In primary total knee arthroplasty (TKA), managing the patella is a heavily debated flashpoint. For decades, routine patellar resurfacing, sawing off the native articular surface, and cementing on a polyethylene button has been the dominant paradigm in the United States, driven by a fear that leaving an arthritic patella behind guarantees debilitating anterior knee pain.
However, routine resurfacing is not benign; it introduces significant risks, including costly and complex patellar implant revisions for loosening, fracture, or catastrophic wear. Recognizing these risks, a growing contingent of surgeons has shifted toward “selective resurfacing,” deliberately retaining the native patella if it meets specific structural criteria. This shift is heavily supported by the advent of modern “patella-friendly” femoral components, which feature deeply anatomic, accommodating trochlear grooves that gently guide the native kneecap.
