Compress® Knee Arthroplasty Has 80% 10-year Survivorship and Novel Forms of Bone Failure
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.
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.
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.
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.
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.
- Abrams GD, Gajendran VK, Mohler DG, Avedian RS. Surgical technique: methods for removing a Compress® Compliant Pre-Stress Implant. Clin Orthop Relat Res. 2012;470:1204–1212. CrossRef
- Avedian RS, Goldsby RE, Kramer MJ, O’Donnell RJ. Effect of chemotherapy on initial compressive osseointegration of tumor endoprostheses. Clin Orthop Relat Res. 2007;459:48–53. CrossRef
- Bergin PF, Noveau JB, Jelinek JS, Henshaw RM. Aseptic loosening rates in distal femoral endoprostheses: does stem size matter? Clin Orthop Relat Res. 2012;470:743–50. CrossRef
- Bhangu AA, Kramer MJ, Grimer RJ, O’Donnell RJ. Early distal femoral endoprosthetic survival: cemented stems versus the Compress implant. Int Orthop. 2006;30:465–472. CrossRef
- Biau D, Faure F, Katsahian S, Jeanrot C, Tomeno B, Anract P. Survival of total knee replacement with a megaprosthesis after bone tumor resection. J Bone Joint Surg Am. 2006;88:1285–1293. CrossRef
- Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer MM. Distal femur resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop Relat Res. 2002;400:225–235. CrossRef
- Bini SA, Johnston JO, Martin DL. Compliant prestress fixation in tumor prostheses: interface retrieval data. Orthopedics. 2000;23:707–711; discussion 711–712
- Bruns J, Delling G, Gruber H, Lohmann CH, Habermann CR. Cementless fixation of megaprostheses using a conical fluted stem in the treatment of bone tumours. J Bone Joint Surg Br. 2007;89:1084–1087. CrossRef
- Farfalli GL, Boland PJ, Morris CD, Athanasian EA, Healey JH. Early equivalence of uncemented press-fit and Compress femoral fixation. Clin Orthop Relat Res. 2009;467:2792–2799. CrossRef
- Griffin AM, Parsons JA, Davis AM, Bell RS, Wunder JS. Uncemented tumor endoprostheses at the knee: root causes of failure. Clin Orthop Relat Res. 2005;438:71–79. CrossRef
- Horowitz SM, Glasser DB, Lane JM, Healey JH. Prosthetic and extremity survivorship after limb salvage for sarcoma: how long do the reconstructions last? Clin Orthop Relat Res. 1993;293:280–286.
- Kawai A, Healey JH, Boland PJ, Athanasian EA, Jeon DG. A rotating-hinge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty. 1999;14:187–196. CrossRef
- Kinkel S, Lehner B, Kleinhans JA, Jakubowitz E, Ewerbeck V, Heisel C. Medium to long-term results after reconstruction of bone defects at the knee with tumor endoprostheses. J Surg Oncol. 2010;101:166–169.
- Kramer MJ, Tanner BJ, Horvai AE, O’Donnell RJ. Compressive osseointegration promotes viable bone at the endoprosthetic interface: retrieval study of Compress implants. Int Orthop. 2008;32:567–571. CrossRef
- Langlais F, Belot N, Ropars M, Lambotte JC, Thomazeau H. The long-term results of press-fit cemented stems in total knee prostheses. J Bone Joint Surg Br. 2006;88:1022–1026.
- Mascard E, Anract P, Touchene A, Pouillart P, Tomeno B. [Complications from the hinged GUEPAR prosthesis after resection of knee tumor: 102 cases] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1998;84:628–637.
- Matsumine A, Ueda T, Sugita T, Yazawa Y, Isu K, Kawai A, Abe S, Yakushiji T, Hiraga H, Sudo A, Uchida A; Japanese Musculoskeletal Oncology Group. Clinical outcomes of the KYOCERA Physio Hinge Total Knee System Type III after the resection of a bone and soft tissue tumor of the distal part of the femur. J Surg Oncol. 2011;103:257–263. CrossRef
- Mittermayer F, Krepler P, Dominkus M, Schwameis E, Sluga M, Heinzl H, Kotz R. Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res. 2001;388:167–177. CrossRef
- Morgan HD, Cizik AM, Leopold SS, Hawkins DS, Conrad EU 3rd. Survival of tumor megaprostheses replacements about the knee. Clin Orthop Relat Res. 2006;450:39–45. CrossRef
- Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. Endoprosthetic replacement of the distal femur for bone tumours: long-term results. J Bone Joint Surg Br. 2007;89:521–526. CrossRef
- O’Donnell RJ. Compressive osseointegration of modular endoprostheses. Curr Opin Orthop. 2007;18:590–603. CrossRef
- O’Donnell RJ. Compressive osseointegration of tibial implants in primary cancer reconstruction. Clin Orthop Relat Res. 2009;467:2807–2812. CrossRef
- Pedtke AC, Wustrack RL, Fang AS, Grimer RJ, O’Donnell RJ. Aseptic failure: how does the Compress® implant compare to cemented stems? Clin Orthop Relat Res. 2012;470:735–742. CrossRef
- Plötz W, Rechl H, Burgkart R, Messmer C, Schelter R, Hipp E, Gradinger R. Limb salvage with tumor endoprostheses for malignant tumors of the knee. Clin Orthop Relat Res. 2002;405:207–215. CrossRef
- Ritschl P, Capanna R, Helwig U, Campanacci M, Kotz R. [KMFTR (Kotz Modular Femur Tibia Reconstruction System) modular tumor endoprosthesis system for the lower extremity] [in German]. Z Orthop Ihre Grenzgeb. 1992;130:290–293. CrossRef
- Roberts P, Chan D, Grimer RJ, Sneath RS, Scales JT. Prosthetic replacement of the distal femur for primary bone tumours. J Bone Joint Surg Br. 1991;73:762–769.
- Shehadeh A, Noveau J, Malawer M, Henshaw R. Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res. 2010;468:2885–2895. CrossRef
- Tan PX, Yong BC, Wang J, Huang G, Yin JQ, Zou CY, Xie XB, Tang QL, Shen JN. Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee. Eur J Surg Oncol. 2012 July 16 [Epub ahead of print].
- Tyler WK, Healey JH, Morris CD, Boland PJ, O’Donnell RJ. Compress® periprosthetic fractures: interface stability and ease of revision. Clin Orthop Relat Res. 2009;467:2800-2806. CrossRef
- Unwin PS, Cannon SR, Grimer RJ, Kemp HB, Sneath RS, Walker PS. Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Joint Surg Br. 1996;78:5–13.
- Unwin PS, Cobb JP, Walker PS. Distal femoral arthroplasty using custom-made prostheses: the first 218 cases. J Arthroplasty. 1993;8:259–268. CrossRef
- Webber NP, Seidel M. Combining advanced technologies: the Compress-Repiphysis prosthesis for pediatric limb salvage. Orthopedics. 2010;33:823. CrossRef
- Zimel MN, Cizik AM, Rapp TB, Weisstein JS, Conrad EU 3rd. Megaprosthesis versus condyle-sparing intercalary allograft: distal femoral sarcoma. Clin Orthop Relat Res. 2009;467:2813–2824. CrossRef
- Compress® Knee Arthroplasty Has 80% 10-year Survivorship and Novel Forms of Bone Failure
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Clinical Orthopaedics and Related Research®
Volume 471, Issue 3 , pp 774-783
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Orthopaedic Service of the Department of Surgery, affiliated with Weill Medical College of Cornell University, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA