MAUDE Adverse Event Report: STRYKER ORTHOPAEDICS-MAHWAH TRIDENT 0 DEG X3 INSERT 36MM ID E; PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, POROUS UNCEMENTED

Catalog Number	623-00-36E
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Codes	Joint Dislocation (2374); Metal Related Pathology (4530)
Date of Event	03/08/2023
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported through the filing of a lawsuit that allegedly the patient was implanted with an lfit anatomic cocr v40 femoral head on her right hip on or about (b)(6) 2014, and was revised on (b)(6) 2023.It is further alleged that the patient suffered injuries as a result of implantation and explantation of the device at issue, device recall, and excessive levels of chromium and cobalt in her blood.Update: per medical records received, the revision operative report states this tha had dislocated multiple times necessitating revision.Intra-operatively a great deal of metallic debris was encountered as well as a large effusion.Upon removal of the v-40 femoral head the surgeon remarked the "trunnion was intact".Components were "well fixed".The liner was exchanged to one with an elevated rim.A sleeve and new head were implanted.
Additional Manufacturer Narrative
An event regarding dislocation involving a trident liner was reported.The events were confirmed via clinician review of the provided medical records.Method & results: -product evaluation and results: material analysis, visual, functional and dimensional inspections could not be performed as the device was not returned.-clinician review: a review of the provided medical information by a clinical consultant indicated: "on (b)(6) 2014 the patient underwent an uncomplicated tha.The revision operative report states this tha had dislocated multiple times necessitating revision.Intr-operatively a great deal of metallic debris was encountered as well as a large effusion.Upon removal of the v-40 femoral head the surgeon remarked the "trunnion was intact".Components were "well fixed".The liner was exchanged to one with an elevated rim.A sleeve and new head were implanted.It is confirmed that a revision surgery for tha instability with multiple dislocations occurred.No direct evidence for elevated serum metal ions was presented but the surgeon noted they were elevated in his operative report the root cause of the tha instability cannot be determined from the documentation provided." -product history review: review of the device history records indicate devices were manufactured and accepted into final stock with no relevant reported discrepancies.-complaint history review: there have been no other similar events for the lot referenced.Conclusions: it was reported that the patient was revised due to dislocation and elevated ion levels.Intraoperatively, corrosion and metallic debris were observed.A review of the provided medical information by a clinical consultant indicated: "it is confirmed that a revision surgery for tha instability with multiple dislocations occurred.No direct evidence for elevated serum metal ions was presented but the surgeon noted they were elevated in his operative report the root cause of the tha instability cannot be determined from the documentation provided." no further investigation for this event is possible at this time.If devices and/or additional information become available to indicate further evaluation is warranted, this record will be reopened.H3 other text : not returned.

• Brand Name: TRIDENT 0 DEG X3 INSERT 36MM ID E
• Common Device Name: PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/POLYMER, POROUS UNCEMENTED
• Manufacturer (Section D): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• Manufacturer (Section G): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• Manufacturer Contact: brad curtis ; 325 corporate drive; mahwah, NJ 07430 ; 2018315000
• MDR Report Key: 18473782
• Report Number: 0002249697-2024-00051
• Device Sequence Number: 12368711
• Product Code: LPH
• UDI-Device Identifier: 07613327039542
• UDI-Public: 07613327039542
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K033716
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2014
• Device Explanted Year: 2023
• Reporter Type: Manufacturer
• Report Source: Other
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 01/09/2024

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?: No
• Operator of Device: Health Professional
• Device Expiration Date: 09/30/2019
• Device Catalogue Number: 623-00-36E
• Device Lot Number: MNM3LY
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 12/18/2023
• Initial Report FDA Received Date: 01/09/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 09/03/2014
• 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; Hospitalization
• Patient Age: 71 YR
• Patient Sex: Female