MAUDE Adverse Event Report: MICROPORT ORTHOPEDICS INC. DYNASTY® BF SHELL PRIMARY 52MM GROUP D; HIP COMPONENT

Model Number DBFPGD52

Device Problem Detachment of Device or Device Component (2907)

Patient Problem Insufficient Information (4580)

Event Type  Injury  

Manufacturer Narrative

This event will be updated once the investigation is complete.Trends will be evaluated.

Event Description

Allegedly, the patient who underwent total hip replacement performed elsewhere and has developed recurrent dislocations of the hip and has had 3 dislocations since (b)(6) 2022.She has failed nonoperative management consisting of activity modification, physical therapy and education.

• Brand Name: DYNASTY® BF SHELL PRIMARY 52MM GROUP D
• Type of Device: HIP COMPONENT
• Manufacturer (Section D): MICROPORT ORTHOPEDICS INC.; 5677 airline rd.; arlington TN 38002
• Manufacturer Contact: rachael wise ; 5677 airline road; arlington, TN 38002 ; 9018674771
• MDR Report Key: 17676595
• MDR Text Key: 322604455
• Report Number: 3010536692-2023-00159
• Device Sequence Number: 1
• Product Code: JDI
• UDI-Device Identifier: M684DBFPGD521
• UDI-Public: M684DBFPGD521
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K122382
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 09/08/2023

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?: No
• Device Operator: Other
• Device Model Number: DBFPGD52
• Device Catalogue Number: DBFPGD52
• Device Lot Number: 1781478
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Initial Date Manufacturer Received: 08/11/2023
• Initial Date FDA Received: 09/04/2023
• Supplement Dates Manufacturer Received: 08/11/2023
• Supplement Dates FDA Received: 09/08/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 69 YR
• Patient Sex: Female