Excision Versus Preservation of the Infrapatellar Fat Pad During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Khaled Skaik, Sarah Oulousian, Darius L Lameire et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared preservation with resection of the infrapatellar fat pad during primary total knee arthroplasty. It included 21 comparative studies involving 3,573 patients and 4,107 TKAs. Preservation was associated with fewer complications within six weeks (relative risk = 0.24, 95% confidence interval [CI]: 0.12 to 0.48, P < 0.01), but not at later follow-up. It also reduced anterior knee pain at three months, with no sustained difference later. Resection was associated with greater patellar tendon shortening and slightly less knee flexion at 12 months; pain scores and overall functional scores did not differ significantly.
Key findings
- Preservation was associated with fewer complications within six weeks (relative risk = 0.24, 95% confidence interval [CI]: 0.12 to 0.48, P < 0.01), but not later.
- Anterior knee pain was less frequent with preservation at three months (relative risk = 0.12, 95% CI: 0.02 to 0.94, P = 0.04); the difference was not sustained.
- Resection was associated with greater patellar tendon shortening at 12 months (mean difference = 2.68 mm, P < 0.01) and reduced knee flexion (mean difference = 2.92°, 95% CI: 0.52 to 5.33, P = 0.02).
- Visual analog scale pain scores, operative time, and Knee Society Scores did not differ significantly between groups.
Why it matters
The findings suggest that preserving the infrapatellar fat pad may offer short-term benefits and avoid some changes in patellar tendon length and knee flexion after TKA, without evidence of worse pain or functional scores. The distinction between early and later outcomes is important: the reported reductions in complications and anterior knee pain were not sustained at later follow-up.
What to keep in mind
The review pooled comparative studies, and the abstract does not specify that these were randomised trials; the findings therefore do not establish that preservation caused the observed differences.