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L imb salvage is possible and appropriate in up to 90% of patients with primary sarcomas of the extremities without compromising survival, and this approach achieves almost equal local tumor control when compared to amputation [8], with better functional results. With continuous improvement in survival of patients with metastatic disease, more of these patients are candidates for tumor resection and limb salvage, particularly those with oligometastatic disease [6, 7]. An increasing number of patients with massive bone loss resulting from trauma, osteomyelitis, and failed arthroplasty are being treated with endoprostheses. In order to retain a functional limb following bone and/or joint resection, a durable structural reconstruction is required. Reconstruction options include biologic and endoprosthetic solutions, neither of which is entirely satisfactory. Complications related to the use of endoprostheses include infection, aseptic loosening of prosthetic stems, prosthetic fractures, and joint instability [5]. Intramedullary endoprosthetic fixation, whether achieved by cementing or press-fit, can fail in up to 30% of patients, particularly among patients undergoing knee or elbow reconstructions [5, 7]. The use of compression osteointegration (Compress Compliant Prestress Device [CPS]; Biomet Inc, Warsaw, IN, USA) as a fixation method was introduced, in part, to reduce the risk of aseptic loosening. This technique creates continuous stable high-grade compression forces between the cut bone end and a porous, coated disc or spindle. This compression stimulates osteointegration at the bone-prosthetic interface, avoids stress stem shielding around the stem, prevents osteolysis from particulate wear debris, and preserves bone stock, all of which contribute to a reduction in the likelihood of aseptic loosening. The short intramedullary CORR Insights Published online: 3 April 2017 The Association of Bone and Joint Surgeons1 2017

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CORR Insights®: Use of Compressive Osteointegration Endoprostheses for Massive Bone Loss From Tumor and Failed Arthroplasty: A Viable Option in the Upper Extremity