MAUDE Adverse Event Report: Encore Medical L.P DJO SURGICAL; EMPOWR ACETABULAR, BONE SCREW, 25MM

Catalog Number	940-00-025
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	Joint Laxity (4526)
Date of Event	07/08/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery due to dislocation.
Additional Manufacturer Narrative
The agent reported "(primary tha was performed a year prior, prosthesis only failed due to cup placement not being optimal.Cup partially dislocated from acetabulum while stem was completely osteointegrated.)".The actual length of in-vivo for the item listed is unknown as the original surgery date was not provided or could be established.Item number: 940-00-025, item description: empowr acetabular, bone screw, 25mm, lot number: unknown, part revision: na, product type: hip, manufacturer date: unknown, expiration date: unknown.This investigation is limited in scope as only partial information was provided to djo surgical - austin for review.The revised item was not returned for examination and the item and or lot number was not provided.To adequately investigate this event, the part and lot number are necessary.If this information is submitted at a future date, this investigation will be re-evaluated.Customer complaint history of the reported item showed no present trends or on-going issues that are needing a review.There was no information submitted with this complaint about any patient activities, accidents, or medical contraindications that may have contributed to the reported event.The surgeon performed this revision to remedy the patient's condition.This complaint will be closed pending receipt of additional information.No further action is deemed necessary at this time.

• Brand Name: DJO SURGICAL
• Common Device Name: EMPOWR ACETABULAR, BONE SCREW, 25MM
• 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: 50011298
• Report Number: 1644408-2026-01431
• Device Sequence Number: 8385651
• Product Code: LPH
• UDI-Device Identifier: 00190446293439
• UDI-Public: 00190446293439
• Combination Product (Y/N): N
• Initial Reporter State: AL
• Initial Reporter Country: US
• PMA/510(K) Number: K190057
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• 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): 07/23/2026

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: 940-00-025
• Device Lot Number: Unknown
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/08/2026
• Initial Report FDA Received Date: 07/27/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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: 74 YR
• Patient Sex: Male