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The restor3d rTSA System is indicated for use in patients whose shoulder joint has a grossly deficient rotator cuff with severe arthropathy and/or previously failed shoulder joint replacement with a grossly deficient rotator cuff. The patient must be anatomically and structurally suited to receive the implants and a functional deltoid muscle is necessary.

The restor3d rTSA System is indicated for primary, fracture, or revision total shoulder replacement for the relief of pain and significant disability due to gross rotator cuff deficiency.

Glenoid component with porous surface is indicated for uncemented biological fixation application only. The restor3d rTSA System glenoid baseplate components are intended for cementless application with the addition of screw fixation.

Humeral components with porous surface are indicated for either cemented or uncemented applications.

The restor3d Reverse Total Shoulder Arthroplasty System is intended for patients requiring a reverse shoulder replacement for patients with a functional deltoid muscle and with a deficient rotator cuff. The restor3d Reverse Total Shoulder Arthroplasty System consists of the glenoid baseplate, glenosphere intraoperatively affixed to the baseplate, humeral stem, and polymer bearing component affixed to the humeral stem. Additionally, the system includes supporting standard instrument trays and all required accessories (e.g., security screws, peripheral screws).

The provided text is a 510(k) clearance letter for a medical device: the restor3d Reverse Total Shoulder Arthroplasty System. This document focuses on demonstrating substantial equivalence to a predicate device through non-clinical testing. It explicitly states, "The restor3d Reverse Total Shoulder Arthroplasty System was subject to the following non-clinical performance tests to support the assertion of substantial equivalence."

Therefore, the document describes engineering and material performance testing, not a clinical study involving human patients or analysis of clinical images/data using an AI algorithm. The questions posed in your prompt (e.g., acceptance criteria for device performance/accuracy, sample size for test set/training set, number of experts for ground truth, MRMC study, standalone performance) are typically relevant for AI/ML-enabled medical devices or devices requiring clinical performance studies.

Since the provided text does not describe an AI/ML-enabled device or a clinical study that would generate "device performance" in terms of accuracy, sensitivity, specificity, etc., against a clinical ground truth, I cannot fill out the requested table or answer most of the specific questions.

Here's an explanation based on the provided text, highlighting why the requested information isn't present:

Context from the document:

• Device Type: Reverse Total Shoulder Arthroplasty System (a physical implant)
• Regulatory Pathway: 510(k) (seeking substantial equivalence to a legally marketed predicate)
• Testing Described: "Non-Clinical Testing" which includes:
  • Glenoid Baseplate Loosening per ASTM F2028
  • Glenoid Baseplate Fatigue and corrosion analysis
  • Morse Taper Disassembly Strength per ASTM F2009
  • Humeral Stem Fatigue and corrosion analysis
  • Bone Screw Testing per ASTM F543
  • Poly Liner Performance Tests per ASTM F1820
  • Range of Motion Analysis per ASTM F1378
  • Wear Analysis

These are all benchtop, mechanical, and material science tests designed to show that the new device performs similarly from an engineering standpoint to the predicate and meets established ASTM standards for orthopedic implants. They do not involve "device performance" in terms of clinical accuracy or an AI algorithm's predictive capability.

Therefore, I cannot fulfill your request as it pertains to acceptance criteria and studies typically associated with AI/ML or diagnostic devices that produce "performance" metrics against clinical ground truth.

However, if we interpret "acceptance criteria" and "device performance" within the context of mechanical/material testing as presented in the document, here's what could be inferred, though it won't directly answer your specific table columns:

The "acceptance criteria" for this device would be implicit in meeting the requirements of the cited ASTM standards, such as surviving a certain number of fatigue cycles at a given load, or meeting specific wear rates, or exhibiting particular disassembly strengths. The "reported device performance" would be the results from these bench tests, demonstrating that the device did indeed meet those standard specifications.

To directly address your prompts based on the absence of the requested information in the provided document:

Description of Acceptance Criteria and Study to Prove the Device Meets Them (Based on provided document)

The provided FDA 510(k) clearance letter for the restor3d Reverse Total Shoulder Arthroplasty System primarily relies on non-clinical bench testing to demonstrate substantial equivalence to a predicate device. This submission does not describe a clinical study of diagnostic or predictive performance, nor does it discuss AI model performance. Therefore, the requested information regarding AI/ML-specific acceptance criteria, test set details, expert involvement for ground truth, or MRMC studies is not present in this document.

The "acceptance criteria" for this device are implicitly tied to its ability to meet the performance requirements of established ASTM (American Society for Testing and Materials) standards for orthopedic implants, and to demonstrate comparable mechanical and material characteristics to its predicate device. The "study that proves the device meets the acceptance criteria" refers to a series of non-clinical benchtop tests.

1. Table of Acceptance Criteria and Reported Device Performance:

Note: The provided 510(k) summary only lists the types of tests performed and states they support substantial equivalence. It does not provide the specific numerical acceptance thresholds or the detailed numerical results from these non-clinical tests. This level of detail would typically be found in the full 510(k) submission not in the public clearance letter summary.

Regarding other specific questions (not applicable based on the document's content):

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

• Not applicable. The "test set" here refers to physical implant samples subjected to bench testing, not a dataset of clinical cases for an AI algorithm. The document does not specify the number of physical samples used for each test. Data provenance (country, retrospective/prospective) is not relevant for bench testing of a physical implant.

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

• Not applicable. Ground truth in this context is established by engineering standards (e.g., ASTM specifications, material properties) and physical measurements on the device, not by expert medical review of clinical data.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set:

• Not applicable. This method applies to expert review of clinical cases, not mechanical 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:

• Not applicable. An MRMC study is for evaluating human performance (often with or without AI assistance) in interpreting clinical data. This document describes a physical implant, not an AI diagnostic tool.

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

• Not applicable. This refers to AI algorithm performance. No AI algorithm is described.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.):

• Not applicable in the clinical sense. Ground truth for this device is based on engineering standards (ASTM), material specifications, and physical measurements demonstrating the device's mechanical and material properties are equivalent to the predicate and meet safety requirements.

8. The sample size for the training set:

• Not applicable. This refers to AI model training data. No AI model is described.

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

• Not applicable. This refers to AI model training data. No AI model is described.

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The Kinos Total Ankle System is indicated for patients with ankle joints damaged by severe rheumatoid, post-traumatic, or degenerative arthritis. The Kinos Total Ankle System is additionally indicated for patients with failed previous ankle surgery. The Kinos Total Ankle System is intended for cement use only.

The subject Kinos Total Ankle System consists of implant and instrument components designed to preserve motion in patients with ankle arthritis or previously failed ankle surgery. The device is a fixed bearing and semi-constrained implant construct, intended for replacement of the articulating surfaces of the ankle that have been affected by a disease state or injury. The subject device provides limited mobility to a patient by restoring alignment of the articulating surfaces, reducing pain, and providing flexion- extension movement within the ankle joint. The tibial and talar implants are intended to be used with bone cement. The subject Kinos Total Ankle System consists of three implant components - a tibial implant affixed to the tibia, a bearing implant assembled to the tibial implant and a talar implant affixed to the talus. The tibial implant and bearing implant, assembled intraoperatively, function together and articulate with the talar implant to create a fixed bearing prosthesis, replacing the articulating surface of the tibiotalar joint. The subject line extension includes tibial segments which are assembled intraoperatively to the tibial base plate to enhance tibial fixation height in the tibia.

This document is a 510(k) Summary for the Kinos Total Ankle System. It describes the device, its intended use, and its substantial equivalence to predicate devices. However, it does not contain any information about acceptance criteria or a study proving the device meets those criteria, particularly not in the context of an AI/ML-driven device.

The Kinos Total Ankle System is a physical medical device (an ankle prosthesis), and the submission is for an expansion of indications for use. The performance testing section specifically states: "No performance testing was performed to establish substantial equivalence of the subject device to the predicates." Instead, a "dimensional analysis comparison of device components and a surgical technique comparison" was conducted.

Therefore, I cannot provide the requested information, as the provided text relates to a traditional medical device and its regulatory submission, not a study validating an AI/ML device's performance against specific acceptance criteria.

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The r3 Tibial Implants of the Kinos Total Ankle System are indicated for revision total ankle arthroplasty. The Kinos Total Ankle System is intended for cement use only.

The subject line extension to the Kinos Total Ankle System are implant and instrument components designed to preserve motion in patients with ankle arthritis or previously failed ankle surgery. The device is a fixed bearing and semi-constrained implant construct, intended for replacement of the articulating surfaces of the ankle that have been affected by a disease state or injury. The subject device provides limited mobility to a patient by restoring alignment of the articulating surfaces, reducing pain, and providing flexion-extension movement within the ankle joint. The tibial and talar implants are intended to be used with bone cement. The subject Kinos Total Ankle System consists of three implant components - a tibial implant affixed to the tibia, a bearing implant assembled to the tibial implant and a talar implant affixed to the talus. The tibial implant and bearing implant, assembled intraoperatively, function together and articulate with the talar implant to create a fixed bearing prosthesis, replacing the articulating surface of the tibiotalar joint. The extension includes tibial segments which are assembled intraoperatively to the tibial base plate to enhance tibial fixation height in the tibia.

