Bursectomy
| Bursectomy | |
|---|---|
| ICD-9-CM | 83.5 |
A bursectomy is the removal of a bursa, which is a small sac filled with synovial fluid (a lubricating liquid found in joints) that cushions adjacent bone structures and reduces friction in joint movement. This procedure is usually carried out to relieve chronic inflammation (bursitis) and infection when conservative management has failed to improve patient outcomes.[1]
Because most clinically significant bursae are subcutaneous, the procedure is performed most often at the olecranon, prepatellar, subacromial, trochanteric and scapulothoracic sites, although any bursa in the appendicular skeleton can be removed if symptoms warrant.[2] Textbook guidelines advise that surgery be deferred until active infection sepsis has been controlled with appropriate antibiotics or until at least three months of non-operative management have failed in aseptic bursitis.[2][3]
The classical operation is an open bursectomy conducted through a longitudinal or transverse incision directly over the affected sac, permitting removal of the bursa's outer layer (capsulectomy), scraping away of inflamed tissue (curettage) and, where necessary, excision of associated osteophytes or spurs.[2] Minimally invasive techniques have been developed in parallel: arthroscopic subacromial bursectomy, endoscopic olecranon bursectomy and endoscopic trochanteric bursectomy use small portals to resect the bursa under visual control while preserving overlying skin and reducing postoperative wound problems.[4][3]
A 2021 systematic review comparing 502 hips treated for recalcitrant trochanteric bursitis reported no significant differences in pain relief, functional scores or complication rates between open and arthroscopic approaches, with overall patient-satisfaction levels of 82–95 percent.[4] Complications are uncommon but include wound breakdown, superficial infection, seroma, recurrence of bursal fluid and, rarely, nerve irritation. Combined study data show complication rates varying from 0 to 33 percent across different studies, with actual surgical failures occurring in fewer than 8 percent of cases.[4][3]
Post-operative protocols typically immobilise the limb in a splint or compression dressing for 7–14 days to allow dermal adherence, followed by graduated physiotherapy aimed at restoring range of motion while avoiding direct pressure over the excision site.[2][3]
Most patients regain unrestricted daily activities within six to eight weeks, and the bursa reforms as a thin, non-inflamed sac that rarely becomes symptomatic if the underlying mechanical causes (e.g., repetitive kneeling or leaning) are addressed.[2] Current reviews emphasise that bursectomy should be presented as a supplementary option for select cases rather than a routine first-line intervention, balancing its high success rate against the generally lower morbidity of continued conservative care.[4][3]
See also
[edit]References
[edit]- ^ Mitchell, Justin J.; Chahla, Jorge; Vap, Alexander R.; Menge, Travis J.; Soares, Eduardo; Frank, Jonathan M.; Dean, Chase S.; Philippon, Marc J. (2016). "Endoscopic trochanteric bursectomy and iliotibial band release for persistent trochanteric bursitis". Arthroscopy Techniques. 5 (5): e1185 – e1189. doi:10.1016/j.eats.2016.07.005. PMC 5310191. PMID 28224075.
- ^ a b c d e Azar, Frederick M.; Canale, S. Terry; Beaty, James H. (2021). Campbell's Operative Orthopaedics (14th ed.). Elsevier. ISBN 978-0-323-67217-7.
- ^ a b c d e Nchinda, Nzuekoh N.; Wolf, Jennifer M. (2021). "Clinical management of olecranon bursitis: a review". Journal of Hand Surgery (American Volume). 46 (6): 501–506. doi:10.1016/j.jhsa.2021.02.006. PMID 33840568.
- ^ a b c d Crutchfield, Connor R.; Padaki, Ajay S.; Holuba, Kurt S. (2021). "Open versus arthroscopic surgical management for recalcitrant trochanteric bursitis: a systematic review". Iowa Orthopaedic Journal. 41 (2): 45–57. PMC 8662929. PMID 34924870.