Archives of Orthopaedic and Trauma Surgery

, Volume 136, Issue 5, pp 701–708 | Cite as

The effect of infrapatellar fat pad resection on outcomes post-total knee arthroplasty: a systematic review

  • L. White
  • R. Holyoak
  • J. Sant
  • N. Hartnell
  • J. Mullan
Knee Arthroplasty

Abstract

Introduction

The infrapatellar fat pad (IPFP) is resected in approximately 88 % of total knee arthroplasty (TKA) surgeries. The aim of this review is to investigate the impact of the IPFP resection on clinical outcomes post-TKA.

Materials and methods

A systematic search of five major databases for all relevant articles published until May, 2015 was conducted. Studies comparing the effect of IPFP resection and preservation on outcomes post-TKA were included. Each study was then assessed individually for level of evidence and risk of bias. Studies were then grouped into post-operative outcomes and given a level of evidence ranking based on the collective strength of evidence.

Results

The systematic review identified ten studies suitable for inclusion, with a total of 10,163 patients. Within these ten studies, six post-operative outcomes were identified; knee pain, vascularisation of the patella, range of motion (ROM), patella tendon length/patella infera, wound complications and patient satisfaction. Moderate evidence increased knee pain with IPFP resection post-TKA was found. Conflicting evidence was found for patella vascularisation and patellar tendon length post-TKA. Moderate evidence for no difference in ROM was found. One low quality study was found for wound complications and patient satisfaction.

Conclusions

This systematic review is limited by the lack of level one randomised controlled trials (RCTs). There is however moderate level evidence that IPFP resection increases post-operative knee pain. Further level one RCTs are required to produce evidence-based guidelines regarding IPFP resection.

Systematic Review Level of Evidence: 3.

Keywords

Total knee arthroplasty Infra patellar fat pad Outcomes Pain 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Anderson JG, Wixson RL, Tsai D, Stulberg SD, Chang RW (1996) Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplast 11:831–840CrossRefGoogle Scholar
  2. 2.
    Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA (1998) Patient outcomes after knee replacement. Clin Orthop Relat Res 356:93–110CrossRefPubMedGoogle Scholar
  3. 3.
    Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L (2000) Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 71:262–267. doi: 10.1080/000164700317411852 CrossRefPubMedGoogle Scholar
  4. 4.
    Baker PN, van der Meulen JH, Lewsey J, Gregg PJ, National Joint Registry for England, Wales (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 89:893–900. doi: 10.1302/0301-620X.89B7.19091 CrossRefPubMedGoogle Scholar
  5. 5.
    Pinsornsak P, Naratrikun K, Chumchuen S (2014) The effect of infrapatellar fat pad excision on complications after minimally invasive TKA: a randomized controlled trial. Clin Orthop Relat Res 472:695–701. doi: 10.1007/s11999-013-3321-z CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    White L, Hartnell N, Hennessy M, Mullan J (2015) The impact of an intact infrapatellar fat pad on outcomes after total knee arthroplasty. Adv Orthop Surg 2015:1–6. doi: 10.1155/2015/817906 CrossRefGoogle Scholar
  7. 7.
    Bonutti PM, Mont MA, Kester MA (2004) Minimally invasive total knee arthroplasty: a 10-feature evolutionary approach. Orthop Clin N Am 35:217–226. doi: 10.1016/j.ocl.2004.02.001 CrossRefGoogle Scholar
  8. 8.
    Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H (2011) The 2011 Oxford CEBM Levels of Evidence (Introductory Document). Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653. Accessed 09 May 2015
  9. 9.
    Julian PT, Altman DG (2008) Chapter 8: assessing risk of bias in included studies. Cochrane Database. http://hiv.cochrane.org/sites/hiv.cochrane.org/files/uploads/Ch08_Bias.pdf. Accessed 09 May 2015
  10. 10.
    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi: 10.1136/bmj.d5928 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lemon M, Packham I, Narang K, Craig DM (2007) Patellar tendon length after knee arthroplasty with and without preservation of the infrapatellar fat pad. J Arthroplast 22:574–580. doi: 10.1016/j.arth.2006.04.026 CrossRefGoogle Scholar
  12. 12.
    Macule F, Sastre S, Lasurt S, Sala P, Segur JM, Mallofre C (2005) Hoffa’s fat pad resection in total knee arthroplasty. Acta Orthop Belg 71:714–717PubMedGoogle Scholar
  13. 13.
    McMahon MS, Scuderi GR, Glashow JL, Scharf SC, Meltzer LP, Scott WN (1990) Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/or lateral retinacular release in total knee arthroplasty. Clin Orthop Relat Res 260:10–16PubMedGoogle Scholar
  14. 14.
    Meneghini RM, Pierson JL, Bagsby D, Berend ME, Ritter MA, Meding JB (2007) The effect of retropatellar fat pad excision on patellar tendon contracture and functional outcomes after total knee arthroplasty. J Arthroplast 22:47–50. doi: 10.1016/j.arth.2007.03.031 CrossRefGoogle Scholar
  15. 15.
    Seo SS, Kim CW, Ha DJ, Chung HJ (2010) Role of infrapatellar fat pad on primary total knee arthroplasty. J Bone Joint Surg Br 92B:161Google Scholar
  16. 16.
    Seo GS, Lee SA, Moon Y-W, Lee BH, Ko YH, Chang MJ (2015) Infrapatellar fat pad preservation reduces wound complications after minimally invasive total knee arthroplasty. Arch Orthop Trauma Surg 135:1157–1164. doi: 10.1007/s00402-015-2233-7 CrossRefPubMedGoogle Scholar
  17. 17.
    Subramanyam P, Sundaram PS, Rao N (2012) Scintigraphic assessment of patellar vascularity in total knee replacement surgeries following lateral release. Avicenna J Med 2:54–59. doi: 10.4103/2231-0770.102277 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Tanaka N, Sakahashi H, Sato E, Hirose K, Isima T (2003) Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplast 18:897–902CrossRefGoogle Scholar
  19. 19.
    Van Beeck A, Clockaerts S, Somville J, Van Heeswijk JH, Van Glabbeek F, Bos PK, Reijman M (2013) Does infrapatellar fat pad resection in total knee arthroplasty impair clinical outcome? A systematic review. Knee 20:226–231. doi: 10.1016/j.knee.2013.01.005 CrossRefPubMedGoogle Scholar
  20. 20.
    Toussirot E, Streit G, Wendling D (2007) The contribution of adipose tissue and adipokines to inflammation in joint diseases. Curr Med Chem 14:1095–1100CrossRefPubMedGoogle Scholar
  21. 21.
    Ioan-Facsinay A, Kloppenburg M (2013) An emerging player in knee osteoarthritis: the infrapatellar fat pad. Arthritis Res Ther 15:225. doi: 10.1186/ar4422 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Subhawong TK, Eng J, Carrino JA, Chhabra A (2010) Superolateral Hoffa’s fat pad edema: association with patellofemoral maltracking and impingement. AJR Am J Roentgenol 195:1367–1373. doi: 10.2214/AJR.10.4668 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kayler DE, Lyttle D (1988) Surgical interruption of patellar blood supply by total knee arthroplasty. Clin Orthop Relat Res 229:221–227PubMedGoogle Scholar
  24. 24.
    Dennis DA (2001) Periprosthetic fractures following total knee arthroplasty. Instr Course Lect 50:379–389PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.School of Medicine Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
  2. 2.St George HospitalSt GeorgeAustralia

Personalised recommendations