MAUDE Adverse Event Report: ENCORE MEDICAL L.P FOUNDATION PRIMARY KNEE; INSERT, STD., PRIMARY, SIZE4 9MM CM

Model Number	385-09-504
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	06/01/2017
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery: due to the patient having ankle surgery two weeks ago which became infected and spread to her knee.The surgeon removed the implants and washed out the knee.
Additional Manufacturer Narrative
The reason for this revision surgery was an infection.The previous surgery and the revision detailed in this investigation occurred 5.2 years apart.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.The device has not made been available to djo surgical for examination.A review of the implant device history records (dhrs) show 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 an infection.Customer complaint history of the reported device showed no present trends or on-going issues that are in need of review.The device was verified to have gone through an acceptable sterilization process and was within its expiration date at the time of use during the previous surgery.There were no findings during this investigation that indicate that the reported device had a direct connection with the patient's infection.The root cause of this complaint was a revision surgery due to a previous ankle surgery which became infected and spread to the knee.Inventory containment is not required as there are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: FOUNDATION PRIMARY KNEE
• Common Device Name: INSERT, STD., PRIMARY, SIZE4 9MM CM
• Manufacturer (Section D): ENCORE MEDICAL L.P; 9800 metric blvd; austin TX 78758 5445
• MDR Report Key: 6682692
• Report Number: 1644408-2017-00516
• Device Sequence Number: 16157611
• Product Code: JWH
• UDI-Device Identifier: 00888912117722
• UDI-Public: (01)00888912117722
• Combination Product (Y/N): N
• Initial Reporter State: OK
• Initial Reporter Country: US
• PMA/510(K) Number: K000590
• 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): 08/09/2017

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: 02/28/2016
• Device Model Number: 385-09-504
• Device Catalogue Number: 385-09-504
• Device Lot Number: 59601305
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 06/01/2017
• Supplement Date Received by Manufacturer: 07/12/2017
• Initial Report FDA Received Date: 06/30/2017
• Supplement Report FDA Received Date: 08/09/2017
• 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: Other; Required Intervention
• Patient Age: 66 YR