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VALUE ANALYSIS BRIEF Improving accuracy affordability and patient outcomes in total knee procedures 1 VALUE ANALYSIS BRIEF

Executive summary Contents The aging patient population is challenging healthcare systems globally to rethink how to best deliver care 1 In orthopaedics the growing demand for total knee replacement procedures is expected to increase 80 by 2030 in the US while average Medicare reimbursement has been flat to declining 2 3 Healthcare providers require accurate and affordable solutions that optimize healthcare utilization at the point of care to help better manage growing demands The VELYS Robotic Assisted Solution simplifies total knee arthroplasty TKA by providing valuable insights versatile execution and verified performance designed to deliver efficiency and optimize patient outcomes 4 5 Together with the ATTUNE Knee System the use of the VELYS Robotic Assisted Solution during TKA can lead to clinical and economic benefits when compared to manual TKA Improved accuracy reproducibility5 Improved surgical efficiency6 7 Improved patient outcomes5 8 11 Reduced overall cost of care12 Current challenges in TKA The economic impact 4 The need for accuracy 6 Treatment challenges 7 The value of robotics Introduction to robotic TKA 8 Improved accuracy 9 Improved PROMs and reduced pain 10 Improved surgical consistency 12 Reduced resource use and total cost of care 13 Current limitations of competitive robotic assisted solutions 15 The VELYS Robotic Assisted Solution The system s technology 16 Making robotic assisted solutions affordable 18 Conclusion 19 3

The economic impact Growing demand on a constrained healthcare system The effect of care settings on reimbursement Solutions are required to improve procedural outcomes and reduce costs to optimize healthcare resource utilization In addition facility payment in the HOPD and ASC settings have seen modest increases in recent years and the reduced costs associated with performing procedures in these care delivery settings may help facilitate improved procedure margins16 Demand for TKA continues to rise Rates of TKA have increased by almost 4X since 2000 to an estimated 1 million procedures in 20202 13 By 2030 1 9 million patients are expected to undergo TKA each year in the US representing an increase of almost 80 over the next 10 years13 CMS National Average Reimbursement16 2016 Growth in volume of TKA is creating an increasing economic burden with a cost burden of 25 billion to the US healthcare system in 2017 alone14 6000 4000 2000 0 Inpatient DRG 470 3 4 VALUE ANALYSIS BRIEF performed in hospital outpatient department HOPD or ambulatory surgical center ASC in 2016 2021 8000 2020 10 000 Site of care has shifted significantly for TKA15 2019 12 000 Shifting site of care to less resource intensive care delivery settings can be one way to reduce costs To optimize patient outcomes however advanced technologies that help to reduce healthcare resource utilization are needed 2018 14 000 Costs associated with TKA are increasing3 14 2017 HOPD CPT 27 447 ASC CPT 27 447 Surgeon CPT 27 447 Source CMS IPPS HOPD ASC and PFS payment trends per procedure 2016 2021 16 Projected reimbursement rates Advanced technology12 42 Enable more TKAs to be performed in outpatient settings performed in HOPDs or ASCs in 2020 Reduce complications and revisions Decrease re admissions Facilitate discharge to less costly settings 5

The need for accuracy Treatment challenges in TKA An increasing need for accuracy consistency and predictability17 21 Variation in surgical processes and performance can lead to reduced efficiency increased surgeon stress and poorer patient outcomes 29 30 8000 0 Anterior knee pain One of the most common complaints reported by up to 50 of patients10 The majority of cases exceeded 80 minutes which is higher than the recommended time for optimal patient outcomes 30 4000 Patient dissatisfaction is likely the result of10 24 26 Histogram TKA operative time30 Frequency Knee replacement is widely recognized as one of the most common and successful surgical procedures with survivorship greater than 90 at 10 years 22 However there is still