The prepatellar bursa is a thin sac between the skin and the front of the kneecap. Repeated kneeling or a direct blow can irritate it and fill it with fluid, producing a soft, swollen bump on the front of the knee, sometimes called housemaid's knee.
Most prepatellar bursitis is irritation that settles with simple measures. The important exception is an infected bursa, which is red, warm, and tender and needs prompt treatment to avoid spreading.
Symptoms
Common findings include:
- A soft, swollen bump on the front of the kneecap
- Pain with kneeling or pressure on the front of the knee
- Limited bending when the swelling is large
- Redness, warmth, and fever if the bursa is infected
When to act quickly
A bursa that is red, hot, very tender, or accompanied by fever may be infected (septic bursitis). That needs prompt evaluation, often with aspiration to test the fluid and antibiotics, and sometimes drainage. Distinguishing infected from simply irritated is the key first step.
For a non-infected, irritated bursa, Dr. Lee uses activity modification (especially avoiding kneeling), padding, anti-inflammatory measures, and sometimes aspiration of the fluid. Most settle without surgery.
When infection is suspected, the fluid is tested and treated with antibiotics, with drainage if needed. Surgical removal of the bursa is reserved for chronic, recurrent cases that do not respond to these measures.
Non-surgical treatment
Most irritated bursae respond to:
- Avoiding kneeling and using knee padding
- Anti-inflammatory measures and ice
- Aspiration of the fluid in selected cases
Infection and recurrence
A suspected infected bursa is aspirated, tested, and treated with antibiotics, with drainage when needed. For chronic or repeatedly recurrent bursitis that does not settle, surgical removal of the bursa is an option.
Recovery timeline
Recovery is usually quick for an irritated bursa:
- Weeks 0 to 3Avoid kneeling, use padding, and apply anti-inflammatory measures. Swelling subsides gradually.
- If infectedAntibiotics and close follow-up, with drainage if the infection does not settle promptly.
What patients commonly misunderstand
The one thing not to miss:
- Most are not infected. The majority of prepatellar bursitis is simple irritation that settles with padding and avoiding kneeling. But a red, hot, tender bursa needs prompt evaluation for infection.
- Repeated kneeling is the usual culprit. Occupations and activities that involve frequent kneeling are the classic cause. Padding and avoiding kneeling are both treatment and prevention.
This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.