Developing lymphoedema after orthopaedic surgery is not a common side effect, but, in some cases, it does occur and can have a significant emotional impact on recovery and general wellbeing. Patients report that the emotional impact of developing lymphoedema after orthopaedic surgery (or any type of surgery) is profound. Most of them start dealing with mental health challenges such as anxiety, depression, body image issues, social isolation, and feelings of frustration or helplessness, while recovering from the previous surgery and  looking for answers and treatments for  this new-secondary condition. However, with the right and early diagnosis, treatments and support, patients can maintain a positive outlook and improve their quality of life, continue recovering from surgery while managing lymphoedema physical and emotional symptoms. Let´s have a closer look…

Is lymphoedema common after orthopaedic surgery?

 It’s not as common as swelling from normal post-surgical inflammation (which almost all patients experience). However, persistent secondary lymphoedema can develop if lymphatic vessels or nodes are damaged, blocked, or overwhelmed during surgery or due to scar tissue formation.

What are risk factors for developing lymphoedema after orthopaedic surgery?

Most common causes are:

• Joint replacement (hip, knee, shoulder because they might affect/remove part of the nearest lymphatic system-vessels or nodes- overwhelming limb’s lymphatic system).
• Trauma surgery with extensive soft tissue involvement.
• Previous history of venous disease, obesity, or pre-existing lymphatic insufficiency.
• Infection, fibrosis, or immobility after surgery

Studies suggest that chronic lymphoedema occurs in a minority of patients (estimates vary from 5–20% depending on type of surgery and comorbidities (previous/coexistent conditions).

How do I know swelling turned into lymphoedema?

• Normal swelling: Post-operative oedema usually improves within 2–3 weeks.
• Subacute swelling: In some cases, swelling can persist for 2–3 months, especially after joint replacement.
• Secondary lymphoedema: If lymphatic pathways are damaged, swelling may become chronic and progressive without proper management. For that reason early diagnosis and treatment plan are pivotal for the condition prognosis.

If swelling after surgery lasts more than expected, you feel pain, tenderness or any other symptoms,  ask your surgeon, GP or a lymphoedema therapist. Early diagnosis and treatment (manual lymphatic drainage, compression therapy, exercise, skin care) greatly improve prognosis and may prevent permanent changes.

Emotional impact of developing lymphoedema after orthopaedic surgery

Lymphoedema after orthopaedic surgery doesn’t only affect only the body, but also the emotional well-being of patients, they feel:

• Frustration and disappointment because expected recovery is delayed by persistent swelling and now they have to worry about a new condition.
  
• Anxiety about whether the surgery was successful and what will happen with their affected limb.
  
• Loss of independence. If swelling impairs mobility, daily tasks, or return to work makes them dependent on other people to do these tasks.
  
• Body image concerns due to visible swelling, asymmetry, skin changes and lack of empathy- comments from other people about their appearance or condition.
  
• Depression can develop in cases where pain, reduced function, self-image, social rejection or lack of support produce high Emotional and Mental Health Challenges of patients. 
• Misdiagnosis and lack of awareness among healthcare providers can delay proper care and heighten stress on patients.
• Social stigma and misunderstanding of lymphoedema exacerbate feelings of isolation and emotional pain.

Emotional impact of developing lymphoedema after orthopaedic: what you can do to improve your general wellbeing

1.Seek support groups and create your network. Connecting with peers and sharing experiences (might be similar) can reduce feelings of isolation. There are support groups, both virtual and in-person, that offer safe environments to share challenges and coping strategies. Such communities boost emotional and general well-being and provide practical advice.

2.Professional advice. Visit your psychologist or psychiatrist, professional. Therapies like: cognitive-behavioral therapy (CBT), Acceptance and Commitment Therapy (ACT), and mindfulness-based stress reduction (MBSR) have shown to effectively decrease anxiety and depression in lymphoedema patients. These therapies enhance psychological flexibility, emotional comfort, and adherence to self-care practices like compression therapy and exercise.

3.Exercise. Gentle exercises (link) tailored for lymphoedema management improves lymphatic flow and also supports mental health by reducing stress and enhancing mood (you release endorphins). You can start with walks in nature, swimming or lymphoedema focused exercises recommended by your lymphoedema therapist (if you don’t have one yet, choose the specialist who treats you better).

4.Relaxation techniques. Practice meditation, yoga, or mindfulness techniques such as: art therapy, music therapy, etc., can alleviate emotional discomfort, foster self-expression, and improve self-esteem. They provide enjoyable distractions and promote relaxation, which are crucial in coping with chronic conditions.

5.Positive affirmations. Building a positive self-image through mindful practices and reframing perceptions of your body and condition can mitigate social anxiety and enhance confidence. 

6.Spending time with those who care about you. Empathy and understanding from family, friends, and healthcare providers play an important role in nurturing your own acceptance. Don´t waste your time with people who criticize, laugh or have no empathy about your condition.

7.Eat well to feel well. What you eat matters, nutritious food helps you manage lymphoedema while improving your mood and general wellbeing.

A final word

Developing lymphoedema after orthopaedic surgery is uncommon, but possible, especially after major joint or trauma procedures. Early diagnosis is pivotal for proper treatment and emotional support. If you are dealing with the emotional impact of  lymphoedema diagnosis, don´t be afraid to seek help, we can help you. We know the emotional impact of lymphoedema might come with many physical and psychological challenges, but we are here for you.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

References:

https://pereaclinic.com/emotional-impact-of-lymphedema-coping-with-psychological-effects/

https://www.nature.com/articles/s41598-024-63145-1

https://pmc.ncbi.nlm.nih.gov/articles/PMC4153404/

https://www.lymphapress.com/blog/maintaining-body-positivity-while-living-with-lymphedema/

