Extremity Reconstruction

Dev Joshi, Analyst, Extremity Reconstruction Products and Markets

7235 Vicksburg Pike
Fort Wayne, IN 46804
260.469.4164
dev@pearldiverinc.com

Overview of Extremities

Source: PearlDiver Patient Record Database January, 2004 - June, 2007

Extremities Market Share (2Q 2009)

Global Extremities Market

Total Extremities Global Market Forecast (2006-2012E)

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Numbers in Millions

Company's Extremity Global Market Forecast (2Q09-2012)

REVENUE Model

Numbers in Millions

Market Share

Source: Company's SEC Filings, PearlDiver Estimates and other press releases.

Shoulder US Market Share (2008 E)

Source: Press Releases & PearlDiver Estimates

Most Common Extremity Diagnoses

Source: PearlDiver Patient Record Database 2004 - 2007

Most Common Extremity Procedures

Source: PearlDiver Patient Record Database 2004 - 2007

Foot and Ankle Market Independent Survey

Source: Independent survey conducted with foot and ankle surgeons and members of "American College of Foot and Ankle Surgeons (ACFAS) and American Orthopedic Foot and Ankle Society (AOFAS)."(#1 in Foot and Ankle Products)

Ankle Replacement vs. Ankle Fusion

Source: PearlDiver Patient Record Database January, 2004 - June, 2007

Tennis Elbow / Golfer's Elbow

Source: PearlDiver Patient Record Database January, 2004 - June, 2007

Shoulder Replacement U.S. Market Forecast (2004-2012)

Source: PearlDiver estimates, public sources and PearlDiver Patient Records Database (# of Procedures)

Rotator Cuff Repair U.S. Market (2004-2012)

Source: PearlDiver Patient Record Database, AAOS, and PearlDiver Estimates (# of Procedures)

Carpal Tunnel Surgical Release Forecast (2004-2012)

Source: PearlDiver Patient Record Database, AAOS, and PearlDiver Estimates (# of Procedures)

Procedural Volume Forecast

Upper Extremities

Procedure by Indications	2005	2006	2007	2008E	2009E	2010E	2011E	2012E
Upper Extremities
Carpal Bone Reconstruction	19,578	21,144	22,624	23,981	25,420	26,540	28,079	29,764
Carpal Tunnel Release	375,533	420,596	462,656	499,600	523,581	549,760	577,248	607,265
Epicondylitis Repair	37,158	39,415	41,726	44,149	46,409	48,785	52,493	56,692
Rotator Cuff Repair	370,324	385,137	400,543	415,071	429,183	445,492	464,203	485,092
Other Shoulder Repair	14,440	16,606	19,097	21,961	24,597	27,548	30,579	34,248
Total Shoulder Replacement	17,680	21,054	21,684	21,888	23,834	25,931	28,472	31,319
Partial Shoulder Replacement	18,564	19,513	18,904	19,456	21,401	23,541	25,848	28,381
Reverse Shoulder Replacement	2,652	4,622	10,008	15,200	19,067	22,118	26,320	31,584
Total	855,929	928,086	997,242	1,061,306	1,113,492	1,169,715	1,233,242	1,304,346
% Growth		8.43%	7.45%	6.42%	4.92%	5.05%	5.43%	5.77%

Lower Extremities

Procedure by Indications	2005	2006	2007	2008E	2009E	2010E	2011E	2012E
Lower Extremities
Ankle Fusion	13,120	14,169	15,303	16,374	17,488	18,852	20,398	22,132
Triple Arthrodesis	8,152	8,720	9,550	10,276	10,994	11,764	12,505	13,305
Subtalar Fusion	16,298	16,754	18,811	20,241	21,656	23,172	24,887	26,778
Midtarsal Fusion	14,269	16,008	17,410	18,733	20,043	21,446	23,033	24,830
Tarsometatarsal Fusion	9,112	11,071	11,586	12,466	13,338	14,272	15,271	16,386
MTP Fusion	19,218	20,014	20,816	22,398	23,964	25,641	27,436	29,466
Total Ankle Replacement*	6,720	7,190	7,621	8,079	8,563	9,162	9,895	10,766
Total	86,889	93,926	101,097	108,567	116,046	124,309	133,425	143,663
% Growth		8.10%	7.63%	7.39%	6.89%	7.12%	7.33%	7.67%

*Total Ankle replacement includes with or without implant as well as revision.

