Fat embolism in revision total hip arthroplasty.
Two patients developed fat embolism syndrome after revision of loose total hip arthroplasties (THAs). During both procedures, the prosthesis became rigidly fixed 1 to 1.5 cm before the expected level of fixation. After uncomplicated operative courses, Patient A remained obtunded and febrile for 2.5 days, and Patient B died 1 day postoperatively. In Patient A, a presumptive diagnosis of fat embolism syndrome was based on the postoperative course and a radiograph of the lungs. In Patient B, the diagnosis was confirmed by evidence of cerebral edema on a computed tomography scan of the head. Fat embolism syndrome is unexpected after revision THA because the fatty tissue is removed from the femoral canal during primary THA. In these 2 cases, the rigid fixation and multiple attempts to impact and subsequently to remove the prosthesis may have caused fat embolism syndrome.
Ritter
Merrill A
MA
Center for Hip and Knee Surgery, St Francis Hospital, Mooresville, Mooresville, Indiana, USA. marittermd@aol.com
Harty
Leesa D
LD
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D004620:Embolism, Fat / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation