Targeted Fat Pad Excision during Arthroscopy Improves Early Pain Outcomes in Obese Knee Osteoarthritis Patients

Abstract Knee osteoarthritis (KOA) is a chronic degenerative joint disease characterized by cartilage degradation, resulting in knee pain, restricted mobility, and potential functional disability. This study evaluates postoperative knee pain and joint function recovery in early- to mid-stage KOA patients following arthroscopic debridement combined with partial infrapatellar fat pad (IPFP) resection and identifies factors influencing treatment outcomes. We retrospectively analyzed 82 KOA patients who underwent surgery between October 2023 and June 2024. Forty-one patients received arthroscopic debridement alone (control group), while 41 underwent additional partial IPFP resection (observation group). Resected IPFP tissues were histopathologically examined for inflammation, fibrosis, and other pathological changes. Pain was assessed using the visual analogue scale (VAS), and knee function was evaluated with the Oxford Knee Score (OKS) and range of motion (ROM) at 3, 6, and 12 months postoperatively. Patients were categorized as improved or nonimproved based on clinical outcomes. Pearson correlation analysis was performed to identify factors associated with treatment response. No significant differences in baseline characteristics were observed between the groups (p > 0.05). Histopathological analysis of IPFP tissues revealed increased inflammatory infiltration, fibrosis, neovascularization, and elevated expression of pain-related proteins in diseased samples. At 12 months, the observation group demonstrated significantly greater improvements in VAS, OKS, and ROM compared to the control group. Furthermore, higher body mass index and Kellgren–Lawrence grade were positively correlated with better outcomes in the observation group (r = 0.356 and 0.333, respectively). The study provides level II evidence.