National Joint Replacement Registry. Demographics and Outcome of Elbow & Wrist Arthroplasty

National Joint Replacement Registry Demographics and Outcome of Elbow & Wrist Arthroplasty SUPPLEMENTARY REPORT 2015

CONTENTS INTRODUCTION... 1 ELBOW REPLACEMENT... 2 Categories of Elbow Replacement... 2 Demographics... 3 Primary Partial Elbow Replacement... 5 Demographics... 5 Primary Radial Elbow Replacement... 6 Primary Uni Humeral Elbow Replacement... 7 Primary Uni Humeral with Radial Elbow Replacement... 7 Primary Humeral Hemiarthroplasty... 8 Primary Total Elbow Replacement... 9 Demographics... 9 Primary Total Elbow without Radial Replacement... 10 Primary Total Elbow with Radial Replacement... 11 Revision Elbow Replacement... 12 Demographics... 12 Revision of Known Primary Partial Elbow Replacement... 13 Known Primary Radial Elbow Replacement... 13 Known Primary Uni Humeral with Radial Elbow Replacement... 14 Known Primary Humeral Hemiarthroplasty... 15 Revision of Known Primary Total Elbow Replacement... 16 Known Primary Total Elbow without Radial Replacement... 16 Known Primary Total Elbow with Radial Replacement... 17 WRIST REPLACEMENT... 18 Categories of Wrist Replacement... 18 Demographics... 19 Primary Partial Wrist Replacement... 21 Demographics... 21 Primary Lunate Wrist Replacement... 22 Primary Partial Ulna Wrist Replacement... 22 Primary DRUJ with Ulna Only Replacement... 23 Primary DRUJ with Ulna and Radial Replacement... 24 Primary Scaphoid Interspacer Replacement... 24 Primary Total Wrist Replacement... 25 Demographics... 25 Revision Wrist Replacement... 26 Demographics... 26 Revision of Known Primary Partial Wrist Replacement... 27 Known Primary DRUJ with Ulna Only Replacement... 27 Revision of Known Primary Total Wrist Replacement... 28

LIST OF TABLES Table EG1 Number of Elbow Replacements by Gender... 3 Table EG2 Number of Elbow Replacements by... 3 Table EG3 Time between Procedures for Bilateral Primary Elbow Replacement... 3 Table EG4 All Elbow Replacement by and Gender... 3 Table EG5 Revision Rates of Primary Elbow Replacement by Elbow Class... 4 Table EG6 Yearly Cumulative Percent Revision of Primary Elbow Replacement by Elbow Class... 4 Primary Partial Elbow Replacement... 5 Table EP1 Primary Partial Elbow Replacement by and Gender... 5 Table EP2 Primary Partial Elbow Replacement by Primary Diagnosis... 5 Table EP3 Primary Radial Elbow Replacement by and Gender... 6 Table EP4 Primary Radial Elbow Replacement by Primary Diagnosis... 6 Table EP5 Most Used Radial Head/Stem Prostheses in Primary Radial Elbow Replacement... 6 Table EP6 Primary Uni Humeral Elbow Replacement by and Gender... 7 Table EP7 Primary Uni Humeral Elbow Replacement Primary Diagnosis... 7 Table EP8 Primary Uni Humeral with Radial Elbow Replacement by and Gender... 7 Table EP9 Primary Uni Humeral with Radial Elbow Replacement by Primary Diagnosis... 7 Table EP10 Primary Humeral Hemiarthroplasty by and Gender... 8 Table EP11 Primary Humeral Hemiarthroplasty by Primary Diagnosis... 8 Table EP12 Most Used Humeral Prostheses in Primary Humeral Hemiarthroplasty... 8 Primary Total Elbow Replacement... 9 Table ET1 Primary Total Elbow Replacement by and Gender... 9 Table ET2 Primary Total Elbow Replacement by Primary Diagnosis... 9 Table ET3 Primary Total Elbow without Radial Replacement by and Gender... 10 Table ET4 Primary Total Elbow without Radial Replacement by Primary Diagnosis... 10 Table ET5 Most Used Humeral Prostheses in Primary Total Elbow without Radial Replacement... 10 Table ET6 Primary Total Elbow with Radial Replacement by and Gender... 11 Table ET7 Primary Total Elbow with Radial Replacement by Primary Diagnosis... 11 Table ET8 Most Used Radial Head/Humeral Prostheses in Primary Total Elbow with Radial Elbow Replacement... 11 Revision Elbow Replacement... 12 Table ER1 All Revision Elbow Replacement by and Gender... 12 Table ER2 Type of Revision of All Revision Elbow Replacement... 12 Table ER3 Reason for Revision of All Revision Elbow Replacement... 12 Revision of Known Primary Partial Elbow Replacement... 13 Table EPR1 Revision of Known Primary Radial Elbow Replacement by and Gender... 13 Table EPR2 Type of Revision of Known Primary Radial Elbow Replacement... 13 Table EPR3 Reason for Revision of Known Primary Radial Elbow Replacement... 13 Table EPR4 Revision of Known Primary Uni Humeral with Radial Elbow Replacement by and Gender... 14 Table EPR5 Type of Revision of Known Primary Uni Humeral with Radial Elbow Replacement... 14 Table EPR6 Reason for Revision of Known Primary Uni Humeral with Radial Elbow Replacement... 14 Table EPR7 Revision of Known Primary Humeral Elbow Replacement by and Gender... 15 Table EPR8 Type of Revision of Known Primary Humeral Elbow Replacement... 15 Table EPR9 Reason for Revision of Known Primary Humeral Elbow Replacement... 15 Revision of Known Primary Total Elbow Replacement... 16 Table ETR1 Revision of Known Primary Total Elbow without Radial Replacement by and Gender... 16 Table ETR2 Reason for Revision of Known Primary Total Elbow without Radial Replacement... 16 Table ETR3 Revision of Known Primary Total Elbow with Radial Replacement by and Gender... 17 Table ETR4 Type of Revision of Known Primary Total Elbow with Radial Replacement... 17 Table ETR5 Reason for Revision of Known Primary Total Elbow with Radial Replacement... 17

WRIST REPLACEMENT... 18 Table WG1 Number of Wrist Replacements by Gender... 19 Table WG2 Number of Wrist Replacements by... 19 Table WG3 All Wrist Replacement by and Gender... 19 Table WG4 Revision Rates of Primary Wrist Replacement by Class... 20 Table WG5 Yearly Cumulative Percent Revision of Primary Wrist Replacement by Class... 20 Primary Partial Wrist Replacement... 21 Table WP1 Primary Partial Wrist Replacement by and Gender... 21 Table WP2 Primary Partial Wrist Replacement by Primary Diagnosis... 21 Table WP3 Primary Lunate Wrist Replacement by and Gender... 22 Table WP4 Primary Lunate Wrist Replacement by Primary Diagnosis... 22 Table WP5 Primary Partial Ulna Wrist Replacement by Gender... 22 Table WP6 Primary Partial Ulna Wrist Replacement by Primary Diagnosis... 22 Table WP7 Primary DRUJ with Ulna Only Replacement by and Gender... 23 Table WP8 Primary DRUJ with Ulna Only Replacement by Primary Diagnosis... 23 Table WP9 Most Used Ulna Prostheses in Primary DRUJ with Ulna Only Replacement... 23 Table WP10 Primary DRUJ with Ulna and Radial Replacement by and Gender... 24 Table WP11 Primary DRUJ with Ulna and Radial Replacement by Primary Diagnosis... 24 Table WP12 Primary Scaphoid Interspacer Replacement by and Gender... 24 Table WP13 Primary Scaphoid Interspacer Replacement by Primary Diagnosis... 24 Primary Total Wrist Replacement... 25 Table WT1 Primary Total Wrist Replacement by and Gender... 25 Table WT2 Primary Total Wrist Replacement by Primary Diagnosis... 25 Table WT3 Most Used Carpal/Radial Prostheses in Primary Total Wrist Replacement... 25 Revision Wrist Replacement... 26 Table WR1 All Revision Wrist Replacement by and Gender... 26 Table WR2 Type of Revision of All Revision Wrist Replacement... 26 Table WR3 Reason for Revision of All Revision Wrist Replacement... 26 Revision of Known Primary Partial Wrist Replacement... 27 Table WPR1 Revision of Primary DRUJ with Ulna Only Replacement by and Gender... 27 Table WPR2 Type of Revision of Known Primary DRUJ with Ulna Only Replacement... 27 Table WPR3 Reason for Revision of Known Primary DRUJ with Ulna Only Replacement... 27 Table WTR1 Revision of Known Primary Total Wrist Replacement by and Gender... 28 Table WTR2 Type of Revision of Known Primary Total Wrist Replacement... 28 Table WTR3 Reason for Revision of Known Primary Total Wrist Replacement... 28

LIST OF FIGURES ELBOW REPLACEMENT... 2 Figure EG1 All Elbow Replacement by and Gender... 4 Primary Partial Elbow Replacement... 5 Figure EP1 Primary Partial Elbow Replacement by and Gender... 5 Figure EP2 Primary Radial Elbow Replacement by and Gender... 6 Figure EP3 Primary Uni Humeral Elbow Replacement by and Gender... 7 Figure EP4 Primary Uni Humeral with Radial Elbow Replacement by and Gender... 7 Figure EP5 Primary Humeral Hemiarthroplasty by and Gender... 8 Primary Total Elbow Replacement... 9 Figure ET1 Primary Total Elbow Replacement by and Gender... 9 Figure ET2 Primary Total Elbow without Radial Replacement by and Gender... 10 Figure ET3 Primary Total Elbow with Radial Replacement by and Gender... 11 Revision Elbow Replacement... 12 Revision of Known Primary Partial Elbow Replacement... 13 Figure EPR1 Revision of Known Primary Radial Elbow Replacement by and Gender... 13 Figure EPR2 Revision of Known Primary Uni Humeral with Radial Elbow Replacement by and Gender... 14 Figure EPR3 Revision of Known Primary Humeral Hemiarthroplasty by and Gender... 15 Revision of Known Primary Total Elbow Replacement... 16 Figure ETR1 Revision of Known Primary Total Elbow without Radial Replacement by and Gender... 16 Figure ETR2 Type of Revision of Known Primary Total Elbow without Radial Replacement... 16 Figure ETR3 Revision of Known Primary Total Elbow with Radial Replacement by and Gender... 17 WRIST REPLACEMENT... 18 Figure WG1 All Wrist Replacement by and Gender... 19 Primary Partial Wrist Replacement... 21 Figure WP1 Primary Partial Wrist Replacement by and Gender... 21 Figure WP2 Primary Lunate Wrist Replacement by and Gender... 22 Figure WP3 Primary Partial Ulna Wrist Replacement by and Gender... 22 Figure WP4 Primary DRUJ with Ulna Only Replacement by and Gender... 23 Figure WP5 Primary DRUJ with Ulna and Radial Replacement by and Gender... 24 Figure WP6 Primary Scaphoid Interspacer Replacement by and Gender... 24 Primary Total Wrist Replacement... 25 Figure WT1 Primary Total Wrist Replacement by and Gender... 25 Revision Wrist Replacement... 26 Revision of Known Primary Partial Wrist Replacement... 27 Figure WPR1 Revision of Known Primary DRUJ with Ulna Only Replacement by and Gender... 27 Figure WTR1 Revision of Primary Total Wrist Replacement by and Gender... 28

INTRODUCTION Data presented in this report have been submitted to the Registry by both public and private hospitals. Currently this involves 305 hospitals nationally but varies from time to time due to hospital closures, new hospitals or changes to services within hospitals. Most hospitals began providing data on elbow and wrist arthroplasty procedures on or after the official commencement date of 15 November 2007. The Registry had approval to collect these additional arthroplasty procedures from a number of hospitals prior to the commencement date. These data have also been included. Consequently, there is variation in the starting date for these procedures. The following table shows the reporting period for each type of joint replacement. TYPE OF JOINT REPLACEMENT START OF REPORTING PERIOD END OF REPORTING PERIOD Elbow 2 May 2005 31 December 2014 Wrist 7 July 2006 31 December 2014 End Data Period: 31 Dec 2014 Page 1

ELBOW REPLACEMENT Categories of Elbow Replacement The Registry groups elbow replacement into three broad categories, primary partial, primary total and revision elbow replacement. A primary replacement is the initial replacement procedure undertaken on a joint and involves replacing either part (partial) or all (total) of the articular surface. Primary partial and primary total elbow replacement are further sub-categorised into classes depending on the type of prostheses used. Partial elbow classes are radial, uni humeral, uni humeral plus radial and humeral elbow replacement. Total elbow classes are total and total plus radial elbow replacement. Definitions for each of these are detailed in the relevant chapters. Revision procedures are re-operations of previous elbow replacements where one or more of the prosthetic components are replaced, removed, or another component is added. Revisions include reoperations of primary partial, primary total or previous revision procedures. Elbow revisions are sub-categorised into three classes, minor, major partial and major total revisions. These are defined in the chapter on revisions. ELBOW REPLACEMENT PARTIAL TOTAL REVISION RADIAL MINOR UNI HUMERAL TOTAL MAJOR PARTIAL UNI HUMERAL WITH RADIAL TOTAL WITH RADIAL MAJOR TOTAL HUMERAL HEMIARTHROPLASTY End Data Period: 31 Dec 2014 Page 2

