IPFP preservation versus resection in TKA shows no significant difference in 12-month KOOS scores

This randomized controlled trial evaluated whether preserving versus resecting the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) for knee osteoarthritis affected 12-month patient-reported outcomes. The study stratified 377 total participants into two groups based on preoperative MRI assessment of IPFP quality: Group 1 (normal IPFP, n=179) and Group 2 (abnormal IPFP, n=198). Within each group, patients were randomized to IPFP preservation or resection.

The primary outcome was the 12-month change in the mean of five Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales (range 0-100). In Group 1 (normal IPFP), the preservation group had a mean increase of 38.1 points versus 36.1 points in the resection group, a between-group difference of 1.9 points (95% CI, -1.7 to 5.6). In Group 2 (abnormal IPFP), the preservation group increased by 39.2 points versus 37.5 points in the resection group, a difference of 1.6 points (95% CI, -1.3 to 4.6). In both groups, the confidence intervals for the between-group differences included zero, indicating no statistically significant difference.

Adverse events were predominantly nonserious musculoskeletal or skin-related events. In Group 1, there were three events in the preservation arm versus two in the resection arm. In Group 2, there were eight versus two events, respectively. Serious adverse events and discontinuation rates were not reported. The study was funded by Chinese national and university research programs.

For clinical practice, the results indicate that neither resection of an abnormal IPFP nor preservation of a normal IPFP led to a statistically significant improvement in KOOS scores 12 months after TKA. The small numerical differences favoring preservation were not statistically significant, and the study does not provide evidence to recommend one technique over the other based on 12-month patient-reported outcomes. Surgeons should consider that the evidence does not support changing standard IPFP management during TKA to improve these specific outcomes.