Unicompartmental knee arthroplasties (UKAs) currently represent an important portion of knee arthroplasty procedures and their usage is on an upward trend. Despite offering better functional outcomes and a quicker recovery compared to total knee arthroplasties (TKAs), UKAs are often scrutinized for their longevity. This article provides an in-depth examination of the technical nuances and survival rates of medial versus lateral UKAs, drawing on recent advances and findings in the field. This manuscript thoroughly evaluates the comparability of patient populations undergoing medial and lateral UKAs, considering their anatomical, biomechanical, and demographic differences. It delves into the specific technical challenges associated with each type and systematically assesses the factors that influence failure, including the intricacies of implant design and patient-specific variables. Despite relevant anatomical and biomechanical contrasts between medial and lateral UKAs, recent literature points to comparable survival rates. The prevalence of early failures within the initial five years post-operation underscores the criticality of precise patient selection and refined surgical techniques. The paper succinctly summarizes pivotal literature and provides essential guidance for optimizing UKA survivorship. It underscores the importance of meticulous patient selection and precise surgical techniques, alongside the identification and mitigation of potential pitfalls that impact outcomes. Finally, robotic technology in UKA has considerably enhanced the precision and reproducibility, representing a viable solution to effectively meet and achieve the recommended technical objectives.