Physiologic emboli changes observed during total hip replacement arthroplasty. A clinical prospective study.

Fat embolism does occur with introduction of femoral components during total hip replacement arthroplasty. If massive, abrupt severe irreversible interruption of pulmonary oxygen exchange or profusion can occur. Adequate intramedullary femoral canal venting can significantly reduce the amount or dosage of fat embolism and thereby reduce and prevent primary or superimposing secondary injury of the capillary-alveolar gas exchange area within the lungs. The occurrence of fat embolism supports the mechanical theory. It also demonstrates that a patient surviving the effects of the acute mechanical pulmonary insult may still have to survive the more common and typical clinical picture of the metabolic pulmonary disease result of fat embolism that likewise can be irreversible. To prevent the occurrence of fat embolism during femoral component insertion with total hip replacement arthroplasty, the following techniques are imperative: (1) adequate femoral intramedullary canal venting; (2) maintenance of pulmonary arterial oxygen tension; (3) maintenance of blood volume.