Call number: LD2668 .T4 1932 S41 / Master of Science

AIMS: Multiple studies have shown that arthrocentesis is an effective treatment for internal derangement of the temporomandibular joint. However, it is not known which patient groups will respond to this procedure. It is often difficult for surgeons to preoperatively the outcome of athrocentesis. This had led some researchers to analyze and evaluate specific variables which could possibly be used as prognostic factors to predict the outcome of arthrocentesis. None of those studies used the amount of disc displacement as a prognostic factor to assess the treatment outcome of arthrocentesis. Therefore, our study objective was to evaluate the amount of disc displacement as a prognostic factor for the outcome of arthrocentesis in patients with Internal derangement of the tempromandibular joint. MATERIALS AND METHODS: The study involved a retrospective review of the treatment records of 46 patients who underwent arthrocentesis of the TMJ by a single surgeon between 2010 and 2013. A prognostic factor evaluated for its effect on the treatment outcome of TMJ arthrocentesis in this study was the degree of disc displacement. For study purposes, patients were divided into two groups: 1) Success group, and, 2) Failure group. Patients were categorized as successful if they met the success criteria prescribed by the American Association of Oral and Maxillofacial Surgeons in 1995. MRI of TMJ was performed in two steps. Initially, oblique parasagittal sections were scanned with a 1.5 T MRI machine. The amount of disc displacement was analyzed from sagittal oblique views of the MRI scans in closed mouth positions by measuring the angle between the posterior band of the articular disc and the center of the condylar head. The disc is considered to be in its normal position when the thicker portion of its posterior band lies within ±10° on the 12 o'clock position. First, the condylar head was identified, and a circle was established to describe the outline of the anterior, posterior, and superior surfaces of the condylar head; this allowed separation of the condylar head from the neck region. Second, the center of the circle was identified and a vertical line was drawn from the center of the circle. The last step was to measure the degree of displacement from this vertical line to the posterior band of the disc. Findings were compared for patients in the two groups for the following variables: age (continuous), disc displacement (continuous), and gender (female or male). P-value were calculated for differences in continuous or categorical variables using a T-test or Pearson's chi-squared test, respectively. The mean MMO, pain and diet scores were also reported in the preoperative group and 12 months postoperative group by outcome status. Statistical significance was set at p < .05 based on a two-tailed test. SPSS was used for all statistical analyses (SPSS Inc, Chicago, IL, 1997). RESULTS: 46 patients with 46 joints were evaluated in the present study. Average age of patients was 31 years with arrange of 24 to 46 years. 35 cases (76.1%) were classified as successful and 11 cases (23.9%) were classified as unsuccessful based on the criteria described earlier. In the successful group, the mean MMO score was found to be greater at the 12 months postoperative interval when compared to the preoperative examination. In the unsuccessful group, the mean MMO score was also greater than preoperatively at the 12 months postoperative group but to a lesser extent than seen in the successful group. Pain level improved more in the successful group compared to the unsuccessful group. Diet scores showed improvement in chewing ability in the successful group but remain unchanged in the unsuccessful group There was a statistically significant difference between the two groups in the degree of anteriorly disc displacement. CONCLUSION: In summary, it has been shown that the degree of disc displacement, preoperative pain level, diet score, and MMO can be used as prognostic factors for the outcome of TMJ arthrocentesis. Future investigations should more carefully evaluate the validity of other variables. Identifying prognostic factors for the outcome on arthrocentesis will help with guiding surgeons in the planned evaluation of TMJ cases. More specifically, clinicians will be able to create tailored treatment modalities based upon prognostic factors.

