K Number
K171156
Device Name
OMNI Anseris Hip Stem
Manufacturer
Date Cleared
2017-08-17

(119 days)

Product Code
Regulation Number
888.3353
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The OMNI Anseris Hip Stem is intended for use as the femoral component of a primary or revision total hip replacement when used with the Apex Interface™ Acetabular System. The Apex Interface™ Acetabular System articulates with the Apex Modular Femoral Head (Cobalt Chromium or Ceramic). The femoral hip stem is intended for uncemented fixation and single use implantation. These prostheses may be used for hip arthroplasty to treat the following conditions, as appropriate: - Non-inflammatory degenerative joint disease, including osteoarthritis and avascular necrosis; - Rheumatoid arthritis; - Correction of functional deformity; - Congenital dislocation; - Revision procedures where other treatments or devices have failed; - Femoral neck and trochanteric fractures of the proximal femur. The OMNI Anseris Hip Stem is also intended for use in hemiarthroplasty when used with the Apex Bipolar Head. For further details, please refer to the Apex Bipolar Head Instructions for Use.
Device Description
The OMNI Anseris Stem is a "fit and fill" femoral stem with a tapered conical design and is intended for use as the femoral component of a primary or revision total hip replacement when used with the Apex Interface™ Acetabular System.
More Information

Apex Modular Alumina Head, K012918, Apex hip System Bipolar Head, K082468, Apex Hip System Bipolar Head, K100151, Apex Modular Head, +10.5mm offset, K101575, Apex Modular Hip System Biolox delta Femoral Head, K101451, Interface Acetabular System, Acetabular Insert +4 offset, K092443, Omni Skirted Heads, K152919, Apex Modular Hip Stem, K000788, Apex Modular Acetabular Cup, K031110, Apex Modular Acetabular Cup, K112779, Apex HCLA Acetabular Cup Liners, K062489, Apex HCLA Acetabular Liners, K073150, Biopro Bipolar Head, Models 18130-18152, K082705, OMNI Interface Acetabular System, K142201, +4 Offset Acetabular Insert, K101976, ARC Monoblock Hip Stem, K133381

No
The document describes a mechanical hip stem and associated components, with no mention of AI or ML in the intended use, device description, or performance studies.

Yes
The device, a femoral component for total hip replacement, is intended to treat various medical conditions such as degenerative joint disease, rheumatoid arthritis, and fractures, which falls under the definition of a therapeutic device.

No

Explanation: This device is a hip stem, which is an implant used in total hip replacement surgery to replace the femoral component. Its intended use is surgical intervention to treat various hip conditions, not to diagnose them.

No

The device description clearly states it is a "fit and fill" femoral stem, which is a physical implantable device, not software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly describes a surgical implant (femoral component of a hip replacement) used to treat various conditions affecting the hip joint. This is a therapeutic device, not a diagnostic one.
  • Device Description: The description confirms it's a physical implant (femoral stem).
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.) or providing information about a patient's health status based on such analysis. IVDs are designed to be used in vitro (outside the body) to diagnose or provide information about a disease or condition.
  • Anatomical Site: The device is implanted in the hip, which is an in vivo (within the body) application.

Therefore, the OMNI Anseris Hip Stem is a surgical implant, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The OMNI Anseris Hip Stem is intended for use as the femoral component of a primary or revision total hip replacement when used with the Apex Interface™ Acetabular System. The Apex Interface™ Acetabular System articulates with the Apex Modular Femoral Head (Cobalt Chromium or Ceramic). The femoral hip stem is intended for uncemented fixation and single use implantation. These prostheses may be used for hip arthroplasty to treat the following conditions, as appropriate:

  • Non-inflammatory degenerative joint disease, including osteoarthritis and avascular necrosis;
  • Rheumatoid arthritis;
  • Correction of functional deformity:
  • Congenital dislocation:
  • Revision procedures where other treatments or devices have failed;
  • Femoral neck and trochanteric fractures of the proximal femur.

The OMNI Anseris Hip Stem is also intended for use in hemiarthroplasty when used with the Apex Bipolar Head. For further details, please refer to the Apex Bipolar Head Instructions for Use.

Product codes

LZO, LWJ

Device Description

The OMNI Anseris Stem is a "fit and fill" femoral stem with a tapered conical design and is intended for use as the femoral component of a primary or revision total hip replacement when

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

hip

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

The results of testing of the proposed Anseris Hip Stems met the requirements for fatigue strength per ISO 7206-6 and ISO 7206-4 and the range-of-motion requirement per ISO 21535. These test methods are the same used for the predicate device (K043123).

  • HTR-103 Conical Hip Fatigue Testing
  • HTR-062 Conical Tapered Stem Fatigue FEA
  • HTR-104 ROM Analysis
  • HTR-108 ROM Analysis with Bipolar Heads
  • HTR-106 Conical Stem FEA per ASTM F2996-13
  • HTR-107 Solidworks Simulation Verification
  • HTR-109 Conical Stem Bipolar Head Impingement Risk
    Based on the indications for use, technological characteristics, and the comparison to the predicate devices, OMNIlife Science has determined that the OMNI Anseris Hip Stem is substantially equivalent to currently marketed predicate device. Based on the similar intended use, technological characteristics, material and testing, OMNIlife science believes the proposed introduction of skirted heads to be substantially equivalent to the legally marketed predicate.

