Retention of the infrapatellar fat pad does not influence the outcome of total knee arthroplasty: a systematic review.

Introduction: To improve patient satisfaction after total knee arthroplasty (TKA), retention of the infrapatellar fat pad (IPFP) is advocated.

Source of data: Recently published literature identified from PubMed, EMBASE, Scopus, and Google Scholar.

Areas of agreement: TKA is routinely performed in patients with end-stage joint osteoarthritis, but 18% to 11% of patients are unsatisfied after surgery.

Areas of controversy: Clinical investigations that compared IPFP resection versus retention are limited.

Growing points: Following the 2020 PRISMA statement, the present systematic review compared resection versus retention of the IPFP in TKA in range of motion (ROM), patellar height, patient-reported outcome measures (PROMs), and complications.

Areas timely for developing research: At a mean duration of 18.4 ± 6.6 months of follow-up, no difference was found in ROM, patellar height, PROMs, and the rate of pain in the anterior aspect of the knee. The outcomes of TKA are not influenced by IPFP retention or excision. Based on the available scientific literature, surgeons could retain the IPFP if suitable visibility and exposure are possible, but resect it if necessary to facilitate exposure during TKA. Further high-level randomized controlled trials with sustained follow-up periods are required to prove the superiority of one surgical technique over the other.