Compression Assisted Arthrocentesis and Intraarticular Injection

James Bennett¹, Tej Bhavsar¹, Romy Cabacungan², Sabeen Yaqub¹, Monthida Fangtham³, N. Suzanne Emil¹, Roderick Fields⁴, Konstantin Konstantinov⁵, Arthur Bankhurst⁶, William Hayward⁷ and Wilmer Sibbitt Jr.³, ¹Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, ²Internal Medicine, Division of Rheumatology, University of New Mexico, Albuquerque, NM, ³Rheumatology, University of New Mexico, Albuquerque, NM, ⁴Internal Medicine/ Rheumatology, University of New Mexico School of Medicine, Albuquerque, NM, ⁵1 University Of New Mexico, University of New Mexico, Albuquerque, NM, ⁶Rheumatology, University of NM Medical Center, Albuquerque, NM, ⁷Exercise and Sport Sciences, New Mexico Highlands University, Las Vegas, NM

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: arthritis management, Arthrocentesis, Joint procedures, outcomes and quality improvement

Session Information

Date: Sunday, November 5, 2017

Title: Orthopedics, Low Back Pain and Rehabilitation Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

We hypothesized that compression assisted arthrocentesis of the knee would improve arthrocentesis fluid yields and intraarticular injection outcomes.

Methods:

We performed conventional arthrocentesis on 215 painful knees, both with and without effusions prior to injection. Subsequently a constant compression device (a commercially available elastomeric brace positioned or modified so classic arthrocentesis portals could be utilized) was placed and arthrocentesis was performed on 215 painful knees. In all cases, post arthrocentesis, 1mg/kg of triamcinolone acetonide (60-80 mg total, 80 mg maximum) was injected into each knee. Arthrocentesis fluid yield and time to the next flare were measured. The data were compared using Student’s T-test.

Results:

The demographics of the study groups were similar. Fluid yield for complete arthrocentesis with constant compression was greater (by 230%) than the conventional technique: constant compression 5.3±11.2 ml, conventional 1.6±6.4 ml (difference 3.7 ml, CI of difference 1.9757 <3.7< 5.4243, p<0.00001). Fluid yield was also increased in the effusive knee subgroup (by 166%): constant compression (n = 38) 26.6±113.4 ml, conventional (n=37) 10.0±13.3 ml (p<0.00001)(Figure 1). Time to flare was 35% longer in the subjects treated with constant compression 6.9±3.5 months as opposed to conventional treatment 5.1±2.7 months (p<0.00001)(Figure 2). The prolonged effect of constant compression was present in both the effusive knee (30% longer, p<0.02) and the non-effusive knee (38% longer, p<0.01).

Figure 1:

Figure 2:

Conclusion:

Constant compression of the knee results in greater arthrocentesis fluid yield and improved injection outcomes in both the effusive and non-effusive knee. We hypothesize that more accurate needle placement, forced extrusion of interstitial fluid and cytokines from compressed tissues, and more complete removal of fluid decrease inflammatory cells and cytokines and increase intraarticular drug concentrations, resulting in improved outcomes. Constant compression of the knee is a straightforward and effective quality improvement intervention for knee arthrocentesis and intraarticular injection.

Disclosure: J. Bennett, None; T. Bhavsar, None; R. Cabacungan, None; S. Yaqub, None; M. Fangtham, None; N. S. Emil, None; R. Fields, None; K. Konstantinov, None; A. Bankhurst, None; W. Hayward, None; W. Sibbitt Jr., None.

To cite this abstract in AMA style:

Bennett J, Bhavsar T, Cabacungan R, Yaqub S, Fangtham M, Emil NS, Fields R, Konstantinov K, Bankhurst A, Hayward W, Sibbitt W Jr.. Compression Assisted Arthrocentesis and Intraarticular Injection [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/compression-assisted-arthrocentesis-and-intraarticular-injection/. Accessed .

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