Arthrocentesis: A bedside procedure in which a sterile needle and syringe are used to drain fluid from the joint, and in some conditions, medication is injected into the joint after fluid removal.
2. ArthrocentesisArthrocentesis
A bedside procedure in which a sterile
needle and syringe are used to drain fluid
from the joint, and in some conditions,
medication is injected into the joint after
fluid removal.
3. Knee joint anatomyKnee joint anatomy
It is a synovial hinge joint formed between
three bones: the femur, tibia, and patella.
It has strongest capsule
MCL , LCL, ACL, PCL
med. and lat. menisci
5. IndicationsIndications
DiagnosticDiagnostic knee arthrocentesis:knee arthrocentesis:
Evaluation of monoarticular arthritisEvaluation of monoarticular arthritis
Evaluation of suspectedEvaluation of suspected septic arthritisseptic arthritis
Evaluation of joint effusionEvaluation of joint effusion
Identification of HemarthrosisIdentification of Hemarthrosis
Identification of crystal arthropathyIdentification of crystal arthropathy
6. IndicationsIndications
TherapeuticTherapeutic knee arthrocentesis:knee arthrocentesis:
Relief of pain by aspirating effusion or bloodRelief of pain by aspirating effusion or blood
Injection of medications (corticosteroids,Injection of medications (corticosteroids,
antibiotics, chemotherapy or anesthetics)antibiotics, chemotherapy or anesthetics)
Drainage of septic effusionDrainage of septic effusion
7. ContraindicationsContraindications
There areThere are no absoluteno absolute contraindicationscontraindications
for knee arthrocentesis.for knee arthrocentesis.
RelativeRelative contraindicationscontraindications;;
Cellulitis overlying the joint .Cellulitis overlying the joint .
Skin lesion or dermatitis overlying the jointSkin lesion or dermatitis overlying the joint
Known bacteremiaKnown bacteremia
Adjacent osteomyelitisAdjacent osteomyelitis
Uncontrolled coagulopathyUncontrolled coagulopathy
Joint prosthesisJoint prosthesis
8. EquipmentsEquipments
The materials required for knee arthrocentesisThe materials required for knee arthrocentesis
include the following:include the following:
Sterile gloves and drapesSterile gloves and drapes
5 gauze pads, 4 × 4 in.5 gauze pads, 4 × 4 in.
Skin preparatory solutionSkin preparatory solution
Lidocaine 1%Lidocaine 1%
Syringes, 5 mL, 20 mL, 30 mL, 60 mLSyringes, 5 mL, 20 mL, 30 mL, 60 mL
Needles, 18 or 20 gauge and 25 or 27 gauge, obeseNeedles, 18 or 20 gauge and 25 or 27 gauge, obese
patients might require a 21-gauge spinal Hemostatpatients might require a 21-gauge spinal Hemostat
Specimen tubesSpecimen tubes
BandageBandage
10. Patient PreparationPatient Preparation
informed consent.informed consent.
identification of theidentification of the
needle insertion siteneedle insertion site
and marking it.and marking it.
11. Patient PreparationPatient Preparation
skin preparation andskin preparation and
draping the joint.draping the joint.
Local anesthesia;Local anesthesia;
• lidocaine 1%lidocaine 1%
12. procedureprocedure
Parapatellar approachParapatellar approach midpoint of eithermidpoint of either
the medial or the lateral border of thethe medial or the lateral border of the
patella. Insert a needle 3-4 mm below thepatella. Insert a needle 3-4 mm below the
point.point.
useful when there isuseful when there is
a small effusiona small effusion
13. procedureprocedure
Suprapatellar approachSuprapatellar approach, midpoint of either the, midpoint of either the
superomedial or the superolateral border of thesuperomedial or the superolateral border of the
patella.patella.
Insert a needle through the midpoint of either setInsert a needle through the midpoint of either set
of superior borders.of superior borders.
useful for large effusionsuseful for large effusions
14. procedureprocedure
Infrapatellar approach, position the patient
sitting with knee bent at 90°
Identify inferior border of the
patella and the patellar tendon.
Insert a needle 5 mm below
the inferior border of the patella
and just lateral to the edge of the
patellar tendon.
16. Analysis of Synovial Fluid
AppearanceAppearance
Cytological investigationsCytological investigations
Histological investigationHistological investigation
Biochemical investigationsBiochemical investigations
Culture and sensitivityCulture and sensitivity
17. Analysis of Synovial Fluid
Normal Noninflammatory inflammatory septic
Clarity Transparent Transparent Cloudy Cloudy
Color Clear Yellow Yellow Yellow
WBC/L <200 <200–2000 200–50,000 >50,000
PMN % <25 <25 >50 >50
Culture Negative Negative Negative >50% positive
Crystals None None Multiple or none None
Glucose Normal Normal < 25 < 25
Protein 1.3-1.8 2-3.5 > 4 > 4
Associated
conditions
Osteoarthritis,
trauma, rheumatic
fever
Gout, pseudogout,
spondyloarthropath
ies, RA, Lyme
disease, SLE
Non-
gonococcal or
gonococcal septic
arthritis
18. Complications
1.1. InfectionInfection; with proper; with proper aseptic technique 1;10,0001;10,000
• on infected skin IV-ABon infected skin IV-AB should be administered
2. Hemarthroses are small and self-limited
• coagulopathic patients requires correction
3. damage to articular cartilage
4. Damage to adjacent neurovascular organs