The necessity of patellar resurfacing in Total Knee Arthroplasty (TKA) remains controversial. This study compared outcomes between resurfaced and non resurfaced patients to identify subgroups that benefit most from the procedure. A retrospective analysis of 625 patients undergoing PCL-sacrificing TKA (2012-2023) was conducted. Patients were categorized into non-resurfaced (n=469, 75%) and resurfaced (n=156, 25%) cohorts. Resurfacing was selectively performed for patients with rheumatoid arthritis (RA), severe patellofemoral degeneration, obesity, or prior patellar fractures. Outcomes included functional scores (KSS, WOMAC), pain (VAS), and patient satisfaction (measured via a scores (VAS, WOMAC) or patient satisfaction levels between the two groups. standardized survey).The resurfaced group was significantly older and had higher rates of secondary osteoarthritis, RA, osteoporosis, and prior contralateral knee surgery. Postoperatively, the resurfaced group demonstrated a significant reduction in crepitation. However, there were no significant differences in pain Conclusion: Patellar resurfacing in TKA improves patellofemoral mechanics in high-risk subgroups (those with RA, secondary OA, osteoporosis, or prior surgery). While it did not confer superior pain relief or satisfaction compared to non-resurfacing, selective resurfacing based on these specific risk factors is supported to optimize biomechanical outcomes. A tailored approach, guided by patient-specific factors and intraoperative findings, is recommended.