Aspiration of Knee Joint Arthrocentesis

The knee is one of the largest and most accessible joints for arthrocentesis or joint injection. Aspiration of joint fluid from the knee is performed to assess for infection, inflammation, crystal deposition, or traumatic complications. Infections may show a significantly high white blood cell infiltrate with visible organisms on Gram stain. Inflammation may show the same without organisms seen. Crystal disease may show urate or calcium pyrophosphate crystals. Trauma may produce a bloody aspirate with tears of a ligament or cartilage and fat lobules with an intra-articular fracture.

Prior to the aspiration, the patient is consented and placed in a recumbent position with the knee flexed slightly with a rolled towel. The knee is assessed for effusion and the aspiration site marked and cleansed with a sterilizing wash. The knee joint space can be entered with a 22-gauge needle on a syringe on either side, but usually from the lateral aspect 1 cm lateral and superior to the patella, and directed 45 degrees downward angling under the patella, with aspiration done during insertion. When the joint space is entered, fluid should enter the syringe rapidly. Milking the lateral and medial recesses of the knee toward the needle tip will remove more fluid. The needle is removed after aspiration, or it is left in place and the syringe changed under sterile conditions for a steroid injection to follow, if necessary. Large joints can be injected with 20 to 40 mg of triamcinolone or 6 to 12 mg of betamethasone with 3 to 6 mL of 1% lido-caine for inflammatory conditions unrelated to infections. Procedural risks include septic arthritis, mild injury to the

The complete reference list is available online at www.expertconsult.com.

www.cdc.gov/rabies/exposure/postexposure.html

Centers for Disease Control and Prevention website has advice on rabies prophylaxis for animal bites. www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm#tab3

CDC website has details from the 2001 postexposure prophylaxis (PEP) guidelines. www.mdconsult.com/das/book/body www.npinstitute.com

Postgraduate procedural skills training.

articular cartilage, and hemarthrosis. (See Tuggy Video: Knee Aspiration.)

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