MAUDE Adverse Event Report: ENCORE MEDICAL L.P. OMEGA HIP SYSTEM; NECK, FEMORAL, MODULAR, 32MM 8DEGREE CERASIVE TAPER

Model Number 410-32-108

Device Problem Detachment Of Device Component (1104)

Patient Problem Failure of Implant (1924)

Event Date 02/23/2016

Event Type  Injury  

Event Description

Revision surgery - due to a failed left total hip arthroplasty with disassociation of the modular neck from the femoral stem.

Manufacturer Narrative

The reason for this revision surgery was due to a failed total hip with disassociation of the neck from the stem.The previous surgery and the revision detailed in this investigation occurred 8.4 years apart.There is no information in this complaint about any patient injuries, activities, or accidents that may have contributed to the need for this revision surgery.There are no reported pre-existing patient health conditions.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 device was disposed of at the hospital and not made available to djo surgical for examination.A review of the implant device history records (dhr), shows that the reported component used in the previous surgery met design and manufacturing requirements.There were no non-conforming material reports (ncmrs) associated with the product that may have contributed to the reported event.The device was verified to have gone through an acceptable sterilization process and was within its expiration date at the time of use during the previous surgery.Customer complaint history of the reported device showed no present trends or on-going issues that are in need of review.The root cause of this complaint was a revision surgery due to a failed total hip with disassociation of the neck from the stem.There were no findings during this investigation that indicate that the reported device was defective.There are multiple factors that may contribute to an event that are outside of the control of djo surgical.Inventory containment is not required as there are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: OMEGA HIP SYSTEM
• Type of Device: NECK, FEMORAL, MODULAR, 32MM 8DEGREE CERASIVE TAPER
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd; austin TX 78758 5445
• MDR Report Key: 7361554
• MDR Text Key: 103182827
• Report Number: 1644408-2018-00245
• Device Sequence Number: 1
• Product Code: LPH
• UDI-Device Identifier: 00888912076579
• UDI-Public: (01)00888912076579
• Combination Product (y/n): N
• PMA/PMN Number: K000817
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 05/01/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/22/2018
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 01/28/2013
• Device Model Number: 410-32-108
• Device Catalogue Number: 410-32-108
• Device Lot Number: 53838695
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 04/26/2018
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: 010-55-025, LOT 947661; 430-01-050, LOT 53837553; 432-28-206, LOT 53837642; 497-28-035, LOT 272102; 650-02-120, LOT 2005; 010-55-025, LOT 947661; 430-01-050, LOT 53837553; 432-28-206, LOT 53837642; 497-28-035, LOT 272102; 650-02-120, LOT 2005
• Patient Outcome(s): Required Intervention
• Patient Age: 72 YR