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Orthopaedic surgery can place significant stress, damage or even remove part of your lymphatic system. Your immune system plays a vital role in maintaining fluid balance and immune defense. However, after orthopaedic or any type of surgery, especially procedures involving lymph node removal or disruption, the lymphatic network may become compromised, leading to fluid accumulation and persistent swelling known as lymphoedema. Among other strategies, proper nutrition is a crucial to reduce lymphoedema risk, yet often overlooked; it is also a key element of post-surgical care that supports lymphatic health, improves and speeds up healing, and reduces the risk of developing other secondary conditions. Let’s see how…

Inflammation is a natural response to surgery, it means you are in a recovery process, but excessive or prolonged inflammation can worsen lymphatic congestion, edema and turn into lymphoedema (also caused by damage in your lymphatic system). After surgery, your  lymphatic system can be more vulnerable to fluid retention leading to lymphoedema. Eating properly to reduce systemic inflammation and oxidative stress is key to avoiding chronic inflammation. Polyphenols, natural antioxidants found in colorful fruits and vegetables, specifically target inflammation and support healthy lymphatic vessel function. Weight management through a balanced, calorie-controlled diet also improves lymphoedema symptoms and reduces limb swelling by lowering pressure on lymphatic ducts. Next a list of some foods you can introduce to your daily diet:

Post-orthopaedic surgery Nutrition:What to Eat to Reduce Lymphoedema Risk

1. Eat Foods to Promote Circulation and Reduce Inflammation

Focus on whole, unprocessed foods that contain anti-inflammatory nutrients, antioxidants, and healthy fats, for example:

• Leafy greens

 Detoxify the body, are full of antioxidants and provide magnesium for circulation and muscle relaxation, allowing lymphatic and vascular flow. Some that you can include are:

      Common Leafy Greens

Spinach, kale, lettuce (romaine, butterhead, iceberg, leaf, etc.), Dandelion,  Swiss chard, collard greens, mustard greens, arugula (rocket), cabbage (green, red, savoy, napa), etc.

 Herbs often used as greens (have same properties)

Parsley, cilantro (coriander leaves), basil, dill, mint.

• Berries

They contain antioxidants and flavonoids that reduce oxidative stress and inflammation that can block lymph flow. Some of them are: raspberry, blueberry, blackberry, cranberry, gooseberry, etc.

• Citrus fruits

Such as oranges, lemons, and grapefruits are rich in vitamin C, which supports immune and lymph vessel function.

• Healthy fats

 Most known and easy to find in stores are: avocados, nuts, seeds, and fatty fish (such as salmon). All of them provide omega-3 fatty acids that decrease chronic inflammation and promote vascular health. Disclaimer: Consume with moderation, healthy, doesn´t mean: eat all you can.

• Lean proteins

Lean proteins like fish, poultry (chicken, turkey, quail, etc.), lean meats (beef, pork) and legumes support tissue repair (especially after surgery), immune cell production, and promote lymphatic health.

• Anti-inflammatory spices

Reduce cellular inflammation and support circulation. Most used in kitchen are:

Turmeric (curcumin is the active compound, activate it with black pepper,  ginger, cinnamon, cloves, cardamom, star anise, chili peppers (capsaicin), cayenne pepper, paprika, garlic, black pepper ( remember piperine enhances curcumin absorption), fennel seeds, mustard seeds, coriander seeds, cumin, etc.

• High in water vegetables and fruits

Help detoxification and fluid balance due to their high water and low fructose and sodium content, like: cucumber, celery and watermelon.

2.Hydrate to flow well

Lymph fluid is primarily water, so maintaining adequate hydration is crucial to keep the lymphatic system moving and prevent fluid stagnation. Aim for 8–10 glasses of water daily, adjusting for activity level and climate.

3.Limit sodium and processed foods to avoid fluid retention

High sodium intake causes water retention, increasing swelling and lymphatic overburden. Avoid processed and fast foods because they tend to be high in salt and additives that exacerbate inflammation and fluid retention.

4.Probiotics and fiber for digestive and immune health

Probiotics (found in yogurt, kefir, fermented food, etc.) and prebiotics: Fiber-rich foods such as whole grains, fruits, and vegetables aid digestion and promote a healthy gut microbiome. The gut microbiota reduce systemic inflammation and regulate mental and immune function while, indirectly, benefiting the lymphatic system’s function.

In short

Post-surgical lymphatic nutrition is a cornerstone of lymphoedema prevention and recovery after orthopaedic surgery. A diet focused on reducing inflammation, supporting immune function, maintaining hydration, and providing necessary nutrients optimises lymphatic healing and reduces swelling risk. Combined with MLD, physical therapy, compression (if needed), and medical follow-up, proper nutrition gives you the power to support your lymphatic and general wellbeing after orthopaedic or any type of surgery.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

References:

https://pereaclinic.com/nutrition-and-lymphedema-foods-that-support-a-healthy-lymphatic-system/

https://pubmed.ncbi.nlm.nih.gov/36252267/

https://www.pagepressjournals.org/index.php/vl/article/view/8220

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After orthopaedic surgery (or any type of surgery), swelling in the area or nearby tissues is completely normal. The problem comes when swelling persists over time or becomes chronic: Lymphoedema. Understanding the key differences between normal post-op swelling and lymphoedema is crucial for prevention, timely management and treatment. In this blog, we show you how to know the difference and when to seek medical advice. Let´s have a closer look…

What is pos-orthopaedic (post-op) swelling?

Post-op swelling is a natural inflammatory response to surgery. It covers the treated area and near tissues. This swelling is caused by your immune system in order to help the tissue heal properly. How to recognise it:

• Develops immediately or within a few days after surgery.
• Is temporary, generally improving within weeks or a few months (according to the surgery) as tissues heal.
• May feel soft, a little bit tight and can fluctuate in intensity.
• It is located near the scar.

What is post-orthopaedic lymphoedema?

