Skip to main content
SpringerLink
Log in

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

  • Surgical Technique
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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

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. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12A–C

Similar content being viewed by others

References

  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.

    Article  PubMed  Google Scholar 

  2. Bini SA, Johnston JO, Martin DL. Compliant prestress fixation in tumor prostheses: interface retrieval data. Orthopedics. 2000;23:707–711; discussion 711–712.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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. 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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  14. Mohler DG, Kessler JI, Earp BE. Augmented amputations of the lower extremity. Clin Orthop Relat Res. 2000;371:183–197.

    Article  PubMed  Google Scholar 

  15. Moore AT, Bohlman HR. Metal hip joint: a case report. J Bone Joint Surg. 1943;25:688–692.

    Google Scholar 

  16. O’Donnell RJ. Compressive osseointegration of modular endoprostheses. Curr Opin Orthop. 2007;18:590–603.

    Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  18. Phemister DB. Conservative surgery in the treatment of bone tumors. Surg Gynecol Obstet. 1940;70:35.

    Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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. 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.

    PubMed  CAS  Google Scholar 

  22. Terek RM, Hulstyn MJ. Osteoarticular allograft reconstruction for tumors of the distal femur and proximal tibia. Oper Tech Orthop. 2004;14:236–242.

    Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

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

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Stanford University, 300 Pasteur Drive, Mail Code 5341, Stanford, CA, 94305, USA

    Geoffrey D. Abrams MD, Varun K. Gajendran MD, David G. Mohler MD & Raffi S. Avedian MD

Authors
  1. Geoffrey D. Abrams MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Varun K. Gajendran MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David G. Mohler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raffi S. Avedian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geoffrey D. Abrams 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.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Stanford University Hospital and Clinics, Stanford, CA, USA.

About this article

Cite this article

Abrams, G.D., Gajendran, V.K., Mohler, D.G. et al. Surgical Technique: Methods for Removing a Compress® Compliant Prestress Implant. Clin Orthop Relat Res 470, 1204–1212 (2012). https://doi.org/10.1007/s11999-011-2128-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-2128-z

Keywords

Search

Navigation