Housemaid’s knee, also known as prepatellar bursitis or kneecap bursitis, causes swelling and pain at the front of the knee. So why is it called “housemaid’s knee”, and what can you do about it?
What is a housemaid’s knee?
A housemaid’s knee is a swelling in the sac at the front of the knee, called the prepatellar bursa. This sac sits on top of the kneecap. The prepatellar bursa is one of four bursae in the knee; less frequently, the other bursae are affected.
What causes a housemaid’s knee?
Causes of prepatellar bursitis include:
- A fall onto the knee or direct trauma to the front of the knee
- Repeated minor injury from kneeling for long periods. This kneeling is typical of housemaids — hence the term housemaid’s knee — but other workers, such as carpenters, plumbers, and rugby players, are also at risk.
- Infection. A break in the skin can lead to infection in the bursa, causing pain and swelling (septic bursitis).
Housemaid’s knee symptoms
Prepatellar bursitis causes pain and swelling at the front of the knee, which can come on suddenly or gradually. Pain occurs with kneeling or other direct pressure, and people often describe a sharp, needle-like pain when kneeling. Stiffness and general tightness of the knee are common, and you often see an indent in the knee from swelling.
If the bursa is infected, the skin may feel hot to the touch, and you may develop a fever — an important sign that needs urgent treatment.
Your doctor should rule out other causes of knee pain and swelling, such as runner’s knee, cartilage damage, or other types of bursitis, including infrapatellar bursitis. Ultrasound or MRI helps confirm housemaid’s knee and rule out other causes.
How do you treat kneecap bursitis?
Treatment depends on the cause.
In infective prepatellar bursitis, we use high-dose antibiotic tablets. Sometimes people need to be admitted to hospital for intravenous antibiotics, and occasionally surgery is needed to clear the infection.
In non-infectious prepatellar bursitis, simple treatments are usually enough:
- Avoid activities that aggravate the bursitis, especially kneeling.
- Use knee padding to protect the knee from further friction.
- Take anti-inflammatory tablets such as ibuprofen and use a compression bandage to reduce inflammation.
In cases that don’t settle with simple treatment, draining the fluid from the bursa under ultrasound is the next step — with cortisone held in reserve for bursitis that recurs afterwards.
How long does kneecap bursitis last?
Kneecap bursitis usually lasts weeks to months, and can recur if the irritation from kneeling continues. With treatment, though, symptoms gradually improve.
More about draining a housemaid’s knee (and when we use cortisone)
Prepatellar bursitis is an inflammatory condition, and draining the swollen bursa is usually the first procedure we do. Cortisone is a powerful anti-inflammatory that can settle the bursa and stop it from refilling — but we hold it in reserve rather than using it straight away because injecting into the bursa carries a small risk of infection.
We use ultrasound to improve accuracy and effectiveness. Ultrasound confirms the diagnosis and helps avoid injections into the wrong structures, such as the knee tendons. Because injecting cortisone can occasionally introduce infection, care is essential — so it’s worth asking these four questions before an ultrasound-guided injection.
Our approach is deliberately staged. First, we use a numbing shot such as lidocaine. Then we drain the fluid from the bursa using a needle under ultrasound — and, as a rule, we prefer to drain alone first, without putting anything else into the bursa. Introducing cortisone carries a small risk of infection, so we’d rather avoid it unless it’s needed. Afterwards, we apply pressure to the front of the knee to prevent it from refilling, and wearing a protective sleeve or knee padding is essential to prevent further friction.
If the bursitis recurs after drainage, we then consider a trial of cortisone at that stage to settle the inflammation and prevent the fluid from returning. Taking it in these steps means we only use cortisone in the knee when simple drainage hasn’t held — keeping the infection risk as low as possible. Other possibilities include a sclerosant injeciton such as glucose or polidocanol in intractable cases.
In rare cases, surgery to remove the bursa is needed if all other treatments fail.
How much does treatment for a kneecap bursitis cost?
Dr Masci treats a housemaid’s knee as a one-stop appointment — consultation, diagnostic ultrasound, and, where appropriate, ultrasound-guided drainage of the bursa in a single visit (with cortisone held in reserve for bursitis that recurs). At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided drainage or injection is £400; other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Note: an infected (septic) bursa is treated with high-dose antibiotics rather than a cortisone injection — see the FAQ below.
Frequently asked questions about a housemaid’s knee
Is a housemaid’s knee serious?
Usually not — prepatellar bursitis is benign and more of a nuisance than a serious problem. The important exception is infection (septic bursitis), which needs urgent antibiotic treatment. It is also essential to exclude other causes of pain and swelling at the front of the knee.
How do I know if my housemaid’s knee is infected?
Warning signs of infection include a hot, red area over the knee, spreading redness, a fever, or feeling generally unwell. An infected bursa needs antibiotics (sometimes in hospital) — and must not be treated with a cortisone injection. See a doctor promptly if you have these signs.
Can you drain a housemaid’s knee?
Yes — and draining is usually the first thing we do. We remove the fluid from the bursa with a needle under ultrasound guidance, then apply pressure and padding to prevent it from refilling. We prefer to drain it alone first, without adding cortisone, to keep the risk of infection low. If the swelling returns after drainage, we consider a trial of cortisone to settle it.
How long does a housemaid’s knee take to heal?
Most cases settle over a few weeks to a few months. Recovery is quicker if you avoid the kneeling or pressure that caused it, and it can recur if that irritation continues.
Does a housemaid’s knee come back?
It can, especially if you continue kneeling or putting pressure on the front of the knee. Knee padding, avoiding prolonged kneeling, and protecting the knee at work reduce the chance of it returning.
How do you prevent a housemaid’s knee?
Wear knee pads for jobs or activities that involve kneeling, take breaks from kneeling, and protect any breaks in the skin over the knee to reduce the risk of infection.
Should I change my exercise or gym routine if I develop pre-patellar bursitis?
Yes, we think so. Certainly avoid direct pressure such as kneeling. You should refrain from high-force lower-leg exercises such as squats and lunges unitl the swelling settles.
Final word from Sport Doctor London about prepatellar bursitis
Prepatellar bursitis is a common but benign condition — more of a nuisance than a serious issue. Simple treatments such as ice, compression, and knee padding often provide relief. When a procedure is needed, we drain the bursa first and keep cortisone on hand for recurrent cases. The key exception is an infected bursa, which needs prompt antibiotic treatment.
To discuss treatment for a housemaid’s knee with Dr Masci in London, including in-clinic ultrasound, contact the team here or call +44 (0) 203 488 0350.
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