Independent TKA Failure Factor Uncovered in Mayo Study

A team of researchers from Mayo Clinic in Rochester, Minnesota, has found some intriguing new information about a significant infection risk factor in total knee arthroplasty (TKA). Their study, “Lymphedema: A Significant Risk Factor for Infection and Implant Failure After Total Knee Arthroplasty,” appears in the December 1, 2020 edition of the Journal of the American Academy of Orthopaedic Surgeons.

OTW asked co-author Matthew Houdek, M.D., about the lack of research regarding lymphedema as an infection risk factor and he said, “We think there is a lack of data in this area because it is often something that is overlooked. Lymphedema was frequently observed in patients who were obese or morbidly obese, and often studies only focused on the body mass index factor. There was previous data that we mention looking at repeat failure following revision TKA in the setting of lymphedema and this prompted our study.”

The researchers looked at 144 knees in patients who’d been treated with primary TKA and had a prior diagnosis of ipsilateral lymphedema. The average length of follow up was seven years. The research group designed a 1:2 match (blinded) of knees with lymphedema against a group of patients whose knees did not have lymphedema and who’d been treated with primary TKA. The researchers matched patients according to sex, age, date of surgery, and body mass index.

Body mass index irrelevant?

“The most interesting results of the current study was the highlight that regardless of body mass index lymphedema was an independent factor in failure of TKA, as such body mass index may not be the big factor in these patients leading to failure, but more importantly it is lymphedema.”

“We hope it may alter practice in trying to find ways to reduce the risk of complications in this patient population and to try to find ways to mitigate the lymphedema prior to surgery.”