Irrespective of the radiology, it is the symptom complex and the effect it has on life activities which should guide the treatment choice. Pain is the major symptom to be considered. May patients with isolated patellofemoral osteoarthritis are able to walk long distances and have mild symptoms. To be successful, an Isolated patellofemoral arthroplasty requires essentially normal patellofemoral tracking and little arthritis involving the other two compartments. The information provided suggests that a patellofemoral arthroplasty is unlikely to be successful here. If the symptoms - read pain - of the arthritis is significant and non operative treatments have failed, a well positioned total knee replacement is likely to provide great benefit. Tibial osteotomy is very rarely required.