MAUDE Adverse Event Report: MEDACTA INTERNATIONAL SA AMISTEM-P COLLARED; AMISTEM-P COLLARED LAT. SIZE8

Model Number	01.18.448
Medical Device Problem Code	Implant subsidence (4078)
Health Effect - Clinical Codes	Joint Laxity (4526); Implant Pain (4561)
Date of Event	06/22/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
At about 2 months from the primary, the patient came in presenting pain and instability due to a subsided stem and the cause is unknown.There were no indications of trauma or bone quality issues.The surgeon revised the medacta stem and head to a competitor stem and head and revised the double mobility hc liner d 28/dme to a same size liner.The surgery was completed successfully.
Additional Manufacturer Narrative
Batch review performed on 24 june 2026 stem: amistem-p collared 01.18.448 amistem-p collared lat.Size 8 (k173794) lot 2314853: (b)(4) items manufactured and released on 11-oct-2023.Expiration date: 25-sep-2028.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, while there is no indication that any potential issue with the device may have caused or contributed to the event, and the device history record review does not indicate any potential manufacturing related issue.

• Brand Name: AMISTEM-P COLLARED
• Common Device Name: AMISTEM-P COLLARED LAT. SIZE8
• 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: 25763459
• Report Number: 3005180920-2026-00676
• Device Sequence Number: 18758667
• Product Code: LZO
• UDI-Device Identifier: 07630040720373
• UDI-Public: 07630040720373
• Combination Product (Y/N): N
• PMA/510(K) Number: K173794
• 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): 07/09/2026

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: 01.18.448
• Device Lot Number: 2314853
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/22/2026
• Initial Report FDA Received Date: 07/09/2026
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/11/2023
• 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: Male