Arch Bone Jt Surg. 2022 May; 10(5): 432–438.

Hybrid Cementation Technique Using the New Modular System for Aseptic Knee Arthroplasty Revision Surgery

Alessio Biazzo, MD,1 Riccardo D’Ambrosi, MD,2 Eric Staals, MD,3 Francesco Masia, MD,1 and Francesco Verde, MD1


To evaluate the clinical and radiological outcomes of aseptic revision of total knee arthroplasty (TKA) using the Vanguard 360 Revision Knee System with the hybrid cementation technique.


Between January 2014 and October 2016, nineteen aseptic revision TKAs were carried out with the Vanguard 360 Revision Knee System (Zimmer-Biomet, Warsaw, IN, USA) performed by two different surgeons. The patients were evaluated clinically and radiographically at one, six, and twelve months after surgery and yearly thereafter. Functional outcomes were assessed according to the range of motion (ROM), knee society knee score (KSKS) and knee society function score (KSFS). Radiological evaluations were performed using the hip-knee-ankle angle (HKA), weight-bearing anteroposterior view, latero-lateral view, Rosenberg x-rays of the knee and skyline patellar x-rays. A triple-phase technetium bone scan was performed on all the patients complaining of knee pain after one year from surgery.


Clinical and radiological results including KSKS, KSFS, ROM and HKA angle improved after revision of TKA with a statistically significant difference (p<0.05). There were seven revisions of the CCK prosthesis due to persistent pain.


Patients who underwent revision of TKA using the Vanguard 360 with the hybrid cementation technique had a failure rate of 36.8% at a mean time of 29 months due to aseptic loosening. Further studies are required to analyse the role of cementation in detail to prevent this complication.

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