MAUDE Adverse Event Report: EXACTECH, INC. OPTETRAK ASY, CR POROUS FEMORAL, SZ 3, LEFT; PROSTHESIS, KNEE, PATELLOFEMOROTIBIAL, SEMI-CONSTRAINED, CEMENTED, POLYMER/METAL

Model Number	OPTETRAK ASY, CR POROUS FEMORAL, SZ 3, LEFT
Medical Device Problem Codes	Unstable (1667); Naturally Worn (2988)
Health Effect - Clinical Codes	Pain (1994); Scar Tissue (2060); Osteolysis (2377); Joint Laxity (4526); Metal Related Pathology (4530); Appropriate Clinical Signs, Symptoms and Conditions Term/Code Not Available (4581)
Date of Event	10/15/2021
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that approximately 101 months after a left total knee replacement procedure, the patient underwent a revision procedure to address prosthesis wear, metallosis, pain, joint laxity, joint instability, osteolysis on the medial femoral condyle, and tibial bone loss.Revision surgery operative notes were provided.Patient left the operating room in stable condition.Post operative diagnosis noted wear of the implant.No further issues or complications were reported.No additional information is available." x-ray: no.Operative notes: yes.
Additional Manufacturer Narrative
The device was not returned for evaluation and no medical or other records containing treatment information or patient information have been received; therefore, the reported event cannot be confirmed, nor can the circumstances or potential causes or contributors to the alleged event be evaluated.Should additional, material information become available that permits more analysis or conclusions, a supplemental report will be filed accordingly.D10 concomitant devices: (b)(6), 13a2101 - cemex system fast genta 70g; ( b)(6),200-03-32 - one peg patella 32mm; (b)(6), 200-04-33 - cemented finned tib.Tra sz 3f/3t; (b)(6), 201-78-78 - 4" drill bit, hex, 2 pk; (b)(6), asa0030 - sterile disposable containers.

• Brand Name: OPTETRAK ASY, CR POROUS FEMORAL, SZ 3, LEFT
• Common Device Name: PROSTHESIS, KNEE, PATELLOFEMOROTIBIAL, SEMI-CONSTRAINED, CEMENTED, POLYMER/METAL
• Manufacturer (Section D): EXACTECH, INC.; 2320 nw 66 court; gainesville FL 32653
• Manufacturer (Section G): EXACTECH INC.; 2320 nw 66th ct; gainesville FL 32653
• Manufacturer Contact: geoff gannon ; 2320 nw 66th ct; gainesville, FL 32653
• MDR Report Key: 21252537
• Report Number: 1038671-2025-00475
• Device Sequence Number: 9179723
• Product Code: JWH
• UDI-Device Identifier: 10885862063038
• UDI-Public: 10885862063038
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K032606
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2013
• Device Explanted Year: 2021
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Consumer,Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 01/28/2025

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 10/31/2017
• Device Model Number: OPTETRAK ASY, CR POROUS FEMORAL, SZ 3, LEFT
• Device Catalogue Number: 232-02-03
• Was Device Available for Evaluation?: No
• Distributor Facility Aware Date: 10/05/2023
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/05/2023
• Initial Report FDA Received Date: 01/28/2025
• Date Device Manufactured: 11/05/2012
• 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: A
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SEE H11
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 74 YR
• Patient Sex: Female