DISCOVERY ELBOW-MOSAIC DISTAL HUMERAL REPLACEMENT SYSTEM

• K Number: K033280
• Device Name: DISCOVERY ELBOW-MOSAIC DISTAL HUMERAL REPLACEMENT SYSTEM
• Manufacturer: BIOMET, INC.
• Date Cleared: 2003-12-19 ( 70 days)
• Product Code: JDC
• Regulation Number: 888.3150
• Type: Traditional
• Panel: Orthopedic
• Reference & Predicate Devices: K013042 , K000683 , K020045 , K022079
• Predicate For: K042321 , K042664 , K043505 , K111746 , K112905

Intended Use

The indications for use for the Discovery™ Elbow - Mosaic™ Distal Humeral Replacement System include:

1. Non-inflammatory degenerative joint disease including osteoarthritis and avascular necrosis.
2. Rheumatoid arthritis
3. Revision procedures where other treatments or devices have failed
4. Correction of functional deformity
5. Treatment of acute and chronic fractures with humeral epicondyle involvement which are unmanageable using other treatment methods
6. Oncology applications
   This device is intended to be used with bone cement.

Device Description

The Discovery™ Elbow - Mosaic™ Distal Humeral Replacement System is an elbow replacement device designed for use in cases where there is distal humeral bone loss. The device consists of a ulnar stem with a pre-assembled bearing, a distal humeral component which, with a humeral condyle kit, completes the hinge of the elbow, an extramedullary modular distal segment for bone replacement and a intramedullary humeral stem. Soft tissue attachment sleeves and canal cement plugs complete the system.

AI/ML Overview

The provided text is a 510(k) Summary for a medical device (Discovery™ Elbow - Mosaic™ Distal Humeral Replacement System). It does not contain any information about acceptance criteria or a study proving the device meets those criteria.

Instead, it's a submission to the FDA for market clearance, primarily demonstrating substantial equivalence to pre-existing devices. This type of submission often relies on a comparison to predicate devices, rather than new performance studies with acceptance criteria.

Therefore, I cannot fulfill your request for the tables and study details based on the provided text. The output would be:

No information regarding acceptance criteria or a study proving the device meets those criteria is present in the provided document.

To elaborate on why each point cannot be addressed:

1. A table of acceptance criteria and the reported device performance: Not present. The document focuses on indicating uses and comparing the new device to existing predicate devices.
2. Sample sized used for the test set and the data provenance: No test set is mentioned, as no performance study is detailed.
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable, as no test set or ground truth establishment is described.
4. Adjudication method for the test set: Not applicable.
5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance: Not applicable. This document pertains to a physical elbow prosthesis, not an AI or imaging device involving human readers.
6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done: Not applicable.
7. The type of ground truth used (expert concensus, pathology, outcomes data, etc): Not applicable.
8. The sample size for the training set: Not applicable.
9. How the ground truth for the training set was established: Not applicable.

The "Non-Clinical Testing/ Clinical Testing: None was provided as a basis of substantial equivalence" statement explicitly indicates that no new performance studies were submitted for this clearance.

Summary

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DFC 1 9 2003

BIOMET

K033280
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[e-mail]

510(k) Summary

Applicant/Sponsor:	Biomet Orthopedics, Inc.
Contact Person:	Patricia Sandborn BeresSenior Regulatory Specialist
Proprietary Name:	Discovery™ Elbow - Mosaic™ Distal Humeral Replacement System
Common Name:	Elbow Prosthesis
Classification Name:	Elbow joint metal/polymer constrained cemented prosthesis (888.3150)

Legally Marketed Devices To Which Substantial Equivalence Is Claimed:

• Discovery™ Elbow (K013042) .
• Modified Single Axle Total Elbow (K000683) .
• 3-Piece Proximal Humeral Replacement System (K020045) .
• Short and Long Soft Tissue Attachment Sleeves (K022079) .

Device Description: The Discovery™ Elbow - Mosaic™ Distal Humeral Replacement System is an elbow replacement device designed for use in cases where there is distal humeral bone loss. The device consists of a ulnar stem with a pre-assembled bearing, a distal humeral component which, with a humeral condyle kit, completes the hinge of the elbow, an extramedullary modular distal segment for bone replacement and a intramedullary humeral stem. Soft tissue attachment sleeves and canal cement plugs complete the system.

Indications for Use:

• Non-inflammatory degenerative joint disease including osteoarthritis and avascular necrosis. 1.
• 2. Rheumatoid arthritis.
• 3. Revision where other devices or treatments have failed.
• 4. Correction of functional deformity.
• ട്. Treatment of acute or chronic fractures with humeral epicondyle involvement, which are unmanageable using other treatment methods.
• ୍. Oncology applications.

Summary of Technologies: The Discovery™ Elbow - Mosaic™ Distal Humeral Replacement System components (materials, design, sizes and indications), are similar or identical to the predicate devices.

Non-Clinical Testing/ Clinical Testing: None was provided as a basis of substantial equivalence.

All trademarks are property of Biomet, Inc.

75 MAILING ADDRESS SHIPPING ADDRESS P.O. Box 587 56 E. Bell Drive Warsaw, IN 46581-0587 Warsaw, IN 46582 ()1-FICE FAX [phone].6639

574.267.8137

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Image /page/1/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three wavy lines emanating from its body, enclosed in a circle. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged around the circle's perimeter.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

DEC 1 9 2003

Ms. Patricia Sandborn Beres Senior Regulatory Specialist Biomet Orthopedics Corp. P.O. Box 587 Warsaw, Indiana 46581-0587

Re: K033280

Trade/Device Name: Discovery Elbow – Mosaic Distal Humeral Replacement System Regulation Number: 21 CFR 888.3150 Regulation Name: Flbow joint metal/polymer constrained cemented prosthesis Regulatory Class: Class II Product Code: JDC Dated: October 9, 2003 Received: October 10, 2003

Dear Ms. Beres:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments. or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally

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Page 2 - Ms. Beres

marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Sincerely yours,

for Mark A. Millerson

Celia M. Witten, Ph.D., M.D. Division Director Division of General, Restorative, And Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known):

Device Name: Discovery™ Elbow - Mosaic™ Distal Humeral Replacement System

Indications For Use:

The indications for use for the Discovery™ Elbow - Mosaic™ Distal Humeral Replacement System include:

• 1. Non-inflammatory degenerative joint disease including osteoarthritis and avascular necrosis.
• 2. Rheumatoid arthritis
• 3. Revision procedures where other treatments or devices have failed
• 4. Correction of functional deformity
• 5. Treatment of acute and chronic fractures with humeral epicondyle involvement which are unmanageable using other treatment methods
• 6. Oncology applications

This device is intended to be used with bone cement.

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

for Mark N. Mullerraro

ion of General, Restorative
d Neurological D...

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Regulation Number and Section

§ 888.3150 Elbow joint metal/polymer constrained cemented prosthesis.

(a)
Identification. An elbow joint metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace an elbow joint. It is made of alloys, such as cobalt-chromium-molybdenum, or of these alloys and of an ultra-high molecular weight polyethylene bushing. The device prevents dislocation in more than one anatomic plane and consists of two components that are linked together. This generic type of device is limited to those prostheses intended for use with bone cement (§ 888.3027).(b)
Classification. Class II. The special controls for this device are:(1) FDA's:
(i) “Use of International Standard ISO 10993 ‘Biological Evaluation of Medical Devices—Part I: Evaluation and Testing,’ ”
(ii) “510(k) Sterility Review Guidance of 2/12/90 (K90-1),”
(iii) “Guidance Document for Testing Orthopedic Implants with Modified Metallic Surfaces Apposing Bone or Bone Cement,”
(iv) “Guidance Document for the Preparation of Premarket Notification (510(k)) Application for Orthopedic Devices,”
(v) “Guidance Document for Testing Non-articulating, ‘Mechanically Locked’ Modular Implant Components,”
(2) International Organization for Standardization's (ISO):
(i) ISO 5832-3:1996 “Implants for Surgery—Metallic Materials—Part 3: Wrought Titanium 6-Aluminum 4-Vandium Alloy,”
(ii) ISO 5832-4:1996 “Implants for Surgery—Metallic Materials—Part 4: Cobalt-Chromium-Molybdenum Casting Alloy,”
(iii) ISO 5832-12:1996 “Implants for Surgery—Metallic Materials—Part 12: Wrought Cobalt-Chromium-Molybdenum Alloy,”
(iv) ISO 5833:1992 “Implants for Surgery—Acrylic Resin Cements,”
(v) ISO 5834-2:1998 “Implants for Surgery—Ultra High Molecular Weight Polyethylene—Part 2: Moulded Forms,”
(vi) ISO 6018:1987 “Orthopaedic Implants—General Requirements for Marking, Packaging, and Labeling,”
(vii) ISO 9001:1994 “Quality Systems—Model for Quality Assurance in Design/Development, Production, Installation, and Servicing,” and
(viii) ISO 14630:1997 “Non-active Surgical Implants—General Requirements,”
(3) American Society for Testing and Materials':
(i) F 75-92 “Specification for Cast Cobalt-28 Chromium-6 Molybdenum Alloy for Surgical Implant Material,”
(ii) F 648-98 “Specification for Ultra-High-Molecular-Weight Polyethylene Powder and Fabricated Form for Surgical Implants,”
(iii) F 799-96 “Specification for Cobalt-28 Chromium-6 Molybdenum Alloy Forgings for Surgical Implants,”
(iv) F 981-93 “Practice for Assessment of Compatibility of Biomaterials (Nonporous) for Surgical Implant with Respect to Effect of Material on Muscle and Bone,”
(v) F 1044-95 “Test Method for Shear Testing of Porous Metal Coatings,”
(vi) F 1108-97 “Specification for Titanium-6 Aluminum-4 Vanadium Alloy Castings for Surgical Implants,”
(vii) F 1147-95 “Test Method for Tension Testing of Porous Metal Coatings, ” and
(viii) F 1537-94 “Specification for Wrought Cobalt-28 Chromium-6 Molybdenum Alloy for Surgical Implants.”