an opportunity to improve patient satisfaction with up to 20 of patients stating they were not satisfied with their surgical outcomes 23 Patient dissatisfaction increases when patients engage in high demand activities 23 After their procedure patients reported difficulty with daily activities 38 of patients had a difficult time getting in and out of a car 31 had a hard time getting in and out of a chair and 54 had difficulty with stairs 24 40 Implant fit Overhang can cause irritation of the medial collateral ligament MCL impingement with the popliteal tendon and an increased risk of knee pain25 40 of men and 68 of women have at least one area of the implant with 3 mm or more of overhang25 60 Adapted from George et al 30 80 100 120 140 160 180 Operative Time Minutes Surgeon experience and technique may lead to differences in procedure efficiency An analysis of more than 140 000 TKA procedures highlighted significant variability in OR times30 Instability Attributed to design factors procedure related challenges and inadequate soft tissue stability26 Malalignment can be found in more than 30 of patients27 Malpositioning can be correlated with poor patient outcomes 17 In fact 21 of all revisions are caused by instability and malpositioning of the implant 28 Therefore ensuring accurate and consistent component alignment may be a key factor for improving outcomes in the up to 20 of current patients who are not fully satisfied with their TKA 18 19 23 Incorrect positioning of the implant and improper alignment can cause suboptimal function including acceleration of implant wear and loosening20 21 6 VALUE ANALYSIS BRIEF A mean operative time of approximately 80 minutes has been shown to optimize outcomes and decrease the risk of complications29 30 Lower volume surgeons require an additional 30 minutes to complete each case and are 2x more likely to get poorer outcomes including ongoing pain and reduced range of motion with patients reporting the inability to flex or extend the knee31 32 Lack of predictability can lead to increased surgeon stress33 Increased variation in procedure times makes planning and scheduling difficult for hospital administrators and surgeons 28 of orthopaedic faculty members have experienced burnout which can impact professional performance patient care and lead to an increase in medical errors33 One study found that 17 of orthopaedic faculty members showed elevated levels of psychological distress33 7

Introduction to robotic TKA Improved accuracy Robotic TKA offers a range of benefits over manual TKA Robotic TKA can improve implant alignment and positioning36 By 2027 robotic total joint procedures are anticipated to grow by more than 25 34 This growth will help to address current challenges associated with TKA procedures today The VELYS Robotic Assisted Solution has been designed to address these challenges by Reducing economic burden and enabling increased procedure volume12 29 30 35 Improving procedure outcomes and patient satisfaction6 12 Facilitating procedure efficiency predictability and standardization4 5 Increased accuracy of implant alignment and surgical reproducibility can help shorten patient recovery and reduce post operative complications36 37 Robotic TKA can help achieve desired component alignment and positioning more often according to a meta analysis of robotic vs manual TKA procedures36 Robotic TKA significantly lowered component deviations and outliers in comparison to manual TKA resulting in accurate implant alignment36 Compared to manual TKA robotic TKA has been shown to Improve implant alignment and positioning5 Improve patient reported outcomes6 Reduce patient pain5 6 Reduce overall procedure costs12 In cadaveric studies the VELYS Robotic Assisted Solution has demonstrated superior accuracy compared to manual TKA The VELYS Robotic Assisted Solution with the ATTUNE Knee System has shown significant improvements compared to manual TKA in numerous surgical outcomes in cadaveric testing5 Coronal alignment for femoral P 0 000 and tibial P 0 001 Helps improve accuracy in the mechanical alignment to decrease the risk of revision surgeries Tibial resection depth P 0 000 Implant coronal alignment for femoral P 0 011 and tibial P 0 004 Can reduce outliers and potentially enhance patient outcomes Femoral implant sagittal alignment P 0 006 Together the VELYS Robotic Assisted Solution and the ATTUNE Knee System have the potential to improve accuracy reproducibility and consistency in TKA 8 VALUE ANALYSIS BRIEF 9

