BETHESDA MEMORIAL HOSPITAL 2815 S. Seacrest Blvd.

BOYNTON BEACH, FL 33435 (561) 737-7733 Revised DatejTime 04/11/2011 07:47 OB Ind: * * * * * * FACESHEET *t*ttt

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PT STS: ID SVC: SRG ADMIT DATE TIME DSCH DATE MR#: 108464181 PT NO: 1711024248 04/11/11 06:19 04/14/11 PREV DSCH DATE:

PT NAME: A DSCH DISP: AHR BED: 402401 AGE: 65 BIRTH DT: RACE: 0 MAR STS: M FC: D PT TYPE: S SEX: F ADDR: TEL: RELIGION: NIN

ACC DT: 03/29/11 ACC TIME: 01:OO CITY: ST: FL ZIP:

PT OCCUPATION: EMPR TEL: EMPR NAME: RETIRED EMPR ADDR: VIP STS:

ISOL IND: EMPR CITY: ST: ZIP: EMG CONTACT: REL U EMG ADDR: TEL: EMG CITY: ST: FL ZIP:

ADM DX: RIGHT HIP OSTEOARTHR ADM SOURCE: RA ADM DR#: 001313 ADM DR: ZANN ROBERT ACC INDICATOR: H ATN DR#: 001313 ATN DR: ZANN ROBERT JOB REL IND: PCP DR#: 001313 PCP DR: ZANN ROBERT

GUAR NAME: A REL S GUAR ADDR:

GUAR CITY: ST: FL ZIP: GUAR EMPR NAME: RETIRED GUAR EMPR ADDR: GUAR EMPR TEL

GUAR EMPR CITY: ST: ZIP:

NUMBER OF INSURANCE PLANS: 2 TREATMENT AUTHORIZATION:

PLAN #1 INS CODE: ME1 DESCRIPTION: MEDICARE

PRIORITY GROUP EMPR ID: TEL: 800 - 633-4221

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GUAR TEL:

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POLICY NUMBER: GROUP# :

# 1 ADDRESS: P.O.BOX 1798

CITY: JACKSONVILLE ST: FL ZIP: 32231- SUBSCRIBER:

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PLAN #2 INS CODE: 113 DESCRIPTION: MUTUAL OF OMAHA

PRIORITY GROUP EMPR ID: TEL: 800 - 775-1000 POLICY NUMBER: GROUP# :

# 2 ADDRESS: MUTUAL OF OMAHA PLAZA

CITY: OMAHA ST: NE ZIP: 68175- SUBSCRIBER: A

*****tt***tt**tttt*t*****t.*tttttttfttt*******,*******~~********~~****~* ****~~~*

PLAN #3 INS CODE: DESCRIPTION:

PRIORITY GROUP EMPR ID: TEL: -

PRIOR ADMIT: REMARKS: RIGHT HIP ARTHROPLAS TY 27130 DATE:

POLICY NUMBER: GROUP# :

# SUBSCRIBER: REG BY: 189111

1D:OB

BETHESDA MEMORIAL HOSPITAL , ._e.

PT: MR#: 10-846416-1 SITE: BMH DA: 04/11/2011 a DO:. 04/11/2011 DR: ROBERT B ZANN, MD

OPERATIVE REPORT Page 1

PREOPERATIVE DIAGNOSIS: Degenerative osteoarthritis right hip.

2 POSTOPERATIVE DIAGNOSIS: Degenerative osteoarthritis right hip.

OPERAT I ON : Right total hip arthroplasty cementless (Stryker Trident PSL, X-3 acetabular component Rejuvenate modular femoral component Biolox Delta ceramic head).

SURGEON: Robert B. Zann, M.D.

ASSISTANTS: Ms Cynthia Martinez, Mr. James Fenton, and Ms Elizabeth Huffman.

. .:.

)

ANESTHESIOLOGIST: Dr. Drucker.

\ ANESTHESIA: Spinal. -1

ESTIMATED BLOOD LOSS: 100 mL.

SPECIMENS REMOVED: Femoral head

INDICATIONS FOR SURGERY: Failure of pharmacologic management for the treatment of advanced degenerative joint disease, right hip.

