Handmade Articulating Spacer for Two-stage Exchange at the Knee

Objective: Two-stage exchange with implantation of a temporary spacer is considered gold standard treatment for chronic periprosthetic joint infection of the knee. This article describes a simple and safe technique for handmade articulating spacers at the knee.

Indication: Chronic or relapsing periprosthetic joint infection of the knee.

Relative Contraindications: Known allergy against components of polymethylmethacrylate (PMMA) bone cements or admixed antibiotics. Inadequate compliance for two-stage exchange. Patient not able to undergo two-stage exchange. Bony defect situation at the tibia or femur leading to collateral ligament insufficiency. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy.

Surgical Technique: Removal of the prosthesis, thorough debridement of necrotic and granulation tissue, tailoring bone cement with antibiotics. Preparation of a tibial and femoral stem. Customizing the tibial and femoral articulating spacer components to bony anatomy and soft tissue tension. Confirmation of correct position by intraoperative radiography.

Postoperative Management: Protection of the spacer with an external brace. Restricted weight-bearing. Passive range of motion as possible. Intravenous-followed by oral antibiotics. Reimplantation after successful treatment of infection.