Osteoarthritis of the knee is the most common joint lesion in the middle-aged and elderly in China, with the patellofemoral and medial tibiofemoral joints being the most common lesions. With the aging of our population, this disease is becoming more and more prominent. The active prevention and treatment of this disease is of great importance. Artificial joint replacement has been widely used for severe knee osteoarthritis, but due to the high cost and the inability to meet the high intensity of physical activity after surgery, it is suitable for elderly people aged 65 years or older, with less activity and no need for physical work. Therefore, patients under 65 years of age who are in good health and need to engage in some physical labor, mainly with entropion deformity (commonly known as “internal abductor”, “rotundity” and “O” leg) and medial pain are the most suitable candidates. It has the advantages of small trauma, quick recovery, preservation of the complete joint function and structure, and tolerance of physical labor. The total cost of a unilateral hospitalization is about 20,000 to 30,000 yuan, and is reimbursed at a high rate by medical insurance and the agricultural cooperative. Unicondylar knee osteoarthritis produces internal and external rotational deformities, which can cause abnormal distribution of weight-bearing stresses in the joint, such as internal rotational deformity of the knee, causing a concentration of stress on the medial side of the knee, which accelerates joint degeneration on the medial side. When an external knee deformity occurs, the stresses on the lateral side of the joint are concentrated, causing accelerated degeneration of the lateral joint. High tibial osteotomy for the treatment of middle-aged and elderly knee osteoarthritis knee internal and external knee deformity has obvious effect of pain relief and improvement of function. The rapid disappearance of knee pain after surgery may be directly related to the reduction of intraosseous pressure, improvement of local blood flow and elimination of stagnation after surgery. It is a very effective surgical procedure for the treatment of unicompartmental osteoarthritis of the knee. Some patients with bicompartmental osteoarthritis can still be treated with osteotomy. The main methods are the lateral closed wedge osteotomy, the domed osteotomy and the medial open wedge osteotomy. The biomechanical principle is that the osteotomy corrects the deformity, changes the line of gravity of the affected limb, corrects the poor alignment, corrects the uneven distribution of stress on the knee joint, redistributes the stress on the knee joint surface, shifts the load to the undamaged interval, reduces the symptoms of osteoarthritis, and slows the process of joint degeneration. The principle of tibial high osteotomy for internal derangement is to shift the knee weight line from the medial side to the normal knee weight line or slightly outward, which is a means to make full use of the favorable conditions of the lateral healthy articular cartilage to partially repair the degenerating joint. Precise measurement of the osteotomy angle prior to surgery is critical to the success of the procedure. It is particularly advantageous in the treatment of the most common medial patellofemoral osteoarthritis of the knee, where a single osteotomy reduces the pressure on the patellofemoral joint and corrects the inversion deformity, providing real relief from knee pain and restoring joint mobility. Arthroplasty can be the first choice for those who do not like to be active, are older than 65 years old, and have severe deformities. In the absence of infection, it can be considered the ultimate treatment. A high tibial osteotomy is able to allow the patient to perform various activities, such as sports, without restriction. In contrast to HTO, artificial joints have a limited life span and many young patients under the age of 60 are not candidates for joint replacement surgery. The main concern is that the replacement of young, active patients with artificial joints may have a high joint reaction effect on the durability of the polyethylene joint surface, as biomechanical studies have shown: during activity (involving jumping and running). The surface load generated can exceed the limits of the polyethylene itself, the contact force generated by running is twice the body weight, and when the knee joint is extremely flexed, the reaction force of the patellofemoral joint is nearly 8 times the body weight, and during activity, these forces act together on the artificial joint, thus causing fatigue in the structure of the artificial joint; in addition, repeated and frequent aggravated loads, such as continuous work, swinging, climbing, can endanger the artificial joint, making it This can endanger the artificial joint and make it loose. One of the advantages of HTO is that it allows the patient to continue to maintain a high level of mobility and to engage in high levels of physical activity after surgery, all safely. Therefore, if a patient with osteoarthritis of the knee wants to continue to participate in sports that involve jumping, running, or occupations that require bending, digging, climbing, etc., HTO is definitely the best option. HTO can be fixed either internally with a plate or externally with a minimally invasive approach. The use of the Meng external fixation brace to fix the U-shaped osteotomy end allows for early partial weight-bearing activities after surgery, avoiding the need for patients to undergo a second incision to remove the internal fixation, and achieving satisfactory results. Any surgery is not a panacea, there are advantages and shortcomings, 95% excellent rate in 10 years, 20 years still 60-80% can meet the pain-free daily activities, significantly prolong the life of their own knee joint, and does not increase the difficulty and does not affect the quality of the knee replacement that may be performed later. It also allows many patients with knee problems to avoid artificial joint replacement. In conclusion, HTO as a surgical method for the treatment of osteoarthritis of the knee has the following advantages: 1. The osteotomy plane is located in the cancellous bone, the bone heals quickly after osteotomy, and the incidence of non-union is low. 2. Functional exercises can be performed early after surgery to avoid knee adhesions after surgery. 3.The operation is simple and has few complications. 4.When the efficacy of surgery decreases, it does not affect the effect of the initial artificial knee replacement. 5.Post-operative work can still be performed with certain intensity, which is especially suitable for younger patients with osteoarthritis of the knee.