MAUDE MDR 4690

MDR report key
4690
Report number
4690
Event key
0
Event type
3
Date of event
1992-01-23
Date received
1992-07-31
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
3

Manufacturer Contact#

Report source
U
Manufacturer link flag
N

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1HOWMEDICA PCAHOWMEDICA, INC.LXYMPVD 6638-1-100FIBIAL SURFACE 6638-1-290YY

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
11992-07-3101. O

Event Narratives#

D

Patient 1

PATIENT EXPERIENCE PAINFUL TOTAL KNEE WITH POLYMER. REVISION PERFORMED JANUARY 23, 1992. ON PATHOLOGICAL EXAMINATION, THE METALLIC FEMORAL COMPONENT MEASURED 5.3 X 4.6 CM. THE METALLIC ARTICULAR SURFACE WAS SMOOTH AND SHINY. THE HIGH DENSITY POLYETHYLENE AND METALLIC PATELLAR COMPONENT MEASURED 3.5 X 3.0 X 1.0 CM. THE ARTICULAR SURFACE WAS FOCALLY ROUGHENED. THE HIGH DENSITY POLYETHELENE AND METALLIC TOTAL COMPONENT MEASURED 5.8 X 4.0 X2.0 CM. THE ARTICULAR SURFACE WAS MARKEDLY WORN. THE PATHOLOGICAL DIAGNOSIS WAS CHRONIC PROLIFERATIVE SYNOVITIS WITH FOREIGN BODY REACTIONINVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: UNKNOWN. 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 EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED. RESULTS OF EVALUATION: MATERIAL DEGRADATION/DETERIORATION, OTHER. CONCLUSION: DEVICE FAILURE OCCURRED AND WAS RELATED TO EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: MAYBE. CORRECTIVE ACTIONS: DEVICE DISCARDED. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.