The patellofemoral articulation has been frequently overlooked as a significant contributor to the success of primary total knee arthroplasty. Neglecting the patellofemoral articulation frequently leads to abnormal patellofemoral tracking. To understand the concept of patellofemoral maltracking, the importance of the Q angle, mechanical alignment, femoral component rotation, tibial component positioning, patellar component positioning, patellar height, and patellar resurfacing as factors related to patellofemoral tracking and function must be considered. Greater attention to and understanding of these factors will lead to significant pain relief and overall patient satisfaction.