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Li X, Feng Y, Gong Y, Chen Y. Assessing the Reproducibility of Research Based on the Food and Drug Administration Manufacturer and User Facility Device Experience Data. J Patient Saf 2024; 20:e45-e58. [PMID: 38470959 DOI: 10.1097/pts.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE This article aims to assess the reproducibility of Manufacturer and User Facility Device Experience (MAUDE) data-driven studies by analyzing the data queries used in their research processes. METHODS Studies using MAUDE data were sourced from PubMed by searching for "MAUDE" or "Manufacturer and User Facility Device Experience" in titles or abstracts. We manually chose articles with executable queries. The reproducibility of each query was assessed by replicating it in the MAUDE Application Programming Interface. The reproducibility of a query is determined by a reproducibility coefficient that ranges from 0.95 to 1.05. This coefficient is calculated by comparing the number of medical device reports (MDRs) returned by the reproduced queries to the number of reported MDRs in the original studies. We also computed the reproducibility ratio, which is the fraction of reproducible queries in subgroups divided by the query complexity, the device category, and the presence of a data processing flow. RESULTS As of August 8, 2022, we identified 523 articles from which 336 contained queries, and 60 of these were executable. Among these, 14 queries were reproducible. Queries using a single field like product code, product class, or brand name showed higher reproducibility (50%, 33.3%, 31.3%) compared with other fields (8.3%, P = 0.037). Single-category device queries exhibited a higher reproducibility ratio than multicategory ones, but without statistical significance (27.1% versus 8.3%, P = 0.321). Studies including a data processing flow had a higher reproducibility ratio than those without, although this difference was not statistically significant (42.9% versus 17.4%, P = 0.107). CONCLUSIONS Our findings indicate that the reproducibility of queries in MAUDE data-driven studies is limited. Enhancing this requires the development of more effective MAUDE data query strategies and improved application programming interfaces.
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Affiliation(s)
- Xinyu Li
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yubo Feng
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
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Kavak M, Turgut A, Turgut A. Trunnion fracture of a cobalt-chrome fully porous-coated femoral stem: A case report. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2022; 56:408-411. [PMID: 36567545 PMCID: PMC9885723 DOI: 10.5152/j.aott.2022.22051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Modular femoral stem-head systems are used increasingly due to their ease of application and offset adjustment. However, this modular ity has brought complications of trunnion wear and breakage. Although very rarely encountered, trunnion fracture is a catastrophic com plication that requires challenging revision surgery. This report presents a trunnion fracture of a cobalt-chrome alloy, fully porous-coated femoral stem. Following single-stage revision surgery, full weight-bearing was achieved in six weeks, and the patient was painlessly mobile with a single cane and had a Hip Score of 81 in the last follow-up. Despite all the advantages of the femoral stem and head modu larity, one should remember that a catastrophic complication such as trunnion wear and fracture that require revision surgery is possible.
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Pagani NR, Menendez ME, Moverman MA, Puzzitiello RN, Gordon MR. Adverse Events Associated With Robotic-Assisted Joint Arthroplasty: An Analysis of the US Food and Drug Administration MAUDE Database. J Arthroplasty 2022; 37:1526-1533. [PMID: 35314290 DOI: 10.1016/j.arth.2022.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of robotic assistance in arthroplasty is increasing; however, the spectrum of adverse events potentially associated with this technology is unclear. Improved understanding of the causes of adverse events in robotic-assisted arthroplasty can prevent future incidents and enhance patient outcomes. METHODS Adverse event reports to the US Food and Drug Administration Manufacturer and User Facility Device Experience database involving robotic-assisted total hip arthroplasty (THA), total knee arthroplasty (TKA), and partial knee arthroplasty were reviewed to determine causes of malfunction and related patient impact. RESULTS Overall, 263 adverse event reports were included. The most frequently reported adverse events were unexpected robotic arm movement for TKA (59/204, 28.9%) and retained registration checkpoint for THA (19/44, 43.2%). There were 99 reports of surgical delay with an average delay of 20 minutes (range 1-120). Thirty-one cases reported conversion to manual surgery. In total, 68 patient injuries were reported, 7 of which required surgical reintervention. Femoral notching (12/36, 33.3%) was the most common for TKA and retained registration checkpoint (19/28, 67.9%) was the most common for THA. Although rare, additional reported injuries included femoral, tibial, and acetabular fractures, MCL laceration, additional retained foreign bodies, and an electrical burn. CONCLUSION Despite the increasing utilization of robotic-assisted arthroplasty in the United States, numerous adverse events are possible and technical difficulties experienced intraoperatively can result in prolonged surgical delays. The events reported herein seem to indicate that robotic-assisted arthroplasty is generally safe with only a few reported instances of serious complications, the nature of which seems more related to suboptimal surgical technique than technology. Based on our data, the practice of adding registration checkpoints and bone pins to the instrument count of all robotic-assisted TJA cases should be widely implemented to avoid unintended retained foreign objects.
