K Number
K112983
Device Name
SPACER-S
Manufacturer
Date Cleared
2011-12-12

(67 days)

Product Code
Regulation Number
888.3690
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Interspace Shoulder is indicated for temporary use (maximum of 180 days) as a shoulder replacement (SR) in skeletally mature patients undergoing a two-stage procedure due to a septic process. The head and stem are inserted into the glenoideal cavity and the humeral medullary canal, respectively, following removal of the existing implant and radical debridement. The device is intended for use in conjunction with systemic antibiotic therapy (standard treatment approach to an infection). Interspace Shoulder is not intended for use for more than 180 days, at which time it must be explanted and a permanent device implanted or another appropriate treatment performed (e.g. resection arthroplasty, fusion etc.).
Device Description
The Interspace Shoulder devices is a temporary device composed of fully formed PMMA bone cement with gentamicin and an inner stainless steel metal core. The design mimics a hemi-shoulder prosthesis.
More Information

Not Found

No
The 510(k) summary describes a physical implant device made of bone cement and stainless steel, with no mention of software, algorithms, or any AI/ML related terms or functionalities.

Yes

Explanation: The device is a temporary shoulder replacement intended to treat a septic process, which is a therapeutic intervention.

No

The device is a temporary shoulder replacement intended for surgical implantation during a two-stage procedure due to a septic process, and its purpose is therapeutic (replacing a joint), not diagnostic.

No

The device description explicitly states it is composed of PMMA bone cement and a stainless steel metal core, indicating it is a physical implant, not software.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health.
  • Device Description and Intended Use: The provided text clearly describes a physical implantable device (a shoulder replacement) that is surgically inserted into the body. Its purpose is to temporarily replace a joint during a two-stage procedure for infection.
  • Lack of Diagnostic Function: The device itself does not perform any tests on biological samples to diagnose a condition or provide diagnostic information. It is a therapeutic device used in the treatment of an existing condition (septic process).

Therefore, based on the provided information, the Interspace Shoulder is a medical device, specifically an implantable device, but it does not fit the definition of an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

Interspace Shoulder is indicated for temporary use (maximum of 180 days) as a shoulder replacement (SR) in skeletally mature patients undergoing a two-stage procedure due to a septic process. The head and stem are inserted into the glenoideal cavity and the humeral medullary canal, respectively, following removal of the existing implant and radical debridement. The device is intended for use in conjunction with systemic antibiotic therapy (standard treatment approach to an infection). Interspace Shoulder is not intended for use for more than 180 days, at which time it must be explanted and a permanent device implanted or another appropriate treatment performed (e.g. resection arthroplasty, fusion etc.).

Product codes (comma separated list FDA assigned to the subject device)

HSD, KWS

Device Description

The Interspace Shoulder devices is a temporary device composed of fully formed PMMA bone cement with gentamicin and an inner stainless steel metal core. The design mimics a hemi-shoulder prosthesis.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Shoulder, glenoideal cavity, humeral medullary canal

Indicated Patient Age Range

skeletally mature patients

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Performance testing was conducted to verify that implant performance continues to meet the productions specifications and be adequate for in vivo application under the temporary conditions of use. Mechanical properties, gentamicin release and stability data were evaluated and found to support the substantially equivalence of the devices.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K060535

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 888.3690 Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

(a)
Identification. A shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis is a device made of alloys, such as cobalt-chromium-molybdenum. It has an intramedullary stem and is intended to be implanted to replace the articular surface of the proximal end of the humerus and to be fixed without bone cement (§ 888.3027). This device is not intended for biological fixation.(b)
Classification. Class II.

