Sixty patients with primary varus gonarthrosis were randomized to receive partial Preservation of the infrapatellar fat pad (IPFP) excision (n=30) or complete IPFP preservation (n=30) during unilateral computer-assisted cruciate-retaining TKA, with identical implants, patellar resurfacing, perioperative care, and blinded outcome assessment. The primary outcome was Anterior Knee Pain (AKP) incidence and severity (VAS≥3). Secondary outcomes were modified WOMAC, ROM, mechanical alignment, and Insall–Salvati ratio. Outcomes were assessed at 1, 3, 6, and 12 months. Overall, the results revealed lower AKP incidence and lower VAS pain at 1 month with preservation, with no between-group differences at later time points. WOMAC was transiently better at 6 months in the preservation group but below MCID; ROM and radiographs were comparable. These findings suggest IPFP preservation reduces subacute (≈1 month) AKP without compromising function or alignment at 1 year.