Demographics Table EG1 Number of Elbow Replacements by Gender TOTAL Elbow Replacement N % N % N % Radial 667 57.1 501 42.9 1168 88.4 Uni Humeral 5 71.4 2 28.6 7 0.5 Uni Humeral & Radial 7 38.9 11 61.1 18 1.4 Humeral Hemiarthroplasty 109 84.5 20 15.5 129 9.8 Primary Partial 788 59.6 534 40.4 1322 100.0 Total Elbow 555 74.7 188 25.3 743 95.6 Total Elbow & Radial 19 55.9 15 44.1 34 4.4 Primary Total 574 73.9 203 26.1 777 100.0 Revision 258 61.7 160 38.3 418 100.0 TOTAL 1620 64.4 897 35.6 2517 100.0 Table EG2 Number of Elbow Replacements by <55 55-64 65-74 75-84 85 TOTAL Elbow Replacement N % N % N % N % N % N % Radial 638 54.6 275 23.5 180 15.4 65 5.6 10 0.9 1168 88.4 Uni Humeral 7 100.0........ 7 0.5 Uni Humeral & Radial 9 50.0 5 27.8 3 16.7 1 5.6.. 18 1.4 Humeral Hemiarthroplasty 26 20.2 32 24.8 25 19.4 27 20.9 19 14.7 129 9.8 Primary Partial 680 51.4 312 23.6 208 15.7 93 7.0 29 2.2 1322 100.0 Total Elbow 87 11.7 147 19.8 207 27.9 215 28.9 87 11.7 743 95.6 Total Elbow & Radial 5 14.7 9 26.5 13 38.2 7 20.6.. 34 4.4 Primary Total 92 11.8 156 20.1 220 28.3 222 28.6 87 11.2 777 100.0 Revision 116 27.8 100 23.9 114 27.3 75 17.9 13 3.1 418 100.0 TOTAL 888 35.3 568 22.6 542 21.5 390 15.5 129 5.1 2517 100.0 Table EG3 Time between Procedures for Bilateral Primary Elbow Replacement Same Day 1day-6months 6months TOTAL Bilateral Procedures N Total% N Total% N Total% N Total% Both - Radial 4 8.2.... 4 8.2 Both - Total Elbow.. 8 16.3 36 73.5 44 89.8 Uni Humeral & Radial & Total Elbow.... 1 2.0 1 2.0 TOTAL 4 8.2 8 16.3 37 75.5 49 100.0 Table EG4 All Elbow Replacement by and Gender 1620 64.4% 16 99 65 63.3 15.1 897 35.6% 15 102 53 53.1 17.4 TOTAL 2517 100. 15 102 61 59.7 16.7 End Data Period: 31 Dec 2014 Page 3

Figure EG1 All Elbow Replacement by and Gender 5 45% 4 35% 3 25% 2 15% 5% Table EG5 Revision Rates of Primary Elbow Replacement by Elbow Class Elbow Class N Revised N Total Obs. Years Revisions/100 Obs. Yrs (95% CI) Radial 33 1168 4016 0.82 (0.57, 1.15) Uni Humeral 0 7 29 0.00 (0.00, 12.68) Uni Humeral & Radial 6 18 48 12.49 (4.58, 27.19) Humeral Hemiarthroplasty 10 129 382 2.62 (1.25, 4.81) Total Elbow 63 743 2367 2.66 (2.04, 3.40) Total Elbow & Radial 7 34 131 5.35 (2.15, 11.02) TOTAL 119 2099 6974 1.71 (1.41, 2.04) Table EG6 Yearly Cumulative Percent Revision of Primary Elbow Replacement by Elbow Class CPR 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs 6 Yrs 7 Yrs Radial 1.7 (1.1, 2.7) 3.0 (2.1, 4.2) 3.2 (2.3, 4.5) 3.2 (2.3, 4.5) 3.2 (2.3, 4.5) 3.2 (2.3, 4.5) Uni Humeral 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) Uni Humeral & Radial 17.5 (6.0, 45.1) 23.8 (9.6, 51.9) 39.0 (19.4, 67.8) 39.0 (19.4, 67.8) Humeral Hemiarthroplasty 4.1 (1.7, 9.5) 6.1 (2.9, 12.4) 8.9 (4.6, 16.7) Total Elbow 2.9 (1.9, 4.5) 4.8 (3.4, 6.8) 8.3 (6.2, 10.9) 10.6 (8.1, 13.7) 10.9 (8.4, 14.1) 14.0 (10.6, 18.4) Total Elbow & Radial 5.9 (1.5, 21.5) 16.3 (7.1, 35.1) 20.1 (9.5, 39.7) 24.1 (12.2, 44.4) 24.1 (12.2, 44.4) 24.1 (12.2, 44.4) End Data Period: 31 Dec 2014 Page 4

Primary Partial Elbow Replacement Demographics The Registry sub-categorises primary partial shoulder replacement into three classes. These are defined as: 1. Radial involves resection of the radial head and replacement with a stemmed radial prosthesis. 2. Uni humeral involves replacement of the capitellum. 3. Uni humeral with radial involves replacement of the capitellum and radial head. 4. Humeral Hemiarthroplasty involves resection of the distal humerus and replacement with a stemmed humeral prosthesis. Table EP1 Primary Partial Elbow Replacement by and Gender 788 59.6% 16 99 59 58.1 15.1 534 40.4% 15 102 46 45.6 15.0 TOTAL 1322 100. 15 102 54 53.1 16.2 Figure EP1 Primary Partial Elbow Replacement by and Gender Table EP2 Primary Partial Elbow Replacement by Primary Diagnosis 6 5 Primary Diagnosis Number Percent Fracture/Dislocation 1176 89.0 4 3 Osteoarthritis 115 8.7 Instability 13 1.0 Rheumatoid Arthritis 5 0.4 2 Osteonecrosis 5 0.4 Tumour 3 0.2 Other Inflammatory Arthritis 2 0.2 Other 3 0.2 TOTAL 1322 100.0 End Data Period: 31 Dec 2014 Page 5

