Fat Embolism during Total Hip Replacement

A PROSPECTIVE STUDY

¹ From the Department of Orthopaedic Surgery, Hollywood Presbyterian Hospital, Los Angeles

To demonstrate fat embolism during total hip replacement, thirty-four unselected patients were studied with an ultrasound probe over the femoral vein; twenty-one of them also had serial analyses of control and femoral venous blood for fat. Computer energy-density spectrum analysis of the sounds recorded by the ultrasound probe were performed; the fat emboli were counted in the blood samples by two histological techniques; and the plasma was analyzed for triglycerides before and after filtration. Characteristic sounds ("chirps") were heard with the Ultrasound probe during insertion of the femoral component in all patients. The individual chirps lasted two to five milliseconds and occurred every ten to fifteen milliseconds. The mean duration of activity was 4.2 minutes. Rarely, a few chirps were heard during seating of the acetabular component, reaming, or insertion of the cement into the femur. Blood samples during peak ultrasound activity showed: (1) seventy-nine globules per high-power field (control, 1.7) by the cryostat test; (2) 360 globules per high-power field (control, 6.8) by the millipore filter test; and (3) a mean drop in triglycerides after filtration of 27.8 milligrams per 100 milliliters (control, + 1.2). There was no clinical or laboratory evidence of the fat-embolism syndrome. Venting the femoral medullary canal during placement of the femoral component reduced the amount of fat emboli.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				M. Schafer, R. Elke, J. R. Young, P. Gancs, and C. H. Kindler Safety of one-stage bilateral hip and knee arthroplasties under regional anaesthesia and routine anaesthetic monitoring J Bone Joint Surg Br, August 1, 2005; 87-B(8): 1134 - 1139. [Abstract] [Full Text] [PDF]

				N. Sasano, S. Ishida, S. Tetsu, H. Takasu, K. Ishikawa, H. Sasano, and H. Katsuya Cerebral fat embolism diagnosed by magnetic resonance imaging at one, eight, and 50 days after hip arthroplasty: a case report: [L'embolie graisseuse cerebrale diagnostiquee par imagerie par resonance magnetique aux jours 1, 8 et 50 apres une arthroplastie de la hanche : une etude de cas] Can J Anesth, November 1, 2004; 51(9): 875 - 879. [Abstract] [Full Text] [PDF]

				J. Parvizi, M. H. Ereth, and D. G. Lewallen Thirty-Day Mortality Following Hip Arthroplasty for Acute Fracture J. Bone Joint Surg. Am., September 1, 2004; 86(9): 1983 - 1988. [Abstract] [Full Text] [PDF]

				W. Macaulay, E. A. Salvati, T. P. Sculco, and P. M. Pellicci Single-Stage Bilateral Total Hip Arthroplasty J. Am. Acad. Ortho. Surg., May 1, 2002; 10(3): 217 - 221. [Abstract] [Full Text] [PDF]

				J. Parvizi, T. A. Sullivan, R. T. Trousdale, and D. G. Lewallen Thirty-Day Mortality After Total Knee Arthroplasty J. Bone Joint Surg. Am., August 1, 2001; 83(8): 1157 - 1161. [Abstract] [Full Text]

				R. P. PITTO, M. KOESSLER, and J. W. KUEHLE Comparison of Fixation of the Femoral Component without Cement and Fixation with Use of a Bone-Vacuum Cementing Technique for the Prevention of Fat Embolism During Total Hip Arthroplasty. A Prospective, Randomized Clinical Trial J. Bone Joint Surg. Am., June 1, 1999; 81(6): 831 - 43. [Abstract] [Full Text]

				D. G. LEWALLEN Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Neurovascular Injury Associated with Hip Arthroplasty*{{dagger}} J. Bone Joint Surg. Am., December 1, 1997; 79(12): 1870 - 80. [Full Text]

				E. H. SCHEMITSCH, R. JAIN, D. C. TURCHIN, J. B. MULLEN, R. J. BYRICK, G. I. ANDERSON, and R. R. RICHARDS Pulmonary Effects of Fixation of a Fracture with a Plate Compared with Intramedullary Nailing. A Canine Model of Fat Embolism and Fracture Fixation J. Bone Joint Surg. Am., July 1, 1997; 79(7): 984 - 96. [Abstract] [Full Text]