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Massive modular endoprostheses used for reconstruction of oncologic defects have historically been secured with stems, either cemented or uncemented. These implants have been subject to failure from aseptic loosening secondary to stress shielding and particle-induced osteolysis, especially in certain anatomic locations, and in many young oncology patients. To overcome these serious problems, Compress technology was invented with the goal of providing not only immediate endoprosthetic anchorage, but also ongoing compliant fixation that induces bone hypertrophy and eliminates aseptic loosening.Compress distal femoral endoprosthetic replacements have been analyzed as part of a multiinstitutional 4-year prospective cohort study that culminated in US Food and Drug Administration clearance of the device in December, 2003. Over the past year, the first set of papers detailing the initial experience with Compress patients has been published.Over the past two decades, compressive osseointegration as a means to achieve stable, long-term fixation of modular endoprostheses has moved from concept to reality. Success with distal femoral Compress implants has prompted usage in proximal femoral, proximal tibial, humeral, and intercalary locations. Expansion of orthopaedic osseointegration applications is expected to dramatically change the anchorage of primary arthroplasty and transdermal amputation prostheses.