For non-septic prepatellar bursitis, treatment can vary. Ice, rest, elevation of the affected knee and behavior modification is very helpful. If a person’s job requires that they kneel, the use of knee pads will be recommended to ease the pressure on the knee. Ibuprofen or other NSAIDS have been proven to be helpful in relieving inflammation. Steroid injections, in conjunction with aspiration can be used for more recalcitrant cases. Recurrent cases often have to have a formal excision of the bursa sac.
Occasionally, the bursa can become infected and cause the patient to run a fever. This can happen when a person also suffers abrasions to the knees while kneeling, which allows bacteria to enter the soft tissue, increasing the risk of local infection. If your physician suspects that the bursa may be infected, he or she will often draw fluid out (aspirate) with a hypodermic needle to be sent for a Gram stain and cell culture. By doing so, they can ascertain what type of bacteria is causing the infection and decide upon the best course of antibiotic treatment. Most often, the infection is caused by Staphylococcus, and less frequently Streptococcus.
For cases where infection is present, oral antibiotics will be given as the first course of treatment. If this does not resolve the infection, IV antibiotics may be administered. If the infection does not resolve, removal of the bursa may be necessary, which can be done as a 30 minute outpatient procedure.
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