title: The effect of infrapatellar fat pad resection on outcomes post-total knee arthroplasty: a systematic review.
abstract: BACKGROUND
  The infrapatellar fat pad (IPFP) is resected in approximately 88 % of total knee arthroplasty (TKA) surgeries. The aim of this review is to investigate the impact of the IPFP resection on clinical outcomes post-TKA.
  
  
  METHODS
  A systematic search of five major databases for all relevant articles published until May, 2015 was conducted. Studies comparing the effect of IPFP resection and preservation on outcomes post-TKA were included. Each study was then assessed individually for level of evidence and risk of bias. Studies were then grouped into post-operative outcomes and given a level of evidence ranking based on the collective strength of evidence.
  
  
  RESULTS
  The systematic review identified ten studies suitable for inclusion, with a total of 10,163 patients. Within these ten studies, six post-operative outcomes were identified; knee pain, vascularisation of the patella, range of motion (ROM), patella tendon length/patella infera, wound complications and patient satisfaction. Moderate evidence increased knee pain with IPFP resection post-TKA was found. Conflicting evidence was found for patella vascularisation and patellar tendon length post-TKA. Moderate evidence for no difference in ROM was found. One low quality study was found for wound complications and patient satisfaction.
  
  
  CONCLUSIONS
  This systematic review is limited by the lack of level one randomised controlled trials (RCTs). There is however moderate level evidence that IPFP resection increases post-operative knee pain. Further level one RCTs are required to produce evidence-based guidelines regarding IPFP resection. Systematic Review Level of Evidence: 3.
authors.affiliation: School of Medicine Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia. lw844@uowmail.edu.au.
authors.forename: L
authors.identifier: http://orcid.org/0000-0002-7784-0644
authors.initials: L
authors.lastname: White
authors.affiliation: School of Medicine Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Holyoak
authors.affiliation: St George Hospital, St George, NSW, 2217, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Sant
authors.affiliation: School of Medicine Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Hartnell
authors.affiliation: School of Medicine Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Mullan
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000502:physiology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology; D010329:Patella / Q000098:blood supply / Q000601:surgery*; D017847:Patellar Ligament / Q000033:anatomy & histology / Q000502:physiology; D017060:Patient Satisfaction; D011183:Postoperative Complications; D016059:Range of Motion, Articular
keywords: Infra patellar fat pad; Outcomes; Pain; Total knee arthroplasty