Arthroscopy Procedures

Procedure by Indications	2005	2006	2007	2008E	2009E	2010E	2011E	2012E
Arthroscopy
Shoulder	680,220	734,638	793,409	841,013	883,905	932,520	985,673	1,044,814
Elbow	15,815	17,555	19,310	21,434	23,535	25,888	28,607	31,753
Foot/ankle	76,630	84,293	92,722	100,140	107,350	115,401	124,403	134,604
Wrist/hand	105,670	116,237	127,861	138,090	147,894	158,838	171,069	184,754
Total	878,335	952,722	1,033,302	1,100,677	1,162,684	1,232,647	1,309,751	1,395,925
% Growth		8.47%	8.46%	6.52%	5.63%	6.02%	6.26%	6.58%

Toe Deformities Repair

Procedure by Indications	2005	2006	2007	2008E	2009E	2010E	2011E	2012E
Toe deformities repair
Bunion	120,860	126,903	133,248	139,911	145,087	150,746	157,077	164,303
Hammertoe	398,978	412,942	425,330	438,090	449,043	461,616	475,926	491,632
Hallux valgus	308,020	329,581	352,652	373,811	394,745	417,640	443,534	472,363
Total	827,858	869,427	911,231	951,812	988,875	1,030,001	1,076,536	1,128,297
% Growth		5.02%	4.81%	4.45%	3.89%	4.16%	4.52%	4.81%

Trauma Market

Source: PearlDiver Patient Record Database January, 2004 - June, 2007

Global Trauma Market (2004-2008)

Total Trauma Market

Source: Each Company's SEC Filings, and other press releases.

Number in Billions

Trauma Market Share (2008)

Source: Each Company's SEC Filings, and other press releases.

Fracture Market Procedural Data

Open Fracture Treatments

Procedure by Indications	2005	2006	2007	2008E	2009E	2010E	2011E	2012E
*Fracture Treatments (Open)*
Long Bones	607,514	622,702	635,156	643,095	646,311	656,006	667,486	682,504
Small Bones	144,516	166,668	179,940	192,536	205,761	218,443	231,407	244,911
Total	752,030	789,370	815,096	835,631	852,072	874,449	898,893	927,415
% Growth		4.97%	3.26%	2.52%	1.97%	2.63%	2.80%	3.17%

Closed Fracture Treatments

Procedure by Indications	2005	2006	2007	2008E	2009E	2010E	2011E	2012E
*Fracture Treatments (Closed)*
Long Bones	1,790,492	1,835,254	1,871,960	1,895,359	1,904,836	1,933,408	1,967,243	2,011,506
Small Bones	757,372	817,344	875,863	934,053	994,147	1,053,193	1,114,062	1,178,790
Total	2,547,864	2,652,598	2,747,823	2,829,412	2,898,983	2,986,601	3,081,305	3,190,296
% Growth		4.11%	3.59%	2.97%	2.46%	3.02%	3.17%	3.54%

Nonunion Fracture Treatments

Procedure by Indications	2005	2006	2007	2008E	2009E	2010E	2011E	2012E
*Fracture Treatments (Nonunion)*
Long Bones	19,477	19,964	20,363	20,618	20,721	21,032	21,400	21,881
Small Bones	13,578	14,630	15,763	16,975	18,229	19,542	20,852	22,250
Total	33,055	34,594	36,126	37,592	38,950	40,573	42,251	44,131
% Growth		4.66%	4.43%	4.06%	3.61%	4.17%	4.14%	4.45%

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