Managing the patella remains one of the most polarizing technical decisions in primary total knee arthroplasty (TKA). Historically, the orthopedic dogma was straightforward: if a patient’s patella exhibited severe, “bone-on-bone” osteoarthritis or significant eburnation, the surgeon was obligated to perform a routine resurfacing with a cemented polyethylene button. Failure to do so was presumed to guarantee debilitating post-operative anterior knee pain and a high likelihood of a secondary revision.
However, as implant engineering has drastically evolved over the past decade, a major clinical paradigm shift has occurred. The advent of modern, “patella-friendly” femoral components characterized by significantly deepened trochlear grooves and asymmetric, laterally elevated facets has dramatically reduced retropatellar contact stress. Armed with these advanced designs, a growing segment of high-volume surgeons has adopted “selective patellar resurfacing,” leaving the vast majority of native patellae untouched.