O objetivo do presente estudo foi avaliar a efusão e o posicionamento do disco articular através de imagens por ressonância magnética nuclear (RMN) pré e pós-operatórios de duas técnicas de artrocentese da articulação temporomandibular. Foram incluídos 26 pacientes com deslocamento de o disco articular sem redução (DDSR), divididos aleatoriamente em dois grupos: artrocentese com 1 agulha com distensão do compartimento superior da ATM (A1) e artrocentese convencional com 2 agulhas (A2). Para comparação dos valores da efusão articular entre as intervenções nos diferentes momentos (antes e após um ano das artrocenteses), foi utilizado o teste qui-quadrado. Todas as análises foram realizadas com nível de significância de 5%. Em relação à efusão, após a realização dos tratamentos, foi observada uma diferença estatisticamente significativa entre as diferentes categorias de efusão (p=0,009), sendo essa diferença evidente no grupo de artrocentese convencional. Do total da amostra, apenas um caso não houve qualquer modificação do posicionamento do disco articular. Pode-se concluir que a artrocentese convencional foi capaz de alterar a variável efusão de maneira estatisticamente significativa, enquanto a artrocentese de agulha única e distensão do compartimento superior não. Ambas as técnicas foram responsáveis por alterar o posicionamento da cabeça mandibular, ou do complexo cabeça-disco, projetando-os nessa última situação para uma posição mais anterior o que pode ser verificado no exame de RMN final, com um aumento da distância interincisal máxima. O uso de artrocentese com emprego de uma única agulha é uma técnica mais simples, do que a artrocentese convencional o que possibilita um maior conforto para o paciente com menor tempo de procedimento e com resultados satisfatórios. / The aim of the present study was to evaluate the effusion and positioning of the articular disc through nuclear magnetic resonance imaging (NMRI) before and after two different arthrocentesis techniques for the temporomandibular joint. 26 patients with dislocation of the articular disc without reduction (ADDwoR) were included, and randomly divided into two groups: arthrocentesis using 1 needle with distention of the upper compartment of the TMJ (A1), and conventional arthrocentesis with 2 needles (A2). The chi-square test was used to compare the joint effusion values between the interventions at different moments (before and after one year of arthrocentesis). All analyzes were performed with a significance level of 5%. Regarding effusion, after the treatments, a statistically significant difference was observed between the different effusion categories (p = 0.009), which was evident in the conventional arthrocentesis group. Of the total sample, only one case did not have a modification of the position of the articular disc. It can be concluded that conventional arthrocentesis was able to change the effusion variable in a statistically significant way, whereas the single needle arthrocentesis and distention of the upper compartment did not. Both techniques were responsible for altering the position of the mandibular head, or the disc-head complex, projecting them in the latter situation, to a more anterior position with an increase in the maximum interincisal distance verified in the final NMRI examination. Arthrocentesis with a single needle is simpler than the conventional technique, for it allows greater comfort to the patient, a shorter procedure and satisfactory results.

O objetivo do presente estudo foi avaliar a efusão e o posicionamento do disco articular através de imagens por ressonância magnética nuclear (RMN) pré e pós-operatórios de duas técnicas de artrocentese da articulação temporomandibular. Foram incluídos 26 pacientes com deslocamento de o disco articular sem redução (DDSR), divididos aleatoriamente em dois grupos: artrocentese com 1 agulha com distensão do compartimento superior da ATM (A1) e artrocentese convencional com 2 agulhas (A2). Para comparação dos valores da efusão articular entre as intervenções nos diferentes momentos (antes e após um ano das artrocenteses), foi utilizado o teste qui-quadrado. Todas as análises foram realizadas com nível de significância de 5%. Em relação à efusão, após a realização dos tratamentos, foi observada uma diferença estatisticamente significativa entre as diferentes categorias de efusão (p=0,009), sendo essa diferença evidente no grupo de artrocentese convencional. Do total da amostra, apenas um caso não houve qualquer modificação do posicionamento do disco articular. Pode-se concluir que a artrocentese convencional foi capaz de alterar a variável efusão de maneira estatisticamente significativa, enquanto a artrocentese de agulha única e distensão do compartimento superior não. Ambas as técnicas foram responsáveis por alterar o posicionamento da cabeça mandibular, ou do complexo cabeça-disco, projetando-os nessa última situação para uma posição mais anterior o que pode ser verificado no exame de RMN final, com um aumento da distância interincisal máxima. O uso de artrocentese com emprego de uma única agulha é uma técnica mais simples, do que a artrocentese convencional o que possibilita um maior conforto para o paciente com menor tempo de procedimento e com resultados satisfatórios. / The aim of the present study was to evaluate the effusion and positioning of the articular disc through nuclear magnetic resonance imaging (NMRI) before and after two different arthrocentesis techniques for the temporomandibular joint. 