Fat Embolism Syndrome Following Bilateral Total Knee Replacement with Total Condylar Prosthesis

Lachiewicz, Paul F.; Ranawat, Chitranjan S.

doi:10.1097/00003086-198110000-00013

Cited by 17 publications

(5 citation statements)

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“…The reasons for the difference in outcome profiles are poorly understood, but the exposure of organ systems to the various loads of microemboli during the implantation process and the ensuing inflammatory response may explain the differences in the observed incidence of a number of complications [33,34,39]. The fact that the procedure code for RTKA for a complete knee revision and isolated revisions of a polyethylene insert or a patella component [22] are the same under the current procedure coding system may explain the overall low prevalence of adverse events and procedure-related complications seen in the RTKA group.…”

Section: Discussionmentioning

confidence: 99%

In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges

Memtsoudis

Valle

Besculides

et al. 2008

Clinical Orthopaedics &Amp; Related Research

175

136

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Patients undergoing bilateral total knee arthroplasty (BTKA) may have higher complication rates and mortality than those undergoing a unilateral procedure (UTKA). To evaluate this hypothesis, we analyzed nationally representative data collected for the National Hospital Discharge Survey on discharges after BTKA, UTKA, and revision TKA (RTKA) between 1990 and 2004. The demographics, comorbidities, in-hospital stay, complications, and mortality of each procedure were compared. An estimate of 4,159,661 discharges (153,259 BTKAs; 3,672,247 UTKAs; 334,155 RTKAs) were included. Patients undergoing BTKA were younger (1.5 years) and had a lower prevalence of comorbidities for hypertension (versus UTKA), diabetes, pulmonary disease, and coronary artery disease (versus UTKA and RTKA). The length of hospitalization was 5.8 days for BTKA, 5.3 for UTKA, and 5.4 for RTKA. Despite similar length of hospitalization, the prevalence of procedure-related complications was higher for BTKA (12.2%) compared with UTKA (8.2%) and RTKA (8.7%). In-hospital mortality was highest for patients undergoing BTKA (BTKA, 0.5%; UTKA, 0.3%; RTKA, 0.3%). Patients undergoing BTKA had a 1.6 times higher rate of procedure-related complications and mortality compared with those undergoing UTKA. Outcomes for patients undergoing RTKA for most variables were similar to those for UTKA. BTKA, advanced age, and male gender were independent risk factors for complications and mortality after TKA. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges

Memtsoudis

Valle

Besculides

et al. 2008

Clinical Orthopaedics &Amp; Related Research

175

136

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“…Some surgeons attribute postoperative confusion to fat embolism after TKA 50 . Hemoglobin and hematocrit values are assessed daily, and the patient is transfused with autologous blood if they become symptomatic or their hemoglobin value falls below 9 g per dL.…”

Section: Postoperative Patient Carementioning

confidence: 99%

Sequential Bilateral Total Knee Arthroplasty

Branson¹,

Goldstein²

2001

AORN Journal

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As the senior citizen population has grown, the incidence of osteoarthritis and joint replacement has increased. Bilateral total knee arthroplasty (BTKA) can be performed sequentially during one anesthetic. Studies have shown the complication rates differ only slightly for total knee arthroplasty procedures performed sequentially during one anesthetic or separately requiring two hospitalizations. With the use of staggered tourniquet deflation times, efficient OR time and motion techniques, and careful postoperative management, patients can achieve successful outcomes after BTKA during one anesthetic.

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“…We believe that similar pressures can develop at the time of using intramedullary alignment device in the femur while performing a knee replacement. Embolization occurs at the time of using intramedullary alignment rods and at the time of prosthesis insertion, due to the release of marrow debris and particulate fat [10][11][12][13][14][15][16][17][18]. Several studies have suggested that this risk is increased by using a cemented prosthesis [8,12,19,20].…”

Section: Introductionmentioning

confidence: 99%

Bilateral total knee replacement under a single anaesthetic, using a cementless implant is not unsafe

Shah

Smith

Jones

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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Bilateral knee replacement under single anaesthetic is not a common procedure. There is a general agreement that this is associated with greater morbidity and mortality. However, there is a suggestion in literature that using a cementless implant could reduce this risk. We wanted to make a prospective comparison of safety and clinical results, between unilateral and bilateral cementless knee replacements performed under a single anaesthetic. A prospective non-randomised matched cohort study on 87 consecutive patients who had bilateral simultaneous/sequential knee replacement and 174 consecutive patients who had unilateral knee replacement between the period of 1997 and 2002 were included in this study. All patients had a cementless mobile-bearing implant. All patients had an independent objective assessment at follow-up. There was no significant difference between the two groups in terms of age, sex, primary diagnosis (osteoarthritis or rheumatoid arthritis), co-morbidity, ASA grade, average range of motion and average American knee society score and post-operative surgical complications. There was one early death in the bilateral group, and three in the unilateral group. The clinical results of bilateral group were as good as the unilateral group. Our study showed that in terms of postoperative medical and surgical complications, bilateral simultaneous/sequential knee replacement using a cementless mobile-bearing implant is as safe as a unilateral knee replacement. With careful patient selection, bilateral knee replacement under a single anaesthetic would be a suitable option for patients who present with bilateral symptomatic arthritis of the knee.

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Fat Embolism Syndrome Following Bilateral Total Knee Replacement with Total Condylar Prosthesis

Cited by 17 publications

References 0 publications

In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges

In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges

Sequential Bilateral Total Knee Arthroplasty

Bilateral total knee replacement under a single anaesthetic, using a cementless implant is not unsafe

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