Decoding "State-of-the-Art" in EU's Medical Device Regulation: A Comprehensive Guide


The term “state-of-the-art” is a recurring theme in the European Union’s Medical Device Regulation (MDR), which became effective in May 2022. While the term is frequently mentioned, its precise definition within the MDR remains elusive. This comprehensive guide aims to dissect the term “state-of-the-art” in the context of MDR, delving into the intricacies of standards harmonization, risk management, and clinical data.

The Ambiguity of "State-of-the-Art"

The Oxford Dictionary describes “state-of-the-art” as the pinnacle of technological development, incorporating the latest advancements. However, the Medical Device Coordination Group (MDCG) refers to the International Medical Device Regulators Forum for a more nuanced definition. According to the forum, “state-of-the-art” medical devices are those at a “developed stage of current technical capability and/or accepted clinical practice.” This leaves room for interpretation, creating challenges for manufacturers and notified bodies alike.

Why the Ambiguity?

The MDR aims to prioritize patient safety and remove subjectivity in regulatory approvals. However, the term “state-of-the-art” is intentionally left undefined to allow for flexibility as technology and clinical practices evolve. This flexibility, while beneficial, also creates a layer of complexity that manufacturers must navigate.

Harmonized Standards: A Double-Edged Sword

Harmonized standards, developed by European standards organizations like CEN, CENELEC, or ETSI, serve as a quick reference for compliance. However, the MDR is less clear when non-harmonized standards are involved.

The Role of ISO, IEC, and EN

When harmonized standards are not applicable, manufacturers can turn to international and European consensus standards from ISO, IEC, or EN. These standards often serve as the foundation for MDR harmonized standards and reflect current industry practices.

The Challenge of Non-Harmonized Standards

Manufacturers face a dilemma when dealing with non-harmonized standards. The MDR offers limited guidance, leaving manufacturers to choose technical solutions that ensure compliance. This lack of direction can lead to uncertainties, especially when it comes to demonstrating that a product is truly “state-of-the-art.”

Risk Management: Beyond the Basics

MDR Article 10 outlines a comprehensive product safety risk management system. This includes risk reduction, risk control measures, and human factors.

Chemical Characterization: A New Paradigm

The focus on advanced chemical analyses, particularly ISO 10993-1:2018 and ISO 10993-18:2020, has shifted the landscape. Manufacturers must now provide rigorous chemical characterization data, moving beyond traditional literature reviews.

Human Factors and Residual Risks

The MDR also mandates that risks related to human factors be addressed and that all foreseeable residual risks be outweighed by the benefits of using the device. This adds another layer of complexity to what is considered “state-of-the-art” in risk management..

Clinical Data: The Keystone of Regulatory Compliance

The MDR places a strong emphasis on clinical data, especially for high-risk devices like implantables and class III devices. Manufacturers must either demonstrate equivalence to an existing device or conduct clinical investigations.

Clinical Evaluation and Statistical Robustness

A well-conducted clinical evaluation, performed according to MEDDEV 2.7/1 Rev 4 and applicable MDCG documents, is essential. Notified bodies often scrutinize the statistical robustness of the data, making the role of an experienced biostatistician invaluable.

The Role of Preclinical Data

Before gathering clinical data, manufacturers can benefit from a full biological evaluation consistent with the ISO 10993 family of standards. This preclinical data can be invaluable in substantiating clinical findings when the time comes.


The term “state-of-the-art” in MDR is dynamic and open to interpretation. Understanding its complexities is essential for manufacturers aiming for EU market access. By delving into the nuances of standards harmonization, risk management, and clinical data, manufacturers can better position themselves for regulatory compliance and market success.

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