26 patients with dislocation of the articular disc without reduction (ADDwoR) were included, and randomly divided into two groups: arthrocentesis using 1 needle with distention of the upper compartment of the TMJ (A1), and conventional arthrocentesis with 2 needles (A2). The chi-square test was used to compare the joint effusion values between the interventions at different moments (before and after one year of arthrocentesis). All analyzes were performed with a significance level of 5%. Regarding effusion, after the treatments, a statistically significant difference was observed between the different effusion categories (p = 0.009), which was evident in the conventional arthrocentesis group. Of the total sample, only one case did not have a modification of the position of the articular disc. It can be concluded that conventional arthrocentesis was able to change the effusion variable in a statistically significant way, whereas the single needle arthrocentesis and distention of the upper compartment did not. Both techniques were responsible for altering the position of the mandibular head, or the disc-head complex, projecting them in the latter situation, to a more anterior position with an increase in the maximum interincisal distance verified in the final NMRI examination. Arthrocentesis with a single needle is simpler than the conventional technique, for it allows greater comfort to the patient, a shorter procedure and satisfactory results.

O objetivo do presente estudo foi avaliar a efusão e o posicionamento do disco articular através de imagens por ressonância magnética nuclear (RMN) pré e pós-operatórios de duas técnicas de artrocentese da articulação temporomandibular. Foram incluídos 26 pacientes com deslocamento de o disco articular sem redução (DDSR), divididos aleatoriamente em dois grupos: artrocentese com 1 agulha com distensão do compartimento superior da ATM (A1) e artrocentese convencional com 2 agulhas (A2). Para comparação dos valores da efusão articular entre as intervenções nos diferentes momentos (antes e após um ano das artrocenteses), foi utilizado o teste qui-quadrado. Todas as análises foram realizadas com nível de significância de 5%. Em relação à efusão, após a realização dos tratamentos, foi observada uma diferença estatisticamente significativa entre as diferentes categorias de efusão (p=0,009), sendo essa diferença evidente no grupo de artrocentese convencional. Do total da amostra, apenas um caso não houve qualquer modificação do posicionamento do disco articular. Pode-se concluir que a artrocentese convencional foi capaz de alterar a variável efusão de maneira estatisticamente significativa, enquanto a artrocentese de agulha única e distensão do compartimento superior não. Ambas as técnicas foram responsáveis por alterar o posicionamento da cabeça mandibular, ou do complexo cabeça-disco, projetando-os nessa última situação para uma posição mais anterior o que pode ser verificado no exame de RMN final, com um aumento da distância interincisal máxima. O uso de artrocentese com emprego de uma única agulha é uma técnica mais simples, do que a artrocentese convencional o que possibilita um maior conforto para o paciente com menor tempo de procedimento e com resultados satisfatórios. / The aim of the present study was to evaluate the effusion and positioning of the articular disc through nuclear magnetic resonance imaging (NMRI) before and after two different arthrocentesis techniques for the temporomandibular joint. 26 patients with dislocation of the articular disc without reduction (ADDwoR) were included, and randomly divided into two groups: arthrocentesis using 1 needle with distention of the upper compartment of the TMJ (A1), and conventional arthrocentesis with 2 needles (A2). The chi-square test was used to compare the joint effusion values between the interventions at different moments (before and after one year of arthrocentesis). All analyzes were performed with a significance level of 5%. Regarding effusion, after the treatments, a statistically significant difference was observed between the different effusion categories (p = 0.009), which was evident in the conventional arthrocentesis group. Of the total sample, only one case did not have a modification of the position of the articular disc. It can be concluded that conventional arthrocentesis was able to change the effusion variable in a statistically significant way, whereas the single needle arthrocentesis and distention of the upper compartment did not. Both techniques were responsible for altering the position of the mandibular head, or the disc-head complex, projecting them in the latter situation, to a more anterior position with an increase in the maximum interincisal distance verified in the final NMRI examination. Arthrocentesis with a single needle is simpler than the conventional technique, for it allows greater comfort to the patient, a shorter procedure and satisfactory results.

