The Reverse Shoulder Prosthesis is indicated for treatment of humeral fractures and for primary or revision total shoulder replacement in patients with a grossly rotator cuff deficient shoulder joint with severe arthroplasty 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 glenoid baseplate is intended for cementless application with the addition of screws for fixation.

Device Description

The Glenoid Polyaxial Non-locking Screws are line extensions to the Medacta Shoulder Reverse System (K170452) and the Threaded Glenoid Baseplate (K171058); and provide compatibility with Short Humeral Stem (K180089).

The Glenoid Polyaxial Non-locking Screws implants subject of this submission are comprised of the following products: Glenoid Polyaxial non-locking screw, 10 sizes: from L14 mm to L50 mm with 4mm increment. The Glenoid Polyaxial Non-locking Screws implants are part of the Medacta Shoulder Reverse System. The Medacta Shoulder Reverse System consists of the following components: Humeral Diaphysis Cemented; Humeral Diaphysis Cementless; Humeral Reverse Metaphysis; Humeral Reverse HC Liner (also referred to as PE Liner); Glenoid Baseplate - Pegged; Glenoid Baseplate - Threaded; Glenoidsphere; Glenoid Polyaxial Locking Screw (predicate item); Glenoid Polyaxial Non-Locking Screw (subject item); Reverse Metaphysis Screw; and Glenoidsphere Screw.

The Glenoid Baseplate (pegged version and threaded version) is intended to be fixed on the glenoid bone by means of a central pressfit and with the help of Glenoid Polyaxial Screws. The purpose of this submission is to gain clearance for the new Medacta Glenoid Polyaxial Non-Locking Screws, thus providing to surgeons an alternative to Glenoid Polyaxial Locking Screws for the Glenoid Baseplate fixation process.

The Glenoid Polyaxial Non-Locking Screws are made of Ti-6Al-4V), enhanced with Type-II anodization, according to ISO 5832-3:1996 Implants For Surgery - Metallic Materials - Part 3: Wrought Titanium 6-Aluminum 4-Vanadium Alloy.

AI/ML Overview

The provided text describes a 510(k) premarket notification for a medical device, specifically Glenoid Polyaxial Non-locking Screws. This document focuses on demonstrating substantial equivalence to predicate devices through a comparison of physical characteristics and mechanical testing. It does not involve AI/ML components or clinical studies that would require the type of acceptance criteria and performance data typically associated with AI/ML devices (e.g., sensitivity, specificity, algorithm-only performance, human reader studies with AI assistance).

Therefore, the requested information regarding AI/ML acceptance criteria and performance (ground truth, expert adjudication, MRMC studies, training/test set details) is not applicable to this submission.

The "Performance Data" section (Section VII) only details non-clinical, mechanical tests.

Here's a summary of the available information relevant to acceptance criteria and the study that proves the device meets them:

1. Table of Acceptance Criteria and Reported Device Performance

The document mentions that "Testing was conducted according to written protocols with acceptance criteria that were based on standards." However, the specific quantitative acceptance criteria and the numerical reported device performance are not detailed in the provided text. It lists the types of tests performed and the relevant ASTM standards, implying that meeting these standards was the acceptance criterion.

Test Name	Acceptance Criteria (Implied)	Reported Device Performance
Design Validation Report	Meets design specifications	Not explicitly stated; implied by "demonstrated through comparison..."
Micromotions Assessment (ASTM F2028-14)	Conforms to standard requirements	Not explicitly stated
Static Fatigue Testing (ASTM F543-13)	Conforms to standard requirements	Not explicitly stated
Pull-Out Test (ASTM F543-17)	Conforms to standard requirements	Not explicitly stated
Bacterial Endotoxin Test (European Pharmacopoeia §2.6.14/USP chapter <85>)	Meets pyrogenicity standards	Not explicitly stated
Pyrogen Test (USP chapter <151>)	Meets pyrogenicity standards	Not explicitly stated

2. Sample Size Used for the Test Set and Data Provenance

This is not an AI/ML study, so the concept of test sets for algorithm performance doesn't apply. The "sample size" would refer to the number of devices or components tested in the mechanical studies. This information is not provided in the text. The data provenance is implied to be from internal laboratory testing conducted by Medacta International SA.

