MAUDE Adverse Event Report: SMITH & NEPHEW, INC. JOURNEY TIBIA BASE NP RT SZ 5; PROSTHESIS KNEE PATELLOFEMOROTIBIAL SEMI-CONSTRAINED CEMENTED POLY/METAL/POLY

Catalog Number	74022215
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Injury (2348)
Date of Event	07/14/2017
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that the patient presented an it band syndrome and right patella femoral clunk crepitation for which a knee arthroscopy was performed.No revision required.No additional information specified.
Additional Manufacturer Narrative
The affected journey ii bcs articular insert, journey ii bcs femoral oxinium, journey tibial baseplate and journey bcs resurfacing patella were not returned for evaluation.Thus, a thorough product evaluation could not be performed.However, device details were provided.Therefore, the review of the manufacturing records and complaint history were conducted.The review of the manufacturing records for the listed batches did not reveal any deviation from the standard manufacturing processes.The review of the complaint history for the listed parts revealed no prior complaints for the listed failure mode with the same batch number.At this time, we have no reason to suspect that the products failed to meet any product specifications at the time of manufacture.A relationship, if any, between the device and the reported incident or adverse event could not be corroborated.Without the return of the actual product involved, our investigation of this report is inconclusive.A clinical analysis noted that no relevant clinical medical information was provided to conduct a thorough medical assessment.Without supporting clinical/medical documents a thorough investigation cannot be performed.No further investigation is warranted for this complaint; however we will continue to monitor for future complaints and investigate as necessary.Should the device or additional information be received, the complaint will be reopened.
Additional Manufacturer Narrative
Follow-up and model # contains additional information.

• Brand Name: JOURNEY TIBIA BASE NP RT SZ 5
• Common Device Name: PROSTHESIS KNEE PATELLOFEMOROTIBIAL SEMI-CONSTRAINED CEMENTED POLY/METAL/POLY
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• MDR Report Key: 8260743
• Report Number: 1020279-2019-00205
• Device Sequence Number: 1952958
• Product Code: JWH
• UDI-Device Identifier: 03596010554291
• UDI-Public: 03596010554291
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K042515
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 06/12/2019

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 Catalogue Number: 74022215
• Device Lot Number: 17BM02673
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 01/03/2019
• Supplement Date Received by Manufacturer: 01/03/2019; 01/03/2019
• Initial Report FDA Received Date: 01/18/2019
• Supplement Report FDA Received Date: 06/09/2019; 06/12/2019
• 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; Required Intervention