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The optimal management of the patella during total knee arthroplasty (TKA) remains controversial and surgeons tend to approach the patella with one of three general mindsets: always resurface the patella, never resurface the patella, or selectively resurface the patella based on specific patient or patellar criteria.Studies comparing resurfacing and non-resurfacing of the patella during TKA have reported inconsistent and contradictory findings.When resurfacing the patella is chosen, there are a number of available patellar component designs, materials, and techniques for cutting and fixation.When patellar non-resurfacing is chosen, several alternatives are available, including patellar denervation, lateral retinacular release, and patelloplasty. Surgeons may choose to perform any of these alone, or together in some combination.Prospective randomized studies are needed to better understand which patellar management techniques contribute to superior postoperative outcomes. Until then, this remains a controversial topic, and options for patellar management will need to be weighed on an individual basis per patient. Cite this article: EFORT Open Rev 2021;6:861-871. DOI: 10.1302/2058-5241.6.200156., Competing Interests: ICMJE Conflict of interest statement: TD reports grants pending to their Institution from Stryker Orthopaedics, for relevant financial activities outside the submitted work. RMM reports consulting fees paid by Stryker Orthopaedics pertinent to the work under consideration for publication, and also consultancy fees from the same for relevant financial activities outside the submitted work. SK reports various monies (consultancy, expert testimony, payment for manuscript preparation) paid by Exponent, for relevant financial activities outside the submitted work. They also report grants from Zimmer Biomet, Stryker, Lima Corporate, Osteal, Ferring, Orthoplastics, Wright Medical Technology, DJO, CarbofixSINTX, Celanese, Invibio and Ceramtec – again for relevant financial activities outside the submitted work. All authors declare no conflicts of interest relevant to this work., (© 2021 The author(s).)

Robotic-assisted total knee arthroplasty (RA-TKA) has shown improved reproducibility and precision in mechanical alignment restoration, with improvement in early functional outcomes and 90-day episode of care cost savings compared to conventional TKA in some studies. However, its value is still to be determined.Current studies of RA-TKA systems are limited by short-term follow-up and significant heterogeneity of the available systems.In today's paradigm shift towards an increased emphasis on quality of care while curtailing costs, providing value-based care is the primary goal for healthcare systems and clinicians. As robotic technology continues to develop, longer-term studies evaluating implant survivorship and complications will determine whether the initial capital is offset by improved outcomes.Future studies will have to determine the value of RA-TKA based on longer-term survivorships, patient-reported outcome measures, functional outcomes, and patient satisfaction measures. Cite this article: EFORT Open Rev 2021;6:252-269. DOI: 10.1302/2058-5241.6.200071., Competing Interests: ICMJE Conflict of interest statement: AS reports consultancy for the Zimmer Biomet robot discussed in the paper, outside the submitted work. MRB reports consultancy for Stryker Orthopaedics, outside the submitted work. NSP reports consultancy for Stryker Orthopaedics and grants/grants pending with OREF, RegenLab and Zimmer, all outside the submitted work. The authors declare no conflict of interest relevant to this work., (© 2021 The author(s).)