Patellar resurfacing in total knee arthroplasty remains controversial. This study compared the long-term clinical outcomes of total knee arthroplasties performed with and without the patella resurfaced and is an update of a previous report. Eighty-six patients (118 knees) underwent primary total knee replacement and were randomized into two groups: those treated with and those treated without resurfacing of the patella. Outcomes included the scores according to the Knee Society clinical rating system, the scores according to a forty-one-question patellofemoral-specific patient questionnaire, patient satisfaction, global and anterior knee pain scores, radiographic findings, and complications and revisions. Fifty-seven patients (seventy-eight knees) were followed for a minimum of ten years. No significant differences were identified between the two groups in terms of the range of motion, Knee Society scores, satisfaction, global knee pain, or anterior knee pain. The overall revision rates in the original series of 118 knees were 12% in the nonresurfacing group and 9% in the resurfacing group. Seven patients (12%) in the nonresurfacing group and two patients (3%) in the resurfacing group underwent revision for a reason related to a patellofemoral problem. On the basis of these findings, we concluded that, with the type of total knee arthroplasty used in our patients, similar results may be achieved with and without patellar resurfacing. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.