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Femoral shaft fracture
0%
9/3769
Inadequate fluid resuscitation during surgery
1%
27/3769
Acute myocardial infarction
32/3769
Pulmonary embolism caused by dislodging of deep venous thrombosis during hip exposure
3%
95/3769
Intramedullary fat and marrow embolization
95%
3589/3769
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During insertion of the femoral stem, the intramedullary pressures are increased. Fat and marrow elements can become embolized into the bloodstream at this point resulting in ventilation perfusion mismatch in the lungs. Kim et al prospectively followed 156 total hip arthroplasties including bilateral and unilateral procedures as well as cemented and uncemented procedures. They found no difference in fat embolization amongst any of the groups. However, they did find that if patients had evidence of bone marrow cells in the right atrium on the first postoperative day, they developed diffuse encephalopathy with confusion and agitation that lasted for about twenty-four hours.
4.4
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