Improved PROMs and reduced pain Enhanced alignment and positioning observed with robotic TKA may help contribute to improved patient reported outcome measures PROMs and reduced pain Robotic vs manual TKA comparison of post operative PROMs 6 Participants Along with the VELYS Robotic Assisted Solution the ATTUNE Knee System can help improve patient outcomes Design provides increased stability and improved patellofemoral function compared to competitive knee brands11 42 43 The implant is designed to provide a smooth transition from stability to rotational freedom throughout a patient s range of motion and to work in concert with their soft tissue44 45 PROM Survey Studies Manual Robotic MD 95 CI P value HSS 3 96 130 0 82 0 85 to 2 49 034 A range of primary femoral and tibial sizes to ensure the surgeon has options to size and balance the knee46 WOMAC 3 96 130 2 01 4 00 to 0 001 05 KSS functional score 2 59 63 2 30 0 18 to 4 42 03 The ATTUNE Knee System has shown improved patient reported outcomes compared to other leading knee brands and has performed favorably within the class of TKA in 2 national joint registries8 47 48 HSS Hospital for Special Surgery KSS Knee Society Score MD mean deviation WOMAC Western Ontario and McMaster University Adapted from Ren et al 6 VELYS Robotic Assisted Solution can facilitate a patient specific alignment which may improve PROMs 38 40 Robotic TKA has been shown to reduce patient pain compared to those undergoing manual TKA procedures37 41 43 overall reduction in pain with robotic vs manual TKA37 Robotic 3 6 vs Manual 6 3 P

Improved surgical consistency Robotic TKA may help improve consistency and may enhance provider efficiencies6 7 Robotic TKA may Provide equivalent procedure time to manual procedures after a short learning curve of between 5 and 20 procedures51 53 Create an increased demand from patients leading to higher procedure volume54 Reduce procedure variability improving consistency of scheduling and reducing surgeon stress Minimize the risk of post operative complications6 7 Higher volume centers and surgeons generally have reduced procedure variability and they show32 55 Reduced mortality rates Lowered incidence of peri operative complications Improved patient functional status Reduced length of stay VELYS Robotic Assisted Solution helps to facilitate consistent efficient procedures through improved cuts and final alignment compared to manual TKA4 6 12 VALUE ANALYSIS BRIEF Reduced resource use and total cost of care Robotic TKA improves patient outcomes and is associated with reduced resource utilization compared to manual TKA Robotic TKA has been associated with reduced length of stay more optimal discharge destination reduced re admissions and reduced healthcare visits without increasing procedure duration 12 41 56 Outcome Manual Robotic 7 8 5 2 33 reduction in re admission rates with robotic TKA P 0 0423 Length of stay35 2 72 days 1 8 days 34 reduction in length of stay with robotic TKA P 0 0001 Discharge to skilled nursing12 21 7 12 52 42 fewer discharges to skilled nursing facilities with robotic TKA P

Reduced resource use and total cost of care continued Current limitations of competitive robotic assisted solutions Evidence has also shown that robotic TKA may lower costs across the patient care pathway Robotic solutions have become increasingly popular for TKA However competitive robotic solutions are associated with several limitations which the VELYS Robotic Assisted Solution has been designed to overcome 5 2400 reduction in overall index facility costs12 May be complex to use and require significant training May require additional OR time6 7 Have limitations of cut block dependent or burr based robotic systems61 Have large footprints and can be cumbersome in the OR cost savings during 90 day episode of care12 P

