Patellofemoral arthritis is generally regarded as a contraindication to unicompartmental knee arthroplasty. A retrospective review of 52 patients (60 knees) who underwent this operation together with nonresurfacing excisional patelloplasty was carried out. The patellar facets were resected through subchondral bone retaining the triangular shape of the bone. There were 90% good and excellent results at an average follow-up of 6 years with no patellofemoral pain, despite marked to moderate patellofemoral crepitus in 98%. Patellofemoral arthroplasty can extend the indications for unicompartmental knee arthroplasty, providing an alternative to total knee replacement.