BEUDAMED
    FDA Adverse Event Injury Summary report: N

    M2A-MAGNUM MODULAR HEAD SZ 48MM

    MDR report key: 2580167 · Received May 18, 2012

    Report

    Report Number
    0001825034-2012-00633
    Event Type
    Injury
    Date Received
    May 18, 2012
    Date of Event
    April 13, 2012
    Report Date
    April 19, 2012
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    KWA
    PMA / PMN Number
    PK042037
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    REVIEW OF DEVICE HISTORY RECORDS SHOW THAT LOT RELEASED WITH NO RECORDED ANOMALY OR DEVIATION. THERE ARE WARNINGS IN THE PACKAGE INSERT THAT STATE THAT THIS TYPE OF EVENT CAN OCCUR: "LOOSENING OR MIGRATION OF THE IMPLANTS MAY OCCUR DUE TO LOSS OF FIXATION, TRAUMA, MALALIGNMENT, BONE RESORPTION, OR EXCESSIVE ACTIVITY." EVALUATION IN PROCESS BUT NOT YET COMPLETE. UPON COMPLETION OF EVALUATION, A FOLLOW UP REPORT WILL BE SENT TO THE FDA. THIS REPORT IS NUMBER 4 OF 4 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2012-00630 / 00633).

    Additional Manufacturer Narrative · 1

    THE NECK REGION OF THE STEM SHOWED EVIDENCE OF DEFORMATION IN SEVERAL LOCATIONS. SOME OF THIS DAMAGE MIGHT HAVE OCCURRED DUE TO IMPINGEMENT AGAINST THE CUP OR POSSIBLY AGAINST BONE. THE POROUS COATING ON THE STEM APPEARED TO BE INTACT AND SHOWED EVIDENCE OF BONY INGROWTH. ROOT CAUSE FOR THE MODULAR HEAD BEING STUCK TO THE STEM TAPER COULD NOT BE DETERMINED. THIS FOLLOW-UP REPORT IS NUMBER 4 OF 4 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2012-00630-1 / 00633-1).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT PATIENT UNDERWENT TOTAL HIP ARTHROPLASTY ON (B)(6) 2008. SUBSEQUENTLY, A REVISION PROCEDURE WAS PERFORMED ON (B)(6) 2012 DUE TO MIGRATION OF THE ACETABULAR CUP. THE MODULAR HEAD COULD NOT BE DISENGAGED FROM THE STEM AND A MIDAS-REX WAS USED TO CUT THE TAPER FROM THE STEM. ALL COMPONENTS WERE REMOVED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 M2A-MAGNUM MODULAR HEAD SZ 48MM PROSTHESIS, HIP KWA BIOMET ORTHOPEDICS N/A 154550

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Hospitalization| R