FOOTNOTES

1 “Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030,” S.Kurtz et al, J Bone Joint Surg Am. 2007;89:780-785. U.S. Orthopedic Joint Replacement Markets, Frost & Sullivan (2007).

2 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106.

3 Berend ME, Ritter MA, Meding JB et al. (2004). Tibial Component Failure Mechanisms in Total Knee Arthroplasty. Clinical Orthopaedics and Related Research 428:26-34.

4 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106

5 http://www.aaos.org/news/bulletin/sep07/reimbursement3.asp.

6 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106.

7 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106.

8 Mulhall K, Ghomrawi H, et al (2006). Current Etiologies and Modes of Failure in Total Knee Arthroplasty Revision. Clinical Orthopaedics and Related Research;45:50. Sharkey P, Hozack W, et al (2002). Why Are Total Knee Arthroplasties Failing Today? Clinical Orthopaedics and Related Research 7:13.

9 Berend ME, Ritter MA, Meding JB et al. (2004). Tibial Component Failure Mechanisms in Total Knee Arthroplasty. Clinical Orthopaedics and Related Research 428:26-34.

10 Berend ME, Ritter MA, Meding JB et al. (2004). Tibial Component Failure Mechanisms in Total Knee Arthroplasty. Clinical Orthopaedics and Related Research 428:26-34.

11 Decking, R., et al (2005). Leg Axis After Computer-Navigated Total Knee Arthroplasty, A Prospective Randomized Trial Comparing Computer-Navigated and Manual Implantation. The Journal of Arthroplasty 20:282-288. R.A. Denham, R.E.D. Bishop (1978). Mechanics of the Knee and Problems in Reconstructive Surgery. The Journal of Bone and Joint Surgery (American) Vol. 60-B, No. 3, pp. 345-352. Stulberg, S.D. (2003). How Accurate is Current TKR Instrumentation? Clinical Orthopaedics and Related Research. Number 416, pp. 177-184.

12 Mulhall K, Ghomrawi H, et al (2006). Current Etiologies and Modes of Failure in Total Knee Arthroplasty Revision. Clinical Orthopaedics and Related Research;45:50. Sharkey P, Hozack W, et al (2002). Why Are Total Knee Arthroplasties Failing Today? Clinical Orthopaedics and Related Research 7:13.

13 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106.

14 http://www.aaos.org/news/bulletin/sep07/reimbursement3.asp.

15 J. Katz et al (2004), Association Between Hospital and Surgeon Procedure Volume and the Outcomes of Total Knee Replacement. The Journal of Bone and Joint Surgery (American) 86:1909-1916 [Approximately 80% of TKAs are performed by surgeons with an annual volume of less than 50 procedures per year.]

16 Berend ME, Ritter MA, Meding JB et al. (2004). Tibial Component Failure Mechanisms in Total Knee Arthroplasty. Clinical Orthopaedics and Related Research 428:26-34. The Blue Cross / Blue Shield Technology Evaluation Committee has found the design of the Berend, et al. study and several other published studies too limited to support malalignment as a definitive cause of implant revision. However, the Committee has acknowledged the strong link between malalignment and revision shown by these studies. “Computer-Assisted Navigation for Total Knee Arthroplasty,” Blue Cross / Blue Shield Assessment Program, Volume 22, No. 10, Nov. 2007.

17 The Blue Cross / Blue Shield Technology Evaluation Committee has found the design of the Berend, et al. study and several other published studies too limited to support malalignment as a definitive cause of implant revision. However, the Committee has acknowledged the strong link between malalignment and revision shown by these studies. “Computer-Assisted Navigation for Total Knee Arthroplasty,” Blue Cross / Blue Shield Assessment Program, Volume 22, No. 10, Nov. 2007.

18 Bourne, R., et al. (2007). Role of Obesity on the Risk for Total Hip or Knee Arthroplasty. Clinical Orthopaedics and Related Research 465(4): 188.

19 Jenny, J.Y, et al. (2001). Computer-Assisted Implantation of Total Knee Prostheses: A Case-Control Comparative Study with Classical Instrumentation. Computer Aided Surgery 6:217-220.

20 “U.S. Orthopedic Joint Replacement Markets,” Frost & Sullivan, 2007.

21 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106.

22 http://www.aaos.org/news/bulletin/sep07/reimbursement3.asp.

