Background: Unicompartmental knee osteoarthritis (OA) affects a single compartment of the knee, leading to pain and functional limitations. Proximal fibular osteotomy (PFO) and medial open wedge high tibial osteotomy (MOWHTO) are surgical treatments aimed at relieving symptoms and improving knee alignment, but their comparative effectiveness is still under study. Objective: To compare clinical outcomes, pain relief, functional improvement, and alignment correction achieved with PFO and MOWHTO in patients with unicompartmental knee OA. Methods: This prospective study included 20 patients with unicompartmental knee OA, divided into two groups of 10 each: one group underwent PFO, and the other received MOWHTO. Outcomes were assessed at 3, 6, 12, and 24 months postoperatively using VAS for pain, KOOS for function, and radiographic analysis for alignment correction. Results: Both groups showed significant improvement, but MOWHTO demonstrated superior pain relief, functional improvement, and alignment correction at 24 months. Conclusion: Both PFO and MOWHTO are effective for unicompartmental knee OA, but MOWHTO offers better long-term outcomes. These findings assist clinicians in selecting appropriate surgical options based on patient needs.