Whether to resurface the patella during total knee arthroplasty (TKA) remains controversial. Proponents argue it may reduce anterior knee pain, while critics cite risks of patellar complications. Evidence for routine resurfacing is conflicting.

A 2011 meta-analysis found patellar resurfacing decreased reoperation risk, from 7.8% to 3.9% at 10 years. The difference was only significant after 5 years. Another meta-analysis demonstrated lower risk of reoperation for patellofemoral joint problems with resurfacing. However, the absolute risk reduction was small.

Resurfacing advocates argue it reduces anterior knee pain. A meta-analysis found a 12.9% incidence with resurfacing versus 24.1% without. However, substantial heterogeneity existed between studies. No difference was found in high quality randomized trials. Component design and surgical factors may influence results.

Most studies show no differences in postoperative knee scores or satisfaction between resurfaced and non-resurfaced groups. Pooled estimates also demonstrate no significant difference. Some trials favor resurfacing, but heterogeneity exists.

Current evidence does not clearly support routine patellar resurfacing in TKA. Resurfacing may reduce reoperation risk, but absolute risk reduction is small. It does not improve functional outcomes or satisfaction. Surgeons should individualize decisions based on patient factors. More high-quality comparative research is needed.