Arthrocentesis Procedures News

Synovial fluid tests
Abstract: Infection, crystal arthropathies, osteoarthritis, trauma and a variety of systemic diseases can create a painful, swollen peripheral joint of which septic arthritis is the most serious cause. Synovial fluid (SF) analysis is widely used to aid the diagnosis and management of both acute and chronic arthritis, and can be diagnostic in patients with bacterial infections or crystal-induced synovitis. Most native joints can be aspirated by any physician competent to do so, but where there is difficulty, joints can be aspirated under ultrasound guidance. In cases of suspected infected prosthetic joints, these must be referred to the orthopaedic surgeons for aspiration in theatre under strict asepsis. The SF should be sent to the laboratory promptly for microscopy, culture and crystal se...... MORE...
POSTED 02/17/2010 at 10:03 AM --

A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma.
We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency. Regular surveillance of the patient detected a 3.5 cm HCC lesion. Because the patient had declined surgery, RFA was chosen for therapy. On the third post-procedural day, the laboratory results showed increases in his uric acid and potassium levels, which were compatible with a tumor lysis syndrome. On the 6th post-procedural day, the patient complained of new right knee pain. Subsequent joint aspiration revealed monosodium urate monohydrate crystals. We made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation, which was aggravate...... MORE...
POSTED 02/06/2010 at 06:26 PM --

Is There a Role for Tissue Biopsy in the Diagnosis of Periprosthetic Infection?
CONCLUSIONS: Our data suggest tissue biopsy alone offers no clear advantage over joint aspiration. However, the combination of both techniques provides improved sensitivity and accuracy. We recommend the use of tissue biopsy as an adjunct to joint aspiration in the diagnosis of total joint infection. LEVEL OF EVIDENCE: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID: 20131022 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)... MORE...
POSTED 02/03/2010 at 06:00 PM --

Supervising the Supervisors—Procedural Training and Supervision in Internal Medicine Residency
CONCLUSIONS Residents report low levels of comfort and experience with procedures, and frequently report supervising prior to feeling comfortable. Our findings suggest a need to examine best practices for procedural supervision of trainees. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-009-1226-zAuthors Michelle Mourad, University of California San Francisco Department of Medicine, Division of Hospital Medicine 533 Parnassus Ave Box 0131 San Francisco CA 94143 USAJeffrey Kohlwes, University of San Francisco California Department of Medicine, Division of General Internal Medicine San Francisco USAJudith Maselli, University of California San Francisco Department of Medicine, Division of Hospital Medicine 533 Parnassus Ave Box 0131 San Francisc...... MORE...
POSTED 01/14/2010 at 06:47 PM --

Musculoskeletal Complications of Hemophilia
Abstract The most important clinical strategy for management of patients with hemophilia is the avoidance of recurrent hemarthroses by means of continuous, intravenous hematological prophylaxis. When only intravenous on-demand hematological treatment is available, frequent evaluations are necessary for the early diagnosis and treatment of episodes of intra-articular bleeding. The natural history of the disease in patients with poorly controlled intra-articular bleeding is the development of chronic synovitis and, later, multi-articular hemophilic arthropathy. Once arthropathy develops, the functional prognosis is poor. Treatment of these patients should be conducted through a comprehensive program by a multidisciplinary hemophilia unit. Although continuous prophylaxis can ...... MORE...
POSTED 11/17/2009 at 05:39 PM --

Septic Arthritis in Adults with Sickle Cell Disease Often is Associated with Osteomyelitis or Osteonecrosis.
CONCLUSIONS: The incidence of septic arthritis in adults with SCD is low, but often is associated with osteomyelitis or osteonecrosis. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 19885711 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)... MORE...
POSTED 11/02/2009 at 06:00 PM --

Certification Is Good for Hospital Medicine
DR. DEITELZWEIG is vice president for medical affairs and chairman of hospital medicine at the Ochsner Clinic Foundation in New Orleans The development of a new pathway for certification with Focused Practice in Hospital Medicine is good news for hospitalists. Ideally, hospital medicine would be its own subspecialty, especially since it involves specialized knowledge and the performance of procedures that aren't done in a typical office-based practice, such as vascular access, lumbar puncture, ECG interpretation, and arthrocentesis. But this credential does provide recognition of what we do, and it reflects a natural evolution of hospital medicine. (Source: Hospitalist News)... MORE...
POSTED 10/31/2009 at 07:00 PM --

