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IPFP preservation versus resection in TKA shows no significant difference in 12-month KOOS scoresStudy finds no clear benefit to preserving or removing knee fat pad during joint replacement

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Key Takeaway
Note: IPFP preservation vs resection in TKA showed no significant 12-month KOOS difference.

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.

Researchers conducted a study to see whether preserving or removing a small pad of fat under the kneecap during total knee replacement surgery leads to better outcomes. They studied 377 patients with knee osteoarthritis who were having knee replacement surgery. Patients were divided into groups based on whether their fat pad looked normal or abnormal on MRI, and then randomly assigned to have it preserved or removed during surgery.

The main measure was how much patients' knee pain and function improved one year after surgery, using a standard scoring system. In both groups (normal and abnormal fat pads), patients who had preservation surgery had slightly higher average improvement scores than those who had removal surgery. However, the difference was small enough that it could have happened by chance, meaning there was no clear advantage to either approach.

The study reported some minor side effects like muscle or skin issues, but these were uncommon and not clearly linked to which surgical approach was used. Because the study wasn't large enough to detect small differences between groups, and because the results don't show a clear benefit to either approach, patients should understand that both preservation and removal appear to be reasonable options that surgeons can consider based on individual circumstances.

What this means for you:
Preserving or removing the knee fat pad during replacement surgery showed similar outcomes after one year.

Study Details

Study typeRct
Sample sizen = 90
EvidenceLevel 2
Follow-up12.0 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Preservation of normal-quality infrapatellar fat pads (IPFP) during total knee arthroplasty (TKA) has been proposed, and IPFP of abnormal quality are recommended for resection. METHODS: In this trial, patients with knee osteoarthritis (OA) undergoing TKA were stratified by IPFP status on magnetic resonance imaging (Group 1 with normal IPFP [signal intensity score ≤1; ranging from 0 to 3]; Group 2 with abnormal IPFP [signal intensity score ≥2]) and randomly assigned in a 1:1 ratio to IPFP preservation or IPFP resection. The primary outcome was 12-month change in the mean of five Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales (KOOS), which range from 0 (worst) to 100 (best). RESULTS: In Group 1, 179 participants were randomly allocated to IPFP preservation (n=90) and IPFP resection (n=89), and 198 participants were randomly assigned to IPFP preservation (n=101) and IPFP resection (n=97) in Group 2. The increases in KOOS score were 38.1 and 36.1 in Group 1 and were 39.2 and 37.5 in Group 2 in IPFP preservation and IPFP resection groups, respectively, resulting in between-group differences of 1.9 (95% confidence interval [CI], -1.7 to 5.6) in Group 1 and 1.6 (95% CI, -1.3 to 4.6) in Group 2. Adverse events were predominantly nonserious musculoskeletal or skin-related events (three vs. two in Group 1 and eight vs. two in Group 2). CONCLUSIONS: Resection of abnormal IPFP and preservation of normal IPFP did not improve postoperative outcomes 12 months after TKA. (Funded by National Key Research & Development Program of China, Clinical Research Startup Program of Southern Medical University, and National Natural Science Foundation of China; ClinicalTrials.gov number, NCT03763448.).
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