86 patients with 118 knees undergoing primary total knee arthroplasty for osteoarthritis were randomized to receive patellar resurfacing or not. Patients were evaluated for overall Knee Society score (including the pain and function subscores), patient satisfaction questionnaire, specific questions relating to patellofemoral symptoms, and radiographs. Variables such as obesity, the degree of patellar chondromalacia, and the presence of preoperative anterior knee pain were investigated as possible predictors for postoperative anterior knee pain. 67 patients (93 knees) were followed for a minimum of 5 years, no significant differences were found between the two groups in terms of Knee Society score, and none of the variables were predictive of postoperative knee pain.