Abstract
Osteonecrosis of the tibia is less common than that of the femoral condyle, with no consensus on surgical indications. In this study, a medial opening wedge high tibial osteotomy (OWHTO) was performed to treat the very extensive osteonecrosis of the tibia. This case demonstrates significant symptomatic relief and functional improvement following OWHTO for spontaneous tibial plateau osteonecrosis. The findings support the hypothesis that changes in mechanical stress contribute to disease progression. The promising results of this case study highlight the need for further studies to confirm its efficacy in a larger patient cohort, sparking interest in the future of this field. This case report is complemented by a literature review, which provides insights into management based on the patient's clinical course.