BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TITANIUM SCREW LOW PROF 5X40MM

    MDR report key: 10488577 · Received September 3, 2020

    Report

    Report Number
    0001825034-2020-03423
    Event Type
    Injury
    Date Received
    September 3, 2020
    Date of Event
    January 20, 2020
    Report Date
    March 10, 2022
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    KWT
    PMA / PMN Number
    K030710
    Removal / Correction Number
    NI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    DE, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. TWO SCREWS WERE RETURNED; UPON VISUAL INSPECTION ONE SCREW HEAD APPEARS TO BE FRACTURED AND THE OTHER SCREW APPEARS TO BE FINE. THE ADDITIONAL INFORMATION DOES NOT CHANGE THE OUTCOME OF THE PREVIOUS INVESTIGATION. IF ANY FURTHER INFORMATION IS FOUND WHICH WOULD CHANGE OR ALTER ANY CONCLUSIONS OR INFORMATION, A SUPPLEMENTAL WILL BE FILED ACCORDINGLY. ZIMMER BIOMET WILL CONTINUE TO MONITOR FOR TRENDS.

    Description of Event or Problem · 0

    NO ADDITIONAL INFORMATION ON THE REPORTED EVENT.

    Additional Manufacturer Narrative · 1

    (B)(4). CONCOMITANT MEDICAL DEVICES: 15-105056-M2A 1 PC SHELL 38MMX56MM-831000; 11-173666-M2A 38MM MOD HD +12MM NK SKRT-140670; 14-103202-TAPERLOC MICROP FMRL 7.5MM-374630. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034 - 2020 - 00398 - 1, 0001825034 - 2020 - 00399 - 1, 0001825034 - 2020 - 01925. REPORTED EVENT WAS CONFIRMED. MEDICAL RECORDS/RADIOGRAPHS WERE PROVIDED AND REVIEWED BY A HEALTH CARE PROFESSIONAL. REVIEW OF THE AVAILABLE RECORDS IDENTIFIED THE FOLLOWING: (SUMMARIZED BY HCP). DX: PAINFUL LEFT THA, PROBABLE METALLOSIS, BROKEN FIXATION SCREW. WORKUP FOR INFECTION NEGATIVE, CRP <5.0, METAL IONS ELEVATED, MRI SHOWED FLUID COLLECTION WITH AN OVERALL APPEARANCE OF METALLOSIS. LARGE AMOUNT OF DARK SANGUINEOUS FLUID PRESENT, MODERATE METAL STAINING IN THE SYNOVIAL TISSUES AND BONE SURFACE OF THE ACETABULUM, RIM SCREW BROKEN, SCANT IF ANY OSSEOUS INTEGRATION ON THE BACK OF THE ACETABULUM, FEMORAL COMPONENT WELL FIXED. MODEST TO MODERATE WEAR ON THE TRUNNION AND METALLIC DEBRIS WITHIN THE FEMORAL HEAD SUGGESTED THAT TRUNNIONOSIS WAS INDEED THE LIKELY CAUSE OF METAL DEBRIS. REVIEW OF THE DEVICE HISTORY RECORDS IDENTIFIED NO DEVIATIONS OR ANOMALIES DURING MANUFACTURING. A DEFINITIVE ROOT CAUSE CANNOT BE DETERMINED. IF ANY FURTHER INFORMATION IS FOUND WHICH WOULD CHANGE OR ALTER ANY CONCLUSIONS OR INFORMATION, A SUPPLEMENTAL WILL BE FILED ACCORDINGLY. ZIMMER BIOMET WILL CONTINUE TO MONITOR FOR TRENDS.

    Description of Event or Problem · 1

    IT WAS REPORTED THE PATIENT UNDERWENT A REVISION SURGERY 12 YEARS POST IMPLANTATION DUE TO PAIN AND SUSPECTED METALLOSIS ON MRI. DURING THE REVISION, SIGNIFICANT BLACK STAINING FROM TRUNNIONOSIS WAS NOTED. THE ACETABULAR SHELL WAS REPLACED DUE TO A BROKEN RIM SCREW AND VERY LITTLE OSSEOINTEGRATION ON THE BACK OF THE SHELL. THE STEM WAS WELL-FIXED AND LEFT INTACT. ALL OTHER COMPONENTS WERE REPLACED WITHOUT COMPLICATION. ATTEMPTS HAVE BEEN MADE AND ADDITIONAL INFORMATION ON THE REPORTED EVENT IS UNAVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    952382 TITANIUM SCREW LOW PROF 5X40MM PROSTHESIS, HIP KWT ZIMMER BIOMET, INC. N/A 384740

    Patients

    Seq Age Sex Outcome Treatment
    1 Male Hospitalization| R SEE H10