Which of the following is a contraindication to arthrocentesis?

Which of the following is a contraindication to arthrocentesis?

• A. Overlying cellulitis
• B. Coagulopathy with abnormal bleeding risk
• C. A prosthetic joint
• D. Inaccessible joint

Answer: (A)

Infection risk is the main concern when performing arthrocentesis. If there is cellulitis over the joint, puncturing through that skin can introduce bacteria into the sterile joint space, leading to septic arthritis, which can cause rapid joint destruction and systemic illness. Because of this, arthrocentesis is contraindicated when the skin over the joint is actively infected; the infection should be treated first and the procedure reconsidered once the skin is clear. The other scenarios involve different considerations but do not mandate avoiding the procedure outright: a prosthetic joint can still be aspirated to evaluate for infection, though it may be more challenging; coagulopathy is a bleeding risk and is considered a relative, not absolute, contraindication with correction or careful technique; and an inaccessible joint might require imaging guidance or alternative joint sites rather than a universal restriction.

Infection risk is the main concern when performing arthrocentesis. If there is cellulitis over the joint, puncturing through that skin can introduce bacteria into the sterile joint space, leading to septic arthritis, which can cause rapid joint destruction and systemic illness. Because of this, arthrocentesis is contraindicated when the skin over the joint is actively infected; the infection should be treated first and the procedure reconsidered once the skin is clear.

The other scenarios involve different considerations but do not mandate avoiding the procedure outright: a prosthetic joint can still be aspirated to evaluate for infection, though it may be more challenging; coagulopathy is a bleeding risk and is considered a relative, not absolute, contraindication with correction or careful technique; and an inaccessible joint might require imaging guidance or alternative joint sites rather than a universal restriction.