Clinical Orthopaedics and Related Research®

, Volume 470, Issue 4, pp 1204–1212 | Cite as

Surgical Technique: Methods for Removing a Compress® Compliant Prestress Implant

  • Geoffrey D. Abrams
  • Varun K. Gajendran
  • David G. Mohler
  • Raffi S. Avedian
Surgical Technique



The Compress® device uses a unique design using compressive forces to achieve bone ingrowth on the prosthesis. Because of its design, removal of this device may require special techniques to preserve host bone.

Description of Techniques

Techniques needed include removal of a small amount of bone to relieve compressive forces, use of a pin extractor and/or Kirschner wires for removal of transfixation pins, and creation of a cortical window in the diaphysis to gain access to bone preventing removal of the anchor plug.


We retrospectively reviewed the records of 63 patients receiving a Compress® device from 1996 to 2011 and identified 11 patients who underwent subsequent prosthesis removal. The minimum followup was 1 month (average, 20 months; range, 1–80 months). The most common reason for removal was infection (eight patients) and the most common underlying diagnosis was osteosarcoma (five patients). Three patients underwent above-knee amputation, whereas the others (eight patients) had further limb salvage procedures at the time of prosthesis removal.


Five patients had additional unplanned surgeries after explantation. Irrigation and débridement of the surgical wound was the most common unplanned procedure followed by latissimus free flap and hip prosthesis dislocation. At the time of followup, all patients were ambulating on either salvaged extremities or prostheses.


Although removal of the Compress® device presents unique challenges, we describe techniques to address those challenges.


Limb Salvage Periprosthetic Fracture Kirschner Wire Host Bone Toronto Extremity Salvage Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Daisy-Scarlett MacCallum MD, for assistance with data collection, data analysis, and manuscript preparation.


  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    Bini SA, Johnston JO, Martin DL. Compliant prestress fixation in tumor prostheses: interface retrieval data. Orthopedics. 2000;23:707–711; discussion 711–712.PubMedGoogle Scholar
  3. 3.
    Chang DW, Weber KL. Use of a vascularized fibula bone flap and intercalary allograft for diaphyseal reconstruction after resection of primary extremity bone sarcomas. Plast Reconstr Surg. 2005;116:1918–1925.PubMedCrossRefGoogle Scholar
  4. 4.
    Chen CM, Disa JJ, Lee HY, Mehrara BJ, Hu QY, Nathan S, Boland P, Healey J, Cordeiro PG. Reconstruction of extremity long bone defects after sarcoma resection with vascularized fibula flaps: a 10-year review. Plast Reconstr Surg. 2007;119:915–924; discussion 925–926.PubMedCrossRefGoogle Scholar
  5. 5.
    Dion N, Sim FH. The use of allografts in orthopaedic surgery. Part I: The use of allografts in musculoskeletal oncology. J Bone Joint Surg Am. 2002;84:644–654.Google Scholar
  6. 6.
    Enneking WF, Shirley PD. Resection-arthrodesis for malignant and potentially malignant lesions about the knee using an intramedullary rod and local bone grafts. J Bone Joint Surg Am. 1977;59:223–236.PubMedGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    Gonzalez EG, Corcoran PJ, Reyes RL. Energy expenditure in below-knee amputees: correlation with stump length. Arch Phys Med Rehabil. 1974;55:111–119.PubMedGoogle Scholar
  9. 9.
    Harris IE, Leff AR, Gitelis S, Simon MA. Function after amputation, arthrodesis, or arthroplasty for tumors about the knee. J Bone Joint Surg Am. 1990;72:1477–1485.PubMedGoogle Scholar
  10. 10.
    Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A. Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am. 2008;90:1265–1271.PubMedCrossRefGoogle Scholar
  11. 11.
    Kawai A, Lin PP, Boland PJ, Athanasian EA, Healey JH. Relationship between magnitude of resection, complication, and prosthetic survival after prosthetic knee reconstructions for distal femoral tumors. J Surg Oncol. 1999;70:109–115.PubMedCrossRefGoogle Scholar
  12. 12.
    Kawai A, Muschler GF, Lane JM, Otis JC, Healey JH. Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur: medium to long-term results. J Bone Joint Surg Am. 1998;80:636–647.PubMedCrossRefGoogle Scholar
  13. 13.
    Miner TM, Momberger NG, Chong D, Paprosky WL. The extended trochanteric osteotomy in revision hip arthroplasty: a critical review of 166 cases at mean 3-year, 9-month follow-up. J Arthroplasty. 2001;16(8 suppl 1):188–194.PubMedCrossRefGoogle Scholar
  14. 14.
    Mohler DG, Kessler JI, Earp BE. Augmented amputations of the lower extremity. Clin Orthop Relat Res. 2000;371:183–197.PubMedCrossRefGoogle Scholar
  15. 15.
    Moore AT, Bohlman HR. Metal hip joint: a case report. J Bone Joint Surg. 1943;25:688–692.Google Scholar
  16. 16.
    O’Donnell RJ. Compressive osseointegration of modular endoprostheses. Curr Opin Orthop. 2007;18:590–603.CrossRefGoogle Scholar
  17. 17.
    Otis JC, Lane JM, Kroll MA. Energy cost during gait in osteosarcoma patients after resection and knee replacement and after above-the-knee amputation. J Bone Joint Surg Am. 1985;67:606–611.PubMedGoogle Scholar
  18. 18.
    Phemister DB. Conservative surgery in the treatment of bone tumors. Surg Gynecol Obstet. 1940;70:35.Google Scholar
  19. 19.
    Pinzur MS, Gold J, Schwartz D, Gross N. Energy demands for walking in dysvascular amputees as related to the level of amputation. Orthopedics. 1992;15:1033–1036; discussion 1036–1037.PubMedGoogle Scholar
  20. 20.
    Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur: a long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am. 1994;76:694–656.Google Scholar
  21. 21.
    Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am. 1986;68:1331–1337.PubMedGoogle Scholar
  22. 22.
    Terek RM, Hulstyn MJ. Osteoarticular allograft reconstruction for tumors of the distal femur and proximal tibia. Oper Tech Orthop. 2004;14:236–242.CrossRefGoogle Scholar
  23. 23.
    Waters RL, Perry J, Antonelli D, Hislop H. Energy cost of walking of amputees: the influence of level of amputation. J Bone Joint Surg Am. 1976;58:42–46.PubMedGoogle Scholar
  24. 24.
    Zaretski A, Amir A, Meller I, Leshem D, Kollender Y, Barnea Y, Bickels J, Shpitzer T, Ad-El D, Gur E. Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg. 2004;113:1989–2000.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Geoffrey D. Abrams
    • 1
  • Varun K. Gajendran
    • 1
  • David G. Mohler
    • 1
  • Raffi S. Avedian
    • 1
  1. 1.Department of Orthopedic SurgeryStanford UniversityStanfordUSA

Personalised recommendations