Abstract:[Objective] To introduce the surgical technique and preliminary outcome of total knee arthroplasty (TKA) with patellar ex- clusion for knee osteoarthritis (KOA) accompanied with fixed patellar dislocation. [Methods] Four elderly patients (5 knees) underwent TKA with patellar exclusion using restrictive prosthesis for KOA with fixed patellar dislocation. The joint was opened by anteromedial incision, the patella was trimmed and shaped, denervated, and the lateral retinaculum was released. As judging that the patella could not be reduced, and the patella was left in situ. After the femoral and tibial osteotomies were conducted correctly, the prosthetic components were installed re- spectively, and the incision was sutured. [Results] All patients had TKA performed successfully without serious complications, and followed up for (4.0±0.8) years on an average. Compared with those preoperatively, the VAS score [(7.0±0.9), (1.1±0.9), P＜0.001] and HSS score [(29.9±5.5), (79.2±3.6), P＜0.001] improved significantly at the latest follow-up. All the patients had knee extensor muscle strength of grade 4, and could walk normally, whereas with knee extension sag of 10°~25° in the decubitus position. No prosthesis loosening was observed in anyone of them. [Conclusion] For the elderly knee OA with fixed patellar dislocation, TKA can be performed with patellar exclusion if the functional needs of patients are not high, which does achieve satisfactory clinical outcomes, and should be used as a choice for this scenario.