BEUDAMED
    FDA Adverse Event Injury Summary report: N

    XLPE 10DEG POLY LINER 64 X 40

    MDR report key: 19248624 · Received May 6, 2024

    Report

    Report Number
    0001822565-2024-01474
    Event Type
    Injury
    Date Received
    May 6, 2024
    Date of Event
    November 17, 2023
    Report Date
    May 8, 2024
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    LPH
    PMA / PMN Number
    D009185
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AR, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    (B)(4). D10: 00784301308, REVISION FEMORAL STEM BEADED FULLCOAT PLUS 12/14 NECK TAPER - STANDARD BODY SIZE 13 13 MM DISTAL STEM DIAMETER 200 MM STEM LENGTH 60045549. 00-6200-064-20, TRILOGY FM ACET SHL 64 OD UNIV 25632500. 00625006550, BONE SCREW SELF-TAPPING 6.5 MM DIA. 50 MM LENGTH 22058300. 00625006530, BONE SCREW SELF-TAPPING 6.5 MM DIA. 30 MM LENGTH 80097864. 00625006540, BONE SCREW SELF-TAPPING 6.5 MM DIA. 40 MM LENGTH 23891800. 00801804003, FEMORAL HEAD STERILE PRODUCT DO NOT RESTERILIZE 12/14 TAPER 53226000. 00223200205, INTEGRAL LONG GTR W/4 CABLES 77108200. CUSTOMER HAS INDICATED THAT THE PRODUCT WILL NOT BE RETURNED TO ZIMMER BIOMET FOR INVESTIGATION. THE INVESTIGATION IS IN PROCESS. ONCE THE INVESTIGATION HAS BEEN COMPLETED, A FOLLOW-UP MDR WILL BE SUBMITTED.

    Additional Manufacturer Narrative · 0

    THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL AND/OR CORRECTED INFORMATION. NO PRODUCT WAS RETURNED, OR PICTURES PROVIDED; VISUAL AND DIMENSIONAL EVALUATIONS COULD NOT BE PERFORMED. REVIEW OF THE DEVICE HISTORY RECORDS IDENTIFIED NO DEVIATIONS OR ANOMALIES DURING MANUFACTURING RELATED TO THE REPORTED EVENT. REVIEW OF COMPLAINT HISTORY FOUND NO ADDITIONAL RELATED ISSUES FOR THESE ITEMS AND THE REPORTED PART AND LOT COMBINATIONS. MEDICAL RECORDS WERE PROVIDED AND REVIEWED BY A HEALTH CARE PROFESSIONAL. REVIEW OF THE AVAILABLE RECORDS IDENTIFIED THE FOLLOWING: AN INITIAL LEFT THA WAS PERFORMED ON AN UNKNOWN DAY WITH COMPETITOR PRODUCT. THE FIRST REVISION OCCURRED DUE TO A BONE FRACTURE, ZB PRODUCTS WERE PLACED. OSTEOLYSIS WAS REPORTED AROUND THE FEMUR AND THE STEM WAS IDENTIFIED TO BE FRACTURED AND LOOSE. DURING THE REVISION INSTABILITY AND PAIN WERE NOTED, AS WELL AS WEAR TO THE POLYETHYLENE. ALL PRODUCTS WERE REMOVED, AND COMPETITOR PRODUCTS WERE PLACED. THE BONE FRACTURE OCCURRED DURING TRIALING WITH COMPETITOR PRODUCTS. RADIOGRAPHS WERE PROVIDED AND REVIEWED BY A HEALTH CARE PROFESSIONAL. REVIEW OF THE AVAILABLE RECORDS IDENTIFIED THE FOLLOWING: LEFT TOTAL HIP ARTHROPLASTY WITH A FRACTURED FEMORAL STEM, FRACTURED PROXIMAL CERCLAGE WIRE AND POSSIBLE LOOSE COMPONENT WITHIN THE SUPERIOR ASPECT OF THE JOINT SPACE. A DEFINITIVE ROOT CAUSE CANNOT BE DETERMINED. THIS COMPLAINT WAS CONFIRMED BASED ON THE PROVIDED X-RAYS AND MEDICAL RECORDS CONFIRMING THE REPORTED EVENT. IF ANY FURTHER INFORMATION IS FOUND WHICH WOULD CHANGE OR ALTER ANY CONCLUSIONS OR INFORMATION, A SUPPLEMENTAL REPORT WILL BE FILED ACCORDINGLY. ZIMMER BIOMET WILL CONTINUE TO MONITOR FOR TRENDS.

    Description of Event or Problem · 0

    IT WAS REPORTED THE PATIENT UNDERWENT AN INITIAL LEFT TOTAL HIP ARTHROPLASTY ON UNKNOWN DATE WITH COMPETITOR PRODUCT. THE PATIENT UNDERWENT THEIR FIRST REVISION DUE TO TROCHANTER FRACTURE WITH ZB COMPONENTS IMPLANTED. THE PATIENT UNDERWENT A SECOND REVISION NINETEEN (19) YEARS POST IMPLANTATION DUE TO PAIN, AMBULATION DIFFICULTIES, FRACTURED IMPLANT, AND INSTABILITY. DURING THE REVISION, IT WAS CONFIRMED IMPLANT FRACTURE OF STEM, LOOSENING, SCAR TISSUE, IMPLANT WEAR, AND UPON REDUCTION OF TRIAL COMPONENTS FELT A CRACK ALONG THE PROXIMAL MEDIAL ASPECT OF THE FEMUR. ALL COMPONENTS WERE EXCHANGED WITH STRYKER CUP, LINER, STEM, DELTA BIOLOX HEAD, AND UNKNOWN CERCLAGE WIRES WITH SOME DIFFICULTY REDUCING FINAL COMPONENTS.

    Description of Event or Problem · 0

    NO ADDITIONAL EVENT INFORMATION TO REPORT AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    590858 XLPE 10DEG POLY LINER 64 X 40 PROSTHESIS, HIPS LPH ZIMMER BIOMET, INC. N/A 75213100

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Male Hospitalization| R SEE H11 NARRATIVE