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Affiliation(s)
| | - Mariano E Menendez
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | | | | | - Matthew R Gordon
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA
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Chen J, Akoh CC, Kadakia R, Somerson JS, Easley ME, Adams SB, DeOrio JK, Nunley JA. Analysis of 408 Total Ankle Arthroplasty Adverse Events Reported to the US Food and Drug Administration From 2015 to 2018. Foot Ankle Spec 2021; 14:393-400. [PMID: 32383635 DOI: 10.1177/1938640020919538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Total ankle arthroplasty (TAA) use has increased with newer generation implants. Current reports in the literature regarding complications use data extracted from high-volume centers. The types of complications experienced by lower-volume centers may not be reflected in these reports. The purpose of this study was to determine a comprehensive TAA adverse event profile from a mandatory-reporting regulatory database. Methods. The US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was reviewed from 2015 to 2018 to determine reported adverse events for approved implants. Results. Among 408 unique TAA device failures, the most common modes of failure were component loosening (17.9%), intraoperative guide or jig error (15.4%), infection (13.7%), and cyst formation (12.7%). In addition, the percentage distribution of adverse event failure types differed among implants. Conclusion. The MAUDE database is a publicly available method that requires mandatory reporting of approved device adverse events. Using this report, we found general agreement in types of complications reported in the literature, although there were some differences, as well as differences between implants. These data may more accurately reflect a comprehensive profile of TAA complications as data were taken from a database of all device users rather than only high-volume centers.Levels of Evidence: NA.
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Affiliation(s)
- Jie Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Craig C Akoh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
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Akoh CC, Chen J, Kadakia R, Park YU, Kim H, Adams SB. Adverse events involving hallux metatarsophalangeal joint implants: Analysis of the United States Food and Drug Administration data from 2010 to 2018. Foot Ankle Surg 2021; 27:381-388. [PMID: 32505511 DOI: 10.1016/j.fas.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevalence of osteoarthritis of the hallux metatarsophalangeal joint (MTPJ) is 1 in 40 people over the age of 50. Surgical treatment options for MTPJ arthritis include joint preservation, joint resurfacing, and arthrodesis. Hallux MTPJ implants have evolved over the past several decades, but are associated with various complications. The aim of this study was to examine the MAUDE database to determine reported adverse events for hallux MTPJ implants. MATERIALS AND METHODS The US Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was reviewed from 2010 to 2018 to review voluntary reported adverse event reports for approved implants within the United States. We recorded the type of adverse event and excluded duplicate reports and those extracted from already published literature. RESULTS Among 64 reported hallux MTPJ implant adverse events, the most common modes of adverse events were component loosening (34%), infection (14.1%), component fracture (9.4%), inflammation (9.4%), and allergic reaction (7.8%). Regarding implant type, Cartiva SCI had the highest percentage of adverse events (23.4%), followed by Arthrosurface ToeMotion (20.3%), Ascension MGT (12.5%), Arthrosurface HemiCAP® (10.9%), Futura primus (9.4%), and Osteomed Reflexion (6.3%). There was an increase in reported adverse events after 2016. The MAUDE database does not report the total incidence of implant insertion. CONCLUSION Our study of the MAUDE database demonstrated that component loosening and infection are the most common modes of adverse events for hallux MTPJ implants. Cartiva accounted for one-fourth of the implant-related adverse events during our study period, followed by ToeMotion, and Ascension MGT implants. Continued reporting of adverse events will improve our understanding on short and long-term complications of various hallux MTPJ implants. LEVEL OF EVIDENCE Level IV; Case Series from Large Database Analysis; Treatment Study.
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Affiliation(s)
- Craig C Akoh
- Duke University Medical Center, Box 2887, Durham, NC 27710, United States.
