Surgery on the knee
Inflammation of the bursa in front of the kneecap (Bursitis praepatellaris) is caused by chronic pressure overload or blunt trauma. If there is an open injury to the bursa, it can also lead to infection with bacteria. The surgical treatment of bursitis of the knee offers two options.
One is a partial removal of the bursa. In this procedure, only the inner part of the bursa is removed during a bursoscopy, while the outer sliding layer is preserved. This method is less risky and the wound healing process is faster.
However, this surgical technique is not always possible or effective. On the other hand, a complete removal of the inflamed bursa at the knee is also possible. This operation is usually performed under general anesthesia and the affected person lies on his or her back so that the surgeon has a good view of the knee.
A cuff is applied above the knee, a so-called tourniquet, which reduces bleeding during the operation. The bursa is completely removed and a wide wound remains in the area of the knee, which heals scarred. A drainage is often placed in the wound for some time to allow blood and wound secretion to drain away.
In some cases, the wound on the knee is not completely closed immediately, but only in a second step. This may be necessary especially in cases of infectious bursitis. After the operation, the leg must be spared, usually aids such as splints or a plaster are applied. Physiotherapy and the intake of pain-relieving medication follow the operation.
Surgery on the shoulder
An inflammation of the bursa in the shoulder is usually first treated with conservative methods. Only if these therapies are not sufficient and the complaints in the shoulder persist, surgical removal of the bursa may be indicated.In the course of a shoulder joint endoscopy (arthroscopy), the bursa is removed minimally invasively with the help of the “keyhole method”. In principle, an expansion of the so-called subacromial space is also performed during this procedure.
Here, a part of the acromion is milled off to create a little more space in the inflamed shoulder and to prevent a recurrence of bursitis. During arthroscopy of the shoulder, the surgeon also assesses the condition of the tendon attachments of the shoulder muscles (rotator cuff). If necessary, a necessary reconstruction of these tendons (e.g. in the case of a tear) can be performed in the same procedure.
Acute bursitis of the elbow (bursitis olecrani) is often caused by trauma (e.g. contusion, fall). But also metabolic diseases such as gout, chronic irritation of the elbow (e.g. by supporting the elbow during acute bursitis olecrani can be well treated by making a surgical incision (surgical cut into the tissue) and letting the purulent secretion drain away. If necessary, it may be advisable to empty the bursa completely and then fill it with glucocorticoids (cortisone) to prevent a renewed inflammation.
A chronic inflammation of the bursa at the elbow must often be treated surgically. The bursa is completely removed and the elbow is immobilized with the help of an upper arm splint until the surgical wound has healed (about five to seven days). After that, further treatment with elastic bandages can take place.
In case of septic bursitis olecrani (bursa infected with bacteria), the wound may require special treatment. In this case, antibiotic chains can be placed in the wound for a few days. Often this leads to a lasting success and the bursa forms again. Basically, an inflammation of the bursa must be operated on the elbow if it is purulent or chronic or if the non-operative therapies have failed.