Excision versus Preservation of the Infrapatellar Fat Pad During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Abstract

This study aimed to evaluate whether preservation versus resection of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) affects rates of complications, pain scores, and other clinical outcomes. A systematic review and meta-analysis, searching multiple databases up to November 2024 for comparative studies of IPFP preservation versus resection in primary TKA, was conducted. Outcomes assessed included rates of complications, Visual Analog Scale (VAS) for pain, and the rate of anterior knee pain, Knee Society Score (KSS), patellar tendon length (PTL), range of motion (ROM), and operative time. Data were pooled using random-effects meta-analysis. There were 21 studies (3,573 patients, 4,107 TKAs: 2,298 preserved, and 1,809 resected IPFP) included. The IPFP preservation had a 76% reduction in the rate of complications within six weeks (relative risk (RR) = 0.24, 95% confidence interval (CI): 0.12 to 0.48, P < 0.01), but not at later follow-up. The VAS pain scores did not differ significantly between groups at any time point. The IPFP preservation reduced the risk of anterior knee pain at three months (RR = 0.12, 95% CI: 0.02 to 0.94, P = 0.04), but this was not sustained at later follow-up. There were no significant differences found for operative time and KSS. However, IPFP resection resulted in greater patellar tendon shortening at six and 12 months (mean difference (MD) = 2.68 millimeters at 12 months, P < 0.01), with a significant reduction in knee flexion at 12 months (MD = 2.92°, 95% CI: 0.52 to 5.33, P = 0.02). The IPFP preservation during TKA reduces early postoperative complications and short-term anterior knee pain compared to resection, without affecting operative time or long-term pain. Complete resection is associated with patellar tendon shortening and a slight decrease in flexion at 12 months, but does not impact overall functional scores. These findings support IPFP preservation as the preferred approach in TKA over complete resection.