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

Farfalli, Germán L.; Boland, Patrick J.; Morris, Carol D.; Athanasian, Edward A.; Healey, John H.

doi:10.1007/s11999-009-0912-9

Cited by 73 publications

(88 citation statements)

References 34 publications

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“…We believe these data support the potential long-term durability of an osteointegrated CPS implant. Aseptic mechanical failures occurred early, within 1 year of revision surgery, a finding comparable to other primary CPS implant studies [10,13,19,24]. Few publications have described the outcomes of revision distal femoral prostheses (Table 2).…”

Section: Discussionsupporting

confidence: 74%

“…The CPS implant has a published survival rate of as high as 89% at 5 years [19] and 80% at 10 years [13] when used for primary oncologic reconstruction [24]. In short-term comparison studies, it was shown to have equivalent or higher survival than cemented [3,24] and press-fit [10] stemmed implants for primary oncologic reconstruction [3,24]. Given the versatility of the CPS implant, we began using it for revision of failed distal femoral prostheses, particularly when the residual femoral bone segment was very short, precluding use of a stemmed implant.…”

Section: Introductionmentioning

confidence: 99%

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Revision Distal Femoral Arthroplasty With the Compress® Prosthesis Has a Low Rate of Mechanical Failure at 10 Years

Zimel

Farfalli

Zindman

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patients with failed distal femoral megaprostheses often have bone loss that limits reconstructive options and contributes to the high failure rate of revision surgery. The Compress 1 Compliant Pre-stress (CPS) implant can reconstruct the femur even when there is little remaining bone. It differs from traditional stemmed prostheses because it requires only 4 to 8 cm of residual bone for fixation. Given the poor long-term results of stemmed revision constructs, we sought to determine the failure rate and functional outcomes of the CPS implant in revision surgery. Questions/purposes (1) What is the cumulative incidence of mechanical and other types of implant failure when used to revise failed distal femoral arthroplasties placed after oncologic resection? (2) What complications are characteristic of this prosthesis? (3) What function do patients achieve after receiving this prosthesis? Methods We retrospectively reviewed 27 patients who experienced failure of a distal femoral prosthesis and were revised to a CPS implant from April 2000 to February 2013. Indications for use included a minimum 2.5 mm cortical thickness of the remaining proximal femur, no prior radiation, life expectancy [10 years, and compliance with protected weightbearing for 3 months. The cumulative incidence of failure was calculated for both mechanical (loss of compression between the implant anchor plug and spindle) and other failure modes using a competing risk analysis. Failure was defined as removal of the CPS implant. Followup was a minimum of 2 years or until implant removal. Median followup for patients with [CI], 4%-33%) at both 5 and 10 years. These failures occurred early at a median of 5 months. The cumulative incidence of other failures was 18% (95% CI, 7%-45%) at 5 and 10 years, all of which were deep infection. Three patients required secondary operations for cortical insufficiency proximal to the anchor plug in bone not spanned by the CPS implant and unrelated to the prosthesis. Median MSTS score was 27 (range, 24-30). Conclusions Revision distal femoral replacement arthroplasty after a failed megaprosthesis is often difficult as a result of a lack of adequate bone. Reconstruction with the CPS implant has an 11% failure rate at 10 years. Our results are promising and demonstrate the durable fixation provided by the CPS implant. Further studies to compare the CPS prosthesis and other reconstruction options with respect to survival and functional outcomes are warranted. Level of Evidence Level IV, therapeutic study.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Revision Distal Femoral Arthroplasty With the Compress® Prosthesis Has a Low Rate of Mechanical Failure at 10 Years

Zimel

Farfalli

Zindman

et al. 2016

Clinical Orthopaedics &Amp; Related Research

Self Cite

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“…Loading forces are transmitted directly onto the host bone in an axial direction resulting in bone growth at the boneprosthesis interface and osseointegration ( Fig. 1) [1,8,15]. This device has short-and intermediate-term survivorship that is at least equivalent if not superior to stemmed implants, but there is concern that rotational forces at the bone-prosthesis interface can lead to loosening and failure of the implant (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…This device has short-and intermediate-term survivorship that is at least equivalent if not superior to stemmed implants, but there is concern that rotational forces at the bone-prosthesis interface can lead to loosening and failure of the implant (Fig. 2) [3,8,17]. A strategy to overcome this problem is to insert antirotation pins through the spindle into the host bone (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…Another consideration is that drilling may cause damage to the periosteum and inhibit osseointegration. Therefore, some surgeons favor using no pins or the minimum number necessary to achieve rotational stability [8]. However, to our knowledge, there are no studies to indicate how the number of pins affects rotational stability, increases the risk of fracture, or interferes with osseointegration.…”

