Conclusions

The Zimmer Biomet CPS device appears to have a favorable safety profile, with reported adult periprosthetic fracture rates of approximately 2.7–3.9%. The reported fractures exhibited a clear temporal pattern, occurring predominantly within the first 2 years after implantation, rather than following the progressive failure pattern typically described for traditional cemented stems. Importantly, the bone–implant interface generally remained stable despite fracture, and the short intramedullary footprint of the device may facilitate revision while preserving bone stock. In the pediatric population, although expandable components were associated with a higher overall complication rate, spindle survivorship was 86.3% at 5 years and 66.2% at 10 years, supporting the durability of the compressive osseointegration mechanism. Overall, the CPS device may represent a valuable option for limb salvage reconstruction when careful patient selection, appropriate surgical technique, and strict adherence to postoperative weight-bearing protocols are maintained. Future studies should include longer follow-up, direct comparative analyses using matched populations, and more rigorous evaluation of risk factors and methodological quality.