Recognising the Early Signs of Post-Surgical Lymphoedema: Causes, Symptoms, and Management

Post-surgical lymphoedema is a condition that can arise as a side effect after orthopaedic surgeries, particularly those involving trauma or joint replacements. It occurs due to impaired lymphatic drainage, which leads to fluid accumulation in the affected limb. Lymphoedema may be caused by direct damage to lymphatic vessels or nodes or by an overload of the lymphatic system due to excessive fluid production. Early detection is esential to prevent the advance of the condition and ensure effective management. In this blog, we explore the symptoms to look for, potential causes, risk factors, and the importance of timely intervention.

What is Post-Surgical Lymphoedema?

Post-Surgical Lymphoedema is a type of chronic oedema. Its main characteristic is swelling due to the accumulation of lymph fluid caused by a blockage, damage, or overload in your lymphatic system—specifically, vessels or nodes near to the treated area. In orthopaedic patients, this can result from surgical interventions or trauma that disrupt the lymphatic pathways. Secondary lymphoedema often manifests after procedures such as joint replacements or open fractures.

While post-surgical swelling is normal, in some cases, it can become prolonged and problematic. Understanding the causes, risk factors, and management of chronic oedema can help patients and healthcare providers address the condition effectively.

How Does Lymphoedema Develop After Orthopaedic Surgery?

Orthopaedic procedures can directly or indirectly affect the lymphatic system in several ways:

1. Surgical Trauma

Incisions, tissue manipulation, or repositioning of body parts during surgery may damage lymphatic vessels or nodes. For example, hip or knee replacements often involve deep tissue dissection, raising the risk of lymphatic disruption.

2. Immobility

Reduced movement post-surgery limits muscle contractions that normally pump lymph fluid. Prolonged bed rest or the use of casts can exacerbate fluid pooling, particularly in the legs or arms.

3. Inflammatory Response and Fluid Overload

Surgical trauma increases local inflammation, elevating interstitial protein levels. This creates a cycle where protein-rich fluid overwhelms compromised lymphatic drainage. In some cases, the lymphatic system is simply overwhelmed by excess fluid production, even if it remains structurally intact, leading to lymphoedema.

Recognising the Early Signs of Post-Surgical Lymphoedema

Early detection of lymphoedema is vital for successful management and treatment. The sooner the signs are recognised, the better the outcomes in preventing progression to more severe stages. Patients recovering from orthopaedic surgeries should be vigilant for the following symptoms:

• Persistent Swelling: Swelling that continues or worsens several weeks after surgery. It may initially appear mild but become more pronounced over time or in hot weather.
• Heaviness or Tightness in the Limb: A feeling of heaviness, tightness, or pressure in the affected arm or leg that can interfere with mobility and daily activities.
• Pitting Oedema: Pressing the swollen area may leave a temporary indentation, indicating fluid build-up.
• Reduced Range of Motion: The affected limb may feel stiff or limited in movement due to swelling or discomfort.
• Thickened Skin: Skin may feel firmer, appear shiny, or become itchy or mildly red.
• Pain or Tenderness: Particularly if inflammation is present and persistent.
• Recurrent Skin Infections: Swelling increases the risk of infections, which can further complicate recovery.
• Clothing or Jewellery Feeling Tighter: Items such as rings, watches, or trousers may feel tighter on one limb compared to the other.

Why Early Detection is Key

Early detection of symptoms in post-op orthopaedic surgery patients can significantly reduce the risk of lymphoedema progression. On the other hand, it improves outcomes and speeds up the recovery process. Timely detection and intervention also:

• Prevents Chronic Disability
• Reduces Risk of Complications: Such as delayed wound healing, infections, excessive pain, reduced mobility, and in some cases, wound dehiscence (where sutures may reopen due to swelling pressure).
• Improves Quality of Life: Timely treatment allows patients to regain function and comfort quickly.

What to Do After Detecting Lymphoedema: Management Strategies

Once identified, post-surgical lymphoedema can be managed effectively through:

• Compression Therapy: Bandages or compression garments help reduce swelling by improving fluid circulation. Long-stretch garments may offer better results than standard wraps—always seek guidance from  your surgeon  or a lymphoedema therapist.
• Manual Lymphatic Drainage (MLD): Specialised massage techniques stimulate lymphatic flow, support the immune system, and alleviate symptoms. Make sure your therapist is a lymphoedema specialist registered with MLD UK or the relevant authority in your country
• Exercise and Movement: Gentle, guided exercises help promote lymphatic flow and prevent fluid retention.
• Nutrition: Introduce an anti-inflammatory diet and ensure adequate hydration.
• Medications (if needed): Anti-inflammatory drugs may be prescribed in some cases to reduce swelling and discomfort.

A final word

Post-surgical lymphoedema is a common complication following damage or overload of the lymphatic system during orthopaedic surgeries. Understanding the early signs of persistent swelling, tightness, heaviness, pain, and changes in the skin—allows patients to seek timely medical attention. Not all patients will develop lymphoedema, but those undergoing complex procedures or with other health conditions should be monitored closely. Early intervention not only prevents long-term disability but also ensures a smoother, faster recovery and a better quality of life.

References:

https://pubmed.ncbi.nlm.nih.gov/26753640/

https://pmc.ncbi.nlm.nih.gov/articles/PMC8620266/

https://www.bupa.co.uk/health-information/cancer/lymphoedema

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

https://www.lympho.org/uploads/files/files/Surgery-final.pdf