Chemical ablation as an alternative to surgery for treatment of persistent prepatellar bursitis.

摘要

Swelling of the prepatellar bursa following trauma usually resolves with rest and protection. Aspiration is indicated to rule out infection and may need to be repeated, even when the fluid is not infected, when recurrent swelling is painful or restricts motion. Injection of corticosteroids can be curative. Symptomatic bursitis that persists despite these measures is considered an indication for surgical removal of the bursa. Methods to ablate the bursa by injections of other materials were described 25 or more years ago, but have not been adopted into current practice. I successfully treated 2 patients with intrabursal injection of the scle-rosing agent sodium morruhate, a method described more than 70 years ago.I propose that this simple technique is worthy of wider application in treatment of persistent sterile prepatellar bursitis for which other conservative measures have failed and surgery is being considered. Case 1. A 38-year-old woman with longstanding systemic lupus erythe-matosus developed swelling anterior to her left knee after a fall. Her main problem at the time was a deep non-healing buttock ulcer deemed secondary to lupus and treated with prednisone and intravenous cytoxan; hence, she did not mention her intermittent knee swelling and pain (with kneeling but not at rest) until 9 months after it developed. Examination disclosed a golf-ball sized tense fluid collection anterior to her knee. Aspiration obtained 8 ml of clear fluid (not further analyzed), following which 40 mg of methylprednisolone were injected. Swelling recurred within 2 days. Six weeks later, she inquired about alternate treatments and indicated she wished to avoid surgery. I proposed instillation of the sclerosing agent sodium morrhuate, an agent I had read about in reviewing non-surgical treatments for knee joint synovitis. She verbally consented, and after retrieving 6 ml of clear fluid I instilled 2 ml of sodium morrhuate (NDC 0517-3065-01 50 mg/ml), 40 mg of methylprednisolone, and 1 ml of 1% lidocaine. Swelling resolved over the next week and has not recurred in 15 months of followup.