MAUDE Adverse Event Report: ENCORE MEDICAL L.P. OMEGA II HIP; NECK, FEMORAL, MODULAR, 32MM 8 DEGREE CERASIVE TAPER

Catalog Number 410-32-108

Device Problems Disconnection (1171); Device Dislodged or Dislocated (2923)

Patient Problem No Code Available (3191)

Event Date 01/30/2017

Event Type  Injury  

Event Description

Revision surgery - due to the r120 modular neck disconnecting and causing the hip to dislocate.A neck replacement was not an option for the r120, so a full revision was completed with a lima.

Manufacturer Narrative

Manufacturer narrative: the reason for this revision surgery was the patient's r120 modular neck disconnected and caused the hip to dislocate.The in-vivo length of patient service for the implant was 3.6 years.There is no information in this complaint about any patient injuries, activities, or accidents that may have contributed to the need for this revision surgery.There are no reported pre-existing patient health conditions.The healthcare professional indicated there was no delay in surgery and another suitable device was available for use.Initial or prolonged hospitalization was required.The revision surgery was completed as intended.The device was reported to have been kept by the hospital and not made available to djo surgical for examination.A review of the device history records (dhrs) revealed no discrepancies or issues with the manufacturing of this part.All critical dimensions and specifications in effect at the time the part was manufactured were met.The product complaint report history was reviewed and no trends or on-going issues were deemed as present or in need of review.This event is deemed as non-product related.The root cause for this event was the result of the disassociation of the r120 modular neck causing the hip to dislocate.The root cause for the disassociation was not reported.The scope of this investigation is limited without having the parts available to djo surgical for evaluation.Other conditions relating to this event could not be determined with confidence.Inventory containment is not required as there are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: OMEGA II HIP
• Type of Device: NECK, FEMORAL, MODULAR, 32MM 8 DEGREE CERASIVE TAPER
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd.; austin TX 78758 5445
• Manufacturer (Section G): ENCORE MEDICAL, L.P.; 9800 metric blvd.; austin TX 78758
• Manufacturer Contact: teffany hutto ; 9800 metric blvd.; austin, TX 78758-5445 ; 5128346255
• MDR Report Key: 6347242
• MDR Text Key: 67888248
• Report Number: 1644408-2017-00134
• Device Sequence Number: 1
• Product Code: LPH
• UDI-Device Identifier: 00888912085861
• UDI-Public: (01)00888912085861
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K000817
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date: 06/27/2017

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: 06/30/2019
• Device Catalogue Number: 410-32-108
• Device Lot Number: 896B1044
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 01/30/2017
• Initial Date FDA Received: 02/21/2017
• Supplement Dates Manufacturer Received: Not provided; Not provided
• Supplement Dates FDA Received: 04/14/2017; 06/27/2017
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 06/03/2013
• 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
• Treatment: 411-00-000, LOT 902B1097
• Patient Outcome(s): Hospitalization; Required Intervention
• Patient Age: 53 YR