Syftet med denna studie var att jämföra tre års resultat av enbart lokalanestesi jämfört mot lokalanestesi ochspolning i käkledenpå patienter som lider av smärtande diskdisplacering utan reduktionStudien utfördes från 2003 till 2007 och 45 patienter valdes från sammanlagt 55 utvalda patienter för behandling av TMD till avdelningen för Klinisk bettfysiologi, Odontologiska fakulteten, Malmö högskola, Sverige.Frågeformulär och klinisk undersökning enligt Research Diagnostic Criteria(RDC/TMD), panorama röntgenbilder och magnetisk resonanstomografi utfördes vid start av studien. Tre år efter behandling, sändes ett frågeformulär till 37 patienter.Intensiteten av smärta, fysisk funktion, känslomässig funktion och global förbättring utvärderades.Tjugofyra patienter randomiserades till behandling med lokalanestesi och tjugo patienter randomiserades till behandling med lokalanestesi och spolning. Trettiofyra patienter besvarade enkäten vid 3-års uppföljningen. I en intention-to-treat analys visade det huvudsakliga resultatet att 28/45(62%) hade fått 30% smärtlindring vid uppföljningen. Inga signifikanta skillnader fanns mellan grupperna lokalanestesi och lokalanestesi och spolning avseende smärtlindring, fysisk funktion, känslomässig funktion och global förbättring. Det fanns signifikanta förbättringar (P< 0.05) inom båda grupperna avseendesmärtintensitet, fysisk funktion och emotionell funktion och global förändring vid uppföljning jämfört med start av studien.Eftersom det inte fanns någon skillnader mellan grupperna lokalanestesi och spolningoch enbart lokalanestesii käkleden tre år efter behandling av smärtsam diskdisplacering utan återgång, kan spolning av käkleden ifrågasätts. / The aim of this prospective and longitudinal study was to compare three-year outcomes of local anesthetics compared to anesthetics, arthrocentesis and lavage on patients suffering from painful jaw locking in the TMJThe study was performed from 2003 until 2007 and 45 patients were selected from altogether 55 eligible patients referred for the treatment for TMD to the Department of Stomatognathic Physiology, Faculty of Odontology, Malmö University, Sweden. History questionnaire and clinical examination according toResearch Diagnostic Criteria, panoramic radiographs and Magnetic Resonance Imaging were completed at baseline. A questionnaire was sent three years after treatment to 37 patients. Pain intensity, physical functioning, emotional functioning and global improvement were evaluated.Twenty-five patients were randomised to group anesthetics and 20 patients were randomised to group anesthetics, arthrocentesis and lavage. Thirty-four patients answered the questionnaire at the 3-year follow-up. In an intention-to-treat analysis the primary outcome, showing a ≥30% pain relief, was reported by 28 of 45(62%) patients at the follow-up. No significant differences in improvement were found between group local anesthetics and group anesthetics, arthrocentesis and lavage regarding pain relief, physical functioning, emotional functioning, and global improvement. Significant improvements(P<0.05) were found within both groups regarding pain intensity, physical functioning, emotional functioning and global changes at the follow-up compared to baseline.Since no differences were found between local anesthetics, arthrocentesis and lavage compared to local anesthetics alone of the TMJ three years after treatment of painful disc displacement without reduction, the use of arthrocentesis and lavage can be questioned.

