Bursa Sack Removal

Overview
Reviewed by Joseph Maloney, MD

Also known as Bursectomy.

A bursa is a pad-like sac found near the joint. You have hundreds of them throughout your body. Knee bursae are soft sacs in the knee area filled with lubricating fluid that facilitate motion in the knee and decrease friction. Problems arise when a bursa becomes inflamed. This is known as bursitis, and the bursa loses its gliding capabilities and becomes irritated. Bursitis caries in degrees from a mild irritation to an abscess that causes excruciating pain.

In most cases, bursitis is treated with non-steroidal, anti-inflammatory medication to minimize the pain. Surgery is rarely done as only a small number of patients actually benefit from it. However, it the bursa does not heal after it is medically drained or the walls of the sac have become thickened from chronic inflammation, then excision (removal) of the bursa may be necessary. Removing an entire bursa is usually an easy procedure, but if loss of function or bleeding in the area is serious, excising the bursa completely may be impossible.

Detailed Description
Specialist
Orthopedic surgeon

Procedure
Drainage
Bursitis caused by an injury will usually go away on its own. The body will absorb the blood in the bursa over several weeks, and sac should return to normal. Initial treatment includes controlling inflammation and swelling with medications, such as ibuprofen and aspirin. If the bursa remains filled with fluid, your doctor can drain it. He may also inject a small amount of cortisone to control inflammation. If the drained fluid reveals an infection in your knee, your doctor will prescribe antibiotics.

If the infection is slow to heal, the bursa may have to be drained surgically. A small incision is made and the bursa is opened. The skin and bursa are kept open by inserting a drain tube into the bursa for several days. This allows the fluid to drain and helps the antibiotics clear up the infection.

Surgery
Surgery is sometimes necessary to remove a thickened bursa that has not improved with other treatments and the swollen sac is restricting your activities. To remove the pre-patellar bursa sack, an incision is made over the top of the knee. Since the bursa is in front of the patella, the knee joint is never entered. Surgery is sometimes attempted to remove portions of the bursa to create space and reduce friction in the knee. The thickened bursa sack is removed, and the skin is repaired with sutures. Some type of bursa will grow back after surgery, because the skin needs to slide over the kneecap smoothly. If all goes well, the one that returns after surgery will not be thick and painful, but more like a normal bursa.

Recovery
Allow 6 to 8 weeks for healing after surgery. You may need to stay off your feet somewhat for several days to allow the wound to begin to heal and to prevent bleeding. Resting for just a portion of the recovery pays big dividends and could get you back in action more quickly.

Complications/Risks

• Permanent limitation of the knee's normal mobility
  
• Prolonged healing time if activity or weight-bearing is resumed too soon
  
• Proneness to repeated flare-ups
  
• Arthritic knee following repeated episodes of bursitis
  
• Tender or contracted scars or areas of increased sensitivity in pressure-bearing areas

Medications
Your doctor may prescribe:

• Non-steroidal anti-inflammatory drugs
  
• Antibiotics (if bursa is infected)
  
• Prescription pain relievers for severe pain. Use non-prescription aspirin, acetaminophen or ibuprofen (available under many trade names) for mild pain.
  
• Injection with a long-lasting local anesthetic mixed with a nonsteroidal anti-inflammatory drug, such as triamcinolone.

Follow up with your doctor if:

• You notice excessive swelling, redness, bruising or a rash in the affected area.
  
• Pain is sharp or shooting, especially when you exercise or exert yourself.
  
• You have a fever.

Last updated: 20-Jun-07