300 patients with primary osteoarthritis were previously randomized to undergo total knee replacement either with or without electrocautery of the patellar rim. This study aimed to determine whether the clinical benefits associated with electrocautery at the 1-year follow-up were maintained at 4-year follow-up. Results indicated comparable rates of anterior knee pain, indicating that the clinical effects of electrocautery were not maintained. Additionally, mean total WOMAC and AKS scores were similar between groups. Secondary patellar resurfacing was required in 3 and 7 patients in the electrocautery and control groups, respectively.