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The SMR Modular Glenoid and liner is intended for use in total primary or revision shoulder joint replacement with the SMR Anatomic Shoulder System.

The SMR Anatomic Shoulder System is indicated for patients suffering from disability due to:

• Non-inflammatory degenerative joint disease including osteoarthritis and avascular necrosis; .
• Inflammatory degenerative joint disease such as rheumatoid arthritis; .
• Treatment of acute fractures of the humeral head that cannot be treated with other fracture . fixation methods:
• Revision of a failed primary implant; .
• . Cuff tear arthropathy (CTA Heads only).

The SMR Metal Backed Glenoid/Liner construct when used as part of the SMR Anatomic Shoulder Replacement, is intended for use with bone cement and should be used without bone screws.

The L1 6mm liners are a line extension of the existing SMR Glenoid liners that are used with the SMR Modular Glenoid and SMR TT Metal Back Glenoid. These components are used in anatomic total shoulder replacements as part of the SMR Anatomic Shoulder System. When used for SMR anatomic shoulder replacement, the SMR Modular Glenoid and SMR TT Metal Back Glenoid are intended to be used with bone cement.

The L1 6mm liners are manufactured from UHMWPE (ISO 5834-2 - ASTM F648) and are available in four sizes (Small-R, Small, Standard and Large).

A snap-fit mechanism is used to attach the liner to the glenoid metal back component. Four protrusions on the upper surface of the metal-back glenoid and the conformity between the spherical shaped upper surface of the metal-back and back-side surface of the liner help ensure stability of the coupling.

The articulating surface has a radius of curvature greater than the corresponding humeral head allowing translation in the superior/inferior and anterior/posterior directions. The liners are intended to articulate with all Limacorporate SMR standard and CTA humeral heads. There is no restriction in regard to the pairing of different sizes of humeral heads and glenoid components and each humeral head size can be combined with each glenoid size.

This document is a 510(k) premarket notification from the FDA for a medical device called the "SMR Modular Glenoid." This type of document is for demonstrating substantial equivalence to a legally marketed predicate device, rather than proving that a device meets specific acceptance criteria through an independent study. Therefore, robust clinical study details in the context of AI/ML performance metrics are not present here.

However, based on the non-clinical testing section, we can infer some information relevant to the device's performance and the "study" conducted.

Here's the breakdown based on the provided text, while acknowledging that it's not a study proving AI/ML performance:

1. Table of acceptance criteria and the reported device performance:

Note: The specific numerical acceptance criteria (e.g., maximum shear force, number of cycles for dynamic testing) are not provided in this document.

2. Sample sized used for the test set and the data provenance:

• Sample size: Not explicitly stated for either static shear or dynamic testing. Typically, mechanical testing involves a small number of samples (e.g., n=3 or n=5) per test condition.
• Data provenance: The tests were conducted by Limacorporate S.p.A., the manufacturer, in Italy. These are non-clinical (laboratory/mechanical) tests.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:

This information is not applicable as this document describes mechanical testing of a physical implant device, not diagnostic performance of an AI/ML system. Ground truth in this context would refer to material properties and engineering specifications, not expert consensus on medical images or diagnoses.

4. Adjudication method for the test set:

This is not applicable. Adjudication methods like 2+1 or 3+1 are used for resolving disagreements among human readers in interpreting diagnostic data, which is not relevant to mechanical device testing.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:

This is not applicable. This document describes an orthopedic implant, not an AI/ML diagnostic or assistive device. Therefore, no MRMC study or AI assistance was involved.

6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done:

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

7. The type of ground truth used:

For mechanical testing, the "ground truth" is typically defined by:

• Engineering specifications and design requirements.
• Established material properties (e.g., ISO 5834-2 - ASTM F648 for UHMWPE).
• Industry standards for mechanical strength and fatigue testing.
• Performance of predicate devices under similar test conditions.

8. The sample size for the training set:

This is not applicable. As a physical device, there is no "training set" in the context of machine learning. The design and manufacturing process involves iterative development and testing, but not in the sense of an ML model training.

9. How the ground truth for the training set was established:

This is not applicable. As there is no training set in the AI/ML sense, there is no ground truth established for it. The design criteria for the device are based on biomechanical principles, clinical needs, and predicate device performance.

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The SMR Modular Glenoid is intended for use in total primary or revision shoulder joint replacement with either the SMR Anatomic Shoulder System or the SMR Reverse Shoulder system.

The SMR Anatomic Shoulder System is indicated for patients suffering from disability due to:

• Non-inflammatory degenerative joint disease including osteoarthritis and avascular necrosis:
• Inflammatory degenerative joint disease such as rheumatoid arthritis; ●
• Treatment of acute fractures of the humeral head that cannot be treated with other . fracture fixation methods;
• Revision of a failed primary implant; ●
• Cuff tear arthropathy (CTA Heads only); .

In the US, the SMR Metal Backed Glenoid/Liner construct, used as part of the SMR Anatomic Shoulder Replacement, is intended for use with bone cement and should be used without bone screws.

The SMR Reverse Shoulder System is indicated for primary, fracture or revision total shoulder replacement in a grossly rotator cuff deficient joint with severe arthropathy (disabling shoulder). The patient's joint must be anatomically and structurally suited to receive the selected implants and a functional deltoid muscle is necessary to use the device.

The SMR Metal Backed Glenoid/Connector/Glenosphere construct. used as part of the SMR Reverse Shoulder replacement, is intended for uncemented use with the addition of screws for fixation.

