K Number
K183544
Device Name
Efficient Care 3D Planning
Date Cleared
2019-08-23

(246 days)

Product Code
Regulation Number
892.2050
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Efficient Care 3D Planning is software indicated for assisting orthopedic surgeons in preoperative planning of knee orthopedic surgeries. The software allows for the overlaying of 3D/2D implant models and for the visualization of the radiological images and 3D reconstruction of bones, and includes tools for performing measurements on the images or 3D model of bones, and for selecting and positioning the implant model. Clinical judgments and experience are required to properly use the software. Efficient Care 3D Planning is to be used with the following fixed bearing knee replacement systems in accordance with their indications and contraindications: NexGen CR, NexGen CR-Flex Gender, NexGen CR-Flex Gender, NexGen LPS, NexGen LPS-Flex, NexGen LPS-Flex Gender, Persona® CR, Persona PS, Vanguard® CR, and Vanguard PS.
Device Description
Efficient Care 3D Templating is software application that is intended to assist in the preoperative sizing of femoral and tibial implants. The software solution allows for the processing of multiple 2D X-rays to create 3D bone models that scales to patient bones and compensates for patient leg rotation in the X-rays images. The 3D bone models allow implant sizing to occur and output a template report, which includes overlays of prostheses, in respect to leg orientations on the X-ray images. Final implant sizing is based on intraoperative surgeon assessment.
More Information

Not Found

No
The summary describes image processing and 3D modeling techniques for preoperative planning, but there is no mention of AI or ML algorithms being used for tasks like image analysis, prediction, or decision support. The "Mentions AI, DNN, or ML" field is explicitly marked as "Not Found".

No
This device is software for preoperative planning and assisting surgeons, not directly treating a disease or condition.

No

Explanation: The device is described as software for preoperative planning and assisting with implant sizing for knee orthopedic surgeries. It aids in visualization and measurement but does not make a diagnosis or determine the cause of a disease or condition. It explicitly states that "Clinical judgments and experience are required to properly use the software" and "Final implant sizing is based on intraoperative surgeon assessment," indicating it is a tool for planning and not a diagnostic device.

Yes

The device description explicitly states it is a "software application" and the performance studies include "Software Verification & Validation Testing," indicating it is a software-only device. While it processes 2D X-rays, it does not mention any associated hardware components being part of the device itself.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices intended for use in the collection, preparation, and examination of specimens taken from the human body (such as blood, urine, or tissue) to provide information for the diagnosis, treatment, or prevention of disease.
  • Device's Intended Use: The intended use of "Efficient Care 3D Planning" is for assisting orthopedic surgeons in the preoperative planning of knee orthopedic surgeries. It uses imaging data (2D X-rays) to create 3D models and assist with implant sizing and positioning.
  • No Specimen Examination: The device does not involve the collection, preparation, or examination of any specimens taken from the human body. It operates on medical images.

Therefore, while it is a medical device used in the healthcare setting, its function falls outside the scope of In Vitro Diagnostics.

N/A

Intended Use / Indications for Use

Efficient Care 3D Planning is software indicated for assisting orthopedic surgeons in preoperative planning of knee orthopedic surgeries. The software allows for the overlaying of 3D/2D implant models and for the visualization of the radiological images and 3D reconstruction of bones, and includes tools for performing measurements on the images or 3D model of bones, and for selecting and positioning the implant model. Clinical judgments and experience are required to properly use the software.

Efficient Care 3D Planning is to be used with the following fixed bearing knee replacement systems in accordance with their indications and contraindications: NexGen CR, NexGen CR-Flex Gender, NexGen CR-Flex Gender, NexGen LPS, NexGen LPS-Flex, NexGen LPS-Flex Gender, Persona® CR, Persona PS, Vanguard® CR, and Vanguard PS.

