Improvement in diagnostic and therapeutic arthrocentesis via constant compression

• Published in: Clinical rheumatology 2018-08, Vol.37 (8), p.2251-2259
• Main Authors: Bhavsar, Tej B., Sibbitt, Wilmer L., Band, Philip A., Cabacungan, Romy J., Moore, Timothy S., Salayandia, Luis C., Fields, Roderick A., Kettwich, Scarlett K., Roldan, Luis P., Suzanne Emil, N., Fangtham, Monthida, Bankhurst, Arthur D.
• Format: Article
• Language: English
• Subjects: Arthrocentesis - economics; Arthrocentesis - methods; Braces; Compression; Compression Bandages; Cost analysis; Elastomers; Female; Humans; Knee; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Osteoarthritis; Osteoarthritis, Knee - diagnosis; Osteoarthritis, Knee - therapy; Pain, Procedural - diagnosis; Rheumatology; Synovial Fluid
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-017-3836-x

We hypothesized that constant compression of the knee would mobilize residual synovial fluid and promote successful arthrocentesis. Two hundred and ten knees with grade II–III osteoarthritis were included in this paired design study: (1) conventional arthrocentesis was performed with manual compression and success and volume (milliliters) determined; and (2) the intra-articular needle was left in place, and a circumferential elastomeric brace was tightened on the knee to provide constant compression. Arthrocentesis was attempted again and additional fluid volume was determined. Diagnostic procedural cost-effectiveness was determined using 2017 US Medicare costs. No serious adverse events were noted in 210 subjects. In the 158 noneffusive (dry) knees, sufficient synovial fluid for diagnostic purposes (≥ 2 ml) was obtained in 5.0% (8/158) without compression and 22.8% (36/158) with compression ( p  = 0.0001, z for 95% CI = 1.96), and the absolute volume of arthrocentesis fluid obtained without compression was 0.28 ± 0.79 versus 1.10 ± 1.81 ml with compression (293% increase, p  = 0.0001). In the 52 effusive knees, diagnostic synovial fluid (≥ 2 ml) was obtained in 75% (39/52) without compression and 100% (52/52) with compression ( p  = 0.0001, z for 95% CI = 1.96), and the absolute volume of arthrocentesis without compression was 14.7 ± 13.8 versus 25.3 ± 15.5 ml with compression (72.1% increase, p  = 0.0002). Diagnostic procedural cost-effectiveness was $655/sample without compression and $387/sample with compression. The new technique of constant compression via circumferential mechanical compression mobilizes residual synovial fluid beyond manual compression improving the success, cost-effectiveness, and yield of diagnostic and therapeutic arthrocentesis in both the effusive and noneffusive knee.