INDICATIONS FOR SURGICAL ASSISTANCE: Surgical assistant utilized during patient positioning, prepping and draping, retraction and manipulation of the right lower extremity during surgical exposure, leg length measurement, hip dislocation, femoral neck osteotomy, removal of the femoral head, . preparation of acetabulum and femur, insertion of trial acetabular and femoral components, relocation of hip, repeat leg length

OR I G INAL

1D:OB

BETHESDA MEMORIAL HOSPITAL

PT: MR#: 10-846418-1 SITE: BMH DA: 04/11/2011 DO: 04/11/2011 DR: ROBERT B ZANN, MD

OPERATIVE REPORT Page 2

measurement, hip dislocation, insertion of acetabular and femoral implants, relocation of hip, hemostasis and wound closure.

COMPONENTS IMPLANTED: Stryker 50-mm E Trident PSL acetabular shell, 2 cancellous screws, 36-mm E Trident X-3 10-degree elevated insert, size 7 Rejuvenate modular femoral component, 34-mm 8-degree anteverted 132-degree femoral neck, + O neck 36-mm Biolox Delta ceramic femoral head.

3

DESCRIPTION OF PROCEDURE/FINDINGS: Under spinal anesthesia, the patient was placed in the left lateral decubitus position and the right lower extremity was prepped and draped in the usual fashion. The hip was approached through a posterolateral incision extending through the subcutaneous tissue. The iliotibial band and investing fascia of the gluteus maximus muscle were incised and the muscle split by blunt dissection. The underlying external rotator muscle and sciatic nerve were clearly visualized. The capsule was then opened and elevated off the acetabular margin by sharp dissection. A Steinmann pin was placed into the lateral wing of the ilium to serve as a self-retaining retractor. The hip was dislocated and the femoral neck osteotomized in the usual fashion. The distance between the osteotomy site and the center of the femoral head was measured and recorded for leg length measurement check. The femoral head was removed, and attention turned to the acetabulum.

The remaining acetabular labrum was sharply excised. The acetabulum was progressively reamed to 50 mm. A 50-mm E Trident PSL acetabular shell was impacted and found to have an excellent fit. The shell was secured with 2 cancellous screws. A 36-mm E Trident X-3 10-degree elevated insert was tapped into the shell, dialed at the 12 o clock position. Attention was then turned to the femur

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.;I

1 The lateral cortex of the femoral neck was removed with a box

OR1 GINAL

1D:OB

BETHESDA MEMORIAL HOSPITAL

PT: MR#: 10-846418-1 SITE: BMH DA: 04/11/2011 DO: 04/11/2011 DR: ROBERT B ZANN, MD

OPERATIVE REPORT Page 3

chisel. broached up to a #7 size. Trial reductions were then performed with various head and neck lengths. With the 34-mm 0-degree anteverted 132-degree neck a.nd a +O neck 36-mm head, there was excellent stability throughout a full range of motion. The hip was

. dislocated and the broach removed. A size 7 modular Rejuvenate femoral component was impacted and found to have an excellent fit. A 34-mm 8-degree anteverted 132-degree femoral neck was tapped onto the femoral component. A + O neck 36-mm Biolox Delta ceramic femoral head was tapped onto the femoral component. The wound was copiously irrigated and the hip reduced. A medium Hemovac was placed and the wound closed in layers.

The piriformis tendon and joint capsule were repaired with # 2 Vicryl interrupted sutures. The iliotibial band and investing fascia of the gluteus maximus muscle were repaired with #2 Vicryl. interrupted sutures. The subcutaneous tissue was approximated with 2-0 Vicryl interrupted sutures, and the skin with metallic skin clips. A sterile compressive dressing,was then applied, and the patient was transported to the recovery room in satisfactory condition.

The cahal was progressively reamed and progressively

.I

D: 04/11/2011 8:19 A T: 04/11/2011 11:22 A Job#: 001637000 ID#: 7110411112209283 DOC#: 1091190 CC: ROBERT E ZANN, MD

OR1 GI NAL

LNTH

11111111111111111111111111111111111111 ffal NLV-340800G 1111111111111111111111

34297701 STRYKER ORTHOPAEDICS

Biolox® delta Ceramic V40T° Femoral Head

OD NK LNTH

2 2015-12 111111 If11111111111111111111111111i 11111

542-11-50E • .111 111 111 111 11 11 1111 1 11 11 111 -.

