Two hundred ninety-six total knee arthroplasties were performed with metal-backed patellar components in 206 patients with an average followup of 10 years. These total knee arthroplasties were reviewed retrospectively for survivorship, failure, and revision. There were 28 patellar component failures in 24 patients. Eighteen patellar components required revision. The average time to failure was 6.8 years. The average time to revision was 6.3 years. Survivorship analysis revealed .9662 survivorship at 5 years, which decreased to .8976 at 10 years, and .8641 at 14 years. These results do not compare favorably with the results of total knee arthroplasty with all-polyethylene patellar components. The use of metal-backed patellar components should be avoided.