Insall Award Paper: Primary TKA in Patients With Lymphedema

Lymphedema is a relatively common disorder; wound and vascular complications after orthopaedic surgery are assumed, but not previously shown, to be higher in this population. We reviewed the outcome and complications of knee arthroplasty in patients with lymphedema, documented by physical examination at their preoperative medical assessment. This was a retrospective analysis of prospectively collected data compiled on all patients having knee arthroplasty at our institution. Eighty-three knee replacements were implanted in 63 patients. Patients were followed up for a minimum of 2 years, with a mean followup of 58 months (range, 24–228 months). No patients were lost to followup. We noted significant improvement in the Knee Society score from a preoperative mean of 47 points (range, 16–75 points) to a postoperative mean of 87 points (range, 53–100 points). The knee functional score also improved significantly from a preoperative mean of 36 points (range, 0–80 points), to a postoperative mean of 59 points (range, 0–100 points). The total complication rate was 31%, with 10 superficial wound infections (12%), six deep infections (7%), and three deep venous thromboses (3.6%). We concluded that although knee arthroplasty can be successful in reducing pain and improving function in patients with lymphedema, the complication rate is greater than that seen in patients without this diagnosis.