3. Number of Experts Used to Establish Ground Truth and Qualifications

Not applicable. Ground truth as typically understood in AI/ML (e.g., expert labels for images) is not relevant for this type of mechanical device submission.

4. Adjudication Method for the Test Set

Not applicable.

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

Not applicable. This is a mechanical device, not an AI-assisted diagnostic tool. No human reader studies were conducted or are relevant to this type of submission.

6. Standalone (Algorithm Only) Performance

Not applicable. This is a physical device, not an algorithm.

7. Type of Ground Truth Used

Not applicable in the context of AI/ML. For mechanical testing, the "ground truth" would be established by the physical properties and performance characteristics defined by the referenced ASTM and European Pharmacopoeia standards.

8. Sample Size for the Training Set

Not applicable. There is no AI/ML training set.

9. How the Ground Truth for the Training Set was Established

Not applicable.

Summary

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Medacta International SA % Chris Lussier Director, Quality and Regulatory Medacta USA 3973 Delp Street Memphis, Tennessee 38118

Re: K181826

Trade/Device Name: Glenoid Polyaxial Non-locking Screws Regulation Number: 21 CFR 888.3660 Regulation Name: Shoulder joint metal/polymer semi-constrained cemented prosthesis Regulatory Class: Class II Product Code: PHX, KWS, HSD, MBF Dated: November 14, 2018 Received: November 16, 2018

Dear Chris Lussier:

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/cdrh/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

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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 devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.htm); 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,

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

Enclosure

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2.0 510(k) Summary

I. Submitter

Medacta International SA Strada Regina 6874 Castel San Pietro (CH) Switzerland Phone (+41) 91 696 60 60 Fax (+41) 91 696 60 66

Contact Person: Stefano Bai, Regulatory Affairs Manager, Medacta International SA Date Prepared: July 6, 2018

II. Device

Device Proprietary Name:	Glenoid Polyaxial Non-locking Screw
Common or Usual Name:	Screw for Shoulder Prosthesis
Classification Name:	Shoulder joint metal/polymer semi-constrained cemented prosthesis
Primary Product Code:	PHX, KWS, HSD and MBF
Regulation Number:	21 CFR 888.3660, 21 CFR 888.3690, and 21 CFR 888.3670
Device Classification	II

III. Predicate Device

Substantial equivalence is claimed to the following devices:

. Glenoid Polyaxial Locking Screw (Medacta Shoulder Reverse System), K170452, Medacta International SA:
Delta Xtend™ Reverse Shoulder System, K062250 and K071379, DePuy Orthopaedics, Inc; ●
SMR 1M Modular Shoulder Replacement System, K100858, Lima; and
AEQUALISTM REVERSED II Shoulder Prosthesis, K112144, Wright Medical - Tornier.

IV. Device Description

The Glenoid Polyaxial Non-locking Screws implants subject of this submission are comprised of the following products:

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Glenoid Polyaxial non-locking screw, 10 sizes: from L14 mm to L50 mm with 4mm increment. ● The Glenoid Polyaxial Non-locking Screws implants are part of the Medacta Shoulder Reverse System. The Medacta Shoulder Reverse System consists of the following components:

Humeral Diaphysis Cemented: ●
Humeral Diaphysis Cementless; ●
Humeral Reverse Metaphysis;
Humeral Reverse HC Liner (also referred to as PE Liner); ●
Glenoid Baseplate - Pegged;
. Glenoid Baseplate - Threaded:
Glenoidsphere: ●
Glenoid Polyaxial Locking Screw (predicate item);
Glenoid Polyaxial Non-Locking Screw (subject item); ●
Reverse Metaphysis Screw; and ●
Glenoidsphere Screw. ●

The Glenoid Polyaxial Non-Locking Screws are similar to the predicate devices Medacta Glenoid Polyaxial Locking Screw (K170452), DePuy Delta Xtend™ Reverse Shoulder System (K062250 and K071379), Lima SMRTM Modular Shoulder Replacement System (K100858) and Tornier AEQUALIS™ REVERSED II Shoulder Prosthesis (K112144).

