Background: Total knee arthroplasty is one of the most successful operations in modern orthopedics with less than 5% complications. Unfortunately, half of them are patella complications which naturally make patellar resurfacing a topic of debate since the advent of this surgery. In this randomized prospective left right study, we try to evaluate the best means of overcoming this problem.

Materials and Methods: 60 knees were operated which were in a period of 3 years and followed up for a mean of 21 months. Randomisation was achieved by resurfacing all right knees while retaining all left knees. We had equal number of left and right knees and the results were evaluated with the help of Knee Society score, Patellar score, anterior knee pain and complication rate.

Results: The incidence of anterior pain in knees without patellar resurfacing (24%) was significantly higher than that in knees with patellar resurfacing (12%). This pain was not related to pre op pain and was not related to age, sex, obesity, or grade of chondromalacia of the patella. There were no patella-femoral complications in the resurfaced groups as such.

Conclusion: If equal time and importance is given to the third component of the total knee arthroplasty it helps in preventing the so often encountered patella-femoral complications. This leads to over all better functional results especially lesser incidence of post op anterior knee pain. More importantly selective knee resurfacing is no better as other indicators of resurfacing were proved to be not of much use in this study.