In addition to physician brand preference, this survey report describes the proportion of doctors who would be willing to switch to a single injection product like Genzyme’s Synvisc-One®. The results of the survey indicated a high degree of familiarity with the product within the physician community. There is a general divide in the U.S. medical community between HA brands that are used for a majority of procedures within a practice. The respondents were asked to rate their satisfaction with the various injection products. This in term was compared to the probability of switching brands, and the possible motivating reasons for doing so.

1. U.S. Hyaluronic Acid Viscosupplementation Physician Survey 2011
Report Summary
Over 100 orthopedic specialists were surveyed regarding their perceptions and usage of
hyaluronic acid viscosupplementation during the 2011 American Academy of Orthopaedic
Surgeons (AAOS) conference. This survey report compares usage patters and perceptions of
orthopedic specialists regarding hyaluronic acid viscosupplement product, including single
injection, 3-injection and 5-injection therapy regimes. Satisfaction with current offerings is
examined in detail, along with the market penetration of single injection products. The data
presented describes practice experience, practice volume and the attitudes of the
respondents to the product, as well as how these factors interact.
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In addition to physician brand preference, this survey report describes the proportion of
doctors who would be willing to switch to a single injection product like Genzyme’s Synvisc-
One®. The results of the survey indicated a high degree of familiarity with the product
within the physician community. There is a general divide in the U.S. medical community
between HA brands that are used for a majority of procedures within a practice. The
respondents were asked to rate their satisfaction with the various injection products. This in
term was compared to the probability of switching brands, and the possible motivating
reasons for doing so.
TABLE OF CONTENTS
TABLE OF CONTENTS .I
LIST OF FIGURES.IV
LIST OF CHARTSVI
EXECUTIVE SUMMARY . 1
1.1 OVERVIEW 1
1.2 RESPONDENT PRACTICE LOCATION 2
1.3 COMPETING BRANDS 3
1.4 TRANSITION TO TOTAL KNEE ARTHROPLASTY 4
1.5 TIME TO PAIN RELIEF AFTER LAST HA INJECTION 5
1.6 PURCHASING DECISIONS. 6
1.7 INCENTIVES RECEIVED BY BRAND . 7
1.8 CANADIAN RESPONDENTS 8
SURVEY HIGHLIGHTS 9
2.1 RESPONDENT CHARACTERISTICS . 9
2.1.1 Doctor Profile . 9
2.1.2 Purchasing Channels 9
2.2 RESPONSE SUMMARY . 10
2.2.1 Attitudes Toward Products . 10

2. 2.2.2 Product Incentives 10
2.2.3 Patient Profile. 11
RESEARCH METHODOLOGY. 12
3.1 RESEARCH OVERVIEW 12
3.2 RESEARCH SERVICES 12
3.3 SURVEY METHODOLOGY 13
3.3.1 Step 1: Project Initiation & Team Selection 13
Table of Contents
3.3.2 Step 2: Sample Population Preparation 15
3.3.3 Step 3: Preparation, Questionnaire Design & Administration 16
3.3.4 Step 4: Reporting and Analysis 18
3.3.5 Step 5: Customer Feedback . 18
HYALURONIC ACID VISCOSUPPLEMENTATION SURVEY RESULTS. 19
4.1 QUESTION 1: YEARS OF PRACTICE . 19
4.2 QUESTION 2: VISCOSUPPLEMENT INJECTIONS ADMINISTERED PER MONTH 21
4.2.1 HA Patients Treated per Month 21
4.2.2 Monthly Patient Volume by Year of Practice 23
4.3 QUESTION 3: HA UTILIZATION BY BRAND. 25
4.3.1 HA Utilization by Brand . 25
4.3.2 HA Brand Preference Verses Practice Volume 30
4.4 QUESTION 4: REASONS FOR CHOOSING HA BRAND. 32
4.5 QUESTION 5: LIKELIHOOD OF INCREASING SINGLE INJECTION USE 34
4.5.1 Likelihood of Increased Use . 34
4.5.2 Correlation of Increased Use with Satisfaction 36
4.6 QUESTION 6: SATISFACTION WITH SINGLE INJECTION PRODUCTS. 38
4.7 QUESTION 7: PERCENTAGE OF HA PATIENTS THAT SUBSEQUENTLY UNDERGO TOTAL
KNEE ARTHROPLASTY (TKA) 40
4.8 QUESTION 8: TIME TO TKA AFTER HA AND CONSERVATIVE TREATMENTS. 42
4.8.1 Time to TKA 42
4.8.2 Time to TKA by Practice Profile. 44
4.9 QUESTION 9: HA INJECTION TYPES USED BEFORE TKA 47
4.10 QUESTION 10: PERCEIVED BRAND PURCHASING INCENTIVES . 50
4.11 QUESTION 11: NATURE OF INCENTIVES RECEIVED 52
4.11.1 Incentive Factors Received . 52
4.11.2 Incentive Factors Received by Brand . 54
4.12 QUESTION 12: REASONS TO SWITCH TO DIFFERENT HA BRAND. 56
4.12.1 Reasons to Swtich Brands. 56
4.12.2 Reasons to Switch Brands by Practice Profile 58
4.13 QUESTION 13: PATIENT GROUPS RECEIVING THE MOST BENEFIT FROM HA. 59
4.14 QUESTION 14: IMPORTANCE OF PRICING 61
4.15 QUESTION 15: PURCHASING CHANNELS. 63
Table of Contents
4.15.1 Percentage of Respondents by Purchasing Channels. 63
4.15.2 Importance of Pricing by Purchasing Channel 65
4.16 QUESTION 16: RESPONDENT CLINICAL SETTING 67
4.17 QUESTIONS 17 TO 19: TIME TO RELIEF. 69
4.17.1 Overview of Time to Relief 69

3. 4.17.2 Question 17: Time to Relief After Single Injection Treatment 71
4.17.3 Question 18: Time to Relief After 3-Injection Treatment 72
4.17.4 Question 19: Time to Relief After 5-Injection Treatment 73
APPENDIX 1: CANADIAN RESPONDENTS, 2011 . 74
5.1 QUESTION 1: YEARS OF PRACTICE. 74
5.2 QUESTION 2: HYALURONIC ACID (HA) VISCOSUPPLEMENT INJECTIONS
ADMINISTERED PER MONTH 74
5.3 QUESTION 3: HA UTILIZATION BY BRAND 75
5.4 QUESTION 4:REASONS FOR CHOOSING HA BRAND. 75
5.5 QUESTION 5: LIKELIHOOD OF INCREASING SINGLE INJECTION USE 75
5.6 QUESTION 6: SATISFACTION WITH SINGLE INJECTION PRODUCTS 76
5.7 QUESTION 7: PERCENTAGE OF HA PATIENTS THAT SUBSEQUENTLY GO ON TO
TOTAL KNEE ARTHROPLASTY (TKA) 76
5.8 QUESTION 8: TIME TO TKA AFTER HA AND CONSERVATIVE TREATMENTS 76
5.9 QUESTION 9: HA INJECTION TYPES USED BEFORE TKA . 77
5.10 QUESTION 10: PERCEIVED BRAND PURCHASING INCENTIVES . 77
5.11 QUESTION 11: NATURE OF INCENTIVES RECEIVED 77
5.12 QUESTION 12: REASONS TO SWITCH TO DIFFERENT HA BRAND 78
5.13 QUESTION 13: PATIENT GROUPS RECEIVING THE MOST BENEFIT FROM HA 78
5.14 QUESTION 14: IMPORTANCE OF PRICING . 78
5.15 QUESTION 15: PURCHASING CHANNELS. 79
5.16 QUESTION 16: RESPONDENT CLINICAL SETTING 79
5.17 QUESTION 17: TIME TO RELIEF AFTER INJECTION. 79
APPENDIX 2: SURVEY QUESTIONS. 80
List of Figures
LIST OF FIGURES
EXECUTIVE SUMMARY. 1
SURVEY HIGHLIGHTS . 9
RESEARCH METHODOLOGY. 12
HYALURONIC ACID VISCOSUPPLEMENTATION SURVEY RESULTS . 19
Figure 4-1: Years of Practice, U.S., 2011 . 19
Figure 4-2: HA Patients Treated per Month, U.S., 2011 21
Figure 4-3: Monthly Patient Volume by Year of Practice, U.S., 2011 . 23
Figure 4-4: HA Brand Frequency of Use, Weighted Average, U.S., 2011 25
Figure 4-5: HA Brand Frequency of Use by Response Distribution, U.S., 2011. 26
Figure 4-6: Practice Profile, Synvisc-One® Majority Use, U.S., 2011 30
Figure 4-7: Practice Profile, Three and Five Cycle Majority Use, U.S., 2011 30
Figure 4-8: Reasons for Choosing a HA Brand, U.S., 2011 . 32
Figure 4-9: Likelihood of Switching to Single Injection, U.S., 2011 . 34
Figure 4-10: Satisfaction and Likelihood of Switching to Single Injection for Current
Users of Synvisc-One®, U.S., 2011 36
Figure 4-11: Average Single Injection Satisfaction Verses Likelihood of Increasing
Usage, U.S., 2011 . 36
Figure 4-12: Satisfaction wit Single Injection Products, All Respondents, U.S., 2011 . 38
Figure 4-13: Percentage of HA Patients that Subsequently Go on to Total Knee
Arthroplasty (TKA) , U.S., 2011 . 40
Figure 4-14: Time to TKA After HA and Conservative Treatments, Months, U.S.,

