Clinical Rheumatology

, Volume 37, Issue 8, pp 2251–2259 | Cite as

Improvement in diagnostic and therapeutic arthrocentesis via constant compression

  • Tej B. Bhavsar
  • Wilmer L. SibbittJrEmail author
  • Philip A. Band
  • Romy J. Cabacungan
  • Timothy S. Moore
  • Luis C. Salayandia
  • Roderick A. Fields
  • Scarlett K. Kettwich
  • Luis P. Roldan
  • N. Suzanne Emil
  • Monthida Fangtham
  • Arthur D. Bankhurst
Original Article


We hypothesized that constant compression of the knee would mobilize residual synovial fluid and promote successful arthrocentesis. Two hundred and ten knees with grade II–III osteoarthritis were included in this paired design study: (1) conventional arthrocentesis was performed with manual compression and success and volume (milliliters) determined; and (2) the intra-articular needle was left in place, and a circumferential elastomeric brace was tightened on the knee to provide constant compression. Arthrocentesis was attempted again and additional fluid volume was determined. Diagnostic procedural cost-effectiveness was determined using 2017 US Medicare costs. No serious adverse events were noted in 210 subjects. In the 158 noneffusive (dry) knees, sufficient synovial fluid for diagnostic purposes (≥ 2 ml) was obtained in 5.0% (8/158) without compression and 22.8% (36/158) with compression (p = 0.0001, z for 95% CI = 1.96), and the absolute volume of arthrocentesis fluid obtained without compression was 0.28 ± 0.79 versus 1.10 ± 1.81 ml with compression (293% increase, p = 0.0001). In the 52 effusive knees, diagnostic synovial fluid (≥ 2 ml) was obtained in 75% (39/52) without compression and 100% (52/52) with compression (p = 0.0001, z for 95% CI = 1.96), and the absolute volume of arthrocentesis without compression was 14.7 ± 13.8 versus 25.3 ± 15.5 ml with compression (72.1% increase, p = 0.0002). Diagnostic procedural cost-effectiveness was $655/sample without compression and $387/sample with compression. The new technique of constant compression via circumferential mechanical compression mobilizes residual synovial fluid beyond manual compression improving the success, cost-effectiveness, and yield of diagnostic and therapeutic arthrocentesis in both the effusive and noneffusive knee.


Arthrocentesis Injections Intra-articular Knee Quality 



The authors would like to thank Jackie Cremar for logistic assistance in preparation of this manuscript. We would also like to thank the staff of our local IRB (the Human Research Committee) for guiding us in the preparation of this study, data, and manuscript.

Funding information

There was no internal or external support for this study.

Compliance with ethical standards

Ethical standards

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to any procedures and prior to the inclusion in the study.




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2017

Authors and Affiliations

  • Tej B. Bhavsar
    • 1
  • Wilmer L. SibbittJr
    • 2
    Email author
  • Philip A. Band
    • 3
  • Romy J. Cabacungan
    • 4
  • Timothy S. Moore
    • 5
  • Luis C. Salayandia
    • 6
  • Roderick A. Fields
    • 2
  • Scarlett K. Kettwich
    • 7
  • Luis P. Roldan
    • 8
  • N. Suzanne Emil
    • 2
  • Monthida Fangtham
    • 2
  • Arthur D. Bankhurst
    • 2
  1. 1.The Center for Rheumatology LLCSaratoga SpringsUSA
  2. 2.Department of Internal Medicine, Division of Rheumatology and School of MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueUSA
  3. 3.Department of Orthopaedic Surgery, Biochemistry & Molecular PharmacologyNYU School of MedicineNew York CityUSA
  4. 4.Arizona Arthritis and Rheumatology AssociatesTucsonUSA
  5. 5.Department of Internal Medicine, Division of Rheumatology and School of Medicine, Penncare Rheumatology AssociatesUniversity of Pennsylvania Health SystemPhiladelphiaUSA
  6. 6.El Paso Integrated Physician’s Group, P.A.El PasoUSA
  7. 7.School of DentistryOregon Health & Science UniversityPortlandUSA
  8. 8.School of MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueUSA

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