Coonrad/Morrey Total Elbow: Indications include: post-traumatic lesions or bone loss contributing to elbow instability; ankylosed joints, especially in cases of bilateral ankylosis from causes other than sepsis; advanced rheumatoid or degenerative arthritis with incapacitating pain: revision arthroplasty, and instability or loss of motion when the degree of joint damage precludes less radical procedures. The candidate for total elbow arthroplasty should exhibit joint destruction which significantly compromises the activities of daily living. Patient with single joint involvement (generally those with traumatic or degenerative arthritis) or significant lower extremity disability which require walking aids are less amenable to treatment than patients with advanced and predominantly upper extremity involvement. If possible, elbow replacement should be done after hip or knee surgery to avoid excessive stress to the prosthesis required by crutch walking during total hip or knee rehabilitation.

Zimmer Nexel Total Elbow: Indications for use include: Elbow joint destruction which significantly compromises the activities of daily living; Post-traumatic lesions or bone loss contributing to elbow instability; Ankylosed joints, especially in cases of bilateral ankylosis from causes other than active sepsis; Advanced rheumatoid, post-traumatic, or degenerative arthritis with incapacitating pain; Instability or loss of motion when the degree of joint or soft tissue damage precludes reliable osteosynthesis; Acute comminuted articular fracture of the elbow joint surfaces that precludes less radical procedures, including 13-C3 fractures of the distal humerus; Revision arthroplasty. Caution: This device is intended for cemented use only.

Device Description

The Coonrad/Morrey Total Elbow and Zimmer Nexel Total Elbow are total elbow prosthesis designed for use with bone cement. They are available in multiple sizes and in right and left configurations. The devices are designed to replace the articulating surfaces of and restore motion to the humeroulnar (elbow) joint. The implants are constrained in design and consist of a humeral component and an ulna component joined through bearings in a hinged fashion. The purpose of this submission is the addition of MR conditional language to the labeling for these products. The addition of MR labeling to the subject devices does not impact indications, materials, design features or dimensions of the components, compatibility, packaging or sterilization. Additionally, this submission includes minor modifications to the subject device systems.

AI/ML Overview

The provided text is a 510(k) summary for the Zimmer Nexel Total Elbow and Coonrad/Morrey Total Elbow. It concerns the addition of MR conditional language to the product labeling and minor design modifications, not a study evaluating device performance against specific clinical acceptance criteria. Therefore, most of the requested information regarding acceptance criteria and a study proving the device meets those criteria cannot be extracted from this document.

However, I can provide information on what was studied and the conclusions drawn related to substantial equivalence:

1. Table of Acceptance Criteria and Reported Device Performance:

The document does not present clinical acceptance criteria for the elbow prostheses themselves (e.g., pain reduction, range of motion improvement). Instead, it focuses on the performance related to MR Conditional safety. The acceptance criteria are implicit in the adherence to ASTM standards for MRI compatibility.

Acceptance Criteria (based on ASTM Standards for MR Conditional)	Reported Device Performance
No excessive RF heating (ASTM F2182-11a)	Studies performed to determine MR Conditional
Acceptable image distortion (ASTM F2119-07)	Studies performed to determine MR Conditional
Acceptable magnetically induced displacement force (ASTM 2052-14)	Studies performed to determine MR Conditional
Satisfactory CEM43 analysis	Studies performed to determine MR Conditional
Engineering rationale for minor design modifications	Engineering rationale and testing provided to support minor design modifications

2. Sample Size for Test Set and Data Provenance:

Sample Size: Not applicable in the traditional sense of a clinical trial. The "test set" here refers to the Zimmer Nexel Total Elbow and Coonrad/Morrey Total Elbow implants that underwent MRI compatibility testing. The document does not specify the number of individual implants tested for these non-clinical evaluations, but it refers to the performance of "implants."
Data Provenance: The tests were non-clinical (laboratory/engineering) as performed by Biomet (presumably the manufacturer, as Zimmer is also the manufacturer listed). The location/country of origin of the testing facility is not specified. The studies are by nature prospective in the sense that they were conducted specifically for this submission to address MRI safety.

