Should the kneecap be resurfaced in a knee replacement?
Short answerResurfacing the kneecap probably lowers the chance of kneecap pain and of a later revision operation. Knee scores and satisfaction are much the same either way.
Evidence grade
Does not helpNot enough evidenceHelps a littleGood evidence
Probably helps a little
What it is
In a total knee replacement, the surgeon can leave the back of the kneecap as it is, or cover it with a plastic button. This is called patellar resurfacing. Some surgeons always do it, some never do, and some choose case by case.
What the research shows
enrolled 1,715 people in the United Kingdom. At five years, the Oxford Knee Score averaged 35 points in both groups, and the number of further operations did not differ significantly.
with 5,540 knees found that resurfacing lowered the risk of pain at the front of the knee (relative risk 0.65, range 0.44 to 0.96). It also lowered the risk of revision surgery (relative risk 0.63) and of other kneecap complications such as clunking or crunching (relative risk 0.54). Knee scores, satisfaction and range of movement did not differ.
The review found little trial evidence on choosing case by case. Observational data suggested this approach may not do better than the other two.
What the Australian joint registry shows
In the Australian joint registry, knees where the kneecap was resurfaced needed another operation less often. At 20 years about 7 in 100 had been redone, compared with about 10 in 100 where the kneecap was left alone . Many of the extra operations were to add a kneecap button later. Kneecap resurfacing is now used in about 4 in 5 knee replacements in Australia.
This fits the trials, which found resurfacing lowers the chance of another operation even though pain and function are similar.
Risks and effort
Resurfacing adds some operating time. It can bring its own risks, such as a fracture of the kneecap or damage to the tendon.
What usually works instead
Both approaches give good results for most people. Ask your surgeon which they use and why. See Total Knee Replacement.
Questions people ask
Will I feel the difference?
On average, knee scores and satisfaction were the same. The difference is in how often kneecap pain and further surgery happen.
Can the kneecap be resurfaced later?
Yes, but the results of a second operation for kneecap pain were less satisfying in the studies cited by the review.
Does the type of implant matter?
The trials used many different implants. The review could not say whether the answer changes with the design.
Does resurfacing the kneecap lower the chance of another operation?
In the Australian joint registry, yes. For someone aged 61 to 65, the estimated chance of another operation at some point in life was about 13 in 100 with the kneecap resurfaced, compared with about 23 in 100 without .
Sources
Select a source to read what the study or guideline found, in plain words, with a link to the original.
Last reviewed 24 October 2026. Next review due October 2028.
