MAUDE Adverse Event Report: SMITH & NEPHEW, INC. R3 MULTI HOLE ACETABULAR SHELL 64MM; PROSTHESIS, HIP, SEMI-CONSTRAINED, UNCEMENTED, METAL/POLYMER, POROUS

Catalog Number 71338672

Device Problem Insufficient Information (3190)

Patient Problem Unspecified Infection (1930)

Event Date 07/31/2018

Event Type  Injury  

Event Description

It was reported a hip revision surgery due to infection.Synergy size 12 stem removed & 64mm od multi hole cup & liner removed with a ceramic size 36 head.

Manufacturer Narrative

The associated complaint devices were not returned.The clinical/medical team concluded, this is a complaint from australia reporting the revision of a hip that was originally implanted in january 1999.Reportedly, the revision was due to ¿dislocation and infection¿.The revision was performed in 2 stages and completed after 2 wash-outs were performed between the two stages of the revision.Pictures of the components and a picture of the ¿washouts¿ brief reports were submitted for review.These did not aid in this investigation.No other medical information was provided.All documents and images provided as of this date have been reviewed and considered and unless noted do not contribute to the clinical investigation.Based on the available information, the root cause for the ¿infection and dislocation¿ cannot be concluded.However an infection 18 years post implantation was likely hematogenous in origin and not a prosthesis failure.No information on the patient¿s current status was provided.A review of the production documentation for the corresponding products did not reveal any deviation from the standard manufacturing processes.A review of complaint history for the listed part revealed no prior complaints for the listed batch.Product was sterilized according to sterilization release documentation from quality control.No further clinical/medical investigation is warranted at the time.Without the actual product involved our investigation cannot proceed.If the device or new information is received in the future, this complaint can be re-opened.We consider this investigation closed.

• Brand Name: R3 MULTI HOLE ACETABULAR SHELL 64MM
• Type of Device: PROSTHESIS, HIP, SEMI-CONSTRAINED, UNCEMENTED, METAL/POLYMER, POROUS
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• Manufacturer (Section G): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• Manufacturer Contact: sarah freestone ; 101 hessle road; hull HU3 2-BN ; UK HU3 2BN
• MDR Report Key: 7805373
• MDR Text Key: 117875856
• Report Number: 1020279-2018-01571
• Device Sequence Number: 1
• Product Code: MBL
• Combination Product (y/n): N
• Reporter Country Code: AS
• PMA/PMN Number: K092386
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 11/18/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Catalogue Number: 71338672
• Device Lot Number: ASKU
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 08/22/2018
• Supplement Dates Manufacturer Received: Not provided
• Supplement Dates FDA Received: 11/18/2018
• 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
• Patient Outcome(s): Hospitalization; Required Intervention