18 randomized and quasi-randomized controlled trials (RCTs) were included in this systematic review and network meta-analysis to determine differences in clinical outcomes between patellar denervation, resurfacing, and non-resurfacing in patients undergoing primary total knee arthroplasty (TKA) for osteoarthritis (OA) of the knee. The findings of this study demonstrate a possible positive effect of both patellar denervation and patellar resurfacing on clinical outcomes when compared to non-resurfacing. Additional clinical trials are needed to evaluate the potential for using these treatments in combination.