MAUDE Adverse Event Report: DePuy Orthopaedics Inc US SUMMIT; Summit Hip Stem : Hip Femoral Stem

Catalog Number	157013090
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Pain (1994); Osteolysis (2377); Bone Notching (4890)
Date of Event	08/26/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that the patient presents with pain in her thigh post tha on the above listed date.There appears to be significant lysis around the femoral stem.This patient does not walk as she only transfers from a bed to a wheelchair.Stem is easily removed as the cement was only adhered to the stem proximally.Cement distal to the lytic activity was well fixed and left in place.Massive bone loss was noted both laterally and anteriorly.The liner was exchanged and a new stem and head were cemented with no delay nor patient harm.Cement pressurization was quite difficult with the missing bone but the new implants appeared to be well fixed and rom was deemed appropriate by the surgeon.Distal centralizer was unable to be removed.It was reported that patient was revised due to femoral stem loosening at unknown interface.Cement manufacturer was unknown.Doi: on (b)(6) 2021, dor: on (b)(6) 2026, affected side: left hip.
Additional Manufacturer Narrative
Product complaint#: (b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803 (and/or part 4, as applicable).This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes, or its employees that the report constitutes an admission that the product, depuy synthes, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.D4: udi: as the lot number for the device involved in the event was not provided, the full udi is currently not available.

• Brand Name: SUMMIT
• Common Device Name: Summit Hip Stem : Hip Femoral Stem
• Manufacturer (Section D): DePuy Orthopaedics Inc US; 700 orthopaedic drive; warsaw IN 46581 -098
• Manufacturer (Section G): JTE Warsaw Mfg Site; 700 orthopaedic drive; warsaw IN 46582
• Manufacturer Contact: elba bello ; 700 orthopaedic dr.; warsaw, IN 46581 ; +1(908)386-3534
• MDR Report Key: 50790737
• Report Number: 1818910-2026-15943
• Device Sequence Number: 21475507
• Product Code: JDI
• UDI-Device Identifier: 10603295060222
• UDI-Public: (01)10603295060222
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K170339
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Device Explanted Year: 2026
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup

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: 157013090
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Received by Manufacturer: 08/26/2026
• Supplement Date Received by Manufacturer: 09/16/2026
• Initial Report FDA Received Date: 09/16/2026
• Supplement Report FDA Received Date: 09/17/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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: 82 YR
• Patient Sex: Female