Despite the success of total knee arthroplasty, persistent patellofemoral pain and dysfunction frequently compromise the outcome of knee replacements. Replacement of the patella was introduced as a solution to this problem.. Determining whether a patella should be resurfaced rests with the surgeon. Surgical training and experience, preoperative analysis of patellofemoral tracking, and intraoperative analysis of the patellofemoral articular surface and articulation are critical to the final decision. With optimal implant design and appropriate surgical techniques, optimal outcomes can be obtained for TKA with and without patellar resurfacing.