When is joint aspiration (arthrocentesis) indicated?

Updated: Mar 23, 2020
  • Author: Steven N Berney, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Joint aspiration should be considered for any patient with an inflamed joint or joints who does not have an established diagnosis. Inflamed joints are recognized by being red, warm, tender, swollen, and painful to bend.

A joint presenting as acute monoarthritis should always be aspirated if infection is suspected upon clinical evaluation. Patients with preexisting arthritis (eg, rheumatoid arthritis or gout) are at increased risk for the development of septic arthritis. Therefore, aspiration must be performed whenever there is suspicion of an infected joint in patients with known arthritis.

Repeated aspirations can be part of the management of a septic joint to relieve discomfort and prevent joint damage. Aspiration can be considered in cases of hemarthrosis to prevent adhesions. Aspiration can be performed immediately prior to injecting intra-articular medications such as corticosteroids to improve efficacy.

As a rule, if joint aspiration is being considered, it should probably be performed.

According to Infectious Diseases Society of America (IDSA) guidelines on management of prosthetic joint infection (PJI), diagnostic arthrocentesis should be performed for any suspected acute PJI unless the diagnosis is clinically evident, surgery is planned, and antibiotics can safely be withheld preoperatively. [3] It is also advised in patients with a chronic painful prosthesis who have unexplained elevations of erythrocyte sedimentation rate or C-reactive protein level or in whom PJI is clinically suspected (though it may not be necessary in all cases).

In this setting, synovial fluid analysis should include a total cell count and differential leukocyte count, as well as culture for aerobic and anaerobic organisms. [3] A crystal analysis can also be performed if clinically indicated.

Repeat aspiration may be warranted in joint-replacement patients with conflicting clinical data and a prior history of PJI, with suspected adverse local tissue reaction, or with high clinical suspicion of infection. [4, 5]

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