Inadvertent Introduction of Tissue Coring Into Joints During Arthrocentesis: An Experimental Study

Abstract

BackgroundThe aim of this study was to investigate whether needles introduce skin plugs into joints during arthrocentesis.Material/MethodsIn the first part of this study, the arthrocentesis site was scrubbed with a fluorescein sodium swab, and 90 needles were inserted through the joint tissue and collected for examination under a fluorescence microscope. In the second part of this study, the joints were injected using 720 needles of different gauges. Two different randomly assigned needle insertion techniques were used: needle insertion straight through the joint capsule (subgroup 1) or insertion of the needle into the subcutaneous tissue followed by flushing of the needle with 0.5 mL of 0.9% normal saline prior to advancing the needle through the joint capsule (subgroup 2).ResultsOf the 90 needle tips examined in the first part of this study, 21 had high-grade fluorescein contamination. In the second part of this study, the incidence of tissue, epidermis, and dermis contamination in subgroup 1 was 57.2%, 43.1%, and 25.0%, respectively. There was no significant difference in the incidence among different gauge needles, except for a difference in epidermis contamination between the 21-gauge and 23-gauge needles. Compared to subgroup 1, subgroup 2 had a significantly lower OR for tissue contamination.ConclusionsIt is common to introduce tissue coring with epidermis and dermis into the joint during arthrocentesis, which poses a potential risk for septic arthritis. However, tissue contamination of the joint may be reduced by flushing saline through the needle into the subcutaneous tissues prior to entering the joint capsule.

Safety of intraarticular corticosteroid injection preceding hip and knee arthroplasty: a systematic review and meta-analysis amid resolving COVID-19 arthroplasty restrictions

“…In hip arthroplasty, there appeared to be a temporal relationship, whereby the odds of PJI decreased from 1.45 at 3 months prior to 1.17 within 12 months prior to their arthroplasty. We postulate our significant findings to be due to the immune-modulatory effects of steroids or the inherent risk of inadvertent inoculation of pathogens at ICSI [32][33][34][35]. Both these possible scenarios warrant wider investigation.…”

Clinical Validation of Rapid Gout Detection Method and Kit

“…Our results have also successfully determined a method for processing turbid clinical samples for use with our diagnostic device. Synovial fluid samples obtained from arthrocentesis are not ideal samples and often contain debris from disrupted tissue due to sampling technique, which can negatively affect the microscopic visualization of uric acid crystals and image quality [14]. In cases where much debris is present, it is possible to incorrectly rule out a diagnosis of gout, if the suspended material eclipses or obscures the examiner's view of uric acid crystals.…”

“…As gout is inflammatory, it causes leukocyte counts to increase in the synovial fluid, typically above 2000 cells per millimeter cubed [13]. Larger pieces of contaminant tissue, or debris, can be inadvertently introduced into the sample during arthrocentesis, and therefore techniques of uric acid crystal microscopy can benefit from removing debris from the sample in order to optimize crystal visualization [14]. Another aim of this work is to test whether the reagents used in our method, e.g., silver nitrate, would interfere with microscopic crystal visualization and imaging and whether handheld microscopes would be effective in capturing these images.…”

Case report: Anaerobiospirillum prosthetic joint infection in a heart transplant recipient

“…Septic arthritis is a rare complication of joint aspiration or injection, occurring in approximately 0.04% of procedures [12]. Although the exact mechanism is unclear, injection-related infections may occur through inoculation of skin flora by tissue coring or (in rarer circumstances) due to contamination of the injectate [13]. Repeated injections is also an identified risk factor for PJI [14].…”