MAUDE Adverse Event Report: ZIMMER BIOMET, INC. ANSWER 9X125 COCR LAT; PROSTHESIS, HIP

Model Number N/A

Device Problem Material Erosion (1214)

Patient Problem Metal Related Pathology (4530)

Event Date 08/13/2019

Event Type  Injury  

Manufacturer Narrative

(b)(4).Concomitant medical products: catalog number: 11-173661 lot number:036230 brand name: m2a 38mm mod hd; catalog number:rd118848 lot number:942430 brand name: m2a 38mmx48mm cup; catalog number:162501 lot number:170890 brand name: answer 9x125 cocr lat.Multiple reports were submitted along with this report 0001825034-2022-00678 and 0001825034-2022-00679.Medical records were provided and reviewed by a health care professional.Review of the available records identified the following: failed right total hip replacement with suspected altr from metal on metal bearing.Pseudo capsule and lytic inflammation encountered, gray staining of synovial lining and thickened yellow tan tissue developed and debrided.Corrosion to the trunnion noted and cleaned.Defect behind acetabulum involving posterior portion of the posterior column, cup appeared to be well fixed to the ilium.Black lytic membrane tissue debrided from the hip joint space and allograft bone placed into defect.Noted black material to greater trochanter and debrided.Reported event was confirmed by review of medical records provided.Review of the device history record(s) identified no deviations or anomalies during manufacturing.A definitive root cause cannot be determined.If any further information is found which would change or alter any conclusions or information, a supplemental will be filed accordingly.Zimmer biomet will continue to monitor for trends.

Event Description

It was reported that the patient was revised with suspicion of adverse local tissue reaction approximately 15 years post implantation.During the revision there was a pseudo capsule, corrosion, lytic inflammation, gray staining, black lytic membrane material found and bone defect.Attempts have been made and additional information on the reported event is unavailable at this time.

• Brand Name: ANSWER 9X125 COCR LAT
• Type of Device: PROSTHESIS, HIP
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• Manufacturer Contact: christina arnt ; 56 e. bell dr.; warsaw, IN 46582 ; 5745273773
• MDR Report Key: 14250635
• MDR Text Key: 290383420
• Report Number: 0001825034-2022-00992
• Device Sequence Number: 1
• Product Code: JDG
• UDI-Device Identifier: 00880304252660
• UDI-Public: (01)00880304252660(17)310810(10)170890
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K931194
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Consumer,Health Professional,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 04/29/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/29/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 08/31/2010
• Device Model Number: N/A
• Device Catalogue Number: 162501
• Device Lot Number: 170890
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 04/14/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 08/01/2000
• 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
• Patient Sex: Female