MAUDE Adverse Event Report: Medacta International SA AMIStem-H Proximal Coating Femoral Stems; AMIStem-H Proximal Coating Std. size4

Model Number	01.18.174
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Bone Fracture(s) (1870)
Date of Event	08/26/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery due to a periprosthetic fracture after about 9 years and 2 months from primary.The surgeon cabled the fracture and revised the flat pe hc liner d 32/f to a flat pe hc liner d 40/f at his discretion.
Additional Manufacturer Narrative
Batch review performed on 04 sep 2026 lot 170859: (b)(4)items manufactured and released on 26-apr-2017.Expiration date: 2022-apr-11.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-H Proximal Coating Femoral Stems
• Common Device Name: AMIStem-H Proximal Coating Std. size4
• 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: 50692303
• Report Number: 3005180920-2026-00952
• Device Sequence Number: 9595235
• Product Code: LZO
• UDI-Device Identifier: 07630030804397
• UDI-Public: 07630030804397
• Combination Product (Y/N): N
• PMA/510(K) Number: K161635
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Type of Report: Initial
• Report Date (Section B): 09/09/2026

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 Expiration Date: 04/11/2022
• Device Model Number: 01.18.174
• Device Lot Number: 170859
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/26/2026
• Initial Report FDA Received Date: 09/09/2026
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 04/26/2017
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 74 YR
• Patient Sex: Unknown