Introduction <p>Isolated lateral patellofemoral osteoarthritis is a&#xa0;rare but clinically important condition. Lateral patellar facetectomy can be used as a&#xa0;joint-preserving salvage procedure for patients who are not suitable candidates for total knee arthroplasty or a&#xa0;patellofemoral compartmental prosthesis or who decline these options. This procedure can offer an effective treatment option by reducing pathologically elevated lateral contact pressures and improving patellar tracking, particularly for patients who do not adequately respond to conservative measures.</p> Material and methods <p>This article provides an overview of the anatomical, biomechanical and pathophysiological foundations of lateral patellofemoral osteoarthritis as well as the indications, contraindications and technical aspects of lateral patellar facetectomy. The risks, complications and clinical outcomes are also summarized, both for the native joint and in the context of knee arthroplasty.</p> Conclusion <p>Lateral patellar facetectomy is a&#xa0;safe, effective and minimally invasive procedure for the treatment of isolated lateral patellofemoral osteoarthritis. It enables substantial pain relief and functional improvement with low complication rates and can delay prosthetic joint replacement, particularly in younger or active patients. Optimal outcomes depend on careful patient selection, a&#xa0;precise resection technique and, when appropriate, the combination with other procedures such as lateral retinacular lengthening.</p>