MAUDE Adverse Event Report: MICROPORT ORTHOPEDICS INC. ADVANCE® II MEDIAL PIVOT TIBIAL INSERT SZ 3 LEFT 1; KNEE COMPONENT

Model Number	KIMP310L
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Unspecified Infection (1930)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
This event will be updated once the investigation is complete.Trends will be evaluated.
Event or Problem Description
Allegedly, patient was revised due to infection.Revision njr index no: (b)(4).Side: l.Non revised products: product id: kftcnp3l advance® primary femoral size 3 left nonporous/ lot number: 1600497/ qty: 1.Product id: kpontp32 advance® onlay all-poly patella 32mm tri-peg/ lot number: 1594725/ qty: 1.Product id: kttinp31 advance ii modular titanium tibia base sz 3+ nonporous/ lot number: 0901195804/ qty: 1.Product id: ksp14100 advance® canal filling stem extension 15mm x 100mm/ lot number: 049855338/ qty: 1.Product id: ktagb410 advance® tibial block augment size 4/3+ x 10mm nonporous/ lot number: 127495301/ qty: 1.

• Brand Name: ADVANCE® II MEDIAL PIVOT TIBIAL INSERT SZ 3 LEFT 1
• Common Device Name: KNEE COMPONENT
• Manufacturer (Section D): MICROPORT ORTHOPEDICS INC.; 5677 airline rd.; arlington TN 38002
• Manufacturer Contact: rachael wise ; 5677 airline road; arlington, TN 38002 ; 9018674771
• MDR Report Key: 19778479
• Report Number: 3010536692-2024-00406
• Device Sequence Number: 8654821
• Product Code: JWH
• UDI-Device Identifier: M684KIMP310L1
• UDI-Public: M684KIMP310L1
• Combination Product (Y/N): N
• Initial Reporter Country: UK
• PMA/510(K) Number: K972770
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2015
• Device Explanted Year: 2024
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 10/30/2025

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: Other
• Device Model Number: KIMP310L
• Device Catalogue Number: KIMP310L
• Device Lot Number: 1585281
• 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: 06/24/2024
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 07/18/2024
• Supplement Report FDA Received Date: 10/30/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is the Device Labeled for Single Use? (Y/N): Yes
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 55 YR
• Patient Sex: Male