MAUDE Adverse Event Report: DEPUY IRELAND - 9616671 ATTUNE PS FB INSRT SZ 6 6MM; ATTUNE IMPLANT : KNEE TIBIAL INSERT

Catalog Number	151640606
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	08/22/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Product complaint # (b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803 (and/or part 4, as applicable).This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes, or its employees that the report constitutes an admission that the product, depuy synthes, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
Event or Problem Description
Patient was revised due to medial collapse of tibia prostheses.After the tibia tray was removed, cultures were taken and the tibia was prepped for a revision tibial tray, sleeve and stem.Pathology called into the room and stated there was an infection present and an 16mm poly spacer with antibiotic cement was implanted.Surgical delay unknown.Doi: oct 21, 2014.Dor: (b)(6), 2023.Affected side: left knee.
Additional Manufacturer Narrative
Product complaint # (b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes joint reconstruction, or its employees that the report constitutes an admission that the product, depuy synthes joint reconstruction, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
Additional Manufacturer Narrative
Product complaint # (b)(4).Investigation summary = patient was revised due to medial collapse of tibia prostheses.After the tibia tray was removed, cultures were taken and the tibia was prepped for a revision tibial tray, sleeve and stem.Pathology called into the room and stated there was an infection present and an 16mm poly spacer with antibiotic cement was implanted.Surgical delay unknown.Doi: (b)(6) 2014.Dor: (b)(6) 2023.Affected side: left knee.The device associated with this report was returned to depuy synthes for evaluation.Visual examination of the returned device found evidence of wear on the superior aspect of the condyles, this type of damage/wear can be expected when there is some kind of debris between the femoral component and insert surfaces.The overall appearance of the device is consistent with being implanted over 8+ years.The overall complaint was unconfirmed and there is no evidence that suggest that the observed condition of the attune ps fb insrt sz 6 6mm would have contributed to the complained adverse event.Based on the investigation findings, and it has been determined that no corrective and/or preventative action is proposed.As part of depuy synthes quality process, all devices are manufactured, inspected, and released to approved specifications.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post-market safety surveillance activities.Device history lot = quantity manufactured: (b)(4).Date of manufacture: 2/20/2013.Any anomalies or deviations identified in dhr: none.Expiry date: 01-2018.Ifu reference: 090200828 h3.

• Brand Name: ATTUNE PS FB INSRT SZ 6 6MM
• Common Device Name: ATTUNE IMPLANT : KNEE TIBIAL INSERT
• Manufacturer (Section D): DEPUY IRELAND - 9616671; loughbeg ringaskiddy co.; cork ; EI
• Manufacturer (Section G): JTE WARSAW MFG SITE; 700 orthopaedic drive; warsaw IN
• Manufacturer Contact: kate karberg ; 700 orthopaedic dr.; warsaw, IN 46581-0988 ; 3035526892
• MDR Report Key: 17700294
• Report Number: 1818910-2023-18283
• Device Sequence Number: 7446470
• Product Code: JWH
• UDI-Device Identifier: 10603295050070
• UDI-Public: 10603295050070
• Combination Product (Y/N): N
• Initial Reporter State: WA
• Initial Reporter Country: US
• PMA/510(K) Number: K111433
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2014
• Device Explanted Year: 2023
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 09/07/2023

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?: No
• Operator of Device: Health Professional
• Device Catalogue Number: 151640606
• Device Lot Number: 337799
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 08/22/2023
• Supplement Date Received by Manufacturer: 09/19/2023; 10/20/2023
• Initial Report FDA Received Date: 09/07/2023
• Supplement Report FDA Received Date: 09/19/2023; 10/22/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 02/05/2013
• 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: Unknown
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: ATTUNE FB TIB BASE SZ 6 CEM; UNKNOWN BONE CEMENT
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 81 YR
• Patient Sex: Male