Form Page

First Name*

Last Name*

Phone*

e.g. 555-555-5555

Email*

Have you undergone a Hip, Ankle, or knee replacement from 2004 to 2021?*

Yes

No

Did your replacement include an Exactech plastic insert?

Yes

No

I don't know

Since the surgery have you experienced any of the following:

Corrective Revision Surgery

Disintegration of Bone Cells (Lysis)

Bone Loss

Component Fatigue cracking/fracture

Inability to bear weight

Grinding or other noise

Instability

Premature device failure

None of the Above

When would be a good time to call you?

Central Time

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I Consent