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Hip Joint Aspiration: Difference between revisions
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==Overview== | ==Overview== | ||
[[File:Hip anatomy cadaver.jpg|thumb|Hip anatomy.]] | |||
==Indications== | ==Indications== | ||
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*Insert 18ga needle (for larger joints) into joint space while pulling back on syringe ย | *Insert 18ga needle (for larger joints) into joint space while pulling back on syringe ย | ||
*Stop once you aspirate fluid; aspirate as much fluid as possible | *Stop once you aspirate fluid; aspirate as much fluid as possible | ||
**Send: cell count, culture, | **Send: cell count, culture, gram stain, crystal analysis | ||
===Specific Approach<ref>*Freeman, K., A. Dewitz, et al. (2007). "Ultrasound-guided hip arthrocentesis in the ED." Am J Emerg Med 25(1): 80-86.</ref>=== | ===Specific Approach<ref>*Freeman, K., A. Dewitz, et al. (2007). "Ultrasound-guided hip arthrocentesis in the ED." Am J Emerg Med 25(1): 80-86.</ref>=== | ||
*Should only be done under | *Should only be done under ultrasound guidance | ||
*Orient your probe along the axis of the femoral neck (indicator towards abdomen) | *Orient your probe along the axis of the femoral neck (indicator towards abdomen) | ||
*Identify Landmarks (Femoral V/A/N, Acetabular Labrum, Femoral Head/Neck) | *Identify Landmarks (Femoral V/A/N, Acetabular Labrum, Femoral Head/Neck) | ||
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==Complications== | ==Complications== | ||
{{General arthrocentesis complications}} | {{General arthrocentesis complications}} | ||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
ย | [[Category:Pelvis, Hip and Thigh Procedures]] | ||
[[Category:Pelvis, Hip |
Latest revision as of 18:47, 5 May 2022
Overview
Indications
General arthrocentesis indications
- Suspicion of septic arthritis
- Suspicion of crystal arthropathy
- Evaluation of therapeutic response for septic arthritis
- Unexplained arthritis with synovial effusion
- Evaluation of joint capsule integrity if overlying laceration
- Relative: therapeutic (decrease intra-articular pressure, injection of anaesthetics/steroids)
Contraindications
General arthrocentesis contraindications
- No absolute contraindications for diagnostic arthrocentesis
- Do not inject steroids into a joint that you suspect is already infected
- Relative Contraindications:
- Overlying cellulitis
- Coagulopathy
- Joint prosthesis (refer to ortho)
Equipment Needed
General arthrocentesis equipment
- Betadine or Chlorhexadine
- Sterile gloves/drape
- Sterile gauze
- Lidocaine
- Syringes
- Small syringe (6-12cc) for injection of local anesthetic
- Large syringe (one 60cc or two 30cc) for aspiration
- Needles
- 18 gauge: knee
- 20 gauge: most other joints
- 25 gauge: MTP joints
- 27 gauge for anaesthetic injection
- Collection tubes (red top and purple for crystal analysis)
- Culture bottles
- Consider utilizing U/S to assess for effusion
Procedure
General Setup
- Prep area with betadine or chlorhexadine using circular motion moving away from joint x 3
- Drape joint in sterile fashion
- Inject lidocaine with 25-30ga needle superficially and then into deeper tissues
- Insert 18ga needle (for larger joints) into joint space while pulling back on syringe
- Stop once you aspirate fluid; aspirate as much fluid as possible
- Send: cell count, culture, gram stain, crystal analysis
Specific Approach[1]
- Should only be done under ultrasound guidance
- Orient your probe along the axis of the femoral neck (indicator towards abdomen)
- Identify Landmarks (Femoral V/A/N, Acetabular Labrum, Femoral Head/Neck)
- Effusion will be seen between femoral head/neck and the iliopsoas muscle
- Insert needle under probe, making sure that you know where patient's femoral V/A/N are
Evaluation
Arthrocentesis of synoval fluid
Synovium | Normal | Noninflammatory | Inflammatory | Septic |
---|---|---|---|---|
Clarity | Transparent | Transparent | Cloudy | Cloudy |
Color | Clear | Yellow | Yellow | Yellow |
WBC | <200 | <200-2000 | 200-50,000 |
>1,100 (prosthetic joint) >25,000; LR=2.9 >50,000; LR=7.7 >100,000; LR=28 |
PMN | <25% | <25% | >50% |
>64% (prosthetic joint) >90% |
Culture | Neg | Neg | Neg | >50% positive |
Lactate | <5.6 mmol/L | <5.6 mmol/L | <5.6 mmol/L | >5.6 mmol/L |
LDH | <250 | <250 | <250 | >250 |
Crystals | None | None | Multiple or none | None |
- Viscosity of synovial fluid may actually be decreased in inflammatory or infectious etiologies, as hyaluronic acid concentrations decrease
- The presence of crystals does not rule out septic arthritis; however, the diagnosis is highly unlikely with synovial WBC < 50,000[2]
Complications
General arthrocentesis complications
- Pain
- Infection
- Re-accumulation of effusion
- Damage to tendons, nerves, or blood vessels
External Links
- http://www.youtube.com/watch?v=fZ2dcZhoGP8 Arthrocentesis
- http://emprocedures.com/arthrocentesis/introduction.htm