Background: Proximal fibular osteotomy, which involves excising a proximal portion of the fibular bone, has been shown to be an effective treatment for knee osteoarthritis. This treatment is clinically validated by its immediate and explicit knee pain resorption and radiographically validated by joint space correction. This treatment reasoning is known as non-uniform settlement of the tibia plateau, and it is utilized to determine the origin of knee joint pain. Aim: To evaluate the efficacy of proximal fibular osteotomy (PFO) in isolated medial compartment knee osteoarthritis in terms of pain relief and knee ambulation activities. Material and method: This study is designed as a prospective observational study. Study was done between March 2021 to February 2022 in Chirayu Medical CollegeAnd Hospital, Bhopal, where 20 patients with isolated medial compartment knee OA were operated.Knee pain was assessed using visual analogue scale (VAS), and knee ambulation activities were recorded using American Knee Society score (KSS) preoperatively and postoperatively and then at 3rdmonth and 12thmonths follow-up. Results: The mean age of patients was 58.6 years. Out of 20 patients, 12 were female and 8 were male. Postoperative weight-bearing x-rays of knee joint showed increase in medial joint space and Medio-Lateral joint space ratio (ML ratio)improved significantly postoperatively. Alignment of lower extremity got improved, measured by femorotibial and hip knee ankle angle.In the final analysis, the mean± SD KSS was 90.25±3.31 in females and 89±1.85 in males postoperatively. Medial knee pain got relieved in almost all patients after PFO, pain assessed by VAS score was found significantly improved with Chi-square value = 25.85 and P value = 0.00000036 (<0.001) association is significant postoperatively. Conclusion: Our study demonstrates that PFO effectively relieves pain and improves joint function in patients with isolated medial compartment osteoarthritis knee. It can potentially become an alternative treatment method, especially for patients who cannot undergo total knee replacement because of medical comorbidities and in patients who wants to sit cross leg and squat and doesn’t have access to western toilet.