23 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106.

24 Mulhall K, Ghomrawi H, et al (2006). Current Etiologies and Modes of Failure in Total Knee Arthroplasty Revision. Clinical Orthopaedics and Related Research;45:50. Sharkey P, Hozack W, et al (2002). Why Are Total Knee Arthroplasties Failing Today? Clinical Orthopaedics and Related Research 7:13.

25 http://www.aaos.org/news/bulletin/sep07/reimbursement3.asp.

26 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106

27 http://www.aaos.org/news/bulletin/sep07/reimbursement3.asp.

28 http://www.aaos.org/news/bulletin/sep07/reimbursement3.asp.

29 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106.

30 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106.

31 Mulhall K, Ghomrawi H, et al (2006). Current Etiologies and Modes of Failure in Total Knee Arthroplasty Revision. Clinical Orthopaedics and Related Research;45:50. Sharkey P, Hozack W, et al (2002). Why Are Total Knee Arthroplasties Failing Today? Clinical Orthopaedics and Related Research 7:13.

32 Berend ME, Ritter MA, Meding JB et al. (2004). Tibial Component Failure Mechanisms in Total Knee Arthroplasty. Clinical Orthopaedics and Related Research 428:26-34.

33 Berend ME, Ritter MA, Meding JB et al. (2004). Tibial Component Failure Mechanisms in Total Knee Arthroplasty. Clinical Orthopaedics and Related Research 428:26-34.

34 Decking, R., et al (2005). Leg Axis After Computer-Navigated Total Knee Arthroplasty, A Prospective Randomized Trial Comparing Computer-Navigated and Manual Implantation. The Journal of Arthroplasty 20:282-288. R.A. Denham, R.E.D. Bishop (1978). Mechanics of the Knee and Problems in Reconstructive Surgery. The Journal of Bone and Joint Surgery (American) Vol. 60-B, No. 3, pp. 345-352. Stulberg, S.D. (2003). How Accurate is Current TKR Instrumentation? Clinical Orthopaedics and Related Research. Number 416, pp. 177-184.

35 Mulhall K, Ghomrawi H, et al (2006). Current Etiologies and Modes of Failure in Total Knee Arthroplasty Revision. Clinical Orthopaedics and Related Research;45:50. Sharkey P, Hozack W, et al (2002). Why Are Total Knee Arthroplasties Failing Today? Clinical Orthopaedics and Related Research 7:13.

36 Mason J, Fehring T, et al (2007). Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. The Journal of Arthroplasty 1097:1106.

37 http://www.aaos.org/news/bulletin/sep07/reimbursement3.asp.

38 J. Katz et al (2004), Association Between Hospital and Surgeon Procedure Volume and the Outcomes of Total Knee Replacement. The Journal of Bone and Joint Surgery (American) 86:1909-1916 [Approximately 80% of TKAs are performed by surgeons with an annual volume of less than 50 procedures per year.]

39 Berend ME, Ritter MA, Meding JB et al. (2004). Tibial Component Failure Mechanisms in Total Knee Arthroplasty. Clinical Orthopaedics and Related Research 428:26-34. The Blue Cross / Blue Shield Technology Evaluation Committee has found the design of the Berend, et al. study and several other published studies too limited to support malalignment as a definitive cause of implant revision. However, the Committee has acknowledged the strong link between malalignment and revision shown by these studies. “Computer-Assisted Navigation for Total Knee Arthroplasty,” Blue Cross / Blue Shield Assessment Program, Volume 22, No. 10, Nov. 2007.

40 The Blue Cross / Blue Shield Technology Evaluation Committee has found the design of the Berend, et al. study and several other published studies too limited to support malalignment as a definitive cause of implant revision. However, the Committee has acknowledged the strong link between malalignment and revision shown by these studies. “Computer-Assisted Navigation for Total Knee Arthroplasty,” Blue Cross / Blue Shield Assessment Program, Volume 22, No. 10, Nov. 2007.

41 Bourne, R., et al. (2007). Role of Obesity on the Risk for Total Hip or Knee Arthroplasty. Clinical Orthopaedics and Related Research 465(4): 188.

42 Jenny, J.Y, et al. (2001). Computer-Assisted Implantation of Total Knee Prostheses: A Case-Control Comparative Study with Classical Instrumentation. Computer Aided Surgery 6:217-220.