BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BI-METRIC/X POROUS COLLAR 13X145

    MDR report key: 2580399 · Received May 18, 2012

    Report

    Report Number
    0001825034-2012-00637
    Event Type
    Injury
    Date Received
    May 18, 2012
    Date of Event
    April 16, 2012
    Report Date
    April 20, 2012
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    LPH
    PMA / PMN Number
    PK030055
    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 CAN 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 3 OF 4 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2012-00635 / 00638).

    Additional Manufacturer Narrative · 1

    THE MODULAR HEAD, TAPER ADAPTER, AND FEMORAL STEM WERE STILL ASSEMBLED AND NO ATTEMPT WAS MADE TO SEPARATE THESE COMPONENTS. INDENTATIONS WERE VISIBLE ON THE NECK PORTION OF THE STEM IN SEVERAL LOCATIONS, WHICH MAY HAVE OCCURRED DUE TO IMPINGEMENT AGAINST THE CUP OR POSSIBLY AGAINST BONE. LIGHT COLORED DEPOSITS WERE OBSERVED AT THE JUNCTION BETWEEN THE STEM AND THE TAPER ADAPTER. THE COMPONENTS APPEARED TO SHOW EVIDENCE OF NECK IMPINGEMENT AND SUBLUXATION OF THE JOINT. THESE EVENTS MAY HAVE BEEN CAUSAL OR CONTRIBUTORY FACTORS FOR THE HEAD BECOMING STUCK ON THE STEM TAPER. THIS FOLLOW-UP REPORT IS NUMBER 3 OF 4 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2012-00635-1 / 00638-1).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT PATIENT UNDERWENT TOTAL HIP ARTHROPLASTY ON (B)(6) 2007. SUBSEQUENTLY, A REVISION PROCEDURE WAS PERFORMED ON (B)(6) 2012 DUE TO LOOSENING. THE SURGEON REPORTEDLY COULD NOT DISENGAGE THE TAPER FROM THE STEM. ALL COMPONENTS WERE REMOVED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BI-METRIC/X POROUS COLLAR 13X145 PROSTHESIS, HIP LPH BIOMET ORTHOPEDICS N/A 419020

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R