The disproportionate accumulation of fat in Lipedema causes mechanical imbalances that result in significant orthopedic problems. Degenerative joint disease of the knees is the most common arthritic condition of lipedema patients and it is often disabling.
I am grateful for Dr. Josef Stutz previous work on this subject. He has previously published a paper on the abnormal accumulation of fat in the inner thighs leading to a valgus deformity of the knee [knock knee], which puts increased pressure on the lateral knee compartment and leads to accelerating knee joint degeneration.
My talk today focuses more on the fat accumulation in the distal thigh and proximal calf causing a significantly restricted range of motion. The restricted range of motion and valgus deformity not only causes joint degeneration at the knee, but also greatly complicates total knee replacement once the degeneration has occurred. Restricted range of motion and improper angulation of the knee joint are the number one and number two causes for failed knee replacement and chronic knee pain after knee replacement.
- Identify how Lipedema can cause knee joint range of motion restrictions in patients with Lipedema.
- Explain how liposuction can improve patient range of motion, mobility, decrease pain, and reduce stress on the knee joint.
- Describe how liposuction can improve post-operative recovery after joint replacement surgery – possibly even delay joint replacement surgery.
PATIENT CASE REPORT
This is a case report of a lipedema patient who had advanced degenerative joint disease of the knee with markedly restricted range of motion.
Her orthopedic surgeon advised against proceeding with knee replacement because she would have a poor post-operative prognosis without correction of the abnormal fat deposits on her legs. Pre-operatively the patient’s range of motion was 88° of flexion. Normal flexion >130°.
Pain Free / Mechanical Stress Free
|Sitting Down||95° – 110°|
|Rising from Chair||95° – 100°|
|Tying a Shoe||105°|
|Squatting||130° – 140°|
NORMAL RANGE OF MOTION
RESTRICTED RANGE OF MOTION
PATIENT BEFORE AND AFTER
Post-operatively, after lymph sparing liposuction, the patient had 120° of flexion and extension allowing for pain free descent of stairs. The valgus angulation corrected over 5°. The greatest improvement in pain came from her ability to rise from a chair and get out of the bathtub pain free. Prior to the surgery the patient experienced significant pain with these activities. However, the patient still had some pain with climbing stairs as the joint degeneration itself was not treated – just an improved range of motion.
Before & Afters
The removal of abnormal fat from the posterior thigh, anterior thigh to the knee, and from the upper calf, which restricted the flexion, significantly improved the patients knee mechanics. This has also improved mechanical joint stress with activity and greatly improved pain during activities of daily living (ADL). At a minimum the patient has been able to postpone total knee replacement, and if she does eventually have a total knee replacement, the likelihood of a successful knee replacement is significantly increased.
Liposuction to the legs significantly improved static and dynamic mechanics of the knee, decreased pain, increased patient mobility, and ability to carry out daily activities.