MAUDE Adverse Event Report: ENCORE MEDICAL L.P. 3DKNEE; INSERT, 3D SIZE8 X 9MM R DCM

Model Number	392-09-608
Health Effect - Clinical Codes	Adhesion(s) (1695); Pain (1994); Fibrosis (3167)
Date of Event	05/08/2017
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery: after a primary total knee arthroplasty (tka) the patient developed arthrofibrosis postoperatively; after manipulation she had another lysis of adhesions.A poly exchange was done to change from a 11mm to a 9mm to help regain more motion.The patient has gradually regained much of her lost fexion, but as this happened her knee began to feel less stable and had some pain with this instability.A bone scan showed something at the tibia that they thought may be loosening.However in surgery today her baseplate was found to be well fixed and the only obvious tibial issue was wear on the medial aspect of poly insert.As such, they decided to go back up to an 11mm to both give her a thicker insert for longer wear and hoping this would help make her knee feel stable again and hopefully solve the issues.
Additional Manufacturer Narrative
The reason for this revision surgery was instability.The previous surgery and the revision detailed in this investigation occurred over 9 years and 4 months apart.The healthcare professional indicated there was no delay in surgery and another suitable device was available for use.The revision surgery was completed as intended.The device has not been made available to djo surgical for examination.A review of the implant device history records (dhr) shows that the reported component 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 instability.There were no findings during this investigation that indicate that the reported device was the source or had a direct connection with the event.There are multiple factors which may cause the event that are outside the control of djo surgical are patient bone deterioration, poor bone density, unbalanced joint, patient activities or trauma.The complaint does state that the event occurred over 9 years post-operative and it seems that the poly insert might get worn out during this period of usage.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 SIZE8 X 9MM R DCM
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd.; austin TX 78758 5445
• MDR Report Key: 6616281
• Report Number: 1644408-2017-00416
• Device Sequence Number: 734259
• Product Code: JWH
• UDI-Device Identifier: 00888912120197
• UDI-Public: (01)00888912120197
• Combination Product (Y/N): N
• Initial Reporter State: GA
• Initial Reporter Country: US
• PMA/510(K) Number: K020114
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2008
• Device Explanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 07/20/2017

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: 06/30/2012
• Device Model Number: 392-09-608
• Device Catalogue Number: 392-09-608
• Device Lot Number: 53870043
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 05/08/2017
• Supplement Date Received by Manufacturer: 06/21/2017
• Initial Report FDA Received Date: 06/06/2017
• Supplement Report FDA Received Date: 07/20/2017
• 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: Required Intervention
• Patient Age: 66 YR
• Patient Weight: 113