KMW HIP SYSTEM KM-3 2400-52-104

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1992-11-20 for KMW HIP SYSTEM KM-3 2400-52-104 manufactured by Kirschner Medical Corporation.

Event Text Entries

[1438] Patient was originally treated for a fracture in june 1987 and had a total hip implant. A revision was performed in august 1988. On october 25, 1992 patient was diagnosed as fractured acetabular component left hip arthoiplasty. The patient is extremely active and lifts heavy objects. During week prior to admission, patient felt a snap and experienced pain in left hip. X-rays of left hip revealed a cemented left totalt hip arthroplasty with the femoral component being solidly in place. The acetabular component has a metal backing wihich is solidly in place against acetabular fossa. The polyethylene space has become distorted and the femoral head had now come into contact with the acetabular shell. It also shows sthe polyethylene portions of the acetabular component fracture. Visual examination of the acetabular liner shows a thin (1/16") approx. 1/2" long x 3/16" wide rugged chip fractured from the inside lower portion of the liner. Ecri has stated that they can do a thorough evaluation of this device and could only recommend clemson university as a third party investigator. Device may be sent to manufacturer for evaluationinvalid data - regarding single use labeling of device. Patient medical status prior to event: invalid data. There was not multiple patient involvement. Invalid data - on device service/maintenance. No data - regarding date last serviced. Service provided by: invalid data. Invalid data - service records availability. No imminent hazard to public health claimed. Device used as labeled/intended. Device was not evaluated after the event. Method of evaluation: no data. Results of evaluation: no data. Conclusion: no data. Certainty of device as cause of or contributor to event: invalid data. Corrective actions: device permanently removed from service. Invalid data - on device destroyed/disposed of status.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1882
MDR Report Key1882
Date Received1992-11-20
Date of Report1992-11-18
Date of Event1992-10-26
Date Facility Aware1992-10-26
Report Date1992-11-18
Date Reported to FDA1992-11-18
Date Reported to Mfgr1992-11-13
Date Added to Maude1992-12-14
Event Key0
Report Source CodeUser Facility report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameKMW HIP SYSTEM
Generic NamePROSTHESIS, JOINT, HIP
Product CodeISL
Date Received1992-11-20
Model NumberKM-3
Catalog Number2400-52-104
ID Number2426-52-105
OperatorOTHER
Device AvailabilityY
Implant FlagY
Device Sequence No1
Device Event Key1757
ManufacturerKIRSCHNER MEDICAL CORPORATION


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 1992-11-20

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