Bursectomy

Bursitis is inflammation and swelling of a bursa, which is the fluid-filled sac found in a joint which cushions the tendons and bones and facilitates a gliding motion between the joint surfaces. When a bursa becomes inflamed, the membrane thickens and produces excess synovial fluid causing the bursa to swell. It can no longer fit in the small area between the bone and the muscle or tendon, so it expands outwards, forming a fluid swelling under the skin around the joint.

Elbows and knees are the joints most commonly associated with bursitis. Bursitis in the knee is often called ‘housemaid’s knee’. The condition can also affect the shoulder, hip (trochanteric bursitis), ankle, foot and Achilles tendon.

Bursitis usually causes pain, tenderness and inflammation around the affected joint. Any pain will be experienced as a dull ache, made worse by movement or pressure. It may be difficult to walk, sleep on the affected side, support your weight or move your arms. Trochanteric bursitis symptoms include this pain and discomfort around the hip as this is the joint that is affected in trochanteric bursitis.

Depending on the severity of your condition, bursitis can cause stiffness and swelling, and the joint may be warm to the touch and the skin red.

Septic bursitis, caused by an infection of a bursa, may cause additional symptoms such as a fever, an infection of the deeper layers of skin or broken skin over the affected joint.

Inflammation of a bursa (or a number of bursae) can be caused by repetitive movement, extreme pressure on the joint, traumatic injury to the joint, infection or an inflammatory condition such as rheumatoid arthritis.

Bursitis is more common in patients who regularly engage in physical activities involving repetitive movement. For example, running or jogging can cause bursitis in the ankle. Those with occupations that involve a lot of kneeling (such as carpet fitters) are more susceptible to bursitis knee.

Your GP will usually be able to diagnose bursitis after discussing your symptoms and physically examining the affected area.

In some cases, particularly if you have a fever, they may take a sample of fluid taken from the inflamed bursa to check for the presence of septic bursitis. 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.

A bursa that’s inflamed, but not infected, can usually be successfully treated without surgery using a combination of resting, elevating and icing the joint, physiotherapy and painkillers or anti-inflammatory medication. A steroid injection may be given to the affected joint to reduce the swelling.

Treatment, such as trochanteric bursitis treatment, can include further investigation if it becomes infected, and/or a course of antibiotics is usually necessary. You may need a referral to one of our Consultant Orthopaedic Surgeons to remove the bursa (bursectomy) if it is severe or continually keeps coming back.

Bursectomy is a procedure to remove one or more 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 of the operation.

In a keyhole procedure, your Consultant will make small cuts next to the affected joint. They’ll pass an arthroscope through the holes to better see the area. A specialised tool is passed through the scope to remove the 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.

This procedure is usually carried out as day surgery which means you’ll be able to return home on the same day. You should arrange for someone to pick you up from the hospital as you may not be able to drive yourself.

Immediately after surgery we’ll help manage any discomfort with painkillers. You'll need to avoid strenuous activity for a couple of days after aspiration or an injection, or for a longer period after surgery. We’ll give you physiotherapy instructions before you leave hospital to help your recovery and long-term improvement.

The pain associated with your condition should improve over a few weeks, but any swelling may take longer to disappear completely.

The exact length of your recovery period will depend on the location of your bursitis and if it is caused by an infection (septic bursitis).