MAUDE Adverse Event Report: STRYKER ORTHOPAEDICS-MAHWAH MRHK TIB INS 13MM XS/S S1/S2; PROSTHESIS, KNEE, FEMOROTIBIAL, CONSTRAINED, CEMENTED, METAL/POLYMER

Model Number	6481-3-213
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	12/07/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
It was noted that the device is not available for evaluation.If additional information is received, it will be provided in a supplemental report upon completion of the investigation.Review of the device history records indicate devices were manufactured and accepted into final stock with no reported discrepancies.There have been no other events for the lot referenced.The following devices were also listed in this report: mrhk tib ins 13mm xs/s s1/s2; 64813213; lky021.Mrh axle; 64812120; ctd59714.Mrhk femoral bushing; 64812110; lkn224.Mrhk tibial sleeve; 64812140; lkm996.Mrhk bumper insert 3 degrees; 64812133; lkx417.Mrh tib rot comp xs-xl; 64812100; 180637.Mrhk femoral bushing; 64812110; lkn240.Mrh knee fem xs lft; 64811100; jha6b.Mrh tibial b/plt keel sml 1; 64813110; l6h6t.Triathlonctrfemconeaug sz1&2l; 5549-a-621; lh641.Triathlon sym cone aug sz c; 5549-a-130; t1j51.Tri press-fit stem 14mm x 100mm; 5565-s-014; 0113782k.Tri press-fit stem 16x150mm; 5566-s-016; 0087321d.Mrhk fem distal blk 10mm xs; 64811200; jee4r.Mrhk fem distal blk 10mm xs; 64811200; jee4r.It cannot be determined which, if any of these devices may have caused or contributed to the patient's experience.Not returned.
Event or Problem Description
The patient had an index left tka outside of cors scope.The patient developed pji (periprosthetic joint infection) in the left knee and underwent revision with a gmrs system for pji with all components exchanged on (b)(6) 2021 (then included into cors).The patient developed again pji and was revised only for all rotating hinge components exchanged on (b)(6) 2021.

• Brand Name: MRHK TIB INS 13MM XS/S S1/S2
• Common Device Name: PROSTHESIS, KNEE, FEMOROTIBIAL, CONSTRAINED, CEMENTED, METAL/POLYMER
• Manufacturer (Section D): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• Manufacturer (Section G): STRYKER ORTHOPAEDICS-LIMERICK; raheen business park; limerick NA ; EI NA
• Manufacturer Contact: brad curtis ; 325 corporate drive; mahwah, NJ 07430 ; 2018315000
• MDR Report Key: 15307915
• Report Number: 0002249697-2022-01255
• Device Sequence Number: 2747721
• Product Code: KRO
• UDI-Device Identifier: 07613327043792
• UDI-Public: 07613327043792
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K994207
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Device Explanted Year: 2021
• Reporter Type: Manufacturer
• Report Source: Other,Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 08/28/2022

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: 07/15/2026
• Device Model Number: 6481-3-213
• Device Catalogue Number: 64813213
• Device Lot Number: LKY021
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 08/03/2022
• Initial Report FDA Received Date: 08/28/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 07/16/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention; Hospitalization
• Patient Age: 80 YR
• Patient Sex: Female
• Patient Weight: 82 KG