MAUDE Adverse Event Report: STRYKER ORTHOPAEDICS-MAHWAH NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM; PROSTHESIS, KNEE, PATELLO/FEMOROTIBIAL, SEMI-CONSTRAINED, UNCEMENTED, POROUS, CO

Model Number	5537-G-516
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Codes	Unspecified Infection (1930); Injury (2348)
Date of Event	02/26/2020
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
An investigation is being performed in an attempt to identify the cause of the event.Should additional information become available it will be reported in a supplemental report.The following devices were also listed in this report: triathlon femoral distal augment 5mm - size 5 left; cat# 5540-a-501; lot# di37u.Triathlon femoral distal augment 5mm - size 5 left; cat# 5540-a-501; lot# di37u.Tri press-fit stem 16mm x 100mm; cat# 5565-s-016; lot# 0039973g.Tri ts baseplate size 5; cat# 5521-b-500; lot# dzu3ta.Triathlon sym cone aug sz b; cat# 5549-a-120; lot# apha.Tri lm/rl tib aug sz5 10mm; cat# 5546-a-501; lot# erend2a.Tri rm/ll tib aug sz5 10mm; cat# 5546-a-502; lot# erewy5d.Tri cemented stem 12mmx100mm; cat# 5560-s-212; lot# 0088207l.Triathlon femoral component; cat# 5512-f-501; lot# b3d3e.It cannot be determined which, if any of these devices may have caused or contributed to the patient's experience.Device not returned.
Event or Problem Description
It was reported that the patient's left knee was revised due to infection.All components were removed and a static antibiotic spacer was placed.Rep provided the primary and revision (spacer) usage sheets, explant pictures, and reported that no further information will be released by the hospital or surgeon.

• Brand Name: NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM
• Common Device Name: PROSTHESIS, KNEE, PATELLO/FEMOROTIBIAL, SEMI-CONSTRAINED, UNCEMENTED, POROUS, CO
• Manufacturer (Section D): STRYKER ORTHOPAEDICS-MAHWAH; 325 corporate drive; mahwah NJ 07430
• MDR Report Key: 9882267
• Report Number: 0002249697-2020-00602
• Device Sequence Number: 11487307
• Product Code: MBH
• UDI-Device Identifier: 07613327027327
• UDI-Public: 07613327027327
• Combination Product (Y/N): N
• Initial Reporter State: LA
• Initial Reporter Country: US
• PMA/510(K) Number: K141056
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Device Explanted Year: 2020
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 03/26/2020

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: 10/31/2023
• Device Model Number: 5537-G-516
• Device Catalogue Number: 5537-G-516
• Device Lot Number: D92Y33
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/26/2020
• Initial Report FDA Received Date: 03/26/2020
• 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: 71 YR
• Patient Weight: 98