Abstract
There are concerns that total infrapatellar fat pad (IPFP) excision in total knee
arthroplasty (TKA) results in patellar tendon shortening due to ischemic contracture,
but individual preference of the surgeon is still the main determinant between total
or partial excision. The aim of this randomized controlled study was to compare isokinetic
performance and clinical outcome of TKAs with total and partial excision of the IPFP.
Seventy-two patients scheduled to undergo TKA for primary knee osteoarthritis by a
single surgeon were randomly assigned to either total or partial excision group. Patients
were evaluated preoperatively and at postoperative 1 year, with Knee Society Score
(KSS) and isokinetic measurements. The physiatrist performing isokinetic tests and
patients were blinded to the study. There were no significant differences between
the groups in respect of age, body mass index, gender, and preoperative KSS and isokinetic
performance. Postoperatively, both groups had improved KSS knee and KSS function scores,
with no difference determined. Knee extension peak torque was significantly higher
postoperatively in the partial excision group at postoperative 1 year (p = 0.036). However, there were no significant differences in knee flexion peak torque
following TKA (p = 0.649). The results of this study demonstrated that total excision of the IPFP
during TKA is associated with worse isokinetic performance, which is most likely due
to changes in the knee biomechanics with the development of patella baja. Partial
excision of the IPFP appears to be a valid alternative to overcome this potential
detrimental effect without impeding exposure to the lateral compartment. This is a
Level I, therapeutic study.
Keywords
infrapatellar fat pad - patellar tendon - total knee arthroplasty - isokinetic test
