CASE: A 57-year-old man, 5 years status post right patellofemoral arthroplasty (PFA) with a first-generation (1 G) inlay implant, presented with knee pain and decreased function in midflexion. Radiographs demonstrated minimal degenerative changes in the remainder of the knee. Considering this, he was not a candidate for conversion to total knee arthroplasty (TKA) and was converted to an onlay PFA with excellent pain relief, motion, and return to high demand activities. CONCLUSION: Patients with inlay PFA implants who are not candidates for conversion to TKA may benefit from conversion to onlay PFA designs.