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Updated: Oct 18, 2025
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Knee Arthrocentesis in Adults
Published on: February 25, 2022
8.1K
Ultrasound-versus landmark-guided medium-sized joint arthrocentesis: A randomized clinical trial
Ryan C Gibbons1, Allison Zanaboni2, Jessica Genninger1
1Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Summary
Ultrasound guidance significantly improves the success of arthrocentesis for medium-sized joints compared to landmark-guided procedures. This technique enhances first-pass success and reduces the number of attempts needed for joint fluid aspiration.
Area of Science:
- Emergency Medicine
- Radiology
- Orthopedics
Background:
- Arthrocentesis is a common emergency department procedure.
- Success rates for arthrocentesis vary, especially for medium-sized joints.
- Limited data exists on ultrasound-guided (USG) arthrocentesis for medium-sized joints.
Purpose of the Study:
- To compare the success rates of ultrasound-guided (USG) versus landmark-guided (LMG) arthrocentesis in medium-sized joints.
- To evaluate the impact of USG on first-pass success and the number of attempts required.
Main Methods:
- A single-center, prospective, randomized clinical trial was conducted.
- Adult patients with suspected medium-sized joint effusions (elbow, wrist, ankle) were randomized to LMG or USG.
- Exclusion criteria included anticoagulation, overlying infection, or artificial joints.
Main Results:
- Ultrasound-guided arthrocentesis achieved a significantly higher overall success rate (94.1%) compared to landmark-guided (60%).
- USG demonstrated improved first-pass success (82.4% vs. 46.7%) and required fewer attempts (1.35 vs. 2.00).
- Some cases in both groups were found to have no effusion upon further assessment.
Conclusions:
- Ultrasound guidance is superior to landmark guidance for successful arthrocentesis of medium-sized joint effusions.
- USG enhances both overall success and first-pass accuracy.
- This technique offers a valuable improvement for joint aspiration procedures.