Primary Radial Elbow Replacement Table EP3 Primary Radial Elbow Replacement by and Gender 667 57.1% 16 90 58 56.6 14.3 501 42.9% 15 102 45 45.0 14.8 TOTAL 1168 100. 15 102 53 51.6 15.6 Figure EP2 Primary Radial Elbow Replacement by and Gender Table EP4 Primary Radial Elbow Replacement by Primary Diagnosis 6 5 4 3 Primary Diagnosis Number Percent Fracture/Dislocation 1053 90.2 Osteoarthritis 91 7.8 Instability 13 1.1 Rheumatoid Arthritis 2 0.2 2 Tumour 2 0.2 Other Inflammatory Arthritis 2 0.2 Osteonecrosis 2 0.2 Other 3 0.3 TOTAL 1168 100.0 Table EP5 Most Used Radial Head/Stem Prostheses in Primary Radial Elbow Replacement 2010 2011 2012 2013 2014 N Model N Model N Model N Model N Model 50 Evolve 53 Anatomic 59 48 Radial Stem (Ascension) 37 Anatomic 41 Radial Stem (Ascension) 45 Evolve 51 Evolve 41 Radial Stem (Ascension) 48 Anatomic 50 Anatomic Radial Stem (Ascension) 40 Radial Stem (Ascension) 49 Anatomic 40 Evolve 28 Evolve 21 MOPYC 19 MOPYC 22 MOPYC 18 MOPYC 24 MOPYC 10 RHS 6 rhead 4 rhead 2 ExploR 2 rhead 4 rhead 3 RHS 3 RHS 1 RHS 1 Custom Made (ExploR) 3 ExploR 1 ExploR 1 Generic Radial Stem 1 ExploR 1 Solar 1 Solar 1 RHS 1 Swanson Ten Most Used 173 (7) 100. 170 (9) 100. 190 (8) 100. 150 (6) 100. 147 (8) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 173 (7) 100. 170 (9) 100. 190 (8) 100. 150 (6) 100. 147 (8) 100. End Data Period: 31 Dec 2014 Page 6

Primary Uni Humeral Elbow Replacement Table EP6 Primary Uni Humeral Elbow Replacement by and Gender 5 71.4% 27 54 47 44.4 11.3 2 28.6% 47 52 50 49.5 3.5 TOTAL 7 100. 27 54 47 45.9 9.7 Figure EP3 Primary Uni Humeral Elbow Replacement by and Gender Table EP7 Primary Uni Humeral Elbow Replacement Primary Diagnosis 6 5 4 3 2 Primary Diagnosis Number Percent Osteoarthritis 3 42.9 Fracture/Dislocation 3 42.9 Osteonecrosis 1 14.3 TOTAL 7 100.0 Primary Uni Humeral with Radial Elbow Replacement Table EP8 Primary Uni Humeral with Radial Elbow Replacement by and Gender 7 38.9% 22 83 54 55.7 20.4 11 61.1% 31 67 56 53.3 9.7 TOTAL 18 100. 22 83 55 54.2 14.3 Figure EP4 Primary Uni Humeral with Radial Elbow Replacement by and Gender Table EP9 Primary Uni Humeral with Radial Elbow Replacement by Primary Diagnosis 6 5 4 3 2 Primary Diagnosis Number Percent Osteoarthritis 15 83.3 Osteonecrosis 2 11.1 Fracture/Dislocation 1 5.6 TOTAL 18 100.0 End Data Period: 31 Dec 2014 Page 7

Primary Humeral Hemiarthroplasty Table EP10 Primary Humeral Hemiarthroplasty by and Gender 109 84.5% 18 99 68 68.7 15.0 20 15.5% 22 87 58 55.9 17.3 TOTAL 129 100. 18 99 66 66.7 16.0 Figure EP5 Primary Humeral Hemiarthroplasty by and Gender Table EP11 Primary Humeral Hemiarthroplasty by Primary Diagnosis 6 5 4 3 2 Primary Diagnosis Number Percent Fracture/Dislocation 119 92.2 Osteoarthritis 6 4.7 Rheumatoid Arthritis 3 2.3 Tumour 1 0.8 TOTAL 129 100.0 Table EP12 Most Used Humeral Prostheses in Primary Humeral Hemiarthroplasty 2010 2011 2012 2013 2014 N Model N Model N Model N Model N Model 16 Latitude 21 Latitude 20 Latitude 22 Latitude 15 Latitude Ten Most Used 16 (1) 100. 21 (1) 100. 20 (1) 100. 22 (1) 100. 15 (1) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 16 (1) 100. 21 (1) 100. 20 (1) 100. 22 (1) 100. 15 (1) 100. End Data Period: 31 Dec 2014 Page 8

Primary Total Elbow Replacement Demographics The Registry sub-categorises primary total elbow replacement into two classes. These are defined as: 1. Total elbow without radial includes resection of the olecranon and distal humerus and replacement with a stemmed ulna and stemmed humeral prosthesis. 2. Total elbow with radial includes resection of the olecranon and distal humerus and replacement with a stemmed ulna and stemmed humeral prosthesis combined with replacement of the radial head with a radial prosthesis. Table ET1 Primary Total Elbow Replacement by and Gender 574 73.9% 24 96 72 70.4 12.5 203 26.1% 30 92 69 67.6 13.3 TOTAL 777 100. 24 96 71 69.7 12.7 Figure ET1 Primary Total Elbow Replacement by and Gender Table ET2 Primary Total Elbow Replacement by Primary Diagnosis 6 5 4 Primary Diagnosis Number Percent Osteoarthritis 261 33.6 Fracture/Dislocation 252 32.4 Rheumatoid Arthritis 229 29.5 3 Other Inflammatory Arthritis 22 2.8 2 Instability 4 0.5 Tumour 3 0.4 Osteonecrosis 2 0.3 Other 4 0.5 TOTAL 777 100.0 End Data Period: 31 Dec 2014 Page 9

Primary Total Elbow without Radial Replacement Table ET3 Primary Total Elbow without Radial Replacement by and Gender 555 74.7% 24 96 72 70.6 12.5 188 25.3% 30 92 70 67.8 13.4 TOTAL 743 100. 24 96 72 69.9 12.8 Figure ET2 Primary Total Elbow without Radial Replacement by and Gender Table ET4 Primary Total Elbow without Radial Replacement by Primary Diagnosis 6 5 Primary Diagnosis Number Percent Fracture/Dislocation 249 33.5 4 3 Osteoarthritis 242 32.6 Rheumatoid Arthritis 219 29.5 Other Inflammatory Arthritis 21 2.8 2 Tumour 3 0.4 Instability 3 0.4 Osteonecrosis 2 0.3 Other 4 0.5 TOTAL 743 100.0 Table ET5 Most Used Humeral Prostheses in Primary Total Elbow without Radial Replacement 2010 2011 2012 2013 2014 N Model N Model N Model N Model N Model 61 Coonrad/Morrey 67 Coonrad/Morrey 68 Coonrad/Morrey 59 Coonrad/Morrey 61 Coonrad/Morrey 22 Latitude 26 Latitude 26 Latitude 21 Latitude 19 Latitude 10 Discovery 8 Discovery 14 Discovery 9 Nexel 14 Nexel 1 IBP 2 Souter Strathclyde 1 Souter Strathclyde 4 Discovery 11 Discovery 1 Souter Strathclyde Ten Most Used 95 (5) 100. 103 (4) 100. 109 (4) 100. 93 (4) 100. 105 (4) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 95 (5) 100. 103 (4) 100. 109 (4) 100. 93 (4) 100. 105 (4) 100. End Data Period: 31 Dec 2014 Page 10

