StageOne Disposable Cement Spacer Molds for Temporary Knee Prosthesis

K161273 · Biomet, Inc. · MBB · Jan 25, 2017 · Orthopedic

Device Facts

• Record ID: K161273
• Device Name: StageOne Disposable Cement Spacer Molds for Temporary Knee Prosthesis
• Applicant: Biomet, Inc.
• Product Code: MBB · Orthopedic
• Decision Date: Jan 25, 2017
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 888.3027
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Disposable cement spacer molds are indicated for use to mold a temporary total knee replacement (TKR) for skeletally mature patients undergoing a two-stage procedure due to a septic process. The molded temporary knee prosthesis is indicated for an implantation period of 180 days or less. Because of inherent mechanical limitations of the device material (PALACOS® R+G Bone Cement and Refobacin® Bone Cement R), the molded temporary prosthesis is only indicated for patients who will consistently use traditional mobility assist devices (e.g. crutches, walkers) throughout the implant period.

Device Story

Disposable silicone molds for creating temporary knee spacers; used in two-stage TKR procedures for septic joints. Clinician fills molds with PALACOS® R+G or Refobacin® R bone cement via dispenser/gun or pouring. After curing, clinician removes spacer from mold and implants into joint space. Device remains in situ for ≤180 days until definitive prosthesis implantation. Benefits include temporary joint stabilization and antibiotic delivery during infection treatment. Used in clinical/surgical settings.

Clinical Evidence

No clinical data required. Substantial equivalence established via non-clinical mechanical performance testing and gentamicin elution testing comparing spacers fabricated with PALACOS® R+G and Refobacin® R bone cements against the predicate.

Technological Characteristics

Medical grade silicone molds; femoral and tibial form factors. Used with PALACOS® R+G or Refobacin® R bone cement. Sterile, single-use. No changes to design, materials, or sterilization from predicate.

Indications for Use

Indicated for skeletally mature patients undergoing two-stage TKR procedure due to septic process. Requires consistent use of mobility assist devices (crutches/walkers) during 180-day maximum implantation period.

Regulatory Classification

Identification

Polymethylmethacrylate (PMMA) bone cement is a device intended to be implanted that is made from methylmethacrylate, polymethylmethacrylate, esters of methacrylic acid, or copolymers containing polymethylmethacrylate and polystyrene. The device is intended for use in arthroplastic procedures of the hip, knee, and other joints for the fixation of polymer or metallic prosthetic implants to living bone.

Special Controls

*Classification.* Class II (special controls). The special control for this device is the FDA guidance document entitled “Class II Special Controls Guidance Document: Polymethylmethacrylate (PMMA) Bone Cement.”

Predicate Devices

• Disposable Cement Spacer Molds for Temporary Knee Prosthesis (K050210)

Submission Summary (Full Text)

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Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

January 25, 2017

Biomet, Inc. Ms. Heidi Busz Regulatory Affairs Associate 56 East Bell Drive Warsaw, Indiana 46581

Re: K161273

Trade/Device Name: StageOne™ Disposable Cement Spacer Molds for Temporary Knee Prosthesis Regulation Number: 21 CFR 888.3027 Regulation Name: Polymethylmethacrylate (PMMA) bone cement Regulatory Class: Class II Product Code: MBB, JWH Dated: December 21, 2016 Received: December 22, 2016

Dear Ms. Busz:

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. 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 (reporting of medical devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in

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the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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 the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

# Mark N. Melkerson -S

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

Enclosure

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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: January 31, 2017 See PRA Statement below.

510(k) Number (if known)

# K161273

Device Name

StageOne™ Disposable Cement Spacer Molds for Temporary Knee Prosthesis

Indications for Use (Describe)

Disposable cement spacer molds are indicated for use to mold a temporary total knee replacement (TKR) for skeletally mature patients undergoing a two-stage procedure due to a septic process. The molded temporary knee prosthesis is indicated for an implantation period of 180 days or less. Because of inherent mechanical limitations of the device material (PALACOS® R+G Bone Cement and Refobacin® Bone Cement R), the molded temporary prosthesis is only indicated for patients who will consistently use traditional mobility assist devices (e.g. crutches, walkers) throughout the implant period.

