Prepatellar bursitis, also known as housemaid's knee, describes inflammation of the prepatellar bursa, a fluid-filled sac located between the kneecap (patella) and the skin. The bursa helps to cushion and protect the kneecap and reduce friction between the kneecap and the skin. When the bursa becomes inflamed, it can cause pain, localised tenderness, swelling, and redness in the front of the knee.
Prepatellar bursitis is most commonly seen in people who participate in activities that put repetitive stress on the front of the knee; particularly those who undertake frequent kneeling, such as carpet layers, plumbers, gardeners etc. Recurrent irritation of the bursa leads to thickening and inflammation with increased fluid production. Bursitis can also occur secondary to trauma, i.e. a fall onto the front of the knee or localised infection.
The main symptom of prepatellar bursitis is well-localised pain in the front of the knee, which is very sensitive to light touch and causes severe pain on kneeling. The pain is often worse when you bend or straighten your knee, or when you kneel or sit for long periods of time. Other symptoms may include:
A doctor will typically diagnose prepatellar bursitis based on a medical history, physical examination, and imaging tests. The physical examination will focus on assessing pain, swelling, and range of motion in the knee. Imaging tests, such as an ultrasound or MRI, may demonstrate a localised fluid collection in the subcutaneous tissue in the front of the knee, superficial to the knee cap, associated with localised hypersensitivity to the pressure from the ultrasound probe.
Most cases of prepatellar bursitis can be treated with conservative measures, such as:
In some cases, additional treatment options may be considered, such as:
Corticosteroid injections can be a highly effective way of reducing inflammation and pain in the elbow joint. At The Joint Injection Clinic, corticosteroid injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor. The experienced medical doctor will then place you in a lying position. The knee is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions. Under ultrasound guidance a needle is placed into the bursa and fluid is aspirated (withdrawn). Once the fluid has been removed, a small volume of steroid and local anaesthetic is injected in order to prevent immediate reaccumulating of the fluid. Afterwards a compression bandage may be applied, to be worn for 24-48 hours.
The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given. The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever. If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed. The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours). This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.
Removing the bursa if it is large or causing severe pain
If you experience any of the symptoms of prepatellar bursitis, it is important to see a doctor to get a diagnosis and discuss treatment options. Early intervention can help to prevent further injury and improve overall knee function.