What are the treatment options for knee bursitis?

Treatment Options for Knee Bursitis

The optimal management of knee bursitis requires a combination of pharmacological and non-pharmacological treatment modalities tailored to the type of bursitis and severity of symptoms. 1, 2

Initial Conservative Management

• NSAIDs (oral or topical) are recommended as first-line treatment for pain relief and reducing inflammation in knee bursitis, with topical NSAIDs preferred in patients ≥75 years due to better safety profile 2, 3
• Acetaminophen (up to 4,000 mg/day) can be used as an alternative first-line medication for pain relief in patients who cannot tolerate NSAIDs 2, 4
• Rest, ice, compression, and elevation (RICE) should be implemented immediately following diagnosis to reduce inflammation and pain 5, 6
• Activity modification to avoid pressure on the affected bursa is essential for healing 6, 7

Pharmacological Interventions

• For acute bursitis with significant inflammation, naproxen 500 mg twice daily is effective, with a total daily dose not exceeding 1000 mg for management of bursitis 3
• Aspiration of fluid from the bursa may be necessary in cases of significant swelling, particularly in traumatic/hemorrhagic bursitis 5, 7
• Intra-articular corticosteroid injections are indicated for acute exacerbations of knee bursitis, especially if accompanied by effusion 4, 1
• Antibiotics effective against Staphylococcus aureus should be promptly initiated if septic bursitis is suspected based on clinical presentation and bursal fluid analysis 6, 8

Non-Pharmacological Approaches

• Exercises focused on strengthening the quadriceps and preserving normal knee mobility are strongly recommended for patients with knee bursitis 4, 2
• Weight reduction should be considered for overweight patients to reduce pressure on knee joints 2, 1
• Appliances such as walking sticks, insoles, or knee padding may help reduce pressure on the affected area 2, 4
• Physical therapy modalities including ultrasound and electrical stimulation may facilitate healing 9, 8

Type-Specific Management

Prepatellar Bursitis

• Avoid kneeling and use protective knee pads during activities that require kneeling 6, 8
• Consider aspiration if significant swelling is present, followed by compression bandaging 7, 8

Pes Anserine Bursitis

• Address biomechanical issues such as excessive pronation with appropriate footwear or orthotic devices 9, 1
• Stretching exercises for hamstrings and strengthening exercises for quadriceps 1, 2

Infrapatellar Bursitis

• Modify activities that involve repetitive knee flexion 6, 9
• Consider taping techniques to reduce pressure on the affected bursa 9, 8

When to Consider Surgical Intervention

• Surgical excision of the bursa should be considered only for recalcitrant cases that fail to respond to conservative treatment for 3-6 months 7, 8
• Septic bursitis not responsive to antibiotics or recurrent cases may require surgical drainage 6, 8

Common Pitfalls and Caveats

• Failure to distinguish bursitis from other knee pathologies (arthritis, tendinitis, meniscal tears) may lead to inappropriate treatment 6, 8
• Intrabursal corticosteroid injections for non-septic bursitis may be beneficial but carry a risk of iatrogenic infection 6, 7
• Always rule out septic bursitis before initiating corticosteroid injections, as these can worsen infection 6, 8
• Bursal aspiration of chronic microtraumatic bursitis is generally not recommended due to the risk of iatrogenic septic bursitis 6, 7