Aseptic Failure: How Does the Compress® Implant Compare to Cemented Stems?

Background Failure of endoprosthetic reconstruction with conventional stems due to aseptic loosening remains a challenge for maintenance of limb integrity and function. The Compress ® implant (Biomet Inc, Warsaw, IN, USA) attempts to avoid aseptic failure by means of a unique technologic innovation. Though the existing literature suggests survivorship of Compress ® and stemmed implants is similar in the short term, studies are limited by population size and followup duration. Questions/purposes We therefore compared (1) the rate of aseptic failure between Compress ® and cemented intramedullary stems and (2) evaluated the overall intermediate-term implant survivorship. Methods We reviewed 26 patients with Compress ® implants and 26 matched patients with cemented intramedullary stems. The patients were operated on over a 3-year period. Analysis focused on factors related to implant survival, including age, sex, diagnosis, infection, aseptic loosening, local recurrence, and fracture. Minimum followup was 0.32 years (average, 6.2 years; range, 0.32–9.2 years). Results Aseptic failure occurred in one (3.8%) patient with a Compress ® implant and three (11.5%) patients with cemented intramedullary stems. The 5-year implant survival rate was 83.5% in the Compress ® group and 66.6% in the cemented intramedullary stem group. Conclusions The Compress ® implant continues to be a reliable option for distal femoral limb salvage surgery. Data regarding aseptic failure is encouraging, with equivalent survivorship against cemented endoprosthetic replacement at intermediate-term followup. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.