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Cardiac arrest during total knee replacement using a long-stem prosthesis

F K Enneking1

  • 1Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.

Journal of Clinical Anesthesia
|May 1, 1995
PubMed
Summary

Sudden cardiac arrest during joint replacement surgery can be caused by fat embolism syndrome (FES). This rare complication involves fat and marrow entering circulation, leading to hypoxemia and hypotension.

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Area of Science:

  • Orthopedic Surgery
  • Cardiology
  • Anesthesiology

Background:

  • Sudden cardiac arrest is a rare but serious complication during total joint replacement.
  • Polymethyl methacrylate cement and prosthesis insertion are common triggers.

Observation:

  • A cardiac arrest occurred during the insertion of a long-stem prosthesis for knee replacement revision without a tourniquet.
  • This event was attributed to fat embolism syndrome (FES).

Findings:

  • FES involves hypoxemia from pulmonary embolism of fat/marrow and hypotension from cement monomer absorption.
  • Long-stem prostheses may increase FES risk.
  • Hypoxemia correlates with thromboplastic products and bone marrow release.
  • Diagnosis relies on recognizing hypoxemia, neurologic changes, and fever.

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Implications:

  • Intraoperative monitoring of pulmonary pressures during unexplained hypoxemia is crucial for FES detection.
  • Understanding FES pathophysiology aids in preventing and managing this complication.
  • Awareness of FES is vital for surgeons and anesthesiologists performing joint replacements.