MAUDE Adverse Event Report: ENCORE MEDICAL L.P FMP HIP; FMP HEMISPHERICAL SHELLS W/O SCREW HOLES, 56MM, W/P2 COATING

Model Number 430-99-056

Device Problems Failure to Osseointegrate (1863); Appropriate Term/Code Not Available (3191)

Patient Problem Insufficient Information (4580)

Event Date 12/01/2020

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

Revision surgery - revised a fibrous cup for zero osteointegration.

Manufacturer Narrative

Manufacturer narrative: the reason for this revision surgery was reported as fibrous cup for zero osseointegration.The previous surgery and the surgery detailed in this event occurred 1.4 years apart.The healthcare professional indicated that 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 the 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 complaint was a revision surgery due to a fibrous cup for zero osteointegration.There were no findings during this evaluation that indicate the reported device was 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.There are multiple factors that may 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.

• Brand Name: FMP HIP
• Type of Device: FMP HEMISPHERICAL SHELLS W/O SCREW HOLES, 56MM, W/P2 COATING
• Manufacturer (Section D): ENCORE MEDICAL L.P; 9800 metric blvd; austin,tx 78758-5445
• MDR Report Key: 11285747
• MDR Text Key: 230476798
• Report Number: 1644408-2021-00033
• Device Sequence Number: 1
• Product Code: LPH
• UDI-Device Identifier: 00888912084215
• UDI-Public: (01)00888912084215
• Combination Product (y/n): N
• PMA/PMN Number: K974093
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 03/25/2021

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 Model Number: 430-99-056
• Device Catalogue Number: 430-99-056
• Device Lot Number: 607G1085
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 01/09/2021
• Initial Date FDA Received: 02/05/2021
• Supplement Dates Manufacturer Received: 02/25/2021
• Supplement Dates FDA Received: 03/25/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: 400-03-401 LOT 870B1135; 931-40-756 LOT 763N2028; 400-03-401 LOT 870B1135; 931-40-756 LOT 763N2028
• Patient Outcome(s): Required Intervention
• Patient Age: 68 YR