Patellar Bursa Management in Total Knee Arthroplasty
The patellar bursa (prepatellar bursa) is typically removed or excised during the standard surgical approach to total knee arthroplasty. This occurs as part of the routine anterior midline incision and arthrotomy used to access the knee joint.
Surgical Technique Context
During TKA, the prepatellar bursa is encountered and removed during the initial surgical approach:
- The standard midline anterior incision passes through the prepatellar bursa
- The bursa is excised or dissected away as the surgeon develops the surgical planes to access the joint capsule
- This is a routine part of the exposure, not a specific decision point that requires evidence-based consideration
Why This Isn't Addressed in Guidelines
The provided AAOS guidelines 1 extensively discuss technical decisions in TKA including patellar resurfacing, component fixation, tourniquet use, and instrumentation choices. However, bursa removal is not mentioned because it's a standard technical step during surgical exposure rather than a clinical decision that affects outcomes.
The guidelines focus on decisions that impact morbidity, mortality, and quality of life - such as whether to resurface the patella itself (where moderate evidence supports resurfacing may improve outcomes) 1 - but bursa excision is simply part of gaining surgical access.
Clinical Relevance
The one case report provided 2 describes patellar button migration to the prepatellar bursa 11 years post-TKA, which is only possible if bursa tissue remains or reforms postoperatively. This represents an extremely rare complication and doesn't change standard surgical technique.
In practical terms: Yes, the prepatellar bursa is removed during standard TKA as part of the surgical approach to the knee joint. This is surgical technique rather than a clinical decision requiring evidence-based recommendation.