Contents:

Introduction & Report Overview Recommendations Executive Summary Key Findings Suggested Analysis A SNAPSHOT OF ORTHOPEDIC SURGEONS PRACTICES, PROCEDURES, TRENDS AND SITES OF CARE Introduction & Report Overview Abstract Measurement Objectives Sample Design & Distribution Measurement & Data Collection Design How to read this report Executive Summary & Key Findings Detailed Findings I. Orthopedic Surgeon Demographics a. Orthopedic Surgeons Years in practice b. Orthopedic Surgeons Sites of care (where do they perform their procedures) i. Primary hospitals ii. Surgery centers iii. Private offices c. Orthopedic Surgeon gender II. Orthopedic Surgeons Procedures a. Procedures performed by category i. Minimally invasive ii. Invasive b. Surgical procedures performed by type i. Knee injection ii. Knee arthroscopy iii. Open knee repair iv. Total knee replacement v. Partial knee replacement vi. Knee revision vii. Hip injection viii. Hip arthroscopy ix. Total hip replacement x. Partial hip replacement xi. Hip revision xii. Shoulder injection xiii. Shoulder arthroscopy xiv. Open shoulder repair c. Surgical procedures performed at various sites of care i. Hospital ii. Ambulatory / Surgery center iii. Private office d. Surgical procedural trends i. Increase from past year ii. Decrease from past year iii. No change from last year III. The Orthopedic Patient Profile a. Patients seen by condition type (what types of patients are they seeing) i. Overall / Typical month ii. Elective iii. Arthritis patients iv. Trauma patients b. Elective/chronic patient treatment types received c. Elective/chronic patient conversion trends i. Consultation ii. Elective Procedural Outcomes d. Repeat patients treated by surgeon personally vs. another surgeon e. Patient age f. Patient gender g. Patient ethnicity Conclusions Recommendations Suggested Analysis About the Author Table of Figures Figure A-1 Geographical Spread of respondents Table 1-1 Number of Years in Practice Figure 1-1 Years in Practice Pie chart (Quartile %) Figure 1-2 Years in Practice Histogram Table 1-2 Sites of Care Table 1-3 Operating Suites Table 1-4 Other Orthopedic Surgeons Figure 1-3 Sites of Care Demographic Table 1-5 Male vs. Female Surgeon Respondents Figure 1-4 Surgeon Respondent Gender Pie Chart Table 2-1 Specific Procedures Performed Per Month Figure 2-1 Number of Specific Procedures Performed Per Month Table 2-2 Specific Cosmetic Surgical Procedures Performed Per Month Figure 2-2 Specific Cosmetic Surgical Procedures Performed Per Month Table 2-3 Variability Factors Table 2-4 Specific Surgical Procedures Performed at Various Sites of Care Figure 2-3 Percentage of Specific Surgical Procedures Performed at Various Sites of Care Table 2-5 Changes to the Number of Featured Surgical Procedures Performed Over the Past Year Figure 2-4 Net % of Surgeons Reporting an Increase in the Number of Featured Procedures Table 3-1 Percentage of Patients Seen Figure 3-1 Percentage of Patients Seen for Specific Categories of Procedures Table 3-2 Percentage of Hip, Knee and Shoulder Patients Treated and Not Treated Figure 3-2 Percentage of Patients Seen (pie chart) Table 3-3 Changes in the Number of Hip, Knee and Shoulder Patients Electing Treatment following Consultation over the Past 2 Years Figure 3-3 Percentage of Surgeons Who Experienced Changes in the Number of Hip, Knee and Shoulder Patients Electing Treatments Following Consultation Over the Past 2 Years Table 3-4 Repeat Hip, Knee and Shoulder Patients Treated by Surgeons Personally vs. Other Surgeon Figure 3-4 Percentage of Elective/Chronic Repeat Hip, Knee and Shoulder Patients Treated Personally by Surgeons vs. Other Surgeons Table 3-5 Hip, Knee and Shoulder Patients per Age Category Figure 3-5 Percentage of Elective/Chronic Hip, Knee and Shoulder Patients per Age Category Table 3-5 Hip, Knee and Shoulder Patient Gender Figure 3-4 Percentage of Female vs. Male Elective / Chronic Patients Table 3-6 Hip, Knee and Shoulder Patient Race Figure 3-7 Percentage of Patients per Race Category ORTHOPEDIC SURGERY – THE CUSTOMER CONNECTION: HOW TO INCREASE EFFICIENCY AND EFFECTIVENESS OF SALES CALLS, MARKETING AND PROFESSIONAL EDUCATION Introduction & Report Overview Abstract Measurement Objectives Sample Design & Distribution Measurement & Data Collection Design How to read this report Executive Summary & Key Findings Detailed Findings IV. Medical Sales Representatives seen by Orthopedic Surgeons a. # of times sales reps are seen in a typical month (for any company) b. Frequency of specific sales