Lymphoedema develops when swelling is caused by blockage or damage in the lymphatic system during surgery (trauma or removal in lymphatic vessels or nodes). As a result, lymph and other fluids can not move and drain out of the area, so swelling turns into a chronic condition that needs immediate treatment to relieve symptoms and avoid progression. How to recognise it: 

• Persistent swelling: it lasts more than three months or might develop gradually over time.
• May have a feeling of heaviness, tightness, pain or fullness in the treated area and spreads to the major part or the entire limb.
• Initially, you might feel a tight sensation on the skin, but can harden as the condition progresses.
• Unlike normal swelling, lymphoedema is chronic and can worsen without treatment.

Post-orthopaedic Swelling vs. Lymphoedema: key differences

These are the most common differences between common swelling and lymphoedema (when it is not prevented with MLD)

When to seek help

It’s important to consult a healthcare provider (surgeon, GP, certified lymphoedema therapist, swelling treatment  specialist) if swelling:

• Persists beyond 3 months after surgery or worsens instead of improving.
• Is accompanied by a sensation of heaviness, tightness, or persistent discomfort in the limb.
• Affects mobility or daily activities.
• Shows skin changes such as thickening, redness, easy bruising or even infections.
• Develops suddenly or is very pronounced without obvious cause, causing pain, discomfort and joint mobility issues.

Prevention through MLD eases swelling and enhances the healing process. Also, early diagnosis allows proper assessment and management by a certified  lymphoedema specialist through physical examination, limb measurements, and sometimes imaging (prescribed by a health care provider). Lymphoedema treatment can include compression therapy, Manual Lymphatic Drainage, exercise, diet, skin care, and lifestyle changes.

A final word

While normal post-orthopaedic swelling is part of the healing process and resolves over time, lymphoedema is a chronic condition caused by lymphatic damage that requires ongoing management. Recognising persistent or unusual swelling, especially beyond three months, and consulting a healthcare provider early can avoid condition progression and ensure better outcomes and quality of life.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

 References:

https://www.ncbi.nlm.nih.gov/books/NBK537239/

https://www.lymphapress.com/blog/lymphedema-vs-edema-whats-the-difference/

https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/introduction-lymphoedema-service-face-face-consultation

https://www.facs.org/for-patients/the-day-of-your-surgery/breast-cancer-surgery/after-your-operation/preventing-swelling/

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In this blog, we explore the benefits of Manual Lymphatic Drainage MLD after orthopaedic surgery. Let´s have a closer look…

What is orthopaedic surgery?

It’s a specialised surgery that focuses on treating and repairing musculoskeletal conditions that involve bones, joints, ligaments, tendons, muscles, and in some cases peripheral nerves, for example:

• Joint replacements (hip, knee, shoulder)
• Arthroscopy (minimally invasive joint repair)
• Fracture fixation 
• Corrective surgeries (for deformities)

What are the most common causes of orthopaedic surgeries?

Orthopaedic surgery is usually indicated when conservative treatments (medications, physiotherapy, injections) fail or due to severe trauma that need surgery. Some common causes are:

1. Trauma/accidents/fails
   Fractures, dislocations, ligament/tendon tears.
2. Degenerative Diseases
   Osteoarthritis, rheumatoid arthritis, degenerative disc disease.
3. Genetic conditions or overtime developed deformities
   Hip dysplasia, scoliosis, limb deformities.
4. Sports Injuries
   Meniscus tears, ligament ruptures, rotator cuff injuries.
5. Overuse
   Tendinitis, bursitis, repetitive strain injuries.
6. Bone and Joint Infections or tumors
   Osteomyelitis, benign or malignant bone tumors.

What causes post-orthopaedic lymphoedema?

Lymphoedema after orthopaedic surgery is produced by damage in the lymphatic system (nodes, vessels) nearest to the treated area, causing obstruction (fluid has no way to drain out) as a result there is painful build up of fluid.

What is Lymphatic drainage massage

Lymphatic drainage massage is a gentle, specialised massage technique designed to stimulate the proper function of your lymphatic system (lymph circulation, drainage and expel), promoting the removal of excess fluids and waste from the body. It has gained recognition for its potential benefits in managing post-orthopaedic lymphoedema which is swelling caused by lymphatic fluid buildup after surgery.

What are the benefits of MLD after orthopaedic surgery and related lymphoedema?

MLD is a extremely light treatment although it may feels uncomfortable during the first week or not (according to the type surgery) after the procedure as the area might be very sensitive to touch. It is based on scientific knowledge of the anatomy and physiology of the Lymphatic System. MLD is prescribed as a post-op treatment all over the world because it helps to:

• Treat lymphoedema.
• Reduce swelling, bruising and water retention.
• Avoid or treat seromas and fibrosis (hard lumps).
• Reduce stress and anxiety after surgery.
• Speed up the recovery process.
• Reduce pain.
• Stimulates kidney functions (improving waste flush).
• It’s useful for the treatment of blood circulation problems (venous insufficiency after surgery).
• Reduce or treat  lymphatic problems.
• Stimulates the immune system, increasing the body’s own defenses.
• Helps to protect your body against bacteria and viruses as it works in conjunction with the immune system.
• It has a calming effect on the autonomic nervous system.
• Its direct effect on the parasympathetic system generates a relaxing effect.
• Tones the intestine, which helps fight constipation.
• Regulates the body’s water balance.
• Lowers blood pressure.
• And the list continues, know more benefits click here (link benefits of MLD after surgery)

Findings 

Scientific studies show that Manual Lymphatic Drainage (MLD) may help reduce the incidence and severity of lymphoedema in different types of surgeries like orthopaedic surgeries, but studies have focused on those related to cancer where lymphoedema is more common. However, what can be seen in all lymphoedema patients is that the effectiveness can vary depending on the severity of lymphoedema and whether it is combined with other treatments like complex decongestive therapy (if prescribed). Many patients in and out of the records report significant limb volume reduction, symptom relief and better quality of life. On the other hand, it is clear that to see these and more benefits it is necessary to individualise each treatment plan and further research.

Who performs lymphatic drainage for lymphoedema?

