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.

中文翻译：

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全膝关节置换术后淋巴水肿和脂肪水肿的五年结果：令人鼓舞的功能和临床结果以及低感染率

背景

本研究的目的是确定由多学科团队管理的淋巴水肿和脂肪水肿患者全膝关节置换术 (TKA) 和每日加压包扎后的结果。

方法

一项回顾性研究在一个中心进行。2007 年至 2018 年期间，对 28 名诊断为淋巴水肿和脂肪水肿的连续患者进行了 36 次全膝关节置换术。在最后一次随访时获得了牛津膝关节评分 (OKS)、EuroQol-5D (EQ-5D) 评分、满意度评分、放射照片和并发症。患者在手术前两周被送入医院，并留在病房接受淋巴水肿专家小组的日常加压包扎。

结果

在研究期间，对平均年龄 71 岁（范围 54-90）的 28 名患者（5 名男性，23 名女性）进行了 36 次全膝关节置换术。其中，30 例 TKA 患者患有淋巴水肿，5 例患有脂肪水肿，1 例患有双重诊断。总体而言，最终随访时有 28 例 TKA（21 名患者）可用，平均随访时间为 61 个月（范围 9-138）。平均 BMI 为 38.5 kg/m ²。平均术前和术后牛津膝关节评分从 18（范围 2-38）增加到 29（范围 10-54）；p  < 0.001。EQ-5D 分数从 0.48（范围 0.15-0.80）增加到 0.74（0.34-1.00）（p < 0.001)。平均术后满意度为 7.6/10（范围 2–10），89.3% 的 TKA 患者满意。并发症有 1 例 (4%, 1/28) 深静脉血栓形成、1 例浅表伤口感染、1 例假体关节感染、1 例膝关节僵硬需要操作和 1 例术中股骨骨折。

结论

如果采用多学科方法，淋巴水肿和脂肪水肿不应被视为 TKA 的障碍。