen Inc Histogenics Corporation Hit Medica Srl (a Lima company) Hoogland Spine Products GmbH Hospital Innovations Ltd Hyalose LLC Hyaltech Ltd Icotec IGEA IlluminOss Medical Inc Implanet Implant Technology Systems - ITS Implantcast GmbH Implantes Fico SRL Implants Industrie

URL www.geistlich.com n/a www.genosteo.com www.gentisinc.com www.genzymebiosurgery.com www.gerraspine.com www.gexfix.ch www.giltech.biz www.globalortho.com.au www.globusmedical.com www.gmreis.com.br www.gsortho.net www.goremedical.com www.gpc-medical.com www.graftys.com www.gramedica.com www.groupe-lepine.com www.bioimpianti.it www.gsmedi.com www.handbiolab.com n/a www.harvesttech.com n/a www.histogeninc.com www.histogenics.com www.hitmedica.it www.max-more.com www.hospitalinnovations.com www.hyalose.com www.hyaltech.co.uk www.icotec.ch www.igea.it www.illuminoss.com www.implanet.com www.its-implant.com www.implantcast.de www.datamarkets.com.ar www.prothese.com

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-9 dirEctory of coMpaniES

(Continued)

Company/Entity Implants International Ltd Impliant Inc Impol Instrumental e Implantes Ltda Incisive Surgical Inc Incite Innovation LLC Inion Ltd Innovasis Inc Innovation Medical Technologies Inc Innovative Bioceramix Inc Innovative Delta Technology LLC Innvotec Surgical Inc INOR Orthopaedics Inoteb/Biocoral Integra LifeSciences Corporation Integra Spine InteliFUSE Inc Intelligent Implant Systems LLC Intelligent Orthopaedics Ltd Interface Biotech A/S Internal Fixation Systems Inc International Orthopaedics Holding GmbH International Spinal Innovations LLC Interventional Spine Inc Intralink Spine LLC Intrauma Srl Intrinsic Therapeutics Inc Invibio Invuity Inc Ion Surgical Technologies Inc Ionics Medical Corporation ISTO Technologies Inc Japan MDM/Ortho Development Japan Medical Materials Corporation Japan Tissue Engineering Co Ltd Jeil Medical Corp Jemo Spine LLC JetGuide JMEA Corporation

URL www.implantsinternational.com www.impliant.com www.impol.com.br www.insorb.com www.inciteinnovationllc.com www.inion.fi www.innovasis.com www.innovationmedical.com www.ibioceramix.com n/a n/a www.inor.bbtcl.com www.biocoral.com www.integra-ls.com www.integraspine.com www.intelifuse.com www.intelligentimplantsystems.com www.intelligent-orthopaedics.co.uk www.interfacebio.com www.ifsusa.net www.io-holding.com n/a www.i-spineinc.com www.intralinkllc.com www.intrauma.com www.in-or.com www.invibio.com www.invuity.com n/a n/a www.istotech.com www.jmdm.co.jp www.jmmc.jp www.jpte.co.jp www.jeilmed.co.kr www.jemospine.com www.jet-guide.com www.jmea.com

© ORTHOWORLD Inc., 2010. All rights reserved.

DOC-10 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity Johnson & Johnson Johnson & Johnson Development Corporation Joimax GmbH JRI Orthopaedics Juvent Medical Inc K Spine Inc K2M Inc Kanghui Medical Innovation Co Ltd Kapp Surgical Instrument Inc Karl Storz GmbH & Co Karocell Tissue Engineering AB Kasios Biomaterials Kens FineMedTech Sdn Bhd Kensey Nash Corporation Keratec Limited KFx Medical Corporation Kinamed Inc Kiscomedica SA KLS Martin LP Knee Creations LLC Kobayashi Pharmaceutical Co Ltd Koby Surgical Korea Bone Bank Co Ltd Kuros Biosurgery AG Kyocera Corporation Kyungwon Medical Co Ltd Lafitt SA LAGet Musculoskeletal LLC Lanx LLC LDR Medical LDR Spine Life Spine LifeCell Corporation (a KCI Company) LifeLink Foundation Lifenet Health Ligament Augmentation & Reconstruction System Lima Lto Linares Medical Devices LLC

URL www.jnj.com www.jjdevcorp.com www.joimax.com www.jri-ltd.co.uk www.juvent.com n/a www.k2m.com www.kanghui-international.com www.kappsurgical.net www.karlstorz.com www.karocell.com www.kasios.com www.kensfinemedtech.com www.kenseynash.com www.keratec.co.nz www.kfxmed.com www.kinamed.com www.kiscomedica.com www.klsmartin.com n/a www.kobayashi.co.jp n/a www.kbb.com.co.kr www.kuros.ch www.globalkyocera.com www.kyungwonmedical.co.kr www.lafitt-sa.com www.lagetinc.com www.lanx.us www.ldrmedical.com www.ldrspine.com www.lifespine.com www.lifecell.com www.linkbio.com www.lifenet.org www.lars-ligaments.com www.lima.it www.linaresmedicaldevices.com

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-11 dirEctory of coMpaniES

(Continued)

Company/Entity Link Orthopaedics/Link America Inc LITOS GmbH and CO KG Lotus Medical LLC LRS Ortho Ltd Lubris LLC Lucero Medical LLC Magellan Spine Technologies Inc Magen Medical Solutions Ltd MAKO Surgical Corp MAST Biosurgery Inc Mathys Medical Ltd Maxx Orthopedics Inc Mazor Surgical Technologies Ltd MAXXSPINE Ltd MDT Implantes Ortopedicos Medacta International SA Medartis AG Medical Technologies & Services Medicalex-Francemed medicor e.k. MedicalBiomat Medicrea International Medimetal Ltd Medispec Ltd Medizintechnik Sattler GmbH MedShape Solutions Inc Medtronic Navigation Medtronic Inc MedXpert GmbH Medyssey Co Ltd Mekanika Inc Memometal Technologies Merete Medical GmbH Meridian Medical Merlot OrthopediX Inc Merries International Inc Mesoblast Limited Meta Biomed Co Ltd

URL www.linkbio.com www.litos.com www.lotmed.com www.lrsortho.co.il n/a www.luceromedical.com www.magellanspine.com www.magenmed.com www.makosurgical.com www.mastbio.com www.mathysmedical.com www.maxxortho.com www.mazorst.com www.maxxspine.de www.mdt.com.br www.medacta.ch www.medartis.com www.mts-medical.com www.medicalex.info www.medicor-germany.com www.solibone.com www.medicrea.com www.medimetal.com www.medispec.com www.medizintechnik-sattler.de www.medshapesolutions.com www.stealthstation.com www.medtronic.com www.medxpert.de www.medyssey.com www.mekanika.com www.memometal.com www.merete.de n/a www.merlotorthopedix.com www.merries.com.tw www.mesoblast.com www.meta-biomed.com

© ORTHOWORLD Inc., 2010. All rights reserved.

DOC-12 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity Metasurg MI4 Spine LLC Micro-Imaging Solutions LLC Micromed System Inc Mikai SpA MiMedx Group Inc Minimus Spine Inc minSurg Corporation Mitsubishi Materials Corporation MIV Therapeutics Inc Modern Plastics Inc Mondeal Medical Systems GmbH Musculoskeletal Transplant Foundation Mylad Orthopaedic Solutions Inc Nanotherapeutics Inc Nanovis LLC Neoligaments (a division of Xiros) NeoStem Inc Nerites Corporation Neurospine Innovations and Solutions New Splint Ltd Newclip Technics NewMedical Technology Inc Nexgen Spine Inc Nexxt Spine Inc NGK Spark Plug Co Ltd NMB Medical Applications Ltd NonLinear Technologies Ltd Norm Spinal Products Normed Medizin Technik GmbH NovaBone Products LLC NovaLign Orthopaedics Inc NovaPedix NovaSpine Novozymes A/S NP Solutions NuOrtho Surgical Inc Nutek Orthopaedics LLC