Short-term effects of arthrocentesis plus viscosupplementation in the management of signs and symptoms of painful TMJ disc displacement with reduction. A pilot study
Conclusions A cycle of five weekly hyaluronic acid injections performed immediately following arthrocentesis is effective to improve signs and symptoms in patients with painful temporomandibular joint disc displacement with reduction and to maintain them over a 3-month follow-up. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10006-009-0179-zAuthors Luca Guarda-Nardini, University of Padova TMD Clinic, Department of Maxillofacial Surgery Padova ItalyDaniele Manfredini, University of Padova TMD Clinic, Department of Maxillofacial Surgery Padova ItalyGiuseppe Ferronato, University of Padova TMD Clinic, Department of Maxillofacial Surgery Padova Italy Journal Oral and Maxillofacial SurgeryOnline ISSN 1865-1569Print ISSN 1865-1550 (Source: Oral a...... MORE...
POSTED 10/11/2009 at 02:12 AM --

TMJ hemi-arthroplasty with metal fossa-eminence prothesis for degenerative joint changes: a six-year retrospective audit
We report 65% of the patients experienced an improvement in pain, 58% had an improvement in mouth opening and 19% had an improvement in joint clicking. Seventy percent of the joints operated on did not need further revision surgery. We also present the improvement of these symptoms based on the analog scale. (Source: The British Journal of Oral & Maxillofacial Surgery)... MORE...
POSTED 09/11/2009 at 11:32 AM --

Therapeutic benefits of TMJ arthroscopy and arthrocentesis: a prospective outcome assessment
Patients who fail to respond to routine conservative measures for TMJ related pain, restriction and locking may be submitted to diagnostic arthroscopy or arthrocentesis, both of which are associated with significant therapeutic improvement in 70% or more patients. There is no current data on improvements in mouth opening and lateral deviations achieved during and following arthroscopy. This prospective audit presents 140 patients treated between 2006 and 2008 from one surgeon's practice who have been followed up at least once at 6 weeks following arthroscopy or arthrocentesis. (Source: The British Journal of Oral & Maxillofacial Surgery)... MORE...
POSTED 09/11/2009 at 11:32 AM --

The management of septic arthritis in children: systematic review of the English language literature.
Authors: Kang SN, Sanghera T, Mangwani J, Paterson JM, Ramachandran M We performed a systematic review of the optimal management of septic arthritis in children as recommended in the current English literature using MEDLINE, EMBASE, CINAHL, the Cochrane Library and reference lists of retrieved articles without date restrictions up to 31 January 2009. From 2236 citations, 227 relevant full-text articles were screened in detail; 154 papers fulfilled the inclusion criteria, from which conclusions were drawn on the management of infected joints in children. Our review showed that no single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively joint infection. The roles of aspiration, arthrotomy and arthroscopy in treatment are not clear cut, and the i...... MORE...
POSTED 08/31/2009 at 06:00 PM --

Concerns About Management of Septic Arthritis After ACL Reconstruction
I have serious concerns about the article “Septic Arthritis After Arthroscopic Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis of Incidence, Presentation, Treatment, and Cause” by Wang et al. They report on 21 patients with a postoperative infection, and yet only 16 patients had positive cultures. Of the 21 patients, 6 were treated by simple arthrocentesis and irrigation. I think this is very worrisome to present as a potential treatment for an infected ACL reconstruction. In my opinion, this would clearly be below the standard of care. The authors also state that IV antibiotics were only continued for a mean period of 19.4 days. For some of these serious infections with serious potential complications, this seems like an inordinately short period of time for the IV...... MORE...
POSTED 08/31/2009 at 06:00 PM --

[Histopathological diagnosis of periprosthetic joint infection following total hip arthroplasty : Use of a standardized classification system of the periprosthetic interface membrane.]
CONCLUSION: In the diagnosis of PJI, histopathological evaluation of the periprosthetic interface membrane proved very effective. To analyse the cause of prosthesis loosening, tissue samples of the periprosthetic interface membrane should be evaluated on the basis of the consensus classification in all revision surgeries. PMID: 19690832 [PubMed - as supplied by publisher] (Source: Der Orthopade)... MORE...
POSTED 08/19/2009 at 06:00 PM --

