MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US PINN SECTOR W/GRIPTION 50MM PINNACLE HIP SYSTEM : HIP METAL ACETABULAR CUPS

Model Number 1217-32-050

Device Problem Osseointegration Problem (3003)

Patient Problems Ossification (1428); Cyst(s) (1800); Foreign Body Reaction (1868); Hypersensitivity/Allergic reaction (1907); Nerve Damage (1979); Pain (1994); Scar Tissue (2060); Inadequate Osseointegration (2646); Swelling/ Edema (4577)

Event Date 07/30/2012

Event Type  Injury  

Event Description

Mom medical records received. After review of the medical records, the patient was revised to address pseudotumor, elevated metal ions, neurolysis of sciatic nerve, complex wound of hip, heterotopic ossification and capsular redundancy. Operative note reported scars, metallosis, pseudotumor and metallic debris. There was a large amount of fluid present in the hip joint, sciatic nerve was compressed by the pseudotumor. There was also a large amount of capsular debris, pseudotumor and some heterotopic bone. Medical records indicate the cup was loosened and cystic changes were curetted from behind the cup. Doi: (b)(6) 2009; dor: (b)(6) 2012 ; right hip.

Manufacturer Narrative

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

• Brand Name: PINN SECTOR W/GRIPTION 50MM
• Type of Device: PINNACLE HIP SYSTEM : HIP METAL ACETABULAR CUPS
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• Manufacturer (Section G): DEPUY ORTHOPAEDICS 1818910; 700 orthopaedic dr; warsaw IN 46581 0988
• Manufacturer Contact: kara ditty-bovard ; 700 orthopaedic dr.; warsaw, IN 46581-0988 ; 6107428552
• MDR Report Key: 13769635
• MDR Text Key: 287182944
• Report Number: 1818910-2022-04679
• Device Sequence Number: 1
• Product Code: KWA
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K093646
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other

Reporter Occupation

• Type of Report: Followup
• Report Date: 03/15/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/15/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes

Device Operator

• Device Expiration Date: 07/31/2018
• Device Model Number: 1217-32-050
• Device Catalogue Number: 121732050
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 04/13/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 07/14/2008
• 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: 03/15/2022 Patient Sequence Number: 1

Treatment

PINNACLE MTL INS NEUT36IDX50OD; S-ROM M HEAD 36MM +3; S-ROM*SLEEVE PRX ZTT, 14D-SM; S-ROM*STM STD 30 NK 14X8X130