MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US PINNACLE SECTOR II CUP 56MM; PINNACLE HIP SYSTEM : HIP METAL ACETABULAR CUPS

Model Number 1217-22-056

Device Problems Loss of Osseointegration (2408); Migration (4003)

Patient Problems Inadequate Osseointegration (2646); No Code Available (3191)

Event Date 07/20/2020

Event Type  Injury  

Manufacturer Narrative

Product complaint #: (b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

Event Description

It was reported that the acetabular cup disassociated from bone and migrated superior.It was also indicated that the cup was loose at bone to implant interface.Doi: (b)(6) 2020; dor: (b)(6) 2020; affected side: right hip.

Manufacturer Narrative

Product complaint # (b)(4).Investigation summary: no device associated with this report was received for examination.The information received will be retained for potential series investigations if triggered by trend analysis, post market surveillance, or other events within the quality system.Depuy considers the investigation closed.Should additional information be received, the information will be reviewed, and the investigation will be re-opened as necessary.

• Brand Name: PINNACLE SECTOR II CUP 56MM
• Type of Device: PINNACLE HIP SYSTEM : HIP METAL ACETABULAR CUPS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• MDR Report Key: 10344665
• MDR Text Key: 201052244
• Report Number: 1818910-2020-17208
• Device Sequence Number: 1
• Product Code: KWA
• UDI-Device Identifier: 10603295009849
• UDI-Public: 10603295009849
• Combination Product (y/n): N
• PMA/PMN Number: K073504
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Type of Report: Initial,Followup
• Report Date: 07/20/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/30/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 1217-22-056
• Device Catalogue Number: 121722056
• Device Lot Number: J83D73
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 09/03/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: 12/14 ARTICUL 40MM M SPEC+5; ALTRX NEUT 40IDX56OD; CEMENTRALIZER 13.0; PINN CAN BONE SCREW 6.5MMX30MM; SUMMIT CEMENTED STEM SZ8 HI; 12/14 ARTICUL 40MM M SPEC+5; ALTRX NEUT 40IDX56OD; CEMENTRALIZER 13.0; PINN CAN BONE SCREW 6.5MMX30MM; SUMMIT CEMENTED STEM SZ8 HI
• Patient Outcome(s): Required Intervention
• Patient Age: 74 YR
• Patient Weight: 106