To maximise the benefits and safety of manual lymphatic drainage massage, it is important to work with a certified  lymphoedema therapist who has specialised in the different manual lymphatic drainage techniques. A professional therapist understands you as patient and person, the anatomy and physiology of the lymphatic system; she/he can tailor the treatment to your needs and treats you better. Many licensed therapists are affiliated with recognised organizations, and it is advisable to check credentials and seek referrals or reviews before booking sessions.

Benefits of MLD after orthopaedic surgery and related lymphoedema: A final word

• Lymphoedema after orthopaedic surgery is a common side effect when the lymphatic system is affected by trauma during the procedure.
• MLD has many benefits before and after orthopaedic surgery (and others), and it also is useful to treat and alleviate other conditions.
• For best results book with a certified lymphoedema therapist who treats you better.
• There is scientific evidence of the pivotal role of MLD in treating lymphoedema, but further research in different fields and types of surgeries is needed.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

References:

https://pubmed.ncbi.nlm.nih.gov/32803533/

https://pubmed.ncbi.nlm.nih.gov/38300246/

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Persistent swelling and mobility issues after orthopaedic surgery?  It might be lymphoedema. This swelling condition requires a holistic treatment plan. In our previous blogs, we have talked about the different techniques and tips that help you in managing post-orthopaedic lymphoedema, and today, we´ll  give you some of the most effective exercises for starting to manage this condition. These exercises are focused on promoting lymph flow, reducing swelling, and improving mobility, strength and flexibility. Most of them involve gentle, low-impact movements. Here are some of them:

Be ready for your exercise session 

• Wear your compression garments or bandages if prescribed by your surgeon or physiotherapist. These reduce fluid build-up and enhance lymphatic return.
• Warm up by mobilising your joints. Gently and slowly extend and contract  each joint.
• The non-affected limbs and body parts (neck, shoulders, elbows, wrists, hips, knees, ankles, toes) should be mobilised too.

Deep breathing exercises

Deep breathing exercises (diaphragmatic) improve lymphatic flow through the body while improving your general well being. It works by changing the pressure in your abdomen and chest (by the diaphragmatic movement up and down). This encourages lymphatic flow and blood circulation. It is also highly relaxing. You can do these breathing exercises in any position and place. 

• Sit, lay or stand comfortably.
• Relax your shoulders, chest and tummy.
• Place one hand below your ribs and the other on your abdomen.
• Close your mouth.
• Take a slow, deep  breath through your nose, what you should feel is that your abdomen rises.
• Hold for a short period of time.
• Exhale slowly through pursed lips.

Note: while exercising, try to do deep breathing, it will improve your performance and reduce fatigue.

Upper Limb (arm) lymphoedema exercises 

• Move your shoulders up and down.
• Lift your arms gently and slowly (like trying to reach your ears), then, bring them back to normal position.
• Scratch your shoulders: try to make your hands reach each other behind your back.
• Bend and extend your elbows (gentle and slow movements)
• Arm circles. Raise slowly your arms to the sides, making small forward and then backward circles (it enhances lymphatic and blood circulation while strengthening them).
• Regular joint movement facilitates lymph propulsion and prevents stiffness.
• All movements should be slow and gentle. Do them 8/10 times and repeat 2/3 times.

After a couple of weeks, and monitored by your therapist, you can start with:

• Light resistance training. Using elastic bandages to do your exercises, gives resistance to the movement, strengthening your muscle without risks; in addition muscle pumps improve lymphatic flow.
• Light weights (start with 0,5-pound dumbbells), you can  perform controlled arm lifts, bicep curls, and shoulder raises to build muscle without overloading the limb. 
• All exercises should be prescribed and supervised by your lymphoedema therapist, she will monitor your progression and add weight to your lifts if needed.

Lower limb (leg) lymphoedema exercises

• Ankle pumps. Point your toes downward, then flex them upward to stimulate lymph flow in the lower leg.
• Heel-to-toe raises. Raising your heels off the ground, gently, slowly and assisted if needed; then, go back to normal position.  It helps to engage calf muscles for lymph and blood circulation (muscle contraction pumps fluids).
• Calf stretches. Stretch against a wall to release tension and support lymphatic function.
• Knee-to-chest stretch (if knee can be bent). It mobilises hip and knee, promoting lymphatic drainage.
• Leg lifts. Lye on your back and slowly lift each leg to strengthen thigh muscles and improve circulation.
• Seated marching. Alternating knee lifts while seated to improve circulation with minimal strain.
• Step-ups. Step onto a low platform to engage muscles and improve mobility.
• Butterfly stretches. Sit on a flat surface with soles of feet together to stretch inner thighs, then start doing up and downward repetitive movements (like wings of a butterfly). These movements improve pelvic lymphatic drainage.
• Squats
• 2/3 sets of 8/10 rep, 2/3 times per week.

General ideas for low impact aerobic exercises to start with

Low impact exercises 

Low-impact aerobic exercise supports overall lymph flow and well being, you can start with walking, swimming, cycling, dancing, etc. Do it gradually and enjoy it!

Isometric exercises

Muscle pumping aids lymphatic return and muscle strength. Muscular contractions without joint movement, for example:

• Pressing the hand against a wall ( upper limb) 
• Squeezing a pillow between the knees ( lower limb).
• Hold for 5–10 seconds, repeat 5 times.
• Exercise should be done gradually, avoiding fatigue or overuse of the affected limb.

General recommendations

• Regular joint movement facilitates lymph propulsion and prevents stiffness.
• Compression garments are often worn during exercise to aid lymphatic flow (if prescribed by your surgeon and lymphedema therapist).
• It is essential to work with a lymphedema specialist or physical therapist to tailor exercises safely. They’ll advise you on the number of sets, repetitions and type of exercises you are able to do on each step of your recovery process.
• Regular gentle movement combined with breathing exercises helps promote effective lymphatic drainage.
• Exercise should be done gradually, avoiding fatigue or overuse of the affected limb.