Product codes

LLZ

Device Description

Efficient Care 3D Templating is software application that is intended to assist in the preoperative sizing of femoral and tibial implants. The software solution allows for the processing of multiple 2D X-rays to create 3D bone models that scales to patient bones and compensates for patient leg rotation in the X-rays images. The 3D bone models allow implant sizing to occur and output a template report, which includes overlays of prostheses, in respect to leg orientations on the X-ray images. Final implant sizing is based on intraoperative surgeon assessment.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

2D X-rays

Anatomical Site

Knee bones (femoral and tibial)

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Orthopedic surgeons for preoperative planning of knee orthopedic surgeries.

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)

Implant Predictability Tests:
Objective: To confirm that the Efficient Care device could accurately predict the correct implant size within ±2 sizes in 90% of cases when the magnification sphere object is present and to evaluate the accuracy of the system quantitatively.
Key results: The predicted preop implant size was compared to the post-op implant size to assess the performance of the size evaluation aspect of the Efficient Care device.

Biocompatibility Testing:
Conducted in accordance with ISO 10993. The evaluation reveals that the Efficient Care device meets biocompatibility requirements.

Software Verification & Validation Testing:
Testing was conducted and documentation was provided as recommended by FDA's Guidance for Industry and FDA Staff, "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices". The software was considered as a "moderate level of concern", since a failure or latent design flaw could lead to an erroneous diagnosis or a delay in delivery of appropriate medical care that would likely lead to Minor Injury.

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

Accuracy of implant size prediction within ±2 sizes in 90% of cases.

Predicate Device(s)

K161828

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 892.2050 Medical image management and processing system.

(a)
Identification. A medical image management and processing system is a device that provides one or more capabilities relating to the review and digital processing of medical images for the purposes of interpretation by a trained practitioner of disease detection, diagnosis, or patient management. The software components may provide advanced or complex image processing functions for image manipulation, enhancement, or quantification that are intended for use in the interpretation and analysis of medical images. Advanced image manipulation functions may include image segmentation, multimodality image registration, or 3D visualization. Complex quantitative functions may include semi-automated measurements or time-series measurements.(b)
Classification. Class II (special controls; voluntary standards—Digital Imaging and Communications in Medicine (DICOM) Std., Joint Photographic Experts Group (JPEG) Std., Society of Motion Picture and Television Engineers (SMPTE) Test Pattern).

0

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 and 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.

Orthosoft, Inc. (d/b/a Zimmer CAS) Paul Hardy Sr. Regulatory Specialist 75 Queen St., Suite 3300 MONTREAL, QC, H3C 2N6 CANADA

Re: K183544

Trade/Device Name: Efficient Care 3D Planning Regulation Number: 21 CFR 892.2050 Regulation Name: Picture Archiving and Communications System Regulatory Class: Class II Product Code: LLZ Dated: July 22, 2019 Received: July 23, 2019

Dear Paul Hardy:

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.

August 23, 2019

1

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 devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-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

Thalia T. Mills, Ph.D. Director Division of Radiological Health OHT7: Office of In Vitro Diagnostics and Radiological Health Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K183544

R10044

Device Name Efficient Care 3D Planning

Indications for Use (Describe)

Efficient Care 3D Planning is software indicated for assisting orthopedic surgeons in preoperative planning of knee orthopedic surgeries. The software allows for the overlaying of 3D/2D implant models and for the visualization of the radiological images and 3D reconstruction of bones, and includes tools for performing measurements on the images or 3D model of bones, and for selecting and positioning the implant model. Clinical judgments and experience are required to properly use the software.

Efficient Care 3D Planning is to be used with the following fixed bearing knee replacement systems in accordance with their indications and contraindications: NexGen CR, NexGen CR-Flex Gender, NexGen CR-Flex Gender, NexGen LPS, NexGen LPS-Flex, NexGen LPS-Flex Gender, Persona® CR, Persona PS, Vanguard® CR, and Vanguard PS.

