K Number
K083707
Device Name
ARTHREX DUAL WAVE ARTHROSCOPY FLUID MANAGEMENT DEVICE
Manufacturer
Date Cleared
2009-08-03

(231 days)

Product Code
Regulation Number
888.1100
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Arthrex Dual Wave Arthroscopy Fluid Management Device is intended to provide consistent, non-pulsing control of intra-articular irrigation and distention pressuring during all phases of arthroscopic surgery.
Device Description
The Arthrex Dual Wave Arthroscopy Fluid Management Device is a roller, peristaltic, arthroscopic pump designed with a universal input grade switching power supply. The Arthrex Dual Wave Arthroscopy Fluid Management Device senses the connection and use of the Arthrex Shaver Adapteur System (K932699) and provides an outflow function to support the same.
More Information

No
The summary describes a fluid management pump with basic sensing capabilities, but there is no mention of AI, ML, or any related concepts.

No.
The primary purpose of the device is to manage fluid and pressure during arthroscopic surgery, not to treat a disease or condition itself.

No

The device is described as a fluid management system for irrigation and distention during arthroscopic surgery, and it does not mention diagnosing any medical conditions.

No

The device description explicitly states it is a "roller, peristaltic, arthroscopic pump," which is a hardware device.

Based on the provided information, the Arthrex Dual Wave Arthroscopy Fluid Management Device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is to provide fluid management during arthroscopic surgery, which is a surgical procedure performed on a living patient. IVDs are used to examine specimens from the body (like blood, urine, tissue) outside the body to diagnose or monitor conditions.
  • Device Description: The description details a pump for irrigation and distention during surgery, not a device for analyzing biological samples.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples, reagents, or any of the typical components or processes associated with in vitro diagnostics.

The device is clearly intended for use in vivo (within the living body) during a surgical procedure, not in vitro (outside the living body) for diagnostic purposes.

N/A

Intended Use / Indications for Use

The Arthrex Dual Wave Arthroscopy Fluid Management Device is intended to provide consistent, non-pulsing control of intra-articular irrigation and distention pressuring during all phases of arthroscopic surgery.

Product codes

HRX

Device Description

The Arthrex Dual Wave Arthroscopy Fluid Management Device is a roller, peristaltic, arthroscopic pump designed with a universal input grade switching power supply. The Arthrex Dual Wave Arthroscopy Fluid Management Device senses the connection and use of the Arthrex Shaver Adapteur System (K932699) and provides an outflow function to support the same. Arthrex Dual Wave Arthroscopy Fluid Management Device is intended to provide consistent, non-pulsing control of intra-articular irrigation and distention pressuring during all phases of arthroscopic surgery.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

Not Found

Key Metrics

Not Found

Predicate Device(s)

Arthrex Continuous Wave Arthroscopy Pump, K024291, FMS DUO, K954465

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 888.1100 Arthroscope.

(a)
Identification. An arthroscope is an electrically powered endoscope intended to make visible the interior of a joint. The arthroscope and accessories also is intended to perform surgery within a joint.(b)
Classification. (1) Class II (performance standards).(2) Class I for the following manual arthroscopic instruments: cannulas, currettes, drill guides, forceps, gouges, graspers, knives, obturators, osteotomes, probes, punches, rasps, retractors, rongeurs, suture passers, suture knotpushers, suture punches, switching rods, and trocars. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 888.9.

