MAUDE Adverse Event Report: ARTHREX, INC. PS TIBIAL BEARING, SIZE 4, 10MM, VIT E; KNEE PROSTHESIS PAT/FEM/TIB

Model Number	PS TIBIAL BEARING, SIZE 4, 10MM, VIT E
Medical Device Problem Code	Positioning Problem (3009)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/19/2022
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported on 09/19/2022 by a sales representative via email that an ar-523-b410 tibial bearing would not fit into the implant."over hang of additional material not allowing it to snap into the tibial tray".A new tray was poly was used and case was completed successfully.This was discovered during a case with no patient harm.
Additional Manufacturer Narrative
The most likely cause for the reported failure can be attributed to user error due to misaligned insertion and/or improper bone preparation.This 3500a record is submitted to comply with an fda 483 inspectional observation issued to arthrex inc on may 5, 2023.Arthrex has reassessed the reportability decisions made on historical complaint records using revised criterion.This 3500a document is a result of the reassessment.

• Brand Name: PS TIBIAL BEARING, SIZE 4, 10MM, VIT E
• Common Device Name: KNEE PROSTHESIS PAT/FEM/TIB
• 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: 18876356
• Report Number: 1220246-2024-01405
• Device Sequence Number: 18112078
• Product Code: MBH
• UDI-Device Identifier: 00888867232464
• UDI-Public: 00888867232464
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K171365
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial
• Report Date (Section B): 03/11/2024

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: PS TIBIAL BEARING, SIZE 4, 10MM, VIT E
• Device Catalogue Number: AR-523-B410
• Device Lot Number: 579214708
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/19/2022
• Initial Report FDA Received Date: 03/11/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/01/2022
• 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
• Patient Sex: Unknown