101.1MJMT2D `STRYKER ORTHOPAEDICS

Trident® X30 10° Polyethylene Insert

ID ALPH CDE

11111111111111111111111111111111111111111 r=1623-10-36E 111 111 111 11 111111 I 11 1111 1 111 K1MJT9DT STRYKER ORTHOPAEDICS

Rejuvenate. 2 20154.1

Modular Neck — 127°1132° Neck Angle

Torx® 6.5mm Cancellous Bone Screw

DIA LNTH 1, 6.5mm 20mm I

2016-02 1111111111111111111111111111111111111111 E] 2030-6520-1 III 111 11 III 1 11111 11 1111 11 111

MKA811_ STRYKER ORTHOPAEDICS

'Trident® PSL® HA 2 2015.09 Cluster Acetabular Shell

2 2016-01

1111111111111111111111111111111111111 1 6570-0-136 111111 1 1 11 1 I 11 1 1 1 I 1 1 111 1M136347501 STRYKER ORTHOPAEDICS

SZE ALPH CDE

Rejuvenate® SPT Modular Stem

2 201643

g. 111 11111111 0111111111111111111111111 111 EF SPT -070000S

111 1111111 12 M 1111111 1111111 ill 1I1MTVV 9 STRYKER ORTHOPAEDICS

Torx® 6.5mm Cancellous Bone Screw

DIA LNTH

2 2015-12

11111 1111 111111111111 III III OEFI 2030-6520-1 III 111 111 11 III 1111 III 111 1 111

oT MJTNVJ STRYKER ORTHOPAEDICS

p 201211

STRYKER ORTHOPAEDICS

Blolof l delta 0 miwz Ceremlc V40" Femoral Head

111111 II 11111111111111111111111111 111 I I l I I I I I I I I I I I I1I I I 111

6570-0-1 36

36347501 STRYKER ORTHOPAEDLCS . . .

0 r n w z TridenmX3@ j 100 Polyethylene Insert . * I

36mm E ; il II llllllb I II 1111 ,;i II I II I II I II I I II 111

623-10-36E 111 111 111 II I I I I I I I II 1111 I111

MJT9DT STRYKER ORTHOPAEDICS

Torx@6.5mm 0 201212 Cancellous Bone Screw

! m E 7 ~ 111 I I 1111 lllllllSllll 1111111111111 111 111

EEI 2030-6520-1 II I 111 111 II 111 1111 111 I I I I 111 n MJTNVJ

STRYKER ORTHOPAEDICS

ITrldentXl PSL@ HA 0 m i m

I

El 542-1 1-50E

,Cluster Acetabular Shell

!I1 I111 1111 I II II I I II I II II II I I II I II II I I 111 I I I 111 111 111 II II 1111 I II II 111

MJMT2D STRYKER ORTHOPAEDICS

r ) . .I Ton@ 6.5mm p 2OlW Cancellous Bone Screw

II 111 1111 1111 II 111111 1111111111111 111 111 E l 2030-6520-1 II I 111 II 111 I 1111 I II 1111 II 111 El MKA81 L STRYKER ORTHOPAEDICS

-. . . .

Bethesda Hospital East 2 8 1 5 S.Seacrest Blvd Boynton Beach, FL 3 3 4 3 5 ( 5 6 1 ) 7 3 7 - 7 7 3 3

Bethesda Hospital West 9 6 5 5 Boynton Beach Blvd Boynton Beach, FL 3 3 4 7 2 (561) 336-7000

Patient Name: MR#: 1 0 8 4 6 4 1 8 1 DOB: Account#: 1 7 2 0 0 3 8 0 5 6 Date of Admission: 0 6 / 0 7 / 2 0 1 2 Date of Service: 0 6 / 0 7 / 2 0 1 2 Attending Physician: ELVIS GRANDIC, MD Facility : Procedure Physician: ROBERT ZANN, MD

eOperative Report

PREOPERATIVE DIAGNOSIS: Status post right total hip arthroplasty cementless, metal sensitivity right hip, pseudotumor right. hip.

