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Delayed presentation of fat embolism syndrome following elective total hip arthroplasty
  1. Jeannette Mullins1,
  2. John Stone2 and
  3. Amit Chopra3
  1. 1Albany Medical College, Albany, New York, USA
  2. 2Internal Medicine, Boston Medical Center, Boston, MA, USA
  3. 3Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York, USA
  1. Correspondence to Ms. Jeannette Mullins; mullinj1{at}


Fat embolism syndrome (FES) is a rare complication of long bone fractures with an incidence of 0.3%–1.3%. FES most commonly presents within 72 hours of injury but may develop as late as 10 days following a fracture. FES is rarely associated with elective orthopaedic procedures. In this case report, we describe a patient who developed FES 9 days after an elective left total hip arthroplasty. Presentation far outside of the typical 72-hour window for FES, the diagnosis was initially missed. The patient initially presented to our emergency room on postoperative day 14 with 5 days of dyspnoea and was diagnosed with pneumonia and sent home on antibiotics. Sixteen days following this ED admission and on postoperative day 30, she remained dyspneic and was found to be hypoxic to 74% on room air. CT angiography at this time found bilateral diffuse ground glass opacities. Bronchoalveolar lavage was notable for lipid-laden macrophages, and FES was subsequently diagnosed.

  • Adult intensive care
  • Respiratory medicine
  • Orthopaedic and trauma surgery
  • Radiology (diagnostics)
  • Respiratory system

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  • Contributors JM and JS equally contributed to inception, writing and editing. AC is the principal investigator.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.