Aseptic Failure: How Does the Compress® Implant Compare to Cemented Stems?

Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA 94115-1939, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 11/2011; 470(3):735-42. DOI: 10.1007/s11999-011-2159-5
Source: PubMed


Failure of endoprosthetic reconstruction with conventional stems due to aseptic loosening remains a challenge for maintenance of limb integrity and function. The Compress(®) implant (Biomet Inc, Warsaw, IN, USA) attempts to avoid aseptic failure by means of a unique technologic innovation. Though the existing literature suggests survivorship of Compress(®) and stemmed implants is similar in the short term, studies are limited by population size and followup duration.
We therefore compared (1) the rate of aseptic failure between Compress(®) and cemented intramedullary stems and (2) evaluated the overall intermediate-term implant survivorship.
We reviewed 26 patients with Compress(®) implants and 26 matched patients with cemented intramedullary stems. The patients were operated on over a 3-year period. Analysis focused on factors related to implant survival, including age, sex, diagnosis, infection, aseptic loosening, local recurrence, and fracture. Minimum followup was 0.32 years (average, 6.2 years; range, 0.32-9.2 years).
Aseptic failure occurred in one (3.8%) patient with a Compress(®) implant and three (11.5%) patients with cemented intramedullary stems. The 5-year implant survival rate was 83.5% in the Compress(®) group and 66.6% in the cemented intramedullary stem group.
The Compress(®) implant continues to be a reliable option for distal femoral limb salvage surgery. Data regarding aseptic failure is encouraging, with equivalent survivorship against cemented endoprosthetic replacement at intermediate-term followup.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Available from: Rosanna L Wustrack, Feb 03, 2015
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    • "As the patient population is generally young, major revisions are required to restore a stable fixation, associated with additional bone loss [3] [4]. Stems with a coated collar allowing active bone ingrowth proved to provide a better fixation on the long term [5] [6] [7]. Dynamic compression fixation (Compress) of tumor prostheses was proposed as an alternative to long stems, aiming to improve the long term survivorship of the implant through active osseointegration. "
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    ABSTRACT: Objective. In pursuance of thoroughly understanding and facilitating the evaluation of the radiological changes in the preloaded bone by Compliant Pre-Stress osseointegration (Compress Biomet, Warsaw, Indiana) a new staging method was created depicting four stages. Methods. Two cohorts (10 and 17 patients resp., not-receiving and receiving chemotherapy) were compared in terms of progression of osseointegration. Based on the changes at the bone-metal interface seen on röntgenorgrams four stages were defined: stage 0: immediate postoperative status, no ingrowth, or noncalcified callus; stage 1: early mineralization, calcified callus; stage 2: mature mineralization; and stage 3: hypertrophy at the level of the pins. Results. There were no significant differences between the two cohorts. Group 2, which was significantly younger than group 1 (p < 0.001), presented a delayed initial rate of bone formation and reached stage 1 at 6 months instead of 3 months like group 1. The children from the group 2 demonstrated a visible rebound ingrowth. Conclusion. Despite the fact that the staging fails to demonstrate a statistical difference, it is rather simple and can be used for future studies.
    08/2015; 2015(8):513939. DOI:10.1155/2015/513939
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    • "Biomet, Warsaw, USA). The early aseptic loosening rate varies from 3,8% up to 14% [13-17], but the results are limited by population size, heterogenic population and follow- up duration. The advantage of this system is that the compressive osteointegration avoids stress-shielding and save bone-stock. "
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    ABSTRACT: Background Tumors of the distal femur and diaphysis with proximal metaphyseal extension into the femur present a challenge for limb salvage. The conventional treatment consists of limb salvage with total femur replacement. This case study aims to present preliminary results and experience with short-stem reconstruction, focusing on the mechanical stability of the procedure. Methods Sixteen short stems were implanted in 15 patients. The patients’ mean age was 33,3 years (range 11–73). In 10 patients, the stem was used for distal femur reconstruction, in one patient for diaphyseal reconstruction, and in four for a stump lengthening procedure. All of the patients had a primary sarcoma in their history. The mean follow-up period was 37 months (range 5–95 months). The clinical and functional follow-up data were analyzed. Results Ten patients (67%) were still alive at the time of evaluation. Three complications associated with the stem were noted. In one case, there was aseptic loosening after 58 months; in another, aseptic loosening occurred because the diameter of the stem had initially been too small; and in one case, there was breakage of the fixation screw, without any clinical symptoms. The average Musculoskeletal Tumor Society score for all patients was 23 (range 9–28). The mean result for the distal femur replacement was 24 (range 22–28). None of the surviving patients with distal femur replacements needed any crutches or had a Trendelenburg limp. Both living patients who underwent a stump lengthening procedure were able to walk with an exoprosthesis. Conclusions The short stem is a good solution that can prevent or delay proximal femur resection in patients with tumors extending into the proximal metaphyseal femur. Additional risks of proximal femur resection, such as dislocation, opening of another oncological compartment, Trendelenburg limp, and chondrolysis can be avoided.
    BMC Musculoskeletal Disorders 05/2014; 15(1):190. DOI:10.1186/1471-2474-15-190 · 1.72 Impact Factor
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    • "The Compress® Compliant Pre-Stress Implant (Biomet Inc, Warsaw, IN, USA), a rotating-hinge knee prosthesis, was approved by the FDA based on data from an unpublished short-term feasibility study, conducted by the manufacturer, that showed no difference in the acute complication rate and equivalent functional outcome scores compared with a cemented stem coupled to the same rotating-hinge articulation (Orthopaedic Salvage System [OSS™]; Biomet). Published studies of this device include an investigation in 26 patients, among whom only 10 had followup longer than 24 months [4], a study of 26 patients followed for a period of 0.3 to 9.2 years [23], and a study of 41 patients followed for 3 to 97 months [9]. These studies suggest projected 10-year prosthetic survival is at least 80%, but the number of cases is small and the number followed for this duration is miniscule. "
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    ABSTRACT: BACKGROUND: Compliant, self-adjusting compression technology is a novel approach for durable prosthetic fixation of the knee. However, the long-term survival of these constructs is unknown. QUESTIONS/PURPOSES: We therefore determined the survival of the Compress(®) prosthesis (Biomet Inc, Warsaw, IN, USA) at 5 and 10 actuarial years and identified the failure modes for this form of prosthetic fixation. METHODS: We retrospectively reviewed clinical and radiographic records for all 82 patients who underwent Compress(®) knee arthroplasty from 1998 to 2008, as well as one patient who received the device elsewhere but was followed at our institution. Prosthesis survivorship and modes of failure were determined. Followup was for a minimum of 12 months or until implant removal (median, 43 months; range, 6-131 months); 28 patients were followed for more than 5 years. RESULTS: We found a survivorship of 85% at 5 years and 80% at 10 years. Eight patients required prosthetic revision after interface failure due to aseptic loosening alone (n = 3) or aseptic loosening with periprosthetic fracture (n = 5). Additionally, five periprosthetic bone failures occurred that did not require revision: three patients had periprosthetic bone failure without fixation compromise and two exhibited irregular prosthetic osteointegration patterns with concomitant fracture due to mechanical insufficiency. CONCLUSIONS: Compress(®) prosthetic fixation after distal femoral tumor resection exhibits long-term survivorship. Implant failure was associated with patient nonadherence to the recommended weightbearing proscription or with bone necrosis and fracture. We conclude this is the most durable FDA-approved fixation method for distal femoral megaprostheses. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 10/2012; 471(3). DOI:10.1007/s11999-012-2635-6 · 2.77 Impact Factor
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