PURPOSE: The purpose of this study is to assess the clinical and radiological results of patients who underwent patellar retention or resurfacing for moderate or severe patellar articular defects during total knee arthroplasty and evaluate the clinical efficacy of patellar resurfacing according to the articular defect of the patella. MATERIALS AND METHODS: From May 2003 to March 2006, 252 patients (277 cases) underwent total knee arthroplasty by one surgeon. Intraoperatively, we divided these patients into a moderate articular defect group (50-75%: group I) and a severe articular defect group (75-100%: group II) and randomly performed patellar resurfacing. The average age was 67.2 years. There were 234 female and 17 male patients. The average follow-up period was 74.6 months. Clinical outcomes were analyzed using the Knee Society (KS) knee score. Functional score, Hospital for Special Surgery (HSS) score, Feller patellar score and range of motion (ROM). Radiological outcomes were analyzed using the congruence angle, Insall-Salvati ratio and patella tilt angle. RESULTS: The KS knee score and functional score at the last follow-up were 84.4/73.1 in the retention group and 85.2/71.8 in the resurfacing group (p=0.80, p=0.63) in group I. In group II, the values were 82.1/75.1 and 87.0/71.2, respectively (p=0.51, p=0.26). The HSS score and Feller patella score were 86.7/20.3 in the retention group and 84.3/21.7 in the resurfacing group (p=0.31, p=0.29) in group I. In group II, the values were 91.6/21.2 and 85.5/22.1, respectively (p=0.37/p=0.30). The knee ROM (p=0.36/p=0.41), congruence angle (p=0.22/p=0.16), Insall-Salvati ratio (p=0.16/p=0.21) and patella tilt angle (p=0.12/p=0.19) were not statistically different between the two groups. CONCLUSIONS: In this study, we could not find any correlations between the degree of patellar articular defect and patellar resurfacing in terms of the clinical and radiological results. Therefore, patellar articular defects is thought to be less meaningful in determining patellar resurfacing.