(88 days)
No
The document describes a mechanical implant for shoulder surgery and does not mention any AI or ML components or functionalities.
Yes
The device is an orthopedic implant designed for revision shoulder surgeries, directly treating a medical condition and improving patient health.
No.
The provided text describes the AltiVate Anatomic™ to Reverse Conversion Module as a device indicated for revision surgeries of the shoulder joint, specifically for converting a previously failed total shoulder arthroplasty to a reverse shoulder arthroplasty. It is a surgical implant designed for treatment, not for diagnosing a condition.
No
The device description clearly indicates that the device is a "reverse conversion module" which is a physical component designed to be mated with a humeral stem. The performance studies also mention "FEA analysis for stress analysis" and "Bacterial endotoxin testing," which are tests typically performed on physical medical devices, not software.
Based on the provided information, this device is not an IVD (In Vitro Diagnostic).
Here's why:
- IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
- Device Description and Intended Use: The description and intended use clearly state that this device is a surgical implant used for revising shoulder joint replacements. It is a physical component implanted into the patient's body.
- Lack of Mention of Biological Samples: There is no mention of the device interacting with or analyzing biological samples.
- Focus on Mechanical Function: The description focuses on the mechanical function of the device in converting a traditional shoulder replacement to a reverse shoulder replacement.
Therefore, the AltiVate Anatomic™ to Reverse Conversion Module is a surgical implant, not an in vitro diagnostic device.
N/A
Intended Use / Indications for Use
The AltiVate Anatomic™to Reverse Conversion Module is indicated for revision surgeries in patients with a grossly rotator cuff deficient shoulder joint with severe arthropathy or a previously failed joint replacement with a grossly rotator cuff deficient shoulder joint. The patient's joint must be anatomically and structurally suited to receive the selected implant(s), and a functional deltoid muscle is necessary to use the device. The conversion module is only indicated for use with a well fixed AltiVate Anatomic Humeral Stem.
Humeral components with a porous coated surface are indicated for either cemented or uncemented applications. The glenoid baseplate is intended for cementless application with the addition of screws for fixation.
Product codes (comma separated list FDA assigned to the subject device)
PHX, KWS, PAO
Device Description
In cases of revision surgeries to a well fixed AltiVate Humeral Stem, a reverse conversion module can be mated with the AltiVate stem to convert to a reverse shoulder application.
The currently cleared AltiVate™ Anatomic humeral stem will a conversion module to provide an option to revise a failed traditional total shoulder arthroplasty to a reverse shoulder arthroplasty without the need to remove a well fixed humeral stem.
Mentions image processing
Not Found
Mentions AI, DNN, or ML
Not Found
Input Imaging Modality
Not Found
Anatomical Site
shoulder joint
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)
Non-Clinical Testing: FEA analysis for stress analysis has determined that the subject device is similar to the evaluated predicate device.
Endotoxin Assessment: Bacterial endotoxin testing was conducted and was found to meet the expected endotoxin limits.
Clinical Testing: Clinical testing was not required / performed.
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.
K162024, K041066, K111629, K092873
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.
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
§ 888.3660 Shoulder joint metal/polymer semi-constrained cemented prosthesis.
(a)
Identification. A shoulder joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace a shoulder joint. The device limits translation and rotation in one or more planes via the geometry of its articulating surfaces. It has no linkage across-the-joint. This generic type of device includes prostheses that have a humeral resurfacing component made of alloys, such as cobalt-chromium-molybdenum, and a glenoid resurfacing component made of ultra-high molecular weight polyethylene, and 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,” and
(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,” and
(vii) ISO 9001:1994 “Quality Systems—Model for Quality Assurance in Design/Development, Production, Installation, and Servicing,” and
(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 1044-95 “Test Method for Shear Testing of Porous Metal Coatings,”
(v) F 1108-97 “Specification for Titanium-6 Aluminum-4 Vanadium Alloy Castings for Surgical Implants,”
(vi) F 1147-95 “Test Method for Tension Testing of Porous Metal,”
(vii) F 1378-97 “Standard Specification for Shoulder Prosthesis,” and
(viii) F 1537-94 “Specification for Wrought Cobalt-28 Chromium-6 Molybdenum Alloy for Surgical Implants.”
0
Image /page/0/Picture/0 description: The image contains two logos. The logo on the left is the Department of Health & Human Services - USA logo, which features a stylized depiction of a human figure. The logo on the right is the FDA U.S. Food & Drug Administration logo, with the FDA acronym in a blue square and the full name of the agency written in blue text to the right of the square.
December 26, 2017
Encore Medical, L.P. Teffany Hutto Manager, Regulatory Affairs 9800 Metric Blvd Austin, Texas 78758
Re: K173073
Trade/Device Name: AltiVate Anatomic to Reverse Conversion Module Regulation Number: 21 CFR 888.3660 Regulation Name: Shoulder Joint Metal/Polymer Semi-Constrained Cemented Prosthesis Regulatory Class: Class II Product Code: PHX, KWS, PAO Dated: November 9, 2017 Received: November 13, 2017
Dear Teffany Hutto:
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 Part 807); labeling (21 CFR Part 801); medical device 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.
