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

Document Type : RESEARCH PAPER


1 Hip and Knee Reconstructive Surgery Department, Humanitas Gavazzeni, Bergamo, Italy

2 IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

3 Orthopedic Oncology Division, Rizzoli Orthopedic Institute, Bologna, Italy


Background: 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.
Methods: 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.
Results: 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. 
Conclusion: 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.
Level of evidence: IV


Volume 10, Issue 5
May 2022
Pages 432-438
  • Receive Date: 03 October 2020
  • Revise Date: 17 August 2021
  • Accept Date: 26 August 2021
  • First Publish Date: 30 August 2021