Hand-made articulating spacers for infected total knee arthroplasty: a technical note.

The standard treatment for late infections of knee prostheses is a two-stage reimplantation with a temporary articulating spacer between operations, but there is no universal agreement as to the best type of spacer to be used and surgeons have created modifications according to their technical and economic resources. We describe our modified technique for custom-made articulating spacers. Spacers have evolved from simple monoblock designs made of acrylic cement alone to articulated, modular, complex and expensive designs with different grades of constriction. Many surgeons are reluctant to use these devices because of the costs and the potential risks of inserting metallic or plastic elements into a septic joint. Further refinements for customization of articulating spacers have been attempted (Rand 1993, Goldman et al. 1996). We have found no reports describing a technique for making custom hand-made articulating spacers.