Late infections of the knee joint: Two-stage articulating solutions

Two-stage exchange is the gold standard for the treatment of chronic total knee arthroplasty (TKA) infections in North America. Cement spacers impregnated with high- dose antibiotics have successfully been utilized in the interim period of the two-stage exchange. A number of non-articulating and articulating spacers have been described. With an intact extensor mechanism, a reasonable soft-tissue envelope, and adequate bone, articulating antibiotic spacers provide several advantages. These include an infection eradication rate of approximately 90 %, a higher range of motion after reimplantation, and lower complication rates when compared with non-articulating spacers. In the appropriate patient, articulating antibiotic spacers are an effective and a safe treatment choice in the two- stage exchange process for infected TKAs.