Post-orthopaedic surgery Lymphoedema: Available treatments

How lymphatic drainage and other techniques can help reduce swelling and speed up recovery.

Post-orthopaedic surgery lymphoedema requires a structured approach to minimise swelling and enhance recovery. Combining lymphatic drainage techniques, targeted physical therapy, and strategic movement can significantly improve outcomes for patients with pre-existing lymphoedema or those at risk of post-surgical fluid retention.

What is a joint replacement surgery and why is it performed?

Joint replacement surgery ( arthroplasty) is typically recommended when a joint is severely damaged and conservative treatments are no longer effective (exercise, physiotherapy, or other manual techniques). 

Most common causes of joint replacement (arthroplasty)

1. Osteoarthritis

• A degenerative joint disease that wears down cartilage, causing pain, stiffness, and loss of mobility.
• Typically affects older adults, but can also affect younger people.

2. Rheumatoid Arthritis

• An autoimmune disease causing chronic inflammation of the joints.
• Symptoms: pain, swelling, and deformity over time leading to joint damage.

3. Post-Traumatic Arthritis

• Occurs after an injury such as a fracture or ligament tear.
• Damage from trauma can lead to arthritis and joint deterioration.

4. Avascular Necrosis (Osteonecrosis)

• It is the result of blood supply disruption to the bone, leading to bone death and joint collapse.
• Common causes are: severe trauma, steroid and alcohol abuse, and other certain medical conditions.

5. Congenital or Developmental Joint Disorders

• Some people are born with joint deformities or abnormal joint development (e.g., hip dysplasia). These conditions can lead to early joint degeneration.
  

6. Infection (Septic Arthritis)

• A joint infection can severely damage or even destroy cartilage and bone, requiring surgical replacement.

7. Tumors or Bone Cancer

• When a tumor or bone cancer is located in the joint it might need joint replacement to preserve mobility on the affected limb.

8. Complications or side effect of previous surgeries

• Previous surgeries (like partial replacements or arthroscopies) that fail to relieve symptoms or cause complications may lead to full joint replacement.
  

Joint replacements are most commonly done for the hip, knee, and shoulder, but other joints like the elbow, ankle, and fingers can also be replaced.

Post-orthopaedic surgery Lymphoedema: Available treatments  

How lymphatic drainage and other techniques can help reduce swelling and speed up recovery.

Manual Lymphatic Drainage (MLD)

This specialised massage technique uses gentle, rhythmic strokes to stimulate lymph flow. Studies show MLD reduces pain biomarkers like lactate dehydrogenase (LDH) and improves post-surgery pain thresholds, due to its direct impact on surgical oedema reduction while improving mobility ranges. For best results, start as soon as possible (ask your surgeon first) and be performed by certified therapists who treat you better.

Compression Therapy

• Bandaging. Pre- and post-operative compression bandaging helps manage swelling and supports joint stability while recovering.
• Garments. Proper graduated compressions (sleeves, stockings, etc.) maintain pressure on tissues to prevent fluid accumulation, ask your surgeon, physio or lymphoedema therapist for the right compression according to your needs.

Physical Therapy Strategies

A tailored physical therapy program addresses both mobility and lymphatic function:

• Range-of-motion exercises. Gentle joint bends activate muscle pumps, increase blood and lymphatic flow while reducing fluid buildup.
• Resistance training. Light resistance bands or bodyweight exercises strengthen muscles without overloading the joint. Always advised by your physiotherapist.
• Diaphragmatic breathing and other breathing exercises. They Enhance lymphatic circulation through pressure changes in the thoracic cavity. In addition, specific breathing techniques help to reduce pain, stress and anxiety due to surgery.

Examples of recommended movement protocols (always seek the advise of a specialist)

Early Post-Op Exercises (Days 1–7)

1. Ankle pumps:  Move your feet up and down gently. Do 10–15 repetitions hourly while awake to stimulate calf muscle pumps.
2. Straight-leg raises: 10–15 repetitions, 2–3 times daily. This upside down position helps blood return to heart and increase lymphatic flow.
3. Supported walking: Assisted short walks (with assistive devices or company) help to promote circulation.

Weeks 2–6

• Low-impact aerobic activities: longer walks, swimming or stationary cycling improves lymph flow without joint stress.
• Progressive resistance: Leg presses and step-ups rebuild strength while monitoring swelling. 

Lead your team: multidisciplinary professionals

Successful management requires collaboration between:

• Orthopedic surgeons to optimise surgical technique for lymphatic preservation.
• Lymphedema therapists for MLD, Lymphoedema management strategies advice and compression garment fitting.
• Nutritionists to implement anti-inflammatory diets and weight management strategies.

Post-orthopaedic surgery Lymphoedema: Homework

What you can do to help reduce inflammation:

• Introduce an anti-inflammatory diet to your daily routine 
• Sodium restriction to reduce fluid retention.
• Smoking cessation before and after surgery  (if you quit it is best for your health) to improve microvascular function.
• Stay hydrated to improve lymphatic flow.

A final word…

Patients who have followed these protocols reported:

• 85% satisfaction rates with joint function post-replacement.
• 50% faster return to daily activities compared to non-structured rehab.
• Reduced infection rates (under 2%) when combining compression and MLD.

Remember that while surgical oedema typically resolves within 6–12 weeks, those with chronic lymphoedema require ongoing maintenance therapy. By integrating these evidence-based approaches, patients can achieve better surgical outcomes and long-term mobility.

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://pmc.ncbi.nlm.nih.gov/articles/PMC10763325/

https://pmc.ncbi.nlm.nih.gov/articles/PMC9674715/

https://cancerrehabpt.com/blog/exercises-to-reduce-knee-fluid/