BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DUROM US ACETABULAR COMPONENT 50/44 J

    MDR report key: 2270094 · Received September 22, 2011

    Report

    Report Number
    9613350-2011-00615
    Event Type
    Injury
    Date Received
    September 22, 2011
    Report Date
    August 30, 2011
    Manufacturer
    ZIMMER, INC.
    Product Code
    KWA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NE, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE MFR DID NOT RECEIVE EXPLANTED DEVICES, X-RAYS, OR OTHER SOURCE DOCUMENTS FOR REVIEW. THE LOT NUMBERS WERE RECEIVED FOR THE EXPLANTED DEVICES, THE DEVICE HISTORY RECORDS WERE REVIEWED AND FOUND TO BE CONFORMING. A CLEAR CORRELATION BETWEEN THE DEVELOPED METAL ALLERGY OF THE PT AND THE PRODUCT CANNOT BE RULED OUT AS IT IS ALREADY KNOWN FOR SIMILAR METAL ON METAL DEVICES FROM LITERATURES (K. DE SMET, R. DE HANN, A. CALLISTRI, P.A. CAMPBELL, E. EBRAMZADEH C. PATTYN, AND H.S. GILL. METAL ION MEASUREMENT AS A DIAGNOSTIC TOOL TO IDENTIFY PROBLEMS WITH METAL-ON-METAL HIP RESURFACING. JBJS AM. 2008; 90: 202-208). OUR INVESTIGATION HAS SHOWN THAT METAL ION MEASUREMENTS FOR THE DUROM SYSTEM ARE COMPARABLE TO OTHER MOM DEVICES IN THE MARKET. AN ALLERGIC REACTION CAN BE INHERENT POST-OPERATIVE SIDE EFFECT AS STATED IN ZIMMER'S IFU (D0110500213). THIS IS UNFORTUNATELY PATIENT DEPENDENT AND CAN OCCUR WITH A LOW PERCENTAGE RATE WITH ALL KIND OF METAL ON METAL BASED PRODUCTS. SHOULD ADD'L INFO BECOME AVAILABLE AND/OR THE DEVICES(S) BE RETURNED FOR EVAL AND AN INVESTIGATION RESULT BE AVAILABLE, THAT CHANGES THIS ASSESSMENT, AN AMENDED MEDICAL DEVICE REPORT WILL BE FILED. THE NEED FOR FURTHER CORRECTIVE MEASURES IS NOT INDICATED AT THIS TIME AND ZIMMER (B)(4) CONSIDERS THIS CASE AS CLOSED. (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PT UNDERWENT A TOTAL HIP ARTHROPLASTY APPROX THREE YEARS AGO. PT HAS EXPERIENCED PAIN, METALLOSIS AND ELEVATED COCR LEVEL AND NO EVIDENCE OF RADIOGRAPHIC LOOSENING, BUT WANTED TO BE REVISED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DUROM US ACETABULAR COMPONENT 50/44 J DUROM ACETABULAR COMPONENT AND METASUL KWA ZIMMER, INC. 2436195

    Patients

    Seq Age Sex Outcome Treatment
    1 Other| R