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

In accordance with 21 CFR §807.92 and the Safe Medical Devices Act of 1990, the following information is provided for the Efficient Care 3D Planning 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: | Orthosoft, Inc (d/b/a. Zimmer CAS)
75 Queen St., Suite 3300
Montreal, QC, CANADA H3C 2N6
Establishment Registration Number: 9617840 |
|-----------------|----------------------------------------------------------------------------------------------------------------------------------------------|
| Contact Person: | Paul Hardy
Regulatory Affairs Sr. Specialist
Telephone: 574-372-6799 |
| Date: | August 19, 2019 |
| Subject Device: | Trade Name: Efficient Care 3D Planning
Common Name: Image Processing System |
| | Classification Name:
• LLZ-Picture Archiving and Communications System
(21 CFR 892.2050) |

Predicate Device(s):

ManufacturerDevice Name510(k) Number
ONEFIT medical,
Inc.kneeEOSK161828

Purpose and Device Description:

Efficient Care 3D Templating is software application that is intended to assist in the preoperative sizing of femoral and tibial implants. The software solution allows for the processing of multiple 2D X-rays to create 3D bone models that scales to patient bones and compensates for patient leg rotation in the X-rays images. The 3D bone

4

models allow implant sizing to occur and output a template report, which includes overlays of prostheses, in respect to leg orientations on the X-ray images. Final implant sizing is based on intraoperative surgeon assessment.
Indications for Use:Efficient Care 3D Planning is software indicated for assisting orthopedic surgeons in preoperative planning of knee orthopedic surgeries. The software allows for the overlaying of 3D/2D implant models and for the visualization of the radiological images and 3D reconstruction of bones, and includes tools for performing measurements on the images or 3D model of bones, and for selecting and positioning the implant model. Clinical judgments and experience are required to properly use the software.
Efficient Care 3D Planning is to be used with the following fixed bearing knee replacement systems in accordance with their indications and contraindications: NexGen® CR, NexGen CR-Flex, NexGen CR-Flex Gender, NexGen LPS, NexGen LPS-Flex, NexGen LPS-Flex Gender, Persona® CR, Persona PS, Vanguard® CR, and Vanguard PS.
Summary of Technological Characteristics:The rationale for substantial equivalence is based on consideration of the following characteristics:
Indications for Use: Efficient Care and the predicate device have similar indications for uses.Design Features: Both software packages have the following features: Efficient Care and the predicate device utilize x-ray image(s) for image segmentation and processingEfficient Care and the predicate device provide the capability to visualize 3D models of the boneEfficient Care and the predicate device provide preoperative sizing valuesEfficient Care and the predicate device provide tools to improve visualization, perform implant measurements to choose, size and position the
  • implant Efficient Care and the predicate device export a PDF O planning report for surgeon review

5

Summary of Performance Data (Nonclinical and/or Clinical)

Efficient Care has been evaluated through the following non-clinical testing

Implant Predictability Tests O

The objective of these tests were to confirm that the Efficient Care device could accurately predict the correct implant size within ±2 sizes in 90% of cases when the magnification sphere object is present and to evaluate the accuracy of the system quantitatively. The predicted preop implant size was compared to the post-op implant size to assess the performance of the size evaluation aspect of the Efficient Care device.

Biocompatibility Testing о

The biocompatibility evaluation for Efficient Care was conducted in accordance with ISO 10993. The evaluation reveals that the Efficient Care device meets biocompatibility requirements.

Software Verification & Validation Testing o

Testing was conducted and documentation was provided as recommended by FDA's Guidance for Industry and FDA Staff, "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices". The software was considered as a "moderate level of concern", since a failure or latent design flaw could lead to an erroneous diagnosis or a delay in delivery of appropriate medical care that would likely lead to Minor Injury.

Substantial Equivalence Conclusion

The subject device has the same intended use, similar indications for use, technological characteristics and principles of operation as the predicate device. The differences between the subject device and the predicate device does not introduce new types of safety and effectiveness questions. Therefore, the proposed device is at least as safe and effective as the legally marketed predicate device.