Are short term outcomes superior following total knee arthroplasty when infra-patellar fat pad is resected? A systematic review and meta-analysis

Abstract

Background: Data suggests the infra-patellar fat pad (IPFP) is resected in the majority of total knee arthroplasty cases. Current literature suggests there may be scope for increasing preservations rates. A systematic review and meta-analysis of available literature was performed to assess if resection of IPFP resulted in superior patient outcomes. Methods: Scopus, PubMed, Cochrane, Embase and CINAHL were systematically searched in February 2024 for articles of relevance and meta-analysis conducted. A standardized mean difference and confidence interval of 95% was calculated. An odds ratio was calculated for all included datasets. Heterogeneity was assessed for using the I2 statistic. Results: Thirteen studies were included within this review. IPFP resection shortened the patella tendon at 6 months post-operatively (OR, 0.07; 95% CI, 0.02–0.12, P = 0.006). Results favoured preservation at 12 months post-operatively (OR, 0.02; 95% CI, −0.02 to 0.06, P = 0.32). Oxford Knee Society (OKS) results statistically favoured preservation at 6 months (OR, 1.57; 95% CI, 0.74–2.39, P = 0.0002). Findings at 12 months favoured resection (OR, −0.49; 95% CI, −5.39, 4.41, P = 0.84). Resection increased anterior knee pain at 6–12 months post-operatively (OR, 1.45; 95% CI, 1.12–1.89, P = 0.005). Combined subgroup analysis of flexion favoured resection (OR, −2.15; 95% CI, −6.52 to 2.22, P = 0.34). Conclusion: OKS and patella tendon length results favoured preservation at 6 months however did not reach minimal clinically important difference. Combined subgroup analysis of flexion did not yield a statistically significant result. Rates of anterior knee pain at 6–12 months favoured preservation.