FDA Adverse Event Injury Summary report: N

LRG TAP PRI MOD NCK 8DEG 34MM

MDR report key: 13169363 · Received January 5, 2022

Report

Report Number
0002249697-2022-00021
Event Type
Injury
Date Received
January 5, 2022
Date of Event
January 1, 2014
Report Date
March 8, 2022
Manufacturer
STRYKER ORTHOPAEDICS-MAHWAH
Product Code
MEH
PMA / PMN Number
K092561
Removal / Correction Number
Z-2090-2012
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
AL, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

REVIEW OF THE DEVICE HISTORY RECORDS INDICATE DEVICES WERE MANUFACTURED AND ACCEPTED INTO FINAL STOCK WITH NO RELEVANT REPORTED DISCREPANCIES. THERE HAVE BEEN TWO 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. VOLUNTARY RECALL RA 2012-067 WAS INITIATED FOR ABGII AND REJUVENATE MODULAR STEMS AND NECKS DUE TO THE POTENTIAL RISKS ASSOCIATED WITH THESE DEVICES. THE REPORTED PAIN IS CONSIDERED TO BE UNDER THE SCOPE OF THIS RECALL. NO FURTHER INVESTIGATION IS REQUIRED.

Additional Manufacturer Narrative · 0

REVIEW OF THE DEVICE HISTORY RECORDS INDICATE DEVICES WERE MANUFACTURED AND ACCEPTED INTO FINAL STOCK WITH NO RELEVANT REPORTED DISCREPANCIES. THERE HAVE BEEN TWO 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. VOLUNTARY RECALL RA 2012-067 WAS INITIATED FOR ABGII AND REJUVENATE MODULAR STEMS AND NECKS DUE TO THE POTENTIAL RISKS ASSOCIATED WITH THESE DEVICES. THE REPORTED PAIN IS CONSIDERED TO BE UNDER THE SCOPE OF THIS RECALL. NO FURTHER INVESTIGATION IS REQUIRED.

Additional Manufacturer Narrative · 0

REPORTED EVENT: AN EVENT REGARDING ABNORMAL ION LEVELS INVOLVING A REJUVENATE MODULAR DEVICE WAS REPORTED. THE EVENT WAS NOT CONFIRMED. METHOD & RESULTS: DEVICE EVALUATION AND RESULTS: DEVICE EVALUATION WAS NOT PERFORMED AS NO DEVICES WERE RECEIVED. DEVICE HISTORY REVIEW: REVIEW OF DEVICE HISTORY RECORDS FOUND THE DEVICES IN THE REPORTED LOT WERE ACCEPTED INTO FINAL STOCK WITH NO REPORTED DISCREPANCIES. COMPLAINT HISTORY REVIEW: THE COMPLAINT DATABASES SHOW THERE HAVE BEEN OTHER EVENTS FOR THE REPORTED LOT. SIMILAR EVENTS HAVE OCCURRED FOR THE CATALOG NUMBER AND PRODUCT FAMILY. THESE EVENTS WERE DETERMINED TO BE ASSOCIATED WITH RA 2012-067. CLINICIAN REVIEW: A REVIEW OF THE PROVIDED MEDICAL RECORDS BY A CLINICAL CONSULTANT STATED THE FOLLOWING COMMENT: CONFIRMATION: A REVISION SURGERY OF A REJUVENATE STEM ((B)(6) 2013) CAN BE CONFIRMED BUT INCREASED METAL LEVELS AT THAT TIME CANNOT BE CONFIRMED. A SUBSEQUENT REVISION CAN BE CONFIRMED FOR RECURRENT DISLOCATION ((B)(6) 2014, NOTE: THE STATED EXISTENCE OF METALLOSIS AND POOR TISSUES AT THE PRIOR REVISION WAS NOT CONFIRMED). A THIRD REVISION ((B)(6) 2021) CAN ALSO BE CONFIRMED DURING WHICH COMPONENT TO COMPONENT IMPINGEMENT WAS NOTED WITH NOTCHING OF THE FEMORAL NECK AND SOME METALLOSIS IN THE TISSUES. ADDITIONAL MEDICAL RECORDS WOULD BE REQUIRED TO DEFINE THE EVENT FURTHER. ROOT CAUSE: THE ROOT CAUSE OF THE FIRST REVISION WAS PAIN AND CONCERN WITH THE ASSOCIATION OF A RECALLED IMPLANT. STATED INCREASED METAL LEVEL COULD NOT BE CONFIRMED. THE ROOT CAUSE OF THE SECOND REVISION WAS INSTABILITY. THE ROOT CAUSE OF THE THIRD REVISION CANNOT BE ASCERTAINED WITHOUT ADDITIONAL MEDICAL RECORDS. THAT SAID, IMPINGEMENT AND NOTCHING OF THE FEMORAL NECK WAS NOTED AT THE TIME OF THE REVISION AND THIS COULD CERTAINLY EXPLAIN THE CONCERN AND/OR FINDING OF INCREASED METAL LEVELS (IF CONFIRMED) AND METALLOSIS. CONCLUSIONS VOLUNTARY RECALL RA 2012-067 WAS INITIATED FOR ABGII AND REJUVENATE MODULAR STEMS AND NECKS DUE TO THE POTENTIAL RISKS ASSOCIATED WITH THESE DEVICES. THE REPORTED ABNORMAL ION LEVEL IS CONSIDERED TO BE UNDER THE SCOPE OF THIS RECALL. NO FURTHER INVESTIGATION IS REQUIRED.

Description of Event or Problem · 0

PER MEDICAL RECORDS IN PI, REJUVENATE STEM AND NECK WAS REVISED TO RESTORATION MODULAR STEM AND BODY DUE TO METAL ON METAL REACTION. UPDATE: - (B)(6) 2013 REJUVENATE MODULAR HIP WAS REVISED TO RESTORATION MODULAR DUE TO INCREASING PAIN AND INCREASED METAL IONS.

Description of Event or Problem · 0

PER MEDICAL RECORDS IN PI, REJUVENATE STEM AND NECK WAS REVISED TO RESTORATION MODULAR STEM AND BODY DUE TO METAL ON METAL REACTION. UPDATE: - (B)(6) 2013 REJUVENATE MODULAR HIP WAS REVISED TO RESTORATION MODULAR DUE TO INCREASING PAIN AND INCREASED METAL IONS.

Description of Event or Problem · 0

PER MEDICAL RECORDS IN PI, REJUVENATE STEM AND NECK WAS REVISED TO RESTORATION MODULAR STEM AND BODY DUE TO METAL ON METAL REACTION. UPDATE: (B)(6) 2013 REJUVENATE MODULAR HIP WAS REVISED TO RESTORATION MODULAR DUE TO INCREASING PAIN AND INCREASED METAL IONS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
637172 LRG TAP PRI MOD NCK 8DEG 34MM PROSTHESIS, HIP, SEMI-CONSTRAINED, UNCEMENTED, METAL/POLYMER, NON-POROUS, CALICU MEH STRYKER ORTHOPAEDICS-MAHWAH 37865501

Patients

Seq Age Sex Outcome Treatment
1 74 YR Male Required Intervention| H| R| H