3. Number of Experts and Qualifications for Ground Truth:

Not applicable. This was a non-clinical evaluation based on adherence to engineering standards (ASTM) for MRI safety. Ground truth was established by the specified ASTM test methods. No human expert consensus was used for establishing MRI compatibility ground truth; it's a technical outcome.

4. Adjudication Method for Test Set:

Not applicable. Non-clinical engineering tests do not typically involve adjudication methods like those used in clinical image interpretation studies. The results are quantitative and determined by the test protocol.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study:

No, a MRMC comparative effectiveness study was not done. The submission is for non-clinical testing related to MRI safety and minor design modifications, not for assessing human reader performance or the clinical effectiveness of the elbow prostheses themselves.

6. Standalone Performance (Algorithm Only):

Not applicable. This submission is for medical devices (total elbow prostheses), not a software algorithm.

7. Type of Ground Truth Used:

For the MRI compatibility studies, the ground truth was based on established engineering standards and measurements as defined by ASTM F2503-13, F2182-11a, F2119-07, and F2052-14.
For the minor design modifications, the ground truth was based on engineering rationale and testing to demonstrate that the modifications do not negatively impact device performance or safety.

8. Sample Size for Training Set:

Not applicable, as this is not a machine learning or AI-based device requiring a training set.

9. How Ground Truth for Training Set Was Established:

Not applicable.

Summary

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

Zimmer Inc Patricia Beres Regulatory Affairs Principal P.O. Box 708 Warsaw, Indiana 46581-0708

Re: K181307

Trade/Device Name: Zimmer Nexel Total Elbow, Connrad/Morrey Total Elbow Regulation Number: 21 CFR 888.3150 Regulation Name: Elbow joint metal/polymer constrained cemented prosthesis Regulatory Class: Class II Product Code: JDC Dated: December 18, 2018 Received: December 19, 2018

Dear Patricia 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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrl/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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) for

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devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.html; good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 comprehensive regulatory information about mediation-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,

Image /page/1/Picture/5 description: The image shows the name Michael C. Owens -S. The image also shows that the document was digitally signed by Michael C. Owens -S on January 28, 2019. The time stamp on the document is 15:14:12-05'00'.

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

Enclosure

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Form Approved: OMB No. 0910-0120

Expiration Date: 06/30/2020

See PRA Statement below

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K181307

Device Name Coonrad/Morrey Total Elbow

Indications for Use (Describe)

Indications include: post-traumatic lesions or bone loss contributing to elbow instability; ankylosed joints, especially in cases of bilateral ankylosis from causes other than sepsis; advanced rheumatoid or degenerative arthritis with incapacitating pain: revision arthroplasty, and instability or loss of motion when the degree of joint damage precludes less radical procedures.

The candidate for total elbow arthroplasty should exhibit joint destruction which significantly compromises the activities of daily living. Patient with single joint involvement (generally those with traumatic or degenerative arthritis) or significant lower extremity disability which require walking aids are less amenable to treatment than patients with advanced and predominantly upper extremity involvement. If possible, elbow replacement should be done after hip or knee surgery to avoid excessive stress to the prosthesis required by crutch walking during total hip or knee rehabilitation.

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 PRAStaff@fda.hhs.gov

"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."

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Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: 06/30/2020 See PRA Statement below.

510(k) Number (if known) K181307

Device Name Zimmer Nexel Total Elbow

Indications for Use (Describe)

Indications for use include:

Elbow joint destruction which significantly compromises the activities of daily living
Post-traumatic lesions or bone loss contributing to elbow instability
Ankylosed joints, especially in cases of bilateral ankylosis from causes other than active sepsis
Advanced rheumatoid, post-traumatic, or degenerative arthritis with incapacitating pain
Instability or loss of motion when the degree of joint or soft tissue damage precludes reliable osteosynthesis
Acute comminuted articular fracture of the elbow joint surfaces that procedures, including 13-C3 fractures of the distal humerus
Revision arthroplasty

Caution: This device is intended for cemented use only.

