Pulmonary and Cerebral Fat Embolism Syndrome After Total Knee Replacement

Abstract

Fat embolism occurs after long bone fracture or orthopedic surgery and usually shows mild symptom. But it rarely results in fat embolism syndrome, presenting as multiorgan dysfunction such as lung, brain and skin. Although the diagnosis of fat embolism syndrome is mostly based on clinical features, we experienced fat embolism syndrome involving lung and brain, showing typical imaging findings in pulmonary computed tomography and brain magnetic resonance image. So we present interesting case about fat embolism syndrome after total knee replacement with reviewing associated literatures including imaging findings.

Fat Embolism Syndrome

“…[8][9][10] A few studies regarding the use of computed tomography (CT) are available in the literature. [11][12][13][14] There are also some case reports of macroscopic FE being detected with contrast-enhanced CT. [15][16][17] The purpose of our study was to assess the lung CT findings in a series of patients with a clinical diagnosis of FES, obtained using the diagnostic criteria of Gurd and Wilson. 3,5 …”

Cerebral fat embolism syndrome following total knee replacement causing a devastating neurocognitive sequelae

“…They attributed the respiratory symptoms due to the poor respiratory condition from rheumatoid disease and the long-term use of steroid therapy. Subsequently, several cases of FES following bilateral TKR in 2 healthy patients 2. The incidence of FES in elective orthopedics joint operations is not well known.…”

“…The incidence of FES in elective orthopedics joint operations is not well known. Recently, Lee et al2 retrospectively reviewed a series of 2345 patients underwent simultaneous bilateral TKA procedures and found that the overall incidence of FES with cerebral manifestations was 0.17%. The pathophysiology of fat embolism and its subsequent clinical manifestations is shrouded in controversy.…”

“…The pathophysiology of fat embolism and its subsequent clinical manifestations is shrouded in controversy. However, 3 major theories have been described in the literature 2. First, the Mechanical theory which states that traumatic injury to long bones results in the release of microscopic fat droplets into circulation by the disruption of the fat cell in the traumatized bone or the surrounding adipose tissues.…”

“…The modification of surgical techniques to cementless TKR, and staging (unilateral versus bilateral) TKR procedures or the use of computer-assisted navigation has not been associated with a lower incidence of FES 3. The time onset of the clinical development of FES following knee arthroplasty was variable from an intraoperative cardiorespiratory collapse, before or after deflating the tourniquet, to the development of respiratory, cardiovascular and cerebral dysfunction minutes to hours in the postoperative period 2. The diagnosis of fat embolism is usually a clinical challenge and requires a vigilant high index of suspicion.…”