Post-Op Instructions: Prepatellar Bursa Removal

For a speedy recovery: Respect the healing that takes place in the first few weeks. Let your knee settle down while you restore mobility to your joints. You’ll get better, faster than if you try to cut corners!

The prepatellar bursa is a flat cushion in front of your kneecap, just under the skin. Yours was thickened and inflamed; that’s why it was removed. As your knee heals, a flexible layer of scar tissue will form to replace it


For the first 2-3 days:

Controlling the Pain: The novocaine inside your knee will keep it numb for 8-12 hours after surgery.

  • The most important way to control pain is to control swelling. Keep your whole leg elevated above your heart most of the day and night, “Toes above the nose.”
  • Open the knee brace and place a LARGE ice pack around your knee for 20 minutes every 3-4 hours. Fill 3-4 gallon-sized zippered plastic bags with ice cubes, or buy several LARGE gel-packs that you can rotate through the freezer.
  • Medication: Take your pain medicine (usually Hydrocodone [Vicodin] or Oxycodone [Percocet]) as prescribed for the first 2-3 days, then cut back as you feel better. 
You can switch to over-the-counter acetaminophen (Tylenol), 500mg, up to 2 tablets, 3 times a day after this runs out.
    Anti-Inflammatories: Along with the pain medicine, you can also take:
    _____Over-the-counter ibuprofen (Advil) OR naproxen (Aleve) according to package instructions.
    _____Your prescription anti-inflammatory medication as prescribed:__________________
    _____Do NOT take any anti-inflammatory medication because of your other medical issues

Activity:

  • Wear the knee brace to keep your knee straight for 2 weeks. If you are resting or washing-up and the leg is straight, you may remove the brace if you’d like. Replace it for any other activities, including sleep!
  • It’s OK to put weight on your leg; use the crutches to walk smoothly. Don’t limp; it strains your other joints!
    Move both shoulders, elbows, hips and ankles through a full range of motion every hour to prevent stiffness.
  • Start the exercises on the next page on the first day after surgery. Begin slowly and you’ll improve day by day.

Change the dressing:

  • For the first 2 days, keep the dressing clean and dry. Cover it with a plastic bag and sit on a stool in the shower.
  • It is common to have watery/bloody drainage for a few days. Don’t be alarmed if it soaks through the Ace bandage. You can reinforce the dressing with additional gauze pads or clean washcloths.
  • It’s common to have some bruising around your knee and thigh.
  • On the second day after surgery remove the dressing, wash your leg and pat it dry. DO NOT REMOVE THE PAPER TAPES YET. Sometimes the knee can drain for up to 2 weeks. Just reapply several thick layers of gauze to absorb it until it stops.
  • Wrap your knee with the Ace bandage: a little snug to help the swelling, not too tight.
  • Wear the knee brace to keep your knee straight for 2 weeks.
  • Massage your thigh, knee and calf with both hands for 5 minutes, 3 times/day to help the swelling and stiffness.

What are some problems to watch out for?

  • You’re having extreme pain that’s not relieved with rest, elevation and your prescribed medication.
  • Your calf and ankle are very swollen and tender, and this doesn’t go away after 2 hours of rest, ice and elevation.
    You’re having a fever over 101.5, or your knee is hot, red and very painful.
  • You’re having problems with prescribed medications, with the dressing, or with any issue about your recovery that can’t wait until your follow-up visit.
  • Call the office: 585-271-4272 (or for emergencies after-hours: Dr. Siegrist’s cell phone 585-329-3308 or our answering service 585-723-6566).

For the next 4-14 days:

  • Elevate your leg while resting to let any swelling drain back into circulation. Gradually increase the weight on your knee and the distance you walk. Pain and swelling at this stage mean you’re overdoing it! Continue to use your crutches to avoid limping.</li>
  • Switch from ice to warm compresses if the heat feels better (especially on your thigh, where the tourniquet was.)
  • You can cut your pain medication dose as you feel better: cut the pills in half, or take them less often.
  • Some patients get very constipated after surgery. If you are nauseated and/or don’t have a bowel movement within 2-3 days postop: drink plenty of water or fruit juice, try over-the-counter laxative like Senokot, go for a walk.
  • You can leave the stitches open to the air while you’re resting. Use the Ace wrap and brace if you’re up and around.
  • It’s OK to drive IF you had LEFT knee surgery and are confident about controlling your car. If you had RIGHT knee surgery, it will take longer. Use common sense, and DON’T drive if you can’t safely manage the pedals.
  • Keep working on your exercises. By your 2-week postop visit you should be able to do at least 20 leg lifts.

  • Remember to work your opposite leg!
  • Keep track of your daily exercises on a calendar.
Straight Leg Raises: –strengthen your quadriceps (4 muscles in front of your thigh; major knee supporters)

  • Sit in a chair or lie on your back (bend your opposite knee and rest that foot on the bed for stability if lying down.)
  • Tighten your thigh muscles to lift the heel of your straight leg about 6”.
  • Hold for 5 seconds and slowly lower your heel to the floor.
    • First 2 weeks after surgery: Rest for 5 seconds after each lift, work up to 10 lifts, 10 times/day.
    • 2-6 weeks after surgery: Don’t rest between lifts; start with your leg straight out at hip-level in the chair. Work up to 25 lifts, 4 times/day

  • Also move your shoulders, elbows, hips and ankles to prevent stiffness
Ankle Pumps : – improve your circulation, reduce swelling and prevent blood clots.

  • Elevate your ankle above your hip (so the swelling can flow “downhill”)
  • Contract your shin and calf muscles to move your toes up and down; draw circles and write the alphabet with your foot.
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  • First 2 weeks after surgery: 2-3 minutes every hour.
  • 2-6 weeks after surgery: 2-3 minutes, 4 times/day, or whenever your leg seems swollen.

At 2 weeks after surgery:

  • We’ll remove the brace and paper tapes, and start exercises to bend the knee.
  • You’ll keep wrapping your knee with the Ace bandage, or try an elastic or neoprene knee sleeve/wrap. There are many styles on the market; big drugstores and Wal-Mart have a good selection, or go online. If it’s comfortable, it’s a good one. Not so tight that it causes swelling in your foot!
  • You might have a lot of bruising around your knee and calf. Warm compresses and gentle exercise will help.
  • You’ll move on to more aggressive exercises as your knee heals.
  • We’ll talk about your plans to return to work, so be sure to speak to your employer about any restrictions or paperwork that might be necessary. Complete your section on any disability forms before giving them to our staff. Please allow at least 10 business days, and provide a stamped/addressed envelope.

For more info about Prepatellar Bursitis, Click Here