Abstract
Considerations of how to improve postoperative outcomes for total knee arthroplasty
(TKA) have included preservation of the infrapatellar fat pad (IPFP). Although the
IPFP is commonly resected during TKA procedures, there is controversy regarding whether
resection or preservation should be implemented, and how this influences outcomes.
Therefore, the purpose of this systematic review was to evaluate how IPFP resection
and preservation impacts postoperative flexion, pain, Insall-Salvati Ratio (ISR),
Knee Society Score (KSS), patellar tendon length (PTL), and satisfaction in primary
TKA. PubMed, EBSCO host, and SCOPUS were queried to retrieve all reports evaluating
IPFP resection or preservation during TKA, which resulted into 488 studies. Two reviewers
independently reviewed these articles for eligibility based on pre-established inclusion
and exclusion criteria. Eleven studies were identified for final analysis, which reported
on 11,996 cases. Patient demographics, type of surgical intervention, follow-up duration,
and clinical outcome measures were collected and analyzed. Complete resection was
implemented in 3,723 cases (31%), partial resection in 5,458 cases (45.5%), and preservation
of the IPFP in 2,815 cases (23.5%). Clinical outcome measures included PTL (5 studies),
knee flexion (4 studies), pain (6 studies), KSS (3 studies), ISR (3 studies), and
patient satisfaction (1 study). No differences were found following IPFP resection
for patient satisfaction (p = 0.98), ISR (p > 0.05), and KSS (p > 0.05). There was mixed evidence for PTL, pain, and knee flexion following IPFP resection
versus preservation. Studies of shorter follow-up intervals suggested improved pain
following resection, while reports of longer follow-up times indicated that resection
resulted in increased pain. Given the mixed data available from the current literature,
we were unable to conclude that one surgical technique can definitively be considered
superior over the other. More extensive research, including randomized controlled
trials, is required to better elucidate potential differences between the surgical
handling choices. Future studies should focus on patient conditions in which one technique
would be best indicated to establish guidelines for best surgical outcomes in those
patients.
Keywords
infrapatellar fat pad - resection - preservation - total knee arthroplasty - outcomes