V. Indications for Use

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 glenoid baseplate is intended for cementless application with the addition of screws for fixation.

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VI. Comparison of Technological Characteristics

The Glenoid Polyaxial Non-Locking Screws and the predicate devices share the following characteristics:

indications for use;
head design (with exception of Medacta Locking Screw predicate, K170452); ●
thread design;
ROM:
material of construction;
biocompatibility:
device usage:
sterility;
shelf life; and
packaging. ●

The Glenoid Polyaxial Non-Locking Screws are technologically different from the predicate devices as follows:

. sizes and lengths.
The subject Glenoid Polyaxial Non-Locking Screws have technological characteristics of the Medacta predicate device Glenoid Polyaxial Locking Screws (K170452) with the only exception of the Non-Locking mechanism, feature shared with the other predicates: the Non-Locking screws possess a cylindrical shaped head which allows for the insertion and placement of the implant into the dedicated seat of the baseplate, compressing it on the glenoid vault; on the other hand, the Locking screws own a "petal shaped" head which can also expand in order to lock its position into the baseplate.

The subject Glenoid Polyaxial Non-Locking Screws provide a wider range of lengths if compared to predicate devices and these length options do not represent worst cases because the length of the screws does not have any influence on the mechanical properties (torque resistance and pull-out strength).

Biocompatibility testing conducted on the predicate devices for the same or similar materials supports the biological safety of the Glenoid Polyaxial Non-Locking Screws. Subject and predicate devices are manufactured from the following material: Titanium Alloy (Ti-6Al-4V) ISO 5832-3:1996 Implants For Surgery - Metallic Materials - Part 3: Wrought Titanium 6-Aluminum 4-Vanadium Alloy.

This material has an extensive amount of biocompatibility data that has been provided in the listed predicate devices 510(k) submissions Medacta Glenoid Polyaxial Locking Screw (K170452), DePuy Delta Xtend™ (K062250 and K071379), Lima SMR™ Modular Shoulder Replacement System (K100858) and Wright Medical - Tornier AEQUALISTM REVERSED II Shoulder Prosthesis (K112144).

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VII. Performance Data

Testing was conducted according to written protocols with acceptance criteria that were based on standards. The following mechanical studies were performed in support of a substantial equivalence determination:

Non-Clinical Studies:

Characterization Tests
- o Design Validation Report.
Performance Tests ●
- Micromotions Assessment In Reverse Configuration: ASTM F2028-14: Standards o Test Methods For Dynamic Evaluation of Glenoid Loosening Or Disassociation Prostheses:
- Static Fatigue Testing: ASTM F543-13: Standard Specification And Test Methods o For Metallic Medical Bone Screws; and
- Pull-Out Test: ASTM F543-17: Standard Specification and Test Methods for Metallic o Medical Bone Screws.
Pyrogenicity
- Bacterial Endotoxin Test (LAL test) was conducted according to European o Pharmacopoeia §2.6.14 (which is equivalent to USP chapter <85>) and pyrogen test according to USP chapter <151> for pyrogenicity determination; and
- O the subject devices are not labeled as non-pyrogenic or pyrogen free.

Clinical Studies:

No clinical studies were conducted. ●

VIII. Conclusion

Based on the above information, the Glenoid Polyaxial Non-Locking Screws are substantially equivalent to the identified predicate devices.

Substantial equivalence has been demonstrated through a comparison of intended use, design, and technological characteristics, as well as performance evaluations. The Glenoid Polyaxial Non-Locking Screws implants are as safe and effective as the predicate devices Medacta Glenoid Polyaxial Locking Screw (K170452), DePuy Delta Xtend™ (K062250 and K071379), Lima SMRTM Modular Shoulder Replacement System (K100858), and Wright Medical - Tornier AEQUALIS™ REVERSED II Shoulder Prosthesis (K112144).

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

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

510(k) Number (if known)

K181826

Device Name Glenoid Polyaxial Non-Locking Screws

Indications for Use (Describe)

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 glenoid baseplate is intended for cementless application with the addition of screws for fixation.

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.

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Regulation Number and Section

§ 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.”