Medial opening wedge high tibial osteotomy is one of the standard procedures used frequently to manage varus deformity of the knee through shifting the load laterally in the knee. To assess the safety and efficacy of opening wedge high tibial osteotomy using the puddu plate in patients with genu varum deformityThis study was conducted on 22 knees in 20 consecutive patients who had performed medial opening-wedge high tibial osteotomy using Puddu plate between October 2017 and May 2019 for varus malalignment. This study was conducted in Benha university hospitals. The total knee society score was compared between preoperative and postoperative to assess the patients' outcome. Also individual elements of the score including alignment, instability and range of motion were assessd postoperatively. Varus angle and mechanical axis deviation were measured preoperative and postoperative.In this study, there was a significant improvement of knee society score post operatively. (P value <.00001). There was significant improvement of mechanical axis deviation with pre-operative mean 17.82 mm to post-operative -2.23 mm (valgus). (P value < .00001). Patients started partial weight bearing at 8 weeks, then, full weight bearing started at 12 weeks, most patients returned to work after 15 weeks.The findings of our study showed many benefits of medial opening wedge high tibial osteotomy with puddu plate procedure including easier procedure, no need for bone graft. This procedure had satisfactory outcomes regarding union rates pre and post-operative scores, patient satisfaction and low rate of complications.