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Fifty-three patients with incapacitating patellofemoral arthritis and minimal tibiofemoral changes underwent a total knee replacement. Their results were compared with the results of a concomitant series of patients with tricompartmental osteoarthritis. Preoperatively group of patients with patellofemoral arthritis had more individuals with a lateral patellar tilt and inability to climb stairs in a bipedal manner than in the group with tricompartmental arthritis. Furthermore, fewer patients in the group of patients with patellofemoral arthritis could rise independently from a chair than could those patients with tricompartmental arthritis. The mean followup period was 7.4 years. The rate of lateral parapatellar releases was three times greater in the patients with patellofemoral arthritis. The group of patients with patellofemoral arthritis had higher knee scores and a greater ability to climb stairs in a bipedal manner as compared with the patients with tricompartmental arthritis. Residual anterior knee pain was present in approximately 7% of patients in both groups. Total knee replacement resulted in better outcomes for older patients with patellofemoral arthritis as compared with patellofemoral replacement, debridement procedures, and patellectomy.