Compress knee arthroplasty has 80% 10-year survivorship and novel forms of bone failure.
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.


OBJECTIVE
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.


METHODS
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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. healeyj@mskcc.org
John H
JH
Healey
Carol D
CD
Morris
Edward A
EA
Athanasian
Patrick J
PJ
Boland
D000293:Adolescent; D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D005260:Female; D005266:Femoral Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010020:Osteonecrosis / Q000209:etiology / Q000601:surgery; D057068:Periprosthetic Fractures / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult