Fatal Fat Embolism following Femoral Head Resection in Total Hip Arthroplasty

Walker, N.; Bateson, Thomas F.; Reavley, Paul; Prakash, Divya

doi:10.1177/112070000801800412

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…23 A fatal fat embolism has also been reported immediately following removal of the femoral head, prior to further preparation of the acetabulum or of the femoral shaft. 24 This was presumably a consequence of the rise in intramedullary pressure during the processes of dislocation and resection of the femoral neck. At the time of arthroplasty it can occur when cement is used, 7 but has also been observed with cementless implants.…”

Section: Mortality Ratesmentioning

confidence: 99%

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Mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur

Timperley

Whitehouse

2009

The Journal of Bone and Joint Surgery. British volume

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Recently the National Patient Safety Agency in the United Kingdom published a report entitled "Mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur". A total of 26 deaths had been reported to them when cement was used at hemiarthroplasty between October 2003 and October 2008. This paper considers the evidence for using cement fixation of a hemiarthroplasty in the treatment of hip fractures.

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Section: Mortality Ratesmentioning

confidence: 99%

“…42 Intraoperatively, every effort should be made to reduce the possibility of embolisation of fat and marrow contents, whether the arthroplasty is to be cemented 38 or not. 24,26,43 Pressurised lavage. Thorough lavage of the medullary cavity with a pressurised system is mandatory to reduce the embolic load.…”

Section: Peri-operative Mortality: Risk Factorsmentioning

confidence: 99%

Mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur

Timperley

Whitehouse

2009

The Journal of Bone and Joint Surgery. British volume

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“…These emboli would flow into the pulmonary circulation and cause pulmonary embolism (PE), potentially leading to fatal fat embolism syndrome (FES). [ 6 ] The incidence of postoperative FES is approximately 1% to 30%, according to previous reports. FES usually presents as a multisystem disorder that seriously affects organs, including the lungs, brain, cardiovascular system, and skin.…”

Section: Introductionmentioning

confidence: 98%

A study on dynamic monitoring, components, and risk factors of embolism during total knee arthroplasty

et al. 2017

Medicine

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Background:Fat embolism is a common complication of orthopedic surgery. However, the exact component and risk factor responsible for this complication remains unelucidated. This study aimed to detect the origin of the pulmonary embolus and identify relevant risk factors of pulmonary embolism in total knee replacement.Methods:A total of 40 osteoarthritis patients who underwent primary unilateral TKA were recruited into this study. Transesophageal echocardiography (TEE) was utilized to dynamically monitor the embolism. Pulmonary arterial pressure was recorded and biopsies were obtained from the medullary cavity during surgery.Results:After tourniquet release, the arterial embolism was observed by TEE to have a peak signal at 30 seconds when pulmonary arterial pressure was increased by 25% to 40% (P = .002). The pathology study of the embolism revealed its bone marrow origin. Total embolus quantity was positively correlated with age (P = .021), body mass index (BMI, P = .041), and fat content of the bone marrow (P = .003). Logistic regression analysis revealed that the fat content of the marrow (OR: 1.432, 95% CI: 1.335–1.592), age (OR: 1.632, 95% CI: 1.445–1.832), and BMI (OR: 1.231, 95% CI: 1.032–1.381) were risk factors for pulmonary hypertension.Conclusion:This study revealed that the embolus detected in the right atrium was derived from bone marrow tissues, and this led to pulmonary arterial pressure fluctuations after tourniquet release. Therefore, elderly patients who have high BMI or bone marrow fat content are at high-risk for pulmonary fat embolism during TKA.

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