Total knee arthroplasty with and without preservation of the infrapatellar fat pad:  a meta-analysis

doi:10.3969/j.issn.2095-4344.0790

Abstract

Abstract:

BACKGROUND: During total knee arthroplasty, the infrapatellar fat pad is usually resected to enhance surgical exposure and install the prosthesis easily. However, it is still controversial whether the infrapatellar fat pad is removed or retained in the clinic.

OBJECTIVE: To systematically assess the effectiveness and safety of the excision and preservation of infrapatellar fat pad during total knee arthroplasty.

METHODS: Wanfang Data, CNKI, CBM, VIP, Cochrane Library, Pubmed and EMbase were researched for the clinical controlled trials from the database establishment to August 2017 according to inclusion and exclusion criteria. The included data were extracted and quality was evaluated. Meta-analysis was performed by using RevMan 5.3 software.

RESULTS AND CONCLUSION: (1) Totally 12 clinical controlled trials with 1 478 knees were included. (2) Meta-analysis results showed that infrapatellar fat pad excision could significantly increase shortening of the patellar tendon, compared with the infrapatellar fat pad preservation at the follow-up period of 12 to 18 months and 28 to 38 months postoperatively [MD=2.90, 95%CI (2.21, 3.58), P < 0.000 01; MD=2.65, 95%CI (1.96, 3.35), P < 0.000 01]. However, the difference of shortening of the patellar tendon between two groups within 1 to 2 months and 6 months postoperatively was not statistically significant (P > 0.05). (3) Anterior knee pain, American knee society knee score, hospital for special surgery knee score and Insall-Salvati ratio were not significantly different between the two groups (P > 0.05). (4) Infrapatellar fat pad, especially the dense vascular position, should be preserved as much as possible and protected from injury during total knee arthroplasty.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Knee, Evidence-Based Medicine, Tissue Engineering

CLC Number:

R318

Jie Ke, Deng Peng, Zeng Jian-chun, Feng Wen-jun, Zeng Hui-liang, Wu Ke-liang, Zeng Yi-rong. Total knee arthroplasty with and without preservation of the infrapatellar fat pad: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(23): 3759-3765.

Figures/Tables 4

2.2 纳入研究方法学质量评价结果纳入的12篇研究文献，其中有6篇为随机对照试验，4篇提及了分配隐藏，2篇使用了盲法，8篇提及撤出或退出情况，1篇文献提及存在结果评估盲法高风险因素，2篇文献提及存在选择性报告高风险因素。11项描述了研究对象的基线资料并且报告基线具有良好的相似度，具有可比性，1项未提及。按照改良Jadad评分的标准，6篇文献为高质量研究，6篇为低质量研究，见图1。 2.3 Meta分析结果 2.3.1 膝前痛发生率 5项纳入研究报道了全膝关节置换后膝前痛发生率[8-9，11，14-15]，共446例患膝，其中包括髌下脂肪垫切除组221例，髌下脂肪垫保留组225例。按随访时间分为3个亚组，术后一至两个月、术后6个月异质性检验分析显示，研究间存在异质性(P=0.03，I2=72%；P=0.01，I2=83%)，故这2组采用随机效应模型；术后1年异质性检验分析显示，研究间有同质性(P=0.18，I2=42%)，故该组采用固定效应模型。Meta分析结果显示，随访一至两个月RR=1.70，95%CI(0.61，4.79)，试验组和对照组差异无显著性意义(P=0.31> 0.05)；随访6个月RR=1.84，95%CI (0.05，63.91)，差异无显著性意义(P=0.74 > 0.05)；随访1年RR=1.13，95%CI(0.48，2.62)，差异无显著性意义(P=0.78> 0.05)，见图2。 2.3.2 KSS评分 3项纳入研究报道了全膝关节置换后KSS评分[16-18]，共722例患膝，其中包括髌下脂肪垫切除组348例，髌下脂肪垫保留组374例，术后1年异质性检验分析显示研究间存在异质性(P=0.002，I2=84%)，故该组采用随机效应模型。Meta分析结果显示，术后1年MD=-0.27，95%CI(-1.41，0.87)，差异无显著性意义(P=0.65> 0.05)，见图3。 2.3.3 HSS评分 3项纳入研究报道了全膝关节置换后HSS评分[14-15，19]，共266例患者，其中包括髌下脂肪垫切除组133例，髌下脂肪垫保留组133例，合并进行异质性检验(P=0.58，I2=0%)，各纳入研究之间存在同质性，故该组采用固定效应模型。Meta分析结果显示，术后一至两年时HSS评分合并效应量MD=0.74，95%CI(-0.26，1.73)，差异无显著性意义(P=0.15)，见图4。 2.3.4 Insall-Salvati指数 4项纳入研究报道了全膝关节置换后Insall-Salvati指数[13-15，19]，共332例患者，其中包括切除髌下脂肪垫组166例，保留髌下脂肪垫组166例，合并进行异质性检验(P=0.000 1，I2=85%)，各纳入研究之间有异质性，故该组采用随机效应模型。Meta分析结果显示，术后一至两年时Insall-Salvati指数合并效应量MD=-0.03，95%CI(-0.07，0.01)，差异无显著性意义(P=0.09)，见图5。 2.3.5 髌韧带缩短长度 6项纳入研究报道了全膝关节置换后髌韧带缩短长度[8-10，12-13，16]，共457例患者，其中包括髌下脂肪垫切除组229例，髌下脂肪垫组228保留例，按随访时间分为4个亚组，术后一至两个月、28-38个月异质性检验分析显示研究间都存在同质性(P=0.43，I2=0%；P=0.81，I2=0%)，故采用固定效应模型；术后6个月、12-18个月时异质性检验分析显示研究间存在异质性(P < 0.000 01，I2=94%；P=0.003，I2=79%)，故该组采用随机效应模型。Meta分析结果显示，术后一至两个月时髌韧带缩短长度效应量MD=-0.10，95%CI(-0.31，0.12)，差异无显著性意义(P=0.39)；6个月时效应量MD=-0.70，95%CI (-0.08，1.47)，差异无显著性意义(P=0.08)；随访12-18个月时MD=2.90，95%CI(2.21，3.58)，说明12-18个月时试验组髌韧带缩短的长度值较对照组更大，差异有显著性意义(P < 0.000 01)；随访28-38个月时MD=2.65，95%CI (1.96，3.35)，说明28-38个月时试验组髌韧带缩短的长度值较对照组更大，差异有显著性意义(P < 0.000 01)，见图6。"

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