Whether to resurface the patella during a primary Total Knee Replacement (TKR) performed as a treatment of degenerative osteoarthritis remain a controversial issue. Patellar resurfacing was introduced because early implants were not designed to accommodate the native patella in an anatomic fashion during the range of motion. Complications related to patella resurfacing became a primary concern and have been associated with the variable revision rates often report post TKR. Subsequent modifications in implant design have been made to offer the surgeon option of leaving the patella un-resurfaced.

Numerous clinical trials have been done to determine the superiority of each option. Unfortunately, there is little consensus and surgeon preference remains the primary variable. One of the major reasons given to support patella resurfacing is to eliminate Anterior Knee Pain post operatively. However, studies have shown that this problem was not exclusively found in non-resurfaced patients so the author conclude that anterior knee pain is probably related to component design or to the details of the surgical technique, such as component rotation rather that whether or not the patella is resurfaced.

An increasing rate of complications with the extensor mechanism after patellar resurfacing led to the concept of selective resurfacing of the patella in TKR. Decision making algorithms with basis of clinical, radiographic and intraoperative parameters have been developed to determine which patients are suitable for patella resurfacing and which are suitable for patella non-resurfacing.

Finally, the continued study of this topic with longer follow up term in randomized, controlled, clinical trials remains essential in our understanding of patella in TKR. The development of joint registry will allow surgeons to draw conclusions on the basis of larger numbers of patients and will improve the reporting of the results of patellar non resurfacing in clinical trials. In general, surgeons in United States always resurface while their counterparts in Europe tend to never resurface.