MAUDE Adverse Event Report: ZIMMER BIOMET, INC. OSS POLY BUMPER LOCK PIN; PROSTHESIS, KNEE

Catalog Number	150510
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	04/21/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).The product has been received by zimmer biomet and the investigation is in process.Once the investigation has been completed, a follow-up mdr will be submitted.
Event or Problem Description
It was reported that the patient underwent right knee revision approximately 5 months post implantation due to the bumper locking pin sheering off and loose femoral component.Attempts have been made, and no further information has been provided.
Additional Manufacturer Narrative
This follow-up report is being submitted to relay additional information.The following sections were updated: b4; b5; g3; g6; h1; h2; h3; h6; h10; h11.Visual examination of the returned product identified signs of use and implantation in the form of gouges, wear, and foreign debris on the implants surface.The implant is fractured, and it is not determined if all pieces were returned.Dimensional analysis of the product determined that the product, where measured, was conforming to print specifications.The device was submitted for further analysis.Analysis determined the base of the locking pin and the bumper fragment both show possible evidence of stress whitening and slight plastic deformation at the fracture surface.The superior side of the bumper shows possible evidence of impingement damage, possibly from the femoral component during hyperextension.The tabs on the inferior side of the bumper both appear to have some plastic deformation and/or impingement damage but the timeline for this cannot be stated with certainty.The failure of the bumper locking pin was due to high bending or shear forces acting on the pin after insertion, possibly exacerbated by impingement from the femoral component.The device history record was reviewed and no discrepancies relevant to the reported event were found.Medical records were not provided.Complaint is confirmed for implant breakage with the returned device.The complaint of implant loosening is not confirmed.If any further information is found which would change or alter any conclusions or information, a supplemental report will be filed accordingly.Zimmer biomet will continue to monitor for trends.
Event or Problem Description
No further event information available at the time of this report.

• Brand Name: OSS POLY BUMPER LOCK PIN
• Common Device Name: PROSTHESIS, KNEE
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; p.o. box 587; warsaw IN 46581
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 56 e. bell drive; p.o. box 587; warsaw IN 46581
• Manufacturer Contact: jennifer rapsavage ; 56 e. bell dr.; warsaw, IN 46582 ; 5745260384
• MDR Report Key: 22004847
• Report Number: 0001825034-2025-01379
• Device Sequence Number: 18402742
• Product Code: KRO
• UDI-Device Identifier: 00880304240223
• UDI-Public: (01)00880304240223(17)290620(10)66702612
• Combination Product (Y/N): N
• Initial Reporter State: WI
• Initial Reporter Country: US
• PMA/510(K) Number: K051479
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,Distributor
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 09/03/2025

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: Lay User/Patient
• Device Catalogue Number: 150510
• Device Lot Number: 66702612
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/28/2025
• 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: 04/21/2025
• Supplement Date Received by Manufacturer: 08/28/2025
• Initial Report FDA Received Date: 05/12/2025
• Supplement Report FDA Received Date: 09/03/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/20/2024
• 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
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 69 YR
• Patient Sex: Female