FDA Adverse Event Summary report: N

COBALT CHROME TAPER FEMORAL HEAD

MDR report key: 3129030 · Received May 6, 2013

Report

Report Number
3129030
Date Received
May 6, 2013
Date of Event
May 2, 2013
Report Date
May 6, 2013
Manufacturer
SMITH AND NEPHEW
Product Code
LZO
Report Source
User Facility report
Reporter Location
TN, US

Narratives

Description of Event or Problem · 1

PATIENT UNDERWENT LEFT HIP NONCEMENTED BIPOLAR HEMIARTHROPLASTY FOR A COMPLETELY DISPLACED LEFT FEMORAL NECK FRACTURE. APPROXIMATELY 5 WEEKS LATER, THE PATIENT PRESENTED AGAIN TO THE HOSPITAL FOR LEFT HIP DISLOCATION AFTER A FALL SUSTAINED AT HOME 4 DAYS PRIOR. PATIENT REPORTED HEARING "HIP POP OUT WHEN SHE HAD FALLEN AND NO OTHER INJURY". THE PATIENT DID REQUIRE A REVISION TO A UNIPOLAR HEAD COMPONENT AND REDUCTION OF THE HIP. X-RAYS ON SECOND ADMISSION REVEALED THE LEFT HIP PROSTHESIS WAS DISLOCATED SUPERIORLY FROM THE ACETABULUM AND THE HEAD OF THE PROSTHESIS WAS DISLOCATED FROM THE STEM. NO BONY FRAGMENTATION WAS IDENTIFIED. THERE WAS NO INJURY TO THE PATIENT, THERE IS CONCERN THIS IS AN IMPLANT FAILURE.MANUFACTURER RESPONSE FOR FEMORAL HEAD IMPLANT, COBALT CHROME TAPER FEMORAL HEAD (PER SITE REPORTER).MANUFACTURER HAS REQUESTED DEVICE FOR EXAM.WHAT WAS THE ORIGINAL INTENDED PROCEDURE?REPAIR OF DISLOCATED LEFT HIP HEMIARTHROPLASTY WITH BIPOLAR COMPONENT DISSOCIATION.DEVICE #1IS THIS A LABORATORY DEVICE OR LABORATORY TEST?NO.DEVICE #2IS THIS A LABORATORY DEVICE OR LABORATORY TEST?NO.DEVICE #3IS THIS A LABORATORY DEVICE OR LABORATORY TEST?NO.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
197914 COBALT CHROME TAPER FEMORAL HEAD PROSTHESIS, HIP, IMPLANT LZO SMITH AND NEPHEW * 12LM08620
197915 TANDEM BIPOLAR IMPLANT PROSTHESIS, HIP, SHELL AND LINER JDI SMITH AND NEPHEW * 12FM17095
197916 SYNERGY POROUS-COATED STEM PROSTHESIS, HIP, FEMORAL COMPONENT MEH SMITH AND NEPHEW * 12CM11330

Patients

Seq Age Sex Outcome Treatment
1 74 YR