Postoperative periprosthetic fractures associated with compressive osseointegration: a systematic review of the...

The Zimmer Biomet Compress^® Compliant Pre-Stress (CPS) device uses a compressive osseointegration technique for endoprosthetic fixation and provides an alternative to stemed implants. Despite having benefits, such as bone stock retention, periprosthetic fractures continue to remain a concern. Therefore, this systematic review presents the prevalence, risk factors, and outcomes of the CPS device and periprosthetic fractures after treatment. Medical databases (PubMed, Embase, and Google Scholar) were searched to identify studies reporting complications related to the CPS device. Peer-reviewed studies with at least 2 years of follow-up for fracture rates, revision results, and implant survivorship were included. The primary data collected were fracture incidence and timing of complications, and the CPS device was compared with the traditional cemented stem. This review highlights important studies, including a cohort of 221 patients and pediatric data from 36 patients. Adult populations showed a periprosthetic fracture rate of 2.7-3.9%. A distinct temporal pattern emerged: the frequency of fractures was most pronounced within the first 2 years after surgery. In the pediatric context, spindle survivorship was 86.3% at 5-10 years, despite higher rates of mechanical complications. Notably, for most fracture cases, the bone-implant interface was radiographically stable, providing easier revision with significantly less bone loss with the CPS device than with the traditional cemented stem. The CPS device showed a periprosthetic fracture rate similar to or lower than that of the traditional cemented stem and an early onset temporal profile with distinct features. The stability of the bone-implant interface despite fracture and its ability to be modified after implantation highlight its suitability for limb salvage surgery. To reduce the fracture risk, strict postoperative weight-bearing protocols are recommended during the early osseointegration period. This review highlights important studies, including a cohort of 221 patients and pediatric data from 36 patients. Adult populations showed a periprosthetic fracture rate of 2.7-3.9%. A distinct temporal pattern was observed, with fractures occurring most frequently within the first 2 years after surgery. In pediatric populations, spindle survivorship was 86.3% at 5 years and 66.2% at 10 years, despite higher rates of mechanical complications. Notably, for most fracture cases, the bone-implant interface remained radiographically stable, providing easier revision with significantly less bone loss than with traditional cemented stems. The CPS device showed low reported adult periprosthetic fracture rates and an early-onset temporal profile with distinct features. The stability of the bone-implant interface despite fracture occurrence, together with the ability to modify the implant after implantation, highlight its suitability for limb salvage surgery. To reduce fracture risk, strict postoperative weight-bearing protocols are recommended during the early osseointegration period.