MAUDE Adverse Event Report: STRYKER ORTHOPAEDICS-MAHWAH MRHK TIB INS 10MM M/L M2/L2; PROSTHESIS, KNEE, FEMOROTIBIAL, CONSTRAINED, CEMENTED, METAL/POLYMER

Model Number	6481-3-310
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Unspecified Infection (1930); Injury (2348)
Date of Event	12/27/2019
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The following devices were also listed in this report: mrh tibial b/plt keel med 2; cat# 64813112; lot# b7s9n, tri cemented stem 12mmx50mm; cat# 5560-s-112; lot# 0066007h, gmrs extension piece 120mm; cat# 64956120; lot# axy4l, gmrs dist fem comp sml r 65mm; cat# 64952020; lot# dec6h, gmrs extension price 70mm; cat# 64956070; lot# dae2j, mrhk bumper insert - neutral; cat# 64812130; lot# lhf530, gmrs small axle; cat# 64952115; lot# ctd21117, gmrs small femoral bushing; cat# 64952105; lot# lhe836, gmrs small femoral bushing; cat# 64952105; lot# lhe836, mrh tib rot comp xs-xl; cat# 64812100; lot# 120180, mrhk tibial sleeve; cat# 64812140; lot# lhc767, proximal fem comp std; cat# 64951001; lot# c472d, gmrs connection piece 90mm rht; cat# 64956019; lot# ctd18716, delta v-40 ceramic head 36/+5; cat# 6570-0-236; lot# 61396401.It cannot be determined which, if any of these devices may have caused or contributed to the patient's experience.Review of the device history records indicate devices were manufactured and accepted into final stock with no relevant reported discrepancies.There have been no other similar events for the lot referenced.It was noted that the device is not available for evaluation.Should additional information become available, it will be provided in a supplemental report upon completion of the investigation.
Event or Problem Description
It was reported that the patient's right knee has been revised due to recurring infection.An above-knee amputation was performed, retaining all proximal femoral components, and implanting a custom prosthesis cap.Usage sheets have been provided, and the rep confirmed that no further information will be available.

• Brand Name: MRHK TIB INS 10MM M/L M2/L2
• Common Device Name: PROSTHESIS, KNEE, FEMOROTIBIAL, CONSTRAINED, CEMENTED, METAL/POLYMER
• Manufacturer (Section D): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• MDR Report Key: 9624202
• Report Number: 0002249697-2020-00156
• Device Sequence Number: 10893645
• Product Code: KRO
• UDI-Device Identifier: 07613327043822
• UDI-Public: 07613327043822
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K994207
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Device Explanted Year: 2019
• Reporter Type: Manufacturer
• Report Source: health professional,other
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 01/23/2020

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: 07/31/2023
• Device Model Number: 6481-3-310
• Device Catalogue Number: 64813310
• Device Lot Number: LHN647
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 12/27/2019
• Initial Report FDA Received Date: 01/23/2020
• 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
• Patient Age: 50 YR
• Patient Weight: 91