Cerebral fat microembolism and cognitive decline after hip and knee replacement

Sebastian Koch, Alejandro Forteza, Carlos Lavernia, Jose G. Romano, Iszet Campo-Bustillo, Nelly Campo, Stuart Gold

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


BACKGROUND AND PURPOSE - Intra-operative cerebral microembolism may be a factor in the etiology of cognitive decline after orthopedic surgery. We here examine the impact of intra-operative microembolism on cognitive dysfunction after hip and knee replacement surgery. METHODS - We enrolled 24 patients, at least 65 years old, requiring elective knee or hip replacement surgery. A transcranial Doppler shunt study was done to determine study eligibility so that the final study population consisted of 12 consecutive patients with and 12 consecutive patients without a venous-arterial shunt. A standard neuropsychological test battery was administered before surgery, at hospital discharge and 3 months after surgery. All patients were monitored intra-operatively for microemboli. Quality of life data were assessed at 1 year. RESULTS - The mean age of patients was 74 years. All patients had intra-operative microemboli. The mean number of emboli was 9.9±18. Cognitive decline was present in 18/22 (75%) at discharge and in 10/22 (45%) at 3 months, despite improved quality of life measures. There was no correlation between cognitive decline and intra-operative microembolism. CONCLUSION - Cognitive decline was seen frequently after hip and knee surgery. Intra-operative microembolism occurred universally but did not significantly influence postoperative cognition. Quality of life and functional outcome demonstrated improvement in all cases in spite of cognitive dysfunction.

Original languageEnglish (US)
Pages (from-to)1079-1081
Number of pages3
Issue number3
StatePublished - Mar 2007


  • Fat embolism
  • Postoperative cognitive decline

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)
  • Medicine(all)


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