MAUDE Adverse Event Report: ZIMMER TMT TRABECULAR METAL ACETABULAR REVISION SYSTEM ACETABULAR AUGMENT; PROSTHESIS, HIP

Catalog Number 00489406630

Device Problem Loosening of Implant Not Related to Bone-Ingrowth (4002)

Patient Problem No Information (3190)

Event Date 12/13/2016

Event Type  Injury  

Manufacturer Narrative

(b)(4).Multiple mdr reports were filed for this event, please see associated reports: 3005751028 - 2020 - 00058.Concomitant medical product(s): unk liner; unk stem; stryker restoration cup 56 mm part#1235-2-562 lot#g5830067; stryker x3 size 28/56 insert part#1236-2-856 lot#306413; cer option type 1 tpr sleve +6 pe 1 part#650-1068 lot#646880; delta ceramic option head dia2 8 part#650-1055 lot#195030.No product was returned or pictures provided; visual and dimensional evaluations could not be performed.A summary of the investigation was sent to the complainant conveying proper surgical technique and use of the device.3rd revision op notes dated (b)(6) 2016 demonstrated that the patient was revised due to cup loosening.Same bone loss was identified around femur and acetabulum as what was identified in the previous surgery.Acetabular augment had lost it fixation to the bone and spontaneously de-coupled from the acetabular component.Acetabular component was moving slightly but was not grossly loose.Dhr was reviewed and no discrepancies relevant to the reported event were found.A definitive root cause cannot be determined.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.

Event Description

Legal counsel for patient reported that patient underwent an additional left hip revision arthroplasty approximately 5 months after the previous surgery due to loosening of the acetabular components.No further event information available at the time of this report.

• Brand Name: TRABECULAR METAL ACETABULAR REVISION SYSTEM ACETABULAR AUGMENT
• Type of Device: PROSTHESIS, HIP
• Manufacturer (Section D): ZIMMER TMT; 10 pomeroy road; parsippany NJ 07054
• Manufacturer (Section G): ZIMMER TMT; 10 pomeroy road; parsippany NJ 07054
• Manufacturer Contact: william hara ; 10 pomeroy road; parsippany, NJ 07054 ; 9735760032
• MDR Report Key: 10008067
• MDR Text Key: 191916320
• Report Number: 3005751028-2020-00059
• Device Sequence Number: 1
• Product Code: LPH
• UDI-Device Identifier: 00889024306950
• UDI-Public: (01)00889024306950
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K042871
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: consumer,health professional
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 04/28/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/28/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 08/31/2020
• Device Catalogue Number: 00489406630
• Device Lot Number: 63020448
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 10/28/2018
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 08/17/2015
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Removal/Correction Number: NI
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization; Required Intervention