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Clinical Rheumatology Aug 2018We hypothesized that constant compression of the knee would mobilize residual synovial fluid and promote successful arthrocentesis. Two hundred and ten knees with grade...
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.
Topics: Arthrocentesis; Braces; Compression Bandages; Female; Humans; Male; Middle Aged; Osteoarthritis, Knee; Pain, Procedural; Synovial Fluid
PubMed: 28913649
DOI: 10.1007/s10067-017-3836-x -
Seminars in Arthritis and Rheumatism Apr 2016The objective was to assess the efficacy of ultrasound-guided (USG) versus landmark (LM) knee arthrocentesis in adults with knee pain or effusion. (Review)
Review
OBJECTIVES
The objective was to assess the efficacy of ultrasound-guided (USG) versus landmark (LM) knee arthrocentesis in adults with knee pain or effusion.
METHODS
A systematic review of the literature was performed until August 2015. All controlled trials reporting the accuracy or clinical efficacy between USG and LM knee joint arthrocentesis were selected. Pooled weighted mean difference (WMD) using the D-L fixed models for continuous outcomes and the risk ratio (RR) for dichotomous outcomes were assessed by meta-analysis. Heterogeneity between studies was estimated by I(2) statistic.
RESULTS
Nine studies including 715 adult patients (725 knee joints) were eligible for this review versus LM group; there was a statistically significant difference in favor of USG for knee arthrocentesis accuracy rate (risk ratio = 1.21; 95% CI: 1.13-1.29; P < 0.001; I(2) = 37%), lower procedural pain scores (WMD = -2.24; 95% CI: -2.92 to -1.56; P < 0.001; I(2) = 4%), more aspiration volume (WMD = 17.06; 95% CI: 5.98-28.13; P = 0.003; I(2) = 57%), and decreased pain score 2 weeks after injection (WMD = 0.84; 95% CI: 0.42-1.27; P < 0.001; I(2) = 0). There was no statistically significant difference in procedural duration between two groups (WMD = -0.8; 95% CI: -2.24 to 0.74; P = 0.31; I(2) = 0).
CONCLUSIONS
Ultrasound-guided knee joint arthrocentesis offer a significantly greater accuracy and clinical improvement over landmark technique in adults with knee pain or joint effusion.
Topics: Arthrocentesis; Humans; Injections, Intra-Articular; Knee Joint; Ultrasonography, Interventional
PubMed: 26791571
DOI: 10.1016/j.semarthrit.2015.10.011 -
Journal of Clinical Medicine May 2023The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular... (Review)
Review
The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular joints (TMJs). Medical databases covered by the ACM, BASE, Google, NLM, and ResearchGate were searched on 23 February 2023. The assessment of the level of evidence was based on the Oxford Center for Evidence-Based Medicine 2011 scale. The risk of bias was assessed for randomized controlled trials with the RoB2 tool. Extracted data were tabulated, and the changes in effect values were calculated. A total of eight studies qualified, of which five trials on 213 patients were randomized and controlled (RCTs). In each of the RTC study groups, arthrocentesis was performed, and 1-2 mL per joint of I-PRF (700 rpm/3 min/60 g centrifugation) was administered. Articular pain in three months decreased to 0-25% of the initial pre-interventional values in the study and 38-50% in the control groups. Mandible mobility increased to 121-153% and 115-120% in the I-PRF groups and controls, respectively. The main limitations of the evidence were the small number of RCTs and the lack of any RCT study groups receiving I-PRF without prior arthrocentesis. In conclusion, supplementing the temporomandibular joint rinsing with I-PRF administration further relieves pain and improves mandible mobility. The lack of RCTs on the intra-articular administration of I-PRF as a stand-alone procedure encourages further research. This research received no external funding. The review protocol has not been previously published.
PubMed: 37176766
DOI: 10.3390/jcm12093326 -
Cureus Sep 2023Temporomandibular joint (TMJ) disorders present complex challenges in pain management and functional restoration. This review delves into the innovative approach of... (Review)
Review
Temporomandibular joint (TMJ) disorders present complex challenges in pain management and functional restoration. This review delves into the innovative approach of using platelet-rich plasma (PRP) and hyaluronic acid (HA) combination therapy in TMJ arthrocentesis to address these issues. The potential benefits of this approach are highlighted through an exploration of mechanisms, clinical studies, safety considerations, and future directions. PRP's regenerative properties and HA's lubrication and anti-inflammatory effects offer a comprehensive solution to multifactorial TMJ pain and dysfunction. Clinical studies reveal significant pain reduction, improved mobility, and enhanced satisfaction in patients treated with PRP and HA. Although mild and transient adverse effects have been reported, the safety profile remains favorable. While the evidence is promising, more extensive randomized controlled trials are needed to establish sustained efficacy and safety. As research evolves, collaborative efforts among clinicians and researchers are crucial in realizing the potential of PRP and HA combination therapy, ultimately providing a novel pathway to alleviate TMJ-related pain and enhance patient well-being.