| | - Jie Chen
- Duke University Medical Center, Box 2887, Durham, NC 27710, United States
| | - Rishin Kadakia
- Duke University Medical Center, Box 2887, Durham, NC 27710, United States
| | - Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggido, Republic of Korea
| | - Hyongnyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Samuel B Adams
- Duke University Medical Center, Box 2887, Durham, NC 27710, United States
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Moriarty P, Vles G, Haddad F, Konan S. Early clinical and radiological outcomes of a new tapered fluted titanium monobloc revision stem in hip arthroplasty. Arch Orthop Trauma Surg 2021; 141:1065-1071. [PMID: 33486556 DOI: 10.1007/s00402-021-03778-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/06/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE A new fluted, titanium, monobloc stem with a three degree taper has been designed in an attempt to overcome the challenges associated with femoral reconstruction in the setting of extensive bone loss. The aim of this study was to report its early clinical and radiographic outcomes. METHODS This is a retrospective review of prospectively collected data carried out at a single institution between Jan 2017 and Dec 2019. Forty-three femoral revisions were performed using a new tapered, fluted, titanium, monobloc (TFTM) revision stem. Complications, clinical and radiographic data were obtained from medical records and a locally maintained database. Clinical outcomes were assessed using the Oxford Hip Score (OHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). All post-operative radiographs were analysed for subsidence, osteolysis and femoral cortical bone remodelling. RESULTS Mean follow-up was 24 months (range 8-42 months). Subsidence of 1.2 mm was noted in one patient. No cases of clinically significant subsidence (> 10 mm) were observed. At final follow-up, a statistically significant improvement was noted in functional outcome scores. The mean OHS preoperatively and at final follow-up were 24 (SD 13) and 42 (SD15). p = 0.04 mean difference 18 (95% CI 15-22). The mean WOMAC scores preoperatively and at final follow-up were 62 (SD23) and 88 (SD7) respectively (p < 0.001, mean difference 26; 95% CI 21-34). No stem fractures were noted within the follow-up period. CONCLUSION Positive early clinical and radiological outcomes have been observed with this tapered, fluted, titanium, monobloc stem. Based on these results, this implant may be considered as a viable option in the majority of uncemented femoral revisions.
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Affiliation(s)
- Peter Moriarty
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Trust, 250 Euston Road, London, NW1 2BU, UK
| | - Georges Vles
- Division of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Fares Haddad
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Trust, 250 Euston Road, London, NW1 2BU, UK
| | - Sujith Konan
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Trust, 250 Euston Road, London, NW1 2BU, UK.
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Sukopp M, Taylor D, Forst R, Seehaus F. Femoral Stem Fracture in Hip Revision Arthroplasty: A Systematic Literature Review of the Real-World Evidence. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:160-171. [PMID: 33851402 PMCID: PMC8967430 DOI: 10.1055/a-1348-2873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background
Total hip arthroplasty (THA) presents as an excellent treatment for the osteoarthritic hip, demonstrating good survival rates. However, aseptic loosening and infection are the main causes of operative revision. The methods used in revision surgery are non-modular or modular THA implants. In addition to the abovementioned revision reasons for THA, this treatment could be associated with the possibility of femoral stem fracture, especially in the modular system. The topic of material failure has been focused on in the public media. The question arises as to how such media reports correlate with the published literature. The observed mentioned number of cases concerning a femoral stem fracture vary between one single case and up to 18.5% within a clinical study, thus presenting an inhomogeneous data situation with a large span. The specific aim of this systematic review is to establish facts and clarify the number of unforeseen events of a femoral stem
fracture based on peer review articles and registry data. This clarification is important to us, as these media reports have led to uncertainty among patients.
Methods
A systematic review was performed in accordance with the PRISMA statement. Peer review articles in English and German, presenting original articles, meta-analyses, or case reports, were searched from the turn of the millennium up to December 2019. Only articles that reported a femoral stem component fracture, with content of clinical data as well as register data, were included. Relevant papers published after the defined research time frame were taken into account within the discussion.
Results
In total, 218 fractures of a femoral stem (141 primary and 77 revision THA) component could be identified within the selected literature. Most cases of a femoral stem fracture occurred in the modular THA implants compared to the non-modular stems. Regarding revision THA, in summary, 77 implants, presenting 23 non-modular and 54 modular implants, failed by means of femoral stem fracture. A review of 11 National Joint Registries shows a revision rate between 0.04 and 0.05% in only 2 registers according to the specific subject of a femoral stem fracture. For the remaining 9 registers, however, detailed information is lacking and only nonspecific information such as a generic “implant failure” or “other reason” (which can cover a multitude of causes) is supplied.
Conclusion
A femoral stem fracture presents a devastating complication for the patient, the surgeon as well as for the manufacturer of the implant. Modular THA implants play an increasingly valuable role concerning restoration of individual anatomy in modern THA revision surgery, especially within complex cases. Regarding revision procedures, data suggests a lower risk of femoral stem fracture for modular implants compared to primary procedures, while the risk of fracture for non-modular implants seems to increase during revision. Ultimately, it cannot be proven whether this is actually applicable, since the absolute number of implanted prosthesis systems is not known. Various implant-, patient-, and surgeon-related factors may lead to these reported femoral stem fractures. However, this systematic review suggests that this is, in general, a rare complication.