Primary Total Elbow with Radial Replacement Table ET6 Primary Total Elbow with Radial Replacement by and Gender 19 55.9% 42 80 68 64.6 10.5 15 44.1% 45 83 67 65.8 11.3 TOTAL 34 100. 42 83 67 65.1 10.7 Figure ET3 Primary Total Elbow with Radial Replacement by and Gender Table ET7 Primary Total Elbow with Radial Replacement by Primary Diagnosis 6 5 4 3 2 Primary Diagnosis Number Percent Osteoarthritis 19 55.9 Rheumatoid Arthritis 10 29.4 Fracture/Dislocation 3 8.8 Other Inflammatory Arthritis 1 2.9 Instability 1 2.9 TOTAL 34 100.0 Table ET8 Most Used Radial Head/Humeral Prostheses in Primary Total Elbow with Radial Elbow Replacement 2010 2011 2012 2013 2014 N Model N Model N Model N Model N Model 6 Latitude 2 Latitude 2 Latitude 1 Latitude 3 Latitude Ten Most Used 6 (1) 100. 2 (1) 100. 2 (1) 100. 1 (1) 100. 3 (1) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 6 (1) 100. 2 (1) 100. 2 (1) 100. 1 (1) 100. 3 (1) 100. End Data Period: 31 Dec 2014 Page 11

Revision Elbow Replacement Demographics The Registry sub-categorises elbow revisions into three classes. These are defined as: 1. Major total revision is the insertion, removal and/or replacement of a major component on both the proximal and distal side of the joint. 2. Major partial revision is the insertion, removal and/or replacement of a major component on either the proximal or distal side of the joint. Major components are prostheses that are fixed to bone. These are the humeral prosthesis and the ulna prosthesis in elbow replacement. Although the radial prosthesis is fixed to bone, it is not considered a major prosthesis. Different types of major partial and minor revisions are identified based on the specific prostheses or implants used in the revision. 3. Minor revision is the insertion, removal and/or replacement of any other prostheses or implant in elbow replacement. Table ER1 All Revision Elbow Replacement by and Gender 258 61.7% 21 94 65 63.3 14.1 160 38.3% 20 97 62 59.5 15.4 TOTAL 418 100. 20 97 64 61.9 14.7 Table ER2 Type of Revision of All Revision Elbow Replacement Table ER3 Reason for Revision of All Revision Elbow Replacement Revision Type Number Percent Humeral/Ulnar 115 27.5 Radial Component 68 16.3 Humeral Component 58 13.9 Elbow Pin Only 51 12.2 Ulna Component 38 9.1 Cement Spacer 24 5.7 Removal of Prostheses 22 5.3 Radial Head Only 8 1.9 Reoperation 8 1.9 Ulna Cap Only 7 1.7 Radial Neck Only 7 1.7 Uni Humeral/Radius 3 0.7 Reinsertion of Components 3 0.7 Radial/Ulnar 2 0.5 Cement Only 2 0.5 Minor Components 2 0.5 TOTAL 418 100.0 Revision Diagnosis Number Percent Loosening/Lysis 141 33.7 Infection 102 24.4 Fracture 54 12.9 Instability 31 7.4 Prosthesis Dislocation 13 3.1 Pain 11 2.6 Progression Of Disease 6 1.4 Implant Breakage Ulna 5 1.2 Implant Breakage Humeral 5 1.2 Malposition 5 1.2 Incorrect Sizing 5 1.2 Arthrofibrosis 4 1.0 Metal Related Pathology 3 0.7 Heterotopic Bone 2 0.5 Synovitis 1 0.2 Wear Humeral 1 0.2 Wear Ulna 1 0.2 Implant Wear Pin/Bushing 1 0.2 Other 27 6.5 TOTAL 418 100.0 End Data Period: 31 Dec 2014 Page 12

Revision of Known Primary Partial Elbow Replacement Known Primary Radial Elbow Replacement Table EPR1 Revision of Known Primary Radial Elbow Replacement by and Gender 19 57.6% 27 77 53 53.2 14.5 14 42.4% 20 66 50 47.3 12.2 TOTAL 33 100. 20 77 52 50.7 13.7 Figure EPR1 Revision of Known Primary Radial Elbow Replacement by and Gender Table EPR2 Type of Revision of Known Primary Radial Elbow Replacement 10 9 8 7 6 5 4 3 2 Type of Revision Number Percent Radial Component 16 48.5 Humeral/Ulnar 8 24.2 Radial Neck Only 3 9.1 Removal of Prostheses 2 6.1 Uni Humeral/Radius 1 3.0 Reinsertion of Components 1 3.0 Reoperation 1 3.0 Radial Head Only 1 3.0 TOTAL 33 100.0 Table EPR3 Reason for Revision of Known Primary Radial Elbow Replacement Reason for Revision Number Percent Loosening/Lysis 9 27.3 Instability 7 21.2 Fracture 4 12.1 Infection 3 9.1 Incorrect Sizing 3 9.1 Pain 2 6.1 Arthrofibrosis 1 3.0 Prosthesis Dislocation 1 3.0 Progression Of Disease 1 3.0 Other 2 6.1 TOTAL 33 100.0 End Data Period: 31 Dec 2014 Page 13

Known Primary Uni Humeral with Radial Elbow Replacement Table EPR4 Revision of Known Primary Uni Humeral with Radial Elbow Replacement by and Gender 3 50. 55 71 70 65.3 9.0 3 50. 53 64 61 59.3 5.7 TOTAL 6 100. 53 71 63 62.3 7.5 Table EPR5 Type of Revision of Known Primary Uni Humeral with Radial Elbow Replacement Figure EPR2 10 9 8 7 6 5 4 3 2 Revision of Known Primary Uni Humeral with Radial Elbow Replacement by and Gender Type of Revision Number Percent Humeral/Ulnar 3 50.0 Removal of Prostheses 2 33.3 Radial Component 1 16.7 TOTAL 6 100.0 Table EPR6 Reason for Revision of Known Primary Uni Humeral with Radial Elbow Replacement Reason for Revision Number Percent Loosening/Lysis 4 66.7 Fracture 1 16.7 Progression Of Disease 1 16.7 TOTAL 6 100.0 End Data Period: 31 Dec 2014 Page 14

Known Primary Humeral Elbow Replacement Table EPR7 Revision of Known Primary Humeral Elbow Replacement by and Gender 8 80. 34 88 56 58.9 16.4 2 20. 33 40 37 36.5 4.9 TOTAL 10 100. 33 88 54 54.4 17.3 Figure EPR3 Revision of Known Primary Humeral Elbow Replacement by and Gender Table EPR8 Type of Revision of Known Primary Humeral Elbow Replacement 6 5 4 3 2 Type of Revision Number Percent Ulna Component 6 60.0 Humeral/Ulnar 1 10.0 Radial/Ulnar 1 10.0 Reinsertion of Components 1 10.0 Cement Spacer 1 10.0 TOTAL 10 100.0 Table EPR9 Reason for Revision of Known Primary Humeral Elbow Replacement Reason for Revision Number Percent Instability 4 40.0 Infection 2 20.0 Loosening/Lysis 1 10.0 Prosthesis Dislocation 1 10.0 Pain 1 10.0 Progression Of Disease 1 10.0 TOTAL 10 100.0 End Data Period: 31 Dec 2014 Page 15

Revision of Known Primary Total Elbow Replacement Known Primary Total Elbow without Radial Replacement Table ETR1 Revision of Known Primary Total Elbow without Radial Replacement by and Gender 42 66.7% 30 85 69 66.0 12.7 21 33.3% 31 89 71 67.7 13.9 TOTAL 63 100. 30 89 69 66.6 13.0 Figure ETR1 6 5 4 3 2 Revision of Known Primary Total Elbow without Radial Replacement by and Gender Figure ETR2 Type of Revision of Known Primary Total Elbow without Radial Replacement Type of Revision Number Percent Humeral Component 15 23.8 Humeral/Ulnar 11 17.5 Ulna Component 10 15.9 Cement Spacer 9 14.3 Elbow Pin Only 9 14.3 Radial Component 2 3.2 Reoperation 2 3.2 Ulna Cap Only 2 3.2 Removal of Prostheses 2 3.2 Minor Components 1 1.6 TOTAL 63 100.0 Table ETR2 Reason for Revision of Known Primary Total Elbow without Radial Replacement Reason for Revision Number Percent Infection 23 36.5 Loosening/Lysis 18 28.6 Fracture 9 14.3 Malposition 3 4.8 Progression Of Disease 2 3.2 Instability 1 1.6 Prosthesis Dislocation 1 1.6 Metal Related Pathology 1 1.6 Arthrofibrosis 1 1.6 Other 4 6.3 TOTAL 63 100.0 End Data Period: 31 Dec 2014 Page 16

Known Primary Total Elbow with Radial Replacement Table ETR3 Revision of Known Primary Total Elbow with Radial Replacement by and Gender 4 57.1% 62 82 70 71.0 8.4 3 42.9% 59 68 64 63.7 4.5 TOTAL 7 100. 59 82 68 67.9 7.6 Table ETR4 Type of Revision of Known Primary Total Elbow with Radial Replacement Figure ETR3 7 6 5 Revision of Known Primary Total Elbow with Radial Replacement by and Gender Type of Revision Number Percent Humeral/Ulnar 2 28.6 Radial Head Only 2 28.6 Removal of Prostheses 1 14.3 Cement Spacer 1 14.3 Ulna Cap Only 1 14.3 TOTAL 7 100.0 4 3 2 Table ETR5 Reason for Revision of Known Primary Total Elbow with Radial Replacement Reason for Revision Number Percent Infection 3 42.9 Instability 2 28.6 Prosthesis Dislocation 1 14.3 Loosening/Lysis 1 14.3 TOTAL 7 100.0 End Data Period: 31 Dec 2014 Page 17

WRIST REPLACEMENT Categories of Wrist Replacement The Registry groups wrist replacement into three broad categories, primary partial, primary total and revision wrist replacement. A primary replacement is the initial replacement procedure undertaken on a joint and involves replacing either part (partial) or all (total) of the articular surface. Primary partial wrist replacement is further subcategorised into four classes depending on the type of prostheses used. Partial wrist classes are lunate, partial ulna, distal radial ulna joint (DRUJ) with ulna only replacement and DRUJ with ulna and radial replacement. Definitions for each of these are detailed in the relevant chapters. Revision procedures are re-operations of previous wrist replacements where one or more of the prosthetic components are replaced, removed, or another component is added. Revisions include re-operations of primary partial, primary total or previous revision procedures. Wrist revisions are sub-categorised into three classes, minor, major partial and major total revisions. These are defined in the chapter on revisions. WRIST REPLACEMENT PARTIAL TOTAL REVISION LUNATE PARTIAL ULNA MINOR DRUJ WITH ULNA ONLY REPLACEMENT TOTAL MAJOR PARTIAL DRUJ WITH ULNA AND RADIAL REPLACEMENT MAJOR TOTAL SCAPHOID INTERSPACER REPLACEMENT End Data Period: 31 Dec 2014 Page 18

Demographics Table WG1 Number of Wrist Replacements by Gender TOTAL Wrist Replacement N % N % N % Lunate 2 40.0 3 60.0 5 3.5 Partial Ulnar 13 72.2 5 27.8 18 12.8 DRUJ - Ulnar Only 44 56.4 34 43.6 78 55.3 DRUJ - Ulnar & Radial 4 26.7 11 73.3 15 10.6 Scaphoid Interspacer 6 24.0 19 76.0 25 17.7 Primary Partial 69 48.9 72 51.1 141 100.0 Primary Total 53 64.6 29 35.4 82 100.0 Revision 21 75.0 7 25.0 28 100.0 TOTAL 143 57.0 108 43.0 251 100.0 Table WG2 Number of Wrist Replacements by <55 55-64 65-74 75-84 85 TOTAL Wrist Replacement N % N % N % N % N % N % Lunate 3 60.0 2 40.0...... 5 3.5 Partial Ulnar 4 22.2 8 44.4 1 5.6 4 22.2 1 5.6 18 12.8 DRUJ - Ulnar Only 28 35.9 16 20.5 18 23.1 15 19.2 1 1.3 78 55.3 DRUJ - Ulnar & Radial 4 26.7 5 33.3 3 20.0 3 20.0.. 15 10.6 Scaphoid Interspacer 13 52.0 7 28.0 3 12.0 2 8.0.. 25 17.7 Primary Partial 52 36.9 38 27.0 25 17.7 24 17.0 2 1.4 141 100.0 Primary Total 21 25.6 25 30.5 20 24.4 14 17.1 2 2.4 82 100.0 Revision 10 35.7 9 32.1 5 17.9 4 14.3.. 28 100.0 TOTAL 83 33.1 72 28.7 50 19.9 42 16.7 4 1.6 251 100.0 Table WG3 All Wrist Replacement by and Gender 143 57. 21 85 63 60.5 15.0 108 43. 18 87 57 57.1 16.0 TOTAL 251 100. 18 87 61 59.1 15.5 Figure WG1 All Wrist Replacement by and Gender 6 5 4 3 2 End Data Period: 31 Dec 2014 Page 19

