When should you consider arthrocentesis for your patient?

Siamak Moayedi, MD
19th Nov 2020

What is arthrocentesis? 

Arthrocentesis is the puncture of a joint and aspiration of joint fluid. It can be used for diagnosing and treating conditions of the shoulder, elbow, wrist, knee, and ankle joints. 

Left knee joint showing a syringe entering the knee joint, inside the knee capsule. Cartoon.

Figure 1. Arthrocentesis is the puncture of a joint and aspiration of joint fluid. 

 

Indications for arthrocentesis

There are five common reasons for performing an arthrocentesis:

  1. For the evaluation of suspected septic arthritis.
  2. For the evaluation for joint inflammation like gout, arthritis, and hemarthrosis (blood in the joint).
  3. To provide therapy, such as when injecting steroids and anesthesia into the joint.
  4. For pain relief by removing fluid in the joint due to bleeding or inflammation. 
  5. For the evaluation of potential joint laceration with methylene blue. 

Multi-component image of indications for arthrocentesis: infectious organisms, inflammation of knee, steroid bottle, woman smiling with pain relief, fluid leaking out of knee joint due to laceration. Cartoons.

Figure 2. Indications for arthrocentesis include infection, inflammation, steroid therapy, pain relief, and potential joint laceration. 

 

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Contraindications to arthrocentesis

There are four major situations where you should not perform an arthrocentesis:

  1. Your patient has a coagulopathy (impaired clot formation). 
  2. Your patient has thrombocytopenia (lack of platelets). 
  3. Your patient has a prosthetic joint.  
  4. Your patient has a skin infection at the site of skin puncture. 

Multi-component image of contraindications to arthrocentesis:  Infectious organism on the surface of the skin, blood cells adhering to each other, drop of blood lacking platelets, prosthetic joint with caution symbol. Cartoons.

Figure 3. Contraindications to arthrocentesis include skin infection, coagulopathy, thrombocytopenia, and prosthetics. 

If you decide that the benefit of making a diagnosis outweighs the risk, then the procedure should be done. For patients with prosthetics, orthopedic surgeons prefer to perform the procedure themselves in these patients. Call them whenever possible.

However, to proceed with arthrocentesis, you must get informed consent from your patient.

 

How to obtain informed consent for arthrocentesis 

Informed consent involves telling your patient the reason for the test, alternatives, and potential complications. 

The main complications of arthrocentesis are the risks of infection and bleeding. Infection can develop in a septic joint. Bleeding can lead to a painful hemarthrosis.

If the patient refuses an arthrocentesis or has a contraindication to it, then appropriate alternatives can be discussed. 

 

Alternatives to arthrocentesis

If your patient refuses an arthrocentesis, or has contraindications to it, what alternatives are there? 

It is important for your patient to know that there are no appropriate alternatives for this treatment. In the case of a septic joint, antibiotics can be prescribed if the patient is presenting with a fever, or a hot and swollen joint. 

Thermometer plus a hot and red knee joint with a box of antibiotics. Illustration.

Figure 4. A patient who presents with fever plus a hot and swollen joint may require antibiotics, especially if they refuse to consent to an arthrocentesis.

Now you know what an arthrocentesis procedure is. Great work! 

That’s it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients.

Recommended reading

  • Roberts, J. 2019. “Arthrocentesis”. In: Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th edition. Philadelphia: Elsevier.