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Affiliation(s)
- Matthias Sukopp
- Institute of Orthopaedic Research and Biomechanics, Centre of Trauma Research, Medical Centre, Ulm University, Ulm, Germany
| | - Dominic Taylor
- Department of Orthopaedic Surgery, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Seehaus
- Department of Orthopaedic Surgery, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Graulich TJ, Graeff P, Heidenblut T, Krettek C, Liodakis E. Revision of a Fractured Titanium Modular Revision Hip Stem Without Removal of the Well-Fixed Part of the Stem: A New Approach Using a Cemented Tube. Arthroplast Today 2020; 6:363-368. [PMID: 32566718 PMCID: PMC7298535 DOI: 10.1016/j.artd.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
Component fracture is a rare cause for revision in total hip arthroplasty. For a fractured well-fixed long femoral stem, the options are limited. We sought to develop a technique to address this problem with lower morbidity. A newly developed cemented tube was constructed and cemented onto a fractured Revitan revision hip femoral stem to retain the distal well-fixed component. At the 2-year follow-up, the Harris Hip Score, pain level, and radiographic images were analyzed. At the 2-year follow-up, no radiological signs of loosening or failure could be observed. The patient's preoperative Harris Hip Score improved from 42.8 to 97 points. The pain level improved from 7/10 to 0/10. Our case report depicts excellent clinical and radiographic outcomes at 2-year follow-up by a newly developed cemented tube technique. This technique is a potential new option for revision of fractured well-fixed diaphyseal stems without major bone loss. Our successful results suggest this technique is worthy of consideration and further study.
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Affiliation(s)
| | - Pascal Graeff
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Thorsten Heidenblut
- Institute of Material Science From the Leibniz University of Hannover, Garbsen, Germany
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Timely recognition of total elbow and radial head arthroplasty adverse events: an analysis of reports to the US Food and Drug Administration. J Shoulder Elbow Surg 2019; 28:510-519. [PMID: 30466818 DOI: 10.1016/j.jse.2018.08.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent recalls of several commonly used elbow arthroplasty implants have prompted interest in the modes by which elbow implants fail and the timing of reports of these failures. METHODS We reviewed the adverse event reports to the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database from 2012 to 2015 regarding elbow arthroplasty to determine the event date and the type of each adverse event. RESULTS Among 179 total elbow adverse event reports, the most common modes of failure were implant dissociation (23%), loosening (22%), and infection (16%). The most common modes of failure among 58 radial head replacement reports were component dissociation (19%) and linkage screw failure (19%). The percentage distribution of adverse event types differed among different arthroplasty systems and from that reported in published reviews of elbow arthroplasty. Three implant recalls were implemented 2, 5, and 9 years after the first adverse event report in the MAUDE database. For 2 of the recalls, the first reports of the device failures were published 2 and 5 years after the first MAUDE reports. CONCLUSIONS The MAUDE database is a publicly funded and publicly available means by which surgeons can identify adverse events for the prostheses they use before such information becomes available through journal publication or recall notification. In this study, MAUDE data revealed a higher relative frequency of mechanical dissociation of elbow implants than what has been represented in the literature. Early identification of these adverse events may help surgeons by informing their implant selection and surgical technique.
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Somerson JS, Hsu JE, Neradilek MB, Matsen FA. Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016. J Shoulder Elbow Surg 2018; 27:1978-1986. [PMID: 29759905 DOI: 10.1016/j.jse.2018.03.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/19/2018] [Accepted: 03/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most of the literature on shoulder arthroplasty failure comes from high-volume centers. These reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder joint replacements. METHODS We analyzed the failure reports mandated by the US Food and Drug Administration for all hospitals. Each reported event from 2012 to 2016 was characterized by implant, failure mode, and year of surgery. RESULTS For the 1673 anatomic arthroplasties, the most common failure modes were glenoid component failure (20.4%), rotator cuff/subscapularis tear (15.4%), pain/stiffness (12.9%), dislocation/instability (11.8%), infection (9%), and humeral component loosening (5.1%). For the 2390 reverse arthroplasties, the most common failure modes were dislocation/instability (32%), infection (13.8%), glenosphere-baseplate dissociation (12.2%), failed/loosened baseplate (10.4%), humeral component dissociation/tray fracture (5.5%), difficulty inserting the baseplate (4.8%), and difficulty inserting the glenosphere (4.2%). Although the percentage distribution among the different failure modes was relatively consistent over the years of this study, the percentage distribution of these failure modes differed substantially among different implant manufacturers. CONCLUSIONS The Food and Drug Administration database reveals modes of shoulder arthroplasty failure that are not emphasized in the published literature, such as rotator cuff tear, infection, and postoperative pain/stiffness for anatomic total shoulder arthroplasty and implant dissociation and baseplate failure for reverse shoulder arthroplasty. Knowledge of these failure modes may help inform surgical technique and implant design in ways that will lower the risk of implant failure in the future.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | | | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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