Osteoarthritis (OA), which will affect 86 million people worldwide by 2020, is the most prevalent type of arthritis in the Indian population. Treatment options include unicondylararthroplasty, high tibial osteotomy, total knee arthroplasty and high tibial osteotomy with a proximal fibular osteotomy (PFO). PFO helps in decreasing the pain and satisfactory functional recovery. The purpose of this study was to evaluate the radiological and clinical outcomes of medial compartment OA knee treatment with minimally invasive PFO as a novel and alternative modality of care.A total of 44 patients, aged 48 to 69, who underwent PFO for medial compartment OA knee between January 2022 and March 2023, were selected (12 men and 32 women).A weight-bearing whole lower extremity scanogram was taken both before and after surgery to evaluate the lower limb alignment (femorotibial angle) and joint space ratio (medial/lateral joint space). Functional outcome was assessed with American Knee Society Score (KSS), and knee pain was assessed with visual analog scale (VAS). In our study, 44 patients received PFO treatment and underwent at least three months of observation. Following surgery, the VAS significantly decreased from 6.93 before surgery to 3.78 afterward, and all patients reported feeling significantly less pain. Weight-bearing lower extremity radiographs showed a significant expansion of the medial knee joint space in 42% of patients. Additionally, we observed an increase in the medial joint space, which went from 1.84 ± 0.22 mm preoperatively to 3.95 ± 0.56 mm after surgery. Similar improvement were also observed in Oxford knee score and knee society score. PFO is an innovative, secure, and efficient treatment for medial compartment arthritis of the knee that is minimally invasive, reduces pain, and improves joint function. It aids in the adjustment of a varus knee.