STRYKER ORTHOPAEDICS-MAHWAH TRIATHLON PS FEM COMPONENT, CEMENTED; PROSTHESIS, KNEE, PATELLO/FEMOROTIBIAL, SEMI-CONSTRAINED, UNCEMENTED, POROUS, CO
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Catalog Number 5515-F-401 |
Device Problems
Device Emits Odor (1425); Device Damaged Prior to Use (2284); Manufacturing, Packaging or Shipping Problem (2975); Moisture or Humidity Problem (2986)
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Patient Problems
No Consequences Or Impact To Patient (2199); Injury (2348)
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Event Date 12/03/2015 |
Event Type
malfunction
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Manufacturer Narrative
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Additional information has been requested.Should additional information become available it will be reported in a supplemental report upon completion of the investigation.
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Event Description
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The customer reported that as they opened up the triathlon femoral component in theatre, they noticed that there was water or condensation in the inside of the inner box which smelled like sewage.The customer further reported that the plastic seal on the outside of the implant was still intact.The stryker sales representative reported that the device was out of a loan kit and as such the customer did not have any additional items on the shelf to continue the case.The stryker sales representative reported that she was able to get hold of another device from a neighboring hospital and that resulted in a 30 minute delay to surgery.Surgery was completed successfully.There were no adverse consequences for the patient.The stryker sales representative further reported that she had checked the kit 2 days before the case and there was no water in the kit at that time.The outer box of the implant appeared to be normal.
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Manufacturer Narrative
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An event regarding packaging damage involving a triathlon femoral component was reported.The event was confirmed.Method and results: device evaluation and results: based on the visual inspection of the returned packaging it appears that the packaging got soaking wet at some stage prior to surgery as condensation inside the the box and a sewage-like smell was noticed while opening the packaging in theatre.The unit carton has severe water damage and was still damp with an odour coming from the packaging when received in limerick for review but has since dried out.Both the outer and inner blister packaging appear to be intact.Upon opening of the inner packaging the device itself is unremarkable.Medical records received and evaluation: not performed as the event relates to a packaging issue.Other than a 30 minute delay in surgery, no further adverse consequences to the patient were reported.Device history review: dhr review for the reported lot determined that the device was manufactured and packed to specification.Complaint history review: chr review determined that there were no similar events reported for the lot.Conclusions: based on the visual inspection of the returned packaging and the information provided in the event description, it appears that the device packaging got soaking wet shortly before surgery as the stryker sales representative indicated that there was no water in the kit two days before the surgery and that the implant box appeared to be normal.Also, during surgery, condensation inside the the box and a sewage-like smell was noticed while opening the packaging.The unit carton was still damp with an odour coming from the packaging when received in limerick for review but has since dried out.The device would not have left the finished goods warehouse in this condition.No further investigation for this event is possible at this time.
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Event Description
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The customer reported that as they opened up the triathlon femoral component in theatre, they noticed that there was water or condensation in the inside of the inner box which smelled like sewage.The customer further reported that the plastic seal on the outside of the implant was still intact.The stryker sales representative reported that the device was out of a loan kit and as such the customer did not have any additional items on the shelf to continue the case.The stryker sales representative reported that she was able to get hold of another device from a neighboring hospital and that resulted in a 30 minute delay to surgery.Surgery was completed successfully.There were no adverse consequences for the patient.The stryker sales representative further reported that she had checked the kit 2 days before the case and there was no water in the kit at that time.The outer box of the implant appeared to be normal.
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Search Alerts/Recalls
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