(iv) The patella in total knee replacement

The role and management of the patella in total knee replacement remains controversial. The patella is an important sesamoid bone, with a rich vascular and neural network surrounding it, and it must be managed appropriately in order to ensure a satisfactory outcome after a total knee replacement. The controversies concern arguments for and against resurfacing as well as other considerations influencing the decision surrounding the management of the patella. There is sufficient evidence within the orthopaedic literature to support pretty much any reasonable decision that the surgeon might make. Ultimately, to resurface, not to resurface or to selectively resurface the patella is an operator-dependent decision, and in association with a good prosthetic design and surgical technique satisfactory and comparable results can be achieved.