Enhanced arthrocentesis of the effusive knee with pneumatic compression

Abstract

Aim: Complete arthrocentesis of the effusive knee ameliorates patient pain, reduces intra-articular and intraosseous pressure, removes inflammatory cytokines, and has been shown to substantially improve the therapeutic outcomes of intra-articular injections. However, conventional arthrocentesis incompletely decompresses the knee, leaving considerable residual synovial fluid in the intra-articular space. The present study determined whether external pneumatic circumferential compression of the effusive knee permitted more successful arthrocentesis and complete joint decompression.Methods: Using a paired sample design, 50 consecutive effusive knees underwent conventional arthrocentesis and then arthrocentesis with pneumatic compression.Pneumatic compression was applied to the superior knee using a conventional thigh blood pressure cuff inflated to 100 mm Hg which compressed the suprapatellar bursa and patellofemoral joint, forcing fluid from the superior knee to the anterolateral portal where the fluid could be accessed. Arthrocentesis success and fluid yield in mL before and after pneumatic compression were determined.Results: Successful diagnostic arthrocentesis (≥3 mL) of the effusive knee was 82% (41/50) with conventional arthrocentesis and increased to 100% (50/50) with pneumatic compression (P = .001). Synovial fluid yields increased by 144% (19.8 ± 17.1 mL)

The preferred technique for knee synovium biopsy and synovial fluid arthrocentesis

“…The same brace was used in another study, which also demonstrated an increase of 72.1% in absolute [27]. Brahmbatt et al used pneumatic compression in a comparative trial and found significant increase in synovial fluid uptake [39] compared to no compression while seated in 90° flexion. As opposed to the other studies, the authors made use of an inexpensive and commonly owned cuff, such as a thigh blood pressure leg cuff.…”

“…Arthrocentesis using LMP and MMP were performed with patients in supine positions with either full knee extension or a slight flexion of 0°-20° [20,22,24,30,31,35,38,43], while AL and AN were predominantly performed on patients in seated positions with flexed knees (90°) [20,22,28,30,35,[37][38][39]43].…”