Short-term comparison between resection and preservation of the infrapatellar pad of fat in patients undergoing primary total knee replacement

Abstract

Background: Resection of infrapatellar pad of fat (IPPF) is an ordinary step performed in primary total knee joint replacement (TKR) in approximately 88% to get a clearer field and eases patellar retraction to a side away during the surgical procedure. Objectives: The aim of this study was to evaluate the preservation versus resection of the IPPF regarding postoperative pain and range of movements in patients undergoing primary TKR. Materials and Methods: This was a prospective, case series study conducted in Erbil Teaching Hospital from March 1, 2018 till December 31, 2018. A total of 28 patients who underwent primary TKR were randomly allocated into two equal groups. In the first group the pad of fat was resected, whereas in the other group the pad of fat was preserved. The follow-up period of this study was 9 months. Patients of both groups were seen and followed up in the ward in the first 5 days of admission and seen again at the outpatient clinic at weeks 2, 6, 12, 24, and 36. The anterior knee joint pain and range of movement were recorded and observed by visual analog scale (VAS) score, knee score, and knee functional score. Results: Twenty-eight patients who underwent primary TKR were included in this study. Among them, 18 patients were women (64.28%) and 10 were men (35.72%). The mean age of the patients was 63.42 years ± 4.31 years, ranging from 56 to 71 years. Improved postoperative VAS score of the IPPF resection group (6.28 ± 0.91) and preserved group (5.92 ± 0.82) were observed (P < 0.045) at the 6 months of follow-up. Improvement in the degree of flexion observed in the IPPF preservation group over the resected one (P < 0.0060), with either no statistical differences were noticed of the final Knee Society Scores or the functional scores of the two groups, (62.78 ± 4.91) and (50.07 ± 5.80) of the IPPF resected group, (64.57 ± 5.54) and (52.14 ± 5.08) of the IPPF preservation group with both scores (P = 0.059 and 0.850), respectively. Conclusions: Preservation over resection of the IPPF during primary TKR decreases the postoperative anterior knee joint pain. Consequently, no significant changes were observed regarding the knee joint functionality.

Keywords

• infrapatellar pad of fat
• resection versus preservation
• total knee replacement