Surgical Technique: Methods for Removing a Compress® Compliant Prestress Implant

• Published in: Clinical orthopaedics and related research 2012-04, Vol.470 (4), p.1204-1212
• Main Authors: Abrams, Geoffrey D., Gajendran, Varun K., Mohler, David G., Avedian, Raffi S.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Amputation; Biological and medical sciences; Conservative Orthopedics; Debridement; Device Removal - methods; Diseases of the osteoarticular system; Female; Femur - surgery; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Prostheses and Implants - adverse effects; Prosthesis-Related Infections - surgery; Retrospective Studies; Sports Medicine; Staphylococcal Infections - surgery; Surgery; Surgical Orthopedics; Surgical Technique; Tumor
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-011-2128-z

Background The Compress® device uses a unique design using compressive forces to achieve bone ingrowth on the prosthesis. Because of its design, removal of this device may require special techniques to preserve host bone. Description of Techniques Techniques needed include removal of a small amount of bone to relieve compressive forces, use of a pin extractor and/or Kirschner wires for removal of transfixation pins, and creation of a cortical window in the diaphysis to gain access to bone preventing removal of the anchor plug. Methods We retrospectively reviewed the records of 63 patients receiving a Compress® device from 1996 to 2011 and identified 11 patients who underwent subsequent prosthesis removal. The minimum followup was 1 month (average, 20 months; range, 1–80 months). The most common reason for removal was infection (eight patients) and the most common underlying diagnosis was osteosarcoma (five patients). Three patients underwent above-knee amputation, whereas the others (eight patients) had further limb salvage procedures at the time of prosthesis removal. Results Five patients had additional unplanned surgeries after explantation. Irrigation and débridement of the surgical wound was the most common unplanned procedure followed by latissimus free flap and hip prosthesis dislocation. At the time of followup, all patients were ambulating on either salvaged extremities or prostheses. Conclusion Although removal of the Compress® device presents unique challenges, we describe techniques to address those challenges.