Question: I have arthritis in my hip, the same leg has lymphoedema and I am receiving conflicting advice as to whether I should have a hip replacement and wondered if any other members have had the same problem.
I was initially told that any operation would be out of the question as it could make my lymphoedema worse and cause cellulitis or septicaemia so I would just have to take painkillers and put
up with the fact of increasingly becoming less mobile. I have also recently been told that a hip replacement is possible with antibiotics, three weeks has been suggested and that my lymphoedema would possibly get worse but would eventually improve. My other worry is my father who had a fused leg, due to a knee replacement which went wrong, had a hip replacement but the leg kept pulling it out as it was heavy, my leg is also quite stiff.
I am finding this very confusing and wondered if any other members have been in the same situation and how they resolved it. I do attend a clinic on a 6 monthly basis, just a check and possible new prescription for my stocking. The clinic is quite hit and miss since the original nurse had to retire through ill-health and has not been replaced on a permanent basis yet, so staff taking the clinic are on loan and frequently change. My own doctor has no opinion on the matter and would be guided by what I want; I think she understands the condition but not very well. My condition has got worse over the last couple of years and I have a problem walking.

Answer: We always suggest that you weigh up the pros and cons of having surgery against the risk of possible infection/increased swelling post op.
Having had a hip replacement myself – I can empathise with the constant pain/discomfort one gets as the hip becomes more and more worn (not helped in your case of course by the weight of the lymphoedema). The trouble is, as pain worsens, so does your leg function and mobility. This in turn leads to increased swelling (muscle activity is crucial to enhance the lymphatic drainage system) and then this leads to increased weight, leading to more pain. A vicious circle.
So our advice is usually to take the bull by the horns and go for surgery with the following advice:


1. Get your lymphoedema as stable as possible first. The smaller it is and the better the skin and tissues are; the less likely are there to be complications post-surgery. Sometimes we do a short course of Decongestive Lymphatic Therapy before surgery to get the limb in as good a condition as possible (but this depends on funding/resources in your area).
2. We also suggest that a course of antibiotics be commenced just before, during and after surgery. This is a preventative (prophylactic) measure and seems to have worked with all our patients. If the surgical team are reluctant to do this then you need to be vigilant after the operation and start them as soon as possible if it looks as though Cellulitis is starting. A cellulitis will not help your recovery at all, so prevention is often better than cure!
3. Surgery will inevitably lead to an increase in your swelling immediately after – this is NORMAL... however, you need to be pro-active and follow the specific leg exercises you are given as soon as possible after the operation. This will not only help with your hip – but with your lymphoedema too. By ‘guarding’ the hip (worrying about moving and therefore not moving) will lead to increased swelling. The good thing is that your hip pain will have gone after surgery – and although you will be sore from the scar – moving should actually be easier!
4. Try and go back to your compression garment as soon as possible after surgery. You may well be issued with a white TED stocking before surgery (to prevent Deep Vein Thrombosis) – however, once you are up and about, it is much better to go back to your usual stocking as this gives a better, graduated pressure and will ensure the swelling is kept to a minimum. HOWEVER – you may need help to put it on in the initial weeks/months after surgery as bending is not advised after a hip replacement (can cause dislocation!) Either get a family member to help, or change your applicator to one that keeps bending to a minimum. Again – it is worth speaking to your lymphoedema therapist before surgery to ensure these things are put in place before hand.
5. Keep up with your skin care routine when in hospital and when you get home. Increased swelling may cause the skin to dry and a more intensive skin cream maybe required to deal with this. Remember not to bend. Use a sponge on a stick to help you to reach your feet – or use a moisturising spray. Again, take advice from your lymphoedema therapist.

6. Finally – I always recommend that when patients go into hospital – that they take info about lymphoedema (LSN fact sheet on what lymphoedema is – as well as wearing an LSN hospital wrist band). You need to ensure that staff know that blood pressures and blood sampling/injections etc. are not done in the swollen limb. And last but not least, I have also started to encourage my patients to take in a few of the cards highlighting the BMJ Learning module on the Management of Chronic Oedema/Lymphoedema. This enables you to spread the word and raise awareness!

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