MAUDE Adverse Event Report: LIMACORPORATE S.P.A SMR SHOULDER; SMR TT METAL BACK BASEPLATE (TI6AL4V) - SMALL R

Model Number	1375.15.605
Medical Device Problem Code	Patient Device Interaction Problem (4001)
Health Effect - Clinical Code	Loose body in joint (4926)
Date of Event	06/17/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Explanted components have been discarded therefore cannot be returned to manufacturer for identification and analysis.No review of manufacturing records for complained parts can be performed either since lot number is unknown.No x-rays nor pictures of explanted components were provided either.From follow-up communication with complaint source it was confirmed that no further information regarding the case can be retrieved, therefore no further root cause investigation is possible.Taking into account the involved product family smr shoulder, no adverse trend has been identified for reported issue in the last year.According to investigation carried out, no corrective action is needed for this event.If any additional information is received that would change or alter any conclusion, a supplemental report will be filed accordingly.The manufacturer will continue monitoring the market in order to detect any similar event.
Event or Problem Description
Revision surgery was performed on (b)(6) 2025 due to loosening.Patient received a reverse total should arthroplasty with smr stem, reverse humeral body (pn 1352.15.010), reverse liner std (pn 1360.50.810), 36mm glenosphere with connector (1374.09.105) and smr metal back baseplate (pn 1375.15.605) at an unknown date prior to 2020.Records could not be found of original implants.Due to osteolysis around the baseplate, possibly due to mal-positioned baseplate or notching, the glenoid construct was deemed unstable and loose.Upon revision, above mentioned components, with exception of the humeral stem, were easily removed.An anatomic humeral body trauma medium (pn 1350.15.010) and humeral head dia42mm (pn 1322.09.420) were implanted with eccentrical adaptor taper 2mm long (pn 1331.15.272), and the bone loss on glenoid was filled with bone graft for a potential second stage revision surgery to implant a reverse baseplate.Surgery was completed as intended.Patient is female, date of (b)(6) 1944.The event occurred in the united states.

• Brand Name: SMR SHOULDER
• Common Device Name: SMR TT METAL BACK BASEPLATE (TI6AL4V) - SMALL R
• Manufacturer (Section D): LIMACORPORATE S.P.A; via nazionale 52; villanova di san daniele, udine 33038 ; IT 33038
• Manufacturer Contact: via nazionale 52; villanova di san daniele, udine 33038
• MDR Report Key: 24178569
• Report Number: 3008021110-2026-00050
• Device Sequence Number: 10177570
• Product Code: KWS
• UDI-Device Identifier: 08033390089562
• UDI-Public: 8033390089562
• Combination Product (Y/N): N
• PMA/510(K) Number: K133349
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 01/26/2026

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: 1375.15.605
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 01/26/2026
• 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: Required Intervention
• Patient Sex: Unknown