MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US PINN CAN BONE SCREW 6.5MMX20MM; BONE SCREWS AND PINS : SCREWS

Model Number 1217-20-500

Device Problem Loss of Osseointegration (2408)

Patient Problems Ossification (1428); Edema (1820); Foreign Body Reaction (1868); Hypersensitivity/Allergic reaction (1907); Pain (1994); Tissue Damage (2104); Weakness (2145); Discomfort (2330); Injury (2348); Osteolysis (2377); Ambulation Difficulties (2544); Inadequate Osseointegration (2646); Limited Mobility Of The Implanted Joint (2671)

Event Date 11/11/2019

Event Type  Injury  

Manufacturer Narrative

(b)(4).Initial reporter occupation: lawyer.(b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

Event Description

Pinnacle litigation record received.Litigation alleges discomfort, pain, weakness, walking difficulty, osteolysis, metallosis, elevated metal ions, pseudotumor, loosening of cup and stem, leg length discrepancy( 1/2 inch shorter than the right leg), bone loss, limited mobility, muscle and ligament injury.The plaintiff is seeking compensatory damages.Pfs alleges metallosis with pseudotumor, aseptic loosening of the cup and stem resulting to pain, discomfort, swelling, walking difficulty, osteolysis, elevated cobalt and chromium level, abductor tendinopathy with partial tears and limited adl.Ppf have mostly same allegation except for metal wear and abductor muscle repair.After review of the medical records confirmed the patient was revised due to metallosis, pseudotumor secondary to mom tha, elevated metal ions, osteolysis and aseptic loosening for both cup and stem.Operative noter reported small amount of clear straw-colored joint fluid.This was sent for microbiology.There was also a small amount of metallosis involving synovium and pericapsular tissues.Femoral and acetabular component was derbrided noted to be grossly loose.The cup was noted to be undersized and retroverted.Mri reported loosening and osteolysis for both cup and head.There is some heterotopic ossification to the left greater trochanter and mild tendinosis.Cobalt level is above 7ppb.Doi: (b)(6) 2010; dor: (b)(6) 2019; left hip.

Manufacturer Narrative

Product complaint # (b)(4).Correction: e1, e2, e4.Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.

Manufacturer Narrative

Product complaint # (b)(4).Investigation summary: an analysis of the product could not be performed since a physical sample was not received for evaluation.As part of our company quality system process, all devices are manufactured, inspected, and distributed to approved specifications.Additional complaint information monitoring for potential safety signals will be conducted through complaint trending as part of the post-market surveillance.However, if the product is received at a later date, the investigation will be updated as applicable.

Manufacturer Narrative

Product complaint # (b)(4).Investigation summary : the device associated with this report was not returned to depuy synthes for evaluation.All available x-rays were reviewed, and no evidence of implant fracture, disassociation, or anything indicative of a device nonconformance was found.The reported allegation cannot be confirmed.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post-market safety surveillance activities.Device history lot : the product investigation found no evidence suspecting an error in the manufacturing or material that would be a contributing factor in the reported allegation(s).A manufacturing records evaluation (mre) was not performed.

• Brand Name: PINN CAN BONE SCREW 6.5MMX20MM
• Type of Device: BONE SCREWS AND PINS : SCREWS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• Manufacturer (Section G): DEPUY RAYNHAM, A DIV. OF DEPUY ORTHO 1219655; 325 paramount drive; raynham MA 02767
• Manufacturer Contact: kara ditty-bovard ; 700 orthopaedic drive; warsaw, IN 46581-0988 ; 6107428552
• MDR Report Key: 10392290
• MDR Text Key: 202527118
• Report Number: 1818910-2020-17899
• Device Sequence Number: 1
• Product Code: LPH
• UDI-Device Identifier: 10603295009795
• UDI-Public: 10603295009795
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K983014
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Consumer
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup,Followup
• Report Date: 02/19/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/11/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 01/31/2020
• Device Model Number: 1217-20-500
• Device Catalogue Number: 121720500
• Device Lot Number: 420710
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 03/28/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 02/09/2010
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Treatment: ASPHERE M SPEC 12/14 36 +5; CORAIL2 STD SIZE 12; PINN CAN BONE SCREW 6.5MMX20MM; PINNACLE MTL INS NEUT36IDX54OD; PINNACLE SECTOR II CUP 54MM
• Patient Outcome(s): Required Intervention
• Patient Age: 65 YR
• Patient Sex: Male
• Patient Weight: 106 KG
• Patient Race: White