MAUDE Adverse Event Report: ZIMMER BIOMET, INC. FEMORAL STEM CEMENTED STD. COLLAR 12/14 NECK TAPER EXT. NECK; PROSTHESIS, HIP

Model Number N/A

Device Problems Unstable (1667); Noise, Audible (3273); Loosening of Implant Not Related to Bone-Ingrowth (4002)

Patient Problems Fall (1848); Failure of Implant (1924); Pain (1994); Ambulation Difficulties (2544); Osteopenia/ Osteoporosis (2651)

Event Date 03/15/2023

Event Type  Injury  

Manufacturer Narrative

(b)(4).D10: cat# 30103604 lot# 64797272 g7 vit e neutral lnr 36mm d.Cat# 00877503601 lot# 3031184 biolox⮠delta, ceramic femoral head, s, 㸠36/-3.5, taper 12/14.Cat# unknown lot# 838baf1806 refobacin bone cement.Multiple mdr reports were filed for this event, please see associated reports: 0001822565 - 2023 - 01039.The customer has indicated that the product will not be returned to zimmer biomet for investigation as its location is unknown.The investigation is in process.Once the investigation has been completed, a follow-up mdr will be submitted.

Event Description

It was reported that the patient underwent an initial right hip arthroplasty.Subsequently the patient reported a fall occurred on an unknown date and experienced pain and instability.Imaging revealed nonunion of greater trochanter fracture.The patient underwent a revision approximately 2.5 years after initial surgery.The shell was retained, as noted to be well fixed.Surgeon confirmed aspectic loosening at cement mantle, and patient had been experiencing anterior and posterior impingement.Attempts have been made and no further information has been provided.

Manufacturer Narrative

This follow-up report is being submitted to relay additional information.Upon receipt of additional information, it was determined this product should not have been reported under this mfr number.This report should be voided and a corrected report will be filed under mfr number (b)(4).

Event Description

No further information at the time of this report.

• Brand Name: FEMORAL STEM CEMENTED STD. COLLAR 12/14 NECK TAPER EXT. NECK
• Type of Device: PROSTHESIS, HIP
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 1800 w. center st.; warsaw IN 46580
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 1800 w. center st.; warsaw IN 46580
• Manufacturer Contact: jennifer rapsavage ; 56 e. bell dr.; warsaw, IN 46582 ; 5745260384
• MDR Report Key: 16751607
• MDR Text Key: 313411832
• Report Number: 0001822565-2023-01038
• Device Sequence Number: 1
• Product Code: JDI
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K950312
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,Distributor
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 06/08/2023

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?: Yes
• Device Operator: Health Professional
• Device Model Number: N/A
• Device Catalogue Number: 00785001520
• Device Lot Number: 64608216
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Initial Date Manufacturer Received: 03/27/2023
• Initial Date FDA Received: 04/17/2023
• Supplement Dates Manufacturer Received: 06/07/2023
• Supplement Dates FDA Received: 06/09/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Removal/Correction Number: N/A
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization; Required Intervention
• Patient Sex: Female
• Patient Weight: 91 KG