Balanced, Stemmed, and Augmented Articulating Total Knee Spacer Technique

Explantation and placement of an antibiotic spacer is a well-recognized treatment for periprosthetic infection after total knee replacement. Although static spacers may be occasionally indicated, many patients benefit from an articulating spacer that preserves the function and range of motion. However, many articulating spacer techniques provide an imbalanced cement-on-cement articulating knee that cannot tolerate full weight-bearing or provide adequate stability for daily function. A more durable articulating spacer may be ideal by permitting unrestricted weight-bearing, a functional range of motion, and potentially delayed reimplantation for medically complex patients. We present our evolved and reproducible technique for gap-balanced articulating spacers using cement augments and dowel stems. The result is a stable construct that permits full weight-bearing and a functional range of motion.