Lymphedema Is a Significant Risk Factor for Failure After Primary Total Hip Arthroplasty

• Published in: Journal of bone and joint surgery. American volume 2022-01, Vol.104 (1), p.55-61
• Main Authors: Rainer, William G., Kolz, Joshua M., Wyles, Cody C., Houdek, Matthew T., Perry, Kevin I., Lewallen, David G.
• Format: Article
• Language: English
• Subjects: Aged; Arthroplasty, Replacement, Hip; Female; Humans; Lymphedema - etiology; Male; Postoperative Complications - etiology; Prosthesis Design; Prosthesis Failure; Registries; Reoperation; Risk Factors
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.20.01970

Lymphedema is a chronic disease characterized by fluid buildup and swelling that can lead to skin and soft-tissue fibrosis and recurring soft-tissue infections. Literature with regard to the increased risk of complications following a surgical procedure in patients with lymphedema is emerging, but the impact of lymphedema in the setting of primary total hip arthroplasty (THA) remains unknown. The purpose of this study was to review outcomes following primary THA performed in patients with lymphedema compared with a matched cohort without lymphedema. Using our institutional total joint registry and medical records, we identified 83 patients (57 were female and 26 were male) who underwent THA with ipsilateral lymphedema. For comparison, these patients were matched 1:6 (based on sex, age, date of the surgical procedure, and body mass index [BMI]) to a group of 498 patients without lymphedema who underwent primary THA for osteoarthritis. Subsequently, postoperative complications and implant survivorship were evaluated for each group. The mean follow-up for each group was 6 years. Survivorship was compared between cohorts using Kaplan-Meier methodology and included both survivorship free of infection and survivorship free of reoperation or revision. Univariate Cox regression analysis was utilized to assess the association between patient factors for the time to event outcomes noted above. In patients with a history of lymphedema, there was an increased risk of complications (hazard ratio [HR], 1.97; p < 0.01), including reoperation for any cause (HR, 3.16; p < 0.01) and postoperative infection (HR, 4.48; p < 0.01). The 5-year infection-free survival rate was 90.3% for patients with lymphedema compared with 97.7% for patients without lymphedema (p < 0.01). Patients with lymphedema are at increased risk for complications, including reoperation and infection, following primary THA. These data emphasize the importance of appropriate preoperative counseling in this population and should encourage efforts to identify methods to improve outcomes, including further investigation of the effects of preoperative optimization of lymphedema prior to THA and methods for improved perioperative management. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.