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Housemaid’s knee: the condition associated with prolonged kneeling

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It’s estimated that one in every 200 visits to the GP is because of bursitis. Bursitis occurs when the small fluid sac under the skin, known as the bursa, becomes inflamed between the joints, bones and tendons. Jonathan Bell, FRCS Consultant Orthopaedic Surgeon at Wimbledon Clinics, talks us through prepatellar bursitis – inflammation of the bursa in front of the kneecap – or housemaid’s knee, as it’s more commonly known.

What is Housemaid’s knee?

Housemaid’s knee is a swelling at the front of the knee as a result of the bursa in between the skin and the kneecap (the prepatellar bursa) being traumatised or injured. Although it doesn’t tend to be terribly painful, it can look somewhat unsightly and cause a reduction in the knee’s range of movement. It is a condition that affects people who regularly kneel on hard surfaces, hence the name (although carpet-fitter’s knee might be more appropriate in the 21st century). 

Housemaid’s knee is signified by knee swelling – it can look like someone’s inserted half a golf ball under the knee – caused by an increase in the amount of fluid within the bursa sac. It is the role of the bursa to provide a slippery interface between the knee and the skin, but when it becomes inflamed, it can end up producing too much fluid.

What else could it be?

A swollen knee doesn’t necessarily mean you have housemaid’s knee. Knee swelling is also symptomatic of patella tracking problems. Kneecap tracking issues are most common in girls and those who are hyper-mobile or double-jointed. Sufferers will experience swelling in and around the fat pad, just behind the kneecap.

Housemaid’s knee can also be confused with ‘wear and tear’ arthritis (osteoarthritis). An osteoarthritic knee can become swollen internally, leading to the whole knee swelling up.

A swelling of the knee bursa might also indicate an infection. Other symptoms include pain, redness and fevers. A knee infection needs fairly rapid attention and shouldn’t be neglected. When identified early by a knee specialist, a knee infection in the bursa may respond to antibiotic treatment.

What causes housemaid’s knee?

Housemaid’s knee tends to be occupational, i.e. it relates to a job or profession. Historically, housemaids would spend long periods of time on their knees scrubbing floors, putting pressure on the kneecap (patella). This repeated minor trauma to the front of the knee can cause the bursa to become inflamed. A fall or sudden blow to the knee can also cause the bursa to become inflamed.

How can it be prevented?

The best way of preventing it is to avoid repeatedly kneeling. However, in certain occupations this may not be practical, so Jonathan’s advice is to wear knee pads, which can help protect the bursa from repeated pressure. Thick foam cushions are another preventive solution, which require little or no preparation. While knee pads are the preferential solution, as they will continue to offer protection even after many uses, it’s easy to forget to put them on before getting to work.

How can it be treated?

It’s much easier to prevent housemaid’s knee than it is to treat it. That’s why we strongly advise you to get into the routine of putting on knee pads or resting on a thick foam cushion if your job requires you to put repeated pressure on your knees.

However, if the damage has already been done and you have been diagnosed with housemaid’s knee by a knee specialist, some form of treatment will be necessary. The initial course of treatment will likely comprise resting the knee, applying ice packs and taking anti-inflammatory drugs, while avoiding further kneeling. This should help reduce inflammation.

If housemaid’s knee becomes more troublesome, a steroid injection into the bursa may be used as a one-off to counteract the inflammation. This needs to be done by a knee specialist who has excluded infection from their diagnosis, as the steroid injection can make any pre-existing infection worse.

Knee surgery may be required if the condition persists or becomes chronic – the fluid sac can be removed – but this is seen as a last resort because the surgical operation causes some scarring.

It’s for this reason that the removal of the bursa is often carried through a small incision,. This treatment can prove very successful, given that the knee joint can function perfectly well without the bursa.

If you are experiencing any swelling of the knee, then contact us today and we’ll assess your injury and put together a clear strategy for treatment and recovery, so you can be back to your best as soon as possible.

Call us on: 0208 944 0665 or email us at:[email protected]