Managing the patella remains one of the most fiercely debated topics in primary total knee arthroplasty (TKA). While routine patellar resurfacing with a polyethylene button has historically dominated American operating rooms, a massive counter-trend toward leaving the native patella unresurfaced has surged over the past decade, climbing to 10.3% of all cases nationally. This shift is fueled by the emergence of “patella-friendly” femoral components designed with deeper, more anatomical trochlear grooves that dramatically lower patellofemoral contact pressures.
Despite these biomaterial updates, many surgeons hesitate to abandon the polyethylene button due to an entrenched fear of postoperative anterior knee pain and a perceived need for secondary revision surgeries. Historically, pooled literature painted a grim portrait of unresurfaced patellae, citing secondary resurfacing rates up to 8.7%.
