Epithelial tissue cut‐out following needle insertion into a joint: a potential complication during arthroscopy. Issue 5 (9th April 2019)

• Record Type: Journal Article
• Authors: Epstein, Daniel J.; McCullough, Keith
• Is Part Of: ANZ journal of surgery. Volume 89:Issue 5(2019)
• Page Start: 557
• Page End: 561
• Publication Date: 2019-04-09
• Subjects: arthroscopy -- infection -- needle -- orthopaedics -- septic arthritis; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.15131
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract : Background: Knee arthroscopy is a common orthopaedic procedure and often involves insertion of a needle through skin into a joint. This needle insertion can create epithelial tissue cut‐outs possibly containing commensal bacteria that can be flushed into the joint, and potentially lead to post‐arthroscopy septic arthritis. This study aims to assess the frequency of epithelial tissue cut‐out creation on insertion of different needle sizes at different angles to the skin. Methods: Using an ex‐vivo porcine limb tissue model, needles of various gauge (14–23G) were inserted at angles of 90, 60, 45 and 30° to the skin surface. Ten passes were undertaken at each angle. Needle lumen contents were then examined for solid tissue cut‐out. Results: Two hundred and eighty needle passes were performed resulting in 70 tissue cut‐outs (25%) containing solid material. This was more common amongst lower gauge needles. 8 of the 70 (11.4%) tissue cut‐outs contained macroscopic evidence of epithelium. The overall rate of epithelial tissue cut‐out was 2.9%. The 23G needle had the lowest rate of tissue cut‐out creation, occurring twice out of 40 passes ( P = 0.002). Neither of these contained macroscopic epithelial tissue. Conclusion: Hypodermic needle insertion through skin into a joint can create epithelial tissue cut‐out. Epithelial tissue cut‐out occurs more frequently with use of lower gauge needles. This study suggests use of a 23G needle during arthroscopy, inserted either at 60 or 90° to the skin, to reduce epithelial tissue cut‐out and any potential contribution to post‐arthroscopy septic arthritis.