30 female patients scheduled for total knee arthroplasty (TKA) were randomized to undergo the procedure with or without intramedullary canal irrigation. The purpose of this study was to evaluate and compare the formation of fat emboli during the procedure between the two groups. Transesophageal echocardiography (TEE) was used to determine the grey-scale score and area ratio of fat emboli during the procedure. Hemodynamic parameters were also assessed. Results indicated that there was a significantly lower grey-scale score and area ratio in the irrigation group when compared to the conventional group specifically during preparation of the femoral and tibial canals. Groups did not significantly differ during any other phase of the procedure. Additionally, hemodynamic parameters were similar between groups during the procedure.