Valgus producing high tibial osteotomy (HTO) is an effective treatment option for medial compartment osteoarthrosis with varus deformity in young patients. The most common complications of conventional high tibial osteotomy techniques are related to accuracy of correction. Major angle correction of more than 15 degrees with an osteotomy proximal to the tibial tuberosity may cause significant change in patellofemoral mechanics and patellar height. Valgus HTO was performed in 11 lower limbs of 9 patients with gradual correction of the varus deformity using an Ilizarov external fixator, with the osteotomy at the distal border of the tibial tuberosity. The mean age of the patients was 38.5 years. The average correction was 17 degrees. They were followed up for an average of 25 months. The mean preoperative "Hospital for Special Surgery" (HSS) score was 68 and improved to a mean of 90 at follow-up. Nine limbs had excellent or good HSS scores. Disadvantages of this technique were mainly pin tract infection and poor patient acceptance and noncompliance.