MAUDE Adverse Event Report: MEDACTA INTERNATIONAL SA GMK-SPHERE FEMORAL COMPONENT SPHERE CEMENTED SIZE 3+ R; KNEE CEMENTED FEMUR

Catalog Number	02.12.0023R
Medical Device Problem Code	Device Appears to Trigger Rejection (1524)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	11/13/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Batch review performed on 14 november 2023: lot 168767: (b)(4) manufactured and released on 28-mar-2017.Expiration date: 2022-03-20.No anomalies found related to the problem.To date, 48 items of the same lot have been sold with no similar reported event during the period of review.Additional devices involved: batch reviews performed on 14 november 2023.Gmk-sphere 02.12.0211fr tibial insert fixed sphere flex size 2/11 mm r (k140826) lot 166511:(b)(4) manufactured and released on 13-dec-2016.Expiration date: 2021-11-21.No anomalies found related to the problem.To date, 71 items of the same lot have been sold with no similar reported event during the period of review.Gmk-sphere 02.07.1202r tibial tray fixed cemented size 2 r (k090988) lot 160577: (b)(4)manufactured and released on 23-mar-2016.Expiration date: 2021-03-13.No anomalies found related to the problem.To date, all items of the same lot have been sold with no similar reported event during the period of review.
Event or Problem Description
At about 6 years and 4 months from the primary, the patient came in due to signs of infection and the pathogen was identified as mrsa.The surgeon performed a washout and revised the femoral component, insert and tibial tray.The surgery was completed successfully.

• Brand Name: GMK-SPHERE FEMORAL COMPONENT SPHERE CEMENTED SIZE 3+ R
• Common Device Name: KNEE CEMENTED FEMUR
• Manufacturer (Section D): MEDACTA INTERNATIONAL SA; strada regina; castel san pietro, switzerland 6874 ; SZ 6874
• Manufacturer (Section G): MEDACTA INTERNATIONAL SA; strada regina; castel san pietro, switzerland 6874 ; SZ 6874
• Manufacturer Contact: marco giannessi ; strada regina; castel san pietro, switzerland 6874 ; SZ 6874
• MDR Report Key: 18301127
• Report Number: 3005180920-2023-00938
• Device Sequence Number: 3613373
• Product Code: JWH
• UDI-Device Identifier: 07630030862380
• UDI-Public: 07630030862380
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K140826
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2023
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 12/11/2023

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 Expiration Date: 03/20/2022
• Device Catalogue Number: 02.12.0023R
• Device Lot Number: 168767
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/13/2023
• Initial Report FDA Received Date: 12/11/2023
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 03/28/2017
• 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
• Patient Age: 68 YR
• Patient Sex: Female
• Patient Weight: 47 KG
• Patient Race: White