Pulmonary Fat Embolism After Total Hip and Total Knee Arthroplasty

Papagelopoulos, Panayiotis J.; Apostolou, Constantinos; Karachalios, Theofilos; Themistocleous, George S.; Giannakopoulos, Christos K; Ioannidis, Theologos T

doi:10.3928/0147-7447-20030501-23

Cited by 13 publications

(5 citation statements)

References 47 publications

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“…Because fat embolism during orthopaedic surgery is common, whereas FES is rare, and some patients with fat embolism develop FES, whereas others do not, several risk factors and intrinsic metabolic changes can predispose patients with fat embolism to FES 21 . Reduced cardiorespiratory reserve, hypovolemia, oste-oporosis, and possibly the female sex have all been identified as risk factors for developing FES 6,12,14,22 . FES is diagnosed on the basis of several clinical and laboratory criteria (Table I) [23][24][25] .…”

Section: Discussionmentioning

confidence: 99%

“…FES is most commonly associated with traumatic fractures of the lower extremities and pelvis, and its incidence correlates with the multiplicity of fractures and the energy of trauma 1,2,5 . In patients undergoing elective orthopaedic surgery, FES has been mainly associated with hip and knee arthroplasty [6][7][8] . Only a few case reports have described FES during or after various spinal surgery procedures [9][10][11][12][13][14][15][16] .…”

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confidence: 99%

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Fatal Fulminant Fat Embolism Syndrome in Adult Spine Deformity Surgery

Mohar

2022

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Case: A 68-year-old woman was scheduled to undergo elective correction of coronal spinal malalignment after a previous lumbar instrumented fusion. In the final stages of the operation, the patient became hemodynamically unstable. Her systemic condition worsened subsequently, leading to cardiac arrest followed by unsuccessful resuscitation. An autopsy revealed a massive fat embolism in the lungs. Conclusions:The diagnosis of fat embolism syndrome (FES) is clinical, and treatment is supportive, with no clinical or investigative criteria that can facilitate diagnosis in a patient under general anesthesia. This is the first description of FES in adult spinal deformity surgery.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B870).

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Fatal Fulminant Fat Embolism Syndrome in Adult Spine Deformity Surgery

Mohar

2022

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“…Also in this patient, we supposed that the delay of the clinical presentation was In this case, the tibia was reamed thoroughly up to 17 mm by machine reamer to fix the osteotomized site by cementless press-fit extension-stem only. The decision to use cement or cementless fixation of the extended stem should also be considered [8,12]. We consider the use of a press-fit extension-stem enough to fix an osteotomized tibia.…”

Section: Discussionmentioning

confidence: 99%

Thermal necrosis after simultaneous tibial osteotomy and total knee arthroplasty using press-fit extension-stem

Ishida

Tsumura

Takayama

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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One-staged tibial corrective osteotomy and total knee arthroplasty is a challenging but effective treatment for arthritic knees with extra-articular deformity. Although osteocutaneous thermal necrosis is accepted as a complication of intramedullary reamed nailing following long bone fractures, only 15 cases have been reported in the English literature at present. This report illustrates a rare case of thermal necrosis in a patient undergoing tibial corrective osteotomy coincident with long-stemmed total knee arthroplasty. Excessive reaming with a machine reamer is hypothesized as the cause of this serious complication. In this report, we highlight this rare but serious complication after long-stemmed total knee arthroplasty.

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“…We consider that one of most invasive aspects of TKA is the violation of the intramedullary (IM) femoral canal and the subsequent use of IM instruments. In addition, it has been established that the IM reaming procedure increases fat emboli release to lung and brain during TKA [6,8,16,22,24,38] and that fat embolism syndrome is fatal in *50% of affected patients [14,27,42,43,46]. These reports support the extramedullary (EM) approach.…”

Section: Introductionmentioning

confidence: 99%