MAUDE Adverse Event Report: THEKEN COMPANIES INSITU TOTAL HIP SYSTEM; CERAMIC FERMORAL HEAD

Model Number	10-21-4002
Medical Device Problem Code	Patient Device Interaction Problem (4001)
Health Effect - Clinical Code	Joint Dislocation (2374)
Date of Event	05/23/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Dislocation after tha is a known and risk that is specified in the instructions for use.Dislocation can be caused by numerous events, including, but not limited to trauma, malpositioning of component, or hyperlaxity of the joint.Common treatment for dislocation is a liner or cup that restricts range of motion.
Event or Problem Description
It was reported by the distrubtor that a dislocation occured in a patient.The aptient went to teh doctor after dislocation.A neutral liner and ceramic head were replaced.

• Brand Name: INSITU TOTAL HIP SYSTEM
• Common Device Name: CERAMIC FERMORAL HEAD
• Manufacturer (Section D): THEKEN COMPANIES; 1800 trplett blvd; akron OH 44306
• Manufacturer Contact: jenna amawi ; 1800 triplett blvd; akron, OH 44306 ; 3307337600
• MDR Report Key: 22290060
• Report Number: 3002498892-2025-00005
• Device Sequence Number: 18220169
• Product Code: LPH
• UDI-Device Identifier: 00816127022548
• UDI-Public: 00816127022548
• Combination Product (Y/N): N
• PMA/510(K) Number: K161184
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2025
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 06/19/2025

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
• Device Model Number: 10-21-4002
• Device Lot Number: 7011885430
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/23/2025
• Initial Report FDA Received Date: 06/19/2025
• Date Device Manufactured: 07/01/2024
• 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
• Concomitant Medical Products and Therapy/Usage Dates: 40 MM, +4 MM CERAMIC FEMORAL HEAD; SIZE 54/56 X 40 MM NEUTRAL ACETABULAR LINER
• Outcome Attributed to Adverse Event: Other
• Patient Age: 80 YR
• Patient Sex: Female