Mind your knees

Housemaid's knee is a painful condition that can prevent you from bending your knee joint and can pose severe damage to the joints.

Ever felt a twinge in the knee, after a difficult workout session at the gym or as you climbed up a long flight of stairs? At some time or the other, most of us have had knee problems, which took a few days to disappear, and required only a short period of rest, an ice pack and a painkiller or two.

Housemaid’s knee or prepatellar bursitis, however, is caused by kneeling for long periods of time or repetitive knee movements. In this condition, the fluid builds up in the bursa (the sac of fluid that cushions the knee joints), resulting in swelling behind the knee, which is called as a ‘Baker’s cyst’.

Fact or friction?
Bursitis is generally an inflammation of a bursa, a small sac of fluid with a thin lining. Our body has a number of these sacs, which are found in places where there has been an unusual pressure or friction around the joints, and in the places where tendons and ligaments pass over the bones. The function of the bursa is to reduce this friction, allowing maximum movement around the joints. In case of inflammation, the bursa swells due to an increased amount of fluid within the sac.

Although, there are four bursae around the knee joints, the one between the skin and the kneecap is most commonly affected.

Pressure point
A number of factors lead to housemaid’s knee. Extended or continued pressure on the bursa in front of the knee is the main cause of the problem. Apart from this, a sudden injury to the knee, recurrent minor injuries to the area or infections can cause this problem.

People who have gout or pseudogout are at a higher risk of developing bursitis. The problem of gout is characterised by a build-up of uric acid crystals, which are generally harmless and eliminated in the urine. When a person has gout, uric acid builds up and collects in the joints resulting in pain, inflammation, and swelling.

Some of the symptoms of the condition are as follows:

• A severe pain and swelling in the knee
• Redness of the skin over the knee
• Tender kneecap
• Difficulty in bending the knee
• Problem in kneeling and walking
• High fever (especially if the problem is caused by infection)

The diagnosis includes the examination of the fluid from the bursa. This procedure is carried out under a sterilised environment using a small needle, which is used to take out the sample directly from underneath the skin in front of the kneecap. After the examination of the fluid, suitable treatment and antibiotics are suggested.

Treatment options
If the condition is caused because of an infection, the doctor may prescribe antibiotics or non-steroidal anti-inflammatory drugs, which will calm the pain and reduce inflammation.
The infected fluid may be removed by making a small incision on the knee to bring down the swelling.

Supportive treatments include resting the knee and use of ice packs on the knee. Exercise is another solution if your knee joints are affected by a reduced range of movement.

A keyhole surgery is the last option. In the procedure, the local anaesthetic is used to numb the area around the knee joint and the prepatellar bursa is removed during the surgery.

If you have a hobby or a job that involves kneeling for long hours, you have a chance of developing housemaid’s knee. The condition can be prevented by resting your knee on a cushion or with the regular use of knee pads.

(The author is head of the department of Orthopaedics, Max Super Speciality Hospital, New Delhi.)