URL www.metasurg.com www.mi4spine.com www.micro-imaging.us www.micromedsystem.com www.mikai.it www.mimedx.com www.minimusspine.com www.trufuse.com www.mmc.co.jp www.mivtherapeutics.com www.modernplastics.com www.mondeal.com www.mtf.org www.myladortho.com www.nanotherapeutics.com www.nanovisinc.com www.neoligaments.com www.neostem.com www.nerites.com n/a www.newsplint.co.uk www.newcliptechnics.com www.newmedical.com www.nexgenspine.com www.nexxtspine.com www.ngkntk.co.jp www.nmb-med.com www.nonlinear-tech.com www.normltd.net www.normed-online.com www.novabone.com www.osteolign.com www.novapedix.com www.novaspine.fr www.novozymes.com n/a www.nuorthosurgical.com www.nutekortho.com

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-13 dirEctory of coMpaniES

(Continued)

Company/Entity NuVasive Inc Octane Medical Group Olive Medical Corp Olympus Medical Systems Corp Olympus Terumo Biomaterials Corp Omeros Corporation OMNILife science Inc OptiMed Medizinische Instrumente GmbH Organogenesis Inc Orteq Bioengineering Ltd OrthAlign Inc Ortheon Medical Ortho Development Corporation Ortho Devices Inc Ortho Select GmbH Implant Technology Ortho Solutions LLC Orthocon Inc Orthodynamics Ltd OrthoDynamix LLC Orthofix Inc Orthogem Limited Orthogen AG OrthoHelix Surgical Designs Inc OrthoMed Inc Orthomed SA OrthoMediTec Ltd OrthoMEMS Inc Orthometrix Inc OrthoMimetics Ltd OrthoNetx Inc Orthonics Inc Orthopaedic Innovation Ltd Orthopaedic International Inc Orthopaedic Synergy Ltd OrthoPediatrics Corp Orthopedic Designs Inc Orthopedic Sciences Inc Orthopeutics LP

URL www.nuvasive.com www.octaneco.com www.olivemedical.com www.olympus.co.jp www.biomaterial.co.jp www.omeros.com www.omnils.com www.opti-med.de www.organogenesis.com www.orteq.com www.orth-align.com www.ortheon.com www.orthodevelopment.com www.orthodevices.com www.ortho-select.de www.orthosol.com www.orthocon.com www.orthodynamics.co.uk www.orthodynamix.com www.orthofix.com www.orthogem.com www.orthogen.com www.orthohelix.com www.orthomedinc.com www.orthomed.fr n/a n/a www.orthometrix.net www.orthomimetics.com n/a n/a www.o-i.co.uk www.oii.com www.orthopaedicsynergy.com www.orthopediatrics.com www.orthopedicdesigns.com www.orthopedicsciences.com www.orthopeutics.com

© ORTHOWORLD Inc., 2010. All rights reserved.

DOC-14 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity OrthoPro LLC Orthos (UK) Limited Orthosonics Ltd Orthosurgical Implants Inc OrthoTec LLC Orthovita Inc Orthox Ltd Ortosintese Ltda Osiris Therapeutics Inc Osprey Biomedical Corp Ossacur AG Osseon Therapeutics Inc OST Developpement OsteoGenix Inc OsteoMed Corporation Osteon nv Osteopore International Osteotech Inc OTIS Biotech Co Ltd OtisMed Corporation Ouroboros Inc Oxford Performance Materials Inc Paradigm BioDevices Inc Paradigm Spine LLC Parametrics Medical LLC Parcus Medical LLC PEAK Surgical Inc Pega Medical Inc Pentax Corporation Performance Grafts LLC Permedica spa Peter Brehm GmbH Phygen LLC PINA Medizintechnik Vertriebs AG Pioneer Surgical Technology Inc Pisharodi Surgicals Inc Polaris Rx Corporation Poly 5 Group LLC

URL www.orthoprollc.com www.orthos.com www.orthosonics.com www.orthosurgical.com www.orthotec.net www.orthovita.com www.orthox.co.uk www.ortosintese.com.br www.osiristx.com www.ospreybiomedical.com www.ossacur.de www.osseon.com www.osteotech.com www.osteogenix.com www.osteomedcorp.com www.osteon.be www.osteopore.com.sg www.osteotech.com www.otisbiotech.com www.otismed.com www.ouroborosinc.com www.oxfordpm.com www.paradigmbiodevices.com www.paradigmspine.com www.parametricsmedical.com www.parcusmedical.com www.peaksurgical.com www.pegamedical.com www.pentax.co.jp www.performancegrafts.com www.permedica.com www.peter-brehm.de www.phygenspine.com www.pina-med.de www.pioneersurgical.com www.pisharodisurgicals.com www.polarisrx.co.jp www.poly5group.com

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-15 dirEctory of coMpaniES

(Continued)

Company/Entity Polyganics BV PolyNovo Biomaterials Pty Ltd Praxim Medivision Precision Surgery Ltd Prima Implantes S A Privelop AG ProChon Biotech Ltd Produits Dentaires SA Progenteq Ltd Progentix Orthobiology BV PROMED Advance Technology Co Ltd Protetim Medical Technical Company pSivida Limited Q-Med AB Quantum Medical Concepts R Tree Innovations LLC Ranier Technology Limited RE Spine LLC Reduction Technologies Inc ReGen Biologics Inc Regenerative Medical System Regenerative Sciences Inc RegenTec Ltd Regentis Biomaterials Ltd Renova Orthopedics LLC Renovis Surgical Technologies Replication Medical Inc RepRegen Ltd Restorative Physiology Group LLC Revivicor Inc Rhausler Spinal Implants Richard Wolf GmbH Rigid fx Orthopedics Corporation ROBODOC/Curexo Technology Corporation Roth Medical Components Pty Ltd Rottapharm SpA Royer Biomedical Inc RS Medical

URL www.polyganics.com www.polynovo.com www.praxim.fr n/a www.prima-implantes.com.ar www.privelop.ag www.prochon.com www.pdsa.ch n/a www.progentix.com n/a www.protetim.hu www.psivida.com www.q-med.com www.quantummedicalconcepts.com n/a www.ranier.co.uk n/a www.reductiontechnologies.com www.regenbio.com www.rmsbio.net www.regenexx.com www.regentec.net www.regentis.co.il www.renovaorthopedics.com www.synergy-surgical.com www.replicationmedical.com www.repregen.com www.restorativephysiology.com www.revivicor.com www.rhausler.com www.richard-wolf.com www.rigidfx.com www.robodoc.com www.rothmed.co.za www.rotta.com www.royerbiomedical.com www.rsmedical.com

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DOC-16 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity RSB Spine LLC RTI Biologics Inc Rush Pin LLC S14 Implants SaluMedica LLC Samo Biomedica Sanacor LLC Sanatmetal Ltd SanuWave Inc Sapphire Medical Inc Scandius Biomedical Inc (acquired by Covidien) Schwartz Biomedical LLC Science for Bio Materials Scient'x Scil Technology GmbH Scorpion Surgical Technologies Ltd Scyon Orthopaedics SeaSpine Inc Seikagaku Corporation Seremm International SERF Dedienne Sante Serica Technologies Inc Sewon Cellontech Co Ltd Sgarlato Laboratories Inc SH Pitkar Orthotools Pvt Ltd Sharma Surgical & Eng Pvt Ltd Shoulder Options Inc Showa Ika Kohgyo Co Ltd SI Bone Inc SIC Brevetti SRL Siemens Medical Solutions Inc Signal Medical Corp Signus Medical LLC Signus Medizintechnik GmbH Simpex Medical Inc Simplicity Orthopedic Solutions LLC Sintea Biotech Srl Sintea Plustek Srl

URL www.rsbspine.com www.rtix.com www.rushpin.com www.s14implants.com www.salumedica.com www.samobiomedica.com www.sanacor.com www.sanatmetal.hu www.sanuwave.com n/a www.scandius.com www.schwartzbiomedical.com www.s-b-m.fr www.scient-x.com www.sciltechnology.com www.scorpionsurgical.com www.scyon.ch www.seaspine.com www.seikagaku.co.jp n/a www.serf-dediennesante.com www.sericainc.com www.cellontech.com www.sgarlatolabs.com www.pitkar.com www.ssepl.com www.shoulderoptions.com www.showaika.co.jp www.si-bone.com n/a www.siemensmedical.com www.signalmd.com www.signusmedical.com www.signus-med.de www.simpexmedical.com www.simplicityortho.com www.sinteabiotech.com www.sinteaplustek.com

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-17 dirEctory of coMpaniES

(Continued)