How Common is MRSA in Adult Septic Arthritis?
Conclusion: In this 2-ED population from a single geographic region, MRSA was the most common cause of community-onset adult septic arthritis. Synovial fluid cell counts were unexpectedly low in MRSA septic arthritis cases. (Source: Annals of Emergency Medicine)... MORE...
POSTED 08/09/2009 at 07:00 PM --

[Case Report] The emergence of lymphogranuloma venereum in Europe
A 42-year-old white homosexual man presented to our clinic in April, 2008, with a 12-day history of right knee and back pain, conjunctivitis, and proctitis. 10 days earlier, after a normal radiograph, an arthrocentesis of his right knee had been done; 40 mL of clear synovial fluid was aspirated and corticosteroids were injected locally. There was no history of recent injury, febrile illness, or rheumatological conditions. He reported anonymous unprotected receptive anal sex 1 month earlier. Since 2000, he had had three episodes of uncomplicated urethritis, secondary syphilis, HIV, and an episode of primary syphilis (rapid plasma reagin [RPR] 1/32 in August, 2007). He had been taking antiretrovirals since October, 2007, with a CD4 count of 300 per μL (31%) and undetectable viral load in Ma...... MORE...
POSTED 07/23/2009 at 06:00 PM --

Single-Puncture Arthrocentesis—Introducing a New Technique and a Novel Device
Arthrocentesis of the temporomandibular joint was introduced in 1991 by Nitzan et al and has since gained widespread popularity among practitioners who treat temporomandibular joint disorders. It is considered by many as the first-line surgical treatment for patients who do not respond to conservative treatment (physical therapy, occlusal splint therapy, pain medication, and lifestyle and behavioral changes). It is regarded as a minimally invasive procedure and is easily performed in an office setting. It allows lavage of the joint space and lysis of adhesions via hydraulic distension. (Source: Journal of Oral and Maxillofacial Surgery)... MORE...
POSTED 07/17/2009 at 05:54 AM --

[RSNA Education Exhibits] Emergency Joint Aspiration: A Guide for Radiologists on Call
Septic arthritis is a disabling and possibly life-threatening disease that requires early diagnosis for optimal management. It is important that clinical and imaging features of septic arthritis be promptly identified. In addition, because other disease entities may have characteristics similar to those of septic arthritis, analysis of a needle biopsy specimen may be necessary for differential diagnosis. Radiologists may be asked to perform emergent aspiration of a possibly infected joint. It is important that those who perform aspiration procedures be familiar with a safe and effective imaging-guided arthrocentesis technique that is tailored to the individual patient and the specific joint affected. © RSNA, 2009 (Source: Radiographics recent issues)... MORE...
POSTED 07/14/2009 at 06:00 PM --

Emergency Joint Aspiration: A Guide for Radiologists on Call [RSNA Education Exhibits]
Septic arthritis is a disabling and possibly life-threatening disease that requires early diagnosis for optimal management. It is important that clinical and imaging features of septic arthritis be promptly identified. In addition, because other disease entities may have characteristics similar to those of septic arthritis, analysis of a needle biopsy specimen may be necessary for differential diagnosis. Radiologists may be asked to perform emergent aspiration of a possibly infected joint. It is important that those who perform aspiration procedures be familiar with a safe and effective imaging-guided arthrocentesis technique that is tailored to the individual patient and the specific joint affected. © RSNA, 2009 (Source: Radiographics recent issues)... MORE...
POSTED 07/14/2009 at 06:00 PM --

Evaluation of persistent pain after hip resurfacing.
Authors: Evaluation and treatment of pain following hip resurfacing arthroplasty can be challenging, even for the most experienced arthroplasty surgeon. As in any total hip replacement, there are a number of investigative tools at the disposal of orthopaedic surgeons to elicit the underlying causes of pain for diagnosis and treatment. A detailed history and physical examination are the most important frst steps in the differential diagnosis of the intrinsic and extrinsic etiologies of hip pain. Serial radiographs from the time of surgery also should be reviewed and compared for changes indicative of loosening, migration, and osteolysis, in combination or alone. Diagnostic injections with local anesthetic agents additionally can be performed to localize the origin of pain. Bone scintig...... MORE...
POSTED 07/09/2009 at 12:40 PM --

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