Seventy-two patellofemoral arthroplasties in 65 patients were followed an average of 4 years (range, 2–12 years). In 69 cases concomitant surgery was performed, including soft tissue realignments, tibial tubercle transfers, and unicompartmental femorotibial reconstructions. Twenty-two patients had already had knee procedures, 18 of which addressed their patellofemoral joint. The implant used in all cases features a deep, nonanatomic trochlear component. Using the Mansat scoring system, 85% of the results were good to excellent, with nearly 50% of these excellent. Fourteen complications were noted, seven related to the implant itself and seven associated with extrapatellar pathology. The authors have found patellofemoral arthroplasty to be a viable solution to end-stage patellofemoral arthritis, keeping in mind a nonforgiving surgical technique and the necessity to address all extraarticular pathology.