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Periarticular osteotomies, either a high tibial osteotomy for a varus deformity or a distal femoral osteotomy for a valgus deformity, are performed for symptomatic unicompartmental degenerative joint disease (DJD) of the knee. These procedures provide pain relief by realigning the mechanical axis and unloading the degenerative compartment. Although arthroplasty has become a reliable procedure for DJD, premature wear and revision remain a concern for younger individuals as well as for individuals who desire to participate in high impact activities. Long-term follow-up studies have shown good results for osteotomy at over 10 years of follow-up. Periarticular osteotomies are a reliable and durable way to provide symptomatic relief for these younger and more active patients with symptomatic DJD of the knee.