The system s technology Delivering simplicity with valuable insights versatile execution and verified performance Valuable insights Verified performance Gap balance data to help surgeons visualize and predict joint stability Accurate consistent plan execution with the ATTUNE Knee System to provide better patient outcomes 5 8 11 Natural Joint Assessment Pre resection assessment of alignment and predicted gap balance to help surgeons plan for optimal ATTUNE Knee System implant position PROADJUST Planning Single page planning to easily adjust parameters helping surgeons personalize alignment and balance relative to soft tissues ACCUBALANCE Graph Soft tissue stability graph provides balancing data throughout the full range of motion prior to execution of bony cuts to help surgeons visualize and predict joint stability ADAPTIVE TRACKING Technology High speed camera triple drive motion technology and PURESIGHT Hydrophobic Optical Reflectors work together to adjust and control the resection plane for accurate consistent execution to plan5 Procedural Joint Verification Post resection assessment to help surgeons verify final gap balance and overall leg alignment for intra operative confirmation of the ATTUNE Knee System implant position The ATTUNE Knee System Performance Works exclusively with the ATTUNE Knee System which has shown to improve patient reported outcomes by working in harmony with the patient s anatomy to deliver both stability and motion5 8 11 Versatile execution Instinctive integrated design to give surgeons the control they re used to while optimizing daily OR flow 4 NATURAL CONTROL Technology A proprietary technology that maintains the saw cut plane to help execute precise reproducible surgeon controlled cuts without the need for a cutting block5 Instinctive User Interface Clear interface streamlined clinical application adaptable workflow and fast registration process aim to improve procedural efficiency4 Integrated Operating Platform The ATTUNE Knee System INTUITION Instrumentation and an easily maneuverable robotic design to help streamline OR integration and improve daily OR flow4 16 VALUE ANALYSIS BRIEF 17

Making robotic assisted solutions affordable Compared to other robotic assisted solutions The VELYS Robotic Assisted Solution can offer improved efficiency and affordability compared to other robotic assisted solutions It is associated with lower capital costs and demonstrates significant value throughout the patient care pathway Pre operatively Reduced pre op imaging when compared with many competing robotic solutions Does not require specialized imaging such as CT scans because of use of intra operative registration and dynamic compensation saving an average of 130 per case and eliminating an additional appointment for the patient62 Intra operatively Efficient patient registration requiring fewer than 20 points or surfaces to define all relevant anatomical landmarks and axes63 Achieves a high level of efficiency in the primary resections of the knee using a saw that is controlled without the use of cut blocks The system maintains planar control of the saw blade during resection in accordance with the surgical plan The surgeon is in full control of the saw actuating and manipulating it within the aligned resection plane without the use of cut blocks Does not require a product specialist or technician thereby reducing OR staff Post operatively The ATTUNE Knee System provides proven performance and has been shown to decrease length of stay reduce discharge to acute rehabilitation centers and improve PROMs58 60 Long term outcomes data on the use of the ATTUNE Knee System with the VELYS Robotic Assisted Solution is being collected to further demonstrate the synergistic value of using the 2 technologies 18 VALUE ANALYSIS BRIEF Conclusion At DePuy Synthes we are committed to improving the orthopaedic experience for patients healthcare professionals and hospitals The VELYS Robotic Assisted Solution works exclusively with the ATTUNE Knee System optimizing its performance and delivering both stability and motion 8 11 The VELYS Robotic Assisted Solution has been developed to allow for consistent reproducible procedures providing an enhanced surgeon experience It has been designed to address shortcomings found in current robotic technology it is more economical more efficient and provides more flexibility for the surgeon and the hospital DePuy Synthes is committed to the development of innovation to optimize care for TKA patients across the entirety of the patient care pathway That s why we have created VELYS Digital Surgery solutions that go beyond robotics VELYS Digital Surgery is a platform of connected technologies powered by data insights and designed to elevate the TKA experience for patients surgeons and care teams

References 1 Haseltine WA Aging populations will challenge healthcare systems all over the world Forbes April 2 2018 Accessed October 16 2020 https www forbes com sites williamhaseltine 2018 04 02 aging populations will challenge healthcaresystems all over the world 62aa73cd2cc3 2 Sloan FA George LK Hu L Productivity improvements in hip and knee surgery Arthritis 2014 2014 615 784 3 Mayfield CK Haglin JM Levine B Della Valle C Lieberman JR Heckmann N Medicare reimbursement for hip and knee arthroplasty from 2000 to 2019 an unsustainable trend J Arthroplasty 2020 35 5 1174 1178 4 User experience evaluation of the VELYS Robotic Assisted Solution for total knee July 2020 ADAPTIV Report 103744839 5 Doan G Curtis P Wyss J Clary C Resection Accuracy Improved during Robotic Assisted Total Knee Arthroplasty March 2021 Internal Report 103720852 6 Ren Y Cao S Wu J Weng X Feng B Efficacy and reliability of active robotic assisted total knee arthroplasty compared with conventional total knee arthroplasty a systematic review and meta analysis Postgrad Med J 2019 95 1121 125 133 7 Khlopas A Sodhi N Sultan AA Chughtai M Molloy RM Mont MA Robotic arm assisted total knee arthroplasty J Arthroplasty 2018 33 7 2002 2006 8 Hamilton WG Brenkel I Clatworthy M et al Comparison of existing and new total knee arthroplasty implant systems from the same manufacturer a prospective multicenter study 2019 Poster presented at American Academy of Orthopaedic Surgeons 2019 Annual Meeting March 12 16 2019 Las Vegas NV Poster PO614 9 Fisher D Parkin D Optimizing the value of your patients TKA how to leverage data from patient reported outcomes Becker s Hospital Review webinar October 3 2019 Accessed October 18 2019 www ATTUNEevidence com clinical evidence 10 Ranawat CS White PB West S Ranawat AS Clinical and radiographic results of ATTUNE and PFC Sigma knee designs at 2 year follow up a prospective matched pair analysis J Arthroplasty 2017 32 431 436 11 Indelli PF Pipino G Johnson P Graceffa A Marcucci M Posterior stabilized total knee arthroplasty a matched pair analysis of a classic and its evolutional design Arthroplasty Today 2016 2 193 198 12 Cool CL Jacofsky DJ Seeger KA Sodhi N Mont MA A 90 day episode of care cost analysis of robotic arm assisted total knee arthroplasty J Comp Eff Res 2019 8 5 327 336 13 Singh JA Yu S Chen L Cleveland JD Rates of total joint replacement in the United States future projections to 2020 2040 using the National Inpatient Sample J Rheum 2019 46 9 1134 1140 14 Blue Cross Blue Shield Planned knee and hip replacement surgeries are on the rise in the U S Published January 23 2019 Accessed November 12 2020 https www bcbs com the health of america reports planned knee and hip replacement surgeries are the rise theus 15 HEMA Analysis of Medicare standard analytic file and IBM MarketScan commercial databases 2016 Q1 2020 16 Centers for Medicare Medicaid Services CMS 42 CFR parts 410 414 415 423 424 and 42 2020 17127 17 Valkering KP Breugem SJ van den Bekerom MPJ Tuinebreijer WE van Geenen RCI Effect of rotational alignment on outcome of total knee Acta Orthopaedica 2015 86 4 432 439 18 Noble PC Conditt MA Cook KF Mathis KB Patient expectations affect satisfaction with total knee arthroplasty Clin Orthop Relat Res 2006 452 35 43 19 Baker PN van der Meulen JH Lewsey J Gregg PJ The role of pain and function in determining patient satisfaction after total knee replacement J Bone Joint Surg Br 2007 893 900 20 Sharkey PF Hozack WK Rothman RH Shastri S Jacoby SM Why are total knee arthroplasties failing today Clin Orthop Relat Res 2002 404 7 13 21 Yuan FZ Wang SJ Zhou ZX Yu JK Jiang D Malalignment and malposition of quadriceps sparing