Abstract Isolated patellofemoral osteoarthritis (PFOA) is symptomatic in around 10% of people aged over 55 years. This article presents a review of the treatment of PFOA with isolated patellofemoral arthroplasty (PFA). PFA has evolved in patient selection, surgical technique and implant design since its inception in the 1950s. Despite good clinical outcomes and survivorship being reported in the literature from a number of implants, PFA still remains a controversial subject due to high revision rates reported from large registries such as the National Joint Registry (NJR). Whilst patient selection and intra-operative techniques to optimize extensor mechanism function and avoid dynamic ‘overstuffing' of the patellofemoral joint are key to the success of PFA, they are often overlooked. More recently, concomitant procedures to address patellar instability, tibiofemoral malalignment and patellofemoral malalignment have been performed to optimize PFA outcomes. With attention to detail in patient selection and surgical technique, using appropriate implants, PFA can lead to improved clinical outcomes and high survivorship for the treatment of isolated severe PFOA.