MAUDE Adverse Event Report: SMITH & NEPHEW, INC. DELTA HEAD 36MM 12/14 SHORT +0MM; PROSTHESIS, HIP, SEMI-CONSTRAINED,METALCERAMICPOLYMER,CEMENTEDORNON-POROUS

Model Number 76539165

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Bone Fracture(s) (1870); Subluxation (4525)

Event Date 09/17/2019

Event Type  Injury  

Event Description

It was reported that, after a right thr revision surgery had been performed on (b)(6) 2019 with loosening - of the socket and lysis of the socket diagnosis, the patient experienced dislocation/subluxation that made necessary a second revision surgery on (b)(6) 2019.According to the report contents, the femoral stem, acetabular cup, modular head and acetabular liner were explanted and replaced with a competitors device.This information was provided by the national joint registry of the united kingdom, as part of a retrospective data collection of patients who underwent a first thr revision surgery with a hip prosthesis construct that included a polarstem femoral prosthesis and that required a second revision surgery due to specific reasons.As such, no further information will be available.

Manufacturer Narrative

Internal complaint reference: (b)(4).This complaint was opened by smith+nephew to document a patient complication identified through a review of the national joint registry from united kingdom that includes reference to the use of a smith+nephew product.The reported issue(s) relate to known inherent procedural risks that are appropriately documented in our risk files.Smith+nephew will continue to monitor trends in accordance with our post-market surveillance process and take necessary action as required if anticipated severity and/or occurrence rates are exceeded.Smith+nephew has no reason to suspect that the product failed to meet any specifications at the time of manufacture.Based on our review of all currently available information, we are unable to confirm a relationship between the reported event and the device or identify a definitive root cause.However, as the use of our product cannot be excluded as a potential cause or contributory factor to the reported issue, we are conservatively submitting this report in accordance with applicable regulations.If additional information becomes available that alters the conclusions of this report, a follow-up report will be submitted as required.

Manufacturer Narrative

Corrected data: h6 (health effect - clinical code, medical device problem code).

• Brand Name: DELTA HEAD 36MM 12/14 SHORT +0MM
• Type of Device: PROSTHESIS, HIP, SEMI-CONSTRAINED,METALCERAMICPOLYMER,CEMENTEDORNON-POROUS
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• Manufacturer (Section G): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• Manufacturer Contact: holly topping ; 7000 west william cannon drive; austin, TX 78735 ; 5123913905
• MDR Report Key: 16286919
• MDR Text Key: 308675673
• Report Number: 1020279-2023-00239
• Device Sequence Number: 1
• Product Code: LZO
• UDI-Device Identifier: 03596010566959
• UDI-Public: 03596010566959
• Combination Product (y/n): N
• Reporter Country Code: UK
• PMA/PMN Number: K083762
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign,Company Representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 06/01/2023

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: Health Professional
• Device Expiration Date: 04/22/2024
• Device Model Number: 76539165
• Device Catalogue Number: 76539165
• Device Lot Number: 14DT41526
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 01/31/2023
• Initial Date FDA Received: 02/02/2023
• Supplement Dates Manufacturer Received: 05/31/2023
• Supplement Dates FDA Received: 06/01/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 04/22/2014
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: A
• Patient Sequence Number: 1
• Treatment: 71331964 / 13AM14901.; 71332764 / 11LM10968.; 75100479 / B1816928.
• Patient Outcome(s): Required Intervention
• Patient Age: 71 YR
• Patient Sex: Male