A bursectomy is a surgical procedure to remove an inflamed or infected bursa. It is considered when non-surgical treatments have not provided sufficient relief. The procedure aims to alleviate discomfort and restore function in the affected area.
Understanding the Bursa and the Procedure
A bursa is a small, fluid-filled sac located in the body, typically near joints, between bones, tendons, and muscles. These sacs contain synovial fluid, a lubricating liquid that helps reduce friction during movement and acts as a cushion to absorb pressure. There are over 150 bursae throughout the human body, with major ones found in areas like the hips, knees, shoulders, and elbows. A bursectomy is the surgical removal of this sac.
Conditions Requiring a Bursectomy
Bursectomy is generally considered when conservative treatments for bursitis, such as rest, medication, physical therapy, or injections, have not been effective. This procedure is often indicated for chronic bursitis, where inflammation persists for several months or recurs frequently. Infected bursitis, also known as septic bursitis, may also necessitate a bursectomy if antibiotic treatment alone does not resolve the infection. Common sites for bursectomy include the shoulder (subacromial bursa), elbow (olecranon bursa), hip (trochanteric bursa), and knee (prepatellar bursa). Severe inflammation leading to restricted joint movement or significant daily activity impairment can also lead to a recommendation for this surgery.
The Surgical Process
A bursectomy can be performed using either an open surgical technique or a minimally invasive arthroscopic approach. The choice of method depends on the bursa’s location, its size, and the surgeon’s preference. Anesthesia, either local or general, is administered to ensure the patient’s comfort during the procedure.
In an open bursectomy, a larger incision is made directly over the affected bursa for direct visualization and removal. This approach is typically used for superficial bursae, such as those in the elbow or knee.
For an arthroscopic bursectomy, several small incisions are made near the joint. An arthroscope, a thin instrument with a camera and light, is inserted through one incision, projecting images onto a monitor to guide the surgeon. Specialized tools are then inserted through other small incisions to carefully remove the inflamed bursa and any surrounding scar tissue. After the bursa is removed, the incisions are closed with sutures or surgical staples, and a bandage is applied. A drain may also be placed to manage any excess fluid or blood.
Recovery and Rehabilitation
Following a bursectomy, immediate post-operative care involves managing pain and swelling. Patients are often advised to elevate the affected limb and apply ice packs to reduce inflammation. Pain medication will be prescribed to help with any discomfort. A bulky dressing or splint might be kept in place for about 10-14 days to protect the surgical site and support the joint.
Physical therapy is a structured part of rehabilitation, beginning with gentle range-of-motion exercises to prevent stiffness and encourage blood flow. As the initial swelling and pain subside, usually within the first few weeks, the focus shifts to progressive strengthening exercises for the muscles around the joint. Patients typically work to restore full range of motion and improve strength over several weeks to months. The timeline for returning to normal activities varies but generally ranges from six to eight weeks for unrestricted daily activities, with more strenuous activities or sports requiring a longer recovery, potentially up to 12-16 weeks. While uncommon, potential complications can include infection at the surgical site or joint stiffness.