MAUDE Adverse Event Report: ZIMMER BIOMET, INC. FEMORAL STEM 12/14 NECK TAPER SIZE 12.5; PROSTHESIS, HIP

Catalog Number	00771101200
Medical Device Problem Codes	Adverse Event Without Identified Device or Use Problem (2993); Patient Device Interaction Problem (4001)
Health Effect - Clinical Codes	Extraskeletal ossification (1428); Necrosis (1971); Osteolysis (2377); Metal Related Pathology (4530); Muscle/Tendon Damage (4532); Swelling/ Edema (4577)
Date of Event	11/26/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).Multiple mdr reports were filed for this event, please see associated reports: 0001822565-2023-03528 0002648920-2023-00296 0002648920-2023-00296 d10: cat #: 00630505036 / liner standard 3.5 mm offset 36 mm i.D.For use with 50/52/54 mm o.D.Shells / lot#: 62496977 cat #: 00620005222 / shell porous with cluster holes 52 mm o.D./ lot #: 62481050 cat #: 00801803601 / femoral head sterile product do not resterilize 12/14 taper / lot #:62536063 the device will not be returned for analysis; however, an investigation of the reported event is in progress.Once the investigation is completed, a supplemental medwatch will be submitted.
Event or Problem Description
It was reported a patient underwent a left hip revision approximately seven years post implantation due to recurring dislocations.During the procedure, the surgeon encountered a large amount of edema in the subcutaneous tissues, osteolysis with osteolytic tissue, and instability.The surgeon also found heterotopic bone of the acetabulum and femur, large pseudotumor with soft tissue necrosis, trunnionosis, poly wear, and metallosis throughout all the tissues.All the implants, except for the stem, were revised without further complications.Attempts have been made and no further information is available.
Additional Manufacturer Narrative
(b)(4).This follow-up report is being submitted to relay additional information.Proposed component code: mechanical (g04)- stem.No product was returned or pictures provided; visual and dimensional evaluations could not be performed.Dhr was reviewed and no discrepancies related to the reported event were found.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 on (b)(6) 2014.The patient began experiencing dislocations and pain, with a revision on (b)(6) 2021.During the revision, heterotopic bone was found in the acetabulum, osteolysis and a pseudotumor, metallosis, and trunnionosis with tissue damage.All components except the stem were explanted and replaced with zb product.The complaint was confirmed based on the provided medical records.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 additional event information to report at this time.

• Brand Name: FEMORAL STEM 12/14 NECK TAPER SIZE 12.5
• 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: 18303884
• Report Number: 0001822565-2023-03529
• Device Sequence Number: 20493969
• Product Code: LZO
• UDI-Device Identifier: 00889024131866
• UDI-Public: (01)00889024131866(17)230831(10)62444872
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K192660
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2014
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Consumer,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 03/20/2024

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: 08/31/2023
• Device Catalogue Number: 00771101200
• Device Lot Number: 62444872
• 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: 11/17/2023
• Supplement Date Received by Manufacturer: 03/15/2024
• Initial Report FDA Received Date: 12/11/2023
• Supplement Report FDA Received Date: 03/20/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 08/09/2013
• 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
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SEE H10 NARRATIVE
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Sex: Female
• Patient Weight: 103 KG