CHAPTER 20. ARTHROCENTESIS OF THE KNEE
Indications165
Contraindications166
Equipment166
Practical procedure166
Post-procedure investigations169
Complications169
The Libellus de Medicinalibus Indorum Herbis (or ‘little book of the medicinal herbs of the Indians’, originally an Aztec herbal manuscript composed in 1552 in Nahuatl which was translated into Latin) described puncturing the swollen joint with the bone of an eagle or a lion. The original book no longer exists but its translation was presented as a gift to Prince Philip (the future Philip II) of Spain. However, after several further owners and via a circuitous route over the centuries it ended up in the Vatican library. In 1990 Pope John Paul II returned it to Mexico.
INTRODUCTION
The aspiration and examination of fluid from the knee is fundamental to the investigation of an acute knee monoarthritis. The technique employed in arthrocentesis may also be employed for therapeutic purposes, although these should be performed by a specialist (rheumatologist or orthopaedic surgeon).
INDICATIONS
THERAPEUTIC
Only to be performed by a specialist:
• Intra-articular steroid or local anaesthetic administration (contraindicated in a suspected or confirmed septic joint).
• Drainage of a tense haemarthrosis.
• Drainage of a septic joint.
CONTRAINDICATIONS
• Lack of consent.
• Coagulopathy (should be corrected before aspiration to reduce the risk of haemarthrosis).
• Skin infection at the intended puncture site.
• Joint prosthesis (discuss the case with an orthopaedic surgeon).
EQUIPMENT
• Sterile gloves.
• Dressing pack.
• Chlorhexidine cleaning solution.
• Skin pen.
• Gauze.
• Orange needle.
• 2 × Green needle.
• 5 mL syringe.
• 20 mL syringe.
• Lidocaine.
• 3 × specimen pots.
• 1 × fluoride oxalate blood Vacutainer® (glucose).
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