The SMR Modular Glenoid consists of a metal-back and a liner; when used without cement, bone screws are used for additional fixation. These components are used in total shoulder replacements: the SMR Modular Glenoid metal-backs can be used either in anatomical replacement (when coupled with SMR Modular Glenoid liners) or in reverse replacement (when coupled with previously cleared glenospheres and connectors). The SMR Metal Backed Glenoid and Liner construct, when used as part of a SMR Anatomic Shoulder Replacement is intended for use with bone cement and should be used without bone screws. The SMR Metal Backed Glenoid, Connector and Glenosphere construct, when used as part of a SMR Reverse Shoulder Replacement is intended for uncemented use with the addition of screws for fixation. The size large metal back is not suitable for coupling with 36 mm concentric glenosphere.

Metal-backed glenoids are made from Ti6A14V. The backside surface of the metal-back is plasma spray titanium coated. Four sizes (small, Standard and Large) are available.

Liners are manufactured from UHMWPE. In anatomical replacement, these devices are intended to be coupled with the SMR Modular Glenoid metal-backs and articulate with previously cleared SMR standard or CTA humeral heads. Liners are available in four sizes (small-R, Small, Standard and Large).

The liner articulating surface has a radius of curvature greater than the corresponding humeral head allowing translation in the superior/inferior and anterior/posterior directions. The SMR system has no restriction in regard to the pairing of different sizes of humeral heads and glenoid components. Each humeral head size can be combined with each glenoid size.

Bone screws are manufactured from titanium alloy Ti6AI4V (ASTM F1472 - ISO 5832-3). Bone screws have a diameter of 6.5 mm and are available in lengths from 20 to 40 mm.

Here's an analysis of the provided text regarding the SMR Modular Glenoid, focusing on the acceptance criteria and study details. It's important to note that this document is a 510(k) summary for premarket notification, which typically focuses on demonstrating substantial equivalence to existing devices rather than new proof of safety and effectiveness through extensive clinical trials. Therefore, the information provided often differs from what might be found in a full PMA (Premarket Approval) application for novel devices.

Acceptance Criteria and Device Performance

The document does not explicitly state "acceptance criteria" in a quantitative, pass/fail manner. Instead, it describes non-clinical testing performed to demonstrate that the SMR Modular Glenoid's performance is comparable or superior to the predicate devices and that it can "perform under expected clinical conditions." The implied acceptance criteria are that the device performs equivalently or better than the predicates in the specified mechanical tests.

Table of Acceptance Criteria and Reported Device Performance

Study Details

1. Sample Size Used for the Test Set and Data Provenance:

   • Test Set Sample Size: The document does not specify exact sample sizes for each non-clinical test conducted. It states that "All mechanical testing was done on worst case components or constructs." This implies multiple samples were tested for each scenario, but quantitative numbers are not provided.
   • Data Provenance: The tests are non-clinical (laboratory/mechanical testing), not human subject data. The manufacturer is Limacorporate S.p.A. in Udine, Italy. The testing would have been conducted in a laboratory setting, likely in Italy or a certified testing facility hired by the manufacturer. The data is prospective for these tests, as they were specifically performed for this 510(k) submission.

2. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts:

   • This is not applicable as the "test set" refers to mechanical testing of the device, not human data requiring expert ground truth. The "ground truth" here is the physical performance and material properties determined by testing equipment and protocols.

3. Adjudication Method for the Test Set:

   • Not applicable. Adjudication methods like 2+1 or 3+1 refer to expert review of medical images or patient outcomes, which is not relevant for mechanical testing.

4. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:

   • Not applicable. This device is a shoulder implant, not an AI-assisted diagnostic tool. No MRMC studies were performed.

5. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was done:

   • Not applicable. This device is a physical medical implant, not a software algorithm.

6. The Type of Ground Truth Used:

   • The "ground truth" for the non-clinical tests was established through standardized mechanical engineering tests using established protocols (some referencing "standard test methods" to allow comparison to predicate devices). This involves physical measurements, stress/strain analysis, and material property evaluations.

7. The Sample Size for the Training Set:

   • Not applicable. This device does not involve a "training set" in the context of machine learning or AI.

8. How the Ground Truth for the Training Set was Established:

   • Not applicable. As there's no training set for AI, there's no ground truth established in this manner.

Summary of the Study for Substantial Equivalence:

The study conducted for the SMR Modular Glenoid was a non-clinical bench testing program. The primary goal was to demonstrate that the device is substantially equivalent to legally marketed predicate devices. This was achieved by:

• Design and Material Comparison: Highlighting similarities in intended use, indications, design (minor modifications like lugs for versatility), and materials (Ti6A14V, UHMWPE) to the predicate devices.
• Mechanical Testing: Performing a series of mechanical tests on the SMR Modular Glenoid, including:
  • Static Shear Testing
  • Dynamic Testing
  • Plasma Spray Titanium Coating tests (Adhesion, Shear, Shear Fatigue, Abrasion)
  • Range of Motion simulation
• Worst-Case Scenarios: Conducting mechanical tests on "worst case components or constructs" to ensure robustness.
• Standard Test Methods: Utilizing standard test methods where possible to facilitate comparison with predicate device testing.
• Conclusion: The testing results "demonstrated the device's ability to perform under expected clinical conditions," implicitly indicating that its performance was comparable or superior to the predicate devices, thereby supporting the claim of substantial equivalence.

Clinical Testing: The document explicitly states: "Clinical Testing: Clinical testing was not necessary to demonstrate substantial equivalence of the SMR Modular Glenoid to the predicate devices." This is common for 510(k) submissions where sufficient non-clinical data and comparison to predicates can establish equivalence.

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