POSTOPERATIVE DIAGNOSIS: Status post right total hip arthroplasty cementless, metal sensitivity right hip, pseudotumor right hip.

OPERATION: Exploration of right hip, soft tissue debridement right hip, revision right femoral components cementless (Stryker Restoration Modular Femoral Component, Restoration Modular Cone Body, Biolox Delta Ceramic femoral head).

SURGEON: Robert B. Zann, M.D.

ASSISTANTS: Elvis Grandic, M.D.; Cynthia Martinez, PA-C; and Elizabeth Huffman, RNFA.

ANESTHESIOLOGIST: Dr. Santiago.

ANESTHESIA: Spinal.

ESTIMATED BLOOD LOSS: 200 mL.

SPECIMENS REMOVED: Soft tissue and femoral components.

INDICATION FOR SURGERY: This patient underwent an uneventful right total hip arthroplasty with an excellent postoperative recovery period. began experiencing pain approximately two months ago. This progressively worsened to the point that her pain is not controlled with narcotic analgesics. and an MRI scan showing a pseudotumor with a large effusion surrounding her right hip. Because of the metal sensitivity and the enlarging pseudotumor, she was brought to surgery for the above surgical procedure.

INDICATIONS FOR SURGICAL ASSISTANTS: Surgical assistants utilized during patient positioning, prepping and draping, retraction and manipulation of the right lower extremity during surgical exposure, leg length measurement, hip dislocation, soft tissue debridement, revision of femoral component, relocation of hip, repeat leg length measurement, hip dislocation, insertion of acetabulum and femoral implants, relocation of hip, hemostasis, and wound closure.

COMPONENTS IMPLANTED: Stryker 14-mm x 150-mm Restoration Modular Conical stem, 19-mm +10 Restoration Modular Cone body, to neck, 36-mm Biolox Delta

She

A workup revealed a positive elevated level of serum cobalt

Page 1 of 3

Bethesda Hospital East 2 8 1 5 S.Seacrest Blvd Boynton Beach, FL 3 3 4 3 5 ( 5 6 1 ) 7 3 7 - 7 7 3 3

Bethesda Hospital West 9 6 5 5 Boynton Beach Blvd Boynton Beach, FL 3 3 4 7 2 ( 5 6 1 ) 3 3 6 - 7 0 0 0

Patient Name: MR#: 1 0 8 4 6 4 1 8 1 DOB: Account#: 1 7 2 0 0 3 8 0 5 6 Date of Admission: 0 6 / 0 7 / 2 0 1 2 Date of Service: 0 6 / 0 7 / 2 0 1 2 Attending Physician: ELVIS GRANDIC, MD Facility : Procedure Physician: ROBERT ZANN, MD

eOperative Report

ceramic femoral head.

DESCRIPTION OF PROCEDURE/FINDINGS: Under spinal anesthesia, the patient was placed in the left lateral decubitus position and the right lower extremity prepped and draped in the Usual fashion. The hip was approached through the prior well healed posterolateral incision extending to the subcutaneous tissue. The iliotibial band and the vesting fascia of the gluteus maximus were incised and the muscles split by blunt dissection. A pseudocapsule and sciatic nerve were immediately identified. The pseudocapsule was then opened and elevated off of the acetabulum margin with sharp dissection. Upon entering the hip joint, a large amount of milky appearing fluid was encountered and drained. Cultures of the hip joint were then taken for anaerobic and aerobic cultures and sensitivities with gram stain. Inspection of the hip joint revealed significant soft tissue thickening with a white avascular appearing soft tissue filling the acetabulum and creating a pseudo-lining around the acetabulum. By soft tissue dissection, the lining of the pseudotumor was then removed and the acetabulum inspected. Acetabulum was found to be solidly attached to the underlying bone with absolutely no evidence of significant wear. Attention was then turned to the femur.

The femoral head was removed along with the femoral neck. The proximal femur was then circumferentially exposed and using reciprocating saws and side cutting burs, separated from the underlying bone. The femoral component was then removed. The proximal femur was inspected and found to have no significant disruption. The canal was then prepared for revision.

The canal was progkessively reamed to 14 mm. Modular Conical Stem was then inserted in to the canal and impacted. The proximal canal was then reamed to 19-mm to accept the +10 proximal cone body.

