Should Hoffa's fat pad be resected during total knee arthroplasty? A review of literature

Abstract

Knee osteoarthritis is caused by the degeneration of joint tissues through mechanical loading as well as inflammatory effects. The number of total knee arthroplasties is increased and is expected to further be increased by 2050 compared to 2021. The infrapatellar fat pad, also known as Hoffa's fat pad, is often partially or fully resected during total knee arthroplasty to improve the surgeon's view in the upper tibia as well may reduce the risk of soft tissue involvement, when placing the prosthesis. The purpose of this study is to present the importance and functions of Hoffa's fat pad, as well as the latest data on the two conflicting views, on the removal or not of Hoffa's fat pad in total knee arthroplasty. However, there is not a consensus regarding Hoffa's fat pad resection, as its preservation has been associated with increased postoperative anterior knee pain. Due to the fact, that there are no current official guidelines for this issue, it would be preferable that surgeons try to preserve it, but only if there are no visibility and/or access problems during surgery. The choice of complete or partial resection or preservation is based on the surgeon's preferences, experience as well as patient's needs. More high-quality research and randomized clinical trials are needed for better guidance regarding Hoffa’s fat pad management at total knee replacement