Total Joint Arthroplasty in Patients With Lymphedema as Compared to a Propensity-Matched Control Cohort.

Background: Lymphedema is rare in arthroplasty patients but has been associated with a higher complication rate. This study sought to determine the outcomes of total joint arthroplasty in patients with lymphedema as compared to a matched control cohort.

Methods: Treatment-control propensity matching was implemented on 335 patients following total knee or hip arthroplasty generating 5-patient sets of one patient with presurgery lymphedema (67 total) to 4 patients without presurgery lymphedema (268 total) and matched on age, sex, and surgery year. Body mass index and presence of diabetes were controlled using multivariable generalized estimating equations.

Results: In the lymphedema cohort, 1 patient (1.5%) had a deep vein thrombosis within 90 days of their surgery, 36 (53.7%) were discharged to a rehabilitation center, 16 (23.9%) had a readmission, 14 (20.9%) were admitted to the emergency room within 90 days, 6 (9.0%) experienced infection, and 6 (9.0%) had a revision/reoperation. Lymphedema significantly increased emergency room admission within 90 days (odds ratio [OR] 4.56,  = .01) and non-home discharge (OR 4.14, < .01), affected readmission within 90 days (OR 2.21,  = .09), revision/reoperation (OR 2.82,  = .09), and no effect on deep vein thrombosis within 90 days (OR 0.57,  = .45), postsurgical infection (OR 1.47,  = .45), length of stay (OR 0.00,  = .99), operative time (OR 0.04,  = .38), or estimated blood loss (OR 0.09,  = .47), after adjusting for various factors.

Conclusions: Preoperative lymphedema is a significant risk factor for patients who are undergoing total joint arthroplasty. Preoperative and postoperative modalities should be utilized to help control lymphedema and mitigate these increased risks.