MAUDE Adverse Event Report: ENCORE MEDICAL L.P. FMP HIP; LINER, ACETABULAR, FMP CONSTRAINED 28XMP10

Model Number 436-28-010

Device Problems Device Dislodged or Dislocated (2923); Appropriate Term/Code Not Available (3191)

Patient Problem Insufficient Information (4580)

Event Date 03/01/2021

Event Type  Injury  

Manufacturer Narrative

Additional reporting on this event will be provided as a supplemental report to this document if it becomes available.

Event Description

Second revision surgery - patient dislocated after a hip revision.A proximal femur was the component used.

Manufacturer Narrative

Manufacturer narrative: the reason for this revision surgery was reported as dislocation.The previous surgery and the surgery detailed in this event occurred 12 days apart.Initial or prolonged hospitalization was required.The healthcare professional indicated there was no delay in surgery and another suitable device was available for use.The revision surgery was completed as intended.The devices were disposed of at hospital and not made available to djo surgical for examination.A review of the device history records (dhr) show that the reported components used in the previous surgery, when released for use, met design and manufacturing requirements.There were no non-conforming material reports (ncmr) associated with the products that may have contributed to the reported event.The devices were verified to have gone through an acceptable sterilization process and were within its expiration date at the time of the previous surgery.Customer complaint history of the reported devices showed no present trends or on-going issues that are needing a review.The root cause of this compliant was a revision surgery due to dislocation.There were no findings during this evaluation that indicate the reported devices were defective.No information was submitted with the complaint regarding pre-existing conditions of the patient or any activities the patient was involved in that may have contributed to the event.Due to short time between previous and revision surgery, it is possible that the event may have occurred due to lack of post-operative care, patient noncompliance with medical instructions, improper surgical technique, patient activities or trauma.There are multiple factors that may also contribute to an event that are outside the control of djo surgical.There are no indications of a product or process issue affecting implant safety or effectiveness.Additional reporting on this event will be provided as a supplemental report to this document if it becomes available.

Event Description

Revision surgery - patient dislocated after a hip revision.A proximal femur was the component used.

• Brand Name: FMP HIP
• Type of Device: LINER, ACETABULAR, FMP CONSTRAINED 28XMP10
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd.; austin TX 78758 5445
• MDR Report Key: 11590546
• MDR Text Key: 242988701
• Report Number: 1644408-2021-00231
• Device Sequence Number: 1
• Product Code: KWZ
• UDI-Device Identifier: 00888912085755
• UDI-Public: (01)00888912085755
• Combination Product (y/n): N
• PMA/PMN Number: K023794
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 05/20/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/30/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 05/20/2021
• Device Model Number: 436-28-010
• Device Catalogue Number: 436-28-010
• Device Lot Number: 502C1008
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 04/22/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: 436-28-000 LOT 496C1088.; 436-28-000 LOT 496C1088
• Patient Outcome(s): Hospitalization; Required Intervention
• Patient Age: 66 YR