Table of Contents

1. OVERVIEW OF MUSCULOSKELETAL DISEASES/DISORDERS…………. 1-1
1.1 Back Pain and Spine Surgery…………………………………………………… 1-1
1.2 Carpal Tunnel Syndrome…………………………………………………………. 1-5
1.3 Duchenne Muscular Dystrophy…………………………………………………. 1-6
1.4 Osteoarthritis …………………………………………………………………………. 1-7
1.5 Osteoporosis and Fractures …………………………………………………….. 1-8
1.6 Rheumatoid Arthritis……………………………………………………………….. 1-9
Exhibit 1-1: Musculoskeletal Surgery, Procedure Volumes Forecast,
by Type, 2011-2017………………………………………………………………… 1-2
Exhibit 1-2: Musculoskeletal Diseases/Disorders, Hospital Discharges
and Prevalence…………………………………………………………………….. 1-11
2. MUSCULOSKELETAL DISEASES/DISORDERS………………………………… 2-1
2.1 Arthritis …………………………………………………………………………………. 2-1
2.1.1 Osteoarthritis …………………………………………………………… 2-2
2.1.1.1 Etiology ……………………………………………………. 2-2
2.1.1.2 Epidemiology…………………………………………….. 2-5
2.1.2 Rheumatoid Arthritis…………………………………………………. 2-6
2.1.2.1 Etiology ……………………………………………………. 2-6
2.1.2.2 Epidemiology…………………………………………….. 2-8
2.2 Carpal Tunnel Syndrome…………………………………………………………. 2-9
2.2.1 Etiology…………………………………………………………………… 2-9
2.2.2 Epidemiology…………………………………………………………. 2-11
2.3 Duchenne Muscular Dystrophy……………………………………………….. 2-13
2.3.1 Etiology…………………………………………………………………. 2-15
2.3.2 Epidemiology…………………………………………………………. 2-15
2.4 Osteoporosis ……………………………………………………………………….. 2-16
2.4.1 Etiology…………………………………………………………………. 2-16
2.4.2 Epidemiology…………………………………………………………. 2-20
Exhibit 2-1: Prevalence of Arthritis, in 5-Year Intervals, 2005-2030 ………………… 2-3
Exhibit 2-2: Osteoarthritis, Facts and Figures, 1999-2009, and 2011………………. 2-4
Exhibit 2-3: Rheumatoid Arthritis, Facts and Figures, 1999-2009, and 2011 ……. 2-7
Exhibit 2-4: Carpal Tunnel Syndrome, Facts and Figures, 1999-2009,
and 2010 and 2011……………………………………………………………….. 2-10
Exhibit 2-5: Carpal Tunnel Syndrome, Cases Resulting in Time Away
from Work, 1999-2010…………………………………………………………… 2-12
Exhibit 2-6: Duchenne Muscular Dystrophy, Facts and Figures, 1999-2009,
and 2011 …………………………………………………………………………….. 2-14
Exhibit 2-7: Incidence of Osteoporosis-Related Fractures, by Site………………… 2-17
Exhibit 2-8: Osteoporosis, Facts and Figures, 1999-2009, and 2011…………….. 2-18
Exhibit 2-9: 2011, Percentage of Men and Women with Osteoporosis
and Osteopenia, by Ethnicity………………………………………………….. 2-21
3. MUSCULOSKELETAL SURGICAL PROCEDURES ……………………………. 3-1
3.1 Fracture Repair………………………………………………………………………. 3-2
3.1.1 Bone Grafts …………………………………………………………….. 3-5
3.1.2 Biotechnology in Fracture Repair ……………………………….. 3-6
3.1.3 Procedure Volumes………………………………………………….. 3-7
3.2 Total Joint Arthroplasty……………………………………………………………. 3-8
3.2.1 Total Knee Arthroplasty…………………………………………… 3-11
3.2.1.1 Procedure Volumes………………………………….. 3-12
8.2.2 Unicompartmental Knee Arthroplasty………………………… 3-12
3.2.2.1 Procedure Volumes………………………………….. 3-14
3.2.3 Hip Arthroplasty……………………………………………………… 3-16
3.2.3.1 Revision Hip Arthroplasty ………………………….. 3-19
3.2.3.2 Procedure Volumes………………………………….. 3-19
3.3 Spine Surgery………………………………………………………………………. 3-20
3.3.1 Disc Arthroscopy ……………………………………………………. 3-22
3.3.2 Nerve Root Decompression …………………………………….. 3-24
3.3.2.1 Discectomy……………………………………………… 3-25
3.3.2.1.1 Procedure Volumes ………………. 3-25
3.3.2.2 Laminectomy and Laminotomy…………………… 3-26
3.3.2.2.1 Procedure Volumes ………………. 3-28
3.3.3 Spinal Fusion…………………………………………………………. 3-29
3.3.3.1 Anterior Lumbar Interbody Fusion………………. 3-32
3.3.3.2 Posterior Lumbar Interbody Fusion …………….. 3-33
3.3.3.3 Lateral Lumbar Interbody Fusion………………… 3-33
3.3.3.4 Instrumented Fusion…………………………………. 3-33
3.3.4 Vertebroplasty ……………………………………………………….. 3-34
3.3.4.1 Procedure Volumes………………………………….. 3-35
3.4 Arthroscopy …………………………………………………………………………. 3-35
3.4.1 Knee Arthroscopy…………………………………………………… 3-35
3.4.1.1 Procedure Volumes………………………………….. 3-38
3.4.1.2 Cartilage Repair and Transplantation………….. 3-39
3.4.1.3 Meniscectomy …………………………………………. 3-41
3.4.1.3.1 Procedure Volumes ………………. 3-42
3.4.1.4 Anterior Cruciate Ligament Reconstruction….. 3-43
3.4.1.4.1 Procedure Volumes ………………. 3-46
3.4.2 Shoulder Arthroscopy……………………………………………… 3-46
3.4.2.1 Primary Anterior Shoulder Dislocation…………. 3-48
3.4.2.2 Recurrent Anterior Shoulder Dislocation ……… 3-48
3.4.2.3 Acromioclavicular Joint Resection………………. 3-49
3.4.2.4 Rotator Cuff Repair ………………………………….. 3-50
3.4.2.5 Procedure Volumes………………………………….. 3-52
3.4.3 Wrist Arthroscopy …………………………………………………… 3-52
3.4.3.1 Carpal Tunnel Release……………………………… 3-54
3.4.3.2 Procedure Volumes………………………………….. 3-56
Exhibit 3-1: Open Fracture Reduction with Internal Fixation,
Procedure Volumes Forecast, 2011-2017 ………………………………….. 3-9
Exhibit 3-2: Knee Arthroplasty, Procedure Volumes Forecast, 2011-2017……… 3-13
Exhibit 3-3: Unicompartmental Knee Arthroplasty,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-15
Exhibit 3-4: Hip Arthroplasty, Procedure Volumes Forecast, 2011-2017………… 3-21
Exhibit 3-5: Discectomy, Procedure Volumes Forecast, 2011-2017………………. 3-27
Exhibit 3-6: Spinal Decompression, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………… 3-30
Exhibit 3-7: Spinal Fusion and Refusion, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………… 3-36
Exhibit 3-8: Arthroscopic Knee Surgery, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………… 3-40
Exhibit 3-9: Meniscectomy and Meniscal Repair,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-44
Exhibit 3-10: Anterior Cruciate Ligament Reconstruction,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-47
Exhibit 3-11: Arthroscopic Shoulder Surgery, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………… 3-53
Exhibit 3-12: Carpal Tunnel Release, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………… 3-57