MAUDE Adverse Event Report: BIOMET ORTHOPEDICS 22.2MM DIA COCR MOD HD -3MM NK; PROSTHESIS, HIP

Model Number N/A

Device Problems Detachment of Device or Device Component (2907); Device Dislodged or Dislocated (2923)

Patient Problem No Code Available (3191)

Event Date 07/08/2015

Event Type  Injury  

Event Description

It was reported that the patient underwent an initial total hip arthroplasty on (b)(6) 2015.Subsequently, the patient was revised on (b)(6) 2015 due to dislocation.During the revision, the locking ring popped off while impacting the liner into the acetabular cup.Another liner was utilized to complete the procedure and the modular head and acetabular cup were removed and replaced.

Manufacturer Narrative

Current information is insufficient to permit a conclusion as to the cause of the event.Review of device history records show that lot released with no recorded anomaly or deviation.There are warnings in the package insert that state that this type of event can occur: "dislocation and subluxation due to inadequate fixation and improper positioning.Muscle and fibrous tissue laxity can also contribute to these conditions." this report is number 1 of 2 mdrs filed for the same event (reference 1825034-2015-03447 & 03448).

• Brand Name: 22.2MM DIA COCR MOD HD -3MM NK
• Type of Device: PROSTHESIS, HIP
• Manufacturer (Section D): BIOMET ORTHOPEDICS; 56 e. bell drive; warsaw IN 46582
• Manufacturer (Section G): BIOMET ORTHOPEDICS; 56 e. bell drive; warsaw IN 46582
• Manufacturer Contact: megan haas ; 56 e. bell drive; warsaw, IN 46582 ; 5743726700
• MDR Report Key: 4954487
• MDR Text Key: 6636043
• Report Number: 0001825034-2015-03447
• Device Sequence Number: 1
• Product Code: KMC
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: PK853259
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 07/09/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/30/2015
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Physician
• Device Expiration Date: 07/31/2023
• Device Model Number: N/A
• Device Catalogue Number: 163653
• Device Lot Number: 990240
• Other Device ID Number: N/A
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 07/09/2015
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 08/01/2013
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Removal/Correction Number: N/A
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization; Required Intervention
• Patient Age: 51 YR