A growing trend in total knee arthroplasty (TKA) is shifting toward cementless fixation and unresurfaced patellae, reflecting evolving surgical philosophies and implant technology. Cementless designs aim to promote biologic fixation through bone ingrowth, potentially improving long-term durability and reducing issues related to cement failure. At the same time, some surgeons are increasingly opting not to resurface the patella, seeking to preserve native anatomy and avoid complications associated with patellar components. Early findings suggest that these approaches can yield comparable outcomes in appropriately selected patients, though long-term data remain essential. Together, these trends highlight a broader move toward biologic fixation and more selective, individualized strategies in knee arthroplasty.