Definition & Overview
Bursectomy is a surgical procedure used to remove the bursa, a cushion-like sac found within the joints in the body.
Bursae are filled with synovial fluid that lubricates the joints. They serve as points of friction between the bones and the surrounding muscles, ligaments, tendons, and skin. One of the largest bursae in the body is found between the kneecap and the skin and is just a few millimeters thick and about four centimeters in diameter. The primary function of these structures is to provide cushion during movement.
During injury or conditions like rheumatoid arthritis, the synovial membrane of the bursa becomes inflamed due to the excess production of synovial fluid, leading to the condition known as bursitis. Commonly affecting the knees, elbows, hips, and shoulders, it causes pain and restricted movements. The condition can also affect the heels and the base of big toes.
Bursectomy is typically done in orthopedic clinics and on an outpatient basis.
Who Should Undergo and Expected Results
Patients who are diagnosed with bursitis are typically advised to take anti-inflammatory medications to manage their conditions. However, when the condition worsens over time or when the patient no longer responds to medications, bursectomy is advised to achieve long-term pain relief. The procedure can also be recommended to athletes with related injuries and for those with recurring septic bursitis, in which the inflammation of the bursa is caused by bacterial infection, causing the synovial membrane to be filled with pus that needs to be drained constantly. The physician may advise removing the bursa altogether to make sure the infection does not spread or recur.
The procedure is considered safe and minimally invasive. The majority of the affected joints heal without any reported serious complications. Patients are advised to rest for several weeks to facilitate healing, making sure the affected area is used as little as possible. Pain medications and anti-inflammatory drugs may be prescribed to reduce discomfort. Physical therapy sessions after the operation can be beneficial to encourage the recovery of affected joints and regain their strength. In the majority of cases, patients are able to achieve long-term relief from pain as well as regain mobility in the affected joints.
How is the Procedure Performed?
In most cases, the affected joint is numbed using topical anesthesia and there is no need to sedate the patient. If the physician determines that drainage is required from the affected joint, a small incision is made and the bursa is opened. A small drain tube is inserted and kept in the bursa for several days to remove the fluid. A concurrent antibiotic medication is also prescribed to avoid infection.
In cases where draining fluid does not provide relief, the physician may decide to remove the bursa altogether. This is especially the case if it has thickened to a point where movement is severely restricted and the patient is experiencing debilitating pain. The surgeon still makes an incision and removes the thickened bursa. However, there are some instances when the surgeon decides to remove only a portion of it and leave a small portion intact to maintain a degree of lubrication and reduce friction. If such is the case, there is a possibility for the bursa to grow back to its normal size. The incision is then closed with sutures.
A modified version, called arthroscopic bursectomy, is performed on those who are diagnosed with trochanteric bursitis or inflammation of the bursa in the hip joint. The surgeon makes an incision in the hip area and inserts a small camera to guide his instruments toward the bursa. Special surgical tools are then used to drain excess fluid. In some cases, a shaver is used to completely cut the bursa from the surrounding muscles and tissues. The incision is then closed.
Possible Risks and Complications
Bursectomy can lead to the development of infection at the incision site, which can be prevented by taking antibiotic medications. If left untreated or inadequately managed, the infection can lead to skin death or necrosis.
Patients also need to follow the prescribed rest period a few weeks after the procedure. Otherwise, healing will be slow and there will be a possibility of recurrence. This is a big possibility especially if the joint was made to bear weight even if it has not completely healed.
In areas where there are repeated movements, such as the knees or shoulders, there is a possible limitation of normal mobility that the patient will experience long after bursectomy was performed. For some patients, this complication might even be permanent.
In few instances, some patients report the development of arthritic knee symptoms following bursectomy.
Snider RK. Olecranon bursitis. Snider RK, ed. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997. 156-9.
McGee DJ. Elbow joints. Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1992. 143-167.