1
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.
For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).
Sincerely,
Mark N. Melkerson -S
Mark N. Melkerson Director Division of Orthopedic Devices Office of Device Evaluation Center for Devices and Radiological Health
Enclosure
2
| Form Approved: | OMB No. 0910-0120 |
|---|---|
| Expiration Date: | 06/30/2020 |
| See PRA Statement below. |
| 510(k) Number (if known) | K173073 |
|---|---|
| Device Name | AltiVate Anatomic™ to Reverse Conversion Module |
| Indications for Use (Describe) | The AltiVate Anatomic™to Reverse Conversion Module is indicated for revision surgeries in patients with a grossly rotator cuff deficient shoulder joint with severe arthropathy or a previously failed joint replacement with a grossly rotator cuff deficient shoulder joint. The patient's joint must be anatomically and structurally suited to receive the selected implant(s), and a functional deltoid muscle is necessary to use the device. The conversion module is only indicated for use with a well fixed AltiVate Anatomic Humeral Stem. |
| Humeral components with a porous coated surface are indicated for either cemented or uncemented applications. The glenoid baseplate is intended for cementless application with the addition of screws for fixation. |
| 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) |
CONTINUE ON A SEPARATE PAGE IF NEEDED.
This section applies only to requirements of the Paperwork Reduction Act of 1995.
DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.
The burden time for this collection of information is estimated to average 79 hours per response, including the
time to review instructions, search existing data sources, gather and maintain the data needed and complete
and review the collection of information. Send comments regarding this burden estimate or any other aspect
of this information collection, including suggestions for reducing this burden, to:
Department of Health and Human Services
Food and Drug Administration
Office of Chief Information Officer
Paperwork Reduction Act (PRA) Staff
"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB number."
FORM FDA 3881 (7/17)
Page 1 of 1
PSC Publishing Services (301) -443-6740 EF
article the see a contribute the comments of the formation in the first the first and
A F (
3
510(k) Summary
Date: December 15, 2017
Manufacturer: DJO Surgical (legally Encore Medical, L.P.) 9800 Metric Blvd Austin, TX 78758
Contact Person: Teffany Hutto Manager, Regulatory Affairs Phone: (512) 834-6255 Fax: (760) 597-3466 Email: teffany.hutto@djoglobal.com
| Product | Classification | Product Code |
|---|---|---|
| AltiVate Anatomic to Reverse Conversion Module | Class II | PHX, KWS, PAO |
| Product Code | Regulation and Classification Name |
|---|---|
| PHX | Shoulder joint metal/polymer semi-constrained cemented prosthesis per 21 CFR 888.3660 |
| KWS | Shoulder joint metal/polymer semi-constrained prosthesis per 21 CFR 888.3660 |
| PAO | Shoulder joint metal/polymer semi-constrained cemented prosthesis per 21 CFR 888.3660 |
Description:
In cases of revision surgeries to a well fixed AltiVate Humeral Stem, a reverse conversion module can be mated with the AltiVate stem to convert to a reverse shoulder application.
The currently cleared AltiVate™ Anatomic humeral stem will a conversion module to provide an option to revise a failed traditional total shoulder arthroplasty to a reverse shoulder arthroplasty without the need to remove a well fixed humeral stem.
| Component | 510(k) Clearance |
|---|---|
| RSP Socket Inserts | K041066, K051075, K141006 |
| RSP Glenoid Heads | K041066, K051075 |
| RSP Glenoid Baseplate | K041066, K051075 |
Compatible Components
Indications for Use:
The AltiVate Anatomic™ to Reverse Conversion Module is indicated for revision surgeries in patients with a grossly rotator cuff deficient shoulder joint with severe arthropathy or a previously failed joint replacement with a grossly rotator cuff deficient shoulder joint. The patient's joint must be anatomically suited to receive the selected implant(s), and a functional deltoid muscle is necessary to use the device. The conversion module is only indicated for use with a well fixed AltiVate Anatomic Humeral Stem.
Humeral components with a porous coated surface are indicated for either cemented applications. The glenoid baseplate is intended for cementless application with the addition of screws for fixation.
Predicate Devices:
- DJO Surgical AltiVate™ Anatomic Shoulder System K162024 ●
- DJO Surgical Reverse® Shoulder Prosthesis K041066 ●
- DJO Surgical Turon to RSP Conversion Shell K111629 ●
- DJO Surgical RSP Size 44 Heads - K092873
Comparable Features to Predicate Device(s): Features comparable to predicate devices include the same design features, geometry, and dimensions, surface finish, taper angle, indications, intended use, materials, packaging, sterilization, and shelf life.
Key Differences in Subject Device to Predicate Device(s): Insert length, shell length, gage point, taper and shell fillets
4
Non-Clinical Testing: FEA analysis for stress analysis has determined that the subject device is similar to the evaluated predicate device.
Endotoxin Assessment: Bacterial endotoxin testing was conducted and was found to meet the expected endotoxin limits.
Clinical Testing: Clinical testing was not required / performed.
Conclusions: All testing and evaluations demonstrate that the device is substantially equivalent to the predicates identified.