Company/Entity Skeletal Dynamics LLC Skeletal Kinetics LLC Skeltex Inc Small Bone Innovations LLC Smart Disc Inc SmArt Spine SARL Smit Medimed Pvt Ltd Smith & Nephew Endoscopy Smith & Nephew Inc Soft Tissue Regeneration Inc Solana Surgical LLC Solco Biomedical Co Ltd Sonoma Orthopedic Products Inc Sonorex Inc SOTA Orthopaedics Ltd Soteira Inc Southern Spine LLC Sovereign Medical Ltd Spartek Medical Inc Specialty Spine Products LLC Spinal Devices LLC Spinal Edge LLC Spinal Elements Inc Spinal Instrumentation Simplification Systems LLC Spinal Kinetics Inc SpineNetwork Spinal Restoration Inc Spinal Simplicity Spinal USA SpinalCyte LLC SpinalMotion Inc Spine 360 Spine Now LLC Spine Wave Inc Spine21 Ltd SpineAlign Medical Inc Spineart SpineCraft LLC

URL www.skeletaldynamics.com www.skeletalki.netics.com www.biomec.gme.usherb.ca/skeltex www.totalsmallbone.com www.smartdsc.com www.smartspine.fr www.smitmedimed.com www.smith-nephew.com www.smith-nephew.com www.softtissueregeneration.com n/a www.solco.co.kr www.sonomaorthopedics.com www.sonorex.com www.sotaorthopaedics.com n/a n/a www.sovereignmedical.co.uk www.spartekmedical.com n/a n/a n/a www.spinalelements.com n/a www.spinalkinetics.com www.spinenetwork.info www.spinalrestoration.com www.spinalsimplicity.com www.spinalusa.com n/a www.spinal-motion.com www.spine360.com www.spinenow.com www.spinewave.com www.spine21.com www.spinealignmedical.com www.spineart.ch www.spinecraft.com

© ORTHOWORLD Inc., 2010. All rights reserved.

DOC-18 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity SpineForm LLC SpineFrontier Inc SpineGuard Inc SpineLab AG Spineology Group The SpineSmith Partners LP SpineView Inc SpineVision Inc Spineway SpineWorks LLC Stanmore Implants Worldwide Ltd StelKast Inc Stellartech Research Corporation Stemcup Medical Products AG Storz Medical AG Stout Medical Group Stryker Biotech Stryker Corporation Stryker Endoscopy Stryker Interventional Spine Stryker Spine Stuckenbrock Medizintechnik GmbH Summit Medical Limited Surgical Implant Generation Network (SIGN) Surgicraft Ltd Surgival Surgix Ltd Sushrut Surgical Pvt Ltd Symbios Orthopedic SA Sync Medical Renovis Surgical Technologies Synimed Synergie Ingénierie Médicale SARL Synovis Orthopedic and Woundcare Inc Synthasome Inc SyntheMed Inc Synthes Spine Synthes Inc Taeyeon Medical Co Ltd

URL www.spineform.com www.spinefrontier.com www.spineguard.com www.spinelab.com www.spineology.com www.spinesmithusa.com www.spineview.com www.spinevision.com www.spineway.com www.spineworksusa.com www.stanmoreimplants.com www.stelkast.com www.stellartechresearch.com www.stemcup.de www.storzmedical.ch www.stoutmedicalgroup.com www.op1.com www.stryker.com www.stryker.com www.strykerivs.com www.stryker.com www.stuckenbrock.de www.summit-medical.co.uk www.sign-post.org www.surgicraft.co.uk www.surgival.com www.surgix-med.com www.sushrut.com www.symbios.ch www.syncmedical.com www.synergy-surgical.com www.synimed.com www.synovisorthowound.com www.synthasome.com www.synthemed.com www.synthes.com www.synthes.com www.tymedical.com

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-19 dirEctory of coMpaniES

(Continued)

Company/Entity TAG Medical Products Taisho Pharmaceutical Co Ltd Takiron Co Ltd Tantum AG TBF Tissue Engineering Technologie Transysteme Tecres SPA TEI Biosciences Inc Tekka SA TekMed LLC Teknimed SA Telos Medical Corp Tepha Inc TETEC Tissue Engineering Technologies AG TGS Knee Innovations LLC TheraCell Inc ThermoGenesis Corporation Tianjin Tiashan Medical TiGenix NV Tigran Technologies AB Tissue Banks International Tissue Genesis Incorporated Tissue Regeneration Systems Inc Tissue Regeneration Therapeutics Inc Tissue Regenix Limited Tissue Science Laboratories Plc TissueGene Inc Tissuenet TiTaMED Titan Spine Toby Orthopaedics LLC Tornier Inc Total Joint Orthopedics Inc Tradimedics Traiber SL TranS1 Inc TransTissue Technologies GmbH Transysteme S A

URL www.tag-med.com www.taisho.co.jp www.takiron.co.jp www.tantum-ag.de www.tbf-lab.com www.transysteme.fr www.tecres.it www.teibio.com www.tekka.fr n/a www.teknimed.com www.telosmedical.com www.tepha.com www.tetec-ag.de www.tgskneeinnovations.com www.theracellinc.com www.thermogenesis.com www.tfly.com.cn www.tigenix.com www.tigran.se www.tbionlineorg www.tissuegenesis.com n/a www.verypowerfulbiology.com www.tissueregenix.com www.tissuescience.com www.tissuegene.com www.tissuenet.com www.titamed.co.za www.titanspine.com www.tobyortho.com www.tornier.com www.tjoinc.com www.tradimedics.com www.traiber.es www.trans1inc.com www.transtissue.com www.transysteme.fr

© ORTHOWORLD Inc., 2010. All rights reserved.

DOC-20 Companies/Entities dirEctory of coMpaniES

(Continued)

Company/Entity Trauson Medical Co Ltd TRB Chemedica Ltd Treu Instrumente GmbH Trilliant Surgical Ltd TriMed Inc Trinity Orthopedics LLC TrueVision Systems Inc TTK Healthcare U&I Corporation Ulrich Medical Ulrich Medical USA Uma Surgicals Unilab Surgibone/CanMedica Union Surgical LLC United Endoscopy United Orthopedic Corporation UPex LLC US Spine Inc USBiomaterials Corp Van Straten Medical Velcura Therapeutics Inc Vertebral Technologies Inc Vertebration Inc Verticor VertiFlex Inc Vertos Medical Inc Vexim SAS VG Innovations LLC Vidacare Corp Vilex Inc Vivoxid Ltd VOT Solutions VQ OrthoCare Waldemar Link GmbH and Co KG Waston Medical Appliance Co Ltd Weigao Orthopedic Device Co Ltd Wenzel Spine Inc Whiteside Biomechanics

URL www.trauson.com www.trbchemedica.co.uk www.treu.com www.trilliantsurgical.com www.trimedortho.com www.trinity-ortho.com www.truevisionsys.com www.ttkhealthcare.com www.youic.com www.ulrichmedical.com www.ulrichmedicalusa.com www.umasurgicals.com www.canmedica.com www.unionsurgical.com www.endoscope.com www.uoc.com.tw www.upexco.com www.us-spine.com www.usbiomat.com www.vanstraten.net www.velcura.com www.vertebraltechnologies.com www.vertebration.com www.verticorspine.com www.vertiflex.net www.vertosmed.com www.vexim.fr www.verteloc.com www.vidacare.com www.vilex.com www.vivoxid.com www.votechnology.com www.vqorthocare.com www.linkhh.de www.wastonmed.com www.weigaogroup.com www.wenzelspine.com www.whitesidebio.com

© ORTHOWORLD Inc., 2010. All rights reserved.

