<p><strong>Background</strong>: Patellofemoral joint management during total knee replacement remains a controversial topic among knee surgeons. The purpose of this study is to evaluate the influence of resurfaced patellar component tilt on the functional outcome of total knee arthroplasty.</p><p><strong>Methods</strong>: This is a retrospective study reviewing all the patients who underwent total knee arthroplasty in our institution, operated by a single surgeon using a single implant design.</p><p><strong>Results:</strong> A total of 48 patients and 82 knees were enrolled into this study. Patients were evaluated by Oxford knee score, knee society score, Melbourne patellar score, anteroposterior, lateral, and Merchant’s view radiographs. The patellar tilt was divided into three grades according the measurement obtained from knee radiographs.</p><p><strong>Conclusions: </strong>A higher degree of patella tilt (more than 10 degree) is associated with poor outcome following total knee arthroplasty. Melbourne patella score is more sensitive than knee society score and Oxford score in assessing the effect of patella tilt on the outcome of total knee arthroplasty.</p>