Trial reductions were then performed with the appropriate components. With the +O neck length, there was excellent stability throughout a full range of motion. The hip was dislocated and the trial component removed. A Restoration Module 19-mm, + l o , cone body was then attached to the conical stem with a locking screw. A +O neck, 36-mm Biolox Delta ceramic femoral head was then tapped on to the femoral component. irrigated and the hip reduced. A medium Hemovac was placed and the wound closed in layers.

The pseudocapsule was repaired with # 2 Vicryl interrupted suture. The iliotibial band and the vesting fascia of the gluteus maximus muscle were repaired with # 2 Vicryl interrupted sutures. The subcutaneous tissue were approximated with 2-0 Vicryl interrupted sutures and the skin with metallic skin clips. patient transported to the recovery room in satisfactory condition.

A 14-mm by 155-mm Restoration

The wound was copiously

A sterile compression dressing was then applied and the

Page 2 of 3

Bethesda Hospital East 2815 S.Seacrest Blvd Boynton Beach, EL 33435 (561) 737-7733

Bethesda Hospital West 9655 Boynton Beach Blvd Boynton Beach, EL 33472 (561) 336-7000

Pat ient Name: MR#: 108464181 DOB: A c c o u n t # : 1720038056 Date of Admission: 06/07/2012 Date of Service: 06/07/2012 Attending Physician: ELVIS GRANDIC, MD Facility : Procedure Physician: ROBERT ZANN, MD

eOperative R e p o r t

ROBERT ZANN, MD E d i t e d B y ZANN, ROBERT 25-Jul-2012 16:58:03 -04:OO Signed by ZANN, ROBERT on 25-Jul-2012 16:58:04 -04:OO Electronically signed when datehime present

D: 0 6 / 0 7 / 2 0 1 2 08 :36 T: 0 6 / 0 7 / 2 0 1 2 09:28 Job#: 001755251 ID#: 4120607092853302 DOC It: 1 2 1 6 7 8 1 cc: ELVIS GRANDIC, MD

ROBERT ZANN, MD

Page 3 of 3

.L.

OR CASE RECORD REPORT Page 7 of 7

Transported Tu: PACU

Truiiqiuit Methud: Bed

Skin Asscssment: Cnmmcnt: W;lrln D V

Nurse Dingnusiu Nutes: @ 07 15 MD REQUESTED TROCHANTERIC GRIP FROM ZIMMER FOR PROCEDURE, UNABLE TO FIND READILY DESPITE A MULTIPERSONS SEARCH. MCJKRAUSE, R.N.

Name: MRN: 108464181 DOE: Gender: F Age: 66 Accirunt #: 1720038056 Surgery Date: 06/07/2012 Case Numlier: 705(M) Facility: Bethesda Mciiiorinl Hospital

Patient Information

Specimen Information Specimen: MR068253E Requisition: 001 1447 In: 0011447

Patient Information I Specimen Information I: MR068253E - .

T e s t CHROMIUM, Name SERUM COBALT

In 1.0 Range 0 1 Reporting Limit: 1.0 !ncq/L

- Normal.. serum .va.lues -.a.re- less. than -1.0 rncg Analysis by Inductively Coupled Plasrna/Mass Spectrometry (ICP/MS)

PERFORMING SITE: WD QUESTDlACN:OSllCSNICHOU W S m U T E C H A N n U Y , l 4 ~ H E I V B R O O I ; D R N E M A N T I U Y . V A I O I J I - ~ ~ ~ ~ u ) EY NMS LABS, 3701 W U J H ROAD, \ V M O W GROVE. PA 190900137 Imbmly D k w : ROBERT A. MIDDLE8EROAID.OABFI

A G E 66 Gender: F Phone: Patient ID: 1321 15 Health ID: 8573004886216128

Your request to have a duplicate copy faxed has be Queued to: 15613958636

Collected: 04/17/2012 / 12:43 EDT Keceived: 04/17/2012 / 1248 EDT Reported: 04f2lR012 /W05 EDT

(*A Copy Fmm)

* PARK SHERIDAN PLAZA PSC h z requested n copy of this repon be sent to you. Ordering Physician: i

CLIENT SERVICES: 866.697.8378 SPECIMEN: MR0682S3E .\

Q u m , Qvcrt Dlngnmlis, the uwxiated logo m d all -htd Qual Dhgnmlin marks arc the trademarks Of Ql

Report Status: Fina

Client Information Client #: Not Given 9999999 ROBERT B. ZANN MD 1401 NW 9TH AVE BOCA KATON, FL 33486

~

e r e n c e Ranae Lab A ? ? EY

:tu: K ~ N E I H L S I S C O . M D . U I * : ~ ~ ~ ~ I E O I A: 3900197898

acknowledged.

