Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee?

Scand J Rheumatol. 2012 Feb;41(1):66-72. doi: 10.3109/03009742.2011.599071. Epub 2011 Nov 21.

Abstract

Objective: The present randomized controlled trial compared arthrocentesis of the effusive knee followed by corticosteroid injection performed by the conventional anatomic landmark palpation-guided technique to the same procedure performed with ultrasound (US) needle guidance.

Methods: Sixty-four palpably effusive knees were randomized to (i) palpation-guided arthrocentesis with a conventional 20-mL syringe (22 knees), (ii) US-guided arthrocentesis with a 25-mL reciprocating procedure device (RPD) mechanical aspirating syringe (22 knees), or (iii) US-guided arthrocentesis with a 60-mL automatic aspirating syringe (20 knees). The one-needle two-syringe technique was used. Outcome measures included patient pain by the Visual Analogue Scale (VAS) for pain (0-10 cm), the proportion of diagnostic samples, synovial fluid volume yield, complications, and therapeutic outcome at 2 weeks.

Results: Sonographic guidance resulted in 48% less procedural pan (VAS; palpation-guided: 5.8 ± 3.0 cm, US-guided: 3.0 ± 2.8 cm, p < 0.001), 183% increased aspirated synovial fluid volumes (palpation-guided: 12 ± 10 mL, US-guided: 34 ± 25 mL, p < 0.0001), and improved outcomes at 2 weeks (VAS; palpation-guided: 2.8 ± 2.4 cm, US-guided: 1.5 ± 1.9 cm, p = 0.034). Outcomes of sonographic guidance with the mechanical syringe and automatic syringe were comparable in all outcome measures.

Conclusions: US-guided arthrocentesis and injection of the knee are superior to anatomic landmark palpation-guided arthrocentesis, resulting in significantly less procedural pain, improved arthrocentesis success, greater synovial fluid yield, more complete joint decompression, and improved clinical outcomes.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Arthritis, Rheumatoid / diagnostic imaging
  • Arthritis, Rheumatoid / drug therapy*
  • Humans
  • Injections, Intra-Articular
  • Knee Joint / diagnostic imaging*
  • Osteoarthritis / diagnostic imaging
  • Osteoarthritis / drug therapy*
  • Pain Measurement
  • Palpation*
  • Paracentesis / methods*
  • Synovial Fluid / metabolism
  • Treatment Outcome
  • Ultrasonography, Interventional*

Substances

  • Adrenal Cortex Hormones