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

X 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.

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"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."

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510(k) Summary

In accordance with 21 CFR §807.92 and the Safe Medical Devices Act of 1990, the following information is provided for the Comprehensive Shoulder System 510(k) premarket notification. The submission was prepared in accordance with the FDA guidance document, 'Format for Traditional and Abbreviated 510(k)s', issued on August 12, 2005.

Sponsor:	Zimmer, Inc.P.O. Box 708Warsaw, IN 46581-0708Establishment Registration Number:
Contact Person:	Patricia Sandborn BeresRegulatory Affairs PrincipalTelephone: (574-267-6639)Fax: fax (574-372-1683)
Date:	January 25, 2019
Subject Device:	Trade Name: Coonrad/Morrey Total ElbowZimmer Nexel Total Elbow
	Common Name: Total Elbow Prosthesis
	Classification Name: Elbow joint metal/polymer constrained cementedprosthesis (21 CFE 8888 3150)

Product Code: JDC

Predicate Device(s): All predicate devices are manufactured by Zimmer Inc.

Device	510(k)Number
Zimmer Nexel Total Elbow	K150501
Coonrad/Morrey Total Elbow	K053189
Coonrad/Morrey Total Elbow	K040389
Coonrad/Morrey Total Elbow	K001989
Coonrad/Morrey Total Elbow	K973357

Purpose and Device Description:

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The purpose of this submission is the addition of MR conditional language to the labeling for these products. The addition of MR labeling to the subject devices does not impact indications, materials, design features or dimensions of the components, compatibility, packaging or sterilization. Additionally, this submission includes minor modifications to the subject device systems.

Intended Use and Indications for Use:

Coonrad/Morrey Total Elbow

Indications include: post-traumatic lesions or bone loss contributing to elbow instability; ankylosed joints, especially in cases of bilateral ankylosis from causes other than sepsis; advanced rheumatoid or degenerative arthritis with incapacitating pain; revision arthroplasty, and instability or loss of motion when the degree of joint damage precludes less radical procedures.

Zimmer Nexel Total Elbow

Indications for use include:

Elbow joint destruction which significantly compromises the activities of daily living
Post-traumatic lesions or bone loss contributing to elbow instability -
Ankylosed joints, especially in cases of bilateral ankylosis from causes other than active sepsis
-Advanced rheumatoid, post-traumatic, or degenerative arthritis with incapacitating pain
Instability or loss of motion when the degree of joint or soft tissue damage precludes reliable osteosynthesis
Acute comminuted articular fracture of the elbow joint surfaces that precludes less radical procedures, including 13-C3 fractures of the distal humerus
Revision arthroplasty -

Caution: This device is intended for cemented use only

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Summary of Technological

Characteristics:

The rationale for substantial equivalence is based on consideration of the following characteristics:

Intended Use: Identical to predicate ●
Indications for Use: Identical to predicate 0
Materials: Identical to predicate
Design Features: Identical to predicate ●
Sterilization: Identical to predicate ●

Summary of Performance Data

(Nonclinical and/or Clinical)

0 Non-Clinical Tests:
- Biomet has performed non-clinical Magnetic Resonance Imaging (MRI) O studies on implants which are determined to be MR Conditional in accordance to ASTM F2503-13 Standard Practice for Marking Medical Devices and Other Items for Safety in the Magnetic Resonance Environment. MR Tests included the following:
  - RF heating- ASTM F2182-11a ■
  - Image Distortion- ASTM F2119-07
  - Magnetically Induced Displacement Force - ASTM 2052-14
  - CEM43 analysis
- Engineering rationale and testing have been provided to support the minor o design modifications
Clinical Tests: 0
- O None provided

Substantial Equivalence

Conclusion

Non-clinical tests provided in this Traditional 510(k) establish the conditional safety and compatibility of the passive implants in a magnetic resonance (MR) environment. The subject devices are substantially equivalent to the legally marketed predicated devices.

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.”