Delayed presentation of fat embolism syndrome following elective total hip arthroplasty

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.