Companies/Entities DOC-21 dirEctory of coMpaniES

(Continued)

Company/Entity Woll BioOrthopedics LLC Wright Medical Technology Inc Xiros plc X-Spine Systems Inc Xylos Corporation Ziehm Imaging GmbH Zimmer Inc

URL www.wollbio.com www.wmt.com www.xiroseu.com www.x-spine.com www.xyloscorp.com www.ziehm-imaging.de www.zimmer.com

© ORTHOWORLD Inc., 2010. All rights reserved.

index

OF

cOmpanies

Index of Companies I-1

Symbols

3Cor Medical D-1, DOC-1 3D-Matrix C-1, E-1, DOC-1 3D Medical Concepts 30, B-1, DOC-1 4th Column D-1, DOC-1

A

aap 6, 77, 78, 93, 113, A-1, B-1, D-1, E-1, DOC-1 Aastrom 98, E-1, DOC-1 Accelalox 101, B-1, DOC-1 ACell 107, E-1, DOC-1 Acme Spine D-1, DOC-1 Acologix 99, E-1, DOC-1 Acrobot Company DOC-1 Active Implants 17, 18, 43, A-1, DOC-1 Acumed 6, 28, 30, 93, A-1, B-1, E-1, DOC-1 Acute Innovations B-1, DOC-1 Adaptive Specialty D-1, DOC-1 Advanced Biologics E-1, DOC-1 Advanced Biomaterial 23, D-1, DOC-1 Advanced BioMedical B-1, DOC-1 Advanced Bio-Surfaces 19, 21, DOC-1 Advanced Ceramics E-1, DOC-1 Advanced Medical 54, D-1, DOC-1 Advanced Orthopaedic B-1, DOC-1 Advanced Prosthetic 60, D-1, DOC-1 Advanced Surgical Design DOC-1 Advanced Vertebral 55, DOC-1 Aequos A-1, DOC-1 Aesculap 6, 14, 17, 18, 20, 29, 54, 58, 60, 72, 83, 84, 87, 92, 103, A-1, B-1, C-1, D-1, E-1, DOC-1 Affinergy 99, E-1, DOC-1 AG Digital 93, E-1, DOC-1 ALBU B-1, DOC-1 ALCeraX DOC-1 Alexandria Research DOC-1 Allograft 9, 91, 92, 93, E-1, DOC-1 AlloSource 92, 93, E-1, DOC-1 Alphamed A-1, D-1, DOC-1 Alpha Orthopaedics 42, C-1, DOC-1 Alphatec 5, 6, 54, 55, 57, 58, 69, 72, 75, 78, 92, D-1, E-1, DOC-2 Altimed A-1, DOC-2 Amedica 15, 55, 56, 59, D-1, DOC-2 Amendia 54, D-1, DOC-2

American Medical Specialties B-1, DOC-2 Amplitude 6, 19, 20, 21, 23, 47, 87, A-1, B-1, C-1, E-1, DOC-2 Anatomica 6, D-1, DOC-2 AngleFix 31, B-1, DOC-2 Anika 5, 6, 101, 103, 107, 111, 113, 114, 116, E-1, DOC-2 Anteis 114, DOC-2 Anthem B-1, DOC-2 Anulex 73, D-1, DOC-2 AO Foundation 84, DOC-2 AOI Medical 75, B-1, D-1, DOC-2 ApaTech DOC-2 Apollo D-1, DOC-2 Appiades Meditech B-1, DOC-2 Applied Spine 67, 69, D-1, DOC-2 Aptis 22, A-1, DOC-2 ARCA MEDICA D-1, E-1, DOC-2 ArchiMed D-1, DOC-2 ARC Pharmaceuticals 111, 113, E-1, DOC-2 ARC Surgical B-1, C-1, DOC-2 AREX B-1, C-1, E-1, DOC-2 ARGE Medizintechnik DOC-2 Argomedical A-1, B-1, DOC-2 Arteriocyte 97, DOC-2 Arthrex 6, 31, 41, 43, 45, 47, 109, A-1, B-1, C-1, E-1, DOC-2 ArthroCare 6, 41, 42, 43, 44, 47, 54, 75, 78, C-1, D-1, DOC-2 Arthro Kinetics 66, 103, D-1, E-1, DOC-2 Arthroscopic Innovations C-1, DOC-2 Arthrosurface 19, 21, 22, DOC-2 ArthroVision 59, DOC-2 Articular Engineering 73, 110, E-1, DOC-2 Articulinx A-1, DOC-2 Artimplant 22, 44, 48, A-1, C-1, DOC-2 Asahi Kasei Pharma DOC-2 Ascension Orthopedics B-1, E-1, DOC-2 Asia Orthopaedics 15, 17, 20, 21, A-1, DOC-3 A-Spine 75, 78, D-1, DOC-3 A-Spine Asia DOC-3 A-Spine USA DOC-3 Atlas Spine 55, D-1, DOC-3 Austofix B-1, DOC-3 Australian Surgical Design & Manufacture Pty DOC-3 Autogenesis B-1, DOC-3 Axial Biotech 73, DOC-3

© ORTHOWORLD Inc., 2010. All rights reserved.

I-2 Index of Companies AxioMed Spine DOC-3 Axis Surgical Technologies 5, 42, DOC-3 Azellon 103, DOC-3 Bio Recherches Innovations 44, 49, DOC-3 Bioretec B-2, DOC-4 BioSET 100, E-2, DOC-4 BioSpine 68, 69, D-2, DOC-4 BioStructures E-2, DOC-4 BioSurface Engineering Technologies DOC-4 BioSyntech 103, DOC-4 Biotechni 6, 21, A-1, D-2, DOC-4 BioTech One B-2, E-2, DOC-4 Biotek A-1, B-2, D-2, DOC-4 BioTissue Technologies 98, 103, E-2, DOC-4 BK Meditech B-2, D-2, DOC-4 Blazejewski Medi-Tech 54, DOC-4 Blue Belt Technologies 84, 87, DOC-4 Bone Bank Allografts E-2, DOC-4 Bone Biologics 100, E-2, DOC-4 BoneGrafix E-2, DOC-4 Bone Solutions 94, E-2, DOC-4 BoneSupport 78, 94, D-2, E-2, DOC-4 Bonovo Orthopedics A-1, DOC-4 Bonutti Research DOC-4 BonWrx D-2, DOC-4 BrainLAB 84, 87, DOC-4 Bricon 58, 60, D-2, DOC-4

B

B1 Medical 43, B-1, DOC-3 Bacterin 92, E-1, DOC-3 BAE Systems E-1, DOC-3 Baumer 6, 15, 21, 23, A-1, B-1, D-1, E-1, DOC-3 Baxano 72, DOC-3 Baxter 5, 94, 100, E-1, DOC-2, DOC-3 Benvenue Medical 75, 78, D-1, DOC-3 Berkeley Advanced Biomaterials DOC-3 Beznoska A-1, B-1, DOC-3 Bidoia 23, B-1, DOC-3 Biedermann Motech DOC-3 Binder Biomedical 5, 54, 55, D-1, E-1, DOC-3 BioActive Bone Substitutes DOC-3 BioAfix E-1, DOC-3 Biocomposites 6, 44, 46, 94, C-1, E-1, DOC-3 Biocoral 94, E-2, DOC-3, DOC-9 BioCure 75, D-1, DOC-3 BioD DOC-3 BioE E-2, DOC-3 BioGrafts E-2, DOC-3 Bioimplant Scandinavia A-1, DOC-3 Biomatlante 94, E-2, DOC-3 bioMD 109, C-1, E-2, DOC-3 Biomecanica 6, A-1, B-1, D-2, DOC-3 Bio-Medical Devices B-1, D-2, DOC-3 BioMedical Enterprises 44, 47, B-1, C-1, D-2, DOC-4 Biomerix 73, D-2, E-2, DOC-4 Biomet 4, 5, 6, 14, 16, 17, 18, 19, 20, 21, 23, 28, 29, 31, 32, 41, 44, 47, 48, 54, 55, 57, 59, 66, 68, 69, 78, 83, 84, 85, 92, 94, 97, 103, 107, 115, A-1, B-1, C-1, E-2, DOC-4 Biomet Biologics DOC-4 Biomet Spine 55, DOC-4 Biomet Sports Medicine 31, 41, 44, 48, 107, DOC-4 Biomimedica C-1, DOC-4 BioMimetic Therapeutics E-2, DOC-4 Bioniche 114, 116, E-2, DOC-4 Biopharm 100, 102, E-2, DOC-4 Bioplate B-1, DOC-4 BioPoly 20, DOC-4 BioPRO 18, 20, 22, A-1, B-2, DOC-4

C

Calcitec 94, E-2, DOC-5 Calvary Spine D-2, DOC-5 Cam Bioceramics 94, E-2, DOC-5 Cambridge Polymer Group DOC-5 Cannuflow C-1, DOC-5 Captiva Spine 55, D-2, DOC-5 Carbylan Biosurgery DOC-5 Cardo Medical 20, 21, 55, A-1, D-2, E-2, DOC-5 CareFusion 76, 78, D-2, DOC-5 Carmell Therapeutics E-2, DOC-5 Carticept Medical 103, E-2, DOC-5 Cartilix 5, 103, E-2, DOC-5 Cayenne Medical 44, DOC-5 CellGenix Technologie Transfer DOC-5 Celling Technologies 98, DOC-5 CellTec E-2, DOC-5 Centinel Spine D-2, DOC-5 Century Medical DOC-5 Ceramconcept A-1, DOC-5 Ceramisys 94, E-2, DOC-5

© ORTHOWORLD Inc., 2010. All rights reserved.

