ArticleMedicine2017
A study on dynamic monitoring, components, and risk factors of embolism during total knee arthroplasty.
Article in Medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 16 citations in OpenAlex.
- Bone cement implantation syndrome: a scoping review.British journal of anaesthesia · 2025Article
- Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial.Arthroplasty today · 2025Article
- Observational
- Pathologic mechanism of hidden blood loss after total knee arthroplasty: oxidative stress induced by free fatty acids.International journal of clinical and experimental pathology · 2022Article
- Cerebral and pulmonary fat embolism after unilateral total knee arthroplasty.Arthroplasty today · 2019Article
- Neurologic Complications of Fat Embolism Syndrome.Current neurology and neuroscience reports · 2019Review
- Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain.JB & JS open accessArticle
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Authors and funding
5 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundFat embolism is a common complication of orthopedic surgery. However, the exact component and risk factor responsible for this complication remains unelucidated. This study aimed to detect the origin of the pulmonary embolus and identify relevant risk factors of pulmonary embolism in total knee replacement.
methodsA total of 40 osteoarthritis patients who underwent primary unilateral TKA were recruited into this study. Transesophageal echocardiography (TEE) was utilized to dynamically monitor the embolism. Pulmonary arterial pressure was recorded and biopsies were obtained from the medullary cavity during surgery.
resultsAfter tourniquet release, the arterial embolism was observed by TEE to have a peak signal at 30 seconds when pulmonary arterial pressure was increased by 25% to 40% (P = .002). The pathology study of the embolism revealed its bone marrow origin. Total embolus quantity was positively correlated with age (P = .021), body mass index (BMI, P = .041), and fat content of the bone marrow (P = .003). Logistic regression analysis revealed that the fat content of the marrow (OR: 1.432, 95% CI: 1.335-1.592), age (OR: 1.632, 95% CI: 1.445-1.832), and BMI (OR: 1.231, 95% CI: 1.032-1.381) were risk factors for pulmonary hypertension.
conclusionThis study revealed that the embolus detected in the right atrium was derived from bone marrow tissues, and this led to pulmonary arterial pressure fluctuations after tourniquet release. Therefore, elderly patients who have high BMI or bone marrow fat content are at high-risk for pulmonary fat embolism during TKA.
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