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

| <span style="font-family:Wingdings;">X</span> 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 StageOne™ Knee Spacer Mold 510(k) premarket notification. The submission was prepared as a Traditional 510(k) in accordance with the FDA guidance document, 'Format for Traditional and Abbreviated 510(k)s', issued on August 12, 2005.

| Sponsor: | Biomet Inc.<br>56 East Bell Drive<br>PO Box 587<br>Warsaw, IN 46581<br>Establishment Registration Number: 1825034 |
|-----------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact: | Heidi Busz<br>Regulatory Affairs Associate<br>574-372-4249 |
| Fax: | 574-372-4710 |
| Date: | June 24, 2016 |
| Subject Device: | Trade Name: StageOne™ Disposable Cement Spacer Molds for<br>Temporary Knee Prosthesis<br>Common Name: Bone Cement Knee Spacer Mold; Disposable Cement<br>Spacer Molds for Temporary Knee Prosthesis; StageOne™ Knee Spacer<br>Mold<br>Classification Name:<br>• MBB- Polymethylmethacrylate (PMMA) bone cement, antibiotic<br>(21 CFR 888.3027)<br>• JWH - Knee joint patellofemorotibial polymer/metal/polymer<br>semi-constrained cemented prosthesis (21 CFR 888.3560) |

#### Legally marketed devices to which substantial equivalence is claimed:

- K050210 - Disposable Cement Spacer Molds for Temporary Knee Prosthesis
# Device Description

The disposable cement spacer molds (femoral and tibial) are sterile disposables made of medical grade silicone. They are intended to be filled with PALACOS® R+G Bone Cement or Refobacin® Bone Cement R*, either by injecting with a dispenser/gun, or by pouring the prepared cement into the mold. After the cement cures, the temporary spacers are to be removed from the molds and placed into the joint space. The spacers remain in place (180 days or less) until the second stage of the two-stage procedure is performed to implant a conventional knee joint prosthesis.

# Indications for Use

Disposable cement spacer molds are indicated for use to mold a temporary total knee replacement (TKR) for skeletally mature patients undergoing a two-stage procedure due to a septic process. The molded temporary knee prosthesis is indicated for an implantation period of

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180 days or less. Because of inherent mechanical limitations of the device material (PALACOS® R+G Bone Cement and Refobacin® Bone Cement R*), the molded temporary prosthesis is only indicated for patients who will consistently use traditional mobility assist devices (e.g. crutches, walkers) throughout the implant period.

# Summary of Technological Characteristics

The subject modifications include the removal Cobalt™ G-HV Bone Cement from the Instructions for Use and the addition of PALACOS® R+G Bone Cement and Refobacin® Bone Cement R* for use with the subject device.

The subject modification does not result in any changes to the StageOne™ Knee Spacer Mold design features, materials, sizes, sterilization method, manufacturing process, sterility assurance level, or shelf life of the StageOne™ Knee Spacer Molds.

#### Summary of Performance Data (Nonclinical and/or Clinical)

- . Non-Clinical Tests
- Mechanical performance testing and Gentamicin Elution testing of StageOne® o Knee Spacers fabricated with PALACOS® R+G Bone Cement and Refobacin® Bone Cement R was conducted. The results demonstrated that StageOne® Knee Spacers fabricated with PALACOS® R+G Bone Cement and Refobacin® Bone Cement R possess mechanical and elution characteristics equivalent to those of the predicate device.
- Clinical Tests
- o Clinical data was not required to establish substantial equivalence between the subject StageOne™ Knee Spacer Molds and the predicate device.

# Substantial Equivalence Conclusion

Based on predicate and the subject devices being the same in design, function, fundamental scientific technology, and very similar in indications for use, the subject devices are very similar to the predicate devices and do not introduce any new risks of safety or efficacy. Therefore, Biomet concludes that the subject devices are substantially equivalent to the predicate devices.

*Where available