Section: Introductionmentioning

confidence: 99%

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Antirotation Pins Improve Stability of the Compress Limb Salvage Implant: A Biomechanical Study

Avedian

Chen

Lindsey

et al. 2014

Clin Orthop Relat Res

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Background Limb salvage implants that rely on compliant compression osseointegration to achieve bone fixation may achieve longer survivorship rates compared with traditional cemented or press-fit stemmed implants; however, failures resulting from rotational instability have been reported. The effect of using antirotation pins on the rotational stability of the fixation has not been well studied. Questions/purposes We asked the following question: When tested in a cadaver model, does the use of antirotation pins increase the torque required to cause implant failure or rotation?Methods Thirty-two cadaver femurs were divided into four groups of eight femurs. We compared the torque to failure among groups containing zero, one, two, three, and four pins using a servohydraulic testing device. Conclusions It appears that the use of antirotation pins improves rotational stability of the compliant compression endoprosthesis. Although these findings need to be verified in a clinical study, the addition of antirotation pins may improve osteointegration and we have changed our practice to use a minimum of three antirotation pins when implanting this device. Clinical Relevance Improvements in implant technology and surgical techniques may lead to improved clinical outcomes and patient quality of life. Addition of antirotation pins appears to improve implant stability and may decrease the need for revision surgery.

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Sex and Laterality Differences in Medullary Humerus Morphology

Drew

Tashjian

Henninger

et al. 2019

The Anatomical Record

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Percutaneous osseointegrated (OI) prosthetic limb attachment holds promise for transhumeral amputees. Understanding humeral medullary morphology is necessary for informed design of upper extremity OI systems, and is beneficial to the field of megaprosthetic reconstruction of the distal humerus where diaphyseal fixation is desired. The purpose of this study was to quantify the sex and laterality differences in humerus morphology, specifically over the diaphysis. Three‐dimensional surface reconstructions of 58 pairs of cadaveric humeri (43 male, 15 female) were generated from CT data. Measures describing periosteal and medullary morphology were collected relative to an anatomic coordinate system. Sex and laterality differences in biomechanical length (BML) were observed (P ≤ 0.001 and 0.022, respectively). Head radius was larger in males than females (P ≤ 0.001). Retroversion was increased in right humeri relative to left (P ≤ 0.001). Canal orientation exhibited a conformational shift from anteversion to retroversion distally at approximately 65% BML. Right humeri exhibited larger medullary diameters than left in the 1st and 2nd principal directions (P ≤ 0.024). Males displayed larger diameter medullary canals proximally (P ≤ 0.029) and an increased rate of divergence of the endosteal cortex in the proximal diaphysis (P ≤ 0.009). Females exhibited higher canal aspect ratios at mid‐shaft (P ≤ 0.014) and lower mean cortical thickness (P ≤ 0.001). Human humeral diaphysis morphology exhibits sex and laterality differences, which are dependent on position along the diaphysis. Understanding humeral morphology is necessary to achieve adequate primary stability and bone apposition in design of endoprosthetic stems for percutaneous OI implants, and distal humerus replacement. Anat Rec, 302:1709–1717, 2019. © 2019 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association for Anatomy

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

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

Cited by 73 publications

References 34 publications

Revision Distal Femoral Arthroplasty With the Compress® Prosthesis Has a Low Rate of Mechanical Failure at 10 Years

Revision Distal Femoral Arthroplasty With the Compress® Prosthesis Has a Low Rate of Mechanical Failure at 10 Years

Antirotation Pins Improve Stability of the Compress Limb Salvage Implant: A Biomechanical Study

Sex and Laterality Differences in Medullary Humerus Morphology

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