Two-stage revision total knee arthroplasty with articulating spacer for infection

Articulating spacers have gained popularity for the management of chronic deep periprosthetic knee infections. Their ability to maintain reasonable function between stages in patients undergoing 2-stage revision for infection, while not compromising the infection cure rate, has resulted in the increased use of articulating spacers. The ability to maintain a range of motion between stages results in improved comfort and function for most patients and facilitates reimplantation by reducing stiffness.This article provides an overview of the technique for 2-stage exchange revision knee surgery. The principles of using articulating spacers, and specifically the use of the PROSThesis of Antibiotic Loaded Acrylic Cement (PROSTALAC) articulating spacer, are outlined in detail. In addition, the principles of diagnosing and managing chronic deep infection in total knee replacements are discussed.