This paper reports a novel technique to create an antibiotic spacer for the treatment of infected total knee replacements (TKA) with surface contours similar to that of the original TKA.

This new technique involved the intra-operative construction of a custom mold made from bone cement along with the removed implant. Twelve consecutive patients treated with this technique were reviewed in the aspect of the degree of flexion, difficulty in exposure at the 2nd stage reimplantation, and complications related to the technique. The functional status was evaluated using the Knee Society score.

The degree of flexion was 85 (40-130) preoperatively and 100 (70-110) prior to reimplantation. The postoperative flexion was 112 (90-140) at 6 weeks, 108 (70-140) at 3 months, and 110 (75-140) at 1 year postoperatively. A rectus snip was required in 8 out of 12 cases. Other extensile approaches were not needed. The knee society score was significantly improved from 30/24 to 87/80. No specific complications were noted at the final follow-up.

This technique allows the immediate stability and mobility after the first stage of reimplantation. This technique offers ease and convenience of surgical technique without considerable increase in surgical cost or time. In addition, it eliminates the requirement for costly commercial mold or special pre-manufactured implants.