MAUDE Adverse Event Report: Smith & Nephew Orthopaedics AG POLARSTEM Stem Std Ti/HA 4 non-cem; Prosthesis, Hip, Semi-Constrained, Metal/Ceramic/Polymer, Cemented Or Non-Porous

Catalog Number	75100467
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Pain (1994); Prolapse (2475); Bursitis (4832); Implant site sclerosis (4903)
Date of Event	05/01/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that, during the first week of recovery following a bhr to thr conversion performed on (b)(6) 2018, the patient experienced persistent pain in the anterior groin.It is particularly painful when lifting the right leg, when he goes from sitting to standing, and getting into or out of cars.The pain is described as burning sharp sensation, and the patient reported weakness and limited movement.The patient received a fluoroscopy guided injection in the iliopsoas bursa on (b)(6) 2025, but he states that it really did not help at all.A recent mri on (b)(6) 2026 revealed mild capsulitis, capsular fluid prolapsing into the iliopsoas bursa, and mild thickened synovium.The adverse event had not been resolved.A revision surgery has been scheduled for on (b)(6) 2026.
Additional Manufacturer Narrative
Internal complaint reference: (b)(4).This complaint was opened by smith+nephew to document a patient complication reported that includes reference to the use of a smith+nephew product without evidence about a specific product problem.The reported complication relates to known inherent procedural risks that are appropriately documented in our risk files.Smith+nephew will continue to monitor trends in accordance with our post-market surveillance process and take necessary action as required if anticipated severity and/or occurrence rates are exceeded.Smith+nephew has no reason to suspect that the product failed to meet any specifications at the time of manufacture.Based on our review of all currently available information, we are unable to confirm a relationship between the reported event and the device or identify a definitive root cause.However, as the use of our product cannot be excluded as a potential cause or contributory factor to the reported issue, we are submitting this report in accordance with applicable regulations.If additional investigative findings or information becomes available that alters the conclusions of this report, a follow-up report will be submitted as required.

• Brand Name: POLARSTEM Stem Std Ti/HA 4 non-cem
• Common Device Name: Prosthesis, Hip, Semi-Constrained, Metal/Ceramic/Polymer, Cemented Or Non-Porous
• Manufacturer (Section D): Smith & Nephew Orthopaedics AG; schachenallee 29; aarau CH-50 00; SZ CH-5000
• Manufacturer (Section G): Smith & Nephew Orthopaedics AG; schachenallee 29; aarau CH-50 00; SZ CH-5000
• Manufacturer Contact: holly topping ; 1450 brooks rd.; memphis, TN 38116 ; +1(512)391-3905
• MDR Report Key: 50029306
• Report Number: 9613369-2026-00057
• Device Sequence Number: 9793545
• Product Code: LZO
• UDI-Device Identifier: 07611996118582
• UDI-Public: 07611996118582
• Combination Product (Y/N): N
• Initial Reporter State: NC
• Initial Reporter Country: US
• PMA/510(K) Number: P150030
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2018
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 09/21/2026

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 Expiration Date: 10/27/2024
• Device Catalogue Number: 75100467
• Device Lot Number: B1716261
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/01/2026
• Supplement Date Received by Manufacturer: 09/02/2026
• Initial Report FDA Received Date: 07/27/2026
• Supplement Report FDA Received Date: 09/21/2026
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/27/2017
• 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
• Concomitant Medical Products and Therapy/Usage Dates: 71332530, 17HB00424.; 71332756, 17LM15598.; 71335556, 17LW04997.; 71336530, 16HB00596.; 71343600, 17CM20159.
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 64 YR
• Patient Sex: Male
• Patient Weight: 150 LB