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Abstract Number: 1305

Quality Improvement in Diagnostic and Therapeutic Arthrocentesis in the Flexed Knee Using Pneumatic Compression of the Suprapatellar Bursa

Fatemeh Jafari Farshami1, Jaren Trost 2, Wilmer Sibbitt 2, Maheswari Muruganandam 2, Philip Band 3, Monthida Fangtham 1, Nicole Emil 1, William Hayward 4, Luke Haseler 5 and Arthur Bankhurst 1, 1Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 2Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, 3Department of Orthopaedic Surgery, Biochemistry & Molecular Pharmacology NYU School of Medicine, New York City, New York City, NY, 4The Department of Exercise and Sport Sciences, New Mexico Highlands University, Las Vegas, NM, 5Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Arthrocentesis, injection and procedure, Knee, synovial fluid

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Session Information

Date: Monday, November 11, 2019

Session Title: Osteoarthritis – Clinical Poster I

Session Type: Poster Session (Monday)

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

Background/Purpose: Arthrocentesis is an essential procedure in diagnosing inflammatory and septic arthritis and is a basic procedure for intra-articular therapy, including therapeutic arthrocentesis and intra-articular injection. Complete arthrocentesis before injection of corticosteroid or hyaluronan confirms the diagnosis, reduces the possibility of superimposed infection, reduces patient pain, and improves response to the injected drug. Meehan et al and others have demonstrated that constant external compression of the knee improves arthrocentesis yield and outcomes. As a quality improvement process, we used a pneumatic compression cuff to apply constant compression to the flexed knee to remove the operator`s hands from potential needlestick, mobilize synovial fluid, and permit more complete arthrocentesis.

Methods: 25 consecutive painful knees (11 OA, 9 OA/RA, 4 RA, 1 RA/septic joint) underwent arthrocentesis performed conventionally and with pneumatic compression. The mean age of the population was 61.3±14.3 years with male:female of 1: 2.1. Pre-procedural pain according to the 10 cm Visual Analogue Pain Scale (VAS) was 8.0±1.2 cm.The quality intervention was designed as a paired study in the same knee: that is, first conventional arthrocentesis in the flexed knee position using the inferolateral approach was performed and quality and outcome measures were obtained. After fluid return ceased, a pneumatic leg cuff, which was placed over the suprapatellar bursa prior to starting the procedure, was inflated to 60 millimeters Hg. Arthrocentesis was then re-attempted, and quality measures were obtained once again.

Results: Procedural pain according to the 10 cm VAS was 3.9±2.8cm and post-procedural pain was 1.0±1.3 cm. In 25 painful knees, conventional arthrocentesis yield was 7.8±18.2 ml and using pneumatic compression was 14.3±27.9 ml, an 84.1% increase (Figure 2). When the 13 effusive knees were analyzed separately, conventional arthrocentesis yield was 18.2±22.7 ml and using pneumatic compression was 27.9±28.6 ml, a 53.3% increase. The mean enhanced arthrocentesis yield reported here with the pneumatic compression in the flexed knee is similar to improved fluid yield that we have reported previously of 16.7±11.3 ml with elastomeric compression of the flexed knee (p = 0.69) and both are similar to the 16.9±15.7 ml arthrocentesis yield that was reported in conventional extended knee arthrocentesis (p = 0.69) (Yaqub et al 2018).

Conclusion: The technique of constant compression using a pneumatic cuff mobilizes residual synovial fluid and improves arthrocentesis success. The use of a pneumatic leg cuff in the flexed knee is a low-cost quality improvement technique that can readily be incorporated into clinical musculoskeletal practice and is particularly useful for performing arthrocentesis in patients in the sitting position, confined to wheelchairs, or with flexion contractures of the knee. Further, since the pneumatic cuff is spatially superior to the inferolateral portal at the puncture site, errant synovial fluid flows down the leg away from the cuff and does not contaminate the device unlike compression devices used in the extended knee positioning.

Arthrocentesis in flexed knee position, using a pneumatic leg cuff

Arthrocentesis yield from the knee with and without pneumatic compression


Disclosure: F. Jafari Farshami, None; J. Trost, None; W. Sibbitt, None; M. Muruganandam, None; P. Band, None; M. Fangtham, None; N. Emil, None; W. Hayward, None; L. Haseler, None; A. Bankhurst, None.

To cite this abstract in AMA style:

Jafari Farshami F, Trost J, Sibbitt W, Muruganandam M, Band P, Fangtham M, Emil N, Hayward W, Haseler L, Bankhurst A. Quality Improvement in Diagnostic and Therapeutic Arthrocentesis in the Flexed Knee Using Pneumatic Compression of the Suprapatellar Bursa [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/quality-improvement-in-diagnostic-and-therapeutic-arthrocentesis-in-the-flexed-knee-using-pneumatic-compression-of-the-suprapatellar-bursa/. Accessed January 28, 2023.
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