MAUDE Adverse Event Report: ENCORE MEDICAL, L.P. 3DKNEE; INSERT, 3D SIZE6 X 9MM R DCM

Catalog Number	392-09-606
Health Effect - Clinical Code	Failure of Implant (1924)
Date of Event	02/15/2017
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery - the patient had a right total knee arthroplasty (tka) performed in 2012, and had developed significant medial wear on the poly insert.The surgeon performed a poly exchange and synovectomy to correct mal-alignment.
Additional Manufacturer Narrative
The reason for this revision surgery was significant medial wear on the poly insert.The previous surgery and the revision detailed in this investigation occurred over 5 years apart.There are no reported pre-existing patient health conditions.The healthcare professional indicated there was a significant adverse event to the patient.There was no delay in surgery and another suitable device was available for use.The revision surgery was completed as intended.Initial or prolonged hospitalization was required.The device was disposed of at the hospital and not made available to djo surgical for examination.A review of the implant device history records (dhr) shows that the reported components used in the previous surgery met design and manufacturing requirements.There were no non-conforming material reports (ncmrs) associated with the product that may have contributed to the event.The device was within its expiration date at the time of use during the previous surgery.Customer complaint history of the reported device showed no present trends or on-going issues that are in need of review.The root cause of this complaint was a revision surgery due to poly wear.There were no findings during this investigation that indicate that the reported device was the source or had a direct connection with the poly wear.There are multiple factors that may contribute to the event that are outside the control of djo surgical are excessive loading, unbalanced joint, patient activities, trauma and patient non-compliance with medical instructions.The complaint states that event occurred over 5 years post-operative and it seems that the poly insert might get worn out significantly on medial side due to mal-alignment of patient's knee anatomy.No additional information was submitted with the complaint regarding pre-existing conditions of the patient or any activities that may have contributed to the event and hence a definitive root cause cannot be determined.Inventory containment is not required as there are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: 3DKNEE
• Common Device Name: INSERT, 3D SIZE6 X 9MM R DCM
• Manufacturer (Section D): ENCORE MEDICAL, L.P.; 9800 metric blvd.; austin TX 78758
• MDR Report Key: 6410911
• Report Number: 1644408-2017-00170
• Device Sequence Number: 13682582
• Product Code: JWH
• UDI-Device Identifier: 00888912120173
• UDI-Public: (01)00888912120173
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K020114
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2012
• Device Explanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 05/02/2017

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: 02/28/2015
• Device Catalogue Number: 392-09-606
• Device Lot Number: 59600120
• Was Device Available for Evaluation?: No
• Type of Report(Section G): FDA Requested
• Initial Date Received by Manufacturer: 02/15/2017
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 03/16/2017
• Supplement Report FDA Received Date: 05/02/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Hospitalization; Other; Required Intervention
• Patient Age: 73 YR