Total Fat Pad Excision Leads to Worse Isokinetic Performance in Total Knee Arthroplasty
Condition: Osteoarthritis, Knee; Knee Arthritis
MeSH terms: Osteoarthritis, Knee
Study type: Interventional

Summary: 
      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 trial is to compare knee society score (KSS),
      knee extension and flexion peak torque in patients undergoing TKA with total IPFP excision or
      partial IPFP excision. The hypothesis of the study is that during TKA, total IPFP excision
      would lead to worse isokinetic performance and clinical outcome.

      A total of 72 patients scheduled to undergo TKA for primary osteoarthritis of the knee by a
      single surgeon were randomly assigned to either the total or partial excision group. Patients
      were evaluated preoperatively and at postoperative 1 year, with Knee Society Score (KSS) and
      isokinetic measurements. Physiatrist doing isokinetic tests and patients were blinded to the
      study.
    


Intervention name(s): Total infrapatellar fat pad excision; Partial infrapatellar fat pad excision
Intervention type(s): Procedure; Procedure
Intervention description(s): Exposure for total knee arthroplasty (TKA) commonly includes total excision of the infrapatellar fat pad (IPFP). The rationale behind this is to obtain improved access to the lateral tibial plateau allowing a more accurate bone cut, baseplate placement and easier management of soft tissue interposition in the bone and cement interface. However, there is growing concern that as the IPFP is a highly vascularized and innervated fibrous adipose tissue filling the anterior compartment of the knee, its complete excision may have a detrimental effect on knee biomechanics and ultimately, TKA outcome. The reason for this effect has been suggested to be patellar tendon (PT) scarring and shortening via ischemic contracture following impaired vascularization, maintenance and biological repair of the tendon.; It has been suggested in the literature that partial infrapatellar fat pad excision instead of total excision would diminish the potential negative effect on patellar tendon and knee biomechanics. However, there is only limited data in the literature and choice of total/partial infrapatellar fat pad excision in TKA remains debatable.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Patients were randomized in a 1:1 ratio via computer-generated randomization using Microsoft Excel 2016 (Microsoft Corporation, Seattle, WA, USA) to be allocated in the total or partial infrapatellar fat pad excision group before the TKA operation (Figure 1). Unblinded senior resident implemented the randomization. Patients and physiatrists performing isokinetic measurements were blinded to group allocation.
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Infrapatellar fat pad; Total knee arthroplasty; Isokinetic test; Strength