The role of Hoffa fat pad in total knee arthroplasty: A retrospective comparative study of functional and radiological outcomes

The infrapatellar fat pad (IPFP), or Hoffa fat pad, is frequently resected during total knee arthroplasty (TKA) to improve surgical exposure. However, its removal may affect patellar tendon integrity, vascular supply, and long-term functional outcomes. The role of the IPFP in osteoarthritis and its contribution to anterior knee pain remain topics of debate. To compare radiological and functional outcomes of patients undergoing TKA with either preservation or complete resection of the IPFP. This retrospective, observational study was conducted at a single institution between 2018 and 2021. Patients undergoing primary TKA for idiopathic osteoarthritis were divided into 2 groups according to the operating surgeon's routine practice: IPFP preserved or IPFP resected. The primary outcomes were Insall-Salvati ratio, Oxford Knee Score, and Visual Analog Scale for anterior knee pain. Radiological and clinical evaluations were performed at 6 and 12 weeks, and annually up to 3 years postoperatively. At final follow-up, baseline demographics were comparable between groups. Postoperative Insall-Salvati ratio was 1.077 ± 0.12 in the excision group and 1.076 ± 0.12 in the preservation group (P = .93). Knee flexion improved similarly (115.8 ± 10.2° vs 116.0 ± 10.5°, P = .86). At 3 years, mean Oxford Knee Score was 20.3 ± 5.1 in the excision group and 19.9 ± 5.4 in the preservation group (P = .45), while mean Visual Analog Scale for anterior knee pain was 3.27 ± 0.4 versus 3.17 ± 0.4 (P = .064). Surgical time was shorter in the excision group (88 ± 8 vs 90 ± 6 minutes, P = .022); however, this small difference is unlikely to be clinically meaningful. Both groups demonstrated significant improvement in functional outcomes from baseline, with no long-term superiority of either approach. IPFP management during TKA does not significantly influence mid-term radiological or functional outcomes. Preservation may help maintain tendon integrity, whereas excision may modestly reduce operative time without affecting long-term patient-reported results. The choice to resect or preserve should therefore be based on intraoperative exposure and surgeon preference rather than expectations of improved outcomes.