Updated: 11/19/2019

Prepatellar Bursitis (Housemaid's Knee)

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https://upload.orthobullets.com/topic/3018/images/clinical image prepatellar bursitis.jpg
https://upload.orthobullets.com/topic/3018/images/bursae in knee.jpg
Introduction
  • Swelling and inflammation of the anterior knee
  • Epidemiology
    • incidence
      • most common bursitis of the knee
    • location
      • bursa anterior to patella
    • risk factors
      • excessive kneeling
      • common in wrestlers
        • concern for septic bursitis in wrestlers
  • Pathophysiology
    • may be septic or aseptic
      • 20% are septic
Anatomy
  • Prepatellar bursa
    • the prepatellar bursa is a potential space
    • function to enhance gliding of tissue over patella 
Presentation
  • History
    • often patients have a history of kneeling
  • Symptoms
    • pain
    • swelling
  • Physical exam
    • can be warm to touch, especially if septic
Studies
  • Aspiration with gram stain and culture
    • indicated to distinguish between septic versus aseptic
      • on physical exam a septic presentation is difficult to distinguish from an aspetic presentation
        • the collection is extra-articular so the patient does not have the pain one has with septic arthritis
      • S. aureus is the most commonly cultures organism in both septic olecranon and prepatellar bursitis 
Treatment
  • Nonoperative
    • compressive wrap, NSAIDs, +/-aspiration and immobilization for 1 week
      • indications
        • most cases
      • technique
        • corticosteroid use is controversial
  • Operative
    • bursal resection
      • indications
        • rare
        • open or arthroscopic
          • arthroscopic bursal resection 

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