The provided document is an FDA 510(k) clearance letter for the Kinos Total Ankle System. This document focuses on the substantial equivalence of a new device (a line extension) to a previously cleared predicate device, rather than the performance of an AI/ML device.

Therefore, the information required to answer the prompt (acceptance criteria, study details for AI/ML device performance, sample sizes, expert involvement, ground truth, etc.) is not present in this document.

The document details the device's classification, indications for use, and a summary of performance testing primarily related to mechanical properties of the implant (e.g., fatigue testing, bone stability, assembly tests, porous surface characterization). This is typical for a medical device clearance that is a physical implant, not a software or AI/ML diagnostic tool.

In summary, this document does not contain the information requested in your prompt regarding AI/ML device acceptance criteria and performance study details.

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The restor3d Kinos Axiom Total Ankle System is indicated for patients with ankle joints damaged by severe rheumatoid, post-traumatic, or degenerative arthritis. The restor3d Kinos Total Ankle System is additionally indicated for patients with failed previous ankle surgery. The restor3d Kinos Axiom Total Ankle System is intended for cement use only.

The subject restor3d Kinos Axiom Total Ankle System is an implant and instrument system designed to preserve motion in patients with ankle arthritis or previously failed ankle surgery. The device is a fixed bearing and semi-constrained implant construct, intended for replacement of the articulating surfaces of the ankle that have been affected by a disease state or injury. The device provides limited mobility to a patient by restoring alignment of the articulating surfaces, reducing pain, and providing flexion-extension movement within the ankle joint. The device is intended to be used with bone cement. The subject restor3d Kinos Axiom Total Ankle System consists of three implant components - a tibial implant affixed to the tibia, a bearing implant assembled to the tibial implant and a talar implant affixed to the talus. The tibial implant and bearing implant, assembled intraoperatively, function together and articulate with the talar implant to create a fixed bearing prosthesis, replacing the articulating surface of the tibiotalar joint.

The additively manufactured r3 talar dome and Vitamin E, cross-linked ultra-high molecular weight polyethylene (UHMWPE) r3 bearing component, subject of this 510(k), are compatible with:

• All Kinos Axiom Total Ankle System Tibial Tray Components and associated . instrumentation cleared via K192778
• All Kinos Axiom Total Ankle System X-Stem Tibial Components and associated . instrumentation cleared via K232595

This document is a 510(k) Summary for the restor3d Kinos Axiom Total Ankle System, which is a medical device. It does not describe an AI/ML-based device or a study involving human readers and AI assistance. The performance testing mentioned (ASTM F2665, engineering analyses) pertains to the mechanical and physical properties of the ankle implant, not to the performance of a software algorithm.

Therefore, most of the requested information (e.g., acceptance criteria for AI performance, sample size for test set/training set, ground truth establishment for AI, expert consensus, MRMC studies) is not applicable to this document.

The document discusses:

• Device Name: restor3d Kinos Axiom Total Ankle System
• Regulation Number: 21 CFR 888.3110 (Ankle Joint Metal/Polymer Semi-Constrained Cemented Prosthesis)
• Regulatory Class: Class II
• Product Code: HSN
• Indications for Use: Patients with ankle joints damaged by severe rheumatoid, post-traumatic, or degenerative arthritis, or failed previous ankle surgery. Intended for cement use only.
• Predicate Devices: Primarily INFINITY Total Ankle System (K123954) and SALTO TALARIS Total Ankle Prosthesis (K182878).
• Device Description: An implant and instrument system designed to preserve motion in patients with ankle arthritis or previously failed ankle surgery. It's a fixed bearing and semi-constrained implant construct, consisting of a tibial implant, a bearing implant (Vitamin E, cross-linked UHMWPE), and a talar implant (additively manufactured r3 talar dome).
• Performance Testing:
  • Contact Area Testing per ASTM F2665
  • Constraint Testing per ASTM F2665
  • Range of Motion Testing per ASTM F2665
  • Locking Mechanism Fatigue Strength Analysis per ASTM F2665
  • Implant Strength Engineering Analysis per ASTM F2665
  • Wear Engineering Analysis per ASTM F2665
• Conclusion: The device is substantially equivalent to predicate devices, and changes (additively manufactured talar component, Vitamin E cross-linked UHMWPE bearing component, design/size changes) do not raise new safety or effectiveness concerns.

