32 patients (64 knees) undergoing primary bilateral single-stage total knee arthroplasty (TKA) for the treatment of osteoarthritis were randomized to undergo one of two procedures at each knee. The first group underwent patellar resurfacing for the first TKA and patellar nonresurfacing on the second. The second group underwent patellar nonresurfacing for the first TKA and patellar resurfacing on the second. The results indicated that no significant differences were seen at the 10-year follow-up in outcomes of pain, range of motion, revision rates, operative procedure, patient satisfaction and preference between the two procedures.