What are the contraindications for joint aspiration (arthrocentesis)?

Updated: Mar 23, 2020
  • Author: Steven N Berney, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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No strict contraindications for arthrocentesis are recognized; however, caution is advised in certain situations.

A needle should not be passed through an area of infection (eg, overlying cellulitis) before entering a joint, because seeding infection into the joint capsule may occur.

Patients who are anticoagulated or have a bleeding diathesis (eg, hemophilia or thrombocytopenia) are at increased risk for hemarthrosis. It has been recommended that when possible, aspiration should be delayed until the coagulopathy is reversed, and that when a delay is not possible, the physician should be prepared to treat bleeding (eg, with appropriate factor concentrates in a hemophiliac patient).

However, some studies have found arthrocentesis to be safe in patients receiving anticoagulant therapy. [6, 7, 8]

When aspiration of artificial joints is necessary, it is generally handled by an orthopedic surgeon.

When a clinical need to aspirate a joint is present in a patient with overlying infection or coagulopathy, the physician must weigh the risks and benefits of aspiration in their decision whether to proceed with arthrocentesis.

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