Index of Companies I-3 CeraPedics 100, E-2, DOC-5 Ceraver Osteal 94, DOC-5 CG Surgical D-2, DOC-5 ChM A-1, B-2, C-1, D-2, DOC-5 CH Medical B-2, DOC-5 ChoiceSpine 55, D-2, DOC-5 Circle Biologics 97, DOC-5 Citagenix E-2, DOC-5 Citieffe 6, 17, 21, A-1, B-2, DOC-5 Clariance 5, 63, 64, 66, D-2, DOC-5 Clearant 92, E-2, DOC-5 Coapt Systems B-2, DOC-5 co.don 98, 104, E-2, DOC-5 Cohera Medical B-2, DOC-5 coLigne 56, D-2, DOC-5 Collagen Matrix 46, 94, 107, E-3, DOC-5 CollEngin E-3, DOC-5 Comis Orthopaedics A-2, DOC-6 Community Tissue Services E-3, DOC-6 Competitive Technologies 102, E-3, DOC-6 ConforMIS 18, 19, 20, 21, A-2, DOC-6 ConMed Linvatec 31, B-2, DOC-6 Consensus Orthopedics 20, 85, A-2, DOC-6 Cook Surgical DOC-6 Core Essence Orthopaedics 44, DOC-6 CoreLink D-2, DOC-6 Corentec Co DOC-6 CoreSpine Technologies 73, DOC-6 Corin Group DOC-6 Cousin Biotech 47, 49, 59, A-2, C-1, D-2, E-3, DOC-6 Covalent Materials DOC-6 Covalon Technologies DOC-6 Covidien 44, 47, 111, 113, C-1, E-3, DOC-6, DOC-16 Covision Medical B-2, DOC-6 Creaspine D-2, DOC-6 Creative Medical Designs B-2, DOC-6 CrossCart E-3, DOC-6 Crosstrees Medical D-2, DOC-6 CryoLife 64, 66, 107, D-2, E-3, DOC-6 curasan 94, 102, 114, 116, E-3, DOC-6 Curative Biosciences 100, 102, DOC-6 Custom Spine 6, 55, 56, 69, D-2, DOC-6 CyberOrthology B-2, DOC-6 Cytex Therapeutics 104, DOC-6 Cytomedix 97, DOC-6 Cytori 97, DOC-6

D

Dedienne Sante 6, 17, 21, 85, B-5, DOC-16 Del Palma 5, 45, DOC-6 DePuy 5, 6, 15, 16, 17, 18, 19, 20, 21, 23, 28, 30, 31, 41, 42, 45, 47, 54, 55, 56, 57, 58, 59, 61, 66, 68, 69, 73, 76, 78, 84, 85, 92, 94, 97, 100, 102, 104, 108, 112, 114, A-2, B-2, C-1, D-2, E-3, DOC-6 Dfine DOC-6 DGIMed 5, 29, B-2, DOC-6 Dimicron 16, DOC-6 Direx 33, DOC-6 Disc Motion Technologies 62, 67, 69, DOC-6 Diverquin B-2, DOC-7 DJO 6, 17, 20, 21, 32, 33, 85, A-2, B-2, D-3, DOC-7 Doctors Research Group 94, E-3, DOC-7 Dornier 33, DOC-7 DSS Syntec Scientific DOC-7 DyfucaMed E-3, DOC-7 Dynamic Spine 65, 66, 67, D-3, DOC-7

E

Eden Spine 61, 67, 68, 69, D-3, DOC-7 Educell doo DOC-7 Efratgo B-2, DOC-7 EgiFix Medical D-3, DOC-7 Elite Surgical 21, A-2, B-2, D-3, DOC-7 Ellipse 74, D-3, DOC-7 Ellis Development 49, C-1, DOC-7 Eminent D-3, DOC-7 Endotec 21, A-2, DOC-7 Erothitan 6, A-2, B-2, DOC-7 ESM Technologies D-3, DOC-7 ETEX 6, 91, 92, 94, DOC-7 Euros Company DOC-7 EuroSpine D-3, DOC-7 Exactech 6, 16, 17, 20, 21, 85, 92, 94, 97, 104, A-2, D-3, E-3, DOC-7 Expanding Orthopedics 31, B-2, D-3, DOC-7 Expandis D-3, DOC-7 ExtraOrtho 30, B-2, DOC-7 Extremity Innovations B-2, DOC-7 Extremity Medical 22, 30, B-2, DOC-7

F

Facet Solutions 63, 64, D-3, DOC-7 FH Orthopedics 20, 47, A-2, B-2, C-1, D-3, E-3, DOC-7

© ORTHOWORLD Inc., 2010. All rights reserved.

I-4 Index of Companies Fin Ceramica Faenza DOC-7 Finsbury 5, 15, 17, 22, 83, 85, DOC-7 Flex Biomedical 114, E-3, DOC-7 Flexuspine 62, 63, D-3, DOC-7 Formae C-1, DOC-7 Fusion Medical 30, A-2, B-2, DOC-7 FxDevices 31, B-2, DOC-7 FzioMed 110, 112, 113, E-3, DOC-7

I

Icotec 55, B-3, DOC-8 IGEA B-3, DOC-8 IlluminOss B-3, DOC-8 Implanet 17, A-2, C-2, DOC-8 Implantcast 6, 17, 18, 19, 20, 21, 22, 85, A-2, B-3, D-3, DOC-8 Implantes 6, 7, 15, 46, A-2, A-3, B-3, B-4, B-5, C-2, C-3, D-4, D-6, DOC-8, DOC-9, DOC-11, DOC-15 Implants Industrie A-2, B-3, DOC-9 Implants International 17, 18, A-2, B-3, D-3, DOC-9 Implant Technology B-3, DOC-8, DOC-13 Impliant 56, 62, 63, D-3, DOC-9 Impol Instrumental 6, DOC-9 Inion 31, 45, 56, 100, B-3, C-2, DOC-9 Innovasis D-4, E-4, DOC-9 Innovation Medical D-4, DOC-9 Innovative Bioceramix DOC-9 Innovative Delta D-4, DOC-9 Innvotec 54, D-4, DOC-9 Innvotec Surgical 54, D-4, DOC-9 INOR A-2, B-3, D-4, DOC-9 Inoteb E-4, DOC-9 Integra 6, 21, 29, 30, 32, 48, 54, 55, 56, 61, 70, 72, 78, 84, 87, 92, 95, 108, 112, 113, A-2, B-3, C-2, D-4, E-4, DOC-9 Integra LifeSciences 92, 95, 108, 112, 113, A-2, B-3, C-2, E-4, DOC-9 Integra Spine 55, 56, 61, 72, 78, D-4, DOC-9 InteliFUSE 32, 47, B-3, C-2, DOC-9 Intelligent Implant Systems 76, D-4, DOC-9 Intelligent Orthopaedics 15, 30, B-3, DOC-9 Interface Biotech 104, 105, E-4, DOC-9 Internal Fixation Systems 31, B-3, DOC-9 International Orthopaedics Holding DOC-9 International Spinal Innovations 55, DOC-9 Interventional Spine 7, 56, 65, 67, 70, 77, D-4, DOC-9, DOC-18 Intralink 74, E-4, DOC-9 Intrauma 29, 30, B-3, DOC-9 Intrinsic 74, D-4, DOC-9 Invibio 18, 31, 45, DOC-9 Invuity C-2, DOC-9 Ionics D-4, DOC-9 Ion Surgical 5, 45, E-4, DOC-9 ISTO 7, 95, 105, 109, E-4, DOC-9