0

510(k) Summary

Christine L. Brauer, Ph.D. Official correspondent: US AGENT Manufacturer/Submitter: Tecres S.p.A. Via A. Doria 6 37066 Sommacampagna Verona - Italy FDA Owner/Operator ID: 9033624 December 9, 2011 Date: 510(k) Number: K112983 Trade/Proprietary model names: Interspace Shoulder Temporary Shoulder Prosthesis with Gentamicin Common name: Semi-constrained Cemented Prosthesis Prosthesis, Shoulder, Device classification name: Hemi-, Humeral, Metallic, Cemented or Uncemented 21 CFR § 888.3690 Classification regulation Class II Regulatory class: Orthopedic Classification panel: HSD - Prosthesis, Shoulder, Hemi-, Humeral, Metallic Classification product code: Uncemented Semi-Constrained, Shoulder. Prosthesis, K WS — Metal/Polymer, Cemented The Interspace Shoulder devices is a temporary device Device description: composed of fully formed PMMA bone cement with gentamicin and an inner stainless steel metal core. The design mimics a hemi-shoulder prosthesis. Indication for Use and IntendedInterspace Shoulder is indicated for temporary use (maximum of 180 days) as a shoulder replacement (SR) in skeletally Use: mature patients undergoing a two-stage procedure due to a septic process. The head and stem are inserted into the glenoideal cavity and the humeral medullary canal, respectively, following removal of the existing implant and radical debridement. The device is

... ..........................................................................................................................................................................

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DEC 1 2 2011

1

| Substantial Equivalence: | intended for use in conjunction with systemic antimicrobia
antibiotic therapy (standard treatment approach to an
infection).
Interspace Shoulder is not intended for use for more than 180
days, at which time it must be explanted and a permanent
device implanted or another appropriate treatment performed
(e.g. resection arthroplasty, fusion etc.). |
|--------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| | The Interspace Shoulder Spacer has the same intended use as
the predicate device, the Interspace Shoulder Spacer cleared
via K060535. Both devices are intended for use as a
temporary shoulder implant for patients undergoing a two-
stage revision procedure due to an infection. |
| | The Tecres Interspace Shoulder Spacer device is substantially
equivalent to itself. The device has previously been cleared:
K060535. The intended use and conditions of use remain the
same. This 510(k) application was submitted for the
introduction of a metal reinforcing structure into the device
and to add a new material supplier. |
| | Performance testing was conducted to verify that implant
performance continues to meet the productions specifications
and be adequate for in vivo application under the temporary
conditions of use. Mechanical properties, gentamicin release
and stability data were evaluated and found to support the
substantially equivalence of the devices. |
| | Based on the same fundamental scientific technology and on
the results of the verification activities, it is concluded that the
modified Tecres Interspace Shoulder Spacer device is
substantially equivalent to legally marketed Tecres spacer
device. |

:

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features the department's emblem, which is a stylized caduceus-like symbol with three lines representing the human form. The emblem is encircled by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA". The text is arranged in a circular fashion around the emblem.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

DEC 1 2 2011

Tecres S.p.A. % Brauer Device Consultants, LLC Christine L. Brauer. Ph.D. Regulatory Affairs Consultant 7 Trailhouse Court Rockville, Maryland 20850

Re: K112983

Trade/Device Name: Tecres Spacer-S Regulation Number: 21 CFR 888.3690 Regulation Name: Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis Regulatory Class: Class II Product Code: HSD, KWS Dated: November 18, 2011 Received: November 18, 2011

Dear Dr. Brauer:

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. Ilsting 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.

3

Page 2 - Christine L. Brauer, Ph.D.

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 (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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fdagov/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/cdrh/mdr/ 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 (301) 796-7100 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

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

Enclosure

4

510(k) Number: K112983

Device Names: Interspace Shoulder

INDICATIONS FOR USE STATEMENT

Interspace Shoulder

Interspace Shoulder is indicated for temporary use (maximum of 180 days) as a shoulder replacement (SR) in skeletally mature patients undergoing a two-stage procedure due to a septic process.

The head and stem are inserted into the glenoideal cavity and the humeral medullary canal, respectively, following removal of the existing implant and radical debridement. The device is intended for use in conjunction with systemic antibiotic therapy (standard treatment approach to an infection). Interspace Shoulder is not intended for use for more than 180 days, at which time it must be explanted and a permanent device implanted or another appropriate treatment performed (e.g. resection arthroplasty, fusion etc.).

Signature of

(Division Sign-Off) (Division Sign-On), Orthopedic, Divisionative Devices

510(k) Number __

Please do not write below this line - use another page if needed.

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Part 21 CFR 801 Subpart D) and/or Over the Counter Use (21 CFR 801 Subpart C)