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Should We Resect Hoffa's Fat Pad during Total Knee Replacement?

Hannah Sellars1, Alun Yewlett2, Ryan Trickett2

  • 1Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, Exeter, United Kingdom.

The Journal of Knee Surgery
|February 25, 2017
PubMed
Summary

Resecting Hoffa's fat pad during total knee arthroplasty did not significantly alter the Insall-Salvati ratio at one year. Both preserving and excising the fat pad are viable surgical options for total knee replacement, showing no long-term radiological differences.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Radiology

Background:

  • Hoffa's fat pad resection during total knee arthroplasty (TKA) is debated due to potential patellar tendon complications.
  • Concerns exist regarding compromised blood supply and subsequent shortening of the patellar tendon after fat pad excision.

Purpose of the Study:

  • To compare the Insall-Salvati ratio in TKAs with preserved versus excised Hoffa's fat pad.
  • To evaluate the radiological impact of Hoffa's fat pad management on patellar tendon length post-TKA.

Main Methods:

  • Retrospective review of 161 TKAs performed by two surgeons with differing fat pad management techniques over 3 years.
  • Analysis of preoperative, immediate postoperative, and 1-year follow-up radiographs for Insall-Salvati ratio.
  • Statistical comparison of Insall-Salvati ratios between the fat pad preserved and excised groups.

Main Results:

  • No significant difference in preoperative Insall-Salvati ratio between groups (p=0.094).
  • A significant difference was observed in the immediate postoperative Insall-Salvati ratio change (p=0.010), favoring the preserved group.
  • No significant difference in the change of Insall-Salvati ratio at 1-year follow-up (p=0.059).

Conclusions:

  • Radiologically, there is no significant difference in the Insall-Salvati ratio at 1-year follow-up between knees with preserved or excised Hoffa's fat pad.
  • This study supports the use of either technique for Hoffa's fat pad management in TKA based on 1-year radiological outcomes.
  • Surgical decision-making regarding Hoffa's fat pad can consider both preservation and excision without apparent long-term radiological detriment to patellar tendon length.