MAUDE Adverse Event Report: ENCORE MEDICAL, L.P. FMP; LINER, ACETABULAR, FMP, HOODED, 20D 32XMP7 CM

Model Number	433-32-207
Health Effect - Clinical Code	No Information (3190)
Date of Event	06/05/2019
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The reason for this revision surgery was due to poly swap.The previous surgery and the surgery detailed in this investigation occurred 10.5 years 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 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 component used in the previous surgery, when released for use, met design and manufacturing requirements.There were no non-conforming material reports associated with the product(s) that may have contributed to the reported event.The device was verified to have gone through an acceptable sterilization process and was within its expiration date at the time of 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 swap as the patient complaints.There are many factors that may contribute to the event that are outside the control of djo surgical are unbalanced joint, excessive range of motion, excessive load or torque, patient's age, patient activities and trauma.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.There are no indications of a product or process issue affecting implant safety or effectiveness.
Event or Problem Description
Revision surgery - patient was complaining so the doctor did a swap.

• Brand Name: FMP
• Common Device Name: LINER, ACETABULAR, FMP, HOODED, 20D 32XMP7 CM
• Manufacturer (Section D): ENCORE MEDICAL, L.P.; 9800 metric blvd.; austin texas 78758
• MDR Report Key: 8761604
• Report Number: 1644408-2019-00625
• Device Sequence Number: 1590848
• Product Code: LPH
• UDI-Device Identifier: 00888912085328
• UDI-Public: (01)00888912085328
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K973119
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2009
• Device Explanted Year: 2019
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 07/02/2019

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 Expiration Date: 12/31/2011
• Device Model Number: 433-32-207
• Device Catalogue Number: 433-32-207
• Device Lot Number: 53834521
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/05/2019
• Initial Report FDA Received Date: 07/03/2019
• 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: Required Intervention
• Patient Age: 70 YR