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Prepatellar bursitis: Causes and Treatment of ‘Housemaid's Knee’

Prepatellar Bursitis: Causes and Treatment of Housemaid's Knee

Our knees bear the brunt of a significant amount of pressure and friction in our day-to-day lives. Just one of many complex, weight-bearing joints within our bodies, they are comprised of multiple structures which make them susceptible to a variety of different injuries.

A common occupational knee injury is prepatellar bursitis. This is the inflammation of a fluid-filled sac, called the bursa, located in front of the kneecap (patella), which cushions the tendons and bones and prevents friction in the joints. There are a total of four bursae around the knee joint and all are prone to inflammation, but the prepatellar bursa is the most commonly affected.

What causes prepatellar bursitis?

The condition commonly occurs in people who spend prolonged periods of time kneeling or engaged in a repetitive motion of kneeling down and standing up, hence its colloquial name: Housemaid’s Knee. It’s also known by a variety of other colourful names such as Nun's Knee, Carpet-layer's Knee or Coal Miner's Knee.

Although the injury is most often associated with tradespeople, it is also likely to affect people playing sports where there is a risk of sudden impact trauma on the knee, such as football, rugby and athletics.

A fall or a direct hit to the knee can cause prepatellar bursitis, and those with other inflammatory conditions such as gout or rheumatoid arthritis have an increased risk of being affected.

Symptoms of prepatellar bursitis

The inflamed bursa over the kneecap can become painful, with that pain often felt as a dull ache with significant swelling occurring, sometimes accompanied by redness of the skin and tenderness. This can restrict movement in the knee and consequently affect your ability to walk, kneel or support your own weight.

Treatment – the good news

The good news is that the symptoms of bursitis can usually be treated using painkillers and self-care techniques such as rest and avoiding movement which aggravates the condition. The outcome for the injury is generally very good with the right treatment, and the condition will clear up within a few weeks. However, in some cases, additional specialist intervention may be required to treat it.

Your GP will usually be able to diagnose prepatellar bursitis after discussing your symptoms, potentially asking questions about your occupation and physically examining the affected area.

In some cases, particularly if you have a fever, they may draw a sample of fluid from the inflamed bursa to check for the presence of an infection. You may also have to have a blood test to check for rheumatoid arthritis. Sometimes a magnetic resonance imaging (MRI) scan will be suggested to check for any damage to tissue.

In most cases, the condition can usually be successfully treated without surgery using a combination of supportive treatments. These will likely involve:

  • Resting and elevating the knee
  • Using an ice pack on the joint
  • The use of knee pads and cushioning

Your GP may also recommend painkillers, anti-inflammatory medication or a steroid injection to reduce the swelling

If your knee joint is affected by a reduced range of movement, you may be referred to our eam of Physiotherapists, who can help by producing a tailored rehabilitation programme which may include gentle strengthening and stretching exercises and electrotherapy.

Surgical treatment

In rare cases when the bursitis doesn’t go away or keeps recurring with severe symptoms, you may need a referral to one of our Consultant Orthopaedic Surgeons for a bursectomy. This is a procedure to remove a bursa in order to treat bursitis when other methods haven’t worked.

A bursectomy can be carried out either endoscopically (keyhole method) or with open surgery. A local anaesthetic will be used to numb the area around the knee joint.

In a keyhole procedure, your Consultant will make small cuts next to the affected joint and will pass an arthroscope through the holes to better see the area. A specialised tool is passed through the scope to remove the prepatellar bursa and any scar tissue. The scope and tools are removed, and the holes closed with stitches. A bandage will be placed over the area and you may need a sling to support the joint. The knee joint can function perfectly well without the prepatellar bursa and there are not usually any long-term effects to the knee.

This procedure is usually carried out as day surgery, which means you’ll be able to return home on the same day.

Access our private GP or Physiotherapy services

If you suspect you may be suffering from prepatellar bursitis, book an appointment online for fast access to a face-to-face private GP or Physiotherapy appointment at Benenden Hospital.

Published on 29 March 2023