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Aims: Medial compartment arthritis is very common in the Asian population because of a preponderance of varus knees. High tibial osteotomy and total knee replacement are technically demanding procedures, while proximal fibular osteotomy (PFO) significantly relieves pain and improves joint function in knee osteoarthritis (OA). This retrospective study was conducted at Patna Medical College and Hospital. The objective of this study was to assess functional outcomes after PFO and its correlation with bone mineral density. Settings and Design: The study design was a retrospective study. Subjects and Methods: Twenty patients with unicompartmental OA with varus deformity were included in the study. Inclusion criteria included patients with moderate-to-severe symptomatic medial unicompartmental OA of the knee, who had an indication for a surgical procedure, and who were able to give informed consent for the surgery. Exclusion criteria included patients with posttraumatic knee OA or inflammatory joint disease and patients with a history of previous operations or fractures the primary outcome was measured by calculating the ratio of knee joint space. The secondary outcome measure was pain measured by the visual analog scale (VAS). Statistical Analysis Used: Statistical analysis was performed by measurement of study variable. Results: Immediate postoperative pain relieved was noticed in all twenty patients. While at 1-, 3-, and 6-month follow-up, pain relieved was noticed maximum in osteoporotic group patients (n = 12). At 9-month follow-up, pain relieved was noticed equally in all patients. Radiographs of the weight-bearing lower extremity showed an average increase in the medial knee joint space postoperatively compared with preoperatively. The ratio of the knee joint space (medial/lateral compartment) improved significantly from 0.50 ± 0.30 preoperatively to 0.58 ± 0.28 postoperatively. Conclusions: PFO is a simple, safe, fast, and affordable surgery to relieve pain and improve joint function and the medial joint space in knee osteoarthritis, particularly in osteoporotic individuals.