Anteromedial osteoarthritis is a common phenomenon in degenerative conditions of the knee. This limited wear pattern is contingent on a functioning anterior cruciate ligament and medial collateral ligament, and can be managed differently to tricompartmental or inflammatory arthritis. The UK National Institute for Health and Care Excellence (NICE) stipulate that patients with this pattern of disease should be offered the choice of either unicondylar (UKA) or total knee replacements, but many knee surgeons are either unfamiliar with UKA or do not readily include it in their practice. The Oxford UKA is an established and trusted prosthesis with excellent outcomes, yet cumulative marginal gains that improve outcomes further can be achieved by following the approach of high-volume centres. In this article we discuss the Oxford perspective on this subject, touching on the design philosophy, indications, perioperative pearls, day-case protocols, outcomes and tips for starting practice. The most common number of UKAs performed by knee surgeons a year is one; this article aims to provide readers with the understanding, confidence and tips to optimize UKA use within their practice and maximize patient outcomes.