<p>Intra-articular glucocorticoid injection therapy is frequently used to relieve symptoms of arthritis, but there is considerable variation in injection routines among physicians. One issue of debate concerns the importance of synovial fluid aspiration during the injection procedure. In the present randomised controlled study of patients with rheumatoid arthritis (RA), a significantly reduced risk for arthritis relapse was observed when arthrocentesis was included in the intra-articular injection procedure of the knee. </p><p>Furthermore, there is no consensus about the post-injection regimes. Previous studies have shown beneficial effects of post-injection rest of the knee, but also injection routines for other joints often include such recommendations. The present randomised controlled trial showed that 48-hour rest in elastic orthosis after intra-articular injection in the wrist did not improve the outcome. Thus, the effect of post-injection rest varies between different joints. </p><p>The improved treatment result of post-injection rest of the knee is supposed to be caused by retarded steroid resorption from the joint. In order examine the metabolic effects in cartilage, bone and the hypothalamic-piuitary-adrenal (HPA)-axis, resting and mobile RA patients were studied after intra-articular knee injections. Serum levels of the injected glucocorticoid, triamcinolone hexacetonide (THA), were analysed, as well as cartilage oligomeric matrix protein (COMP) as a marker of cartilage turnover, osteocalcin for bone formation and deoxypyridinoline for bone resorption. The HPA-axis was assessed using serum levels of cortisol and adrenocorticotropine hormone. The result showed a short term and reversible suppression of the HPA-axis and bone formation, whereas bone resorption was unaffected. No differences between mobile and resting patients were observed. In both groups reduction of COMP levels were seen, but these were significantly more pronounced in resting patients, suggesting a cartilage-protective effect. The THA levels increased similarly in both groups, indicating that rest did not affect glucocorticoid resorption. </p><p>Consequently, another explanation for the beneficial effects of postinjection rest of knee synovitis should be considered. In the present material the incidence of infectious complications of intra-articular treatment was less than 1/12,000 injections. </p><p>The findings in this thesis can be applied in the clinical practice and should be considered when new guidelines for intra-articular glucocorticoid therapy are created.</p>

Intra-articular glucocorticoid injection therapy is frequently used to relieve symptoms of arthritis, but there is considerable variation in injection routines among physicians. One issue of debate concerns the importance of synovial fluid aspiration during the injection procedure. In the present randomised controlled study of patients with rheumatoid arthritis (RA), a significantly reduced risk for arthritis relapse was observed when arthrocentesis was included in the intra-articular injection procedure of the knee. Furthermore, there is no consensus about the post-injection regimes. Previous studies have shown beneficial effects of post-injection rest of the knee, but also injection routines for other joints often include such recommendations. The present randomised controlled trial showed that 48-hour rest in elastic orthosis after intra-articular injection in the wrist did not improve the outcome. Thus, the effect of post-injection rest varies between different joints. The improved treatment result of post-injection rest of the knee is supposed to be caused by retarded steroid resorption from the joint. In order examine the metabolic effects in cartilage, bone and the hypothalamic-piuitary-adrenal (HPA)-axis, resting and mobile RA patients were studied after intra-articular knee injections. Serum levels of the injected glucocorticoid, triamcinolone hexacetonide (THA), were analysed, as well as cartilage oligomeric matrix protein (COMP) as a marker of cartilage turnover, osteocalcin for bone formation and deoxypyridinoline for bone resorption. The HPA-axis was assessed using serum levels of cortisol and adrenocorticotropine hormone. The result showed a short term and reversible suppression of the HPA-axis and bone formation, whereas bone resorption was unaffected. No differences between mobile and resting patients were observed. In both groups reduction of COMP levels were seen, but these were significantly more pronounced in resting patients, suggesting a cartilage-protective effect. The THA levels increased similarly in both groups, indicating that rest did not affect glucocorticoid resorption. Consequently, another explanation for the beneficial effects of postinjection rest of knee synovitis should be considered. In the present material the incidence of infectious complications of intra-articular treatment was less than 1/12,000 injections. The findings in this thesis can be applied in the clinical practice and should be considered when new guidelines for intra-articular glucocorticoid therapy are created.

