Background: Osteoarthritis of the knee is a prevalent form of joint disease that can result in debilitating pain and limited movement.  Objectives: This study aimed to know the better management of medial compartment osteoarthritis with varus deformity. Patients and Methods: This clinical trial was conducted at Orthopedic Surgery Department, Zagazig University through the period from January 2019 to June 2022. Twenty-four cases of medial compartment knee osteoarthritis were included in this study, all of which had proximal fibular osteotomy (PFO). The mean age of the included cases was 56.6 years. Results: In this study, American Knee Society (AKS) scores showed a significant increase (p < 0.001) from 41.6 ± 5.4 preoperatively up to 80.6 ± 2.6 at 12th month postoperatively. There was significant decrease in visual analogue scale from 8.4 ± 1.6 pre-operation to 1.5 ± 0.8 at 12th month post-operation. Conclusion: Patients with medial compartment knee osteoarthritis often find relief from their symptoms and an increase in their quality of life following a proximal fibular osteotomy.