MAUDE Adverse Event Report: ENCORE MEDICAL L.P EMPOWR 3D KNEE; EMPOWR 3D KNEETM INS, 9L 10MM, VE

Model Number 341-10-709

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Fall (1848); Muscular Rigidity (1968)

Event Date 12/05/2022

Event Type  Injury  

Event Description

Revision surgery - the patient was experiencing fluid build-up and drainage from wound.When surgeon went into the case it looked like the patent has fallen and ruptured his quadriceps tendon.Continued with an irrigation and drainage and swapped out the insert.

Manufacturer Narrative

The reason for this revision surgery was reported as ruptured quadriceps tendon after a fall.The previous surgery and the surgery detailed in this event occurred 25 days apart.The healthcare professional indicated there was no delay in surgery and another suitable device was available for use.The revision surgery was completed as intended.The device was disposed of at hospital and not made available to djo surgical for examination.A review of the device history record (dhr) shows that the reported component used in the previous surgery, when released for use, met design and manufacturing requirements.There was a nonconformance associated with the main part #341-10-709, empowr 3d kneetm ins, 9l 10mm, ve which documents that out of 40 parts lot, 1 part was rejected and scrapped due to part had major scratch in area a.All other items in the lot were met with fit, form and function requirements.The device was verified to have gone through an acceptable sterilization process and was within its expiration date at the time of the previous surgery.Customer complaint history of the reported device showed no present trends or on-going issues that are needing a review.The root cause of this complaint was a revision surgery due to ruptured quadriceps tendon after a fall.There were no findings during this evaluation that indicate the reported device was defective.No information was submitted with the complaint regarding pre-existing conditions of the patient or any activities the patient was involved in that may have contributed to the event.Agent has clearly mentioned that "patient fell" and due to short time between previous and revision surgery, it is possible that the event may have occurred due to lack of post-operative care, patient noncompliance with medical instructions, improper surgical technique, patient activities or trauma.There are multiple factors that may also contribute to an event that are outside the control of djo surgical.There are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: EMPOWR 3D KNEE
• Type of Device: EMPOWR 3D KNEETM INS, 9L 10MM, VE
• Manufacturer (Section D): ENCORE MEDICAL L.P; 9800 metric blvd; austin TX 78758 5445
• Manufacturer (Section G): ENCORE MEDICAL L.P; 9800 metric blvd; austin TX 78758 5445
• Manufacturer Contact: james mcmahon ; 9800 metric blvd; austin, TX 78758-5445
• MDR Report Key: 15949968
• MDR Text Key: 305157877
• Report Number: 1644408-2022-01677
• Device Sequence Number: 1
• Product Code: JWH
• UDI-Device Identifier: 00888912166867
• UDI-Public: (01)00888912166867
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K143242
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 12/09/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/09/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 341-10-709
• Device Catalogue Number: 341-10-709
• Device Lot Number: 069T1131
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 12/05/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 07/22/2022
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 77 YR
• Patient Sex: Male