Skip to main content
SpringerLink
Log in

Early Equivalence of Uncemented Press-fit and Compress® Femoral Fixation

  • Symposium: Selected Papers Presented at the 2008 Meeting of the Musculoskeletal Tumor Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Bone ingrowth promises more durable biologic fixation of megaprostheses. The relative performance of different types of fixation is unknown. We compared the fixation of two forms of biologically fixed femoral components: an intramedullary uncemented press-fit stem (UCS; Group 1, 50 patients) and a Compress® uncemented fixation (CPS; Group 2, 41 patients). In Group 1, the overall Kaplan-Meier prosthetic survival rates were 85% at 5 and 71% at 10 years. Most failures were long-term developments. Aseptic loosening was the primary cause of failure. Stem diameters less than 13.5 mm and a diaphyseal/stem coefficient greater than 2.5 mm were associated with decreased prosthetic survival. In Group 2, the overall rate of CPS survival was 88% at 5 years. Failure of femoral fixation or fracture during the first year was the main reason for revision. Five-year survival rates were similar between the groups and we observed no difference in the functional success of the implants. We found no failures after 1-year followup in Group 2 (CPS). Any difference in prosthetic survival can only be proven by longer-term study or a randomized trial.

Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Avedian R, Goldsby RE, Kramer MJ, O’Donnell RJ. Effect of chemotherapy on initial compressive osseointegration of oncologic endoprostheses. Clin Orthop Relat Res. 2007;459:48–53.

    Article  PubMed  CAS  Google Scholar 

  2. 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.

    Article  PubMed  CAS  Google Scholar 

  3. Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer M. Distal femoral resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop Relat Res. 2002;400:225–235.

    Article  PubMed  Google Scholar 

  4. Bini SA, Johnston JO, Martin DL. Compliant prestress fixation in tumor prostheses: interface retrieval data. Orthopedics. 2000;23:707–712.

    PubMed  CAS  Google Scholar 

  5. Capanna R, Morris HG, Campanacci D, Del Ben M, Campanacci M. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Joint Surg Br. 1994;76:178–186.

    PubMed  CAS  Google Scholar 

  6. Cristofolini L, Bini SA, Toni A. In vitro testing of a novel limb salvage prosthesis for the distal femur. Clin Biomech. 1998;13:608–615.

    Article  Google Scholar 

  7. Enneking WF, Dunham W, Gebhardt MC, Malawer M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.

    PubMed  Google Scholar 

  8. Finn HA, Simon MA. Limb-salvage surgery in the treatment of osteosarcoma in skeletally immature individuals. Clin Orthop Relat Res. 1991;262:108–118.

    PubMed  Google Scholar 

  9. Flint MN, Griffin AM, Bell RS, Ferguson PC, Wunder JS. Aseptic loosening is uncommon with uncemented proximal tibia tumor prostheses. Clin Orthop Relat Res. 2006;450:52–59.

    Article  PubMed  Google Scholar 

  10. Freedman EL, Eckardt JJ. A modular endoprosthetic system for tumor and non-tumor reconstruction: preliminary experience. Orthopedics. 1997;20:27–36.

    PubMed  CAS  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. Healey JH, Abdeen A, Morris CD, Athanasian EA, Boland PJ. Telescope allograft method to reconstitute the diaphysis in limb salvage surgery. Clin Orthop Relat Res. 2008 Oct 3 [Epub ahead of print].

  13. 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.

    PubMed  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. 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.

    Article  PubMed  CAS  Google Scholar 

  16. 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.

    Article  PubMed  CAS  Google Scholar 

  17. 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.

    Article  PubMed  CAS  Google Scholar 

  18. Kneisl JS, Finn HA, Simon MA. Mobile knee reconstructions after resection of malignant tumors of the distal femur. Orthop Clin N Am. 1991;22:105–119.

    CAS  Google Scholar 

  19. Kramer MJ, Tanner BJ, Horvai AE, O’Donnell RJ. Compressive osseointegration promotes viable bone at the endoprosthetic interface: retrieval study of Compress(R) implants. Int Orthop. 2008;32:567–571.

    Article  PubMed  CAS  Google Scholar 

  20. Laverdiere C, Kolb EA, Supko JG, Gorlick R, Meyers PA, Maki RG, Wexler L, Demetri GD, Healey JH, Huvos AG, Goorin AM, Bagatell R, Ruiz-Casado A, Guzman C, Jimeno J, Harmon D. Phase II study of ecteinascidin 743 in heavily pretreated patients with recurrent osteosarcoma. Cancer. 2003;98:832–840.

