REVERSE SHOULDER PROSTHESIS MONOBLOCK STEM, REVERSE SHOULDER PROSTHESIS HUMERAL INSERTS, MODEL 510-00-006/012

K100741 · Encore Medical L.P. · PHX · Aug 2, 2010 · Orthopedic

Device Facts

• Record ID: K100741
• Device Name: REVERSE SHOULDER PROSTHESIS MONOBLOCK STEM, REVERSE SHOULDER PROSTHESIS HUMERAL INSERTS, MODEL 510-00-006/012
• Applicant: Encore Medical L.P.
• Product Code: PHX · Orthopedic
• Decision Date: Aug 2, 2010
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 888.3660
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

For treatment of patients with a grossly rotator cuff deficient shoulder joint with severe arthropathy 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. The humeral stem is intended for cemented use only.

Device Story

Reverse Shoulder Prosthesis; orthopedic implant for shoulder joint replacement. Modification of existing RSP device; features monoblock design joining humeral socket with humeral stem; includes additional humeral insert sizes. Used by orthopedic surgeons in clinical/surgical settings. Device replaces damaged joint components to restore function in patients with rotator cuff deficiency. Surgeon selects appropriate implant sizes based on patient anatomy. Output is physical restoration of joint mechanics. Benefits include improved shoulder function and pain relief for patients with severe arthropathy.

Clinical Evidence

No clinical data provided. Substantial equivalence supported by bench testing, including geometric analysis for insert articulation, socket lever-out strength, stress analysis, tolerance analysis, plasma coating characterization, and design comparison.

Technological Characteristics

Metal/polymer semi-constrained cemented prosthesis. Features monoblock humeral component (socket joined to stem). Glenoid baseplate designed for cementless application with screw fixation; humeral stem for cemented use. Verification included plasma coating characterization and material properties review.

Indications for Use

Indicated for patients with grossly rotator cuff deficient shoulder joint with severe arthropathy or failed joint replacement. Requires anatomically/structurally suited joint and functional deltoid muscle.

Regulatory Classification

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).

Special Controls

*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.”

Predicate Devices

• Reverse Shoulder Prosthesis (K041066, K051075, K092873)

Submission Summary (Full Text)

{0}------------------------------------------------

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized caduceus symbol, which is often associated with medicine and healthcare. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the symbol.

#### Public Health Service

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

November 2, 2016

Encore Medical, L.P. Ms. Teffany Hutto Manager, Regulatory Affairs 9800 Metric Boulevard Austin, Texas 78758

Re: K100741

Trade/Device Name: Reverse® Shoulder Prosthesis Regulation Number: 21 CFR 888.3660 Regulation Name: Shoulder joint metal/polymer semi-constrained cemented prosthesis Regulatory Class: Class II Product Code: PHX, KWS Dated: July 6, 2010 Received: July 7, 2010

Dear Ms. Hutto:

This letter corrects our substantially equivalent letter of August 2, 2010.

We have reviewed your Section 510(k) premarket notification of intent to market the device w o no ro rove a your a your ce 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 ooniner of ITI-J 2011-11-17 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). and Cosmetic Treef the device, subject to the general controls provisions of the Act. The I ou may, therefore, maines 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 additeration. Fload noter 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 If your device to additional controls. Existing major regulations affecting your device can be may of our 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 I lease be activisou that I Dr o lesan to evice complies with other requirements of the Act that I Dri has made a 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 (21 CFR 807); laboring (27 CFR 803); good manufacturing practice requirements as set

{1}------------------------------------------------

Page 2 – Ms. Teffany Hutto

forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic forth in the quality by overns (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 If you don't openire ad resumer 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" (21CFR Part the regulation of the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

(21 Of RT art 800); please are of Surveillance and Biometrics/Division of Postmarket Surveillance.

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

http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

# Lori A. Wiggins -S

for

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

Enclosure

{2}------------------------------------------------

Device Name: Reverse Shoulder Prosthesis

Indications for Use:

### AUG 02 2010

### Reverse® Shoulder Prosthesis Indications for Use

For treatment of patients with a grossly rotator cuff deficient shoulder joint with severe arthropathy 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. The humeral stem is intended for cemented use only.

Prescription Use X (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Sontu for mxm
(Division Sign-Off)

Division of Surgical, Orthopedic, and Restorative Devices

**510(k) Number** K100741

(Division Sign-Oft) Division of Surgical, Orthopedic, and Restorative Devices

510(k) Number

Page 1 of I

{3}------------------------------------------------

K100741

p. 1/1.

. .j

## Summary of Safety and Effectiveness

Date: July 27, 2010

Manufacturer: DJO Surgical (legally Encore Medical, L.P.) 9800 Metric Blvd Austin, TX 78758

Contact Person: Teffany Hutto AUG 02 2010 Manager, Regulatory Affairs Phone: [phone] Fax: [phone] Email: [e-mail]

| Product | 510(k) Number, Clearance Date/ Classification | Product Code | Product Code | Regulation and Classification Name |
|------------------------------|----------------------------------------------------------------------------------|--------------|--------------|---------------------------------------------------------------------------------------|
| Reverse® Shoulder Prosthesis | K041066 – March 24, 2005<br>K051075 – May 27, 2005<br>K092873 – October 27, 2009 | KWS | KWS | Shoulder joint metal/polymer semi-constrained cemented prosthesis per 21 CFR 888.3660 |
| | Class II | | | |

Description: The modification consists of creating a monoblock device by joining the humeral socket with the humeral stem and to add additional humeral insert sizes. There is no change to the intended use or fundamental scientific technology of the RSP with the modifications in this Special 510(k) submission. This includes no changes to packaging or sterilization.

Indications for Use: The RSP is indicated for treatment of patients with a grossly rotator cuff deficient shoulder joint with severe arthropathy 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. The humeral stem is intended for cemented use only.

#### Predicate Device:

- Reverse Shoulder Prosthesis K041066, K051075, K092873. .
Comparable Features to Predicate Device(s): Features comparable to predicate devices include the same indications, sterilization, and intended use.

Non-Clinical Testing: Mechanical testing has demonstrated the device's ability to perform under expected clinical conditions.

Verification activities were performed to determine if the modifications demonstrate equivalent characteristics to the predicate device. These activities included: geometric analysis for insert articulation, socket lever out strength, stress analysis, tolerance analysis, plasma coating characterization, material properties review, and design comparison. All activities demonstrate that the modified device is substantially equivalent to the predicate.

Clinical Testing: None provided.