Zielstellung: Ermittlung der Komplikationsrate nach intraartikulärer Punktion und Aufdeckung eines möglichen Zusammenhangs mit der Durchführung der Gelenkpunktion. Studiendesign: Es handelt sich um eine retrospektive Studie, basierend auf einer Fragebogenumfrage. Methoden: Erarbeitung eines Fragebogens und Versendung von 618 Exemplaren an 122 Pferdekliniken und 274 Fachtierärzte für Pferde (insgesamt 892 Fragebögen). Berücksichtigt wurden alle Pferdekliniken und Fachtierärzte für Pferde in Deutschland. Die Rückantwort erfolgte anonym. Insgesamt kamen 160 ausgefüllte Fragebögen zurück, von denen 155 in die statistische Auswertung einfließen konnten. Ergebnisse: Im Jahr 2006 wurden von 155 Tierärzten 65099 Gelenkpunktionen beim Pferd durchgeführt, das entsprach 420 Punktionen pro Tierarzt. Hierbei sind bei 51 Tierärzten insgesamt 93 Komplikationsfälle aufgetreten, was einer errechneten mittleren Komplikationsrate von 0,14 % entsprach. 64 (68,8 %) der Komplikationsfälle wurden geheilt, bei 13 (14,0 %) der Komplikationsfälle trat eine Besserung ein und sieben (7,5 %) mussten euthanasiert werden. Eine tödliche Komplikation trat somit zu 0,01 % (7 von 65099) nach einer Gelenkpunktion auf. Ein signifikanter Zusammenhang zwischen der mittleren Komplikationsrate und der Verwendung eines neuen Anbruches des zur Gelenkpunktion angewendeten Medikaments konnte festgestellt werden. Es konnte eine Tendenz zu einem Zusammenhang zwischen der mittleren Komplikationsrate und der Häufigkeit der Durchführung des Waschens vor der Punktion, zwischen der mittleren Komplikationsrate und des, zur Punktion verwendeten, Kanülendurchmessers sowie der mittleren Komplikationsrate und dem Ort der Punktion (Stall oder Klinik) festgestellt werden. Die meisten Punktionen wurden am Hufgelenk (25,0 %) und Fesselgelenk (24,4 %) durchgeführt. Hierauf folgten Tarsometatarsal- und Intertarsalgelenke (15,5 %), Kniegelenk (12,7 %), Talokruralgelenk (9,5 %), Karpalgelenk (7,7 %), Krongelenk (2,9 %), Schultergelenk (1,3 %), Ellbogengelenk (0,7 %) und Hüftgelenk (0,4 %). Die höchste mittlere Komplikationsrate hatte das Hufgelenk mit 0,28 %, dann folgten Ellbogengelenk (0,21 %), Karpalgelenk (0,16 %), Fesselgelenk (0,15 %), Talokruralgelenk (0,11 %), Kniegelenk (0,07 %), Krongelenk (0,05 %), und Tarsometatarsal- und Intertarsalgelenke (0,01 %). Beim Schulter- und Hüftgelenk traten keine Komplikationen auf. Beim Hufgelenk traten signifikant häufiger Komplikationen auf als bei den anderen Gelenken, außer dem Fesselgelenk. Beim Fesselgelenk traten signifikant häufiger Komplikationen auf als bei Tarsometatarsal- und Intertarsalgelenken. Schlussfolgerung und klinische Relevanz: Bei Gelenkpunktionen beim Pferd kann es mit geringer Wahrscheinlichkeit (0,14 %) zum Auftreten von Komplikationen kommen. Es wurde aufgezeigt inwiefern die, in der Literatur empfohlenen, Durchführungspunkte der Gelenkpunktion von den Praktikern umgesetzt wurden. Es wurde veranschaulicht, auf welche Schritte zur Verminderung des Komplikationsrisikos noch größerer Wert gelegt werden sollte. Die Komplikationsanfälligkeit ist zwischen den Gelenken verschieden, wobei vor allem das Hufgelenk mit einem größeren Risiko belastet zu sein schien, was hier ein besonders sorgfältiges Vorgehen verlangt. Die Studie lieferte erstmals Aussagen zum Komplikationsauftreten nach Gelenkpunktion beim Pferd, auch bezüglich der einzelnen Gelenke. Die Ergebnisse können als Grundlage zur Besitzerinformation dienen und hilfreich für die Gutachtertätigkeit sein.

