MAUDE Adverse Event Report: MEDACTA INTERNATIONAL SA BIPOLAR HEADS; 316LVM BIPOLAR HEAD Ø28 X 47

Model Number	25060.2847
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	Joint Dislocation (2374)
Date of Event	06/03/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery due to dislocation of bipolar head from the acetabulum after 20 days from primary surgery.The surgeon revised the head with a head with an option sleeve, and the bipolar head was converted to a zimmer dual mobility.
Additional Manufacturer Narrative
Clinical evaluation a few weeks after primary partial hip arthroplasty, dislocation of the bipolar head from acetabulum occurs.The surgeon decided to converty partial arthroplasty to total, replacing the femoral head and the bipolar cup.No reason to suspect a faulty device as the cause of the dislocation.Batch review performed on 24 jun 2026 lot 2401376: (b)(4) items manufactured and released on 20-jun-2024.Expiration date: 2029-jun-03.No anomalies found related to the problem.To date, (b)(4) items of the same lot have been sold with no similar reported event during the period of review.Root cause: based on the information available, no definitive root cause can be established.The clinical evaluation does not indicate any reason to suspect a faulty device as the cause of the bipolar head dislocation, which occurred a few weeks after primary partial hip arthroplasty.

• Brand Name: BIPOLAR HEADS
• Common Device Name: 316LVM BIPOLAR HEAD Ø28 X 47
• Manufacturer (Section D): MEDACTA INTERNATIONAL SA; strada regina; castel san pietro 6874 ; SZ 6874
• Manufacturer Contact: marco giannessi ; strada regina; castel san pietro 6874 ; SZ 6874
• MDR Report Key: 25691655
• Report Number: 3005180920-2026-00608
• Device Sequence Number: 9670039
• Product Code: KWY
• UDI-Device Identifier: 07630030843655
• UDI-Public: 07630030843655
• Combination Product (Y/N): N
• PMA/510(K) Number: K091967
• 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: Other
• Type of Report: Initial
• Report Date (Section B): 07/02/2026

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 Model Number: 25060.2847
• Device Lot Number: 2401376
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/03/2026
• Initial Report FDA Received Date: 07/02/2026
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• 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: Required Intervention
• Patient Age: 87 YR
• Patient Sex: Female