MAUDE Adverse Event Report: AESCULAP AG AS VEGA PS TIBIAL PLATEAU CEMENTED T2+; KNEE ENDOPROSTHETICS

Model Number	NX054Z
Medical Device Problem Code	Loosening of Implant Not Related to Bone-Ingrowth (4002)
Health Effect - Clinical Codes	Pain (1994); Ambulation or Postural Difficulties (2544); Swelling/ Edema (4577)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The affected device was not available for investigation.Therefore an investigation of the device was not possible.The device quality and manufacturing history records (dhr) were checked for all available lot numbers and were within specifications valid at the time of production.There are no similar complaints against the same lot number(s) with this error pattern.The determination of a definite root cause is due to the non-availability of important information and the device itself not possible.The conclusion from the root cause analysis is that a systematic device deviation is unlikely since the received complaints are limited to certain health care institutions and their applicants.The participation of the applicants in this deviation scenario cannot be excluded by today.Based on the root cause analysis result no corrective actions have been carried out.As a preventive action we were in contact with the affected health care institutions and applicants in order to reduce the probability of recurrence.The complaints were submitted to aesculap ag as a summary report.In order to examine further actions, all cases from the summary report are processed as vigilance suspicion cases and are continuously monitored.
Event or Problem Description
It was reported that there was an issue with nx054z-as vega ps tibial plateau cemented.As a result of having the product implanted, the patient has experienced knee pain, swelling, difficulty walking, and loosening and instability of the implant which resulted in a revision surgery.The primary procedure occurred on (b)(6) 2014, and the revision occurred on (b)(6) 2018.All available information has been provided at this time, if additional information becomes available the complaint will be updated accordingly.The adverse event / malfunction is filed under xc reference (b)(4).Involved components: nn261z (tibial obturator d12mm, l7mm), nx043 (universal patella p3), nx222 (ps pe insert t2/t2+, 14mm), nx009z (ps femur cemented f4n lt).Cement used: zimmer palacos r radiopaque bone cement.
Event or Problem Description
No updates.
Additional Manufacturer Narrative
Associated medwatches: 2916714-2020-00422; 2916714-2020-00423; 2916714-2020-00424; 2916714-2020-00425; 2916714-2020-00426.The investigation was submitted previously.

• Brand Name: AS VEGA PS TIBIAL PLATEAU CEMENTED T2+
• Common Device Name: KNEE ENDOPROSTHETICS
• Manufacturer (Section D): AESCULAP AG; po box 40; tuttlingen, 78501 ; GM 78501
• MDR Report Key: 11310961
• Report Number: 2916714-2020-00422
• Device Sequence Number: 1165250
• Product Code: JWH
• UDI-Device Identifier: 04046963810436
• UDI-Public: 4046963810436
• Combination Product (Y/N): N
• Initial Reporter State: NC
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2014
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Importer
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 02/26/2021
• Report Date (Section F): 02/10/2021

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 08/01/2023
• Device Model Number: NX054Z
• Device Catalogue Number: NX054Z
• Device Lot Number: 51964755
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 10/15/2018
• Event Location: Hospital
• Date Report to Manufacturer: 10/15/2018
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 02/10/2021
• Supplement Report FDA Received Date: 02/26/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: NN261Z-52021708; NX009Z-51981655; NX043-51981446; NX222-51798878
• Outcome Attributed to Adverse Event: Required Intervention
• Date Report Sent to FDA: 02/10/2021