Two patients with Charcot joints developed septic arthritis. The infection in the first patient was treated successfully by repeated needle aspirations and parenteral oxacillin administration. In the second patient closed drainage and parenteral penicillin were not successful in eradicating the infection, and surgical incision with suction drainage was required. Technical difficulties achieving arthrodesis in a Charcot joint suggest that repeated needle aspirations are the preferred method of initial joint drainage. Surgical drainage is advised for loculated, grossly purulent parts of the joint.