MAUDE Adverse Event Report: ENCORE MEDICAL L.P. LINEAR HIP; STEM, HIP, FEMORAL, LINEAR STD. SIZE7

Model Number	498-32-052
Health Effect - Clinical Code	No Information (3190)
Date of Event	01/10/2018
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Additional reporting on this event will be provided as a supplemental report to these document as soon as it becomes available.
Event or Problem Description
Revision surgery - patient undergoes removal of right hip and placement of antibiotic spacer."gross purulence" observed in right hip which caused surgeon to decide to remove the (encore) hip components and place an antibiotic spacer.The operative report does not reflect the finding of any pseudotumor.
Event or Problem Description
Third revision surgery - patient undergoes removal of right hip and placement of antibiotic spacer."gross purulence" observed in right hip which caused surgeon to decide to remove the (encore) hip components and place an antibiotic spacer.The operative report does not reflect the finding of any pseudotumor.
Additional Manufacturer Narrative
Manufacturer narrative: the reason for this revision surgery was reported as pain.The previous surgery and the surgery detailed in this event occurred 2 months and 1 month 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 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 was 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 pain in right hip.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.There are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: LINEAR HIP
• Common Device Name: STEM, HIP, FEMORAL, LINEAR STD. SIZE7
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd; austin, tx 78758-5445,
• MDR Report Key: 9581587
• Report Number: 1644408-2019-01321
• Device Sequence Number: 16338136
• Product Code: LPH
• UDI-Device Identifier: 00888912087599
• UDI-Public: (01)00888912087599
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K974294
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2007
• Device Explanted Year: 2018
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 03/05/2020

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: 03/31/2008
• Device Model Number: 498-32-052
• Device Catalogue Number: 425-00-007
• Device Lot Number: 797851A
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 12/17/2019
• Supplement Date Received by Manufacturer: 02/06/2020
• Initial Report FDA Received Date: 01/13/2020
• Supplement Report FDA Received Date: 03/06/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: 010-55-020 LOT 289812C; 010-55-020 LOT 289812C; 010-55-025 LOT 53796500C; 010-55-025 LOT 53796500C; 400-01-297 LOT 259732K4; 400-01-297 LOT 259732K4; 425-00-007 LOT 797851A; 498-01-052 LOT 53812716; 498-01-052 LOT 53812716; 498-32-052 LOT 276332
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 57 YR