MAUDE Adverse Event Report: STRYKER ORTHOPAEDICS-MAHWAH ANATO STEM SZ 4 RIGHT ANTEVERT; PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, POROUS UNCEMENTED

Model Number	4845-7-104
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Pain (1994)
Date of Event	04/14/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Reported event: an event regarding pain involving a anato stem was reported.The event was not confirmed.Method & results: product evaluation and results: material analysis, visual, functional and dimensional inspections could not be performed as the device was not returned.Clinician review: no medical records were received for review with a clinical consultant.Product history review: review of the device history records indicate devices were manufactured and accepted into final stock with no relevant reported discrepancies.Complaint history review: there has been 1 other similar event for the lot referenced.This was for a intra- operative fracture on the same patient during the revision surgery.Conclusions: the exact cause of the event could not be determined because insufficient information was provided.Further information such as return of the device, pathology reports, pre- and post-operative x-rays and the primary operative report as well as patient history and follow-up notes are needed to complete the investigation for determining root cause.No further investigation for this event is possible at this time.If devices and / or additional information become available to indicate further evaluation is warranted, this record will be reopened.Catalog numbers and lot codes of other devices listed in this report: uh1-44-26, uhr bipolar 26x44mm, lot 9d5505; 6260-9-026, 26mm -3 lfit v40 head, lot 70515709.It cannot be determined which, if any of these devices may have caused or contributed to the patient's experience.
Event or Problem Description
It was reported that the patient's right hip was revised due to pain.A hemi hip consisting of an anato stem, uhr bipolar component, and 26 -3 v40 lfit head were revised to a total hip.While removing the anato stem, an intra-operative femoral fracture occurred and was treated with 2 cables from hospital inventory and implanting a restoration modular stem construct.While implanting a 48mm shell, the shell passed through the patient's acetabulum (surgeon reported this was due to poor bone quality).The surgeon went to a 50 multihole shell with 4 screws.The screws didn't provide adequate fixation in the surgeon's opinion (due to the patient's poor bone quality), so the 50mm shell was cemented in instead.Rep provided the primary and revision usage sheets and confirmed that no further information will be released by the hospital or surgeon.

• Brand Name: ANATO STEM SZ 4 RIGHT ANTEVERT
• Common Device Name: PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, POROUS UNCEMENTED
• Manufacturer (Section D): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• MDR Report Key: 11784571
• Report Number: 0002249697-2021-00804
• Device Sequence Number: 4028446
• Product Code: LPH
• UDI-Device Identifier: 07613252631095
• UDI-Public: 07613252631095
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K143085
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Device Explanted Year: 2021
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 05/06/2021

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?: No
• Operator of Device: Health Professional
• Device Expiration Date: 02/29/2024
• Device Model Number: 4845-7-104
• Device Catalogue Number: 4845-7-104
• Device Lot Number: 66743504
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 04/14/2021
• Initial Report FDA Received Date: 05/06/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 77 YR
• Patient Weight: 55