A final word…

All these exercises improve lymphatic flow by activating muscle pumps and enhancing joint mobility while minimising the risk of exacerbating swelling or discomfort. They should be part of a comprehensive physical therapy program to manage post-surgical orthopaedic lymphoedema effectively.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

References:

https://www.cancerresearchuk.org/about-cancer/coping/physically/lymphoedema-and-cancer/treating/exercise

https://pereaclinic.com/the-role-of-compression-therapy-in-managing-post-orthopaedic-lymphoedema/

https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.31962

https://pmc.ncbi.nlm.nih.gov/articles/PMC3001918/

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Lymphoedema is a long-term condition where lymph fluid builds up in the arms, legs or other parts of the body. This causes swelling, heaviness, discomfort, and sometimes infections. While compression garments, lymphatic massage, and exercise can help in the early stages, advanced lymphoedema often requires surgery. Thanks to recent developments, surgical options are now more effective than ever, offering better outcomes and improved quality of life for patients.

Surgical options for lymphoedema

Lymphaticovenous Anastomosis (LVA)

What it is: LVA is a microsurgical procedure where tiny lymphatic vessels are connected directly to nearby veins. This creates a new route for lymph fluid to drain naturally.

Benefits:

• Minimally invasive with very low complication rates.
• Can reduce swelling and lower the risk of infections.

Limitations:

• Works best in early-stage lymphoedema when lymphatic vessels are still healthy.
• Less effective if the swelling has become firm or fatty.

Vascularised Lymph Node Transfer (VLNT)

What it is: VLNT involves moving healthy lymph nodes from one part of the body, such as the groin or abdomen, to the swollen area to help restore proper lymphatic drainage.

Benefits:

• Effective for more advanced lymphoedema.
• Can reduce infections and improve limb size and comfort.
  

Limitations:

• A longer operation with a moderate risk of complications.
• Small chance of swelling at the site where the nodes are taken.

Liposuction (Suction-Assisted Lipectomy – SAL)

What it is: Liposuction removes excess fatty tissue from limbs where swelling has become fat-dominant rather than fluid-based.

Benefits:

• Very effective for long-standing, firm swelling.
  
• Improves appearance, comfort, and mobility.
  

Limitations:

• Does not repair the lymphatic system itself.
  
• Lifelong use of compression garments is necessary to maintain results.
  

Excisional Procedures (e.g., Charles Procedure)

What it is: In severe cases, surgeons remove thickened skin and tissue to reduce limb size and improve function.

Benefits:

• Can save limbs when other treatments are not possible.

Limitations:

• Higher risk of complications and scarring.
  
• Usually considered only as a last resort.

Future Directions in Lymphoedema Surgery

Advanced Imaging Techniques

New imaging methods, such as near-infrared fluorescence and indocyanine green (ICG) lymphography, allow surgeons to see which lymphatic vessels are working. This helps plan surgeries more precisely, improving the success of procedures like LVA and VLNT.

Wearable Compression Devices

Innovative wearable devices provide gentle, dynamic compression and massage to help move lymph fluid. They can be used alongside traditional compression garments to reduce swelling and support long-term results.

Emerging Innovations in Lymphoedema Surgery

Researchers are exploring new techniques, including robotic-assisted microsurgery, to improve precision in lymphoedema treatment. Early results from specialised centres are promising, but these methods are experimental, not widely available, and long-term outcomes are still being studied.

A final word

Surgery for lymphoedema is not a cure, but it can greatly improve comfort, mobility, and quality of life when other treatments are insufficient. The best surgical option depends on the stage of the condition and whether the swelling is mainly fluid or fatty. Choosing an experienced surgical centre is essential for personalised care and long-term success.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

References:

•  https://pubmed.ncbi.nlm.nih.gov/39806245/
  
•  Lymphovenous Anastomosis https://www.sciencedirect.com/topics/medicine-and-dentistry/lymphovenous-anastomosis
  
• Lymphoedema: https://www.nhs.uk/conditions/lymphoedema/ 

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Lymphoedema is a chronic condition that causes swelling in the arms or legs due to a build-up of lymph fluid. Its main causes are: cancer treatment, surgery, infection, or it may be present from birth. In the early stages, the swelling is mainly fluid, which can often be managed with conservative treatments like compression garments, decongestive therapy  exercise, and manual lymphatic drainage. However, in more advanced stages, the swelling becomes firm, fibrotic, and fat-dominant, making it resistant to these approaches. This is where liposuction may play an important role. Let´s see how…

What is liposuction for lymphoedema?

Liposuction is a surgical procedure that removes excess fat tissue that has built up in the swollen limb. Unlike cosmetic liposuction, which is often done for body contouring, this surgery is medical in nature. Its main purpose is to restore the affected arm or leg to a more normal size and shape, reduce the risk of complications, and improve quality of life.

It is important to understand that liposuction for lymphoedema does not cure the underlying condition. The lymphatic damage remains, which means lifelong management with compression therapy is essential after surgery to maintain the results.

When is liposuction recommended?

Liposuction is not suitable for everyone with lymphoedema. It is usually recommended in very specific situations:

1. Late-stage lymphoedema. The swelling is no longer soft and pitting but firm and fibrotic. This means that the fluid element has largely been replaced by excess fat tissue.
2. Failure of conservative treatment . If complex decongestive therapy (CDT), manual lymphatic drainage, and compression have been tried but are no longer effective, surgery may be considered.
3. Fat-dominant swelling. Clinical examination or imaging confirms that most of the limb swelling is due to fat build-up rather than fluid.
4. Good patient compliance . After surgery, patients must wear compression garments every day for life. Liposuction is only recommended for those who are able and willing to commit to this.
5. Stable medical condition. Patients must be fit for surgery and free from uncontrolled health problems or infections.

When is liposuction not recommended?

