The controversy over whether or not to routinely resurface the patella during a total knee arthroplasty has persisted despite three decades of successful joint replacement procedures. Advocates for routine patellar resurfacing admit the occasional need for secondary patellar resurfacing and declare increased incidence of anterior knee pain in patients with non-resurfaced patellae as a cause for worry. Surgeons that leave the patella unresurfaced cite avoidance of complications that include patellar fracture, avascular necrosis, patellar tendon injury and instability. This review discusses the available literature on patellar resurfacing through an evidence-based analysis of randomized and pseudo-randomized controlled trials and published meta-analyses to date. The published literature seems to favour resurfacing the patellar routinely. Selective patellar resurfacing would be the ideal solution if sound pre-operative criteria could be established. So far, a method for accurately predicting which patients can avoid patellar resurfacing has not been found. Future research looking at patellar resurfacing should concentrate on developing criteria for selecting those patients that would benefit from patellar resurfacing and those that would do as well without resurfacing, and thus, limiting potential surgical complications.