• Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

MAUDE Adverse Event Report: DEPUY IRELAND - 9616671 ATTUNE PS FB INSRT SZ 5 6MM ATTUNE IMPLANT : KNEE TIBIAL INSERT

  • Print
  • Share
  • E-mail
-
Super Search Devices@FDA
510(k) | DeNovo | Registration & Listing | Adverse Events | Recalls | PMA | HDE | Classification | Standards
CFR Title 21 | Radiation-Emitting Products | X-Ray Assembler | Medsun Reports | CLIA | TPLC
 

DEPUY IRELAND - 9616671 ATTUNE PS FB INSRT SZ 5 6MM ATTUNE IMPLANT : KNEE TIBIAL INSERT Back to Search Results
Model Number 1516-40-506
Device Problem Naturally Worn (2988)
Patient Problems Cyst(s) (1800); Granuloma (1876); Pain (1994); Synovitis (2094); Appropriate Clinical Signs, Symptoms, Conditions Term / Code Not Available (4581)
Event Date 07/26/2016
Event Type  Injury  
Manufacturer Narrative

(b)(4). Initial reporter occupation: lawyer. (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

On (b)(6) 2014, the patient had a left total knee arthroplasty to address degenerative arthritis, varus deformity and flexion contracture of the left knee. Depuy components, including depuy patella, and unknown cement were used during this procedure. On (b)(6) 2016, the patient had a revision left total knee, complete and totally synovectomy, excision of reactive bone cyst to address loosening of the tibial component, polyethylene and polymethylmethacrylate wear debris disease, reactive synovitis of left knee secondary to polyethylene wear debris and cement wear debris disease, cystic formation, and knee pain. During the procedure the surgeon observed necrotic looking granulation tissue, and some bone erosions. The tibial screw was noted to be grossly loose, the tibial tray had completely debonded from the cement and the cement was noted to have degraded. There was a large reactive cyst in the medial femoral condyle that was debrided. The tibial tray, tibial insert, and femoral component were revised. The surgeon also reported that the patient¿s components had subsided, but did not specify which components. Depuy components were implanted during this procedure, including depuy cement x2. Doi: (b)(6) 2014, dor: (b)(6) 2016, (left knee).

 
Search Alerts/Recalls

  New Search  |  Submit an Adverse Event Report

Brand NameATTUNE PS FB INSRT SZ 5 6MM
Type of DeviceATTUNE IMPLANT : KNEE TIBIAL INSERT
Manufacturer (Section D)
DEPUY IRELAND - 9616671
loughbeg ringaskiddy co.
cork
EI
Manufacturer (Section G)
DEPUY RAYNHAM, A DIV. OF DEPUY ORTHO 1219655
325 paramount drive
raynham MA 02767 0988
Manufacturer Contact
kara ditty-bovard
700 orthopaedic dr.
warsaw, IN 46581
6107428552
MDR Report Key11658958
MDR Text Key245340877
Report Number1818910-2021-07829
Device Sequence Number1
Product Code OIY
Combination Product (Y/N)N
Reporter Country CodeUS
PMA/PMN NumberK111433
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type OTHER
Reporter Occupation
Type of Report Initial,Followup
Report Date 03/29/2021
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received04/13/2021
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? Yes
Device Operator HEALTH PROFESSIONAL
Device EXPIRATION Date06/30/2019
Device MODEL Number1516-40-506
Device Catalogue Number151640506
Device LOT Number546564
Was Device Available For Evaluation? No
Is The Reporter A Health Professional? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received05/20/2021
Was Device Evaluated By Manufacturer? Device Not Returned To Manufacturer
Date Device Manufactured07/14/2014
Is The Device Single Use? Yes
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient TREATMENT DATA
Date Received: 04/13/2021 Patient Sequence Number: 1
-
-