PubMed: 37868393
DOI: 10.7759/cureus.45646 -
Cranio : the Journal of... Sep 2018To discuss advantages and disadvantages of TMJ arthrocentesis techniques, identifying modifications as reported in the literature.
OBJECTIVES
To discuss advantages and disadvantages of TMJ arthrocentesis techniques, identifying modifications as reported in the literature.
METHODS
A PubMed web-based search was carried out, using the terms TMJ and arthrocentesis, to determine the scope of coverage in well-documented articles in English.
RESULTS
Among 237 articles, 12 distinct techniques were described for TMJ arthrocentesis in 12 articles. Among 12 techniques, 5 were classified as double puncture arthrocentesis (DPA) and 7 as single puncture arthrocentesis (SPA). In total, 17 well documented articles about SPA were found in literature.
DISCUSSION
Arthrocentesis of the temporomandibular joint (TMJ) was first described in 1991. To make the traditional procedure even less invasive, many arthrocentesis methods have been described. However, in 2015, TMJ arthrocentesis techniques were divided into two groups to limit the complexities surrounding the concepts related to TMJ arthrocentesis techniques.
Topics: Arthrocentesis; Humans; PubMed; Punctures
PubMed: 28618972
DOI: 10.1080/08869634.2017.1340226 -
Journal of Maxillofacial and Oral... Mar 2023Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of... (Review)
Review
Efficacy of Arthrocentesis and Stabilization Splints in Treatment of Temporomandibular Joint Disc Displacement Disorder Without Reduction: A Systematic Review and Meta-analysis.
BACKGROUND
Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of joint. The purpose of this analysis was to evaluate the efficacy of arthrocentesis procedure in comparison with stabilization splints used for disc displacement disorders without reduction.
MATERIALS AND METHODS
A systematic search was done in electronic databases (PubMed, Cochrane Central, Web of Science). In addition to this hand search of references and grey literatures was done. Qualities of randomized controlled clinical trials were assessed by Cochrane's tool for Systematic Reviews of Interventions and the Newcastle-Ottawa Scale was followed to assess the prospective and retrospective studies. Outcome variables pain (VAS) and maximum mouth opening were assessed by the software review manager 5.03.
RESULTS
A total of five studies were included in the review. Three studies showed greater improvement of symptoms in patients of arthrocentesis group in terms of maximum mouth opening, pain (VAS) value. Two other studies found no significant advantage of arthrocentesis over the other treatment protocol. The meta-analysis resulted in statistically significant difference between outcome variables favouring arthrocentesis group (VAS 1-10) (Mean Difference: 3.10; 95% CI 1.74, 4.45; ≤ .00001, Mean difference: 2.00; 95% CI 0.29, 3.71; = 0.02).
CONCLUSION
Arthrocentesis showed effective result in terms of increase in mouth opening and reduction of pain level compared to stabilization splint and other non-invasive approaches in patients with disc displacement disorders without reduction. Overall, results supported the rationale of using arthrocentesis in patients with disc displacement disorders without reduction.
PubMed: 36703686
DOI: 10.1007/s12663-021-01675-1 -
AJR. American Journal of Roentgenology Sep 2020The purpose of this evidence-based review is to equip radiologists to discuss and interpret findings obtained with various imaging modalities, guide patient selection... (Review)
Review
The purpose of this evidence-based review is to equip radiologists to discuss and interpret findings obtained with various imaging modalities, guide patient selection for percutaneous aspiration, and safely perform arthrocentesis to assess for infection in both native and prosthetic joints. Septic arthritis is an emergency that can lead to rapidly progressive, irreversible joint damage. Despite the urgency associated with this diagnosis, there remains a lack of consensus regarding many aspects of the management of native and periprosthetic joint infections.
Topics: Arthritis, Infectious; Arthrocentesis; Contrast Media; Diagnosis, Differential; Humans; Minimally Invasive Surgical Procedures; Patient Selection; Prosthesis-Related Infections; Risk Factors; Synovial Fluid
PubMed: 32783556
DOI: 10.2214/AJR.20.22773 -
Journal of Stomatology, Oral and... Oct 2022Application of arthrocentesis in temporomandibular joint disorders preferred and suggested therapeutic treatment option in recent years. This study was designed to...
