This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fallon, K. M. Articles by Morley-Forster, P. Search for Related Content PubMed PubMed Citation Articles by Fallon, K. M. Articles by Morley-Forster, P.

Fat embolization and fatal cardiac arrest during hip arthroplasty with methylmethacrylate

[Embolie graisseuse et arrêt cardiaque fatal pendant l'arthroplastie de la hanche réalisée avec du méthyle méthacrylate]

From the Department of Anesthesia, St. Joseph's Health Care, London, Ontario, Canada.

Address correspondence to: Dr. John G. Fuller, Department of Anesthesia, St. Joseph's Health Care, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada. Phone: 519-663-3283; Fax: 519-663-3079; E-mail: jfuller{at}julian.uwo.ca

Purpose: This case report describes a cardiac arrest during a cemented hip arthroplasty procedure. Hemodynamic instability during methylmethacrylate use in arthroplasty surgery can be explained by fat embolization rather than the inherent toxicity of the monomer.

Clinical features: A 78-yr-old woman required a cemented hemiarthroplasty for a pathologic left subcapital fracture. The patient's past medical history included stable angina, diet-controlled type II diabetes and metastatic breast cancer. During the cementing of the canal and insertion of the femoral prosthesis, desaturation, hypotension and cardiac arrest occurred. The patient underwent a successful intraoperative resuscitation and was transferred to the intensive care unit where she subsequently developed disseminated intravascular coagulopathy. The patient died 24 hr later and autopsy confirmed the cause of death as fat embolization.

Conclusion: The deleterious cardiovascular effects of methylmethacrylate have been discussed in the literature. However, clinical evidence supports fat embolization during arthroplasty surgery as a greater determinant of hemodynamic compromise. Surgical precautions are paramount in minimizing the sequelae of Bone Implantation Syndrome and anesthetic treatment consists of supportive care.

This article has been cited by other articles:

				S. G. Memtsoudis, P. Rosenberger, and J. M. Walz Critical Care Issues in the Patient After Major Joint Replacement J Intensive Care Med, March 1, 2007; 22(2): 92 - 104. [Abstract] [PDF]

				T. Lin, Y. Chen, C. Lu, and M. Wang Use of transoesophageal echocardiography during cardiac arrest in patients undergoing elective non-cardiac surgery Br. J. Anaesth., February 1, 2006; 96(2): 167 - 170. [Abstract] [Full Text] [PDF]

				M. Moriyama, S. Watanabe, T. Hiraki, T. Kano, T. Okawa, and M. Ishibashi Relationship between intraoperative transoesophageal echocardiography findings and perfusion lung scintigraphy results on first postoperative day Br. J. Anaesth., May 1, 2005; 94(5): 607 - 612. [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]

				C. M. Harper Fat embolism and postoperative coagulopathy Can J Anesth, January 1, 2002; 49(1): 108 - 108. [Full Text] [PDF]

				R. J. Byrick Fat embolism and postoperative coagulopathy / L'embolie graisseuse et la coagulopathie postoperatoire Can J Anesth, July 1, 2001; 48(7): 618 - 621. [Full Text] [PDF]