- TKR w/o resurfacing:
      - less than 20 mm of patella thickness is a relative contraindication for patellar resurfacing; 
      - if unsure as to whether or not resurfacing will be performed, then use a TKR design which specifically will accomodate unresurfaced patella; 
      - in report by Barrack, et al, authors sought to determine parameters were predictive of the clinical result following TKR w/ or w/o patellar resurfacing; 
                 - 86 patients (118 knees) undergoing TKR for the treatment of osteoarthritis were enrolled in a prospective, randomized, double-blind study; 
                  - 67 patients (ninety-three knees) were followed for a minimum of five years (range, sixty to 84 months; average, 70.5 months); 
                  - with numbers available, there was no significant difference between groups treated with and w/o resurfacing with regard to overall Knee Society score or the pain and function subscores; 
      - in the study by Smith AJ, et al, there was no benefit to patellar resurfacing;
             - in 22/73 knees (30.1%) with and 18/86 knees (20.9%) without patellar resurfacing there was some degree of anterior knee pain (p = 0.183);
             - a significant association between knee flexion contracture and anterior knee pain was observed in those knees with patellar resurfacing (p = 0.006). 
      - references supporting selective approach to resurfacing:
                - Total knee arthroplasty without patellar resurfacing. 
                - Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system.
                - The patellofemoral joint after total knee arthroplasty without patellar resurfacing.
                - Total knee arthroplasty without patellar resurfacing. Clinical outcomes and long-term follow-up evaluation. 
                - Long-term changes of the nonresurfaced patella after total knee arthroplasty. 
                - Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in opposition.
                - Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery. 
                - Retention of the patella in total knee arthroplasty for rheumatoid arthritis. 
                - Patellar resurfacing in total knee arthroplasty. A meta-analysis. 
                - Patellar Resurfacing in Total Knee Arthroplasty: Does Design Matter?: A Meta-Analysis of 7075 Cases
                - To resurface the patella or not? Better assessments needed to address the benefits for total knee replacement: commentary on an article by George Pavlou, BSc, MRCS, et al.: "Patellar resurfacing in total knee arthroplasty: does design matter? A meta-analysis of 7075 cases".
        - references supporting non-resurfacing:
                - A Prospective Randomized Clinical Trial of Patellar Resurfacing and Nonresurfacing in Bilateral TKA.
                - Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in opposition.
                - Component rotation and anterior knee pain after total knee arthroplasty.
                - Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. 
                - Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system.
                - Long-term clinical results and radiographic changes in the nonresurfaced patella after total knee arthroplasty: 78 knees followed for mean 12 years. 
                - Total knee arthroplasty without patellar resurfacing. 
                - The consequences of not resurfacing the patella. 
                - Patella resurfacing: no benefit for the long-term outcome of total knee arthroplasty. A 10- to 16.3-year follow-up. 
                - Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty.
                - Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study. 
                - Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. 
                - Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results. 
                - Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years' followup. 
                - Resurfacing versus not resurfacing the patella during total knee replacement. 
                - Should the patella be resurfaced in total knee arthroplasty? Efficacy of patellar resurfacing. 
                - Patellar resurfacing vs non resurfacing during primar TKR - a review of the literature.
                - Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. 
                - Patella Resurfacing in TKA
                - Assessment of the damage in retrieved patellar components
                - Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial.
                - Is Further Treatment Necessary for Patellar Crepitus After Total Knee Arthroplasty?

- TKR w/ resurfacing
       - most surgeons presently advocate resurfacing for all patients undergoing TKR; 
       - resurfacing leads to less patellofemoral pain and better stair climbing; 
       - as noted by Barrack, et al (1997), 10 % of 60 patients that did not have patellar resurfacing experienced anterior knee pain that was severe enough to warrant subsequent resurfacing; 
       - in the report by Wood DJ, et al, the authors aimed to identify differences in the clinical outcome of TKR according to whether or not patellar resurfacing had been performed in a prospective, randomized study of 220 osteoarthritic knees. 
                  - 12% of the 128 knees without patellar resurfacing and 10% of the ninety-two knees with patellar resurfacing underwent a revision or another type of reoperation related to the patellofemoral articulation; 
                   - this difference was not significant (chi square with one degree of freedom = 0.206, p = 0.650). 
                   - at time of latest follow-up, there was a significantly higher incidence of anterior pain (p = 0.016) in knees that had not had patellar resurfacing; 
       - references supporting resufacing:
               - Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study.
               - Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial.
               - Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in the affirmative. 
               - Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. 
               - Clinical evaluation of resurfacing of the patella in posterior-stabilizing total knee replacement.
               - Early outcomes of patella resurfacing in total knee arthroplasty
               - Should we resurface the patella in total knee replacement? Experience with the Nex Gen prothesis. 
               - Surface damage of patellar components used in total knee arthroplasty

Patella Resurfacing in TKA