Total knee arthroplasty (TKA) without resurfacing of the patella by a single surgeon was reviewed retrospectively in 125 patients: 66 patients (79 knees) were included in the final study group, 32 patients were deceased, 13 were without current address and not able to be contacted, and 14 patients were unable to complete a questionnaire because of severe illness or language barrier. All patients had a diagnosis of osteoarthrosis. The decision to leave the patella unresurfaced was based on the presence of satisfactory patellar articular cartilage, absence of eburnated bone, congruent patellofemoral tracking, normal anatomic patellar shape, and no evidence of crystalline disease or an inflammatory synovitis. A lateral retinacular release was performed in 13 knees (16.5%) to facilitate congruent patellar tracking. The follow-up period averaged 7.5 years (range, 2.4-15.5 years). There were no component revisions and no reoperations. The mean Knee Society score improved from 23.2 to 89.9 postoperatively and the function score improved from 58.4 to 92.0 postoperatively. Mild anterior knee pain was reported in 19%. Satisfaction with the surgical result was expressed in 89.5% of patients; 4% were somewhat satisfied; 2.6% were somewhat dissatisfied; and 4% were neutral. Of the patients who had mixed bilateral TKA (one TKA with unresurfaced patella, the other resurfaced), 46% rated both as equal; 46% preferred the TKA with the resurfaced patella; and 7.7% preferred the unresurfaced patella. In patients meeting the selection criteria outlined above, TKA without resurfacing of the patella provided satisfactory long-term results and a high degree of patient satisfaction with an absence of mechanical complications and no reoperations at the average 7.5-year follow-up evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)