N. ROBERT B

PAGE I OF I

D l o p w s l i a

500 Chipeta way, salt Lake City, Utah 64108 phone: (801) 563-2797 toll free: (800) 522-2767 fax: (801) 583-2712 web: www.aruplab.com Sherrie L. Perkins, MD, PhD Chief Medical Officer and Director of Laboratories

(012328)0576906 Female Primary Clinician: ZANN, ROBERTO ARUP Requisition Num: 0576906 Accession 1: 50605433 Printed on: 10 Sep 2012 06:20 PM

REFERENCE ORDERED TEST RESULT RESULT FLAG INTERVAL VERIFIED DATE

Memorial Hospital Miramar Inquiry Report

1901 SW 172nd Avenue Miramar, FL 33029

FROM (MOH)SOP 10 2012 10:27,11T.10:22,140.0001003066 P 1

Accession #: 12250543051 Collected on: 06 Sep 2012 11:05 AM

Cobalt, Serum or Plasma 1.7 ug/L High <=1.0

If uncertainty exists regarding the type of blood tube used to collect this specimen, testing should be repeated with a second specimen collected in a certified metal-free tube. Elevated results determined with specimens collected in noncertified metal-free blood tubes may reflect contamination of the tube itself. INTERPRETIVE INFORMATION: Cobalt, Serum or Plasma

Serum or plasma cobalt testing is intended to detect potentially toxic exposure.

Billing Number: 5005180750 Received on: 07 Sep 2012 10:55 AM Ordering Clinician: ZANN, ROBERTO

9/7/12 8:27 PM

The information provided in this report represents the current status of this order. Any addendums will be delivered via your primary reporting process.

LABEVIRATiefite REPORT Page 1. of 1 18716 (ARR-L-400) 4104

LABORATORIES 500 Chipeta Way, Salt Ldke City, Utah 84108 phone: I801) 583-2187 toll free: [800) 522-2787 fax! 18011 583-2112 web: VW.arUDlab.COm Sherrie L. Perkins, HD, PhD Chief Medical Officer and Director of Laboratories

Inquiry Report (0123281 0576906 Memorial Hospital Miramar Female 1901 SW 172nd Avenue Primary Clinician: ZANN, ROBERTO Miramar, FL 33029 ?&UP Requisition Nun: 0576906 Accession # : 50605433 Printed on: 10 Sep 2012 06:20 PM

REFERF,NcE ORDERED TEEST RESULT RESULT FLAG INTERVAL VERIFIED DATE _____._________.....____________________---------------------------..--- ------------------------.-.-

Accession # : 12250543051 Collected on: 06 Sep 2012 11:05 AM

Cobalt, Se- or Plasma 1.7 ug/L High <=1.0

If uncertainty exists regarding the type of blood tube used to collect this specimen, testing should be repeated with a second specimen collected in a certified metal-free tube. Elevated results determined with specimens collected in noncertlfied metal-free blood tubes may reflect contamination of the tube i t s e l € . INTERPRETIVE I N F X M A T I O N : Cobalt, Serum or Plasma

S e m or plasma cobalt testing is intended to detect potentially toxic exposure.

