What is the treatment for prepatellar bursitis following trauma and infection?

From the Guidelines

The treatment for prepatellar bursitis following trauma and infection should prioritize broad-spectrum antibiotic coverage, such as amoxicillin-clavulanate or piperacillin-tazobactam, to address potential polymicrobial infections, including MRSA and anaerobes, as recommended by the Infectious Diseases Society of America 1.

When managing prepatellar bursitis, it's essential to consider the following:

• Rest and immobilization: Avoid activities that put pressure on the affected knee.
• Ice therapy: Apply ice for 15-20 minutes every 2-3 hours to reduce swelling and pain.
• Compression: Use an elastic bandage to compress the area gently.
• Elevation: Keep the affected leg elevated when resting.
• NSAIDs: Take oral anti-inflammatory medications like ibuprofen (400-800 mg every 6-8 hours) or naproxen (250-500 mg twice daily) to reduce pain and inflammation.
• Antibiotics: For infectious bursitis, oral antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily) or piperacillin-tazobactam (3.375 g every 6-8 hours) for 7-10 days are typically prescribed, as suggested by the 2014 IDSA guidelines 1.
• Aspiration: In severe cases, a doctor may drain fluid from the bursa using a needle.
• Physical therapy: Once acute symptoms subside, gentle stretching and strengthening exercises can help restore function.
• Surgery: Rarely needed, but may be considered for chronic or recurrent cases.

The choice of antibiotic should be guided by the severity of the infection, the presence of systemic signs, and the potential for MRSA or anaerobic organisms, as outlined in the 2018 WSES/SIS-E consensus conference recommendations 1. In cases where the infection is severe or necrotizing, broad-spectrum coverage with antibiotics such as piperacillin-tazobactam or carbapenems may be necessary, with the addition of vancomycin or another antimicrobial effective against MRSA, as recommended by the IDSA guidelines 1.

It's crucial to note that the treatment should be adjusted based on culture results and clinical response, and the duration of antibiotic therapy should be guided by clinical improvement and resolution of fever, as suggested by the 2018 WSES/SIS-E consensus conference recommendations 1. Procalcitonin monitoring may be useful to guide antimicrobial discontinuation, as recommended by the expert panel 1.

In summary, the treatment for prepatellar bursitis following trauma and infection requires a comprehensive approach, including conservative measures, antibiotics, and potential surgical intervention, with a focus on broad-spectrum antibiotic coverage and adjustment based on culture results and clinical response, as recommended by the IDSA guidelines and the 2018 WSES/SIS-E consensus conference recommendations 1.

From the Research

Treatment Options for Prepatellar Bursitis

The treatment for prepatellar bursitis following trauma and infection can vary depending on the severity of the condition.

• For traumatic prepatellar bursitis, a protocol of outpatient endoscopic surgery under local anesthesia has been proposed 2.
• The therapy of acute and chronic bursitis is guided mainly by the nature of the aspirate retrieved from the bursa, with serous content justifying conservative treatment and purulent aspirate necessitating bursotomy with incision and drainage, or bursectomy 3.
• In cases of infective prepatellar bursitis, splintage and intravenous antibiotics with or without aspiration of the bursa were usually successful in treating the condition, although some patients required surgical drainage of the bursa 4.

Surgical Intervention

Surgical intervention may be required for recalcitrant bursitis, such as refractory trochanteric bursitis 5.

• A treatment concept for traumatic lesion of the prepatellar bursa involves rapid recovery of the skin and soft tissue of the affected knee joint with surgical debridement of the wound and gentle, as well as risk-balanced partial resection of the traumatic lacerated prepatellar bursa 6.
• The surgical procedure includes exploration of the wound, excision of the wound margins, dissection of the boundary layer between the bursa and the subcutaneous fat, debridement of the wound, and excision of the bruised and contaminated bursa tissue 6.

Non-Surgical Management

Most patients with prepatellar bursitis respond to non-surgical management, including:

• Ice
• Activity modification
• Nonsteroidal anti-inflammatory drugs 5
• Oral antibiotics may be administered in cases of septic bursitis 5
• Local corticosteroid injection may be used in the management of prepatellar bursitis, but steroid injection into the retrocalcaneal bursa may adversely affect the biomechanical properties of the Achilles tendon 5