Background: Osteoarthritis (OA) is the most common type of arthritis in clinical practice and is one of the leading causes of disability worldwide. The hands, knees, and hips are the most commonly affected joints, although any joint can be affected. Proximal fibular osteotomy (PFO) is an alternative treatment to high tibial osteotomy (HTO). It is a surgical procedure for medial compartment knee osteoarthritis (KOA). Hence this study was conducted to assess the functional outcomes of proximal fibular osteotomy in patients with knee osteoarthritis. Materials & methods: A total of 20 patients were assessed. The patients were placed in the supine position after administration of spinal anaesthesia. An approximately 5-cm longitudinal incision was made over the lateral aspect of the proximal fibula, and the fibula exposed between the peroneus muscle and soleus muscle. Knee pain was assessed using a Visual analogue scale. Medical joint space and the hip knee-ankle angle was measured. based on the whole lower extremity radiograph. Results: Significant improvement was observed in the mean VAS improved from preoperative value of 7.5 to 2.7 at 9 months postoperative follow-up. Significant improvement was observed in the Mean knee joint space from preoperative value of 0.42 to 0.67 at 9 months postoperative follow-up. Significant improvement was observed in the mean hip knee ankle angle from preoperative value of 179.2 to 166.9 at 9 months postoperative follow-up. Conclusion: A novel alternative approach for treating knee medial compartment arthritis is represented by PFO.