• Early-stage lymphoedema: If the swelling is still mainly fluid and responds to conservative treatment, liposuction is not necessary.
• Poor compliance: Patients who are unable to wear compression garments after surgery should not undergo liposuction, as the swelling will quickly return.
• Other medical risks: Severe health conditions that make surgery unsafe can rule out the option.

Results and long-term outcomes

Several studies showed excellent results from liposuction for lymphoedema in both arms and legs. A recent five-year prospective study of 67 patients with leg lymphoedema found that all patients achieved complete reduction of swelling with no recurrence when lifelong compression was maintained. By the first year, limb volume was fully normal, and by five years, results were even slightly better. Follow ups didn´t report major complications, showing that liposuction is both safe and effective when carried out in specialist centers.

Patients who undergo this surgery often report improvements in mobility, appearance, comfort, and self-confidence. However, you should remember that compression garments remain a lifelong commitment.

A final word…

Liposuction is not a first-line treatment for lymphoedema. Specialist prefer suggest it to those with late-stage, fat-dominant swelling that no longer responds to conservative methods. For the right patient, it can be life-changing, restoring the limb to a normal size and preventing further complications. The key to success is careful patient selection, specialist surgical care, and strict adherence to lifelong compression therapy.

If you are struggling with lymphoedema in your arm or leg, speak to a specialist to find out whether liposuction could be an option for you. Early referral to a lymphoedema clinic can ensure you receive the right treatment at the right time.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

Refrences:

Brorson H, et al. Complete Reduction of Leg Lymphoedema after Liposuction: A 5-Year Prospective Study in 67 Patients without Recurrence. Plastic and Reconstructive Surgery Global Open. 2023.

National Health Service (NHS) – Lymphoedema Overview

Cancer Research UK – Lymphoedema after Cancer Treatment

Lymphoedema Support Network – Patient Information and Support

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Recovering from orthopaedic surgery is not an easy task, whether it’s a hip or  knee replacement, or even a  fracture repair; it takes effort, time and a tailored-guided treatment plan. While the aim is to restore mobility and quality of life, the journey is not always straightforward. One of the most common complications patients encounter is lymphoedema which is a build-up of fluid that causes swelling, pain, heaviness, and stiffness in the operated limb.

If you are worried because after several weeks after surgery, you continue feeling uncomfortable,  pain, swelling and tenderness in the affected limb. You’re not alone! Many patients experience this, and while it can feel frustrating, the good news is that lymphoedema is manageable. Today, we will talk about two therapies in particular, Manual Lymphatic Drainage (MLD) and physiotherapy, that can make wonders when used together. Let´s have a closer look…

Why does lymphoedema occur after orthopaedic surgery?

It’s normal to have some swelling after an operation, but in certain cases your lymphatic system struggles to cope. Surgery can damage small lymph vessels or nodes and inflammation can slow drainage (there are no paths where fluid can circulate and be drained out, so it gets stocked), reducing range of movement and causing pain and discomfort. If left untreated, this can slow down your rehabilitation and make it harder to get back to everyday activities.

The gentle power of lymphatic drainage

Manual Lymphatic Drainage (MLD) is a gentle form of massage designed to encourage the flow of lymph fluid. Using light, rhythmical strokes, the therapist helps guide fluid towards healthier lymph nodes where it can drain more effectively.

Patients often describe MLD as calming and soothing. Many notice their limb feels lighter and less stiff after just a few sessions. Its benefits include:

• Reducing post-surgical swelling.
• Reducing pain.
• Relieving pressure and discomfort.
• Supporting the healing process.
• Reducing the risk of infection, such as cellulitis.
• Improving range of motion.
• Boosting your immune system.
• Speeding up the recovery process.
• Reducing stress and anxiety.
• Improving your general well being.

By easing the swelling, MLD paves the way for physiotherapy to be more effective. Remember that MLD should be performed by a professional lymphatic drainage therapist certified in lymphoedema management, Seek the one who treats you better!

Physiotherapy: regaining movement and confidence

While MLD addresses fluid build-up, physiotherapy focuses on mobility , strength, and independence. After orthopaedic surgery, it’s natural to feel nervous about moving your operated limb. A physiotherapist will guide you at your own pace, ensuring you regain function safely and confidently.

Physiotherapy helps by:

• Encouraging circulation and lymph flow through safe exercise.
• Restoring flexibility and joint movement.
• Rebuilding muscle strength to support recovery.
• Teaching strategies to protect the operated area.
• Supporting your return to daily activities and routines.

Without physiotherapy, swelling can make it harder to move, and reduced movement can make swelling worse. This is why combining therapies is so effective. Keep in mind that it should be performed by a certified lymphoedema therapist.

Why the combination works best

On their own, both therapies are highly beneficial. But together, they complement each other beautifully:

• MLD reduces swelling, making it easier and more comfortable to move.
• Physiotherapy restores strength and mobility, preventing fluid from building up again.
• Together, they break the cycle of swelling plus stiffness, resulting in more swelling.
• The combined approach speeds up healing and lowers the risk of complications.

Many patients report that this integrated approach not only eases their symptoms but also gives them confidence and reassurance throughout their recovery journey.

Supporting your recovery at home

In addition to professional treatment, small changes at home can make a big difference:

• Wearing compression garments as advised.
• Elevating the operated limb when resting.
• Staying gently active with short walks or light movement.
• Practising good skin care to avoid infection.
• Listening to your body and pacing yourself.

Recovery is a process, and consistency is key. Even small steps each day will move you forward.

Lymphatic Drainage and Physiotherapy: A final word

Lymphoedema after orthopaedic surgery can feel discouraging, but it doesn’t have to hold you back. By combining lymphatic drainage and physiotherapy, you’re not just managing swelling; you’re also supporting your body’s natural healing, regaining movement, and reclaiming your independence.