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The Axiom PSR System is intended to be used as patient specific surgical planning and instrumentation to assist in the positioning of total ankle replacement components intraoperatively, and in guiding bone cutting. The Axiom PSR System is intended for use with the Kinos Axiom Total Ankle System and its cleared indications for use.

restor3d's Axiom PSR System is an ankle surgical guide system, designed for an individual patient from the patient's CT imaging scans. The subject Axiom PSR System is intended to aid in the placement of Kinos Axiom Total Ankle System (K192778) implant components when used in conjunction with the Kinos Axiom standard, reusable instruments. The Axiom PSR System includes preoperative plans developed with and approved by the operative surgeon, tibia and talus resection guides, manufactured from implant grade titanium, bone models manufactured from biocompatible polymer for use with the Kinos Axiom Total Ankle System.

The restor3d Axiom PSR System is a patient-specific surgical planning and instrumentation system designed to assist in the positioning of total ankle replacement components intraoperatively and in guiding bone cutting. The information provided does not include specific acceptance criteria with numerical thresholds. However, the study conducted aims to demonstrate that the Axiom PSR System is at least as accurate as, or more accurate than, the previously cleared Kinos Axiom Total Ankle System standard instruments alone, with respect to implant placement relative to the pre-operative plan in six degrees of freedom.

Here's a breakdown of the requested information based on the provided document:

1. Table of Acceptance Criteria and Reported Device Performance:

The document does not provide a table with specific numerical acceptance criteria. Instead, it states a comparative performance objective.

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

• Sample Size for Test Set: The document mentions "cadaver testing" but does not specify the number of cadavers or individual surgical procedures performed.
• Data Provenance: Retrospective or Prospective is not explicitly stated, but "cadaver testing" implies a controlled, experimental setting, likely
  prospective for the purpose of the study. The origin (country/region) of the cadavers is not mentioned.

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

This information is not provided in the document. The ground truth ("pre-operative plans") is established as a digital design workflow, which is later compared to post-operative CT scans. The experts involved in creating these pre-operative plans and evaluating the post-operative scans are not specified.

4. Adjudication Method for the Test Set:

The document mentions that post-operative CT scans were obtained, and the final implant positions were evaluated in 3D space about six degrees of freedom and then compared to the pre-operative plans. It does not describe any specific multi-reviewer adjudication method (e.g., 2+1, 3+1). The evaluation method appears to be a direct comparison of physical outcomes (post-operative CT) to digital plans.

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

A multi-reader multi-case (MRMC) comparative effectiveness study was not explicitly stated or described. The study compared the device's performance to the standard method rather than comparing human readers with and without AI assistance. The "AI" aspect is in the patient-specific surgical planning and guiding, not in assisting human readers in diagnosis or interpretation.

6. Standalone Performance (Algorithm Only without Human-in-the-Loop Performance):

This aspect is not directly applicable in the typical sense of standalone AI performance for diagnostic algorithms. The Axiom PSR System is a surgical guidance system, and its "performance" is inherently tied to its use in a surgical setting. The digital design workflow is an algorithmic process that creates the patient-specific guides and plans, but the "standalone" performance isn't measured in isolation from the surgical act. The evaluation "compared to the pre-operative plans" could be considered an evaluation of the system's output (the guides) against its intended design.

7. Type of Ground Truth Used:

The ground truth for comparison was the "pre-operative plans." These plans are a digital design output, established through a digital design workflow. The "final implant positions" from post-operative CT scans were then compared against these pre-operative plans.

8. Sample Size for the Training Set:

The document does not provide any information regarding a training set sample size. The Axiom PSR System is a patient-specific device based on individual patient CT scans, not a machine learning model that requires a separate training set for algorithm development in the traditional sense. The "digital design workflow" is likely based on established biomechanical and engineering principles rather than supervised machine learning requiring a training dataset.

9. How the Ground Truth for the Training Set Was Established:

Since there is no mention of a training set or a machine learning model requiring such a set, this information is not applicable based on the provided document. The device's functionality is based on individual patient imaging and a digital design workflow to create custom surgical guides and plans, not on learning from a large labeled training dataset.

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