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(Stroke. 2007;38:1079.)
© 2007 American Heart Association, Inc.

Research Reports

Cerebral Fat Microembolism and Cognitive Decline After Hip and Knee Replacement

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

From the Department of Neurology (S.K., A.F., J.G.R., I.C.-B., N.C., S.G.), Department of Neurology and Psychiatry, University of Miami, Miller School of Medicine; and the Orthopaedic Institute at Mercy Hospital (C.L.), Miami, Fla.

Correspondence to Sebastian Koch, 1150 NW 14th St, Ste #609, Professional Arts Center, Miami, FL 33136. E-mail skoch{at}med.miami.edu

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.

Key Words: fat embolism • postoperative cognitive decline

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