If you’re experiencing persistent swelling after surgery, speak to your healthcare provider or ask to be referred to a lymphoedema specialist. With the right care, you can recover more comfortably and get back to enjoying life faster after surgery.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

Lymphatic drainage and physiotherapy: References:

https://pubmed.ncbi.nlm.nih.gov/33218497/

https://pmc.ncbi.nlm.nih.gov/articles/PMC4348127/

https://www.sciencedirect.com/science/article/pii/S277263202400031X

https://www.breastcancer.org/treatment-side-effects/lymphedema/reducing-risk/exercise

https://pmc.ncbi.nlm.nih.gov/articles/PMC8565523/

https://journals.cambridgemedia.com.au/wpr/volume-24-number-2/evidence-summary-managing-lymphoedema-complex-lymphoedema-therapy

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Persistent swelling? Lymphoedema is a chronic swelling condition, most seen in legs, arms or the nearest area where there is a lymphatic system dysfunction. It´s mainly caused  by lymph node removal or damage during cancer treatments or other types of surgeries; trauma or genetic. Lymphoedema treatment is based on hands-on treatments and lifestyle changes. But in recent years, surgeons have been performing what seems to be a promising surgical solution. It is lymph node transfer surgery, also known as vascularized lymph node transfer (VLNT) for lymphoedema. A surgical option that offers hope for many patients who thought their condition was irreversible. By now, you may wonder: Is it possible and works? Let’s have a closer look…

What is Vascularised Lymph Node Transfer (VLNT)?

Vascularised lymph node transfer (VLNT) is a microsurgical procedure performed by experienced surgeons who harvest healthy lymph nodes (from a donor site e.g. groin, abdomen, or neck) complete with their blood vessels, and transplant them into the area of the limb affected by lymphoedema. By connecting these nodes to local blood vessels, surgeons create new pathways for lymphatic fluid to drain, thereby restoring a more functional lymphatic operation.

Vascularised Lymph Node Transfer (VLNT) for Lymphoedema: How does it work?

The process involves the following steps:

1. Donor site selection. Surgeons choose the best area with surplus (extra) lymph nodes; in order to minimize the risk of causing lymphedema at the donor site.
2. They use reverse lymphatic mapping and imaging as help to ensure safety.
3. Lymphatic nodes are harvested with their blood vessels.
4. Transplantation. Specialised surgeons transplant, meticulously, the nodes and reconnect them to blood vessels using microscopes and fine sutures.
5. Lymphangiogenesis. During the following weeks and months, the transplanted nodes encourage lymphangiogenesis, the growth of new lymphatic vessels, which can connect to the local circulation and start rerouting lymph fluid effectively to the nearest nodes. Here is where magic happens!

What does science say about VLNT?

Recent studies made in 89 patients – 88 female and 1 male-with different types of cancer (65 breast, 18 gynecologic, 2 melanoma and 4 other types of cancer) reported:

• Limb volume (swelling) reduction. The first year, limb volume reduced 8%, and the second year, it reduced 20%-28% or more.
• Less symptoms. Patients reported less swelling, heaviness, pain, and risk of complications such as cellulitis (skin infections).
• Improved life quality. Many patients can reduce daily compression garments after successful surgery. It has to be always advised and supervised by their lymphoedema team (surgeon, lymphoedema therapist, etc.).
• Restore immune function. The transplanted nodes help regain immune surveillance in the affected limb. In other words, restore lymphatic function to the area, reducing the frequency of infections.

Vascularized lymph node for lymphoedema: Is it safe?

Yes, it is. The reverse lymphatic mapping reduces  the risk of developing lymphoedema at the donor site. 

Are there any risk factors?

As with any surgery, risks include infection, scarring, or failure of the harvest nodes to survive However, major complications are rare, for that reason your surgery should be performed by experienced microsurgeons. 

Are there any side effects?

A case study of 89 patients after VLNT 14 reported complications like:

• 1 hernia in the donor site
• 1 episode of transient pancreatitis (pancreas inflammation-treated with medicines)
• 2 cases of flap loss (transplanted piece of tissue loss ) 
• 1 case of partial flap loss (just part of the tissue is lost)
• 3 reported hematoma
• 3 reported seroma
• 2 postoperative infection
• 1 wound dehiscence (wound open/tissue separation)

Vascularized Lymph Node for Lymphoedema:Are there more studies or trials?

Yes, there are, here some key Clinical Studies and Trials

1. Randomized Controlled Trial – Stage II Breast Cancer–Related Lymphedema

• 36 women randomized: 18 underwent VLNT + physiotherapy/compression, and 18 had conservative therapy only
• After 18 months: VLNT group had an average 57% volume reduction vs 18% in control
• Infection episodes dropped significantly in VLNT group
• Functional improvements and reduced heaviness/pain were reported
• VLNT found to be more cost‑effective than conservative care alone

2. Large Prospective Series – Combined VLNT & Lymphovenous Bypass (LVB)

• 328 patients treated; 67% underwent VLNT + LVB
• Avg volume reductions: 21.4% at 1 year, 36.2% at 2 years, with sustained benefits up to 4 years
• Quality-of-life scores (Lymphedema Life Impact Scale) improved significantly over time

3. Suction-Assisted Lipectomy (SAL) + VLNT

• 94 patients with stage IIb–III lymphedema
• Over ~3 years follow‑up: 60% reduction in lower-limb circumference and up to 81% in upper limb at various levels
• Cellulitis episodes were significantly reduced 

4. Lymph Node Flap Transfer for Lower Limb Lymphedema

• Retrospective review of 52 cases: average 46.3% volume reduction in unilateral mild-to-moderate cases
• Better outcomes seen in less advanced presentations 

5. Safety & Complications – Autologous Lymph Node Transplant (ALNT)

• Study of 26 patients (upper and lower limb): 38% had donor-site complications, including chronic lymphedema, lymphocele, pain
• Highlights need for careful patient selection and surgical technique 

6. Emerging Techniques – VLNT + Nanofibrillar Collagen Scaffolds (NCS)

• Observational comparison: VLNT alone vs VLNT combined with BioBridge® NCS
• Early results suggest enhanced lymphangiogenesis and longer-lasting drainage pathways with the scaffold-assisted method 

How long is the recovery process?

