Fat embolism syndrome and elective knee arthroplasty

  • Kathryn Jenkins
  • Frances Chung
  • Richard Wennberg
  • Edward E. Etchells
  • Rod Davey
General Anesthesia

Abstract

Purpose

To report a case of fat embolism syndrome (FES) following elective left knee arthroplasty and review the diagnosis, investigation, prevention and perioperative management of this condition.

Clinical features

A 76-yr-old lady presented for left total knee arthroplasty under general anesthesia. After an uneventful anesthetic and initial recovery, she developed respiratory and neurological complications six hours postoperatively necessitating supportive care in the intensive care unit. Following extensive investigation, a clinical diagnosis of FES was made 48 hr postoperatively supported by the development of diffuse encephalopathy, thrombocytopenia, hypoxemia, chest petechiae and chestx-ray changes. A magnetic resonance imaging scan five days postoperatively confirmed this diagnosis. Her postoperative course showed gradual improvement consistent with a slowly resolving encephalopathy.

Previous published cases of FES associated with knee arthroplasty present either with intraoperative cardiorespiratory collapse or, as with this patient, in the postoperative period with respiratory, cardiovascular and/or cerebral dysfunction.

Conclusions

The clinical diagnosis of FES is essentially one of exclusion, supported by laboratory and radiological investigations. Preoperative identification of at-risk patients, use of appropriate invasive perioperative monitoring and modified surgical techniques may minimize the development of the syndrome. Treatment is supportive.

Keywords

Total Knee Replacement Diffuse Encephalopathy Bilateral Total Knee Replacement Pulmonary Artery Pressure Monitoring Routine Pulse Oximetry 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Embolie graisseuse et arthroplastie du genou non urgente

Résumé

Objectif

Décrire un cas d’embolie graisseuse (EG) survenue après une arthroplastie du genou non urgente et réexaminer le diagnostic, la recherche, la prévention et le traitement périopératoire entourant cette situation.

Éléments cliniques

Une femme de 76 ans s’est présentée pour une arthroplastie totale du genou gauche sous anesthésie générale. La récupération, d’abord sans incident, s’est compliquée de troubles respiratoires et neurologiques six heures après l’intervention, ce qui a nécessité un traitement de soutien à l’unité des soins intensifs. À la suite d’une investigation poussée, un diagnostic d’EG a été fait, 48 h après l’opération, confirmé par le développement d’encéphalopathie diffuse, de thrombocytopénie, d’hypoxémie, de pétéchies thoraciques et de modifications radiographiques pulmonaires. Un examen d’imagerie par résonance magnétique a confirmé le diagnostic cinq jours après l’opération. L’état de la patiente s’est graduellement amélioré en faveur d’une lente résolution de l’encéphalopathie.

Dans les cas déjà publiés d’EG associée à l’arthroplastie du genou, on retrouve soit un collapsus cardiorespiratoire peropératoire, soit un dérèglement postopératoire respiratoire, cardiovasculaire et/ou cérébral comme dans le cas présent.

Conclusion

Le diagnostic clinique d’EG est essentiellement un diagnostic d’exclusion, corroboré par les examens de laboratoire et de radiographie. L’identification préopératoire des patients à risque, l’usage d’un monitorage périopératoire effractif approprié et de techniques chirurgicales modifiées peuvent minimiser le développement de ce syndrome. Le traitement consiste en une thérapie de soutien.

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Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  • Kathryn Jenkins
    • 1
  • Frances Chung
    • 1
  • Richard Wennberg
    • 2
  • Edward E. Etchells
    • 2
  • Rod Davey
    • 3
  1. 1.Department of AnesthesiaUniversity of Toronto, Toronto Western HospitalTorontoCanada
  2. 2.Department of MedicineUniversity of Toronto, Toronto Western HospitalTorontoCanada
  3. 3.Department of Orthopedic SurgeryUniversity of Toronto, Toronto Western HospitalTorontoCanada

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