Fatal fat embolism complicating cemented total knee replacement: another manifestation of the metabolic syndrome?

We report the case of a 52-year-old man who died of massive fat emboli 39 h after undergoing elective total knee replacement. His past medical history included hypertension, obesity and diabetes (most of the clusters of the metabolic syndrome). Post-mortem pathological examination showed fat embolism in the kidneys and the brain. This is the first reported case of fat emboli as the cause of death in an association with metabolic syndrome, and the case suggests that the fat embolism should be anticipated in over weight and obese individuals with three or more of the risk factors of the metabolic syndrome.