Most patients stay in the hospital for several days or as suggested by their surgeons. 

When can I see the results?

• Studies and clinical follow ups showed that most patients see full benefits of surgery up to two years afterwards. 
• Remember that regular follow-up, physiotherapy (with your lymphoedema therapist), compression therapy, exercise, proper hydration and nutrition are essential during the recovery process and maintenance.

Who is a good candidate for VLNT or similar surgeries? When can I consider VLNT or similar surgeries?

• This surgery is most effective for people with secondary lymphedema (often due to cancer treatments)
• Patients who have not found lasting relief from conservative therapies. 
• Lymphoedema carriers who get into an agreement with their surgeon and see VLNT or similar as the best treatment option.

To keep in mind: careful assessment and imaging guide patient selection (to see if you have donor sites or which one is the best for harvesting). These procedures are what ensure the best possible outcomes.

A final word

Vascularised lymph node transfer represents a new hope in the approach of lymphedema treatment and management. As it directly addresses the underlying lymphatic failure, it offers not just symptom relief but the opportunity for real, lasting results. Remember that the surgery by itself cannot do all the work, you should keep exercising, eating and hydrating properly, doing manual lymphatic drainage; and all together will give you long-lasting relief, improve your quality of life and, why not?, making you free from daily compression and discomfort.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

References:

https://pubmed.ncbi.nlm.nih.gov/25285683/

https://pmc.ncbi.nlm.nih.gov/articles/PMC9463125/

https://pmc.ncbi.nlm.nih.gov/articles/PMC4066306/

https://www.mayoclinic.org/medical-professionals/cancer/news/new-minimally-invasive-vascularized-lymph-node-transfer-for-lymphedema/mac-20506177

https://www.youtube.com/watch?v=TLKlMmjruaA

https://pubmed.ncbi.nlm.nih.gov/34994481/

https://pubmed.ncbi.nlm.nih.gov/25771917/

https://pubmed.ncbi.nlm.nih.gov/39846030/

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Post-orthopaedic lymphoedema and compression therapy: After orthopaedic surgery one of the most common complications is lymphoedema, caused by trauma in the lymphatic system during the procedure. Lymphoedema main symptom is persistent swelling due to impaired lymphatic drainage. Managing this condition early and efficiently is crucial for optimal recovery; for that reason, compression therapy and Manual Lymphatic Drainage stand out as one of the most effective non-invasive strategies to treat and manage this condition. Lest´s see how it works…

How do compression garments and wraps reduce swelling?

Compression therapy, e.g., garments (sleeves and socks) and bandaging, plays a pivotal role in treating post-surgical lymphoedema. It should be always advised by your surgeon to avoid circulatory complications and accompanied with MLD for better lymphatic and blood flow. Let´s see how compression therapy can help:

• Reduces fluid accumulation

It applies consistent and controlled pressure to the affected area, helping to prevent the buildup of lymphatic fluid and consequently reducing swelling.

• Improves lymphatic flow and venous return

Compression garments help your lymphatic system in movilising excess fluid away from the surgical area, while increasing venous return; as a result, decreasing the risk of fluid stasis.

• Prevents complications

It limits space available for fluid to collection, so it reduces the chances of developing seromas (fluid pocket) and other complications associated with stocked fluid.

• Tissue healing support

Compression provides structural support to the healing tissues, promoting alignment and reducing strain during movement, which is important for both comfort and the healing process.

• Reduces pain and promotes faster recovery

Patients, in recent studies, showed less swelling. Besides, some cases reported pain reduction, especially in the immediate post-operative period.

Disclaimer

As these kinds of procedures go deep in order to repair tissues, sometimes the nearest area to the surgery can´t be wrapped (even if fluid is retained and is swollen), so compression should always be prescribed by your surgeon and assisted with manual lymphatic drainage to treat the area that cannot be compressed. 

Post-orthopaedic lymphoedema and compression therapy: What are the types of compression garments and wraps?

• Bandages

There are multi-layer and long-stretch bandages; for best results use them right next the post-operative phase, especially when significant edema is present. It is key to wear tailor-graded pressure, which is especially beneficial for severe or diffuse swelling.

• Compression stockings/sleeves

Patients wear them in their limbs (arms or legs) and come in various compression strengths. Stockings are ideal for gradual, sustained compression during daily activities or for periods after the initial acute swelling goes down (but you can continue using bandages if wanted).

• Tailored made garments

Specially confectioned for patients whose limb size or shape does not fit standard sizing.

Choosing the right compression level

Choosing the appropriate compression level, in your garments, maximises treatment efficacy and ensures comfort, always advised by your lymphoedema team. Here, a summary chart of the available compression levels:

Disclaimer: Always consult a healthcare professional (your lymphoedema team) before selecting compression garments to ensure the correct pressure for your condition and anatomy .

To keep in mind: garment’s tips

• Fit Matters

Choose compression garments that fit tight but comfortably; improper fit may reduce efficacy, reduce circulation or cause discomfort.

• Consistency + follow advice

 Wear garments as recommended by your lymphoedema team: surgeon, lymphoedema therapist, etc. Most patients wear them during the day and remove them at night unless advised otherwise.

• Customisation

 Patients who require (unique limb shapes or sizes) custom-fit garments ensure  proper compression.                

A final word

Compression therapy (when properly tailored) is pivotal and offers a lot of benefits to patients when managing post-orthopedic lymphoedema. It helps to reduce swelling and pain; gives support; speeds up the recovery process and prevents complications. Choosing the right compression garment and level guarantees best outcomes. Always work with your lymphoedema team, who treat you better, to create a treatment plan according to your needs.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

Post-orthopaedic lymphoedema and compression therapy-References:

https://pubmed.ncbi.nlm.nih.gov/30967135/

https://pubmed.ncbi.nlm.nih.gov/33218497/

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