Billing Number: 5005160750 Received on: 07 Sep 2012 10:55 Atl Ordering Clinician: ZANN, ROBERTO

9 / 1 / 1 2 8 : 2 7 PM

The information provided in this report represents the arrent status of t h i s order. Any addendums will be delivered via your primary reporting process. kih56HATXMW REPORT Page 1 of 1 18716 (ARl7.L-400) 4/04

AVU 10.GU .eaye OZ el Diagnostic:

Patient Information

07/02/2014 02:47:32

Specimen Information

P1

11:43 EDT 0] :22 EDT 11:08 EDT

Report Status; Final

Client InformaticEn

DOB: 09/1811945 AGE: 68 Gender: F Phone: Patient ID; 138530 Health TO: 8573004886216128

Specimen: MR128 I, 04B Requisition: 0001497

Collected: 06/25/2014 / Received: 06/26/20 ]4 / Repotted: 07/02/2014 /

Giant 11.: 16177 . 601,9000 ZANN, ROBERT B ORTHOPAEDIC SURGERY ASSOC, 2828 S SEACREST BLVD STE 204 BOYNTON BEA.CH, FL 33435-7944

Test Name COBALT, SEWN/PLASMA CHROMIUM, SERUM TITANIUM, SERUM/PLASMA

Reporting Limit: 10 mcg/L

In Range Out Of Range 0.5 H

0,1 None Detected

Reference Range 0.1-0.4 mag/L <-1.4 maga mcg/L

Lab AMD AMD EY

The normal valUe for titanium is gererally less 5 mcg/L. In paU.entb with a titanium-based implant/prosthesis, a serum concentration greater than 10 mcg/L may be indicative o4 wear. However, a reported titanium value alone is not, predictive of prosthesis wear or failure. Analyei,e by Inductively Coupled PlaeMa/Mass Spectrometry (ICP/MS)

CHROMIUM, PLASMA <0.2

than

c 3.6 mcg/L

SLI

l'ERFORIVIING SITE; AMD 01,TESTDIAGNIOSTICRATTCT-IOLS CHANTILLY, 142251,1RW/114.001C DRIVE, CJIANDLLY. VA 20151-2228 IAborrunryDirccror KENNIITIT LS1SCO, MD, CL1A: 447.30221801 111)" N'Mg LABS, 3701 WELSH ROAD, WILLOW OROV1, PA 10040.043/ TAIwiscory1).1vsloa: ROIMMT A. Ivill)TAPBER(1,P110,12ADFT, 30150107848 SU QUEST DIAGNOgleS NIQICILS LENC1A, 21027 TOURNMOA1), VA LINCTA,, CA 91355.584 Labotatocy Dirccior: MiCTIAEL C DUGAN,MD.PCAP, ODOS503017

CLIENT SERVICES: 866.697,8378 SPECIMEN: MR12810413

PAGES I OF I

Quest, Quest Diagnostics, the associated 1i sod all #1.311fic4ikred Quest Diagnos tics mark' *r the traernialo of Om* Dfagnostim

TnT1IT P nnc

07/0,2/2014 02:47:32 .PI4

Bequisitiorl, 0001497 CAPUTI, WANDA

DOE: 09/1#1945 ACE: 68 Collcctcd: 06/25/2014 / I1:43 EDT Rcccivcd: 015/226/2034 / W:22 E M Rcported: 07/02/2014 / 11:08 EDT

Gendof: Phone: 954.961.712 Patient ID: 138530 H C ~ I ~ I Y m: ~57mms6211i 12s

P.008 Report Status: Final

C

Clicnt Information Cliatfl: 16177 . hon9000 ZANN, ROBERT I3 ORTW0PA:EDI C SURGERY ASSOC. 2828 S SBACREST BLVD STB 204 ROYNTCYN REACH, FL 33435-7944

Teat Nma In R m q o Mlt Of R a g e Rafetsnce ~ a n g ~

COBALT. SERUM/PLASWn 0.3 H 0.1-0.4 rncg/L

CHROMIUM. SERUM 0.1 c-1.4 mcg/L TITANIUM, SERUM/BLASMA None ClcteCfed mcg/L

Reparting Limit: 10 mcg/L

Lab AMD AMD EY

The n o m 1 value for titanium ia genorally lesa than 5 mcg/L. In patiante with a titeniLIm-ba#cd implant/proathesia, a mrum concentration greater than 10 rncg/L m y be indicakivE o f mar. nowever, a reported titanium value alone il~ not predictive of prosthesis wear or failure. h a l y a i e by Inductively Coupled Plamrm/Marr Spectrometry (ICP/MB)

CHROMIUM, PLASMA 60.2 c 3.6 mcg/L SLI

PAGP. 1 OF 1

TOTAL P.008