Severe Fat Embolism Syndrome Associated With Uncemented Total Hip Arthroplasty

Abstract

A 53-year-old healthy female developed severe fat embolism syndrome (FES) during uncemented total hip arthroplasty under general anesthesia. During the surgical course, her arterial blood pressure, heart rate and expiratory end-tidal carbon dioxide tension remained stable except for a transient drop in percutaneous hemoglobin oxygen saturation from 99% to 95% approximately 20 min after the insertion of a femoral component. After the operation, she did not regain consciousness, and neurological signs were recognized. The clinical diagnosis of FES was made postoperatively by intracerebral high signal intensity spots on the T₂-weighed MRI scan, hypoxemia consistent with pulmonary edema on the chest radiograph, petechiae on the palpebral conjunctiva and the anterior chest, laboratory findings indicating disseminated intravascular coagulopathy and fat globules in the urine. She suffered from hypoxemia, hypotension and abnormal bleeding from all skin wounds in the intensive care unit. Ventilatory and hemodynamic supports and therapy for coagulopathy were successful by the 5th postoperative day, but she did not recover con-sciousness. Her impaired consciousness has shown no significant improvement in the ten months since surgery.