Five-year results after total knee arthroplasty in lymphoedema and lipoedema: encouraging functional and clinical outcomes and low rates of infection

Abstract

Background The aim of this study was to define outcomes after total knee arthroplasty (TKA) in lymphoedema and lipoedema patients managed by a multidisciplinary team and daily compression bandaging. Methods A retrospective study was performed in a single centre. Between 2007 and 2018, 36 TKA procedures were performed on 28 consecutive patients with a diagnosis of lymphoedema and lipoedema. Oxford Knee Scores (OKS), EuroQol-5D (EQ-5D) scores, satisfaction scores, radiographs, and complications were obtained at the final follow-up. Patients were admitted to the hospital up to two weeks prior to surgery and remained on the ward for daily compression bandaging by the specialist lymphoedema team. Results Over the study period, 36 TKAs were performed on 28 patients (5 males, 23 females) with a mean age of 71 years (range 54–90). Of these, 30 TKAs were in patients with lymphoedema, five with lipoedema, and one with a dual diagnosis. Overall, 28 TKAs (21 patients) were available at the final follow-up with a mean follow-up time of 61 months (range 9–138). The mean BMI was 38.5 kg/m2. The mean pre-operative and post-operative Oxford Knee Score increased from 18 (range 2–38) to 29 (range 10–54); p < 0.001. EQ-5D score increased from 0.48 (range 0.15–0.80) to 0.74 (0.34–1.00) (p < 0.001). Mean post-operative satisfaction was 7.6/10 (range 2–10), with 89.3% TKAs satisfied. Complications were one (4%, 1/28) deep vein thrombosis, one superficial wound infection, one prosthetic joint infection, one stiff knee requiring manipulation, and one intra-operative femoral fracture. Conclusions Lymphoedema and lipoedema should not be seen as barriers to TKA if adopting a multidisciplinary approach.

Postoperative lymphedema after primary total hip arthroplasty: prospective analysis of bikini incision-type direct anterior approach versus established standard approaches

“…Evidence-based treatment options have not yet been adequately described. There is literature on taping [ 25 ], cryotherapy [ 26 ], daily compression bandaging [ 27 ], and lymphedema microsurgery [ 28 ] after artificial joint replacement. Overall further research is needed in this area.…”

Challenges and Solutions: Total Knee Replacement in Patients with Chronic Lymphatic Filariasis

“…Quadriceps weakness induced by edema contributes to slower walking, diminished knee strength, and reduced functional performance 9 . During the follow-up of the patient, any pain should be critically evaluated for aseptic loosening and periprosthetic implant infection and the peri-implant lucency > 2 mm 1 .…”

“…Grade III signifies non-pitting edema that is irreversible, accompanied by skin thickening. The most advanced stage, Grade IV, features non-pitting edema that remains irreversible, showcasing skin thickening and the presence of nodular or warty excrescences, indicative of the well-known stage of elephantiasis 1 .…”

“…Total knee arthroplasty (TKA) in patients with lymphedema has multifaceted challenges, including recurrent cellulitis, lymphangitis, and ulceration, amplifying the risks of superficial and deep wound infection 1 . Surgical interventions are further complicated by increased Body Mass Index and limb circumference, resulting in surgical times up to 23% longer compared with individuals with a normal Body Mass Index 2 .…”