G

Gamma Spine 55, DOC-8 Geistlich 95, 104, E-3, DOC-8 Genesys D-3, DOC-8 GenOsteo E-3, DOC-8 Gentis 65, 66, D-3, E-3, DOC-8 Genzyme 6, 104, 105, 115, 117, E-3, DOC-8 Gerraspine 63, 64, D-3, DOC-8 Gexfix 30, B-2, DOC-8 Giltech 43, DOC-8 Global Orthopaedic Technology 17, A-2, D-3, E-3, DOC-8 Globus 6, 54, 55, 59, 61, 67, 68, 70, 72, 92, 95, 97, D-3, E-3, DOC-8 GMReis 6, 47, 68, 69, 95, 97, B-3, C-1, D-3, E-3, DOC-8 Gold Standard Orthopaedics B-3, D-3, DOC-8 Gore Medical Products DOC-8 GPC Medical A-2, B-3, DOC-8 Graftys 95, 104, E-3, DOC-8 Gramedica A-2, DOC-8 Groupe Lepine 6, 21, 85, A-2, B-3, E-3, DOC-8 Gruppo Bioimpianti 6, 23, A-2, B-3, C-2, DOC-8 GS Medical D-3, DOC-8 G Surgical D-3, DOC-7

H

Hand Biomechanics B-3, DOC-8 Hans Biomed E-3, DOC-8 Harvest Technologies 97, DOC-8 Highgate D-3, DOC-8 Histogen 110, DOC-8 Histogenics 104, E-3, DOC-8 Hit Medica A-2, B-3, E-3, DOC-8 Hoogland 72, DOC-8 Hospital Innovations E-4, DOC-8 Hyalose 115, E-4, DOC-8 Hyaltech 115, 117, E-4, DOC-8

© ORTHOWORLD Inc., 2010. All rights reserved.

Index of Companies I-5

J

Japan MDM 7, 15, A-2, B-3, D-4, E-4, DOC-9 Japan Medical 7, 15, 21, A-2, B-3, D-4, E-4, DOC-9 Japan Tissue E-4, DOC-9 Jeil Medical B-3, DOC-9 Jemo 70, D-4, DOC-9 JetGuide C-2, DOC-9 JMEA B-3, D-4, DOC-10 Johnson & Johnson 4, 14, 73, 85, DOC-10 Joimax 72, C-2, DOC-10 JRI 7, 15, 17, 83, A-2, DOC-10 Juvent B-3, DOC-10

Life Spine 7, 55, 69, 70, 72, D-4, DOC-10 Ligament Augmentation & Reconstruction System DOC-10 Lima 7, 15, 17, 18, 21, 23, 32, A-2, A-3, B-4, DOC-8, DOC-10 Linares D-4, DOC-11 Link Orthopaedics DOC-11 LITOS B-4, DOC-11 Lotus B-4, DOC-11 LRS 84, 87, DOC-11 Lubris E-4, DOC-11 Lucero D-4, DOC-11

K

K2M 7, 54, 55, 56, 68, 70, 72, D-4, DOC-10 Kanghui B-3, DOC-10 Kapp A-3, B-3, D-4, DOC-10 Karl Storz 7, 41, C-2, DOC-10 Karocell 105, E-4, DOC-10 Kasios 95, E-4, DOC-10 Kensey Nash 7, 45, 48, 95, 102, 105, 108, 109, 112, 113, C-2, E-4, DOC-10 Kens FineMedTech 31, B-3, DOC-10 Keratec 93, DOC-10 KFx 45, 47, C-2, DOC-10 Kinamed 18, 21, 87, A-3, B-3, DOC-10 Kiscomedica B-3, D-4, DOC-10 KLS Martin A-3, DOC-10 Knee Creations A-3, DOC-10 Kobayashi 95, E-4, DOC-10 Koby B-4, DOC-10 Korea Bone Bank D-4, DOC-10 K Spine 56, DOC-10 Kuros 76, 93, 100, 102, 109, E-4, DOC-10 Kyocera 7, 18, DOC-10 Kyungwon D-4, E-4, DOC-10

M

Magellan 74, 97, D-4, DOC-11 Magen 48, 74, DOC-11 MAKO 7, 19, 20, 21, 84, 87, A-3, DOC-11 MAST 48, C-2, E-4, DOC-11 Mathys 7, 15, 16, 17, 21, 22, 85, A-3, E-4, DOC-11 Maxx Orthopedics A-3, DOC-11 MAXXSPINE D-4, DOC-11 Mazor 85, 87, DOC-11 MDT 7, 45, 47, A-3, B-4, C-2, D-4, DOC-11 Medacta 7, 18, 19, 21, 85, A-3, E-4, DOC-11 Medartis 7, 29, 30, B-4, E-4, DOC-11 MedicalBiomat E-4, DOC-11 Medicalex-Francemed A-3, B-4, D-4, DOC-11 Medical Technologies & Services 33, DOC-11 medicor DOC-11 Medicrea 7, 55, 56, 69, 95, D-4, E-4, DOC-11 Medimetal B-4, C-2, DOC-11 Medispec 33, DOC-11 Medizintechnik B-4, D-6, E-6, DOC-1, DOC-2, DOC-11, DOC-14, DOC-16, DOC-18 MedShape Solutions 32, 41, 45, 48, B-4, C-2, DOC-11 Medtronic 7, 54, 56, 57, 58, 59, 61, 62, 67, 69, 70, 76, 78, 85, 87, 91, 92, 95, 99, 100, 102, 112, D-5, E-4, DOC-11 Medtronic Navigation 85, DOC-11 MedXpert B-4, DOC-11 Medyssey 54, 70, D-5, DOC-11 Mekanika 70, DOC-11 Memometal Technologies 21, A-3, B-4, DOC-11 Merete 7, 22, A-3, B-4, DOC-11 Meridian B-4, DOC-11 Merlot B-4, DOC-11

L

Lafitt 17, 78, A-3, B-4, D-4, DOC-10 LAGet DOC-10 Lanx 7, 92, D-4, E-4, DOC-10 LDR 7, 54, 55, 56, 58, 59, 61, 95, D-4, E-4, DOC-10 LifeCell 93, 108, E-4, DOC-10 LifeLink E-4, DOC-10 Lifenet DOC-10

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I-6 Index of Companies Merries D-5, E-4, DOC-11 Mesoblast 98, 105, E-4, DOC-11 Meta Biomed E-5, DOC-12 Metasurg 22, A-3, B-4, DOC-12 MI4 Spine D-5, DOC-12 Micro-Imaging 43, C-2, DOC-12 Micromed 48, B-4, C-2, DOC-12 Mikai B-4, D-5, DOC-12 MiMedx 112, 113, E-5, DOC-12 Minimus 74, DOC-12 minSurg DOC-12 Mitsubishi E-5, DOC-12 MIV DOC-12 Modern Plastics 56, DOC-12 Mondeal B-4, DOC-12 Musculoskeletal Transplant Foundation DOC-12 Mylad B-4, DOC-12

O

Octane E-5, DOC-13 Olive 5, 42, C-2, DOC-13 Olympus 7, 41, 95, C-2, E-5, DOC-13 Olympus Terumo Biomaterials DOC-13 Omeros 105, 110, E-5, DOC-13 OMNILife DOC-13 OptiMed D-5, DOC-13 Organogenesis 107, 108, E-5, DOC-13 Orteq Bioengineering 105, DOC-13 OrthAlign 85, 87, DOC-13 Ortheon 45, 48, C-2, E-5, DOC-13 Orthocon 110, E-5, DOC-13 Ortho Development A-2, B-3, D-4, E-4, DOC-9, DOC-13 Ortho Devices D-5, E-5, DOC-13 Orthodynamics A-3, B-4, DOC-13 OrthoDynamix 5, 42, C-2, DOC-13 Orthofix 7, 28, 32, 33, 54, 55, 58, 59, 68, 92, 95, 97, 98, B-4, C-2, D-5, E-5, DOC-13 Orthogem 95, E-5, DOC-13 Orthogen 98, 102, 105, E-5, DOC-13 OrthoHelix 7, B-4, DOC-13 Orthomed 45, 48, 49, 95, C-2, E-5, DOC-13 OrthoMed B-5, DOC-13 OrthoMediTec 31, B-5, DOC-13 OrthoMEMS 55, DOC-13 Orthometrix 33, B-5, DOC-13 OrthoMimetics C-2, E-5, DOC-13 OrthoNetx 31, B-5, DOC-13 Orthonics 109, D-5, E-5, DOC-13 Orthopaedic Innovation A-3, B-5, D-5, DOC-13 Orthopaedic International A-3, B-5, D-5, DOC-13 Orthopaedic Synergy 15, 86, A-3, DOC-13 OrthoPediatrics B-5, D-5, DOC-13 Orthopedic Designs B-5, DOC-13 Orthopedic Sciences D-5, DOC-13 Orthopeutics D-5, E-5, DOC-14 OrthoPro A-3, B-5, E-5, DOC-14 Orthos 95, 97, E-5, DOC-14 Ortho Solutions 29, B-4, DOC-13 Orthosonics 22, DOC-14 Orthosurgical A-3, B-5, DOC-14 OrthoTec D-5, DOC-14 Orthovita 7, 76, 78, 95, 97, D-5, E-5, DOC-14

N

Nanotherapeutics 92, E-5, DOC-12 Nanovis 101, 102, D-5, E-5, DOC-12 Neoligaments 41, 48, 49, C-2, DOC-12 NeoStem E-5, DOC-12 Nerites DOC-12 Neurospine D-5, DOC-12 Newclip Technics DOC-12 NewMedical Technology B-4, DOC-12 New Splint A-3, DOC-12 Nexgen 59, 61, 69, D-5, DOC-12 Nexxt 54, D-5, DOC-12 NGK Spark Plug E-5, DOC-12 NMB A-3, B-4, D-5, DOC-12 NonLinear Technologies D-5, DOC-12 Normed 30, B-4, DOC-12 Norm Spinal 54, 78, D-5, E-5, DOC-12 NovaBone 95, E-5, DOC-12 NovaLign B-4, DOC-12 NovaPedix 32, B-4, DOC-12 NovaSpine 59, D-5, DOC-12 Novozymes 115, E-5, DOC-12 NP Solutions 65, D-5, DOC-12 NuOrtho 5, 42, C-2, DOC-12 Nutek 30, B-4, DOC-13 NuVasive 7, 54, 55, 58, 59, 61, 65, 66, 69, 70, 72, 92, 95, 97, 98, D-5, E-5, DOC-13

© ORTHOWORLD Inc., 2010. All rights reserved.

Index of Companies I-7 Orthox 105, C-2, E-5, DOC-14 Ortosintese 7, 15, 45, A-3, B-5, C-2, D-5, DOC-14 Osiris 98, 105, E-5, DOC-14 Osprey 64, 92, E-5, DOC-14 Ossacur 95, E-5, DOC-14 Osseon 76, 78, D-5, DOC-14 OST DOC-14 OsteoGenix 102, E-6, DOC-14 OsteoMed 7, 22, 29, 30, 95, A-3, B-5, E-6, DOC-14 Osteon 59, D-5, DOC-14 Osteopore 98, E-6, DOC-14 Osteotech 7, 92, E-6, DOC-14 OTIS 54, D-5, DOC-14 OtisMed 18, 19, DOC-14 Ouroboros D-6, DOC-14 Oxford 19, 55, DOC-14 Protetim 15, 20, 21, A-3, B-5, DOC-15 pSivida B-5, E-6, DOC-15

Q

Q-Med 115, 117, E-6, DOC-15 Quantum B-5, DOC-15

R

Ranier 58, 60, 61, D-6, DOC-15 Reduction 75, 78, D-6, DOC-15 ReGen 106, E-6, DOC-15 Regenerative 98, E-6, DOC-15 Regenerative Sciences 98, E-6, DOC-15 RegenTec E-6, DOC-15 Regentis 98, 106, E-6, DOC-15 Renova 5, 76, 79, B-5, DOC-15 Renovis DOC-15, DOC-18 Replication 65, 66, 68, 71, 112, 113, D-6, DOC-15 RepRegen 102, 110, 111, E-6, DOC-15 RE Spine 58, DOC-15 Restorative Physiology D-6, DOC-15 Revivicor 109, C-3, DOC-15 Rhausler D-6, DOC-15 Richard Wolf 7, 41, 73, C-3, DOC-15 Rigid fx B-5, DOC-15 ROBODOC 86, 87, DOC-15 Roth Medical 15, A-3, B-5, D-6, DOC-15 Rottapharm 115, E-6, DOC-15 Royer 102, E-6, DOC-15 RSB Spine 55, D-6, DOC-16 RS Medical B-5, DOC-16 RTI Biologics 92, 93, C-3, E-6, DOC-16 R Tree 55, D-6, DOC-15 Rush Pin B-5, DOC-16

P

Paradigm 7, 55, 68, 70, 71, D-6, DOC-14 Paradigm Spine 7, 68, 70, 71, D-6, DOC-14 Parametrics E-6, DOC-14 Parcus 5, 46, 48, C-2, DOC-14 PEAK 42, C-2, DOC-14 Pega B-5, DOC-14 Pentax E-6, DOC-14 Performance Grafts 93, E-6, DOC-14 Permedica 17, 18, 20, 21, A-3, B-5, D-6, DOC-14 Peter Brehm 7, A-3, D-6, DOC-14 Phygen D-6, DOC-14 PINA D-6, DOC-14 Pioneer 7, 54, 59, 65, 66, 71, 93, 96, 110, B-5, D-6, E-6, DOC-14 Pisharodi D-6, DOC-14 Polaris DOC-14 Poly 5 B-5, DOC-15 Polyganics 108, 112, E-6, DOC-15 PolyNovo 102, B-5, E-6, DOC-15 Praxim 85, 86, 87, DOC-15 Precision Surgery D-6, DOC-15 Prima A-3, B-5, C-3, D-6, DOC-15 Privelop 21, 69, 71, A-3, D-6, DOC-15 ProChon E-6, DOC-15 Produits 96, E-6, DOC-15 Progenteq 106, E-6, DOC-15 Progentix 98, 102, E-6, DOC-15 PROMED 96, E-6, DOC-15

S

S14 Implants D-6, DOC-16 SaluMedica E-6, DOC-16 Samo Biomedica 7, A-3, B-5, DOC-16 Sanacor D-6, DOC-16 Sanatmetal B-5, D-6, DOC-16 SanuWave 33, DOC-16 Sapphire C-3, DOC-16 Scandius 44, DOC-16 Schwartz 20, 106, E-6, DOC-4, DOC-16 Science for Bio Materials 32, 96, B-5, C-3, E-6, DOC-16

© ORTHOWORLD Inc., 2010. All rights reserved.

