MAUDE Adverse Event Report: ARTHREX, INC. AVL ANGLED REAMER SLEEVE ASSEMBLY, 15; ORTHOPEDIC MANUAL SURG INSTR

Model Number	AVL ANGLED REAMER SLEEVE ASSEMBLY, 15
Medical Device Problem Code	Physical Resistance/Sticking (4012)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	01/19/2024
Type of Reportable Event	Malfunction
Event or Problem Description
On 01/19/2024, it was reported by a facility representative via (b)(4) that an ar-9676 angled reamer was welded together with an ar-9297-15 augmented glenoid angled reamer sleeve.This occurred during a case while reaming the glenoid the angled reamer driver shaft welded together with the angled reamer sleeve.This caused the surgeon's wrist to suddenly twist and made the reaming difficult.The case carried on and was completed successfully with a different reamer sleeve and driveshaft.
Additional Manufacturer Narrative
The contribution of the device to the reported event could not be determined as the device was not returned for evaluation.The root cause of the event could not be determined from the information available and without device evaluation.If the device becomes available for evaluation, a follow-up report will be submitted.
Additional Manufacturer Narrative
Complaint is confirmed.Functional testing was performed on the returned ar-9297-15 and found that the ar-9676 angled reamer shaft gets stuck inside the device and cannot be moved freely.Visual evaluation noted that the ar-9676 is stuck inside the angle reamer sleeve.The most likely cause is attributed to misuse due to interference with the mating instrument.Refer to the investigation photos.
Event or Problem Description
Additional information was provided on 2/19/2024 where the facility representative stated that this event occurred during an anatomic shoulder arthroplasty procedure on 1/18/2024.There was an arthrex representative present during this event.The patient's bone quality was average.Duplicate instrumentation was used out of the augmented reverse shoulder tray, ar-9579s to complete the procedure.
Additional Manufacturer Narrative
Additional information was provided on (b)(6) 2024 where the facility representative stated that this event occurred during an anatomic shoulder arthroplasty procedure on 1/18/2024.There was an arthrex representative present during this event.The patient's bone quality was average.Duplicate instrumentation was used out of the augmented reverse shoulder tray, ar-9579s to complete the procedure.

• Brand Name: AVL ANGLED REAMER SLEEVE ASSEMBLY, 15
• Common Device Name: ORTHOPEDIC MANUAL SURG INSTR
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer (Section G): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer Contact: jared engle ; 8009337001
• MDR Report Key: 18659363
• Report Number: 1220246-2024-00820
• Device Sequence Number: 15507097
• Product Code: LXH
• UDI-Device Identifier: 00888867350038
• UDI-Public: 00888867350038
• Combination Product (Y/N): N
• Initial Reporter State: MI
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 12/17/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: AVL ANGLED REAMER SLEEVE ASSEMBLY, 15
• Device Catalogue Number: AR-9297-15
• Device Lot Number: 052224
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/19/2024
• Supplement Date Received by Manufacturer: 04/22/2024; 02/19/2024
• Initial Report FDA Received Date: 02/07/2024
• Supplement Report FDA Received Date: 05/17/2024; 12/17/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 12/06/2022
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown