Routine replacement of the patellofemoral joint with total knee arthroplasty is controversial despite the fact that the incidence of anterior knee pain with disabling symptoms has been reported to be 50% [1–17]. The argument put forward for patellofemoral joint replacement is based on theoretical grounds. It is generally accepted that peak loads in the patellofemoral joint are two to three times body weight. For this reason some surgeons fear that complications such as fracture, wear, and loosening could occur in a significant number of cases.