Lymphoedema is an independent risk factor for complication after total hip arthroplasty

Introduction: Lymphoedema is a chronic disorder characterised by the abnormal buildup of lymphatic fluid, most commonly present in the lower extremities. A paucity of literature exists regarding the impact of lymphedema on outcomes following primary total hip arthroplasty (THA). Therefore, we sought to examine the rates of 90-day complications and 2-year revision free survivorship in patients with and without lymphoedema undergoing THA. Methods: Patients undergoing THA for osteoarthritis between 2009 and 2020 were identified from a national administrative claims database. Those with preoperative lymphoedema were then identified and propensity score matched (1:1) to contemporaries without lymphoedema. Exclusion criteria included bilateral THA, patients under 18, and those with less than 90-day follow-up. 90-day complication rates and 2-year revision free survivorship were then assessed with standard statistical methods. Results: 270,180 patients undergoing THA were identified, of which, 1957 (0.72%) had lymphoedema. Analysis of matched cohorts revealed that patients with lymphoedema had higher rates of 90-day deep vein thrombosis (6.6% vs. 3.2%, p < 0.001) and readmissions (10.0% vs. 8.2%, p = 0.016). At 2 years, lymphoedema was associated with an increased risk of septic revision (HR = 1.55, p = 0.020), but no increase in all-cause or aseptic revision rates. Conclusions: Preoperative lymphoedema is an independent risk factor for increased rates of 90-day deep vein thrombosis, and readmissions in patients undergoing primary THA. Importantly, the association with increased septic revision procedures is a cause for concern. Our results highlight the need for aggressive counselling and preoperative optimisation in patients with lymphoedema who are indicated for THA.