(b)(4).Multiple mdr reports were filed for this event, please see associated reports: 0009613350-2022-00518.0009613350-2023-00111.The newly provided pictures allowed to identify two additional products involved in the event, namely the trial distal and trial proximal part.A review of these pictures found no evident defects or deformation of the two parts.However, no conclusion can be drawn on the conformity of the products as they were not returned for product evaluation.The wagner stem was returned an visual examination was performed.Visual examination found no signs of damage or usage.A dimensional analysis was performed: a representative feature of the device was taken to further confirm the dimensional correctness of the item.All the measurements taken are conform.Wagner stem and trial proximal: review of the device history record identified no deviations or anomalies during manufacturing that might have contributed to the reported event.Trial distal: review of manufacturing records cannot be performed without product identification.Devices are used for treatment.A single frontal static fluoroscopic intraoperative image of the left hip with presence of a left total hip arthroplasty was provided and reviewed by an health care professionnel.Although limited by fluoroscopic technique, total hip arthroplasty appears normally aligned and intact.The femoral head component is not seen, potentially because image was acquired prior to placement or because of density of overlying acetabular cup.No periprosthetic abnormality detected.Limited assessment of the bones demonstrates no obvious acute abnormality.Overall fit and alignment of the implants as well as bone quality appears grossly unremarkable.No signs of loosening, wear, radiolucency, or any contributing factors detected.The wagner stem was returned for investigation and showed no signs of non-conformance.The trial proximal part was not returned for evaluation.However, manufacturing records identified no deviations or anomalies during manufacturing that might have contributed to the reported event.The trial distal part was not returned for evaluation.Moreover, as lot number is missing, it was not possible to review the manufacturing records for this item.With the available information a definitive root cause cannot be established.If any further information is found which would change or alter any conclusions or information, a supplemental will be filed accordingly.Zimmer biomet will continue to monitor for trends.
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