Reverse shoulder implants are named for the way they “reverse” human anatomy of the shoulder. Instead of a ball on the upper arm bone that fits into a socket on the shoulder blade, the implants put the ball on the shoulder and the socket on the arm.
A humeral tray attaches to a stem that has been inserted into the humerus, or upper arm bone. A bearing is then fitted to the tray to form the socket of the new joint.
Fractured Components Lead to Zimmer Biomet Recall
Zimmer Biomet recalled 3,662 reverse shoulder components, one of the largest recalls of its kind in recent years.
In December 2016, Zimmer Biomet recalled 3,662 reverse shoulder components of its Comprehensive model line. It was one of the largest recalls of reverse-shoulder devices in recent years.
In the recall notice, Zimmer Biomet said its Comprehensive Reverse Shoulder System Humeral Tray Model 115340 suffered a high fracture rate. Recalled units had been manufactured between August 2008 and September 2011. Trays manufactured after that time incorporated design changes to prevent fractures.
The affected trays were distributed as late as September 2015.
The U.S. Food and Drug Administration (FDA) categorized the action as a Class I recall, the agency’s most serious type. In an Urgent Field Safety Notice, the company warned that fractures could require patients to undergo revision surgery which could cause serious health complications including infection, loss of shoulder function, and death.
Zimmer Biomet said immediate health risks were not likely, but the devices posed long-term risks. The most likely and most severe risk was that people implanted with the affected Comprehensive models would need revision surgery sometime in the future if the component fractured.
Recent Reverse Shoulder Implant Recalls
The 2016 recall was the fourth involving Zimmer or Biomet reverse shoulder devices since 2010. It also involved the largest number of reverse -shoulder devices since Zimmer’s recall of 9,800 tools used in implant surgery for both conventional and reverse-shoulder implants in 2010.
That recall affected nearly 9,800 Distal Pilots, used in implanting Zimmer’s Trabecular Metal Shoulder, because they were not functioning properly, and the problem could prevent the implant from fitting appropriately to the arm bone. The problem could also lead to delay in surgery, a bone fracture, or the need to alter the way the implant was attached.
Other recalls of reverse shoulder devices between 2010 and 2016 had not been so large. While different companies had recalled devices, for the most part, the numbers of actual units affected had been small.
|Year||Manufacturer/Device||Units Recalled||Reason for Recall|
|2016||Tornier (Wright Medical) Aeuqalis Fx2 shoulder implants, both traditional and reverse configuration||30||Reports of dislocations|
|2015||Zimmer Biomet 25mm size Glenosphere Mini Baseplate for the Comprehensive system||11||Taper adaptor missing from package, causing delay of surgery of more than 30 minutes|
|2014||Integra Titan Reverse Shoulder right and left head cutting templates||12||Template for cutting bone was welded backwards, resulting in wrong angle|
|2011||Encore Medical RSP Humeral Socket Shell||81||Device had the potential to not appropriately connect with the stem attached to the arm bone|
|2010||Biomet (later Zimmer Biomet) Comprehensive Reverse Shoulder Humeral Tray with 49mm Locking Ring||47||Reports of the device fracturing|
The FDA classified these other recalls as Class II – a situation where the device “may cause temporary or medically reversible adverse health consequences” or where there is a remote probability of serious health risks.
Zimmer Biomet Cited for 14 Potential FDA Violations Before Recall
The Comprehensive model line was originally produced by Biomet, Inc., which Zimmer Holdings acquired for nearly $14 billion in 2015, creating Zimmer Biomet.
In a filing with the Securities and Exchange Commission, Biomet had reported that in 2013, “demand for the Comprehensive Shoulder System allowed us to achieve the leadership position in the United States in both the anatomic shoulder and reverse shoulder markets.”
But Zimmer’s acquisition brought it problems as well as anticipated profits. Just a month before the 2016 recall, the FDA issued a lengthy list of potential violations at what prior to the merger had been a Biomet manufacturing plant in Warsaw, Indiana.
FDA inspectors looked over the facility between September and November 2016, before issuing a 58-page review of issues they found.
Eight of the observations included claims that the plant lacked “established procedures” for such things as:
- Verifying inspection and testing results
- Controlling products that failed to conform to specifications
- Having a system to rework non-conforming products
- Controlling product design
- Performing corrective or preventative actions
- Formally reviewing and evaluating product complaints
Inspectors also found the facility did not sample products based on a valid statistical model.
“While the Company is taking the necessary steps to address certain regulatory compliance gaps at the legacy Biomet operation in Warsaw, it remains confident in the quality, safety and efficacy of all of its products,” Zimmer Biomet said in a statement following the inspection. “No patient safety concerns have been identified with any of the products manufactured at the site.”
Comprehensive Reverse Shoulder Fracture Leads to Lawsuit
Alfonso Alarid of Denver, Colorado, received a Comprehensive Shoulder System to replace his left shoulder in September 2009. He received another Comprehensive implant to replace his right shoulder in July 2010.
While undergoing physical therapy in 2012, the humeral tray separated from the stem in his left shoulder and Alarid had to have the implant replaced. In March 2013, the implant in his right shoulder failed in a similar fashion and it, too, had to be replaced.
Both of the devices were among the 47 Comprehensive Reverse Shoulder systems affected by Biomet’s September 2010 recall.
Alarid filed a lawsuit in state court in Colorado against Biomet in July 2014, before the company merged with Zimmer. In his complaint, Alarid claimed that Biomet had received multiple reports of problems with the device. He also claimed Biomet had sold implants in “defective and unreasonably dangerous condition” that resulted in his injuries requiring two revision surgeries.
The case was moved to federal court in Denver in September 2015.
In February 2016, Biomet, by then a part of Zimmer Biomet, agreed to pay Alarid $350,000 to settle the claims against the company.
In its 2016 annual report, Zimmer Biomet listed three major litigations against the company over the Zimmer Durom Cup hip implant, the Zimmer NexGen Knee implant system and the Biomet M2a Magnum hip implant.
“We are also currently defending a number of other product liability lawsuits and claims related to various other products,” Zimmer Biomet’s annual report said. “Product liability lawsuits and claims, safety alerts or product recalls, regardless of their ultimate outcome, could have a material adverse effect on our business and reputation and on our ability to attract and retain customers.”
Terry Turner is an Emmy-winning, former television journalist who holds six Health Literacy certificates from the Centers for Disease Control and Prevention and a Bachelor of Arts in Media Arts from Lyon College. As a Washington-based reporter, he routinely reported on health and medical policy issues before Congress, the FDA and other federal agencies on behalf 100 local news departments across the U.S. Prior to that, he covered state and federal courts for several local television stations in the Midwest and on the East Coast.