Fat Embolism in Hip Arthroplasty

Abstract

Since 1970 cardiorespiratory deterioration has been a well recognised complication during cemented Total Hip Arthroplasty (THA). Originally this effect was attributed to chemical and thermal effects of bone cement. There is evidence from several animal and clinical studies that these cardiorespiratory changes are caused by fat embolism to the lung, and high intramedullary pressure (IMP) is the main causative factor for this fatty marrow release into the circulation. Fat embolism syndrome (FES) as a rare but severe perioperative complication represents the clinical manifestation of severe fat embolism. It is of clinical importance that surgeons have a better understanding on this syndrome. In this review a new pathophysiological model for FES is presented. As there is no causal therapy for FES, several modified surgical techniques are discussed in relation to their efficiency in preventing fat embolism during endoprosthetic surgery of the hip. The anaesthetic contribution to prophylaxis is also described and a therapeutic concept for the symptomatic treatment of FES is proposed.