rep visits for each of the listed companies i. Arthrex ii. ArthroCare iii. Biomet iv. ConMed / Linvatec v. DePuy Orthopedics (J&J) vi. DePuy Mitek (J&J) vii. Encore viii. Ethicon ix. Smith & Nephew Orthopedics x. Smith & Nephew Endoscopy xi. Stryker Orthopedic / Howmedica Osteonics xii. Stryker Biotech xiii. Zimmer xiv. Ortho Development c. Quality of information presented in sales rep meeting for specific companies (New and Valuable) (New, Not Valuable) (Not New, Valuable) (Neither New nor Valuable) i. Arthrex ii. ArthroCare iii. Biomet iv. ConMed / Linvatec v. DePuy Orthopedics (J&J) vi. DePuy Mitek (J&J) vii. Encore viii. Ethicon ix. Smith & Nephew Orthopedics x. Smith & Nephew Endoscopy xi. Stryker Orthopedic / Howmedica Osteonics xii. Stryker Biotech xiii. Zimmer xiv. Ortho Development d. How often do orthopedic surgeons prefer to be seen by sales reps i. Weekly ii. 2 Times per Month iii. Monthly iv. 3-4 Times per Year v. 1 Time per Year or Less vi. Never vii. Only When I Request viii. Only When They Have New Products or Information to Share V. Professional Medical Education for Orthopedic Surgeons a. How many professional education events do orthopedic surgeons attend annually b. How often do orthopedic surgeons attend events by the following companies i. Arthrex ii. ArthroCare iii. Biomet iv. ConMed / Linvatec v. DePuy Orthopedics (J&J) vi. DePuy Mitek (J&J) vii. Encore viii. Ethicon ix. Smith & Nephew Orthopedics x. Smith & Nephew Endoscopy xi. Stryker Orthopedic / Howmedica Osteonics xii. Stryker Biotech xiii. Zimmer xiv. Ortho Development c. What is the quality of the events attended by orthopedic surgeons 25 (Poor) (Needs Improvement) (About Average) (Good) (Excellent) i. Arthrex ii. ArthroCare iii. Biomet iv. ConMed / Linvatec v. DePuy Orthopedics (J&J) vi. DePuy Mitek (J&J) vii. Encore viii. Ethicon ix. Smith & Nephew Orthopedics x. Smith & Nephew Endoscopy xi. Stryker Orthopedic / Howmedica Osteonics xii. Stryker Biotech xiii. Zimmer xiv. Ortho Development VI. Information Sources for orthopedic surgeons a. Orthopedic Surgeons Preferences for learning about new products i. Internet ii. Journals iii. Conventions iv. Sales reps v. Company sponsored events vi. Colleagues vii. Multimedia (CD/DVD) viii. Academic environment (University, Grand rounds, etc.) b. Ortho. Surgeons Preferences for learning about new methods, techniques, treatments i. Internet ii. Journals iii. Conventions iv. Sales reps v. Company sponsored events vi. Colleagues vii. Multimedia (CD/DVD) viii. Academic environment (University, Grand rounds, etc.) c. What are the marketing practices of orthopedic surgeons i. Print advertising (Magazine, Newspaper, Billboard, Yellow pages) ii. TV advertising iii. Radio iv. Web site or internet v. Networking / Developing additional referring physicians vi. Educational seminars / Q & A sessions for public vii. Community activities or charitable involvement viii. Contact with workers comp case managers ix. Contact with large companies in your (the surgeon’s) area d. Time spent on internet & reading medical journals for professional purposes VII. Orthopedic Surgeon Attitudes a. Level of agreement with featured product considerations (Strongly Disagree) (Disagree) (Slightly Disagree) (Neutral) (Slightly Agree) (Agree) (Strongly Agree) i. I am pleased with the quality of the products I currently use in surgery ii. I prefer performing surgery over consulting with patients iii. I am committed to monitoring emerging products and methods in my field iv. Cost is a very important consideration when I select products v. I believe medical manufacturers understand the needs of the surgeon vi. I will not try a new product unless it is supported with published clinical evidence vii. I am very specific regarding my product preferences and will request a specific product viii. I like to try new products and procedures / methods

Summary:

Methodology of this Research 102 American Medical Association (AMA) board certified orthopedic surgeons were randomly selected from a list of 16,100 surgeons to participate in a self-administered questionnaire (SAQ) featured on the internet. Upon completion of the SAQ, 10 of the participants were selected to participate in a follow-up depth interview conducted via the telephone.

Companies Mentioned

-Arthrex -ArthroCare -Biomet -ConMed / Linvatec -DePuy Orthopedics (J&J) -DePuy Mitek (J&J) -Encore -Ethicon -Smith & Nephew Orthopedics -Smith & Nephew Endoscopy -Stryker Orthopedic / Howmedica Osteonics -Stryker Biotech -Zimmer -Ortho Development