Total diz artroplastisi sırasında infrapatellar yağ yastığının yönetimi ile ilgili güncel uygulamalar: Ortopedi cerrahları arasında bir anket araştırması

Öz

Aim: The aim of this study was to evaluate the current practices pertaining to the management of the infrapatellar fat pad (IPFP) during primary total knee arthroplasty (TKA) amongst orthopedic surgeons in Turkey. Material and Methods: A web-based survey of orthopedic surgeons registered in the database of the Turkish Orthopedics and Traumatology Association was conducted between June 2020 and July 2020. The survey questionnaire consisted of seven questions pertaining to the current practices regarding management of the IPFP (preservation of IPFP, partial resection, or total resection) during primary TKA. Results: Of the 1553 registered orthopedic specialists, 266 (17%) completed the questionnaire. A vast majority of orthopedic surgeons (75.2%) claimed that their decision making with regard to the management of IPFP during TKA was not based on evidence (p < 0.001). Conclusion: In a vast majority of respondents, the decision to resect or preserve the IPFP during TKA was not based on scientific reasons. The number of years of experience in the profession and academic position had a significant influence on this decision.

Anahtar Kelimeler

• yağ yastığı
• ortopedi
• ortopedi cerrahı
• total diz artroplastisi

Current practices regarding the management of infrapatellar fat pad during total knee arthroplasty: A survey of orthopedic surgeons

Öz

Amaç: Bu çalışmanın amacı Türkiye'deki ortopedi cerrahları arasında primer total diz artroplastisi (TDA) sırasında infrapatellar yağ yastığının (IPFP) yönetimine ilişkin güncel uygulamaları değerlendirmektir. Gereç ve Yöntemler: Türkiye Ortopedi ve Travmatoloji Derneği veri tabanına kayıtlı ortopedi cerrahlarına yönelik web tabanlı bir anket Haziran 2020 ile Temmuz 2020 arasında gerçekleştirilmiştir. Anket, IPFP'nin yönetimine ilişkin mevcut uygulamalara ilişkin yedi sorudan oluşmaktadır (IPFP'nin korunması, birincil TDA sırasında kısmi rezeksiyon veya tam rezeksiyon). Bulgular: 1553 kayıtlı ortopedi uzmanından 266'sı (% 17) anketi tamamladı. Ortopedi cerrahlarının büyük çoğunluğu (% 75,2) TDA sırasında IPFP'nin yönetimi ile ilgili karar vermelerinin kanıta dayalı olmadığını iddia etti (p <0,001). Sonuçlar: Ankete katılanların büyük çoğunluğunda, TKA sırasında IPFP'yi rezeksiyon veya koruma kararı bilimsel nedenlere dayanmıyordu. Meslek ve akademik pozisyondaki yılların sayısı bu karar üzerinde önemli bir etkiye sahipti.

Anahtar Kelimeler

• fat pad
• orthopedics
• orthopedic surgeon
• total knee arthroplasty

Kaynakça

1. 1. Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 2016; 28: 1-15.
2. 2. Lemon M, Packham I, Narang K, Craig DM. Patellar tendon length after knee arthroplasty with and without preservation of the infrapatellar fat pad. J Arthroplasty 2007; 22: 574-80.
3. 3. Gwyn R, Kotwal RS, Holt MD, Davies AP. Complete excision of the infrapatellar fat pad is associated with patellar tendon shortening after primary total knee arthroplasty. Eur J Orthop Surg Traumatol 2016; 26: 545-9.
4. 4. Banks SA, Hodge WA. Implant design affects knee arthroplasty kinematics during stair-stepping. Clin Orthop Relat Res 2004; 426: 187-93.
5. 5. Van Beeck A, Clockaerts S, Somville J, et al. Does infrapatellar fat pad resection in total knee arthroplasty impair clinicaloutcome? A systematic review. Knee 2013; 20: 226-31.
6. 6. White L. The impact of an intact infrapatellar fat pad on outcomes after total knee arthroplasty. Adv Orthop Surg 2015; 2015.
7. 7. Ye C, Zhang W, Wu W, Xu M, Nonso NS, He R. Influence of the infrapatellar fat pad resection during total knee arthroplasty: a systematic review and meta-analysis. PLoS One 2016; 11: e0163515.
8. 8. Bohnsack M, Wilharm A, Hurschler C, Ruhmann O, Stukenborg-Colsman C, Wirth CJ. Biomechanical and kinematic influences of a total infrapatellar fat pad resection on the knee. Am J Sports Med 2004; 32: 1873-80.

9. 9. Chougule SS, Stefanakis G, Stefan SC, Rudra S, Tselentakis G. Effects of fat pad excision on length of the patellar tendon after total knee replacement. J Orthop 2015; 12: 197-204.
10. 10. Maculé F, Sastre S, Lasurt S, Sala P, Segur JM, Mallofré C. Hoffa’s fat pad resection in total knee arthroplasty. Acta Orthop Belg 2005; 71: 714-17.
11. 11. İmren Y, Dedeoğlu SS, Çakar M, Çabuk H, Bayraktar TO, Gürbüz H. Infrapatellar fat pad excision during total knee arthroplasty did not alter the patellar tendon length: a 5-year follow-up study. J Knee Surg 2017; 30: 479-83.
12. 12. Tanaka N, Sakahashi H, Sato E, Hirose K, Isima T. Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplasty 2003; 18: 897-902.
13. 13. Gandhi R, de Beer J, Leone J, Petruccelli D, Winemaker M, Adili A. Predictive risk factors for stiff knees in total knee arthroplasty. J Arthroplasty 2006; 21: 46-52.
14. 14. Meneghini RM, Pierson JL, Bagsby D, Berend ME, Ritter MA, Meding JB. The effect of retropatellar fat pad excision on patellar tendon contracture and functional outcomes after total knee arthroplasty. J Arthroplasty 2007; 22: 47-50.
15. 15. Pinsornsak P, Naratrikun K, Chumchuen S. The effect of infrapatellar fat pad excision on complications after minimally invasive TKA: a randomized controlled trial. Clin Orthop Relat Res 2014; 472: 695-701.
16. 16. Maculé F, Sastre S, Lasurt S, Sala P, Segur JM, Mallofré C. Hoffa’s fat pad resection in total knee arthroplasty. Acta Orthop Belg 2005; 71: 714-17.
17. 17. Yao B, Samuel LT, Acuña AJ, et al. Infrapatellar fat pad resection or preservation during total knee arthroplasty: a systematic review. J Knee Surg 2019.
18. 18. Nisar S, Lamb JN, Somashekar N, Pandit H, van Duren BH. Preservation vs. resection of the infrapatellar fat pad during total knee arthroplasty part II: A systematic review of published evidence. Knee 2019; 26: 422-6.
19. 19. National Joint Registry for England and Wales:: 1st Annual Report September 2004. Available: www.njrcentre.org.uk. Accessed 6 June 2020.
20. 20. van Duren BH, Lamb JN, Nisar S, Ashraf Y, Somashekar N, Pandit H. Preservation vs. resection of the infrapatellar fat pad during total knee arthroplasty Part I: a survey of current practice in the UK. Knee 2019; 26: 416-21.