4. 2011 . 42
Figure 4-15: Time to TKA in Months by Practice Profile, Weeks to TKA per
Percentage of Patients that Require Surgery, U.S., 2011 44
Figure 4-16: HA Injection Types Used before TKA, Weighted Average, U.S., 2011 47
Figure 4-17: HA Injection Types Used before TKA by Response Distribution, U.S.,
2011 . 48
List of Figures
Figure 4-18: Perceived Brand Purchasing Incentives, U.S., 2011 50
Figure 4-19: Nature of Incentives Received, U.S., 2011 . 52
Figure 4-20: Incentive Factors Received by Brand, U.S., 2011 . 54
Figure 4-21: Reasons to Switch to Different HA Brand, U.S., 2011 56
Figure 4-22: Percent of Patients Who Undergo TKA for Respondents Choosing Better
Clinical Efficacy as a Reason to Switch Brands, U.S., 2011 . 58
Figure 4-23: Percent of Patients Who Undergo TKA for Respondents Not Choosing
Better Clinical Efficacy as a Reason to Switch Brands, U.S., 2011 . 58
Figure 4-24: Patient Groups Receiving the Most Benefit from HA 59
Figure 4-25: Importance of Pricing, U.S., 2011 61
Figure 4-26: Purchasing Channels, U.S., 2011 63
Figure 4-27: Importance of Pricing by Purchasing Channel, U.S., 2011 65
Figure 4-28: Respondent Clinical Setting, U.S., 2011. 67
Figure 4-29: Time to Relief Treatment by Injection Cycle, Weeks, U.S., 2011 69
Figure 4-30: Time to Relief After Single Injection Treatment, Weeks, U.S., 2011. 71
Figure 4-31: Time to Relief After 3-Injection Treatment, Weeks, U.S., 2011 72
Figure 4-32: Time to Relief After 5-Injection Treatment, U.S., 2011 73
APPENDIX 1: CANADIAN RESPONDENTS, 2011 74
APPENDIX 2: SURVEY QUESTIONS 80
List of Charts
LIST OF CHART S
EXECUTIVE SUMMARY. 1
Chart 1-1: Hyaluronic Acid Usage Among Survey Respondents, U.S., 2011 . 1
Chart 1-2: Respondent Location by State, U.S., 2011 . 2
Chart 1-3: Percentage of Usage, Selected Brands, U.S., 2011 . 3
Chart 1-4: Time from HA Treatment to TKA in Weeks, 2011 . 4
Chart 1-5: Time to Relief After Last Injection in Weeks, All Types of HA Injections,
U.S., 2011 5
Chart 1-6: Reasons for Choosing a HA Brand, U.S., U.S., 2011 6
Chart 1-7: Incentives Received by Brand, U.S., 2011 . 7
Chart 1-8: Brand Preference, Canadian Respondents, U.S., 2011 8
SURVEY HIGHLIGHTS . 9
RESEARCH METHODOLOGY. 12
HYALURONIC ACID VISCOSUPPLEMENTATION SURVEY RESULTS . 19
Chart 4-1: Years of Practice, U.S., 2011 20
Chart 4-2: HA Patients per Month, U.S., 2011 22
Chart 4-3: Monthly Patient Volume per Year of Practice, U.S., 2011 24
Chart 4-4: HA Brand Frequency of Use, Weighted Average, U.S., 2011 . 27
Chart 4-5: HA Brand Frequency of Use by Response Distribution, U.S., 2011
(Part 1 of 2) 28
Chart 4-6: HA Brand Frequency of Use by Response Distribution, U.S., 2011

5. (Part 2 of 2) 29
Chart 4-7: Monthly Patients Seen per Month by HA Preference, U.S., 2011 31
Chart 4-8: Reasons for Choosing a HA Brand 33
Chart 4-9: Likelihood of Switching to Single Injection, U.S., 2011. 35
Chart 4-10: Satisfaction and Likelihood of Switching to Single Injection, U.S., 2011 . 37
Chart 4-11: Satisfaction wit Single Injection Products 39
List of Charts
Chart 4-12: Percentage of HA Patients that Subsequently Go on to Total Knee
Arthroplasty (TKA) , U.S., 2011 . 41
Chart 4-13: Time to TKA After HA and Conservative Treatments, U.S., 2011 43
Chart 4-14: Time to TKA in Months by Practice Profile, U.S., 2011 . 45
Chart 4-15: Time to TKA in Months by Practice Profile, Weeks to TKA per
Percentage of Patients that Require Surgery, Response Distribution, U.S., 2011 . 46
Chart 4-16: HA Injection Types Used before TKA, Weighted Average, U.S., 2011 . 49
Chart 4-17: Perceived Brand Purchasing Incentives 51
Chart 4-18: Nature of Incentives Received, U.S., 2011 . 53
Chart 4-19: Incentive Factors Received by Brand, U.S., 2011 . 55
Chart 4-20: Reasons to Switch to Different HA Brand 57
Chart 4-21: Patient Groups Receiving the Most Benefit from HA . 60
Chart 4-22: Importance of Pricing, U.S., 2011 . 62
Chart 4-23: Purchasing Channels, U.S., 2011 . 64
Chart 4-24: Importance of Pricing by Purchasing Channel, U.S., 2011 66
Chart 4-25: Respondent Clinical Setting, U.S., 2011 68
Chart 4-26: Time to Relief by Treatment Cycle, Weeks, U.S., 2011 70
APPENDIX 1: CANADIAN RESPONDENTS, 2011 74
APPENDIX 2: SURVEY QUESTIONS 80
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