Knee osteotomy is used to treat degenerative knee conditions by redistributing forces across the knee joint, thus delaying knee arthroplasty. It is an effective treatment for medial or lateral compartment knee arthritis with varus or valgus deformity of the lower extremity. Osteotomy has become more effective with recent advances in surgical technique, planning, and execution, decreasing complications and improving outcomes. Advanced techniques such as high tibial osteotomy (HTO) and distal femoral osteotomy (DFO), along with other new technologies, such as computer navigation systems, have improved the accuracy and precision of osteotomy. This procedure can be further improved with mechanical and biological correction in osteotomy, as well as regenerative or enhanced tissue repair using regenerative medicine techniques and other promising modalities. This chapter provides background information on the technical variations of the procedure and patient selection. It discusses how these new therapies are evolving to improve patient outcomes, function, and mobility, as well as delaying future knee replacement.