Patients With Lymphedema are at Increased Risk of Complication After Total Knee Arthroplasty: A Population Level...

Lymphedema, a chronic disorder characterized by abnormal lymphatic fluid buildup, most commonly affects the lower extremities. Limited literature exists regarding the impact of lymphedema on outcomes following primary total knee arthroplasty (TKA). This study examined the effect of lymphedema's impact on complications and early revision-free survivorship following primary TKA using population-level data. We hypothesized that patients with preoperative lymphedema would have higher complication and revision rates.

Patients undergoing TKA for osteoarthritis between 2009 and 2020 were identified from a national claims database. Those with preoperative lymphedema were matched 1:1 to contemporaries without lymphedema using propensity score matching. Comparisons between matched and unmatched cohorts were performed using Chi-square and independent t-tests, while Cox proportional hazards models assessed revision risk.

Of the 530,938 TKA patients, 1.05% (n = 5602) had preoperative lymphedema. Matched analysis showed lymphedema had higher 90-day rates of periprosthetic joint infection (2.9% vs 1.4%, P < .001), superficial surgical site infection (2.3% vs 1.6%, P = .007), wound complications (2.4% vs 1.7%, P = .013), and pulmonary embolism (6.6% vs 4.6%, P < .001). At 2 years, lymphedema was associated with increased risk of all-cause (hazard ratio (HR) = 1.42, P < .001) and septic revisions (HR = 1.88, P < .001) but not aseptic revisions (HR = 0.99, P = .929).

Preoperative lymphedema is associated with increased 90-day rates of periprosthetic joint infection and superficial surgical site infection, wound complications, and pulmonary embolism after primary TKA. Although aseptic revision risk was not increased, the association with higher all-cause and septic revisions warrants attention. These findings emphasize the need for aggressive counseling and preoperative optimization before TKA in lymphedema patients.