High tibial valgus osteotomy for varus gonarthrosis is a time-honored procedure in the treatment of medial compartment arthritis of the knee joint. The results of high tibial osteotomies have traditionally been shown in the literature to delay total knee arthroplasty from 5 to 10 years, on average. The ideal patient has classically been an active young person with a varus deformity of less than 10 to 12 degrees with primarily medial compartment arthrosis and uninvolved patellofemoral lateral compartments. Good bone stock is also desirable and, given that the osteotomy is performed through metaphyseal bone, healing has not been a problem with this procedure. The literature reports wide variations in the approach used for the high tibial osteotomy, implants used for fixation of the osteotomy, and ultimate outcome. Certainly, wide variations exist in the ultimate correction and alignment obtained from the osteotomy. This review focuses on the anatomic goals of the osteotomy, as well as recent and more classic reports of the results of this procedure.