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SMITH & NEPHEW ORTHOPAEDICS AG TRIAL FEMORAL HEAD 36 S/+0; PROSTHESIS, HIP, SEMI-CONSTRAINED, METAL/CERAMIC/POLYMER, CEMENTED OR NON-POROUS
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| Catalog Number |
75100856 |
| Medical Device Problem Codes |
Fracture (1260); Separation Failure (2547)
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| Health Effect - Clinical Code |
No Clinical Signs, Symptoms or Conditions (4582)
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| Date of Event |
03/18/2025
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Type of Reportable Event
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Malfunction
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Event or Problem Description
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It was reported that during a thr surgery, the trial femoral head 36 s/+0 stuck in the acetabular portion.It was use a hook to dislocate without success.It was used osteotome that slide and broke the trial head inside of the wound.Pieces fell inside the wound but all parts were removed by hand with clamp.In addition, the surgeon washed the wound carefully with bactisure wound lavage.The procedure was resumed, without any delay, using a s+n back-up device.Patient was not injured as consequence of this problem.
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Additional Manufacturer Narrative
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Internal complaint reference: (b)(4).This complaint was opened by smith+nephew to document a product problem associated with a smith+nephew device.The reported problem relates to known inherent device and/or procedural risks that are appropriately documented in our risk files.Smith+nephew will continue to monitor trends in accordance with our post-market surveillance process and take necessary action as required if anticipated severity and/or occurrence rates are exceeded.Smith+nephew has no reason to suspect that the product failed to meet any specifications at the time of manufacture.Based on our review of all currently available information, we are unable to identify a definitive root cause.However, as the use of our product cannot be excluded as a potential cause or contributory factor to the reported issue, we are conservatively submitting this report in accordance with applicable regulations.If additional information becomes available that alters the conclusions of this report, a follow-up report will be submitted as required.
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Additional Manufacturer Narrative
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H3, h6: the complaint used in treatment was returned for investigation.A visual evaluation of the device was conducted, and it was concluded that the device is heavily destroyed and fractured.Due to the damage of the device, the functional evaluation could not be performed.A review of the production documentation did not detect any deviation that could have contributed to the reported failure mode.The review of historical complaints for the alleged device revealed 1 additional similar complaints reported for the same batch, and 16 additional similar complaints for the same product number over the past 12 months with similar a failure mode.A review of past corrective actions was performed.No further escalation is required.A review of the risk management documentation verifies the failure mode, occurrence and severity of the reported issue.There is no indication that the reported device failed to meet manufacturing specifications upon release for distribution.The root cause of the reported event remains undetermined.This device is a reusable instrument that can be exposed to numerous surgeries.Damage from repeated resterilization, prolonged use, misuse or rough handling are likely potential factors that could contribute to the reported event.Furthermore, the damage found in the visual inspection indicates that the device will not function as intended.Therefore, all reusable instruments must be routinely inspected for signs of wear and damage after reprocessing.Any instruments found to be damaged should be replaced as necessary to ensure their proper functioning and to maintain patient safety.This guidance is provided by smith & nephew orthopaedics ag (reference: lit.N°03389-en 1363 v3 11/19).The need for further actions is not indicated.Nevertheless, smith+nephew will continue to monitor this device for similar issues.The returned device will be discarded.Additional information: d9.
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