approach in primary total knee arthroplasty a systematic review and meta analysis J Orthop Surg 2017 12 1 129 22 Argenson JN Boisgard S Parratte S et al Survival analysis of total knee arthroplasty at a minimum 10 years follow up a multicenter French nationwide study including 846 cases Orthopaedics and traumatology Surgery and research Orthop Traumatol Surg Res 2013 99 385 390 23 Bourne RB Chesworth B Davis A Mahomed N Charron K Comparing patient outcomes after THA and TKA is there a difference Clin Orthop 2010 468 2 542 546 24 Parvizi J Nunley RM Berend KR et al High level of residual symptoms in young patients after total knee arthroplasty Clin Orthop 2014 472 1 133 137 25 Mahoney O Kinsey T Overhang of the femoral component in total knee arthroplasty risk factors and clinical consequences J Bone Joint Surg Am 2010 92 1115 1121 26 Noble PC Gordon MJ Weiss JM et al Does total knee replacement restore normal knee function Clin Ortho Rel Res 2005 431 157 165 27 Stucinskas J Robertsson O Sirka A Lebedev A Wingstrand H Tarasevicius S Moderate varus valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength Acta Ortho 2015 86 6 728 733 28 Dalury DF Pomeroy DL Gorab RS Adams MJ Why are total knee arthroplasties being revised J Arthroplasty 2013 28 8 Suppl 120 131 29 Shah RP Lauthen D Geller JA Cooper HJ Average operative times for 1 313 primary total hip arthroplasty and 1 300 primary total knee arthroplasty over 39 months are roughly equal to Medicare attributed operative times J Arthroplasty 2019 34 8 1553 1556 30 George J Mahmood B Sultan AA et al How fast should a total knee arthroplasty be performed An analysis of 140 199 surgeries J Arthroplasty 2018 33 8 2616 2622 31 Ong K Lau E Manley M Kurtz SM Patient hospital and procedure characteristics influencing total hip and knee arthroplasty procedure duration J Arthroplasty 2009 24 6 925 931 32 Katz JN Mahomed NN Baron JA et al Association of hospital and surgeon procedure volume with patient centered outcomes of total knee replacement in a population based cohort of patients age 65 years and older Arthritis Rheum 2007 56 2 568 574 33 Sargent MC Sotile W Sotile MO et al Managing stress in the orthopaedic family avoiding burnout achieving resilience J Bone Joint Surg Am 2011 93 8 e40 34 Millennium Research Group Inc Orthopaedic Surgical Robotic Devices 2018 M360SU0001 35 Pierce J Needham K Adams C Coppolecchia A Lavernia C Robotic arm assisted knee surgery an economic analysis Am J Manag Care 2020 26 7 e205 e210 36 Chin BZ Tan SSH Chua KCX Budiono GR Syn NL O Neill GK Robot assisted versus conventional total and unicompartmental knee arthroplasty a meta analysis of radiological and functional outcomes published online ahead of print March 17 2020 J Knee Surg 2020 doi 10 1055 s 0040 1701440 37 Kayani B Konan S Tahmassebi J Pietrzak JRT Haddad FS Robotic arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig based total knee arthroplasty a prospective cohort study Bone Joint J 2018 100 B 7 930 937 38 Calliess T Bauer K Stukenborg Colsman C Windhagen H et al PSI kinematic versus non PSI mechanical alignment in total knee arthroplasty a prospective randomized study Knee Surg Sports Traumatol Arthrosc 2016 DOI 10 1007 s00167 016 4136 8 39 Dossett HG Estrada NA Swartz GJ LeFevre GW et al A randomised controlled trial of kinematically and mechanically aligned total knee replacements Bone Joint J 2014 907 913 40 Murgier J Clatworthy M Variable rotation of the femur does not affect outcome with patient specific alignment navigated balanced TKA published online ahead of print August 11 2020 Knee Surg Sports Traumatol Arthrosc 2020 doi 10 1007 s00167 020 06226 8 41 Marchand RC Sodhi N Khlopas A et al Patient satisfaction outcomes after robotic arm assisted total knee arthroplasty a short term evaluation J Knee Surg 2017 30 9 849 853 42 Toomey SD Daccach JA Shah JC Himden SE Lesko JP Hamilton WG Comparative incidence of patellofemoral complications between 2 total knee arthroplasty systems in a multicenter prospective clinical study J Arthroplasty 2017 32 9S S187 S192 43 Martin JR Jennings JM Watters TS Levy DL McNabb DC Dennis DA Femoral implant design modification decreases the incidence of