inforMED
InjuryLTO

CEMENTRALIZER 9.25MM

Received Jan 27, 2021 · Event occurred Jan 14, 2021

Report 1818910-2021-01907 · MDR key 11237935

Device

Generic name

Hip Miscellaneous : Cement Centralizer/plug

Model number

1376-47-000

Catalog number

137647000

Lot number

J92X53

Product problems

  • Adverse Event Without Identified Device or Use Problem
  • Adverse Event Without Identified Device or Use Problem

Patient

87 YR

  • Joint Laxity
  • Joint Laxity

Narrative

Additional Manufacturer Narrative

PRODUCT COMPLAINT # (B)(4). INVESTIGATION SUMMARY: NO DEVICE ASSOCIATED WITH THIS REPORT WAS RECEIVED FOR EXAMINATION. THE INFORMATION RECEIVED WILL BE RETAINED FOR POTENTIAL SERIES INVESTIGATIONS IF TRIGGERED BY TREND ANALYSIS, POST MARKET SURVEILLANCE, OR OTHER EVENTS WITHIN THE QUALITY SYSTEM. DEPUY CONSIDERS THE INVESTIGATION CLOSED. SHOULD ADDITIONAL INFORMATION BE RECEIVED, THE INFORMATION WILL BE REVIEWED, AND THE INVESTIGATION WILL BE RE-OPENED AS NECESSARY.

Additional Manufacturer Narrative

PRODUCT COMPLAINT #: (B)(4). IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE.

Description of Event or Problem

IT WAS REPORTED THAT THE HIP REVISION OF CEMENTED BIPOLAR CONSTRUCT DUE TO INSTABILITY AND DISLOCATION. STEM WAS REMOVED AND A NEW STEM WAS CEMENTED IN PLACE. THIS WAS IMPLANTED WITH A COMPETITORS DUAL MOBILITY CUP CONSTRUCT. DOI: (B)(6) 2020 - DOR: (B)(6) 2021 (LEFT HIP).