Pre-patellar and Infra-patellar Bursitis

Pre-patellar and infra-patellar bursitis is particularly common in those who frequently kneel (e.g. carpet fitters, joiners).
Acute inflammation may occur which typically settles with time. In some cases, bacterial infection can occur with spreading cellulitis and fever. Early infections may settle with oral antibiotics. Bacterial infection with systemic upset and spreading cellulitis typically requires admission (Infectious Diseases during daytime hours or Acute Medicine OOH)for intravenous antibiotics.
Aspiration may identify the causative organism (usually Staph. aureus) and decrease the bacterial load aiding resolution.
Most cases of inflammatory bursitis settle however a thickened sac of bursal tissue can remain. Some have recurrent episodes where a minor impact or repeated kneeling results in further inflammation and recurrence of swelling. Some cases progress to chronic inflammation where the swelling persists.
Surgical excision is discouraged in most cases as there is a significant risk of wound complications, nerve injury and recurrence.
Surgical excision is therefore only considered in chronic recalcitrant cases with careful counselling regarding the risks of surgery.