Arthrocentesis. in Orthopaedics .pptx

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NamanSharda2

Arthrocentesis

Health & Medicine

• Indications
• Contraindications
• Basic technique
• Guided techniques
• Synovial fluid analysis
• Complications
Arthrocentesis Joint injection
• Use in ED
• Medications

MR ARTHUR
RITIS
• 52 year old man
• 24 hours of hot, swollen,
painful right knee.
• PMHx
T2DM, HTN, A Touch
Overweight, Gout
• Meds
Olmesartan/HCT, Metformin
• NKDA

MR ARTHUR
RITIS
• General Exam
Temp 37.7
Knee
• Warm, large effusion, mild
tenderness
• ROM reduced

MR ARTHUR
RITIS
• Blood tests
FBP (WCC)1
CRP2
? ESR1
? Pro-calcitonin3
? uric acid
• Imaging
Plain film Xray

MR ARTHUR
RITIS
• Blood tests
WCC 12.5
CRP 60

• Indications
Investigation of
unexplained mono-
articular arthritis.
Confirm diagnosis of first
episode crystal
arthropathies.
Symptomatic tap for
large effusion.

• Contra-indications
Non compliant patient
• Relative
Overlying Cellulitis4
Uncontrolled bleeding
disorder5,6
Prosthetic joint

• Technique
Sterile gloves
Skin prep
• SCGH ED Guideline
• Springer et al.
Joint Arthrocentesis in the
Emergency Department.

SYNOVIAL FLUID
ANALYSIS
Macroscopic assessment
Microscopy
Gram stain7
Crystals
Cell count (WCC, % Polymorphonuclear)7,8
Culture

MR ARTHUR RITIS
Macroscopic assessment: yellow, slightly cloudy
Microscopy
Gram stain: no bacteria seen.
Crystals: urate crystals
Synovial WCC: 15000 PMN: 60%
Culture: pending

• Osteoarthritis9
• Rheumatoid arthritis10
• Gout 11

1. Li S, Cassidy C, Chang C et al. Diagnostic utility of laboratory tests in septic arthritis. Emergency Medicine Journal. 2007;24(2): 75-
77.
2. Hugle T, Scheutz P, Mueller B et al. Serum procalcitonin for discrimination between septic and non septic arthritis. Clin Exp Rheum.
2008;26:305-8.
3. Maharajan et al. Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis. J
Orth Surg Research. 2013;8.
4. Dooley DP. Aspiration of the possibly septic joint through potential cellulitis: Just do it! J Emerg Med 2002;23:210.
5. Yui J etal. Arthrocentesis and Joint Injection in Patients Receiving Direct Oral Anticoagulants. Mayo clinic proceedings.
2017;92(8):1223-26.
6. Ahmed I. Safety of Arthrocentesis and Joint Injection in Patients Receiving Anticoagulation at Therapeutic Levels. Am J Medicine.
2012;125(3):265-9.
7. Carpenter C et al. Evidence based diagnostics: septic arthritis. Academic Em Med. 2011;18(8): 782-96.
8. Coutlakis PJ. Another look at synovial fluid leukocytosis and Infection. J Clin Rheumatol 2002; 8:67–71.
9. Godwin. Intra-articular steroid injections for painful knees. Systematic review with meta-analysis. Can Fam Phys. 2004;50(2):241-
248.
10. Wallen M, Gillies D. Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid
arthritis. Cochrane Musculoskeletal group. 2006.
11. Wechalekar M et al. Intra-articular glucocorticoids for acute gout. Cochrane musculoskeletal group. 2013.
12. Stephens M et al. Musculoskeletal injections: a review of the evidence. Am Fam Phys. 2008;78(8):971-6.

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