Fat embolism is a known complication of traumatology, especially in long bone fractures. It may also occur in liposuction and articular surgery (0.1%). Fat embolic events are most often clinically insignificant and difficult to recognize since clinical manifestations are varied and there is no routine laboratory or radiographic diagnosis. Classically, fat embolism syndrome presents with the triad of pulmonary distress, mental status changes, and cutaneous manifestations. We report the case of a 33-year-old woman who developed acute respiratory distress 10 days after hip arthroplasty. Several aetiologies such as fibrinocruoric pulmonary embolism, pulmonary aspiration and bacterial pneumonia were discussed. Fat embolism was diagnosed, based on suggestive clinical manifestations, radiographic and laboratory findings, although fat embolism after hip arthroplasty without intramedullary pressurization is infrequent.