I-8 Index of Companies Scient'x 5, 54, 55, 56, 57, 69, DOC-16 Scil Technology 101, E-6, DOC-16 Scyon B-5, DOC-16 SeaSpine 7, 54, 60, 61, 69, D-6, DOC-16 Seikagaku 7, 101, 115, 116, 117, E-6, DOC-16 Seremm A-4, DOC-16 SERF 15, A-4, B-5, DOC-16 Serica C-3, E-6, DOC-16 Sewon 98, E-6, DOC-16 Sgarlato A-4, DOC-16 Sharma B-5, C-3, D-6, DOC-16 Shoulder Options B-5, DOC-16 Showa 8, 55, A-4, D-6, E-6, DOC-16 SH Pitkar D-6, DOC-16 SI Bone B-5, DOC-16 SIC Brevetti B-6, DOC-16 Siemens 33, 86, 87, DOC-16 Signal Medical A-4, DOC-16 Signus Medical 56, D-6, DOC-16 Signus Medizintechnik E-6, DOC-16 Simpex Medical B-6, DOC-16 Simplicity Orthopedic Solutions 31, DOC-16 Sintea 8, 76, 79, 101, 109, B-6, D-6, E-7, DOC-16, DOC-17 Sintea Biotech Srl DOC-16 Sintea Plustek Srl DOC-17 Skeletal Dynamics 30, B-6, DOC-17 Skeletal Kinetics E-7, DOC-17 Skeltex 76, 79, D-6, DOC-17 Small Bone Innovations 21, 30, A-4, B-6, C-3, E-7, DOC17 Smart Disc 58, D-6, DOC-17 SmArt Spine D-6, DOC-17 Smith & Nephew 4, 8, 14, 17, 18, 19, 20, 21, 23, 28, 29, 32, 41, 42, 46, 48, 55, 84, 85, 86, 87, 93, 96, 98, 102, 115, 116, 117, A-4, B-6, C-3, E-7, DOC-17 Smit Medimed B-6, D-7, DOC-17 Soft Tissue Regeneration 106, C-3, DOC-17 Solana A-4, DOC-17 Solco 8, 55, B-6, D-7, DOC-17 Sonoma 30, B-6, DOC-17 Sonorex 33, DOC-17 SOTA B-6, DOC-17 Soteira 77, 79, D-7, DOC-17 Southern Spine D-7, DOC-17 Sovereign 21, DOC-17 Spartek D-7, DOC-17 Specialty Spine Products D-7, DOC-17 SpinalCyte 106, DOC-17 Spinal Devices 55, D-7, DOC-17 Spinal Edge D-7, DOC-17 Spinal Elements 8, 64, 72, D-7, DOC-17 Spinal Instrumentation D-7, DOC-17 Spinal Kinetics 58, 60, 61, D-7, DOC-17 SpinalMotion 58, 60, 61, D-7, DOC-17 Spinal Restoration 109, 110, E-7, DOC-17 Spinal Simplicity 55, D-7, DOC-17 Spinal USA 8, 55, D-7, DOC-17 Spine21 74, D-7, DOC-17 Spine 360 D-7, DOC-17 SpineAlign 77, 79, D-7, DOC-17 Spineart 55, 60, 61, D-7, DOC-17 SpineCraft 55, D-7, E-7, DOC-18 SpineForm 74, DOC-18 SpineFrontier 55, D-7, DOC-18 SpineGuard 56, DOC-18 SpineLab 68, 71, D-7, DOC-18 SpineNetwork D-7, DOC-17 Spine Now 72, DOC-17 Spineology 55, 77, 79, D-7, E-7, DOC-18 SpineSmith 8, 98, D-7, E-7, DOC-18 SpineView 74, C-3, DOC-18 SpineVision 69, 71, D-7, DOC-18 Spine Wave 8, 55, 65, 77, 79, D-7, DOC-17 Spineway D-7, E-7, DOC-18 SpineWorks D-7, DOC-18 Stanmore Implants 83, DOC-18 StelKast 17, 20, A-4, DOC-18 Stellartech 55, DOC-18 Stemcup A-4, DOC-18 Storz 7, 33, 41, C-2, DOC-10, DOC-18 Stout 55, 75, DOC-18 Stryker 4, 8, 14, 16, 17, 18, 19, 20, 21, 23, 28, 29, 41, 42, 46, 48, 54, 55, 56, 60, 62, 65, 66, 77, 79, 86, 87, 92, 93, 96, 99, 101, 104, 108, A-4, B-6, C-3, D-7, E-7, DOC-18 Stryker Biotech 101, DOC-18 Stryker Endoscopy 46, DOC-18 Stryker Interventional Spine 77, DOC-18 Stryker Spine 55, DOC-18 Stuckenbrock B-6, DOC-18

© ORTHOWORLD Inc., 2010. All rights reserved.

Index of Companies I-9 Summit Medical 23, A-4, D-7, DOC-18 Surgical Implant Generation Network 28, DOC-18 Surgicraft 8, 30, 31, 46, 49, C-3, D-7, DOC-18 Surgival A-4, B-6, D-8, DOC-18 Surgix 86, 87, DOC-18 Sushrut 15, A-4, B-6, D-8, DOC-18 Symbios 15, A-4, DOC-18 Sync Medical D-8, DOC-18 Synimed 23, DOC-18 Synovis 106, 108, E-7, DOC-18 Synthasome E-7, DOC-18 SyntheMed 112, 113, E-7, DOC-18 Synthes 8, 28, 29, 30, 31, 54, 57, 58, 60, 62, 65, 66, 71, 77, 84, 93, 96, 109, B-6, D-8, E-7, DOC-18 Synthes Spine DOC-18 TiTaMED 54, DOC-19 Titan 56, D-8, DOC-19 Toby 46, B-6, C-3, DOC-19 Tornier 5, 8, 17, 20, 21, 46, 48, 87, 100, 108, A-4, B-6, C-3, E-7, DOC-19 Total Joint A-4, DOC-19 Tradimedics B-6, D-8, DOC-19 Traiber 8, 21, A-4, B-6, D-8, DOC-19 TranS1 8, 54, 55, 62, 65, 66, 72, D-8, DOC-19 TransTissue DOC-19 Transysteme 32, A-4, B-6, E-7, DOC-19, DOC-20 Trauson 5, 8, B-6, DOC-20 TRB 116, 117, E-7, DOC-20 Treu A-4, B-6, D-8, DOC-20 Trilliant A-4, DOC-20 TriMed 30, B-6, DOC-20 Trinity 56, 98, D-8, DOC-20 TrueVision 86, 87, DOC-20 TTK A-4, B-6, DOC-20

T

Taeyeon B-6, D-8, DOC-19 TAG DOC-19 Taisho E-7, DOC-19 Takiron 8, 46, 48, 60, 62, 95, B-6, C-3, D-8, DOC-19 Tantum A-4, B-6, DOC-19 TBF E-7, DOC-19 Technologie Transysteme 32, DOC-19 Tecres 8, 22, 79, A-4, D-8, DOC-19 TEI Biosciences 100, E-7, DOC-19 Tekka B-6, DOC-19 TekMed D-8, DOC-19 Teknimed 8, 49, 77, 79, 96, C-3, D-8, E-7, DOC-19 Telos 49, C-3, DOC-19 Tepha 46, 110, 111, C-3, E-7, DOC-19 TETEC DOC-19 TGS 5, 20, 84, DOC-19 TheraCell 99, E-7, DOC-19 ThermoGenesis 97, DOC-19 Tianjin 15, A-4, B-6, DOC-19 TiGenix 5, 103, 106, 107, C-2, E-5, E-7, DOC-19 Tigran 23, DOC-19 Tissue Banks International DOC-19 TissueGene E-7, DOC-19 Tissue Genesis 98, 106, E-7, DOC-19 Tissuenet DOC-19 Tissue Regeneration Systems 102, E-7, DOC-19 Tissue Regeneration Therapeutics 96, 99, E-7, DOC-19 Tissue Regenix 107, E-7, DOC-19 Tissue Science E-7, DOC-19

U

U&I Corporation DOC-20 Ulrich 8, 71, 84, D-8, DOC-20 Ulrich Medical 84, D-8, DOC-20 Uma Surgicals 15, A-4, B-6, D-8, DOC-20 Unilab Surgibone 96, E-7, DOC-20 Union Surgical B-6, DOC-20 United Endoscopy C-3, DOC-20 United Orthopedic 8, 15, 17, 21, A-4, B-6, DOC-20 UPex 31, DOC-20 USBiomaterials E-8, DOC-20 US Spine 56, D-8, E-7, DOC-20

V

Van Straten 18, 21, A-4, E-8, DOC-20 Velcura E-8, DOC-20 Vertebral 54, 55, 56, 65, 66, 75, 76, 77, 78, D-8, DOC-1, DOC-20 Vertebration D-8, DOC-20 Verticor D-8, DOC-20 VertiFlex 68, 71, DOC-20 Vertos 68, 71, DOC-20 Vexim 77, 79, D-8, DOC-20 VG 56, DOC-20 Vidacare D-8, DOC-20 Vilex A-4, B-7, DOC-20

© ORTHOWORLD Inc., 2010. All rights reserved.

I-10 Index of Companies Vivoxid 96, E-8, DOC-20 VOT 19, 20, A-4, DOC-20 VQ B-7, D-8, DOC-20

W

Waldemar 8, 15, 17, 18, 20, 21, 84, A-4, B-7, D-8, DOC-20 Waston B-7, D-8, DOC-20 Weigao 8, B-7, D-8, DOC-20 Wenzel D-8, DOC-20 Whiteside 20, A-4, B-7, DOC-21 Woll B-7, DOC-21 Wright 8, 14, 17, 19, 20, 21, 22, 23, 29, 30, 46, 48, 84, 85, 92, 93, 96, 108, A-4, B-7, C-3, E-8, DOC-21

X

Xiros 49, C-3, DOC-12, DOC-21 X-Spine 8, 65, D-8, DOC-21 Xylos 48, 109, DOC-21

Z

Ziehm 84, DOC-21 Zimmer 4, 8, 14, 16, 17, 18, 19, 20, 21, 23, 28, 46, 48, 54, 55, 62, 65, 66, 68, 71, 84, 85, 86, 87, 92, 93, 96, 109, 116, A-4, B-7, C-3, D-8, E-8, DOC-21

© ORTHOWORLD Inc., 2010. All rights reserved.

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