Archives of Orthopaedic and Trauma Surgery - 2026-08-22 - Journal Article; Systematic Review; Review
Postoperative periprosthetic fractures associated with compressive osseointegration: a systematic review of the Zimmer Biomet Compress ® device.
Hashimoto K, Nishimura S, Goto K
Topics
Key Takeaway
The Zimmer Biomet Compress CPS device demonstrates a periprosthetic fracture rate of 2.7–3.9% in adults, concentrated within the first 2 years postoperatively, with preserved bone-implant interface stability in most fracture cases facilitating easier revision than cemented stems.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This systematic review examined periprosthetic fracture prevalence, risk factors, and outcomes associated with the Compress CPS compressive osseointegration device versus traditional cemented stems in limb salvage surgery. Adult periprosthetic fracture rates ranged 2.7–3.9%, with fractures clustering in the first 2 postoperative years; pediatric spindle survivorship was 86.3% at 5 years and 66.2% at 10 years. Despite fracture occurrence, the bone-implant interface remained radiographically stable in most cases, enabling revision with less bone loss than cemented stem failure.
Key Limitation
The review is limited by small, heterogeneous study cohorts—particularly the pediatric dataset of only 36 patients—precluding definitive conclusions about fracture risk factors or subgroup-specific survivorship.
Original Abstract
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.