MAUDE Adverse Event Report: SMITH & NEPHEW, INC. JOURNEY DCF AP FEM CUT BLK 9; PROSTHESIS, KNEE, FEMOROTIBIAL, SEMI-CONSTRAINED, CEMENTED, METAL/POLYMER

Model Number	74012419
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/21/2021
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that during a tka surgery, the journey distal cut first anterior posterior femoral cutting block broke, when it was being impacted on to the femur inside the patient.The broken piece was recovered and the procedure was successfully completed, without delay using a smith and nephew back-up device.Despite the fact, this incident occurred inside the patient, no harm, injury or other complications were reported.
Event or Problem Description
It was reported that during a tka surgery, the journey distal cut first anterior posterior femoral cutting block broke, when it was being impacted on to the femur inside the patient.It broke while the surgeon was using an oscillating tip blade through the block.The two fracture pieces fell on the operative field but not in the patient.The broken piece was recovered and the procedure was successfully completed, without delay using a smith and nephew back-up device.Despite the fact, this incident occurred inside the patient, no harm, injury or other complications were reported.
Additional Manufacturer Narrative
It was reported that during a tka surgery, the journey distal cut first anterior posterior femoral cutting block broke, when it was being impacted on to the femur inside the patient.It broke while the surgeon was using an oscillating tip blade through the block.The two fracture pieces fell on the operative field but not in the patient.The broken piece was recovered and the procedure was successfully completed, without delay using a smith and nephew back-up device.Despite the fact, this incident occurred inside the patient, no harm, injury or other complications were reported.
Additional Manufacturer Narrative
H3, h6: the device, used in treatment, was not returned for evaluation and the reported event could not be confirmed.A review of complaint history did not reveal additional complaints for the listed batch.A review of the manufacturing records did not reveal a manufacturing abnormality that could have caused or contributed to the reported incident.At this time, we have no reason to suspect that the product failed to meet any product specifications at the time of manufacture.A review of the risk management file revealed this failure mode was previously identified.This device is a reusable instrument that can be exposed to numerous surgeries; damage from repeated use can occur.Damage from prolonged use, misuse or rough handling are likely probable causes of the reported event.We recommend that all reusable instruments be routinely inspected for wear and damage and replaced as necessary.Based on this investigation, the need for corrective action is not indicated.Without the return of the actual product involved or product information, our investigation could not proceed.Should the device or additional information be received, the complaint will be reopened.No further investigation is warranted for this complaint; however, we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.

• Brand Name: JOURNEY DCF AP FEM CUT BLK 9
• Common Device Name: PROSTHESIS, KNEE, FEMOROTIBIAL, SEMI-CONSTRAINED, CEMENTED, METAL/POLYMER
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• MDR Report Key: 11816097
• Report Number: 1020279-2021-04130
• Device Sequence Number: 3224301
• Product Code: HRY
• UDI-Device Identifier: 03596010556714
• UDI-Public: 03596010556714
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• PMA/510(K) Number: K121393
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 07/19/2021

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 Model Number: 74012419
• Device Catalogue Number: 74012419
• Device Lot Number: 14EM22233
• Was Device Available for Evaluation?: Yes
• Initial Date Received by Manufacturer: 04/21/2021
• Supplement Date Received by Manufacturer: 04/21/2021; 07/15/2021
• Initial Report FDA Received Date: 05/13/2021
• Supplement Report FDA Received Date: 06/13/2021; 07/19/2021
• 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: Required Intervention