Table WG4 Revision Rates of Primary Wrist Replacement by Class Wrist Class N Revised N Total Obs. Years Revisions/100 Obs. Yrs (95% CI) Lunate 1 5 12 8.12 (0.21, 45.22) Partial Ulnar 0 18 58 0.00 (0.00, 6.33) DRUJ - Ulnar Only 6 78 265 2.26 (0.83, 4.92) DRUJ - Ulnar & Radial 0 15 39 0.00 (0.00, 9.44) Scaphoid Interspacer 0 25 66 0.00 (0.00, 5.56) Total Wrist 3 82 312 0.96 (0.20, 2.81) TOTAL 10 223 754 1.33 (0.64, 2.44) Table WG5 Yearly Cumulative Percent Revision of Primary Wrist Replacement by Class CPR 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs DRUJ - Ulnar Only 4.2 (1.4, 12.4) 7.4 (3.1, 16.8) 7.4 (3.1, 16.8) 9.7 (4.4, 20.7) 9.7 (4.4, 20.7) 9.7 (4.4, 20.7) Scaphoid Interspacer 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) Total Wrist 0.0 (0.0, 0.0) 3.0 (0.8, 11.5) 3.0 (0.8, 11.5) 3.0 (0.8, 11.5) 3.0 (0.8, 11.5) 8.4 (2.2, 29.1) Other (3) 2.7 (0.4, 17.7) 2.7 (0.4, 17.7) 2.7 (0.4, 17.7) 2.7 (0.4, 17.7) 2.7 (0.4, 17.7) Note: Only Wrist Classes with over 20 procedures have been listed End Data Period: 31 Dec 2014 Page 20

Primary Partial Wrist Replacement Demographics The Registry sub-categorises primary partial wrist replacement into five classes. These are defined as: 1. Lunate involves replacement of the lunate bone with a lunate prosthesis. 2. Partial Ulna involves the replacement of part of the distal ulnar surface with a stemmed ulnar prosthesis. 4. Distal Radial Ulna Joint (DRUJ) with ulna and radial replacement involves resection of the ulna head and replacement with a stemmed ulna prosthesis and a distal radial notch and plate. 5. Scaphoid Interspacer is used to replace the proximal pole in the scaphoid. 3. Distal Radial Ulna Joint (DRUJ) with ulna only replacement involves resection of the ulna head and replacement with a stemmed ulna prosthesis. Table WP1 Primary Partial Wrist Replacement by and Gender 69 48.9% 21 85 63 60.6 16.0 72 51.1% 18 83 57 55.8 16.7 TOTAL 141 100. 18 85 59 58.1 16.5 Figure WP1 Primary Partial Wrist Replacement by and Gender Table WP2 Primary Partial Wrist Replacement by Primary Diagnosis 6 5 4 3 Primary Diagnosis Number Percent Osteoarthritis 88 62.4 Fracture/Dislocation 19 13.5 Rheumatoid Arthritis 19 13.5 Instability 7 5.0 2 Osteonecrosis 3 2.1 Tumour 1 0.7 Other Inflammatory Arthritis 1 0.7 Other 3 2.1 TOTAL 141 100.0 End Data Period: 31 Dec 2014 Page 21

Primary Lunate Wrist Replacement Table WP3 Primary Lunate Wrist Replacement by and Gender 2 40. 21 57 39 39.0 25.5 3 60. 22 57 27 35.3 18.9 TOTAL 5 100. 21 57 27 36.8 18.6 Figure WP2 Primary Lunate Wrist Replacement by and Gender Table WP4 Primary Lunate Wrist Replacement by Primary Diagnosis 8 7 6 5 4 3 2 Primary Diagnosis Number Percent Osteonecrosis 3 60.0 Fracture/Dislocation 1 20.0 Osteoarthritis 1 20.0 TOTAL 5 100.0 Primary Partial Ulna Wrist Replacement Table WP5 Primary Partial Ulna Wrist Replacement by Gender 13 72.2% 35 85 63 60.6 16.1 5 27.8% 49 77 63 63.6 10.2 TOTAL 18 100. 35 85 63 61.4 14.5 Figure WP3 Primary Partial Ulna Wrist Replacement by and Gender Table WP6 Primary Partial Ulna Wrist Replacement by Primary Diagnosis 6 5 4 3 2 Primary Diagnosis Number Percent Osteoarthritis 12 66.7 Rheumatoid Arthritis 3 16.7 Fracture/Dislocation 2 11.1 Instability 1 5.6 TOTAL 18 100.0 End Data Period: 31 Dec 2014 Page 22

Primary DRUJ with Ulna Only Replacement Table WP7 Primary DRUJ with Ulna Only Replacement by and Gender 44 56.4% 26 85 64 61.1 15.7 34 43.6% 19 83 60 59.5 16.0 TOTAL 78 100. 19 85 62 60.4 15.7 Figure WP4 Primary DRUJ with Ulna Only Replacement by and Gender Table WP8 Primary DRUJ with Ulna Only Replacement by Primary Diagnosis 6 5 Primary Diagnosis Number Percent Osteoarthritis 52 66.7 4 3 Rheumatoid Arthritis 12 15.4 Fracture/Dislocation 8 10.3 Instability 2 2.6 2 Tumour 1 1.3 Other Inflammatory Arthritis 1 1.3 Other 2 2.6 TOTAL 78 100.0 Table WP9 Most Used Ulna Prostheses in Primary DRUJ with Ulna Only Replacement 2010 2011 2012 2013 2014 N Model N Model N Model N Model N Model 5 uhead 3 DRUJ (Ascension) 7 uhead 5 Herbert UHP 5 Herbert UHP 4 Herbert UHP 2 Herbert UHP 5 Herbert UHP 2 Eclypse 3 DRUJ (Ascension) 3 DRUJ (Ascension) 1 E-Centrix 3 DRUJ (Ascension) 2 Eclypse 1 Eclypse 1 uhead 1 uhead Ten Most Used 13 (4) 100. 7 (4) 100. 15 (3) 100. 7 (2) 100. 11 (4) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 13 (4) 100. 7 (4) 100. 15 (3) 100. 7 (2) 100. 11 (4) 100. End Data Period: 31 Dec 2014 Page 23

