MAUDE Adverse Event Report: STRYKER ORTHOPAEDICS-MAHWAH NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM; PROSTHESIS, KNEE, PATELLO/FEMOROTIBIAL, SEMI-CONSTRAINED, UNCEMENTED, POROUS, CO

Model Number	5537-G-713-E
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Rupture (2208)
Date of Event	08/16/2022
Type of Reportable Event	Serious Injury
Event or Problem Description
As reported: "pt.Presented with a ruptured patellar tendon of the left knee.Pt.Received a revision of the same knee on (b)(6) 2022, from a primary triathlon tka to a ts revision construct.Patient also had a subsequent poly exchange (b)(6) 2022.Due to the ruptured tendon, dr.Opted to explant the pt's ts construct, implant an mrh construct, and perform a tendon repair.
Additional Manufacturer Narrative
It was noted that the device is not available for evaluation.Should additional information become available, 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 relevant reported discrepancies.There have been no other similar events for the lot referenced.The following devices were also listed in this report: device name#tri ts baseplate size 7 ; cat#5521-b-700; lot#g339oa, device name#tri ts femur sz7 left ; cat#5512-f-701; lot#hyo4x, device name#triathlon cemented stem-15mm x 100mm ; cat#5560-s-215 ; lot#0101902m, device name#triathlon cemented stem-15mm x 100mm ; cat#5560-s-215 ; lot#0116720a, device name#tri rm/ll tib aug sz7 5mm ; cat#5545-a-702 ; lot#erekl4a, device name#triathlon femoral distal augment 5mm - size 7 left ; cat#5540-a-701 ; lot#hz34u, device name#triathlon femoral distal augment 5mm - size 7 left ; cat#5540-a-701 ; lot#hz34u, device name#tri lm/rl tib aug sz7 5mm ; cat#5545-a-701 ; lot#erehr6d.It cannot be determined which, if any of these devices may have caused or contributed to the patient's experience.Device not returned to the manufacturer.

• Brand Name: NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM
• Common Device Name: PROSTHESIS, KNEE, PATELLO/FEMOROTIBIAL, SEMI-CONSTRAINED, UNCEMENTED, POROUS, CO
• Manufacturer (Section D): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• Manufacturer (Section G): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• Manufacturer Contact: arokiya raj ; 325 corporate drive; mahwah, NJ 07430 ; 2018315000
• MDR Report Key: 15394016
• Report Number: 0002249697-2022-01319
• Device Sequence Number: 17417735
• Product Code: MBH
• UDI-Device Identifier: 07613327287806
• UDI-Public: 07613327287806
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K172634
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2022
• Device Explanted Year: 2022
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 09/09/2022

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: 07/31/2025
• Device Model Number: 5537-G-713-E
• Device Catalogue Number: 5537-G-713-E
• Device Lot Number: 178PDW
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 08/16/2022
• Initial Report FDA Received Date: 09/09/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 07/29/2020
• 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: 64 YR
• Patient Sex: Male
• Patient Weight: 125 KG