MAUDE Adverse Event Report: WRIGHT MEDICAL TECHNOLOGY INC INBONE TIBIAL TRAY, RIGHT SIZE #4, RIGHT; PROSTHESIS, ANKLE, SEMI-CONSTRAINED, CEMENTED, METAL/POLYMER

Model Number 200222904

Device Problem Detachment of Device or Device Component (2907)

Patient Problems Failure of Implant (1924); Unspecified Infection (1930)

Event Date 10/31/2022

Event Type  Injury  

Event Description

It was reported that the physician believed that he didn¿t engage the tibial stem to the tibial tray correctly.The tibial tray came away from the stem.It was noted that infection occurred around the stem.The surgeon explanted all the components.The patient is healing in preparation for fusion.

Manufacturer Narrative

Once the investigation has been completed any additional information will be reported in a supplemental report.

Manufacturer Narrative

The reported event could not be confirmed due to lack of additional information.The device inspection revealed the following: visual examination of the returned devices found scratches and deformations around the tibial stem base.Scratches and blemishes can also be seen on the superior side of the talar dome.Part of the tibial stem base can be seen to be chipped off.The poly was found connected to the tibial tray and could not be detached.Remnants of bone cement and ossification are visible around the tibial tray, tibial stem and talar dome.Infections are often caused by a multitude of factors such as comorbidity of the patient, the trauma, the surgical intervention and the aftercare.More detailed information about the complaint event as well as the affected device must be available in order to determine the root cause of the complaint event.A review of the device history for the reported lot did not indicate any abnormalities.No corrective actions are required at this time.A review of the labeling did not indicate any abnormalities.No indications of material, manufacturing or design related problems were found during the investigation.If more information is provided, the case will be reassessed.

Event Description

It was reported that the physician believed that he didn¿t engage the tibial stem to the tibial tray correctly.The tibial tray came away from the stem.It was noted that infection occurred around the stem.The surgeon explanted all the components.The patient is healing in preparation for fusion.

• Brand Name: INBONE TIBIAL TRAY, RIGHT SIZE #4, RIGHT
• Type of Device: PROSTHESIS, ANKLE, SEMI-CONSTRAINED, CEMENTED, METAL/POLYMER
• Manufacturer (Section D): WRIGHT MEDICAL TECHNOLOGY INC; 1023 cherry rd; memphis TN 38117
• Manufacturer (Section G): WRIGHT MEDICAL TECHNOLOGY, INC.; 11576 memphis arlington rd; arlington TN 38002
• Manufacturer Contact: anna jusinski ; 325 corporate drive; mahwah, NJ 07430 ; 2018315000
• MDR Report Key: 15843454
• MDR Text Key: 304097789
• Report Number: 3010667733-2022-00399
• Device Sequence Number: 1
• Product Code: HSN
• UDI-Device Identifier: 00840420124104
• UDI-Public: 00840420124104
• Combination Product (y/n): N
• Reporter Country Code: AS
• PMA/PMN Number: K051023
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 02/22/2023

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: Lay User/Patient
• Device Model Number: 200222904
• Device Catalogue Number: 200222904
• Device Lot Number: 1705541
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 10/31/2022
• Initial Date FDA Received: 11/22/2022
• Supplement Dates Manufacturer Received: 01/27/2023
• Supplement Dates FDA Received: 02/22/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 05/05/2021
• 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): Required Intervention
• Patient Age: 64 YR
• Patient Sex: Male