INTRODUCTION
Application of arthrocentesis in temporomandibular joint disorders preferred and suggested therapeutic treatment option in recent years. This study was designed to investigate and compare the effect of intra-articular injection of botulinum toxin-A (Btx-A) on pain and mouth opening after arthrocentesis in nonreduction disc displacement.
MATERIALS AND METHODS
This restrospective study was conducted on 30 patients with a visual analogue scale is higher than five and limited mouth opening. Patients were divided into 2 groups as conventional arthrocentesis group (group A) and intra-articular Btx-A injection following arthrocentesis group (group B). Maximum mouth openining and temporomandibular joint pain were measured in preoperative (t0) and at postoperative 1-week (t1), 1-month (t2) and 6-month (t3).
RESULTS
When VAS scores of group A and group B were examined, no statistical difference was observed at t0 and t1 time intervals; an increased in mouth opening values and decreased VAS score values were observed in both groups in the 1 month (t2) and 6t3) months, mostly in group A.
CONCLUSION
İntra-articular injection of Btx-A following arthrocentesis can induce mouth opening and reduce the pain and dysfunction in patients with anterior disc displacement.
Topics: Botulinum Toxins, Type A; Humans; Injections, Intra-Articular; Pain; Range of Motion, Articular; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 35523405
DOI: 10.1016/j.jormas.2022.04.019 -
Journal of Maxillofacial and Oral... Sep 2018The purpose of the study was to compare the efficacy of arthrocentesis alone and arthrocentesis with duloxetine in patients with TMJ pain.
PURPOSE
The purpose of the study was to compare the efficacy of arthrocentesis alone and arthrocentesis with duloxetine in patients with TMJ pain.
MATERIALS AND METHODS
This study comprised of 20 patients. Patients with TMJ pain as confirmed by RDC/TMD and with pain duration of at least 3 months were included in the study. Patients were randomly divided into two groups, group A in which patients were treated with arthrocentesis alone and group B in which patients were treated with arthrocentesis followed by duloxetine 30 mg twice daily for 12-week therapy. Patients were followed up at regular interval at day 1, day 5, day 7, week 4, week 6 and week 12. Outcome assessment of pain, swelling, maximal mouth opening, painful/pain-free lateral or protrusive jaw movement was done. Hospital anxiety and depression (HAD) scale was used to assess pre- and post-treatment anxiety and depression. Radiologic assessment was done based on OPG and CBCT. Biochemical assessment of IL-6 in lavage fluid between groups A and B was done pre-operatively and postoperatively.
RESULTS
There was significant reduction of pain in both groups, but reduction of pain was more in group B than in group A at week 4, week 6 and week 12. Mouth opening was significantly higher in group B than in group A patients. Reduced painful lateral and protrusive movements were seen in group B than in group A patients. There was no significant difference in hospital anxiety and depression scale among the groups at pre-operative and at 4th week post-operative. Though a significant reduction of IL-6 levels was seen post-operatively, there was no significant difference between the two groups.
CONCLUSION
Arthrocentesis is an effective procedure for relieving symptoms in patients with temporomandibular disorders. In this study, combination of duloxetine with arthrocentesis gave much better outcome than arthrocentesis alone. Further studies with large sample size required to evaluate the effect of arthrocentesis plain or in combination with duloxetine in providing permanent relief to the patient.
PubMed: 30034142
DOI: 10.1007/s12663-017-1037-4 -
Journal of Functional Morphology and... Mar 2020Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment...
Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment efficacy. The aim of this study was to evaluate the clinical indexes variation in patients affected by temporomandibular joint disorders treated with arthrocentesis and sodium hyaluronate (SH) injections. A total of 28 patients suffering from temporomandibular joint disorders underwent one cycle of five arthrocentesis and infiltrations of sodium hyaluronate. Spontaneous mouth opening improved from 36.3 ± 7.5 mm to 45.1 ± 1.9 mm at six months follow-up. A significant reduction in the pain at rest and during mastication mean values emerged at follow-up ( < 0.0001). The mean masticatory efficiency, evaluated through a visual analogic scale, showed improvement at the follow-up period, highlighted by the increase of mean value from a baseline of 3.1 ± 1.2 to a mean value of 8.5 ± 1.2 ( < 0.0001). The mean severity of the joint damage at baseline time was 2.4 ± 0.9 and decreased to 0.4 ± 0.3 at the end of the follow-up period. The decrease in values is confirmed by statistical test ( < 0.05). Our data show how arthrocentesis integrated with sodium hyaluronate infiltrations performed under local anesthesia is a valid method of treating temporomandibular joint disorders.
PubMed: 33467234
DOI: 10.3390/jfmk5010018