patellar crepitus in total knee arthroplasty J Arthroplasty 2017 32 4 1310 1313 44 Pfitzner T von Roth P Preininger B Perka C Gibt es die ideale Knietotalendoprothese f r j ngere Patienten Does the ideal total knee arthroplasty for younger patients exist Z Orthop Unfall 2014 152 4 393 398 45 Takagi H Asai S Sato A Maekawa M Kawashima H Kanzaki K Case series report of navigation based in vivo knee kinematics in total knee arthroplasty with a gradually reducing femoral radius design Ann Med Surg Lond 2017 17 33 37 46 Fisher DA Parkin D Advancing patient outcomes and economic value in total knee arthroplasty the evidence of the ATTUNE Knee System Internal Report 125873 191018 47 National Joint Registry for England Wales Northern Ireland and the Isle of Man 14th Annual Report 2017 Data to 31 December 2016 Table 3 25 a Table 3 28 Accessed January 22 2021 https reports njrcentre org uk portals 0 pdfdownloads njr 2016th 20annual 20report 20 2019 pdf 48 Australian Orthopaedic Association National Joint Replacement Registry Annual Report Tables KT7 KT33 KT34 Full summary Accessed January 22 2021 https aoanjrr sahmri com annual reports 2020 49 Clary CW Fitzpatrick CK Maletsky LP Rullkoetter PJ Improving dynamic mid stance an experimental and finite element study Poster No 1044 ORS 2013 Annual Meeting 50 Ali AA Mannen EM Rullkoetter PJ Shelburne KB In vivo comparison of medialized dome and anatomic patellofemoral geometries using subject specific computational modeling J Orthop Res 2018 36 7 1910 1918 51 Kayani B Konan S Huq SS Tahmassebi J et al Robotic arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning Knee Surg Sports Traumatol Arthrosc 2019 27 1132 1141 52 Clement ND Al Zibari M Afzal I Deehan DJ Kader D A systematic review of imageless hand held robotic assisted knee arthroplasty learning curve accuracy functional outcome and survivorship EFORT Open Reviews 2020 5 319 326 53 Sodhi N Khlopas A Piuzzi NS et al The learning curve associated with robotic total knee arthroplasty published correction appears in J Knee Surg 2018 Apr 31 4 370 J Knee Surg 2018 31 1 17 21 54 Leddy LS Lendvay TS Satava RM Robotic surgery applications and cost effectiveness Open Access Surgery 2010 3 99 107 55 Lau RL Perruccio AV Gandhi R Mahomed NN The role of surgeon volume on patient outcome in total knee arthroplasty a systematic review of the literature BMC Musculoskeletal Dis 2012 13 250 56 Mont MA Cool CL Gregory D Coppolecchia A Sodhi N Jacofsky DJ Health care utilization and payer cost analysis of robotic arm assisted total knee arthroplasty at 30 60 and 90 days published online ahead of print September 2 2019 J Knee Surg 2019 doi 10 1055 s 0039 1695741 57 Costs amid the pandemic Hospital admissions declined dramatically in the early months of the pandemic before mostly rebounding by mid summer Kaiser Family Foundation https www kff org health costs Accessed November 19 2020 58 Meermans G Galvain T Wigham R Do Rego B Schroer D Comparative analysis investigating the impact of implant design on hospital length of stay and discharge destination in a Dutch hospital with an established enhanced recovery program J Arthroplasty 2020 35 1 182 187 59 Etter K Lerner J Kalsekar I de Moor C Yoo A Swank M Comparative analysis of hospital length of stay and discharge status of two contemporary primary total knee systems J Knee Surg 2018 31 6 541 550 60 Bruggenjurgen B Muehlendyck C Gador LV Katzer A Length of stay after introduction of a new total knee arthroplasty TKA results of a German retrospective database analysis Med Devices Auckl 2019 12 245 251 61 Waddell BS Carroll K Jerabek S Technology in arthroplasty are we improving value Curr Rev Musculoskelet Med 2017 10 378 387 62 Premier HOPD 2018 2020 Q1 December 2020 Internal Report 63 VELYS Robotic Assisted Solution for total knee Surgical technique femur first approach August 2020 ADAPTIV Report 103744585 Please refer to the instructions for use for a complete list of indications contraindications warnings and precautions The third party trademarks used herein are the trademarks of their respective owners DePuy Synthes 2021 All rights reserved 161772 201204 DSUS

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