Introduction: Patellar resurfacing during total knee replacement (TKR) remains a subject of debate among orthopedic surgeons. Although it is included in many TKR procedures, its impact on the functional outcomes of the knee is not fully understood. This study investigates the functional outcomes of patellar resurfacing using bony landmarks in patients undergoing TKR, focusing on postoperative knee function and patient satisfaction. Objective: To evaluate the functional outcomes of patellar resurfacing using bony landmarks in patients undergoing total knee replacement. Methodology: A retrospective study was conducted and total of 55 patients who underwent total knee replacement with patellar resurfacing were added in the study. Functional outcomes were assessed using the Knee Society Score (KSS), range of motion (ROM), and patient-reported outcomes such as satisfaction and pain levels. The data were analyzed using standard statistical methods. Results: The study found significant improvements in knee function, including increased range of motion and KSS scores. The mean age of the patients was 62.4 ± 8.2 years, with 45% being male and 55% female. The patient population was primarily diagnosed with knee osteoarthritis (80%), while the rest (20%) had post-traumatic arthritis. Both age groups (≤60 years and >60 years) showed significant improvements in ROM, with patients over 60 showing a slightly greater mean improvement of 22.7° compared to 21.3° in those under 60, indicating that even older patients benefit substantially from the procedure. In terms of gender, both male and female patients showed similar improvements in ROM (22.6° and 22.8°, respectively), suggesting that the technique is equally effective across genders. Conclusion: Patellar resurfacing using bony landmarks in total knee replacement offers favorable functional outcomes, including increased ROM, reduced pain, and high patient satisfaction. This method appears to be an effective approach for improving knee function postoperatively.