Background: Unicompartmental knee arthroplasty (UKA) is a procedure with low morbidity and fast recovery. Anatomic implants or robotic-assisted UKA has been proposed to improve outcomes with precise positioning. Femoral component position (FCP) relative to the tibial insert could be a factor influencing the contact stresses. We aimed to evaluate the effect of the FCP relative to the tibial insert on clinical outcomes and stress distribution after medial UKA. Methods: Sixty-two medial fixed-bearing UKAs were evaluated at a minimum two-year follow-up using the Knee Society Score. Postoperative radiological evaluation performed on frontal X-rays classified the FCP relative to the tibial insert into the following: group M (medial), group C (central), and group L (lateral). A finite element model was developed to evaluate the biomechanical effects of the FCP relative to the tibial component. Results: The postoperative radiological evaluation showed 9 cases in group M, 46 cases in group C, and 7 cases in group L. The maximum knee flexion angle and the 2-year postoperative ``symptom'' and ``patient satisfaction'' scores of the Knee Society Score were significantly higher in group C. Compared with central positioning, a shift along the mediolateral axis leads to a displacement of the contact pressure center. Conclusion: The FCP relative to the tibial insert may increase patient outcomes at a minimum follow-up of two years after fixed-bearing medial UKA. Accordance between FCP and contact stresses on the polyethylene insert could be a contributing factor of long-term survival of UKA. (C) 2022 Elsevier Inc. All rights reserved.