Controlling inflammation of the bursa is the primary goal of treating bursitis. Whether septic or aseptic, treatment of knee bursitis requires resting the knee to avoid joint friction and to give the inflammation a chance to subside. Septic knee bursitis requires antibiotic treatment and monitoring.
Treating and Preventing Prepatellar Bursitis
Below is a list of specific treatment methods used to alleviate prepatellar bursitis symptoms. Once successfully treated, patients may prevent future cases of bursitis by avoiding putting direct pressure on the knee. People who must spend time on their knees (people who install tile and carpet floors, for example) and people who play high-impact sports may benefit from using kneepads.
Rest. Activities that may aggravate the affected prepatellar bursae, such as high impact sports and kneeling or crawling, should be avoided.
Cold compress. Applying a cold compress to the knee for about 20 minutes two or three times a day may help alleviate symptoms and decrease swelling.
Elevating the affected knee. Keeping the knee elevated above the heart may help reduce swelling. Sitting in a recliner, sitting with the leg elevated on a footstool or ottoman, or lying down with the knee elevated on a pillow, can also help relieve swelling.
Compression. An elastic medical bandage (e.g. Ace™ bandage) wrapped around the affected knee joint can help control swelling.
Non-steroidal anti-inflammatory drugs, or NSAIDs. To reduce pain, swelling, and inflammation, patients may take prescription or over-the-counter anti-inflammatory medications, such as aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve), and COX-2 inhibitors (e.g. Celebrex). Patients should check with their physician before taking NSAIDs, as they may interact with supplements, vitamins, and/or other medications.
Topical medications. Creams, sprays, gels and patches applied directly to the skin over the knee can provide pain relief. Topical medications may be a good choice for people who want to minimize the gastrointestinal side effects that can be caused by oral medications.
- Topical analgesics. The creams contain counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and distract the brain from knee pain. These creams are often sold over the counter and are available in most drug stores. Examples of brand names include Ben-Gay, Icy-Hot and Zostrix. Most can be used in combination with oral pain medications.
- Topical non-steroidal anti-inflammatory drugs, or NSAIDs. Topical medications containing the NSAID diclofenac have been found effective in treating isolated musculoskeletal pain. Topical NSAIDs are available only with a prescription and sold under the names Voltaren, Flector, Pennsaid, and Solaraze.
- Lidocaine patches. Lidocaine is a topical numbing agent that interrupts pain signals to the brain. Adhesive patches containing 5% lidocaine can be applied directly to the painful knee. These patches are available only with a prescription.
It is possible to have side effects or negative drug interactions from using topical medications. Patients should always discuss new medications with their doctor or pharmacist and read drug labels and instructions.
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Aspiration. Removing fluid from the swollen prepatellar bursa using a needle and syringe will immediately relieve pressure in the knee. This procedure, called aspiration or arthrocentesis, may be immediately followed by a corticosteroid injection to reduce knee swelling. The physician may send some of the aspirated bursa fluid to a lab to be tested for signs of infection and/or other problems, such as gout. (Infection would indicate septic bursitis and require treatment with antibiotics.)
Corticosteroid injections. Symptoms may be quickly relieved with corticosteroid injections. While effective, some studies have shown these injections have been associated with side effects such as pain and skin degeneration near the site of injection. Therefore, corticosteroid injections are usually reserved for patients that have not responded to other treatments.
More on Injections for Arthritis
Antibiotics. Septic prepatellar bursitis requires treatment with antibiotics. The choice of antibiotic may be influenced by what microorganism is causing the infection, if it is known (often Staphylococcus Aureus). Most people with septic bursitis are effectively treated with oral antibiotics. More challenging cases may require hospitalization and antibiotics delivered intravenously.
Surgery. Challenging cases of chronic knee bursitis and septic knee bursitis may warrant a surgery to remove the affected bursae, called a bursectomy. Some doctors believe septic prepatellar bursitis justifies immediate removal the infected bursa, though there is not agreement on this subject.1
In a traditional bursectomy an incision is made at the knee and the prepatellar bursa(e) is removed. To lower the risk of surgical complications, such as tenderness and trouble with skin healing, some doctors perform arthroscopic bursectomies. This minimally invasive procedure takes between 15-30 minutes and usually doesn't require stitches.2
More information on Knee Surgery
Physical therapy. After the bursitis symptoms have abated, a doctor may assign knee stretching and strengthening exercises to help ward off recurrent bursitis.
Rest, combined with other methods to alleviate swelling, is usually successful in treating knee bursitis. It is important to wait until all knee pain and swelling is gone before resuming normal activities. Returning to activities that cause friction or stress on the prepatellar bursa before it is healed will likely cause the symptoms to flare up again.