Updated: 5/29/2021

Prepatellar Bursitis (Housemaid's Knee)

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  • Summary
    • Prepatellar bursitis is the swelling and inflammation of the anterior knee bursa associated with pain with kneeling. 
    • Diagnosis is made clinically with mild swelling and tenderness over the anterior knee overlying the patella. 
    • Treatment is nonoperative with compressive wraps and NSAIDs. Occasionally, in the setting of septic bursitis, antibiotics may be indicated.
  • Epidemiology
    • Incidence
      • most common bursitis of the knee
    • Anatomic location
      • bursa anterior to patella
    • Risk factors
      • excessive kneeling
      • common in wrestlers
        • concern for septic bursitis in wrestlers
  • Etiology
    • 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
      • rarely indicated
        • can be used to distinguish between septic versus aseptic if necessary
          • on physical exam a septic presentation is difficult to distinguish from an aseptic 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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