Osteoarthritis of the patellofemoral joint is one of the main causes of knee pain, with a high prevalence in middle-aged and older people, especially women. Patients present with difficulty walking up and down stairs and squatting, with pain in the flexed knee position, and arthroscopic examination reveals degeneration and wear of the patellar and femoral talocrural cartilage or a tendency to lateral displacement of the patella. There is a lack of highly effective clinical management. Patellofemoral arthroplasty (PFA) surgery, after a long period of clinical practice and prosthetic renewal, has gradually become an alternative treatment for simple patellofemoral osteoarthritis. Development and status Attempts to treat patellofemoral osteoarthritis with prosthetic replacement began in the 1960s: McKeever first reported successful patellofemoral surface replacement in 1955, and Depalma et al. confirmed the feasibility of the procedure in 1960, followed by Levitt’s long-term follow-up report, stating that it was a successful alternative to patellar resection or partial resection, especially for simple patellofemoral osteoarthritis. The procedure has been shown to be a successful alternative to patellar resection or partial patellar resection, especially for simple patellar disease. Prosthetic design and surgical techniques are becoming more sophisticated, and outcomes have improved. Its clinical efficacy and acceptance are far from that of total knee arthroplasty, with PFA being chosen in only 2-3% of cases. Problems Strict selection of suitable cases for surgery is a prerequisite to ensure the efficacy of PFA after surgery. So far, there is no widely accepted and specific clinical indication criteria for PFA, and only a certain consensus has been formed on the basis of clinical practice experience: middle-aged patients with simple and secondary patellofemoral osteoarthritis, excluding those with abnormal force lines of the tibiofemoral joint have better outcomes after PFA, but there are still no exact criteria for the selection of specific cases. In patients with primary osteoarthritis, because the progression of tibiofemoral joint osteoarthritis cannot be predicted yet, rash surgery is bound to lead to surgical failure. These factors limit the development of PFA surgery, and some physicians even recommend direct TKA for patients with simple patellofemoral osteoarthritis. practice has shown that the efficacy of PFA surgery is directly related to the appropriateness of case selection. In addition, there are controversies regarding age, gender selection and whether to choose PFA treatment for patients with chondromalacia patellae. In-depth research on the pathogenesis of patellofemoral osteoarthritis and the normal anatomical morphology and biomechanical characteristics of the patellofemoral joint, understanding the various factors affecting patellar trajectory and corresponding measures, proposing practical prosthesis design and using precise surgical operating instruments and positioning systems may be the future direction of PFA.