What is the role of surgery in the treatment of prepatellar bursitis (housemaid's knee)?

Updated: Sep 15, 2020
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Dean H Hommer, MD  more...
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Answer

Incision and drainage of the prepatellar bursa usually is performed when symptoms of septic bursitis have not improved significantly within 36-48 hours. Surgical removal of the bursa (ie, bursectomy) may be necessary for chronic or recurrent prepatellar bursitis. [10] Arthroscopic or endoscopic excision of the bursa has more recently been reported to have satisfactory results, with less trauma than open excision. [11, 12]

Using a systematic literature review, Baumbach et al developed a treatment algorithm for olecranon and prepatellar bursitis in which they advised that septic forms of these conditions initially be treated conservatively. They recommended that incision, drainage, or bursectomy be reserved for patients with severe, refractory, or chronic/recurrent disease. [26]

A study by von Dach et al suggested that even in cases of moderate to severe septic prepatellar or olecranon bursitis, it is safe to substitute a one-stage bursectomy with primary closure for a two-stage procedure. The study, which included 168 patients, also found that the median hospital stay was 2 days shorter with the one-stage approach than with the two-stage operation. [27] A study by Uçkay et al concluded that for adults with moderate to severe septic bursitis who require inpatient treatment, bursectomy with primary closure in combination with 7 days of antibiotic drug therapy is a safe and effective approach that saves resources. [28]

A study by Meade et al of 27 cases of recalcitrant septic prepatellar or olecranon bursitis indicated that endoscopic bursectomy can effectively treat these conditions. It has been questioned whether, when performed endoscopically, the procedure allows infected tissue to be adequately debrided in bursitis, thus preventing the disease’s recurrence. However, wound healing complications in the study were absent, and there was just one minor recurrence. In addition, hospital stays were reported to be much shorter than have been found in association with more conservative therapy for septic bursitis and in previous case series on endoscopic bursectomy. [29]


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