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. 2008 Oct;32(5):567-71.
doi: 10.1007/s00264-007-0392-z. Epub 2007 Jun 19.

Compressive osseointegration promotes viable bone at the endoprosthetic interface: retrieval study of Compress implants

M J Kramer  1 , B J Tanner, A E Horvai, R J O'Donnell
Affiliations

Compressive osseointegration promotes viable bone at the endoprosthetic interface: retrieval study of Compress implants

M J Kramer et al. Int Orthop. 2008 Oct.

Abstract
in English, French

The Compress implant (Biomet, Warsaw, IN) is an innovative device developed to enable massive endoprosthetic fixation through the application of compressive forces at the bone-implant interface. This design provides immediate, stable anchorage and helps to avoid the long-term complication of aseptic loosening secondary to stress shielding and particle-induced osteolysis seen in conventional, stemmed megaprostheses. The purpose of our study was to evaluate the in vivo biological effects of the high compressive forces attained. Twelve consecutive Compress patients undergoing revision surgery for infection, periprosthetic fracture, or local tumour recurrence were reviewed in order to exclude the possibility of osteonecrosis at the prosthetic interface. Compressive forces ranged from 400-800 lb. Duration of implantation averaged 3.3 years (range 0.4-12.2 years). Two patients with infection demonstrated loosening at the bone-prosthetic interface; otherwise, there was no radiographic evidence of prosthetic failure in any of the patients. No patient demonstrated histological evidence of osteonecrosis. In fact, new woven bone and other findings consistent with viable bone were noted in all of the retrieved specimens.

La prothèse Compress® (Biomet, Warsaw, In) est une endo-prothèse massive, innovante, développée pour permettre une fixation avec des forces de compression au niveau des interfaces os-implant. Le dessin de l’implant permet une stabilité immédiate au niveau de l’ancrage et semble éviter des complications, à long terme, comme le descellement aseptique, secondaire à un stress shielding rencontré de façon habituelle dans les méga prothèses. Le but de cette étude est d’évaluer les effets biologiques in vivo de ces forces de compression. 11 prothèses consécutives de type Compress® ont été réalisées chez 11 patients, nécessitant une réintervention pour infection, pour fracture périprothétique ou pour récidive d’une tumeur locale. Les forces de compression ont été évaluées de 400 à 800 lb. Le temps d’implantation moyen a été de 2.5 ans (0.4 à 6.5 ans). Deux patients ont présenté un descellement infectieux à l’interface os-prothèse, il n’a pas été mis en évidence, sur le plan radiographique d’échecs de cet implant chez aucun des patients. Aucun patient n’a également montré de façon évidente des phénomènes d’ostéonécrose histologique et, l’analyse des prothèses explantées a montré qu’il existait au contact de celles-ci un os vivant.

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Figures

Fig. 1
Fig. 1
Schematic diagram of the Compress® implant, demonstrating belleville washers stacked over a traction bar housed within the endoprosthetic taper at the bone-prosthetic interface
Fig. 2
Fig. 2
Graphic illustration of the means by which immediate, stable fixation is achieved at the bone-prosthetic interface, as a nut is tightened against the belleville washers
Fig. 3
Fig. 3
AP femoral radiograph demonstrating stable compressive osseointegration with hypertrophic bone formation at the interface of implant 4, retrieved for reasons of prosthetic infection 1.3 years after a 64-year-old woman underwent revision of a failed long-stem total hip replacement with the Compress® device. The radiograph demonstrates a stable pattern of osseointegration despite infection. The versatility of the Compress® implant is revealed by the ability to successfully fix megaprostheses to an extremely short distal femoral metaphyseal segment above a pre-existing total knee replacement
Fig. 4
Fig. 4
Photograph of anterior aspect of distal femoral retrieval specimen (implant 4) demonstrating gross evidence of new bone formation and stable, solid osseointegration at bone-prosthetic interface
Fig. 5
Fig. 5
Histology of bone at prosthetic interface from three patients (a, b patient 8, c patient 2, d patient 3). Viable osteocytes are diffusely present in all three patients immediately adjacent to the medullary cavity. Viable bone marrow (solid arrowheads) and osteoblastic rimming (open arrowhead) are demonstrated around intraosseous vessels. Woven bone and loose fibrosis was also identified at the interface (d). Haematoxylin and eosin; original magnification 40× (a) and 200× (b–d)
See this image and copyright information in PMC

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