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

Arch Orthop Trauma Surg. 2016 May;136(5):701-8. doi: 10.1007/s00402-016-2440-x. Epub 2016 Mar 22.


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: Infra patellar fat pad; Outcomes; Pain; Total knee arthroplasty.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adipose Tissue / surgery*
  • Arthroplasty, Replacement, Knee / adverse effects
  • Arthroplasty, Replacement, Knee / methods*
  • Humans
  • Knee Joint / physiology
  • Knee Joint / surgery
  • Osteoarthritis, Knee / physiopathology
  • Osteoarthritis, Knee / surgery*
  • Pain, Postoperative / etiology
  • Patella / blood supply
  • Patella / surgery*
  • Patellar Ligament / anatomy & histology
  • Patellar Ligament / physiology
  • Patient Satisfaction
  • Postoperative Complications
  • Range of Motion, Articular