Should the patella be resurfaced in primary total knee arthroplasty? An evidence-based analysis

Whether or not to resurface the patella in primary total knee arthroplasty remains controversial. Advocates for leaving the patella unresurfaced cite avoidance of complications that include patella fracture, avascular necrosis, patella tendon injury, and instability. Proponents of routine patella resurfacing cite the occasional need for secondary resurfacing procedures and the increased incidence of anterior knee pain in patients with unresurfaced patellae as a cause for concern with leaving a patella unresurfaced during knee arthroplasty. In addition, some advocate selective patellar resurfacing based on patient factors such as quality of the articular cartilage and patellofemoral congruence at the time of surgery. This review will discuss the available literature on patellar resurfacing through an evidence-based analysis.