[Objective] To compare the early and mid-term clinical outcomes of patellar replacement combined with denervation electrotomy and patellar denervation alone in total knee arthroplasty (TKA). [Methods] The clinical data of 45 patients (52 knees) with advanced osteoarthritis undergoing initial TKA admitted to our department from February 2018 to December 2020 were retrospectively analyzed. Randomly selected TKA patients underwent patellar replacement combined with patellar denervation electrotomy (replacement group, 24 patients, 28 knees), and patelloplasty combined with patellar denervation electrotomy (control group, 21 patients, 24 knees). All patients used the same type of total knee prosthesis. After surgery, the patients are regularly followed. The knee joint function and patella function are evaluated using the American Knee Association score (KSS score); The amount of intraoperative bleeding, as well as the decrease in hemoglobin level and the duration of the operation 3 days after the operation were recorded. [Results] All patients were followed up. At the last follow-up, 2 patients in the replacement group experienced mild pain after activity, and 1 patient experienced moderate pain. In the control group, 3 cases had slight rest pain, 3 cases had mild pain, and 2 cases had moderate pain. There were no serious complications such as severe pain, joint instability, prosthesis loosening, and the need for joint revision in both groups. At the last follow-up, there was no statistically significant difference in the clinical score and functional score of KSS between the two groups (P>0.05). [Conclusion] There is no significant difference in the early and medium term efficacy between patellar replacement combined with patellar denervation electrotomy and patelloplasty combined with patellar denervation electrotomy in patients with knee osteoarthritis during initial TKA.