Zielstellung: Ermittlung der Komplikationsrate nach intraartikulärer Punktion und Aufdeckung eines möglichen Zusammenhangs mit der Durchführung der Gelenkpunktion. Studiendesign: Es handelt sich um eine retrospektive Studie, basierend auf einer Fragebogenumfrage. Methoden: Erarbeitung eines Fragebogens und Versendung von 618 Exemplaren an 122 Pferdekliniken und 274 Fachtierärzte für Pferde (insgesamt 892 Fragebögen). Berücksichtigt wurden alle Pferdekliniken und Fachtierärzte für Pferde in Deutschland. Die Rückantwort erfolgte anonym. Insgesamt kamen 160 ausgefüllte Fragebögen zurück, von denen 155 in die statistische Auswertung einfließen konnten. Ergebnisse: Im Jahr 2006 wurden von 155 Tierärzten 65099 Gelenkpunktionen beim Pferd durchgeführt, das entsprach 420 Punktionen pro Tierarzt. Hierbei sind bei 51 Tierärzten insgesamt 93 Komplikationsfälle aufgetreten, was einer errechneten mittleren Komplikationsrate von 0,14 % entsprach. 64 (68,8 %) der Komplikationsfälle wurden geheilt, bei 13 (14,0 %) der Komplikationsfälle trat eine Besserung ein und sieben (7,5 %) mussten euthanasiert werden. Eine tödliche Komplikation trat somit zu 0,01 % (7 von 65099) nach einer Gelenkpunktion auf. Ein signifikanter Zusammenhang zwischen der mittleren Komplikationsrate und der Verwendung eines neuen Anbruches des zur Gelenkpunktion angewendeten Medikaments konnte festgestellt werden. Es konnte eine Tendenz zu einem Zusammenhang zwischen der mittleren Komplikationsrate und der Häufigkeit der Durchführung des Waschens vor der Punktion, zwischen der mittleren Komplikationsrate und des, zur Punktion verwendeten, Kanülendurchmessers sowie der mittleren Komplikationsrate und dem Ort der Punktion (Stall oder Klinik) festgestellt werden. Die meisten Punktionen wurden am Hufgelenk (25,0 %) und Fesselgelenk (24,4 %) durchgeführt. Hierauf folgten Tarsometatarsal- und Intertarsalgelenke (15,5 %), Kniegelenk (12,7 %), Talokruralgelenk (9,5 %), Karpalgelenk (7,7 %), Krongelenk (2,9 %), Schultergelenk (1,3 %), Ellbogengelenk (0,7 %) und Hüftgelenk (0,4 %). Die höchste mittlere Komplikationsrate hatte das Hufgelenk mit 0,28 %, dann folgten Ellbogengelenk (0,21 %), Karpalgelenk (0,16 %), Fesselgelenk (0,15 %), Talokruralgelenk (0,11 %), Kniegelenk (0,07 %), Krongelenk (0,05 %), und Tarsometatarsal- und Intertarsalgelenke (0,01 %). Beim Schulter- und Hüftgelenk traten keine Komplikationen auf. Beim Hufgelenk traten signifikant häufiger Komplikationen auf als bei den anderen Gelenken, außer dem Fesselgelenk. Beim Fesselgelenk traten signifikant häufiger Komplikationen auf als bei Tarsometatarsal- und Intertarsalgelenken. Schlussfolgerung und klinische Relevanz: Bei Gelenkpunktionen beim Pferd kann es mit geringer Wahrscheinlichkeit (0,14 %) zum Auftreten von Komplikationen kommen. Es wurde aufgezeigt inwiefern die, in der Literatur empfohlenen, Durchführungspunkte der Gelenkpunktion von den Praktikern umgesetzt wurden. Es wurde veranschaulicht, auf welche Schritte zur Verminderung des Komplikationsrisikos noch größerer Wert gelegt werden sollte. Die Komplikationsanfälligkeit ist zwischen den Gelenken verschieden, wobei vor allem das Hufgelenk mit einem größeren Risiko belastet zu sein schien, was hier ein besonders sorgfältiges Vorgehen verlangt. Die Studie lieferte erstmals Aussagen zum Komplikationsauftreten nach Gelenkpunktion beim Pferd, auch bezüglich der einzelnen Gelenke. Die Ergebnisse können als Grundlage zur Besitzerinformation dienen und hilfreich für die Gutachtertätigkeit sein.