Abstract
Introduction
In the lower extremity, lymphedema is characterized by fluid buildup and swelling which can lead to fibrosis of the skin and recurring soft-tissue infections. Risk factors include obesity, older age, lower extremity surgery, and radiotherapy. There is currently a paucity of data examining the impact of lymphedema in primary total knee arthroplasty (TKA). The purpose of this study was to review outcomes following primary TKA performed in patients with lymphedema compared to a matched cohort with primary osteoarthritis.
Methods
Over a 19-year period (1998–2016), 144 patients underwent primary TKA with a preceding diagnosis of ipsilateral lymphedema (Table 1). There were 114 (79%) females, a mean age of 69 years, and mean BMI of 37.1 kg/m2. Mean follow-up was 7-years (range 2–17 years). A blinded analyst completed a 1:2 match of patients with lymphedema to a group of patients without lymphedema undergoing primary TKA for osteoarthritis during the same period. Matching criteria included sex, age, date of surgery, and BMI. Matched controls included 228 (79%) females along with a mean age and BMI of 69 and 36.4 kg/m2. The mean follow-up for the comparison cohort was 8 years (range 2–18 years). There were no significant differences between groups on the evaluated baseline parameters.
Results: Patients with a history of lymphedema were at a significantly increased risk of revision TKA (HR 7.60, P<0.001), reoperation for any cause (HR 2.87, P<0.001), and postoperative infection (HR 6.19, P<0.001). Patients with lymphedema were also at increased risk for periprosthetic fracture (p=0.04) and tibial component loosening (p=0.01). Morbid obesity increased the risk of reoperation (HR 2.11, p=0.02) and trended toward increased risk of revision TKA (HR 2.29, p=0.059) and infection (HR 2.37, p=0.06).
Discussion: Patients with lymphedema are at significantly increased risk of revision, reoperation, and infection following primary TKA. This data highlights the need for appropriate patient counseling in this population and optimization of lymphedema management before and after TKA.
Results
Patients with a history of lymphedema were at a significantly increased risk of revision TKA (HR 7.60, P<0.001), reoperation for any cause (HR 2.87, P<0.001), and postoperative infection (HR 6.19, P<0.001). Patients with lymphedema were also at increased risk for periprosthetic fracture (p=0.04) and tibial component loosening (p=0.01). Morbid obesity increased the risk of reoperation (HR 2.11, p=0.02) and trended toward increased risk of revision TKA (HR 2.29, p=0.059) and infection (HR 2.37, p=0.06).
Discussion
Patients with lymphedema are at significantly increased risk of revision, reoperation, and infection following primary TKA. This data highlights the need for appropriate patient counseling in this population and optimization of lymphedema management before and after TKA.
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