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

Not Found

Predicate Device(s)

Apex Modular HA Stem, K043123

Reference Device(s)

Apex Modular Alumina Head, K012918, Apex hip System Bipolar Head, K082468, Apex Hip System Bipolar Head, K100151, Apex Modular Head, +10.5mm offset, K101575, Apex Modular Hip System Biolox delta Femoral Head, K101451, Interface Acetabular System, Acetabular Insert +4 offset, K092443, Omni Skirted Heads, K152919, Apex Modular Hip Stem, K000788, Apex Modular Acetabular Cup, K031110, Apex Modular Acetabular Cup, K112779, Apex HCLA Acetabular Cup Liners, K062489, Apex HCLA Acetabular Liners, K073150, Biopro Bipolar Head, Models 18130-18152, K082705, OMNI Interface Acetabular System, K142201, +4 Offset Acetabular Insert, K101976, ARC Monoblock Hip Stem, K133381

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 888.3353 Hip joint metal/ceramic/polymer semi-constrained cemented or nonporous uncemented prosthesis.

(a)
Identification. A hip joint metal/ceramic/polymer semi-constrained cemented or nonporous uncemented prosthesis is a device intended to be implanted to replace a hip joint. This device limits translation and rotation in one or more planes via the geometry of its articulating surfaces. It has no linkage across-the-joint. The two-part femoral component consists of a femoral stem made of alloys to be fixed in the intramedullary canal of the femur by impaction with or without use of bone cement. The proximal end of the femoral stem is tapered with a surface that ensures positive locking with the spherical ceramic (aluminium oxide, A12 03 ) head of the femoral component. The acetabular component is made of ultra-high molecular weight polyethylene or ultra-high molecular weight polyethylene reinforced with nonporous metal alloys, and used with or without bone cement.(b)
Classification. Class II.

0

Image /page/0/Picture/2 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" around the perimeter. Inside the circle is a stylized image of an eagle with its wings spread.

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

August 17, 2017

OMNIlife Science Christina Rovaldi Regulatory Affairs Specialist 480 Paramount Drive Raynham, Massachusetts 02767

Re: K171156

Trade/Device Name: OMNI Anseris Hip Stem Regulation Number: 21 CFR 888.3353 Regulation Name: Hip Joint Metal/Ceramic/Polymer Semi-Constrained Cemented Or Nonporous Uncemented Prosthesis Regulatory Class: Class II Product Code: LZO. LWJ Dated: July 12, 2017 Received: July 13, 2017

Dear Christina Rovaldi:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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

1

Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical devicerelated 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 contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely.

Mark N. Melkerson -S

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

Enclosure

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Indications for Use

510(k) Number (if known) K171156

Device Name OMNI Anseris Hip Stem

Indications for Use (Describe)

The OMNI Anseris Hip Stem is intended for use as the femoral component of a primary or revision total hip replacement when used with the Apex Interface™ Acetabular System. The Apex Interface™ Acetabular System articulates with the Apex Modular Femoral Head (Cobalt Chromium or Ceramic). The femoral hip stem is intended for uncemented fixation and single use implantation. These prostheses may be used for hip arthroplasty to treat the following conditions, as appropriate:

  • · Non-inflammatory degenerative joint disease, including osteoarthritis and avascular necrosis;
  • · Rheumatoid arthritis;
  • · Correction of functional deformity:
  • · Congenital dislocation:
  • · Revision procedures where other treatments or devices have failed;
  • · Femoral neck and trochanteric fractures of the proximal femur.

The OMNI Anseris Hip Stem is also intended for use in hemiarthroplasty when used with the Apex Bipolar Head. For further details, please refer to the Apex Bipolar Head Instructions for Use.

Type of Use (Select one or both, as applicable)
---------------------------------------------------

Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

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510(k) Summary

TABLE 1: 510(k) SUMMARY
Date Summary Prepared08/03/2017
Manufacturer/Distributor/SponsorOMNIlife Science
480 Paramount Drive
Raynham, MA 02767
510(k) ContactChristina Rovaldi
Regulatory Affairs Specialist
OMNIlife Science
480 Paramount Drive
Raynham, MA 02767
Telephone: (774)-226-1857
Fax: (508)-822-6030
Email: crovaldi@omnils.com
Trade NameOMNI Anseris Hip Stem
Common Nameprosthesis, hip, semi-constrained,
metal/ceramic/polymer, cemented or non-porous,
uncemented
prosthesis, hip, semi-constrained, metal/polymer,
uncemented
ClassificationClass II per 21 CFR §888.3353 Hip joint
metal/ceramic/polymer semi-constrained cemented or
nonporous uncemented prosthesis. Product Code – LZO
Class II per 21 CFR §888.3360 Hip joint femoral (hemi-
hip) metallic cemented or uncemented prosthesis.
Product Code – LWJ
Primary Predicate DeviceApex Modular HA Stem
K043123
Additional Predicate DevicesApex Modular Alumina Head, K012918
Apex hip System Bipolar Head, K082468
Apex Hip System Bipolar Head, K100151
Apex Modular Head, +10.5mm offset, K101575
Apex Modular Hip System Biolox delta Femoral Head
K101451
Interface Acetabular System, Acetabular Insert +4
offset, K092443
Omni Skirted Heads, K152919
Apex Modular Hip Stem, K000788
Apex Modular Acetabular Cup, K031110
Apex Modular Acetabular Cup, K112779
Apex HCLA Acetabular Cup Liners, K062489
Apex HCLA Acetabular Liners, K073150
Biopro Bipolar Head, Models 18130-18152, K082705
OMNI Interface Acetabular System, K142201
+4 Offset Acetabular Insert, K101976
ARC Monoblock Hip Stem, K133381
Purpose of SubmissionThis traditional 510(k) premarket notification is being
submitted to obtain clearance for the OMNI Anseris
Stems to expand OMNI's product offering for total hip
arthroplasty.
Intended UseThe OMNI Anseris Hip Stem is intended for use as the
femoral component of a primary or revision total hip
replacement when used with the Apex Interface™
Acetabular System. The Apex Interface™ Acetabular
System articulates with the Apex Modular Femoral
Head (Cobalt Chromium or Ceramic). The femoral hip
stem is intended for uncemented fixation and single use
implantation. These prostheses may be used for hip
arthroplasty to treat the following conditions, as
appropriate:
• Non-inflammatory degenerative joint disease,
including osteoarthritis and avascular necrosis;
• Rheumatoid arthritis;
• Correction of functional deformity;
• Congenital dislocation;
• Revision procedures where other treatments or devices
have failed;
• Femoral neck and trochanteric fractures of the
proximal femur.
The OMNI Anseris Hip Stem is also intended for use in
hemiarthroplasty when used with the Apex Bipolar
Head. For further details, please refer to the Apex
Bipolar Head Instructions for Use.
Device DescriptionThe OMNI Anseris Stem is a "fit and fill" femoral stem
with a tapered conical design and is intended for use as
the femoral component of a primary or revision total hip
replacement when
Sterility and BiocompatibilityThe proposed devices undergo the same validated
sterilization process, using ethylene oxide (EO), as the
validated devices under the sterility assurance level
(SAL) of 10-6. All ethylene oxide residuals are
monitored and well below standard limits. In addition,
OMNI has developed a plan to test endotoxins on all
OMNIlife science device groups through Limulus
amebocyte lysate (LAL) testing. Products have been
segregated into product families based on manufacturing
process and material type and have generated 8 product
groups that will be tested for endotoxins on a quarterly
basis on a yearly rotation. Product will not be released if
the 20 EU/device limit is exceeded.
Substantial Equivalence Summary:
Technology ComparisonThe proposed Anseris Stems are substantially equivalent
to the predicate Apex Modular Stem (K043123) in terms
of the fundamental scientific technology and intended
uses and the reference predicate in terms of design and
materials. Any differences between the proposed and the
predicates are considered minor and do not raise any
different questions of safety and effectiveness.
The proposed devices are composed of titanium alloy,
unalloyed titanium plasma spray, the identical material
used in the manufacture of the predicate device. The
proposed devices have an integral neck and trunnion
rather than separate modular neck components that are
part of the predicate Apex Modular Stem system.
The Anseris hip stem has a "fit and fill" approach, this
proposed stem will have a conical design similar to
OMNIs Apex Modular Stem (K043123).
Substantial Equivalence Summary:The results of testing of the proposed Anseris Hip Stems
K171156Page 4 of 4
Non-Clinical Testingmet the requirements for fatigue strength per ISO 7206-
6 and ISO 7206-4 and the range-of-motion requirement
per ISO 21535. These test methods are the same used
for the predicate device (K043123).
  • HTR-103 Conical Hip Fatigue Testing
  • HTR-062 Conical Tapered Stem Fatigue FEA
  • HTR-104 ROM Analysis
  • HTR-108 ROM Analysis with Bipolar Heads
  • HTR-106 Conical Stem FEA per ASTM F2996-13
  • HTR-107 Solidworks Simulation Verification
    -HTR-109 Conical Stem Bipolar Head Impingement
    Risk
    Based on the indications for use, technological
    characteristics, and the comparison to the predicate
    devices, OMNIlife Science has determined that the
    OMNI Anseris Hip Stem is substantially equivalent to
    currently marketed predicate device. Based on the
    similar intended use, technological characteristics,
    material and testing, OMNIlife science believes the
    proposed introduction of skirted heads to be
    substantially equivalent to the legally marketed
    predicate. |
    | Conclusion Statement | The conclusions drawn from the nonclinical tests
    demonstrate that the devices are safe, as effective, and
    perform as well as or better than the legally marketed
    device |

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