With the improvement of health conditions in China and the significant increase in per capita life expectancy, aging has arrived and some geriatric diseases have gradually become common in orthopedic clinics, and osteoarthritis of the knee is definitely one of the most colorful of the geriatric orthopedic diseases. When osteoarthrosis of the knee occurs, patients are faced with pain and limited movement of the knee joint, walking, going up and down stairs, and squatting are all limited to varying degrees. I often hear patients ask, “I have osteoarthritis, do I have to have my knee replaced? The following is an introduction to other methods of intervention for osteoarthritis of the knee: Tibial high osteotomy can effectively treat osteoarthritis of the knee: The anatomical characteristics of our human knee joint determine that the knee normally experiences greater medial forces than lateral ones. Therefore, osteoarthritis of the knee is more likely to occur on the medial side. When the knee joint is internally rotated, the pressure on the medial side of the knee joint is further increased and wear and tear is significantly greater. According to statistics, the incidence of osteoarthritis in the inversion knee is four times higher than in the normal knee, and once osteoarthritis occurs, it progresses 20 times faster than in the non-inversion knee. The more the knee turns inward, the greater the stress on the inside of the joint, the greater the cartilage wear, the narrower the joint space, and the more the knee becomes turned inward, which creates a vicious cycle that develops until the cartilage wears out, the knee bones wear the bones, and the patient has difficulty walking. In patients like this one, although the medial cartilage is badly worn, the lateral compartment of the knee joint has been under relatively little stress and the cartilage is almost intact. So the surgeon corrects the inversion of the knee with a high tibial osteotomy and puts more force on the lateral joint and less on the medial. This breaks the vicious cycle of medial osteoarthritis progression and allows the arthritis to stop and gradually recover. Arthroplasty does not fully meet the functional needs of the patient: In total knee arthroplasty, the cruciate ligament inside the knee is removed and replaced with a simple mechanical device. This mechanical device only works after the knee has been flexed to 70 degrees or more. Therefore, until this degree of mobility is reached, the knee joint is basically in a state of cruciate ligament deficiency, with sensory instability, loss of proprioception, and unnatural joint sensation. Also, most patients have problems with limited knee flexion. Therefore, although walking is possible, it is not recommended by many exercise doctors. With more activity, patients are prone to painful swelling and increased wear and tear on the joint. Older people are now becoming more and more active. This has led to a low satisfaction rate and a high rate of future revisions in relatively young elderly patients who have received artificial joint replacements. Therefore, in some countries, such as South Korea and South Africa, new health insurance policies have been introduced where patients under 65 years of age with knee osteoarthritis who undergo joint replacement are not reimbursed by health insurance. This policy curbs the trend of expanding the indications for artificial joint replacement and objectively promotes the development of knee osteotomies. Osteotomies are gradually returning to the mainstream of joint treatment: osteotomies are very well developed in Europe, Japan, and Korea, but poorly developed in the United States. The reason for this is that the United States is home to almost all of the largest artificial joint companies in the world. Artificial joints are a huge medical industry in the United States. The strength and speed of the promotion of artificial joints can be described as a mountain. This has also deeply influenced the medical environment in China, where artificial joints have developed rapidly in recent years, and many hospitals have set up “joint surgery”, which is actually “joint replacement surgery”. In the wave of artificial joints, the voice of osteotomy has been drowned out and reduced to a non-mainstream. Japan and Korea, which are part of the same cultural circle as ours, have been among the best regions for the development of osteotomies, adhering to the philosophy of preserving the patient’s own joints as much as possible. There is also a group of orthopedic surgeons in China who have always adhered to osteotomies in an effort to prevent the expansion of joint replacements. There are other doctors who, with the massive adoption of arthroplasty, have found that it does not meet the functional needs of their patients and that complications are increasing, prompting them to refocus their attention on osteotomy. The second level is philosophically, we advocate a stepwise surgical approach to osteoarthritis: for a patient who has failed conservative treatment, we cannot see joint replacement as the only option. Rather, depending on the patient’s condition, osteotomy or unicondylar replacement should be the preferred option, followed by total knee replacement if that is not possible. Because osteotomy preserves the patient’s joint, postoperative function is best; unicondylar replacement preserves all of the patient’s ligaments, function is second best; and total knee replacement sacrifices both the joint and the ligaments, with the lowest functional score. The ladder of postoperative function dictates that our surgical selection should also be ladder-based. We should give preference to the surgical option that preserves the maximum function of the patient’s knee joint.