Operation on the heel
An inflammation of the bursa at the heel (bursitis subachillea) is usually caused by the normal variant of a pronounced heel bump (Haglund pseudoexostosis) or by external pressure (e.g. from poor footwear). The constant irritation leads to an inflammation of the bursa and often causes severe pain. The surgical treatment of this bursitis therefore usually involves not only the complete removal of the bursa at the heel, but also the removal of the heel bump where the Achilles tendon is attached.
Immediately after the operation, the heel should be spared and kept still. A lower leg or foot splint is often applied for this purpose. Approximately four days after the operation, the foot can be fully loaded again and functional treatment in a so-called stable shoe with one to two centimeters of heel elevation can be started.
This should be worn for about four weeks and the heel elevation is then gradually reduced again. It usually takes eight to twelve weeks before walking is possible again. Particularly if an operation on the Achilles tendon was necessary at the same time, the sports load should start after twelve weeks at the earliest, and physiotherapy should of course be started earlier.
Operation on the hip/thigh
In the case of bursitis of the hip or thigh, surgery is an alternative treatment method if conservative therapy with, for example, medication and cooling has not been successful. The aim of the operation is to stop the tissue-damaging process and the associated pain of the bursitis and to enable pain-free movement of the hip and thigh again. Bursitis can have various causes, which plays an important role in the decision for or against surgery.
If the bursitis of the hip is caused by a bacterial infection or a rheumatic underlying disease, surgery should be avoided, as it would increase the risk of postoperative complications. If the bursa is overloaded by too much or incorrectly performed movement, surgical treatment achieves a good result. There are two different possibilities to operate on the bursitis.
The entire bursa can either be removed through an open access, so that no new process can occur.Or, in a kind of bursa mirroring, the innermost layer of the bursa is removed through small incisions so that the remaining residue can simply heal again. Both procedures have their advantages and disadvantages, which certainly has to do with scars that have arisen after the operation. However, antibiotic and antithrombotic prophylaxis should be given in any case.
Depending on the location and size of the bursa and the degree of inflammation, it can take varying lengths of time for the wound to heal and restore full functionality after surgery. As a rule, a surgical procedure in the area of a bursa cannot be performed on an outpatient basis. Outpatient treatment is only possible if the bursa is punctured, but not if it is completely or partially removed.
If the bursa is removed or partially removed during arthroscopy, only a short inpatient stay is usually necessary. Wound healing occurs quickly and rehabilitation of the affected joint with physiotherapeutic exercises can take place early. However, if the bursa is removed surgically, a longer stay in hospital and extended follow-up treatment over a few weeks must be expected.
Immediately after the operation, a joint splint is usually applied, under which an elastic bandage is wrapped. This achieves a compression effect, which prevents fluid accumulation in the wound, swelling or bleeding. Depending on how extensive the wound cavity is, such a dressing should be worn for two to three weeks.
Immobilization after the operation is generally not necessary. The stitches used to close the wound can be removed after 12 to 14 days. Movement exercises can already be started on the first day after the operation.
However, the affected joint should be spared for four to six weeks after the operation, e.g. heavy weights should not be lifted after an operation on the shoulder and activities above shoulder height should be avoided. For this reason, occupational absenteeism of two to four weeks is usually to be expected. However, this depends on the findings of the bursa and the requirements and stresses at the workplace.
