MAUDE Adverse Event Report: ZIMMER BIOMET, INC. 36MM I.D. SIZE II OBLIQUE LINER USE WITH 52MM O.D. SIZE II SHELL; PROSTHESIS, HIP

Model Number	N/A
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	Joint Dislocation (2374)
Date of Event	07/02/2018
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported the patient underwent an initial left hip arthroplasty.Subsequently, the patient was revised approximately 2 years later due to allegations of instability.Patient was revised again 1 year later due to instability and dislocations.The hip was found to be unstable at 90° flexion and at 60-70° internal rotation.Head and liner were replaced without complications.Attempts have been made and no further information has been provided.
Additional Manufacturer Narrative
(b)(4).Multiple mdr reports were filed for this event, please see associated reports: 0001822565-2023-1860.D10: cat# 00771301100, lot# 62938998, modular femoral stem press-fit plasma sprayed cementless size 11.Cat# 00784802200 ,lot# 62884956, modular neck b 12/14 neck taper use with +0 heads only.Cat# 00875705201, lot# 62898496, 52mm o.D.Size ii porous uncemented with cluster holes shell use with ii liners cat# 00625006530, lot# 62878547, b.One scr 6.5x30 self-tap.Cat# 00625006525, lot# 62854223, bone scr 6.5x25 self-tap.Cat# 00875801028, lot# 63388510, 28mm i.D.Size ii with constraining ring constrained liner use with 52mm o.D.Size ii shell do not use with skirted heads.Cat# 00877502802, lot# 2943895, biolox⮠delta, ceramic femoral head, m, 㸠28/0, taper 12/14.The customer has indicated that the product will not be returned to zimmer biomet for investigation as its location is unknown.The investigation is in process.Once the investigation has been completed, a follow-up mdr will be submitted.
Additional Manufacturer Narrative
This follow-up report is being submitted to relay additional information.No product was returned, or pictures provided; visual and dimensional evaluations could not be performed.Review of the device history records identified no deviations or anomalies during manufacturing.Medical records were provided and reviewed by a health care professional.Review of the available records identified the following: an initial left tha was performed.The first revision occurred due to instability.The second revision occurred due to instability and dislocations, where the hip was found to be unstable in flexion and rotation.A definitive root cause cannot be determined.If any further information is found which would change or alter any conclusions or information, a supplemental will be filed accordingly.Zimmer biomet will continue to monitor for trends.
Event or Problem Description
No further information at the time of this report.

• Brand Name: 36MM I.D. SIZE II OBLIQUE LINER USE WITH 52MM O.D. SIZE II SHELL
• Common Device Name: PROSTHESIS, HIP
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 1800 w. center st.; warsaw IN 46580
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 1800 w. center st.; warsaw IN 46580
• Manufacturer Contact: jennifer rapsavage ; 56 e. bell dr.; warsaw, IN 46582 ; 5745260384
• MDR Report Key: 17298151
• Report Number: 0001822565-2023-01859
• Device Sequence Number: 19799325
• Product Code: JDI
• UDI-Device Identifier: 00889024150911
• UDI-Public: (01)00889024150911(17)210131(10)63276451
• Combination Product (Y/N): N
• Initial Reporter State: IL
• Initial Reporter Country: US
• PMA/510(K) Number: K200823
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2018
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Consumer,Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 08/10/2023

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 Expiration Date: 01/31/2021
• Device Model Number: N/A
• Device Catalogue Number: 00875501036
• Device Lot Number: 63276451
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/15/2023
• Supplement Date Received by Manufacturer: 08/04/2023
• Initial Report FDA Received Date: 07/11/2023
• Supplement Report FDA Received Date: 08/11/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 02/16/2016
• 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
• If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement: N/A
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SEE H10 NARRATIVE.
• Outcome Attributed to Adverse Event: Required Intervention; Hospitalization
• Patient Sex: Female