Primary DRUJ with Ulna and Radial Replacement Table WP10 Primary DRUJ with Ulna and Radial Replacement by and Gender 4 26.7% 45 77 69 64.8 14.2 11 73.3% 43 81 63 61.1 12.1 TOTAL 15 100. 43 81 64 62.1 12.3 Figure WP5 Primary DRUJ with Ulna and Radial Replacement by and Gender Table WP11 Primary DRUJ with Ulna and Radial Replacement by Primary Diagnosis 6 5 4 3 2 Primary Diagnosis Number Percent Osteoarthritis 6 40.0 Instability 3 20.0 Fracture/Dislocation 3 20.0 Rheumatoid Arthritis 2 13.3 Other 1 6.7 TOTAL 15 100.0 Primary Scaphoid Interspacer Replacement Table WP12 Primary Scaphoid Interspacer Replacement by and Gender 6 24. 31 77 62 60.5 16.4 19 76. 18 79 49 47.4 16.9 TOTAL 25 100. 18 79 51 50.5 17.4 Figure WP6 Primary Scaphoid Interspacer Replacement by and Gender Table WP13 Primary Scaphoid Interspacer Replacement by Primary Diagnosis 6 5 4 3 2 Primary Diagnosis Number Percent Osteoarthritis 17 68.0 Fracture/Dislocation 5 20.0 Rheumatoid Arthritis 2 8.0 Instability 1 4.0 TOTAL 25 100.0 End Data Period: 31 Dec 2014 Page 24

Primary Total Wrist Replacement Demographics The Registry sub-categorises primary total wrist replacement into one class. This is defined as: 1. Total Wrist includes resection of the distal radius and replacement with a radial prosthesis combined with replacement of the carpal bones with a carpal prosthesis and carpal spacer. Table WT1 Primary Total Wrist Replacement by and Gender 53 64.6% 22 80 64 62.0 12.9 29 35.4% 29 87 59 60.6 13.5 TOTAL 82 100. 22 87 62 61.5 13.0 Figure WT1 Primary Total Wrist Replacement by and Gender Table WT2 Primary Total Wrist Replacement by Primary Diagnosis 6 5 Primary Diagnosis Number Percent Osteoarthritis 44 53.7 4 3 Rheumatoid Arthritis 29 35.4 Fracture/Dislocation 4 4.9 Other Inflammatory Arthritis 3 3.7 2 Osteonecrosis 1 1.2 Other 1 1.2 TOTAL 82 100.0 Table WT3 Most Used Carpal/Radial Prostheses in Primary Total Wrist Replacement 2010 2011 2012 2013 2014 N Model N Model N Model N Model N Model 10 Re-Motion 10 Re-Motion 5 Re-Motion 7 Re-Motion 4 Re-Motion 4 Universal 2 3 Universal 2 1 Universal 2 3 Universal 2 3 Motec 2 Universal 2 Ten Most Used 14 (2) 100. 13 (2) 100. 6 (2) 100. 10 (2) 100. 9 (3) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 14 (2) 100. 13 (2) 100. 6 (2) 100. 10 (2) 100. 9 (3) 100. End Data Period: 31 Dec 2014 Page 25

Revision Wrist Replacement Demographics The Registry sub-categorises wrist revisions into three classes. These are defined as: 1. Major total revision is the insertion, removal and/or replacement of a major component on both the proximal and distal side of the joint. 2. Major partial revision is the insertion, removal and/or replacement of a major component on either the proximal or the distal side of the joint. 3. Minor revision is the insertion removal and/or replacement of any other prostheses or implant in wrist replacement. Major components are prostheses that are fixed to bone. These are the radial prosthesis and the carpal prosthesis in wrist replacement. The ulna and individual carpal prostheses are not considered major prostheses. Different types of major partial and minor revisions are identified based on the specific prostheses or implants used in the revision. Table WR1 All Revision Wrist Replacement by and Gender 21 75. 32 84 60 56.6 16.7 7 25. 22 83 57 56.1 18.1 TOTAL 28 100. 22 84 59 56.5 16.7 Table WR2 Type of Revision of All Revision Wrist Replacement Table WR3 Reason for Revision of All Revision Wrist Replacement Revision Type Number Percent Removal of Prostheses 7 25.0 Ulna Component 4 14.3 Ulna Head Only 3 10.7 Carpal Component 3 10.7 Sigmoid Notch 3 10.7 Reoperation Fusion 2 7.1 Carpal/Radius 2 7.1 Cement Spacer 1 3.6 Carpal Insert 1 3.6 Sigmoid Notch/Ulna 1 3.6 Unclassified - No components 1 3.6 TOTAL 28 100.0 Revision Diagnosis Number Percent Loosening/Lysis 10 35.7 Pain 6 21.4 Instability 4 14.3 Infection 2 7.1 Contracture 1 3.6 Progression Of Disease 1 3.6 Malposition 1 3.6 Implant Breakage Wrist Plate 1 3.6 Other 2 7.1 TOTAL 28 100.0 End Data Period: 31 Dec 2014 Page 26

Revision of Known Primary Partial Wrist Replacement Known Primary DRUJ with Ulna Only Replacement Table WPR1 Revision of Primary DRUJ with Ulna Only Replacement by and Gender 3 50. 64 83 65 70.7 10.7 3 50. 57 83 64 68.0 13.5 TOTAL 6 100. 57 83 65 69.3 11.0 Figure WPR1 Revision of Known Primary DRUJ with Ulna Only Replacement by and Gender 7 6 5 4 3 2 Table WPR2 Type of Revision of Known Primary DRUJ with Ulna Only Replacement Table WPR3 Reason for Revision of Known Primary DRUJ with Ulna Only Replacement Type of Revision Number Percent Ulna Component 2 33.3 Carpal/Radius 1 16.7 Ulna Head Only 1 16.7 Removal of Prostheses 1 16.7 Sigmoid Notch 1 16.7 TOTAL 6 100.0 Reason for Revision Number Percent Loosening/Lysis 4 66.7 Progression Of Disease 1 16.7 Instability 1 16.7 TOTAL 6 100.0 End Data Period: 31 Dec 2014 Page 27

Revision of Known Primary Total Wrist Replacement Table WTR1 Revision of Known Primary Total Wrist Replacement by and Gender 2 66.7% 32 35 34 33.5 2.1 1 33.3% 58 58 58 58.0. TOTAL 3 100. 32 58 35 41.7 14.2 Figure WTR1 Revision of Primary Total Wrist Replacement by and Gender 10 9 8 7 6 5 4 3 2 Table WTR2 Type of Revision of Known Primary Total Wrist Replacement Table WTR3 Reason for Revision of Known Primary Total Wrist Replacement Type of Revision Number Percent Carpal/Radius 1 33.3 Carpal Component 1 33.3 Reoperation Fusion 1 33.3 TOTAL 3 100.0 Reason for Revision Number Percent Loosening/Lysis 2 66.7 Implant Breakage Wrist Plate 1 33.3 TOTAL 3 100.0 End Data Period: 31 Dec 2014 Page 28