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September 27, 1976

Fat Embolization After Total Knee Replacement

Author Affiliations

Columbus, Ohio

JAMA. 1976;236(13):1451. doi:10.1001/jama.1976.03270140017008

To the Editor.—  Fat and other bone marrow elements have been found in the postmortem examination of the lungs of patients who have died after the insertion of bone cement into the femoral and medullary canals following total hip replacement. Experimental and clinical data have associated the phenomenon of fat embolus with hip surgery.1-4Recently, Bisla et al reported the occurrence of the fat embolus syndrome after bilateral total knee replacements with the Guepar prosthesis.5 To this case report we would like to add a similar incident involving a 50-year-old woman who had known rheumatoid arthritis with serious functional incapacitation caused by severe knee involvement. Bilateral total knee replacements were performed under the same anesthesia.After returning to the recovery room, the patient did not regain consciousness but became hypotensive, and tachypnea developed. Blood gas determinations disclosed a depressed Po2, and massive petechia developed over the chest