Resurfacing of the patella was not a feature of many early designs of total knee prostheses. The occurrence of post-operative patello-femoral pain, particularly in patients who had rheumatoid arthritis, resulted in the incorporation of patello-femoral resurfacing into most subsequent designs with the advent of modern condylar components, resurfacing of the patella became a standard part of total knee arthroplasty.The need for patellar resurfacing during total knee replacement presents a dilemma for the orthopedic surgeon. There are proponents for patellar resurfacing who point out that this is a logical step in total knee replacement and that it gives predictable results.