ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0737

Enhanced Arthrocentesis of the Flexed Knee with Pneumatic Compression

Sumir Brahmbhatt1, Ahsan Iqbal1, Fatemeh Farshami2, Maheswari Muruganandam3, Jaren Trost4, David Cisneros5, Adnan Kiani3, N. Suzanne Emil3, Sharon Nunez1, William Hayward6, Philip Band7 and Wilmer Sibbitt3, 1UNM, Albuquerque, NM, 2University of New Mexico, Albuquerque, MD, 3University of New Mexico, Albuquerque, NM, 4Optum, Albuquerque, NM, 5University of New Mexico School of Medicine, Albuquerque, NM, 6New Mexico Highlands University, Las Vegas, NM, 7NYU SOM, New York, NY

Meeting: ACR Convergence 2021

Keywords: , , , ,

Session Information

Date: Sunday, November 7, 2021

Session Title: Osteoarthritis – Clinical Poster II (0723–0738)

Session Type: Poster Session B

Session Time: 8:30AM-10:30AM

Background/Purpose: To explore an alternative to standard extended knee arthrocentesis using pneumatic compression of the flexed knee.

Methods: Using a paired sample design, 41 consecutive effusive knees underwent arthrocentesis in the flexed knee position first without and then with pneumatic compression of suprapatellar bursa. Arthrocentesis success and fluid yield in milliliters (ml) were measured. For comparison 41 consecutive patients who had undergone extended knee arthrocentesis without and with compression were also studied.

Results: Successful diagnostic arthrocentesis (≥ 3 ml) of the effusive flexed knee was 85% (35/41) without compression and increased significantly to 100% (41/41) with pneumatic compression (p=0.027). Synovial fluid yields were significantly greater with pneumatic compression (36.8±27.7 ml) than without compression (15.2±17.6 ml) (increase of 142% or 21.6±17.6 ml more; 95% CI: 13.0 < 23.4< 33.8, p< 0.0001). Arthrocentesis yield for the extended knee position without compression (12.4±12.9 ml) was similar to the flexed knee without compression (15.2±17.6 ml; 95% -9.9412 < -3.1< 3.7412 (Wald) p=0.36). Arthrocentesis yield for the extended knee with compression (25.2±13.4 ml) was enhanced by 108% (12.8±13.2 ml) similar to the flexed knee with compression (142%, 21.6±17.6 ml).

Conclusions: Compression of the effusive flexed knee with a suprapatellar pneumatic cuff markedly improves the success and fluid yield of arthrocentesis and is non-inferior to standard extended knee arthrocentesis with or without compression. Arthrocentesis of the flexed knee with pneumatic compression is especially useful in patients who wish to remain seated or who cannot extend their knee due to flexion contracture, wheelchair confinement, pain or severe arthritis.

Conclusion: For individuals with knee contractures, the obese, wheelchair-bound individuals, the elderly, or those apprehensive individuals who involuntarily and forcefully contract the quadriceps muscles during a procedure, the standard extended knee superiolateral approaches for arthrocentesis can be difficult and/or inconvenient. Compression of the effusive flexed knee with a suprapatellar pneumatic cuff markedly improves the success and fluid yield of arthrocentesis and is non-inferior to standard extended knee arthrocentesis with or without compression. This pneumatic compression method that permits the patient to remain in the sitting position or equivalent with a flexed knee, but provides high levels of arthrocentesis success and fluid yield will be of obvious clinical utility.

These graphs demonstrate the fluid yield with and without pneumatic compression of the flexed knee using the inferiolateral portal. Pneumatic compression causes a marked increase in fluid yield.

These graphs demonstrate the fluid yield with and without mechanical compression of the extended knee using the superiolateral portal (suprapatellar approach). Mechanical compression causes a marked increase in fluid yield similar to the increase in fluid yield with pneumatic compression shown in Figure 1

Clinical and Research Characteristics of the Study Populations

Disclosures: S. Brahmbhatt, None; A. Iqbal, None; F. Farshami, None; M. Muruganandam, None; J. Trost, None; D. Cisneros, None; A. Kiani, None; N. Emil, None; S. Nunez, None; W. Hayward, None; P. Band, None; W. Sibbitt, None.

To cite this abstract in AMA style:

Brahmbhatt S, Iqbal A, Farshami F, Muruganandam M, Trost J, Cisneros D, Kiani A, Emil N, Nunez S, Hayward W, Band P, Sibbitt W. Enhanced Arthrocentesis of the Flexed Knee with Pneumatic Compression [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/enhanced-arthrocentesis-of-the-flexed-knee-with-pneumatic-compression/. Accessed January 27, 2023.

« Back to ACR Convergence 2021

ACR Meeting Abstracts - https://acrabstracts.org/abstract/enhanced-arthrocentesis-of-the-flexed-knee-with-pneumatic-compression/