Materials and methods

Study design and literature search

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [15] (Fig. 2). An electronic search was performed in the PubMed/MEDLINE, Embase, and Google Scholar databases from inception to December 2024. The search terms included “Zimmer Biomet Compress,” “Compressive Osseointegration,” “Periprosthetic Fracture,” “Postoperative Complications,” and “Limb Salvage” [16].

Fig. 2: PRISMA Flow Diagram: Study Selection Process. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram illustrating the study selection process. The initial search identified 247 records through database searching (PubMed n = 89, Google Scholar n = 112, Embase n = 46) and 15 additional records through other sources (reference lists n = 12, expert consultation n = 3). After removing duplicates, 198 records were screened. Following exclusion of studies not involving the Compress® device (n = 78), case reports only (n = 34), non-English-language publications (n = 22), and conference abstracts (n = 22), 42 full-text articles were assessed for eligibility. Of these, 35 were excluded owing to non-reportable outcome data (n = 15), irrelevant study design (n = 12), or duplicate data (n = 8). Seven studies met inclusion criteria and were included in qualitative and quantitative syntheses (meta-analysis)

Inclusion and exclusion criteria

Studies were included if they were published in peer-reviewed English-language journals; involved human participants treated with the CPS device for oncologic, traumatic, or revision indications; and reported specific data on postoperative fracture rates or implant survivorship with a minimum follow-up of 2 years [17]. Case reports with fewer than five patients and biomechanical studies without clinical data were excluded [18].

Data extraction and analysis

Data regarding patient demographics, surgical indications, follow-up duration, incidence of periprosthetic fractures, timing of fractures relative to the index surgery, status of the osseointegration interface at the time of failure, and revision strategies were extracted [19]. Comparative data on traditional cemented stems were also aggregated for analysis from relevant studies [20, 21].

Methodological quality assessment

Because all included studies were non-randomized observational studies, methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). The eight-item version was used for non-comparative studies and the 12-item version for comparative studies, as appropriate. Two reviewers independently performed the assessment, and disagreements were resolved through discussion and consensus.

The authors used the generative AI tool GenSpark to assist in developing and refining the literature search strategy for this systematic review. All database searches, screening decisions, data extraction, and data synthesis were performed manually by the authors. The authors reviewed and verified all AI-assisted outputs and take full responsibility for the accuracy and integrity of the final review.