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Reported event: an event regarding range of motion (rom) involving a triathlon insert was reported.The event was confirmed.Method & results: product evaluation and results: material analysis, visual, functional and dimensional inspections could not be performed as the device remains implanted.Clinician review: a review of the provided medical records by a clinical consultant indicated: "i can confirm that the patient had bilateral total knee arthroplasty's performed at the same time since i was able to review the operation report and postoperative x-rays.I can also confirm that the patient underwent manipulation under anesthesia since i was able to review the operation report.I can also confirm that the patient sustained a distal femoral fracture above the right total knee arthroplasty requiring open reduction and internal fixation since i was able to review the operation report as well.Root cause analysis: the root cause of these events cannot be determined with certainty.Stiffness following bilateral total knee arthroplasty of one knee or the other is not uncommon.The causes are multifactorial including surgical technique in the way the components are sized, positioned and cemented.In this case it appears that the surgical technique was satisfactory.Patient factors such as lifestyle, activity level, bmi, and ability to comply with postoperative physical therapy and range of motion instructions contribute.In addition there are patients who tend to form scars and are more prone to arthrofibrosis.Regarding the femoral fracture, the patient sustained trauma and that was the definitive cause of the fracture.I would not attribute any causality to the implant itself.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: a manipulation under anesthesia was reported due to limited range of motion.A review of the provided medical records by a clinical consultant indicated: "i can confirm that the patient had bilateral total knee arthroplasty's performed at the same time since i was able to review the operation report and postoperative x-rays.I can also confirm that the patient underwent manipulation under anesthesia since i was able to review the operation report.I can also confirm that the patient sustained a distal femoral fracture above the right total knee arthroplasty requiring open reduction and internal fixation since i was able to review the operation report as well.Root cause analysis: the root cause of these events cannot be determined with certainty.Stiffness following bilateral total knee arthroplasty of one knee or the other is not uncommon.The causes are multifactorial including surgical technique in the way the components are sized, positioned and cemented.In this case it appears that the surgical technique was satisfactory.Patient factors such as lifestyle, activity level, bmi, and ability to comply with postoperative physical therapy and range of motion instructions contribute.In addition there are patients who tend to form scars and are more prone to arthrofibrosis.Regarding the femoral fracture, the patient sustained trauma and that was the definitive cause of the fracture.I would not attribute any causality to the implant itself.No further investigation for this event is possible at this time.If additional information becomes available to indicate further evaluation is warranted, this record will be reopened.The following devices were also listed in this report: device name#triathlon ps fem component cemented ; cat#5515-f-201 ; lot#cxb7e.Device name#triathlon sym patella s27x8mm ; cat#5550l278 ; lot#lga004.It cannot be determined which, if any of these devices may have caused or contributed to the patient's experience.
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