Plumbers, carpet layers and other people who spend a lot of time on their knees often experience swelling in the front of the knee, or prepatellar bursitis. Athletes who participate in sports where direct blows or falls on the knee are common, such as football, wrestling or basketball, can also develop this condition. Also prone to developing prepatellar bursitis are those who have been in a motor vehicle collision and people with rheumatoid arthritis or gout.

Causes
The constant friction irritates a small lubricating sac (bursa) located just in front of the kneecap (patella). The bursa enables the kneecap to move smoothly under the skin. If the bursa becomes inflamed, it fills with fluid and causes swelling at the top of the knee.

Symptoms
Symptoms include pain with activity (but not usually at night); rapid swelling on the front of the kneecap; and a tenderness and warmth to the touch.

Treatment
Conservative treatment is usually effective, as long as the bursa is simply inflamed and not infected. Recommendations may include:

• Rest - Discontinue the activity or substitute another activity until the bursitis clears up.
• Ice - Apply at regular intervals three or four times a day for 20 minutes at a time. Each session should reduce swelling considerably if the knee is also being rested.
• Elevation - Keep the affected leg elevated except when necessary to walk.

Your physician may also recommend an anti-inflammatory medication such as aspirin or ibuprofen. If the swelling is significant, he may decide to drain the bursa with a needle. Chronic swelling that causes disability may also be treated by draining the bursa, but if the swelling continues, your orthopedic surgeon may recommend surgical removal of the bursa.

Surgical Options
The operation is an outpatient procedure. It takes a few days for the knee to regain its flexibility and some weeks before normal activities can be resumed.