    Article  PubMed  CAS  Google Scholar 

  21. Marshall AD, Mokris JG, Reitman RD, Dandar A, Mauerhan DR. Cementless titanium tapered-wedge femoral stem: 10- to 15-year follow-up. J Arthroplasty. 2004;19:546–552.

    Article  PubMed  Google Scholar 

  22. Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Minimum ten-year follow-up of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty. J Bone Joint Surg Am. 2004;86:92–97.

    PubMed  Google Scholar 

  23. Meyers PA, Gorlick R, Heller G, Casper E, Lane J, Huvos AG, Healey JH. Intensification of preoperative chemotherapy for osteogenic sarcoma: results of the Memorial Sloan-Kettering (T12) protocol. J Clin Oncol. 1998;16:2452–2458.

    PubMed  CAS  Google Scholar 

  24. Meyers PA, Heller G, Healey J, Huvos A, Lane J, Marcove R, Applewhite A, Vlamis V, Rosen G. Chemotherapy for nonmetastatic osteogenic sarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol. 1992;10:5–15.

    PubMed  CAS  Google Scholar 

  25. Meyers PA, Schwartz CL, Krailo M, Kleinerman ES, Betcher D, Bernstein ML, Conrad E, Ferguson W, Gebhardt M, Goorin AM, Harris MB, Healey J, Huvos A, Link M, Montebello J, Nadel H, Nieder M, Sato J, Siegal G, Weiner M, Wells R, Wold L, Womer R, Grier H. Osteosarcoma: a randomized, prospective trial of the addition of ifosfamide and/or muramyl tripeptide to cisplatin, doxorubicin, and high-dose methotrexate. J Clin Oncol. 2005;23:2004–2011.

    Article  PubMed  CAS  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. Mittermeyer F, Windhager R, Dominkus M, Krepler P, Schwamels E, Sluga M, Kotz R, Strasser G. Revision of the Kotz type of tumor endoprosthesis for the lower limb. J Bone Joint Surg Br. 2002;84:401–406.

    Article  Google Scholar 

  28. Muscolo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M. Use of distal femoral osteoarticular allografts in limb salvage surgery. J Bone Joint Surg Am. 2005;87:2449–2455.

    Article  PubMed  Google Scholar 

  29. Sanjay BKS, Moreau P. Limb salvage surgery in bone tumour with modular endoprosthesis. Int Orthop. 1999;23:41–46.

    Article  PubMed  CAS  Google Scholar 

  30. Shih LY, Sim FH, Pritchard DJ, Rock MG, Chao EY. Segmental total knee arthroplasty after distal femoral resection for tumor. Clin Orthop Relat Res. 1993;292:269–281.

    PubMed  Google Scholar 

  31. Torbert JT, Fox EJ, Hosalkar HS, Ogilvie CM, Lackman RD. Endoprosthetic reconstructions: results of long-term followup of 139 patients. Clin Orthop Relat Res. 2005;438:51–59.

    Article  PubMed  Google Scholar 

  32. Unwin PS, Cannon SR, Grimer RJ, Kemp HBS, 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.

    PubMed  CAS  Google Scholar 

  33. Wunder JS, Leitch K, Griffin AM, Davis AM, Bell RS. Comparison of two methods of reconstruction for primary malignant tumors at the knee: a sequential cohort study. J Surg Oncol. 2001;77:89–99.

    Article  PubMed  CAS  Google Scholar 

  34. Zwart HJ, Taminiau AH, Schimmel JW, van Horn JR. Kotz modular femur and tibia replacement. 28 tumor cases followed for 3 (1–8) years. Acta Orthop Scand. 1994;65:315–318.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank the residents and fellows who performed the MSTS/ISOLS evaluations during regular clinic care of the patients.

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center (Affiliated with Weill Medical College of Cornell University), 1275 York Avenue, Suite A342, New York, NY, 10021, USA

    German L. Farfalli MD, Patrick J. Boland MD, Carol D. Morris MD, Edward A. Athanasian MD & John H. Healey MD

Authors
  1. German L. Farfalli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick J. Boland MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carol D. Morris MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edward A. Athanasian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John H. Healey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John H. Healey MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his institution has approved the reporting of this study and that all investigations were conducted in conformity with ethical principles of research.

About this article

Cite this article

Farfalli, G.L., Boland, P.J., Morris, C.D. et al. Early Equivalence of Uncemented Press-fit and Compress® Femoral Fixation. Clin Orthop Relat Res 467, 2792–2799 (2009). https://doi.org/10.1007/s11999-009-0912-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-0912-9

Keywords

Search

Navigation