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Management of septic and aseptic prepatellar bursitis: a systematic review

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Despite contributing to significant morbidity in working-age adults, there is no consensus on the optimal treatment for prepatellar bursitis. Much of the existing literature combines prepatellar and olecranon bursitis. This systematic review aims to determine the optimal management of prepatellar bursitis.

Study design and methods

A primary search of electronic published and unpublished literature databases from inception to November 2019 was completed. Articles over 25 years old, case reports with less than four patients, paediatric studies, and non-English language papers were excluded. Our primary outcome was recurrence after 1 year. Comparisons included endoscopic vs open bursectomy, duration of antibiotics. Methodological quality was assessed using the Institute of Health Economics and Revised Cochrane Risk of Bias scoring systems. Meta-analyses were conducted where appropriate.

Results

In total 10 studies were included (N = 702). Endoscopic and open bursectomy showed no difference in recurrence after 1 year (OR 0.41, 95% CI 0.05–3.53, p = 0.67), and surgical complications (OR 1.44, 95% CI 0.34–6.08, p = 0.44). 80% endoscopically-treated patients were pain free after 1 year. Patients treated with antibiotics for less than 8 days were not significantly more prone to recurrence (2/17 vs 10/114, OR 0.66, 95% CI 0.13–3.29, p = 0.64) compared to 8 days plus at minimum 1 year post injury.

Conclusions

Our study represents the largest cohort of patients evaluating management strategies for prepatellar bursitis, and includes data not previously published. Endoscopic bursectomy is non-inferior to open bursectomy, enabling a shorter hospital stay. It also offers a relatively low risk of post-operative pain. Endoscopic bursectomy is a viable option to treat both septic and aseptic prepatellar bursitis. Our small cohort suggests recurrence and hospital stay are not improved with antibiotic treatment exceeding 7 days for septic prepatellar bursitis.

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Authors and Affiliations

  1. St George’s University Hospitals NHS Foundation Trust, London, UK

    Oliver S. Brown, M. Benjamin & C. B. Hing

  2. Oxford University Hospitals, Oxford, UK

    T. O. Smith

  3. Epsom and St Helier Hospitals, London, UK

    T. Parsons

  4. Trauma and Orthopaedic Department, St George’s Hospital, Blackshaw Road, London, SW17 0QT, UK

    Oliver S. Brown

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Appendix 1: Search terms used for database searching

Appendix 1: Search terms used for database searching

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Brown, O.S., Smith, T.O., Parsons, T. et al. Management of septic and aseptic prepatellar bursitis: a systematic review. Arch Orthop Trauma Surg 142, 2445–2457 (2022). https://doi.org/10.1007/s00402-021-03853-9

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