MAUDE Adverse Event Report: ENCORE MEDICAL L.P DJO SURGICAL; SHELL, BIPOLAR, MODULAR, ENCORE, SIZE56

Catalog Number	412-02-056
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	Joint Laxity (4526)
Date of Event	05/27/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery due to dislocation.
Additional Manufacturer Narrative
The agent reported, doctor did a bipolar hip on this patient on (b)(6) 2026.The patient presented yesterday with a hip dislocation.Doctor did a revision.He removed the 56 bipolar and +7 28mm head.He elected to use a 52mm unipolar with a +10.5mm sleeve to stabilize the hip.Male 81.Complaint has been evaluated and is similar to report number 1644408-2019-00943; 412-02-045, s803 - dislocation, revision surgery.If additional information regarding the reported event is submitted at a future date, this investigation will be re-evaluated.

• Brand Name: DJO SURGICAL
• Common Device Name: SHELL, BIPOLAR, MODULAR, ENCORE, SIZE56
• Manufacturer (Section D): ENCORE MEDICAL L.P; 9800 metric blvd.; austin TX 78758
• Manufacturer (Section G): ENCORE MEDICAL L.P; 9800 metric blvd.; austin TX 78758
• Manufacturer Contact: stacey bonnell ; 9800 metric blvd.; austin, TX 78758
• MDR Report Key: 25497792
• Report Number: 1644408-2026-01178
• Device Sequence Number: 10552842
• Product Code: KWY
• UDI-Device Identifier: 00888912077460
• UDI-Public: 00888912077460
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K953510
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2026
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 06/14/2026

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
• Operator of Device: Health Professional
• Device Catalogue Number: 412-02-056
• Device Lot Number: 004C1123
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/27/2026
• Initial Report FDA Received Date: 06/14/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 09/16/2025
• 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
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: 497-28-700 LOT. 635C1325.
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 81 YR
• Patient Sex: Male