MAUDE Adverse Event Report: ENCORE MEDICAL L.P. ALTIVATE SHOULDER; ALTIVATE ANATOMIC, ALL-POLY PEGGED GLENOID, SIZE 46, E-PLUS

Model Number 521-07-246

Device Problem Device Dislodged or Dislocated (2923)

Patient Problem No Code Available (3191)

Event Date 08/01/2018

Event Type  Injury  

Event Description

Revision surgery - due to dislocation with leveraging of the glenoid.Dislodgement of the glenoid into the back of the shoulder.

Manufacturer Narrative

The reason for this revision surgery was due to dislocation of glenoid.The previous surgery and the revision detailed in this investigation occurred 6.7 months apart.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.The revision surgery was completed as intended.The device was disposed of at the hospital and not made available to djo surgical for examination.A review of the implant device history records (dhr) shows that the reported component used in the previous surgery met design and manufacturing requirements.There were no non-conforming material reports (ncmrs) associated with the product that may have contributed to the event.The device was within its expiration date at the time of use during the previous surgery.Customer complaint history of the reported device showed no present trends or on-going issues that are in need of review.The root cause of this complaint was a revision surgery due to dislocation of glenoid.There were no findings during this investigation that indicate that the reported device was the source or had a direct connection with the event.There are multiple factors that may contribute to the event that are outside the control of djo surgical such as: patient activities, excessive loads or torques, inadequate soft tissue support, lack of care, poor bone density or trauma.Inventory containment is not required as there are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: ALTIVATE SHOULDER
• Type of Device: ALTIVATE ANATOMIC, ALL-POLY PEGGED GLENOID, SIZE 46, E-PLUS
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd; austin TX 78758 5445
• MDR Report Key: 7773996
• MDR Text Key: 116801780
• Report Number: 1644408-2018-00759
• Device Sequence Number: 1
• Product Code: PAO
• UDI-Device Identifier: 00190446178378
• UDI-Public: (01)00190446178378
• Combination Product (y/n): N
• PMA/PMN Number: K162024
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 08/27/2018

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: 07/04/2022
• Device Model Number: 521-07-246
• Device Catalogue Number: 521-07-246
• Device Lot Number: 892U1022
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 08/01/2018
• Initial Date FDA Received: 08/10/2018
• Supplement Dates Manufacturer Received: 08/27/2018
• Supplement Dates FDA Received: 08/27/2018
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: 520-07-000, LOT 888U1096; 520-50-218, LOT 949U1020; 520-07-000, LOT 888U1096; 520-50-218, LOT 949U1020
• Patient Outcome(s): Required Intervention
• Patient Age: 43 YR