MAUDE Adverse Event Report: ENCORE MEDICAL L.P. KERAMOS HIP; CUP, AL-AL FLARED RIM FOR CERAMIC INSERT 54MM

Model Number 498-01-054

Device Problems Break (1069); Naturally Worn (2988); Appropriate Term/Code Not Available (3191)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 09/06/2019

Event Type  Injury  

Manufacturer Narrative

The reason for this revision surgery was reported as wear.The previous surgery and the surgery detailed in this event occurred 12 years and 7 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 devices were disposed of at the hospital and not made available to djo surgical for examination.A review of the device history records (dhr) show that the reported components used in the previous surgery, when released for use, met design and manufacturing requirements.There were no non-conforming material reports (ncmr) associated with the products that may have contributed to the reported event.The devices were verified to have gone through an acceptable sterilization process and were within its expiration date at the time of the previous surgery.Customer complaint history of the reported devices showed no present trends or on-going issues that are needing a review.The root cause of this complaint was a revision surgery due to wear.There were no findings during this evaluation that indicate the reported devices were defective.No information was submitted with the complaint regarding pre-existing conditions of the patient or any activities the patient was involved in that may have contributed to the event.There are multiple factors that may contribute to an event that are outside the control of djo surgical poor bone density, degenerative bone disease, excessive range of motion, patient activities or trauma.There are no indications of a product or process issue affecting implant safety or effectiveness.

Event Description

Revision surgery - there were ceramic on ceramic implants.Ceramic pieces were breaking due to wear.Surgeon replaced the cup and liner with zimmer implants.Used djo implants to replace the head and added a sleeve.

• Brand Name: KERAMOS HIP
• Type of Device: CUP, AL-AL FLARED RIM FOR CERAMIC INSERT 54MM
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd; austin, tx 78758-5445
• Manufacturer (Section G): ENCORE MEDICAL L.P.; 9800 metric blvd; austin, tx 78758-5445
• Manufacturer Contact: teffany hutto ; 9800 metric blvd; austin, tx 78758-5445
• MDR Report Key: 9150840
• MDR Text Key: 162048866
• Report Number: 1644408-2019-00959
• Device Sequence Number: 1
• Product Code: MRA
• UDI-Device Identifier: 00888912087445
• UDI-Public: (01)00888912087445
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: N980003
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date: 10/03/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/03/2019
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 09/30/2012
• Device Model Number: 498-01-054
• Device Catalogue Number: 498-01-054
• Device Lot Number: 53808968
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 09/06/2019
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 09/27/2006
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 69 YR