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On or about (b)(6) 2007, (b)(6) of (b)(6) underwent total left knee joint replacement surgery during which, it is believed that contaminants introduced by the device came in contact with his open surgical implant site, resulting in a (b)(6) deep within his left knee and failure of the implant.This knee infection manifested itself with severe pain, gross swelling of the left knee area, foul smell, and the eruption of bloody pus.Due to the infection, he has endured multiple surgical procedures, including amputation.He now wears an artificial left leg, and is forced to use a crutch when he walks.When not wearing his artificial leg, he is wheelchair-bound.Mr.(b)(6), his experts, and lawyers believe that the infection was caused by contamination of the sterile surgical field by the waste heat of the bair hugger forced-air warming system ("faw") used during his surgery.The 3m corporation, mfr of bair hugger faw was notified in writing of the injury by litigation (case (b)(6)).Fda guidance dated july 9, 2013 provides that such legal documents constitute a "complaint" requiring the mfr to report to the fda, as follows: "2.11 where will device-related complaints come from? you may receive complaint info from many different sources, including legal documents." 3m has failed to report this injury within the mandatory 30 days.Mr.(b)(6) and his lawyers assert that the approx 1000 watts of waste heat from bair hugger faw escapes from below the surgical drapes near the floor.From there, it warms the contaminated air normally resident near the floor and forms into convection currents of rising contaminated warm air.The warm air rises alongside the surgical table, easily penetrating operating room ventilation airflow and ending up in the sterile surgical field.This phenomenon has been proved in at least six studies published in top-tier, peer-reviewed medical journals.Many other studies have shown that the concentration of airborne contaminants above the wound positively correlates with the concentration of contaminants in the wound, and also positively correlates with the periprosthetic joint infection ("pji") rate.This leads to the inevitable conclusion that the waste heat from bair hugger faw must be increasing the risk of pji.At least one large outcome study has positively linked this rising waste faw heat to the majority of pji's after total joint replacement surgery.In contrast, there are no outcome studies showing that bair hugger faw is safe in implant surgery.In a separate issue, mr.(b)(6) asserts that 3m has willfully violated the terms of the bair hugger 510 (k).When 510 (k) #12345676 was filed in 2004, the mfr committed to a "hepa" quality inlet filter (99.97%) or greater filtration efficiency).In fact, the inlet filter of the bair hugger model 505 blower was never hepa and has now been reduced to 62% efficiency without notifying the fda.The result of the poor inlet filtration is that the internal airflow pathways of nearly all bair hugger blowers and hoses are contaminated with growing bacterial colonies.This has been shown in three studies published in top-tier, peer-reviewed medical journals.Further, the high-velocity airflow over the bacterial colonies has been shown to aerosolize bacteria out of the hose and into the operating room air.Since it is impossible to disinfect the internal airflow pathway of the bair hugger 505 blower, a hepa filter should be added to the outlet hose of these blowers to prevent the contamination of the operating room with the bacteria growing inside the blower and hose.Given the catastrophic nature of pji's, it is only prudent for the fda to err on the side of caution.Considering that there are several air-free and waste heat-free pt warming devices on the market today, any product that increases the risk of a pji should not be allowed in orthopedic surgery.
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