MAUDE Adverse Event Report: EXACTECH, INC. NV GXL LNR, LIPPED, 32MM ID GROUP 4 CUPS; PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, CEMENTED

Model Number	NV GXL LNR, LIPPED, 32MM ID GROUP 4 CUPS
Medical Device Problem Codes	Naturally Worn (2988); Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Pain (1994); Implant Pain (4561)
Date of Event	11/16/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
D10: concomittents: (b)(6) - 120-65-15 - bone screw 6.5mm dia x 15mm long.(b)(6) - 120-65-20 - bone screw 6.5mm dia x 20mm long.(b)(6) - 120-65-20 - bone screw 6.5mm dia x 20mm long.(b)(6) - 142-32-00 - cocr fem head 32mm +0 offset 12/14.(b)(6) - 164-12-11 - novation element ro x/o sz 11.(b)(6) - 180-01-60 - nv crown cup clstr hole 60mm group 4.Additional information, including the product investigation, will be submitted within 30 days of receipt.
Event or Problem Description
It was reported, a male patient, who had an initial right hip implanted on (b)(6), 2014, underwent a revision procedure on (b)(6), 2023, approximately 9 years 10 months post the initial procedure.The patient was brought back for right hip pain.During the procedure, the femur was dislocated, and the femoral head removed.The stem was checked and found to be well fixed.Attention turned to the cup.The liner was removed with the help of a bone screw.All three screws were removed, and the cup was found to be loose and removed.Femoral head allograft was impacted into the acetabulum with bone graft.A new competitor¿s dual mobility cup was then implanted along with a new femoral head.There were no surgical delays or device breakages during the procedure.An x-ray was provided.The patient was last known to be in stable condition following the event.No device returns are available.The patient requested to keep them.Device images were provided.No further information.
Additional Manufacturer Narrative
This follow-up report is being submitted to relay additional and/or corrected information.The following sections were updated/corrected: d1, h6 mdr section codes updated/corrected: a, b, c, d, e, g.This follow-up report is being submitted to relay additional and/or corrected information.The following sections were updated/corrected: h6 mdr section codes updated/corrected: b, c, d, g the most likely underlying cause for the revision reported is a combination of risk factors: such as use error, implant positioning, implant size selection, and patient factors (fitness for surgery, biomechanics, activity level and local tissue oxidation potential).However, this cannot be confirmed from the reported information, and the devices were not available for evaluation.If any further information is obtained that would change or alter any information provided, a supplemental report will be filed accordingly.

• Brand Name: NV GXL LNR, LIPPED, 32MM ID GROUP 4 CUPS
• Common Device Name: PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, CEMENTED
• Manufacturer (Section D): EXACTECH, INC.; 2320 nw 66 court; gainesville FL 32653
• Manufacturer (Section G): EXACTECH, INC.; 2320 nw 66 court; gainesville FL 32653
• Manufacturer Contact: miguel sosa ; 2320 nw 66 court; gainesville, FL 32653 ; 3523164164
• MDR Report Key: 18346649
• Report Number: 1038671-2023-03008
• Device Sequence Number: 14835631
• Product Code: JDI
• UDI-Device Identifier: 10885862023339
• UDI-Public: 10885862023339
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K070479
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2014
• Device Explanted Year: 2023
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Remedial Action: Recall
• Type of Report: Initial,Followup
• Report Date (Section B): 09/26/2025

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: 06/18/2017
• Device Model Number: NV GXL LNR, LIPPED, 32MM ID GROUP 4 CUPS
• Device Catalogue Number: 132-32-54
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/20/2023
• Supplement Date Received by Manufacturer: 09/25/2025
• Initial Report FDA Received Date: 12/18/2023
• Supplement Report FDA Received Date: 09/26/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 06/19/2012
• 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: Z-1729-2022
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SEE H10.
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Male