A bursectomy is a specialized orthopedic procedure involving the surgical removal of an inflamed bursa, a condition also known as bursitis. This operation is typically reserved for cases where non-surgical treatments have failed to resolve the chronic inflammation or when the bursa has become severely infected. The goal of the surgery is to eliminate the source of persistent pain and swelling to restore normal function to the nearby joint. While bursectomy has a high success rate in relieving symptoms, it is generally considered a last-resort measure after conservative care options have been exhausted.
Understanding the Bursa and Bursitis
A bursa is a small, closed sac lined with a synovial membrane and filled with lubricating synovial fluid. These structures act as cushions, reducing friction between bones, tendons, and muscles near a joint. The human body contains more than 150 known bursae, most commonly located around major joints like the shoulders, elbows, hips, and knees.
Bursitis occurs when a bursa becomes irritated and inflamed, causing it to swell with fluid. The inflammation is frequently caused by repetitive motions, prolonged pressure on a joint, or direct trauma. Common symptoms include localized pain, tenderness, swelling, and a restricted range of motion in the affected joint. When the inflamed bursa is compressed against surrounding tissue, it results in significant discomfort.
Indications for Surgical Intervention
Bursectomy is not a first-line treatment, as most cases of bursitis respond well to conservative therapies such as rest, anti-inflammatory medication, and physical therapy. Surgery becomes a consideration only when symptoms are severe, chronic, or fail to resolve after at least three months of non-operative management.
Another specific trigger for surgical removal is septic bursitis, which is an infection of the bursa usually caused by bacteria like Staphylococcus aureus entering through a break in the skin. While initial treatment for septic bursitis involves antibiotics, a bursectomy may be required if the infection is resistant or if the bursa is severely damaged. The procedure is also considered when the bursa has developed calcification or significant thickening, which non-surgical methods cannot correct.
Details of the Surgical Procedure
A bursectomy is typically performed using either a traditional open approach or a minimally invasive arthroscopic technique. The choice of technique depends on the location and size of the bursa, the extent of the inflammation, and whether other tissues require repair. Anesthesia is administered before the operation, which may be general, regional, or local depending on the complexity of the case.
The open bursectomy involves a single, larger incision directly over the affected bursa. The surgeon carefully dissects the tissue to expose and excise the entire inflamed sac, taking care to protect nearby tendons and nerves. This approach is sometimes necessary for severely inflamed bursae, those with significant scarring, or when an underlying condition like a tendon tear needs simultaneous repair.
In contrast, an arthroscopic bursectomy uses a few small incisions to insert a tiny camera called an arthroscope and specialized instruments. The camera transmits images to a monitor, allowing the surgeon to visualize the area and use a small shaver to remove the inflamed bursal tissue. This minimally invasive method generally leads to quicker recovery times, less post-operative pain, and reduced risk of complications compared to the open procedure.
Recovery and Rehabilitation
The post-operative experience begins with immediate care focused on pain management and monitoring in a recovery area. Patients may be discharged the same day for arthroscopic procedures or require a short hospital stay following an open surgery. The surgical site will be closed with sutures or staples, and sometimes a drainage tube is temporarily placed to prevent fluid accumulation.
Physical therapy (PT) is a major component of the recovery process and usually begins shortly after the operation to restore range of motion and strength. For specific joints, such as the elbow, a splint may be used initially to immobilize the area. Weight-bearing restrictions may be in place, especially for hip or knee procedures, often requiring the use of crutches for several weeks.
The recovery timeline varies significantly based on the joint involved and the type of surgery performed. For many bursectomies, patients can resume light activities within four to six weeks. Full recovery can take approximately 12 weeks, though it may extend to six months or more if a tendon repair was also performed. Adhering to the prescribed rehabilitation program is essential for optimal healing and preventing recurrence.