title: Influence of the Infrapatellar Fat Pad Resection during Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  To enhance surgical exposure, resection of the infrapatellar fat pad (IPFP) is usually a routine procedure in total knee arthroplasty (TKA). However, there is conflicting evidence regarding whether IPFP resection during TKA impairs clinical outcome. We performed a systematic review and meta-analysis to clarify the influence of IPFP resection on primary TKA.
  
  
  METHODS
  Embase, PubMed, and the Cochrane Library were systematically searched up to August 2016 to identify relevant studies. All clinical studies comparing IPFP resection (IPFP-R) and IPFP preservation (IPFP-P) in patients undergoing primary TKA were obtained. The meta-analysis was performed with Revman 5.3 and STATA 12.0 software. The weighted mean was estimated by using random effects (RE) models with 95% CIs, heterogeneity was assessed using the H statistic and the inconsistency index (I2).
  
  
  RESULTS
  Seven studies involving 2,734 patients (3,258 knees) were included. IPFP resection trended to increase the incidence of postoperative anterior knee pain within 2 months postoperatively, compared with patients in whom the IPFP was preserved (odds ratio [OR]s 2.12[0.95, 4.73], p = 0.07). An increased incidence of anterior knee pain was observed in the IPFP resection group > 12 months postoperatively, but the difference was not significant (OR, 3.69 [0.81, 16.82], p = 0.07). In addition, a trend towards more shortening of the patellar tendon was also observed in the IPFP-R group. No significant results were found regarding postoperative knee function.
  
  
  CONCLUSIONS
  These results suggest that preserving the IPFP may be superior to IPFP resection in patients undergoing primary TKA, due to the relatively lower rate of anterior knee pain after short-term follow-up.
authors.affiliation: Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China.
authors.forename: Chenyi
authors.initials: C
authors.lastname: Ye
authors.affiliation: Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China.
authors.forename: Weigang
authors.initials: W
authors.lastname: Wu
authors.affiliation: Department of Plastic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Xu
authors.affiliation: Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China.
authors.forename: Nwofor Samuel
authors.initials: NS
authors.lastname: Nonso
authors.affiliation: Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China.
authors.forename: Rongxin
authors.initials: R
authors.lastname: He
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002358:Cartilage, Articular / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D010149:Postoperative Pain / Q000453:epidemiology*; D017847:Patellar Ligament / Q000378:metabolism / Q000601:surgery*; D017060:Patient Satisfaction; D016059:Range of Motion, Articular