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AUG Ó 8 2009

Arthroll Storex Dual Wave Arthroscopy Fluid Marea Public Maragement Device

11083707

510(k) Summary of Safety and Effectiveness

i af

0

3

| Manufacturer/Distributor/Sponsor | Arthrex, Inc.
1370 Creekside Boulevard
Naples, FL 34108-1945 USA |
|----------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510(k) Contact | Sally Foust
Regulatory Affairs Project Manager
Arthrex, Inc.
1370 Creekside Boulevard
Naples, FL 34108-1945 USA
Telephone: 239/643.5553, ext. 1251
Fax: 239/598.5508
Email: sfoust@arthrex.com |
| Trade Name | Arthrex Dual Wave Arthroscopy Fluid Management Device |
| Common Name | Pump |
| Product Code -Name -Reference | HRX - Arthroscope - CFR 888.1111 |
| Predicate Device | Arthrex Continuous Wave Arthroscopy Pump, K024291
FMS DUO, K954465 |
| Device Description and Intended
Use | The Arthrex Dual Wave Arthroscopy Fluid Management
Device is a roller, peristaltic, arthroscopic pump designed with
a universal input grade switching power supply. The Arthrex
Dual Wave Arthroscopy Fluid Management Device senses
the connection and use of the Arthrex Shaver Adapteur
System (K932699) and provides an outflow function to
support the same.
Arthrex Dual Wave Arthroscopy Fluid Management Device is
intended to provide consistent, non-pulsing control of intra-
articular irrigation and distention pressuring during all phases
of arthroscopic surgery. |
| Substantial Equivalence Summary | The Arthrex Dual Wave Arthroscopy Fluid Management
Device is substantially equivalent to the predicate devices
Arthrex Continuous Wave III Arthroscopy Pump and the FMS
DUO in which the basic features and intended uses are the
same or very similar. Any differences between the Arthrex
Dual Wave Arthroscopy Fluid Management Device and the
predicate devices Arthrex Continuous Wave III Arthroscopy
Pump and FMS DUO are considered minor and do not raise
questions conceming safety and effectiveness. Based on the
information submitted, Arthrex, Inc. has determined that the
new Arthrex Dual Wave Arthroscopy Fluid Management
Device is substantially equivalent to the currently marketed
predicate devices. |

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K083707

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Arthrex. TRADITIONAL 510(k): Arthrex Dual Wave Arthroscopy Fluid Management Device

dministrative Information

Manufacturer / Distributor/ Sponsor / Contact 4.1

4.1.1 Manufacturer/Distributor / Sponsor

Arthrex, Inc. 1370 Creekside Boulevard Naples, Florida 34108-1945 USA Establishment Registration Number: 1220246

4.1.2 Contact

Sally Foust Regulatory Affairs Project Manager Arthrex, Inc. 1370 Creekside Boulevard Naples, Florida 34108-1945 USA Telephone: 239/643.5553, extension 1251 Fax: 239/598.5508 Email: sfoust(@arthrex.com

4,2 Device Identification

4.2.1 Proprietary Name

Arthrex Dual Wave Arthroscopy Fluid Management System

4.2.2 Common Name

Pump

4.2.3 Classification Name and Reference

21 CFR 888.1111: Arthroscope

4.2.4 Regulatory Class

Based on the recommendation of the Orthopedic and Rehabilitation Device Panel, the FDA has classified this device as a Class II medical device.

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K093707

3.73

Arthrex. 8 TRADITIONAL 510(K): Arthrex Dual Wave Arthroscopy Fluid Management Device

4.2.5 Device Product Code

HRX o

Compliance with Special Controls 4,3

Sections 513 and 514 of the act, as amended under the Safe Medical Devices Act of 1990, do apply to this type of device.

Arthrex, Inc. is not aware of any requirements for post-market surveillance or other special controls for this device.

4.4 Conformance to Voluntary Standards

The Arthrex Dual Wave Arthroscopy Fluid Management Device will conform to the following voluntary standards:

EN -55011B (EMC 89/336/CEE): Emission Requirements

IEC-60601-1 (73/23/CEE): Medical electrical equipment, General Requirements for Safety

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is an abstract image of an eagle or other bird-like figure.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Arthrex, Inc. % Ms. Sally Frost Regulatory Affairs Project Manager 1370 Creekside Boulevard Naples, Florida 34108

AUG 0 8 2009

Re: K083707

Trade/Device Name: Arthrex Dual Wave Arthroscopy Fluid Management Device Regulation Number: 21 CFR 888.1100 Regulation Name: Arthroscope Regulatory Class: II Product Code: HRX Dated: July 13, 2009 Received: July 15, 2009

Dear Ms. Forst:

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 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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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Page 2 - Ms. Sally Frost

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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 (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,
for Pedro R.

Mark N. Melkerson Director Division of Surgical, Orthopedic, and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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K08370?

Image /page/5/Picture/1 description: The image shows a series of handwritten letters and a period. The letters appear to be "l o f j" followed by a period. The handwriting is somewhat rough, with the letters not perfectly formed. The image is in black and white, with the letters standing out against the white background.

Arthrex TRADITIONAL 510(k): Arthrex Dual Wave Arthroscopy Fluid Management Device

Indications for Use

510(k) Number:

Device Name:

Arthrex Dual Wave Arthroscopy Fluid Management Device

The Arthrex Dual Wave Arthroscopy Fluid Management Device is intended to provide consistent, non-pulsing control of intra-articular irrigation and distention pressuring during all phases of arthroscopic surgery.

Prescription Use_X_AND/OR Over-The-Counter Use (Per 21 CFR 801 Subpart D) (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

PAGE 1 of 1

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Neil K. Shahani Simpson
(Division Sign Off)

Division of Surgical, Orthopedic, and Restorative Devices

510(k) Number K083707