Ultrasound‐versus landmark‐guided medium‐sized joint arthrocentesis: A randomized clinical trial

Abstract

Objectives: Arthrocentesis is commonly performed in the emergency department, but success rates vary based on location. Presently, there is a paucity of data assessing the utility of ultrasound-guided (USG) medium-sized joint arthrocentesis. The objective of this study was to compare the success of USG and landmark-guided (LMG) medium-sized joint arthrocentesis. Methods:This was a single-center, prospective, randomized clinical trial (NCT03327584) of a convenience sample of adult patients who presented to an urban, university hospital with > 105,000 visits annually. Patients with a suspected medium-sized joint effusion (defined as elbow, wrist, or ankle) undergoing arthrocentesis were randomized into LMG or USG using the GE Logiq e linear transducer (4-10 MHz). The following patients were excluded: on anticoagulation, with soft tissue infection overlying the joint, or involving an artificial joint. Statistical analysis included the Fisher exact, Mann-Whitney U-test, and t-test.Results: Overall, 44 patients were enrolled with 23 patients randomized into the LMG group and 21 patients into the USG arm. USG was significantly better than LMG with an overall success of 94.1% versus 60% for LMG (difference = 34.1%, 95% confidence interval [CI] = 4.90 to 58.83). USG first-pass success was 82.4% versus 46.7% for LMG (difference = 35.7%, 95% CI = 2.76 to 60.37) and a mean of 1.35 attempts versus 2.00 for LMG (difference = 0.65, 95% CI = 0.005 to 1.296). Of the 14 LMG failures, eight had no effusion present on USG crossover. Four patients in the USG group had no effusion present. Conclusions:Ultrasound guidance improved first-pass and overall successful arthrocentesis of medium-sized joint effusions.

Increasing Efficiency With Point-of-Care Ultrasound-Guided Arthrocentesis: A Case Report and Procedure Demonstration

“…While the risks of an arthrocentesis include pain, bleeding, and infection, ultrasound guidance has been proven to minimize these risks, enhancing patient satisfaction and patient outcomes [ 6 ]. As a result, joint aspirations using ultrasound guidance are safer, more effective, and faster than using the landmark technique alone [ 10 ].…”

Point-of-Care Ultrasound-Guided Arthrocentesis of a Pediatric Septic Ankle

“…1,2,7,[10][11][12][13] A retrospective review of 101 POCUS examinations by Acuna et al 7 showed that POCUS use for arthrocentesis was successful in 92.1% of cases when performed by emergency medicine residents. Gibbons et al 14 showed that ultrasound-guided aspiration of medium joints (elbow, wrist, ankle) in 44 adult ED patients had a 94% success rate compared with 60% success in landmark-guided aspiration. Finally, a study by Thom et al 13 showed that POCUS of the hip joint performed by emergency physicians led to expedited diagnosis (68 vs 208 minutes) and arthrocentesis (211 vs 602 minutes) in septic arthritis cases compared with radiology-performed studies.…”

2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice

“…While routine interventions targeting peripheral joints or periarticular structures can be performed using anatomical landmarks, in case of a challenging procedure, imaging guidance is preferable. 44 While fluoroscopy is a valid alternative, ultrasound is the preferred modality for guiding interventions due to the absence of ionising radiation and better visualisation of soft tissue structures. 45 46 Recommendation 10: showing and explaining imaging findings of CiAs to people with such conditions may help them understand their condition and improve treatment adherence in gout.…”